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BACKGROUND AND AIMS: Longitudinal change in income is crucial in explaining cardiovascular health inequalities. However, there is limited evidence for cardiovascular disease (CVD) risk associated with income dynamics over time among individuals with type 2 diabetes (T2D). METHODS: Using a nationally representative sample from the Korean National Health Insurance Service database, 1 528 108 adults aged 30-64 with T2D and no history of CVD were included from 2009 to 2012 (mean follow-up of 7.3 years). Using monthly health insurance premium information, income levels were assessed annually for the baseline year and the four preceding years. Income variability was defined as the intraindividual standard deviation of the percent change in income over 5 years. The primary outcome was a composite event of incident fatal and nonfatal CVD (myocardial infarction, heart failure, and stroke) using insurance claims. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated after adjusting for potential confounders. RESULTS: High-income variability was associated with increased CVD risk (HRhighest vs. lowest quartile 1.25, 95% CI 1.22-1.27; Ptrend < .001). Individuals who experienced an income decline (4 years ago vs. baseline) had increased CVD risk, which was particularly notable when the income decreased to the lowest level (i.e. Medical Aid beneficiaries), regardless of their initial income status. Sustained low income (i.e. lowest income quartile) over 5 years was associated with increased CVD risk (HRn = 5 years vs. n = 0 years 1.38, 95% CI 1.35-1.41; Ptrend < .0001), whereas sustained high income (i.e. highest income quartile) was associated with decreased CVD risk (HRn = 5 years vs. n = 0 years 0.71, 95% CI 0.70-0.72; Ptrend < .0001). Sensitivity analyses, exploring potential mediators, such as lifestyle-related factors and obesity, supported the main results. CONCLUSIONS: Higher income variability, income declines, and sustained low income were associated with increased CVD risk. Our findings highlight the need to better understand the mechanisms by which income dynamics impact CVD risk among individuals with T2D.
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Doenças Cardiovasculares , Diabetes Mellitus Tipo 2 , Renda , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Renda/estatística & dados numéricos , Adulto , Doenças Cardiovasculares/epidemiologia , República da Coreia/epidemiologia , Incidência , Fatores de RiscoRESUMO
BACKGROUND: The risk of incident atrial fibrillation (AF) among breast cancer survivors, especially for younger women, and cancer treatment effects on the association remain unclear. This study aimed to investigate the risk of AF among breast cancer survivors and evaluate the association by age group, length of follow-up, and cancer treatment. METHODS: Using data from the Korean Health Insurance Service database (2010-2017), 113,232 women newly diagnosed with breast cancer (aged ≥ 18 years) without prior AF history who underwent breast cancer surgery were individually matched 1:5 by birth year to a sample female population without cancer (n = 566,160) (mean[SD] follow-up, 5.1[2.1] years). Sub-distribution hazard ratios (sHRs) and 95% confidence intervals (CIs) considering death as a competing risk were estimated, adjusting for sociodemographic factors and cardiovascular/non-cardiovascular comorbidities. RESULTS: BCS had a slightly increased AF risk compared to their cancer-free counterparts (sHR 1.06; 95% CI 1.00-1.13), but the association disappeared over time. Younger BCS (age < 40 years) had more than a 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94), with the association remaining similar over 5 years of follow-up. The increased risk was not observed among older BCS, especially those aged > 65 years. Use of anthracyclines was associated with increased AF risk among BCS (sHR 1.57; 95% CI 1.28-1.92), which was more robust in younger BCS (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤ 50 years). CONCLUSIONS: Our findings suggest that younger BCS had an elevated risk of incident AF, regardless of the length of follow-up. Use of anthracyclines may be associated with increased mid-to-long-term AF risk among BCS.
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Fibrilação Atrial , Neoplasias da Mama , Sobreviventes de Câncer , Humanos , Feminino , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Sobreviventes , Antraciclinas , Fatores de Risco , IncidênciaRESUMO
BACKGROUND: Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms. METHODS: Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics. RESULTS: Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector. CONCLUSIONS: Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries.
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BACKGROUND: The consequences of a single point-in-time compared to cumulative exposure to psychosocial work conditions (PWCs) for young adults' mental health have received relatively little attention. This study investigates (i) the associations between single and cumulative exposure to adverse PWCs at ages 22 and 26 with mental health problems (MHPs) among young adults at age 29 and (ii) the effect of early life MHPs on MHPs at age 29. METHODS: Data were used from 362 participants in the TRacking Adolescents' Individual Lives Survey (TRAILS), a Dutch prospective cohort study with 18-year follow-up. PWCs were assessed at ages 22 and 26 with the Copenhagen Psychosocial Questionnaire. Internalizing (i.e. depressive and somatic complaints, anxiety) and externalizing MHPs (i.e. aggressive and rule-breaking behaviour) were measured by the Youth/Adult Self-Report at ages 11, 13, 16, 19, 22 and 29. Regression analyses were conducted to examine the associations between single and cumulative exposure to PWCs and MHPs. RESULTS: Single exposure to high work demands at ages 22 or 26 and high-strain jobs at age 22 were associated with internalizing problems at age 29; the association attenuated after adjustment for early life internalizing problems but remained significant. No associations were found between cumulative exposures and internalizing problems. No associations were found between single or cumulative exposures to PWCs and externalizing problems at age 29. CONCLUSIONS: In view of the mental health burden in working populations our findings call for early implementation of programmes targeting both work demands and MHPs to keep young adults working.
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Transtornos Mentais , Saúde Mental , Adolescente , Humanos , Adulto Jovem , Adulto , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Estudos Prospectivos , Ansiedade/epidemiologia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Research has shown how regionally varying labor market conditions are associated with differences in work disability duration. However, the majority of these studies have not used multilevel models to appropriately account for the hierarchical clustering of individuals nested within contextual units (e.g., regions). Studies that have used multilevel models have focused on privately insured workers or on disability not specifically caused by work-related injury or illness. METHODS: Using claims data from five Canadian provincial workers' compensation systems, linear random-intercept models were used to estimate how much variance in temporary work disability duration ('work disability duration' for brevity) for work-related injuries and musculoskeletal disorders was due to differences between economic regions, what economic region-level labor market characteristics were associated with work disability duration, and what characteristics best explained economic region differences in work disability duration. RESULTS: Economic region characteristics, such as the unemployment rate and proportion of goods-producing employment, were independently associated with individual-level work disability duration. However, economic region variation only accounted for 1.5%-2% of total variation in work disability duration. The majority (71%) of economic region-level variation was explained by the provincial jurisdiction where the worker lived and was injured. Regional variation tended to be greater for female workers than males. CONCLUSIONS: The findings suggest that while regional labor market conditions matter for work disability duration, system-level differences in workers' compensation and health care are more important factors influencing work disability duration. Furthermore, while this study includes both temporary and permanent disability claims, the work disability duration measure only captures temporary disability.
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Doenças Musculoesqueléticas , Indenização aos Trabalhadores , Masculino , Humanos , Feminino , Análise Multinível , Canadá/epidemiologia , Emprego , Doenças Musculoesqueléticas/epidemiologiaRESUMO
PURPOSE: The Cognitive Symptom Checklist-Work (CSC-W) is a self-report measure to assess cognitive symptoms (i.e., memory and executive function) in working adults with cancer. To date, general working population norm data are lacking worldwide. We established CSC-W norm values in the general working population, and assessed associations of CSC-W scores with work and health-related factors. METHODS: This cross-sectional study consisted of 1,000 Dutch working adults, of whom data was collected through an online respondent panel. The sample was stratified for sex and age, and data were weighted. Summary scores of the CSC-W total scale, and memory and executive function symptoms subscales, were determined (e.g., means, percentiles). Z- and T-scores were calculated, and analysis of (co)variance has been applied. RESULTS: Cognitive symptom scores were relatively stable across age groups, but 18-39-year-old respondents reported lower memory and executive function than respondents in other age groups. Symptom scores of memory function (mean 29.1; SD = 16.7) were higher for all age groups and in both sexes compared to executive function (mean 22.1; SD = 16.8). No sex differences in memory and executive function were observed. Higher symptom scores were associated with performing non-manual work only, manual work only, self-reported long-term illness, and higher levels of depressive symptoms and fatigue. CONCLUSION: The CSC-W norms may enhance the interpretation and facilitate the analysis of self-reported cognitive symptoms in patients with cancer at work. Our findings may support health care professionals in identifying working adults with cancer with cognitive symptoms and in developing personalized treatment.
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Lista de Checagem , Neoplasias , Adulto , Masculino , Feminino , Humanos , Adolescente , Adulto Jovem , Estudos Transversais , Autorrelato , Neoplasias/psicologia , CogniçãoRESUMO
Masks are effective at limiting transmission of SARS-CoV-2, the virus that causes COVID-19 (1), but the impact of policies requiring masks in school settings has not been widely evaluated (2-4). During fall 2021, some school districts in Arkansas implemented policies requiring masks for students in kindergarten through grade 12 (K-12). To identify any association between mask policies and COVID-19 incidence, weekly school-associated COVID-19 incidence in school districts with full or partial mask requirements was compared with incidence in districts without mask requirements during August 23-October 16, 2021. Three analyses were performed: 1) incidence rate ratios (IRRs) were calculated comparing districts with full mask requirements (universal mask requirement for all students and staff members) or partial mask requirements (e.g., masks required in certain settings, among certain populations, or if specific criteria could not be met) with school districts with no mask requirement; 2) ratios of observed-to-expected numbers of cases, by district were calculated; and 3) incidence in districts that switched from no mask requirement to any mask requirement were compared before and after implementation of the mask policy. Mean weekly district-level attack rates were 92-359 per 100,000 persons in the community* and 137-745 per 100,000 among students and staff members; mean student and staff member vaccination coverage ranged from 13.5% to 18.6%. Multivariable adjusted IRRs, which included adjustment for vaccination coverage, indicated that districts with full mask requirements had 23% lower COVID-19 incidence among students and staff members compared with school districts with no mask requirements. Observed-to-expected ratios for full and partial mask policies were lower than ratios for districts with no mask policy but were slightly higher for districts with partial policies than for those with full mask policies. Among districts that switched from no mask requirement to any mask requirement (full or partial), incidence among students and staff members decreased by 479.7 per 100,000 (p<0.01) upon implementation of the mask policy. In areas with high COVID-19 community levels, masks are an important part of a multicomponent prevention strategy in K-12 settings (5).
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COVID-19/prevenção & controle , Política de Saúde , Máscaras , Instituições Acadêmicas , Arkansas/epidemiologia , COVID-19/epidemiologia , Humanos , Incidência , SARS-CoV-2RESUMO
OBJECTIVE: We assessed the measurement properties of the German Work Role Functioning Questionnaire (WRFQ) after its cross-cultural adaptation of the Dutch version. The WRFQ is a generic role-specific instrument that measures how a particular health status influences the ability to meet work demands. METHODS: We performed an observational study among German employees assessing the following measurement properties: 1) structural, 2) convergent and 3) discriminant validity, 4) floor and ceiling effects, 5) internal consistency, 6) reproducibility and 7) responsiveness. Participants were recruited from an online access panel sample aged 18 to 64 years having worked more than 12 hours in the last 4 weeks prior to study enrollment (n(T0) = 653, n(T1) = 66, n(T2) = 95). RESULTS: Measurement properties proved to be good except for structural validity and responsiveness. An exploratory factor analysis showed limited replicability of three of the four original subscales. CONCLUSION: With the WRFQ German version, the extent can be measured, to which employees with a certain health level experience problems can meet their work demands. This widely used health-related work outcome measurement tool, that helps to identify employees with decreasing work functioning, is now also available in German. This gives researchers and practitioners the opportunity to address work functioning in practice, e.g. in intervention studies in occupational health or rehabilitation. Further research to examine valid subscales is needed.
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Nível de Saúde , Avaliação da Capacidade de Trabalho , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
COVID-19 has created pervasive upheaval and uncertainty in communities around the world. This investigation evaluated associations between discrete dimensions of personal meaning and psychological adjustment to the pandemic among community residents in a southern US state. In this cross-sectional study, 544 respondents were assessed during a period of reopening but accelerating infection rates. Validated measures were used to evaluate theoretically distinct dimensions of perceived global meaning (Meaning-in-Life Questionnaire) and pandemic-specific meaning (Meaning in Illness Scale). Adjustment outcomes included perceived stress, pandemic-related helplessness, and acceptance of the pandemic. In multivariate models that controlled for demographic and pandemic-related factors, stronger attained global meaning (i.e., perceptions that life is generally meaningful) and attained situational meaning (i.e., perceptions that the pandemic experience was comprehensible) were related to better adjustment on all three outcomes (all p's < .001). In contrast, seeking situational meaning (i.e., ongoing efforts to find coherence in the situation) was associated with poorer adjustment on all indices (all p's < .001). Results offer novel information regarding theoretically salient dimensions of meaning, which may have direct relevance for understanding how community residents adapt to the challenges of a major public health crisis.
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The coronavirus disease 2019 (COVID-19) pandemic has been associated with a declining volume of patients seen in the emergency department. Despite the need for seeking urgent care for conditions such as myocardial infarction, many people may not seek treatment. This study seeks to measure associations between the COVID-19 pandemic and location of death among individuals who died from ischemic heart disease (IHD). Data obtained from death certificates from the Arkansas Department of Health was used to conduct a difference-in-difference analysis to assess whether decedents of IHD were more likely to die at home during the pandemic (March 2020 through September 2020). The analysis compared location of death for decedents of IHD pre and during the pandemic to location of death for decedents from non-natural causes. Before the pandemic, 50.0% of decedents of IHD died at home compared to 57.9% dying at home during (through September 2020) the pandemic study period (p < .001). There was no difference in the proportion of decedents who died at home from non-natural causes before and during the pandemic study period (55.8% vs. 53.5%; p = .21). After controlling for confounders, there was a 48% increase in the odds of dying at home from IHD during the pandemic study period (p < .001) relative to the change in dying at home due to non-natural causes. During the study period, there was an increase in the proportion of decedents who died at home due to IHD. Despite the ongoing pandemic, practitioners should emphasize the need to seek urgent care during an emergency.
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COVID-19 , Isquemia Miocárdica , Serviço Hospitalar de Emergência , Humanos , Isquemia Miocárdica/epidemiologia , Pandemias , SARS-CoV-2RESUMO
OBJECTIVE: The Work Role Functioning Questionnaire 2.0 (WRFQ), measuring the percentage of time a worker has difficulties in meeting the work demands for a given health state, has shown strong reliability and validity in various populations with different chronic conditions. The present study aims to validate the WRFQ in working cancer patients. METHODS: A validation study of the WRFQ 2.0 was conducted, using baseline data from the longitudinal Work Life after Cancer study. Structural validity (Confirmatory Factor Analysis, CFA), internal consistency (Cronbach's alpha) and discriminant validity (hypothesis testing) were evaluated. RESULTS: 352 working cancer patients, most of them diagnosed with breast cancer (48%) and 58% in a job with mainly non-manual tasks, showed a mean WRFQ score of 78.6 (SD = 17.1), which means that they had on average difficulties for 78.6% of the time they spent working. Good internal consistency (α = 0.96) and acceptable to good fit for both the four and five-factor model (CFA) was found. The WRFQ distinguished between cancer patients reporting good vs. poor health (80.3 vs. 73.0, p = 0.001), low vs. high fatigue (82.0 vs. 72.2, p < 0.001), no vs. clinical depression (80.4 vs. 58.8, p < 0.001) and low vs. high cognitive symptoms (86.1 vs. 64.7, p < 0.001). CONCLUSIONS: The WRFQ 2.0 is a reliable and valid instrument to measure work functioning in working cancer patients. Further psychometric research on responsiveness is needed to support its use in health practice.
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Neoplasias , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Purpose Research has shown that there are important sex and gender-based differences in the work disability duration of men and women. This research is often limited to single jurisdictions, using different outcome measures, and therefore has limited generalisability of findings. This study examined if differences between work disability of men and women differed by province and by duration of work disability. Methods Cohorts of injured workers in the Canadian provinces of British Columbia (BC), Manitoba (MB) and Ontario (ON) were analysed using workers' compensation data for work-related injuries occurring between 2007 and 2011. Work disability duration was measured using cumulative days in receipt of disability benefits paid during one-year post-injury. Poisson models with restricted cubic splines tested whether differences between men and women in the likelihood of transitioning off disability benefits varied by duration of work disability in each province, adjusting for confounders. Results Men transitioned off disability benefits faster than women for claim durations of up to two to four months, after which women transitioned off disability benefits faster until ten months. Differences between men and women were consistent across all jurisdictions. For claims longer than ten months, men transitioned off work disability benefits faster than women in BC and ON, but there were no significant differences between men and women in MB. Conclusions Differences in the work disability duration between men and women vary by province and duration of work disability. Claims management processes need to be sensitive to differences that men and women face and the timing of interventions.
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Pessoas com Deficiência/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto , Colúmbia Britânica , Feminino , Humanos , Masculino , Manitoba , Traumatismos Ocupacionais/epidemiologia , Ontário , Fatores Sexuais , Fatores de Tempo , Indenização aos Trabalhadores/estatística & dados numéricosRESUMO
More than 60% of cancer patients are able to work after cancer diagnosis. However, little is known about their functioning at work. Therefore, the aims of this study were to (1) identify work functioning trajectories in the year following return to work (RTW) in cancer patients and (2) examine baseline sociodemographic, health-related and work-related variables associated with work functioning trajectories. This longitudinal cohort study included 384 cancer patients who have returned to work after cancer diagnosis. Work functioning was measured at baseline, 3, 6, 9 and 12 months follow-up. Latent class growth modeling (LCGM) was used to identify work functioning trajectories. Associations of baseline variables with work functioning trajectories were examined using univariate and multivariate analyses. LCGM analyses with cancer patients who completed on at least three time points the Work Role Functioning Questionnaire (n = 324) identified three work functioning trajectories: "persistently high" (16% of the sample), "moderate to high" (54%) and "persistently low" work functioning (32%). Cancer patients with persistently high work functioning had less time between diagnosis and RTW and had less often a changed meaning of work, while cancer patients with persistently low work functioning reported more baseline cognitive symptoms compared to cancer patients in the other trajectories. This knowledge has implications for cancer care and guidance of cancer patients at work.
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Neoplasias/epidemiologia , Neoplasias/fisiopatologia , Retorno ao Trabalho , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Inquéritos e QuestionáriosRESUMO
This study evaluates the longitudinal relation between self-reported physical activity and health related work limitations (also known as presenteeism) among employees from a public university system. A retrospective longitudinal study design was used to examine research aims. Data were from self-reported health assessments collected from employees at a large University System in Texas during the 2013-2015 plan years (n=6515).Work limitations were measured using the self-report 8-item work limitations questionnaire. Latent growth curve models were used to test whether: 1) baseline physical activity was associated with baseline work limitations; 2) changes in physical activity were related to changes in work limitations; and 3) baseline physical activity predicted changes in work limitations. Models were adjusted for demographic and health-related variables. The final adjusted growth curve model demonstrated excellent fit. Results revealed baseline physical activity was inversely associated with baseline work limitations (ß=-0.12, p<0.001). In addition, changes in physical activity were related to changes in work limitations (ß=-0.33, p=0.02). However, no relation was found between baseline physical activity and changes in work limitations (ß=-0.06, p=0.42). Results provide evidence that increasing physical activity among employees leads to decreases in health-related work limitations. Therefore, promoting physical activity among employee populations can help prevent and reduce presenteeism.
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Exercício Físico/fisiologia , Presenteísmo/estatística & dados numéricos , Autorrelato , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Saúde Ocupacional , Estudos Retrospectivos , Inquéritos e Questionários , Texas , Local de Trabalho/estatística & dados numéricosRESUMO
Purpose Organizational-level policies and practices that promote safety leadership and practices, disability management and ergonomic policies and practices are considered key contextual determinants of return to work. Our objective was to examine the role of worker-reported organizational policies and practices (OPPs) in return to work (RTW) and work role functioning (WRF) and the mediating role of pain self-efficacy and work accommodation. Methods A worker cohort (n = 577) in Ontario, Canada was followed at 1, 6 and 12 months post injury. Both RTW (yes/no) and WRF (WLQ-16) status (3 levels) were measured. OPPs were measured (high vs. low) at 1 month post-injury. Pain self-efficacy (PSE) and work accommodation (WA) were included in mediation analyses. Results OPPs predicted RTW at 6 months (adjusted OR 1.77; 95 % CI 1.07-2.93) and 12 months (adjusted OR 2.07; 95 % CI 1.18-3.62). OPPs predicted WRF at 6 months, but only the transition from working with limitations to working without limitations (adjusted OR 3.21; 95 % CI 1.92-5.39). At 12 months, OPPs predicted both the transition from not working to working with and without limitations and from not working or working with limitations to working without limitations (adjusted OR 2.13; 95 % CI 1.37-3.30). Offers of WA mediated the relationship between OPPs and both RTW and WRF at 6 months follow-up. PSE mediated the relationship between OPPs and RTW and WRF at 6 months. At 12 months neither mediated the relationship. Conclusions The findings support worker-reported OPPs as key determinants of both RTW and WRF. These results point to the importance of WA and PSE in both RTW and WRF at 6 months.
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Doenças Musculoesqueléticas/reabilitação , Traumatismos Ocupacionais/reabilitação , Política Organizacional , Retorno ao Trabalho/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/psicologia , Traumatismos Ocupacionais/psicologia , Razão de Chances , Ontário , Estudos Prospectivos , Retorno ao Trabalho/psicologia , Inquéritos e Questionários , Fatores de Tempo , Adulto JovemRESUMO
Purpose To evaluate factorial validity, scale reliability, test-retest reliability, convergent validity, and discriminant validity of the 8-item Work Limitations Questionnaire (WLQ) among employees from a public university system. Methods A secondary analysis using de-identified data from employees who completed an annual Health Assessment between the years 2009-2015 tested research aims. Confirmatory factor analysis (CFA) (n = 10,165) tested the latent structure of the 8-item WLQ. Scale reliability was determined using a CFA-based approach while test-retest reliability was determined using the intraclass correlation coefficient. Convergent/discriminant validity was tested by evaluating relations between the 8-item WLQ with health/performance variables for convergent validity (health-related work performance, number of chronic conditions, and general health) and demographic variables for discriminant validity (gender and institution type). Results A 1-factor model with three correlated residuals demonstrated excellent model fit (CFI = 0.99, TLI = 0.99, RMSEA = 0.03, and SRMR = 0.01). The scale reliability was acceptable (0.69, 95% CI 0.68-0.70) and the test-retest reliability was very good (ICC = 0.78). Low-to-moderate associations were observed between the 8-item WLQ and the health/performance variables while weak associations were observed between the demographic variables. Conclusions The 8-item WLQ demonstrated sufficient reliability and validity among employees from a public university system. Results suggest the 8-item WLQ is a usable alternative for studies when the more comprehensive 25-item WLQ is not available.
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Nível de Saúde , Saúde Ocupacional/estatística & dados numéricos , Inquéritos e Questionários/normas , Avaliação da Capacidade de Trabalho , Adulto , Doença Crônica/epidemiologia , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos , Desempenho ProfissionalRESUMO
INTRODUCTION: This study evaluated whether stages of change for physical activity (PA) predict sign-up, participation, and completion in a PA competition. METHOD: Deidentified data were provided to evaluate a PA competition between 16 different institutions from a public university system. Employees who completed a health assessment (HA) prior to the start of the PA competition ( n = 6,333) were included in the study. Participants completed a self-report HA and logged their PA throughout the competition. Multivariable logistic regression models tested whether stages of change predicted PA competition sign-up and completion. An ordinal logistic regression model tested whether stages of change predicted number of weeks of PA competition participation. RESULTS: Stages of change predicted PA competition sign-up and completion, but not weeks of participation. The odds for PA competition sign-up were 1.64 and 1.98 times higher for employees in preparation and action/maintenance (respectively) compared with employees in precontemplation/contemplation. The odds for PA competition completion were 4.17 times higher for employees in action/maintenance compared with employees in precontemplation/contemplation/preparation. CONCLUSION: The PA competition was more likely to reach employees in preparation, action, or maintenance stages than precontemplation/contemplation. Most of the completers were likely participating in regular PA prior to the competition.
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BACKGROUND: Most patients with malaria seek treatment first in retail drug shops. Myriad studies have examined retailer behaviours and characteristics to understand the determinants to these behaviours. Geospatial methods are helpful in discovering if geographic location plays a role in the relationship between determinants and outcomes. This study aimed to discover if spatial autocorrelation exists in the relationship between determinants and retailer behaviours, and to provide specific geographic locations and target behaviours for tailoring future interventions. METHODS: Retailer behaviours and characteristics captured from a survey deployed to medicine retailers in the Webuye Demographic and Health Surveillance Site were analysed using geographic weighted regression to create prediction models for three separate outcomes: recommending the first-line anti-malarial therapy to adults, recommending the first-line anti-malarial therapy to children, and selling that therapy more than other anti-malarials. The estimated regression coefficients for each determinant, as well as the pseudo R2 values for each final model, were then mapped to assess spatial variability and local areas of best model fit. RESULTS: The relationships explored were found to be non-stationary, indicating that spatial heterogeneity exist in the data. The association between having a pharmacy-related health training and recommending the first-line anti-malarial treatment to adults was strongest around the peri-urban centre: comparing those with training in pharmacy to those without training (OR = 5.75, p = 0.021). The association between knowing the first-line anti-malarial and recommending it to children was strongest in the north of the study area compared to those who did not know the MOH-recommended anti-malarial (OR = 2.34, p = 0.070). This is also the area with the strongest association between attending a malaria workshop and selling the MOH-recommended anti-malarial more than other anti-malarials, compared to retailers who did not attend a workshop (OR = 2.38, p = 0.055). CONCLUSION: Evidence suggests that spatial heterogeneity exists in these data, indicating that the relationship between determinants and behaviours varies across space. This is valuable information for intervention design, allowing efforts to focus on those factors that have the strongest relationship with their targeted behaviour within that geographic space, increasing programme efficiency and cost-effectiveness.
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Antimaláricos/administração & dosagem , Conhecimentos, Atitudes e Prática em Saúde , Malária/tratamento farmacológico , Farmácias , Adulto , Feminino , Humanos , Quênia , Masculino , Regressão Espacial , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Efforts to improve malaria case management in sub-Saharan Africa have shifted focus to private antimalarial retailers to increase access to appropriate treatment. Demands to decrease intervention cost while increasing efficacy requires interventions tailored to geographic regions with demonstrated need. Cluster analysis presents an opportunity to meet this demand, but has not been applied to the retail sector or antimalarial retailer behaviors. This research conducted cluster analysis on medicine retailer behaviors in Kenya, to improve malaria case management and inform future interventions. METHODS: Ninety-seven surveys were collected from medicine retailers working in the Webuye Health and Demographic Surveillance Site. Survey items included retailer training, education, antimalarial drug knowledge, recommending behavior, sales, and shop characteristics, and were analyzed using Kulldorff's spatial scan statistic. The Bernoulli purely spatial model for binomial data was used, comparing cases to controls. Statistical significance of found clusters was tested with a likelihood ratio test, using the null hypothesis of no clustering, and a p value based on 999 Monte Carlo simulations. The null hypothesis was rejected with p values of 0.05 or less. RESULTS: A statistically significant cluster of fewer than expected pharmacy-trained retailers was found (RR = .09, p = .001) when compared to the expected random distribution. Drug recommending behavior also yielded a statistically significant cluster, with fewer than expected retailers recommending the correct antimalarial medication to adults (RR = .018, p = .01), and fewer than expected shops selling that medication more often than outdated antimalarials when compared to random distribution (RR = 0.23, p = .007). All three of these clusters were co-located, overlapping in the northwest of the study area. CONCLUSION: Spatial clustering was found in the data. A concerning amount of correlation was found in one specific region in the study area where multiple behaviors converged in space, highlighting a prime target for interventions. These results also demonstrate the utility of applying geospatial methods in the study of medicine retailer behaviors, making the case for expanding this approach to other regions.
Assuntos
Antimaláricos/uso terapêutico , Comércio/estatística & dados numéricos , Demografia/estatística & dados numéricos , Malária/epidemiologia , Farmácias/estatística & dados numéricos , Inquéritos e Questionários , Adulto , Antimaláricos/economia , Análise por Conglomerados , Comércio/tendências , Demografia/tendências , Feminino , Previsões , Humanos , Quênia/epidemiologia , Malária/tratamento farmacológico , Malária/economia , Masculino , Pessoa de Meia-Idade , Farmácias/tendênciasRESUMO
OBJECTIVE: The aim of this study was to ascertain Patients' pre-operative expectations of total knee arthroplasty (TKA) recovery. METHODS: Two hundred and thirty-six patients with knee osteoarthritis (OA) who underwent TKA completed self-administered questionnaires before their surgery. Patients' expectations of time to functional recovery were measured using an ordinal time-response scale to indicate expected time to recovery for each of 10 functional activities. Expected time to recovery was dichotomized into short- and long-term expectations for recovery of each activity using median responses. Knee pain and function were ascertained using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Other measures included the SF-36, the Depression, Anxiety and Stress Scale (DASS) and the Medical Outcomes Study Social Support Survey (MOS-SSS). Multivariate logistic regression was used to identify pre-operative characteristics associated with short- vs. long-term expectations. RESULTS: Sixty-five percent of the patients were females and 70% Whites; mean age was 65 years. Patients were optimistic about their time to functional recovery: over 65% of patients expected functional recovery within 3 months. Over 80% of the patients expected to perform 8 of the 10 activities within 3 months. Patients who expected to be able to perform the functional activities in <6 weeks were more likely to be younger, male, and have lower self-reported pain and better general health before surgery compared to those who expected to be able to perform the activities 3 months post-surgery or later. CONCLUSION: Pre-operative patient characteristics may be important to evaluate when considering individual Patients' expectations of post-operative outcomes.