The development of noise-induced hearing loss in the Swedish County of Ostergötland in the 1980s and 1990s

This retrospective cross-sectional study of median hearing threshold levels of males employed in two specific occupations shows that the trend with decreasing noise-induced hearing loss in Sweden during the 1970s and 1980s continues into the 1990s. In the occupational categories mechanical work and wood processing men in age groups 30-39, 40-49 and 50-59 years old examined during the time period 1971-76, 1981-86 and 1991-96 were compared. Possible explanations to the improvement might be a wider use of hearing protectors at work and less exposure to noise during military service. The results show that the awareness of noise-induced occupational hearing loss has improved but the hearing conservation programs are still necessary as hearing threshold levels in these occupational groups continue to be poorer than expected in relation to age.     

The chicken or the egg? Endogeneity in labour market participation of informal carers in England

Around 14% of the UK labour force has informal care responsibilities and almost everyone in society will be an informal carer in their lifetime. A well-known fact in the small economic literature on informal care is the apparent negative relation between care responsibilities and labour market participation. Yet, caring and labour market participation may be endogenous. Using an instrumental variable approach and panel data techniques and employing data from the British Household Panel Study from 1991 to 2002, this paper shows that not accommodating for endogeneity in the labour market participation equation may significantly overestimate the impact care exhibits on the employment decision of informal carers. Moreover, it is shown that a negative impact on employment only applies to some care-types. Policy implications are derived.     

Is the core-periphery labour market structure related to perceived health? findings of the Northern Swedish Cohort

Background

There is controversy as to whether peripheral employment is related to poor health status or not. This study aims at examining whether 1) the accumulation of time in peripheral labour market positions is associated with psychological distress and poor or average self-rated health; 2) the proposed association is different among women than among men.

Method

Participants in the 1995 and 2007 follow-up surveys of the Northern Swedish Cohort (n = 985) completed self-administered questionnaires about psychological and general health and about employment positions during the follow-up years. Associations between 12 year peripheral labour market positions (no, low, medium and high exposure) and health were examined using logistic regression.

Results

Exposure to peripheral employment was positively related to psychological distress in both women and men (p-values for trend < 0.001). Adjustment for sociodemographics and psychological distress at baseline, as well as for unemployment and being out of the labour market at the follow-up, resulted in attenuation of the odds ratios, particularly in the group with high exposure to peripheral employment, although results remained significant in men in the fully adjusted model. Women and men with high exposure to peripheral employment had high odds of poor or average self-rated health, but the association was rendered non-significant after adjustment for the covariates.

Conclusions

Our findings suggest that exposure to peripheral employment positions has an impact particularly on mental health, partly due to the over-representation of other unfavourable social and employment conditions among those with substantial exposure to peripheral employment.

     

Effect of psychiatric illness and labour market status on suicide: a healthy worker effect?

STUDY OBJECTIVE: To describe the association between labour market status and death by suicide with focus on admission with a psychiatric disorder. DESIGN: Nested case-control study. Data from routine registers. SETTING: Entire Danish population. PARTICIPANTS: 9011 people aged 25-60 years who committed suicide during 1982-1997 and 180 220 matched controls. MAIN RESULTS: In the general population, not being fully employed is associated with a twofold to threefold increased relative risk of death by suicide, compared with being fully employed. In contrast, fully employed people who have been first admitted to a psychiatric hospital within the past year are at increased suicide risk. Patients who are unemployed, social benefits recipients, disability pensioners, or otherwise marginalised on the labour market have a suicide risk of 0.60 (95% CI: 0.46 to 0.78), 0.41 (0.23 to 0.74), 0.70 (0.45 to 1.08), and 0.86 (0.53 to 1.41), respectively. Although a similar risk decrease is found in women, men, people younger than 30 years, people older than 45 years, and in people who become unemployed, the reversed effect attenuates with time since admission, and little association is seen when a marginal structural model is applied. CONCLUSIONS: Although the results show an increased suicide mortality associated with unemployment and labour market marginalisation in the general population, the results suggest little or an inverse association between unemployment and suicide in people with psychiatric illness. The associations seen suggest the need to consider healthy worker selection effects when studying the causal pathway from unemployment and psychiatric illness to suicide.     

The Swedish SCOPA-SLEEP for assessment of sleep disorders in Parkinson’s disease and healthy controls

Purpose

SCOPA-SLEEP is a rating scale for night-time sleep and daytime sleepiness (DS) proposed for use among people with Parkinson’s disease (PD) as well as others. We translated it into Swedish and assessed its psychometric properties in PD and age-matched healthy controls.

Methods

Following translation according to the dual-panel approach, the Swedish SCOPA-SLEEP was field-tested regarding comprehensibility, relevance and respondent burden (n = 20). It was then psychometrically tested according to classical test theory (data completeness, scaling assumptions, targeting, reliability and construct validity) using data from 149 people with PD and 53 age-matched healthy controls from the prospective Swedish BioFINDER study.

Results

SCOPA-SLEEP took a mean of 3.5 min to complete and was considered easy to use and relevant. Missing item responses were <8 %, corrected item–total correlations were ≥0.47 (except for one DS item among controls), factor analyses suggested one dimension per scale, floor/ceiling effects were ≤17 %, reliability was ≥0.85 except for the DS scale among controls (0.65) and construct validity was supported.

Conclusions

Observations concur with previous evaluations, thus providing initial support for the Swedish SCOPA-SLEEP among people with PD. Further studies are needed to establish its generic properties and to understand its measurement properties in better detail.

     

Elder care: the employee benefit of the 1990s?

Long-term care is costing companies significantly in lost employee productivity. Case management services offer employers a way to ease the burden for employees with relatives who are chronically disabled and minimize disruption at work.     

Hospital management in the 1990s: fundholding consultants?

Explores a model of clinical management which attempts to cope with the management-professional conflict and seeks to enable the hospital to run effectively and efficiently. Two key goals are identified for the hospital which are: to support consultant staff and provide physical and emotional support for patients. Notes that clinical services do not lend themselves to bureaucratic management and that there needs to be two distinct and parallel organizations within the hospital. Outlines the new structure for clinical service management.     

The selling of health care services: are all sales jobs the same?

The selling activities of 272 salespeople were identified by polling 122 health care services organizations nationwide. A taxonomy of sales jobs was developed to classify the range of selling tasks within health care. The taxonomy is presented, discussed, and compared with a similar industrial one. Managerial implications and suggestions for future research are discussed.     

Welfare and poverty in the Europe of the 1990s: social progress or social dumping?

Social policy in Europe is changing fundamentally from a system of public (government) support to a welfare pluralism, or a "welfare mix" supported by the private and public sectors and by voluntary agencies. The overall tendencies are privatization, decentralization, and debureaucratization. With the prospect of a single-market economy within the European Communities in 1993, the fight against poverty in member nations may lead to "social dumping." Two major problems are identified: the lack of guaranteed minimum income schemes in the so-called "Latin Rim" countries, and the effect on workers' and citizens' rights in an integrated Europe. The fight against poverty is--despite some efforts from the Commission of the European Communities--basically left to the individual member states. This portends a gloomy scenario for the poorer populations of Europe in the 1990s. The author examines welfare state types within clusters of countries: the modern (Scandinavia), the corporatist (Federal Republic of Germany), the residual (Britain), and the rudimentary (Latin Rim). The conclusion, unfortunately, is that future overall development of European welfare systems in the 1990s will probably be toward "Americanization," with a move away from the modern, or Scandinavian, model toward a corporatist model for welfare policy.     

Getting a piece of the pie? The economic boom of the 1990s and declining teen birth rates in the United States

In the United States, the 1990s was a decade of dramatic economic growth as well as a period characterized by substantial declines in teenage childbearing. This study examines whether falling teen fertility rates during the 1990s were responsive to expanding employment opportunities and whether the implementation of the Personal Responsibility and Work Opportunities Act (PRWORA), increasing rates of incarceration, or restrictive abortion policies may have affected this association. Fixed-effects Poisson regression models were estimated to assess the relationship between age-specific birth rates and state-specific unemployment rates from 1990 to 1999 for Black and White females aged 10-29. Falling unemployment rates in the 1990s were associated with decreased childbearing among African-American women aged 15-24, but were largely unrelated to declines in fertility for Whites. For 18-19 year-old African-Americans, the group for whom teen childbearing is most normative, our model accounted for 85% of the decrease in rates of first births. Young Black women, especially older teens, may have adjusted their reproductive behavior to take advantage of expanded labor market opportunities.     

Fixing the system? The experience of service users of the quasi‐market in disability services in Australia

A qualitative study involving semi-structured interviews with 31 people with disabilities and 32 carers in the state of Queensland, Australia, found that their experience of supportive service delivery had not improved despite reforms of the service delivery system driven by a version of the quasi-market model. Instead of delivering increased consumer choice and improved efficiency in service delivery, service users experienced inadequate service supply, service cutbacks, and an increased emphasis on cost subsidisation and assessment processes. Additionally, few consumers felt that individualised funding arrangements had personally delivered the benefits which the quasi-market model and associated policy paradigm had indicated that they should receive. For many consumers, the notion of consumer 'choice' around service provision was fictitious and they felt that any efficiency gains were at the agency level, largely at the consumers' cost. It is concluded that there appears to be no particular benefit to service users of quasi-market reforms, particularly in policy contexts where service delivery systems are historically under-funded.     

Medicaid managed care: the last bastion of the HMO?

States rely on health maintenance organizations (HMOs) for their Medicaid beneficiaries because they offer guaranteed access to comprehensive benefits at a predictable cost. This is true despite movement away from HMOs, or at least the more restrictive variants, in the private sector. Plans that focus on Medicaid are becoming more central to states' programs as commercial plans exit. Publicly traded, Medicaid-focused plans are also emerging. Medicaid participating plans are aggressively managing costs and care, contrasting sharply with commercial insurance where the trend is toward less intrusive managed care. In this context, state Medicaid managed care programs are facing important policy challenges related to plan participation, mainstreaming, and product design.     

Is globalization undermining the welfare state? The evolution of the welfare state in developed capitalist countries during the 1990s.

The authors analyze the evolution of macro-indicators of social and economic well-being during the 1990s in the majority of developed capitalist countries, grouped according to their dominant political traditions since the end of World War II. Their analysis shows that, despite the economic globalization of commerce and finance, "politics still matters" in explaining the evolution of the welfare states and labor markets in these countries; the impact of the globalization of financial capital in forcing reductions in the financial resources available for welfare state purposes has been exaggerated.