Systematic review of studies of productivity loss due to rheumatoid arthritis

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, debilitating disease with a significant impact on workplace productivity. AIM: To perform a systematic review of studies of the relationship between RA and reduced workplace productivity. METHODS: Screening of 307 titles identified in bibliographic database searches resulted in 38 articles subject to systematic review. Productivity loss was expressed by three different measures: work disability, work loss (synonymous with absenteeism or short-term sick leave) and work limitation (reduction in productivity while present at work). RESULTS: A median of 66% (range 36-84%) of employed RA subjects experienced work loss due to RA in the previous 12 months, for a median duration of 39 days (range 7-84 days). The times from RA diagnosis until a 50% probability of being work disabled varied from 4.5 to 22 years. In inception cohort studies, the baseline variables consistently predictive of subsequent work disability were a physically demanding work type, more severe RA and older age. CONCLUSIONS: RA-related work-disability rates were similar in the USA and European countries. An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically demanding work rather than to epidemiologic changes in RA. The majority of the literature addresses permanent disability and temporary work loss; none of the studies reviewed reported the effect of RA on presenteeism, i.e. work limitation from the employer perspective, and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss.     

The prevalence of urinary incontinence in elderly women

On the basis of a survey in March 1989 among non institutionalized women aged 60 years and older living in Amstelveen, the prevalence of urinary incontinence was estimated. Also investigated were factors potentially associated with urinary incontinence, as well as the psychosocial impact on daily living activities. The sample comprised 1049 women; 719 postal histories were completed. Statistical analyses involved chi 2 and chi 2 trend tests, and the influence of determinants was assessed with multivariate logistic regression. The prevalence of urinary incontinence was 23.5%, with a slight increase with increasing age. Daily urine loss was reported in 14.0% of all women. Significantly associated with urinary incontinence were an increased diurnal as well as nocturnal voiding frequency, immobility and use of diuretics. Urinary incontinence actually interfered with daily living activities in 65.3% of the women.     

The evaluation and treatment of urinary incontinence in women: a primary care approach.

BACKGROUND: Urinary incontinence, the involuntary loss of urine severe enough to have adverse social or hygienic consequences, is a major clinical problem and a significant cause of disability and dependency. At least 10 million adults in the US suffer from urinary incontinence, including an estimated 15 to 30 percent of community-dwelling older persons. In spite of its high rate of occurrence, fewer than one-half of women with regular urinary incontinence seek medical help for their problem, either because of embarrassment or the perception that their symptoms are normal. METHODS: MEDLINE files were searched from 1970 to 1990 using the key words "incontinence," "prevalence," and "diagnosis" and for specific nonsurgical treatments. Only articles pertaining to adult women were chosen. RESULTS AND CONCLUSIONS: Urinary incontinence frequently can be diagnosed accurately by family physicians using basic tests in the office. Many women experience improvement of incontinence with properly employed behavioral and pharmacologic therapy. Other women benefit from referral for specialized evaluation and consideration for surgical therapy.     

The Bristol Stress and Health Study: accidents, minor injuries and cognitive failures at work

BACKGROUND: Accidents and injuries at work account for several million working days lost each year. Cognitive failures (problems of memory, attention or action) can lead to accidents and injuries in certain contexts. AIM: This work describes the prevalence and associations of workplace accidents, minor injuries and cognitive failures reported by respondents to a follow-up postal questionnaire as part of the community-based Bristol Stress and Health Study. METHODS: Postal questionnaires were sent to 4673 people who participated in the first phase of the study (in which questionnaires were sent to individuals selected at random from the electoral roll). RESULTS: Four per cent of workers reported an accident at work, 8% reported quite or very frequent minor injuries and 13% reported quite or very frequent cognitive failures. Accidents at work were associated with being male, smoking and higher negative job characteristics. Respondents reported workplace accidents at a level similar to the overall UK rate. Accidents and minor injuries, and minor injuries and cognitive failures, shared common associations and all three outcomes were associated with each other. CONCLUSION: Information about cognitive failures is important in the study of accidents and injuries at work. In addition, negative job characteristics represent part of the context in which human error is translated into injury.     

The extent and severity of urinary incontinence amongst women in UK GP waiting rooms

INTRODUCTION: Few women seek help for urinary incontinence. Subsequently, there may be many women accessing primary care services who would benefit from treatment or advice. If high levels of unexpressed need are present in this population, a more proactive approach to continence management may be appropriate, but the feasibility of this depends on an accurate assessment of the level of unmet need in this population. AIM: To assess the prevalence of urinary incontinence in a female population attending primary care and the extent of treatment seeking in relation to level of need. METHODS: A cross-sectional survey of urinary incontinence of adult women attending primary care practices in West Yorkshire, London, Glasgow and Leicestershire during a 10- or 15-day period. RESULTS: Three thousand two hundred and seventy-three (54%) women responded. Twenty-one per cent reported stress urinary incontinence only, 3.5% reported urge incontinence only and 21% reported mixed stress and urge incontinence during the preceding month (9% had moderate or severe symptoms). Fifty-three per cent of these had not consulted a health care professional, which is equivalent to 1 in 20 of women in GP waiting rooms, most of whom have stress and urge incontinence (75%) or stress incontinence only (21%). CONCLUSIONS: Nearly half of female primary care attendees had experienced incontinence during the preceding month, but only a minority had sought help. Even amongst the nearly 1 in 10 women with moderate or severe incontinence only about half had sought help. There remains considerable health decrement due to urinary incontinence in those not receiving help in a population readily accessible to primary care services.     

The influence of urinary incontinence on quality of life of community-dwelling, 45-70 year old Dutch women

OBJECTIVE: To establish the prevalence of urinary incontinence in non-institutionalized Dutch women and determine the consequences of urinary incontinence for their quality of life. DESIGN: Cross sectional questionnaire survey. METHOD: A random sample of 1905 women aged 45-70 years of the population of Zeist, the Netherlands, were sent a questionnaire. Generic quality of life was measured with the RAND-36 and disease specific quality of life was measured with a Dutch translation of the Urogenital Distress Inventory (UDI) and Incontinence Impact Questionnaire (IIQ). Based on the answers to the questionnaire four groups of women were formed: no incontinence, only stress, only urge or a combination of stress and urge incontinence. These 4 groups were compared as to questionnaire scores. RESULTS: A total of 1086 questionnaires could be analysed. The prevalence of urinary incontinence was 57.1%: 28.7% stress incontinence, 5.6% urge incontinence and 22.7% both. Of those who reported urinary incontinence 6% were severely inconvenienced by it. Women with urinary incontinence reported a decrease in physical functioning and vitality as compared with women without incontinence (RAND-36). Especially women with urge or a combination of stress and urge incontinence had more severe impairment of their quality of life as compared to women with only stress incontinence. CONCLUSION: The prevalence of urinary incontinence is higher than it is usually reported. Especially the urge component affects the quality of life in a negative way.     

An exploratory workplace study to investigate the perceived value of continuous low-level heatwrap therapy in manual workers

BACKGROUND: Between 60 and 80% of the population in industrialized countries experience low back pain at some time in their lives. The physical demands of work, i.e. manual handling, lifting, bending, twisting, awkward postures and whole body vibration are associated with low back symptoms. This study was undertaken to investigate the benefits of a new form of continuous low-level heatwrap therapy available for the symptomatic relief of acute low back pain in the workplace. METHODS: The subjects were recruited to the study upon their visit to the occupational health doctor after being diagnosed with acute low back pain. RESULTS: The study results show that use of the heatwrap therapy significantly reduced pain intensity and impact of pain on everyday activities. The results of the study were further extrapolated to show potential cost reduction benefits of using this heatwrap therapy in the workplace.     

The impact of urinary incontinence in working women: a study in a production facility

OBJECTIVES: The objectives of this study were to identify the impact of self-reported UI on working women, to describe urine loss symptoms, strategies used to control urine loss, and help-seeking behavior among full-time women working in a rural production facility. METHODS: A cross-sectional survey design was used and questionnaires were distributed to 500 women (response rate, 54%). Items elicited information on demographics, health, parity, symptoms and duration of urine loss, strategies to manage urine loss, effects of UI on work activities, level of knowledge about UI and treatment options, perceived importance of getting professional help, and actual help seeking behavior. RESULTS: Twenty-nine percent (n = 78) reported UI at least monthly. Incontinent women were older (44.8 years vs. 38.1 years) than continent women (t = -5.22, p < .001) and incontinent women had a significantly higher average body mass index (BMI) than continent women (t = -4.3, p < .001). More women reported urine loss with coughing, lifting, bending, and when hands were in water, and were more likely to use pads at work to control urine loss. Few women had reported UI to a health care provider (36%) and most wanted more information about UI (85%). CONCLUSIONS: UI is a prevalent problem for working women. Workplace programs designed to assist women with prevention, treatment, and management of UI are crucial.     

Falls and fractures in women at work

BACKGROUND: Older women have been observed to have more serious injury particularly fractures after slips, trips or falls at the workplace. It is unclear whether this excess reflects a greater likelihood of falling or a greater proportion presenting with fractures once the fall has occurred. METHODS: Two studies were carried out: Study A, of 130 women who fell at work and matched referents, and Study B, of 120 women who fell at work and sustained a major fracture and 314 matched referents who fell but for whom no fracture was recorded. In Study A, the workplace of the case and referent was observed, questionnaires completed and objective health measures carried out. Study B relied on information obtained from the subject by postal questionnaire. RESULTS: Women who fell were older than referents matched on workplace and occupation, but age did not continue to be a significant factor after allowing for bodyweight and use of spectacles. Fractures were more common in older women who fell, particularly post-menopausal women with low body mass. The risk of fracture increased steadily with age without an obvious discontinuity around the likely age of menopause. CONCLUSIONS: The observed excess of fractures in older women falling at work appeared to be explained by the greater risk of fracture among those who fell.     

女性尿失禁患者生活质量调查

目的:探讨妇科门诊患者尿失禁的严重程度及其对生活质量的影响。方法:对2003年11月~2004年12月就诊于广州市妇婴医院妇科门诊年龄为18~86岁的1 880例女性患者以调查表进行面对面问卷调查。调查内容有一般状况(包括年龄、身高、体重、婚姻状况、收入、文化程度)、尿失禁的症状及其严重程度、尿失禁对患者心理的影响、尿失禁对日常生活的影响、尿失禁对性生活的影响、尿失禁对生活质量的影响。结果:病人对此疾病认识严重缺乏,尿失禁对患者生理、心理、日常生活、性生活及生活质量有较大的影响。结论:应采取措施提高人们对尿失禁的认识。提高公众的健康意识、提高医生的理念、技术,提高妇女的生活质量,实现真正意义上的健康。     

The impact of urinary incontinence on female nursing personnel

Was assessed the prevalence of urinary incontinence (UI), its interference in the performance of daily occupational activities and its management among the women's nurse staff of a medical school hospital in Campinas, Sao Paulo. Of the 291 employers, 27.5% reported UI complaint at least monthly. The activities that required greater effort increased the urinary loss, what resulted in stress, feeling embarrassed and lack of concentration at work. The use of pad was the most frequent strategy at management of UI and sometimes the task could not be interrupted to use the restroom. In conclusion, the activities that require more effort and the difficulty for an adequate management of the UI in workplace increase the problem and interfere on professional performance.     

Seafood processing in South Africa: a study of working practices, occupational health services and allergic health problems in the industry

The work practices, occupational health services and allergic health problems among workplaces which process seafood in Western Cape province of South Africa were examined. A cross-sectional study was conducted among 68 workplaces that were sent a self-administered postal survey questionnaire. Workplaces reporting a high prevalence of work-related symptoms associated with seafood exposure were also inspected. Forty-one (60%) workplaces responded to the questionnaire. The workforce consisted mainly of women (62%) and 31% were seasonal workers. Common seafoods processed were bony fish (76%) and rock lobster (34%). Major work processes involved freezing (71%), cutting (63%) and degutting (58%). Only 45% of workplaces provided an on-site occupational health service and 58% of workplaces conducted medical surveillance. Positive trends were observed between workplace size and activities such as occupational health service provision (P = 0.002), medical surveillance programmes (P = 0.055) and reporting work-related symptoms (P = 0.016). None of the workplaces had industrial hygiene surveillance programmes to evaluate the effects of exposure to seafood. Common work-related symptoms included skin rashes (78%), asthma (7%) and other non-specific allergies (15%). The annual prevalence of work-related skin symptoms reported per workplace was substantially higher for skin (0-100%) than for asthmatic (0-5%) symptoms. The relatively low prevalence of employer-reported asthmatic symptoms, when compared to epidemiological studies using direct investigator assessment of individual health status, suggests likely under-detection. This can be attributed to under-provision and under-development of occupational health surveillance programmes in workplaces with less than 200 workers. This is compounded further by the lack of specific statutory guidelines for the evaluation and control of bio-aerosols in South African workplaces.     

Outcome evaluation of a multi-disciplinary community-based continence service for Australian women

This longitudinal study evaluated the effectiveness of a multi-disciplinary community-based service offering conservative treatment for Australian women suffering urinary incontinence and living independently in the community, in terms of urinary incontinence symptom severity, impact on quality of life and knowledge outcomes. One hundred and twenty-three women attending The Waterworx Centre, a multi-disciplinary, publicly funded community-based continence service in South East Queensland Australia participated in the study. They received multi-disciplinary conservative treatment for urinary incontinence, including comprehensive assessment and an individually-tailored plan of care. All the women were also linked back to their own generalist health professional for ongoing care and management. Data were collected over a one-year period: at first consultation, and at three months and six months following the first consultation. The International Continence Society Urinary Symptom Index Short Form-Female Outcome was used to measure urinary symptoms and impact on quality of life, and a researcher-developed test was used to measure changes in knowledge. Results showed that the women experienced an improvement in urinary symptoms and continence-related knowledge at three months following first consultation, and a decreased impact on quality of life, with these improvements either being sustained or increasing at six months. This study demonstrated that multi-disciplinary community-based services offering specialist conservative treatment for women suffering urinary incontinence can be effective in achieving improvements in urinary symptoms and continence-related knowledge and reducing the impact of urinary incontinence on quality of life.     

Urinary incontinence, the hidden health problem of Cretan women: report from a primary care survey in Greece

OBJECTIVE: The prevalence of urine leakage and care-seeking rates of women 35-75 years of age who visited GPs in two rural areas of Crete were investigated. PARTICIPANTS: All the women who visited their family physician in two primary care units during the period of August to November 1997 (N = 251) were asked if they had experienced symptoms of involuntary urine leakage. A set of questions was addressed to the women who replied positively. RESULTS: Sixty-nine of the 251 women (27.5%) reported symptoms of involuntary urine leakage, and among the incontinent women 11 (15.9%) had previously contacted the health services about their problem. Only six out of thirty (20%) of the incontinent women who report effects on household activities, social and sexual life had contacted a physician about urinary incontinence (UI). The most common reason reported for not consulting the physicians was that the symptoms were not considered serious (35 women out of 58, 60.3%). CONCLUSION: This study points out the need for further awareness programs for both women and healthcare professionals to be set up in countries like Greece, in which a low care-seeking rate of incontinent women has been reported.     

Psychopathological features of a patient population of targets of workplace bullying

BACKGROUND: A strong association between workplace bullying and subsequent anxiety and depression, indicated by empirical research, suggests that bullying is an aetiological factor for mental health problems. AIMS: To evaluate levels of stress and anxiety-depression disorder developed by targets of workplace bullying together with outcome at 12 months and to characterize this population in terms of psychopathology and sociodemographic features. METHODS: Forty-eight patients (36 women and 12 men) meeting Leymann Inventory of Psychological Terror criteria for bullying were included in a prospective study. Evaluations were performed at first consultation and at 12 months using a standard clinical interview, a visual analogue scale of stress, the Hospital Anxiety and Depression (HAD) scale, the Beech scale of stress in the workplace and a projective test (Picture-Frustration Study). RESULTS: At first consultation, 81% of patients showed high levels of perceived stress at work and 83 and 52% presented with anxiety or depression, respectively. At 12 months, only 19% of working patients expressed a feeling of stress at work. There was a significant change in symptoms of anxiety while there was no change in symptoms of depression. Stress at work and depression influenced significatively capacity to go back to work. At 12-month assessments, workers showed a significantly better score on the HAD scale than non-workers. Over half the targets presented a neuroticism-related predominant personality trait. CONCLUSION: Workplace bullying can have severe mental health repercussions, triggering serious and persistent underlying disorders.     

Musculoskeletal symptoms among truck assembly workers

BACKGROUND: Concerns were raised about the possibility of a high prevalence of musculoskeletal symptoms in a truck assembly plant. AIM: The aim of this study was to investigate the prevalence of musculoskeletal symptoms in a group of truck assembly workers. METHOD: A cross-sectional study of 461 truck assembly workers was carried out using a modified version of the Nordic questionnaire and the General Health Questionnaire (GHQ12). Employees were further subdivided into three distinct occupational subgroups: skilled line workers (252), bench subassembly workers (108) and material handlers (101). Responses were analysed according to occupational subgroup. RESULTS: Seventy per cent of 461 truck assembly workers responded to the questionnaires. Seventy-nine per cent of respondents had been troubled with musculoskeletal symptoms in the last 12 months. The commonest musculoskeletal symptoms were from the lower back (65%), neck (60%) and shoulders (57%). Musculoskeletal symptoms were related to age, length of service, occupational subgroup and GHQ12 score. CONCLUSION: There was a high reported prevalence of musculoskeletal symptoms in this group of truck assembly workers, with a differing pattern of symptom reporting depending on occupational subgroup. Risk reduction recommendations were made to the site management. A further study investigating the relationship between symptoms and specific hazards is planned.     

Outcome Evaluation of a Multi-Disciplinary Community-Based Continence Service for Australian Women

ABSTRACT

This longitudinal study evaluated the effectiveness of a multi-disciplinary community-based service offering conservative treatment for Australian women suffering urinary incontinence and living independently in the community, in terms ofurinary incontinence symptom severity, impact on quality of life and knowledge outcomes. One hundred and twenty-three women attending The Waterworx Centre, a multi-disciplinary, publicly funded community-based continence service in South East Queensland Australia participated in the study. They received multi-disciplinary conservative treatment for urinary incontinence, including comprehensive assessment and an individually-tailored plan of care. All the women were also linked back to their own generalist health professional for ongoing care and management.

Data were collected over a one-year period: at first consultation, and at three months and six months following the first consultation. The International Continence Society Urinary Symptom Index Short Form-Female was used to measure urinary symptoms and impact on quality of life, and a researcher-developed test was used to measure changes in knowledge.

Results showed that the women experienced an improvement in urinary symptoms and continence-related knowledge at three months following first consultation, and a decreased impact on quality of life, with these improvements either being sustained or increasing at six months. This study demonstrated that multi-disciplinary community-based services offering specialist conservative treatment for women suffering urinary incontinence can be effective in achieving improvements in urinary symptoms and continence-related knowledge and reducing the impact of urinary incontinence on quality of life.     

The impact of Hymenoptera venom allergy on occupational activities

The objective of this study was to investigate the impact ofallergy to hymenoptera venom on the occupational activitiesof patients undergoing immunologic treatment for insect stinganaphylaxis. The design was a cross-sectional study conductedin a sample of 500 out of 1,500 patients undergoing venom inmunotherapyfor insect sting reaction in 13 allergy clinics in Israel. Aself-administered questionnaire was used to collect data aboutdemographic characteristics of patients, severity of the allergicreaction, and adverse effects on occupational activities. Ofthe 204 respondents who were part of the labour force, 48.5%reported adverse effects on routine occupational activities.The factors with a significant influence on the probabilityof adverse occupational effects were: (1) patient's type ofwork (blue collar vs. white collar: OR=;3.22, p<0.001; armyvs. white collar: OR=5.28, p=0.001); (2) severity of the allergicreaction (severe reaction vs. mild/moderate reaction: OR=2.34,p=0.007). Our findings suggest that severe insect sting allergyhas an adverse impact on patients' occupational activities.This factor requires special attention by the medical community.Social workers and occupational physicians should collaboratein the assessment and management of these patients.     

Screening questionnaires for bakers' asthma--are they worth the effort?

The use of a respiratory screening questionnaire is recommendedannually to screen bakery workers in the UK. We compared questionnairescreening with other methods of detecting workers with asthmaticsymptoms and then assessed the significance of these symptomswith careful investigation and follow-up. Reasons for questionnairefailures were then explored. A questionnaire was issued to 362flour-exposed workers in a large bakery. All positive respondentsto respiratory symptom questions were interviewed by an occupationalnurse. Workers with occupationally related symptoms at thisinterview were referred to the chest clinic. In addition, workerswith negative questionnaires were screened using attendancerecords, sick notes and direct workplace observations. Workerswith frequent absence from work or sick notes with respiratorydiagnoses were interviewed in the same manner as those answeringthe questionnaire positively and then referred to clinic. Atclinic, a diagnosis was made for each worker on the basis ofclinical assessment, spirometry, serial peak expiratory flowrate (PEFR) analysis and radioallergosorbent testing (RAST)testing for specific IgE. Using the clinic diagnoses, the referralroutes were audited to assess the rates of case detection ofasthma and occupational asthma. The respiratory screening questionnaireidentified 68 workers with respiratory symptoms. Of these, 21proceeded to full assessment. A diagnosis of asthma was madein five cases, one of which was bakers' asthma. In addition,11 workers not reporting any symptoms by questionnaire werereferred to clinic and five were diagnosed as having asthma.Screening questionnaires may lead to an underestimate of theprevalence of asthmatic symptoms and as such should not be usedalone in workplace screening.     

Urinary incontinence in middle aged women: childhood enuresis and other lifetime risk factors in a British prospective cohort

STUDY OBJECTIVE: To investigate the prevalence and lifetime risk factors for urinary incontinence in middle aged women. DESIGN: Nationally representative birth cohort study with prospective data on childhood enuresis, measured adult height and weight, childbearing histories and measures of socioeconomic status updated at regular contacts, and measures of menopausal status, symptomatology and health care in midlife. SETTING: England, Scotland and Wales. PARTICIPANTS: General population sample of 1333 women aged 48 years. MAIN RESULTS: Fifty per cent reported symptoms of stress incontinence and 22% reported symptoms of urge incontinence in the previous year. Eight per cent had severe symptoms. Women who at age 6 years had wet in the day or several nights a week were more likely to suffer severe incontinence and report urge symptoms but occasional bedwetting was not associated with an increased risk in adult life. Those who were older at the birth of their children and who had vaginal deliveries had an excess risk of stress symptoms. Heavier adult body weight was also a risk factor for these symptoms and for severe incontinence. Postmenopausal women were less likely to report stress symptoms. These risk factors remained significant after taking account of the increased reporting of incontinence among women with high levels of general symptomatology and general practitioner visits, and of stress symptoms among better educated women. CONCLUSIONS: Urinary incontinence is a common problem among middle aged women. This is the first prospective study of a general population sample to support the postulated link between childhood enuresis and adult incontinence. Child-bearing has long term adverse effects, particularly for older mothers. Overweight is a common risk factor.