An integrated approach for economic evaluation of environmental and health costs of occupational diseases in the oil industry.

The health sector is one of the components of development, social welfare and economic growth. The purpose of this study was to develop an economic evaluation model of the environmental and health costs of occupational diseases by hybrid approach. To achieve the study goal, a taxonomy of economic evaluation model of the environmental and health costs of occupational diseases has been developed. The Delphi method was used to identify health and environmental criteria and the analytic network process (ANP) method was used to weigh the sub-criteria. Finally, health and environmental cost were estimated based on the available information. Naft Subspecialty Hospital in Tehran, Iran (NSHT), was selected as the place of case study. In this study, eight and eleven sub-criteria were identified in the health and environmental sector, respectively. The ANP results indicated that the medicine and medical equipment cost criteria with a weight of 0.312 in the Medical sector, and the special and infectious waste cost criteria with a weight of 0.085 in the environmental sector were the most significant cost criteria in NSHT. Furthermore, the parametric model findings indicated that 99.84 and 0.16% of the total costs are associated with health and environmental costs, respectively. The findings indicated that 61.3% of the costs of the health sector were associated with the two sectors of medicine and medical equipment and the cost-of-service personnel, and 91.7% of the costs of the environmental sector are associated with wastewater treatment and the cost of electricity consumption. This study tried to present a quantitative model of the health and environmental costs of NSHT. Implemention of this integrated model can be a practical and effective step in allocating resources and prioritize interventions.

A probabilistic approach for economic evaluation of occupational health and safety interventions: a case study of silica exposure reduction interventions in the construction sector.

BACKGROUND: Construction workers are at a high risk of exposure to various types of hazardous substances such as crystalline silica. Though multiple studies indicate the evidence regarding the effectiveness of different silica exposure reduction interventions in the construction sector, the decisions for selecting a specific silica exposure reduction intervention are best informed by an economic evaluation. Economic evaluation of interventions is subjected to uncertainties in practice, mostly due to the lack of precise data on important variables. In this study, we aim to identify the most cost-beneficial silica exposure reduction intervention for the construction sector under uncertain situations. METHODS: We apply a probabilistic modeling approach that covers a large number of variables relevant to the cost of lung cancer, as well as the costs of silica exposure reduction interventions. To estimate the societal lifetime cost of lung cancer, we use an incidence cost approach. To estimate the net benefit of each intervention, we compare the expected cost of lung cancer cases averted, with expected cost of implementation of the intervention in one calendar year. Sensitivity analysis is used to quantify how different variables affect interventions net benefit. RESULTS: A positive net benefit is expected for all considered interventions. The highest number of lung cancer cases are averted by combined use of wet method, local exhaust ventilation and personal protective equipment, about 107 cases, with expected net benefit of $45.9 million. Results also suggest that the level of exposure is an important determinant for the selection of the most cost-beneficial intervention. CONCLUSIONS: This study provides important insights for decision makers about silica exposure reduction interventions in the construction sector. It also provides an overview of the potential advantages of using probabilistic modeling approach to undertake economic evaluations, particularly when researchers are confronted with a large number of uncertain variables.

Enfermedad renal crónica de causa desconocida: investigaciones en Guatemala y oportunidades para su prevención / Chronic kidney disease of unknown cause: investigations in Guatemala and opportunities for its prevention

El Centro para la Salud, el Trabajo y el Ambiente (CHWE por sus siglas en inglés) inició un proyecto de colaboración con Pantaleon, una empresa agrícola de caña de azúcar en Guatemala, para hacer frente a una epidemia de enfermedad renal crónica (ERC) de causa no tradicional (ERCnT) que afecta a las comunidades agrícolas en Centroamérica y otros lugares. Este artículo describe el conocimiento actual de la epidemia en Centroamérica, las manifestaciones clínicas, el tratamiento y el manejo; las hipótesis actuales de su etiología, la colaboración y el enfoque de CHWE-Pantaleon. Nuestro enfoque de Total Worker Health® (TWH) para abordar la salud renal en Guatemala incluye múltiples estudios de investigación con trabajadores de caña de azúcar, para evaluar la prevalencia, incidencia y factores de riesgo de la lesión renal aguda y la ERC; se incluye también el desarrollo e implementación de medidas de prevención mejoradas e intervenciones para proteger a los trabajadores abordando los factores de riesgo ya conocidos. Se examinan también las necesidades futuras de investigación y las implicaciones globales de la ERCnT, al igual que la producción de bienes y la economía, así como las recomendaciones actuales para las estrategias de prevención ocupacional y comunitaria.

The Center for Health, Work and Environment (CHWE) began a collaborative project with Pantaleon, a Guatemalan sugarcane agribusiness, to address an epidemic of chronic kidney disease of unknown cause (CKDu) that affects agricultural communities in Central America and elsewhere. This paper describes the current knowledge of the epidemic in Central America including clinical manifestations, course, and management, current etiology hypotheses, and the CHWE-Pantaleon collaboration and approach. Our Total Worker Health® (TWH) approach to addressing kidney health in Guatemala has included multiple research studies with sugarcane workers to assess prevalence, incidence and risk factors for acute kidney injury and chronic kidney disease, as well as development and implementation of enhanced prevention measures and interventions to protect workers by addressing known risk factors. Future research needs and the global implications of CKDu including for economy and commodity production are discussed, as well as current recommendations for occupational and community prevention strategies.

Are Office-Based Workplace Interventions Designed to Reduce Sitting Time Cost-Effective Primary Prevention Measures for Cardiovascular Disease? A Systematic Review and Modelled Economic Evaluation.

OBJECTIVES: To assess the cost-effectiveness of workplace-delivered interventions designed to reduce sitting time as primary prevention measures for cardiovascular disease (CVD) in Australia. METHODS: A Markov model was developed to simulate the lifetime cost-effectiveness of a workplace intervention for the primary prevention of CVD amongst office-based workers. An updated systematic review and a meta-analysis of workplace interventions that aim to reduce sitting time was conducted to inform the intervention effect. The primary outcome was workplace standing time. An incremental cost-effectiveness ratio (ICER) was calculated for this intervention measured against current practice. Costs (in Australia dollars) and benefits were discounted at 3% annually. Both deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. RESULTS: The updated systematic review identified only one new study. Only the multicomponent intervention that included a sit-and-stand workstation showed statistically significant changes in the standing time compared to the control. The intervention was associated with both higher costs ($6820 versus $6524) and benefits (23.28 versus 23.27, quality-adjusted life year, QALYs), generating an ICER of $43,825/QALY. The DSA showed that target age group for the intervention, relative risk of CVD relative to the control and intervention cost were the key determinants of the ICER. The base case results were within the range of the 95% confidence interval and the intervention had a 85.2% probability of being cost-effective. CONCLUSIONS: A workplace-delivered intervention in the office-based setting including a sit-and-stand desk component is a cost-effective strategy for the primary prevention of CVD. It offers a new option and location when considering interventions to target the growing CVD burden.

The Association Between Incentive Designs and Health Assessment or Biometric Screening Completion.

OBJECTIVES: To identify statistically significant predictors for completing a Personal Health Assessment (PHA) or biometric screening from attributes of incentive designs. METHODS: A cross-sectional study was conducted that included 426,694 members from 56 employer groups who required a PHA or screening as part of their incentive during 2016. RESULTS: Incentive designs that combine high-value with immediate disbursement can relatively increase employee PHA participation by as much as 66% over plans with low-value and delayed disbursement (56.7% vs 34.1%, P < 0.001). Surcharge component was a significant predictor of PHA completion (P < 0.001); similar predictors were found for screening completion. CONCLUSIONS: This study identified several significant predictors of PHA or screening completion, including: monetary value, time to disbursement, disbursement method, and frequency. Our findings are consistent with prior research in human behavior responses to positive reinforcement.

Investing in workability of patients with inflammatory bowel disease: results of a pilot project Activ84worK (Activate for work).

OBJECTIVES: Inflammatory bowel diseases (IBD) are chronic gastrointestinal conditions mainly affecting young people. Disease symptoms often make it difficult to actively participate in the workplace. The aim of Activ84worK was to stimulate professional activity and reduce absenteeism by removing work-related stress factors and providing patients with more flexible working conditions. PATIENTS AND METHODS: Activ84worK was a collaboration between Abbvie, Mensura, Proximus, SD Worx, and University Hospitals Leuven (UZ Leuven) with the support of the patient association 'Crohn-en Colitis Ulcerosa Vereniging (CCV vzw)' in Flanders, Belgium. Since March 2015, IBD patients whose employer was also willing to participate, were recruited. Informed consent was signed and both the employee and the employer were followed for 6 months. RESULTS: Between March 2015 and October 2016, 70 patients showed interest in the Activ84worK program, 18 were eligible to participate, and 14 completed the program (29% male, 29% private companies). The case studies, based on interviews conducted with participating employees, indicated that removing work-related stress factors resulted in employees feeling much more at ease. Concretely, this led to absence of sick leave for more than 50% of the included patients. A higher degree of workability and focus of employees was achieved, and a decrease in costs of absenteeism was associated with this. CONCLUSION: This pilot project shows that teleworking and flexible working conditions improve labor participation of IBD patients. The results of this project are now used to inspire policy-makers and employers. This initiative should be extended to a larger cohort and tested in other chronic diseases.

The joint contribution of physical activity, insomnia symptoms, and smoking to the cost of short-term sickness absence.

Physical inactivity has been associated with both insomnia symptoms and smoking. Further, they are all independently associated with increased sickness absence (SA) from work. However, joint contribution of either physical activity (PA) with insomnia symptoms or with smoking to SA and, especially, their direct cost for the employer is poorly understood. Therefore, we aimed to examine these joint associations with short-term (<15 days) SA cost. The Helsinki Health Study is a cohort of midlife employees of the City of Helsinki, Finland (baseline n = 8960, response rate 67%). During 2000-2002, the participants were mailed a survey questionnaire that gathered information on health behavior and sociodemographic characteristics. SA, salary, and time of employment were followed up through the employer's personnel register between 2002 and 2016 for those with a written consent to the use of their register data (78% of the participants). Individual salary data were used to calculate the direct cost of short-term SA. Data were analyzed with a two-part model. Inactive participants with frequent insomnia symptoms had 2526€ (95% CI 1736€-3915€) higher cost of short-term SA than vigorously active participants without insomnia symptoms. Furthermore, inactive smokers had 4166€ (95% CI 2737€-5595€) higher cost for the employer over the follow-up than vigorously active non-smokers. In conclusion, this study showed that PA and insomnia symptoms as well as PA and smoking are jointly associated with short-term SA cost. The results emphasize encouraging employers to improve work environments so that they promote active lifestyle, good sleep, and non-smoking in order to reduce the cost of SA.

[Non-occupational but work-related diseases - Legislation, judicature and potential implications to employers and employees in Poland]. / Choroby niezawodowe zwiazane z praca ­ uregulowania prawne, orzecznictwo oraz potencjalne konsekwencje dla pracodawców i pracowników w Polsce.

BACKGROUND: Non-occupational work-related diseases refer to health problems of multifactorial etiology, the occurrence, development and prognosis of which may be affected by work environment or by the way the work is performed but are not treated as occupational diseases under the applicable law. When analyzing their impact on labor market, it is necessary to also consider the employees' right to put in a claim for compensation due to the consequences of the occurrence of such diseases. MATERIAL AND METHODS: Legal regulations as well as judicial decisions on the possibilities and methods of pursuing claims for compensation from an employer due to the occurrence of non-occupational work-related disease were analyzed. RESULTS: The analyzed legal regulations and judicial decisions referred to the regulations of the Labour Code, Civil Code and Resolution of the Supreme Court of 4 December 1987. The paper presents examples of non-occupational diseases considered to be work-related and conditions necessary to assert a claim by the employee at the court. CONCLUSIONS: Despite the lack of precise legal regulations in Poland, non-occupational work-related diseases may impact the legal situation of employees as well as employers. Employees are granted the right to claim for compensation from their employers in accordance with the Civil Code. Depending on the employer's legal responsibility, it is necessary to prove the meeting of the appropriate essential conditions to put in a claim for damage. Raising the employers' awareness of the legal and financial consequences shall support the occupational medicine services in intensifying their activity aimed at preventing all work-related diseases. Med Pr 2018;69(5):539-546.

Costo de los exámenes médicos preventivos en trabajadores / Cost of preventive medical exams performed in workers

Introducción: los exámenes médicos periódicos en sus diferentes modalidades son un componente importante de la atención a la salud de los trabajadores y su concepción y realización se deben corresponder con la necesaria racionalidad y eficiencia. Objetivo: calcular los costos por trabajador y por investigación realizada en los exámenes médicos periódicos en trabajadores. Métodos: investigación descriptiva de corte transversal realizada en el Instituto Nacional de Salud de los Trabajadores. Se utilizaron dos sistemas para calcular los costos, el método ABC y el método paciente/enfermedad, vigente este último en la salud pública cubana. La información se obtuvo mediante revisión documental que incluyó las historias clínicas de los pacientes examinados en el centro. Se confeccionó una base de datos con 3 474 trabajadores que asistieron a los servicios del Instituto durante el período 2008-2013. Resultados: los costos de los exámenes médicos, tanto los realizados en las diferentes especialidades como por trabajador, tuvieron diferencias significativas; su contrastación es difícil pues los exámenes médicos están poco estandarizados en el Instituto. Conclusiones: los costos se obtuvieron con precisión pero es necesario continuar su estudio en las actividades preventivas en salud ocupacional. El método con que se calculen los costos puede influir en la valoración económica de los mismos(AU)

Introduction: the systematic medical examinations in its variants are an important element of the health care of workers and their conception and performance should comply with the required rationality and efficiency. Objetive: to estimate the costs per worker and per research study of systematic medical examinations performed in workers. Methods: the research work was conducted at the National Institute of Occupational Health. Two systems were used to estimate costs, that is, the ABC method and the disease/patient estimation method used in the Cuban public health system. The information was collected from documentary review including the medical histories of patients tested in the center. One database was created with 3 474 workers who went to the Institute services in the 2008-2013 period. Results: the costs of medical examinations, both the ones conducted in the different specialties and those performed per worker, showed significant differences; their comparison is difficult since the medical examinations are poorly standardized in the Institute. Conclusions: the costs were accurately estimated, but it is required to continue studying them in the preventive activities of the occupational health. The method used to estimate costs may influence their economic assessment(AU)

The Value of a Well-Being Improvement Strategy: Longitudinal Success across Subjective and Objective Measures Observed in a Firm Adopting a Consumer-Driven Health Plan.

OBJECTIVE: The objective of this study is to evaluate effectiveness of a firm's 5-year strategy toward improving well-being while lowering health care costs amidst adoption of a Consumer-Driven Health Plan. METHODS: Repeated measures statistical models were employed to test and quantify association between key demographic factors, employment type, year, individual well-being, and outcomes of health care costs, obesity, smoking, absence, and performance. RESULTS: Average individual well-being trended upward by 13.5% over 5 years, monthly allowed amount health care costs declined 5.2% on average per person per year, and obesity and smoking rates declined by 4.8 and 9.7%, respectively, on average each year. The results show that individual well-being was significantly associated with each outcome and in the expected direction. CONCLUSIONS: The firm's strategy was successful in driving statistically significant, longitudinal well-being, biometric and productivity improvements, and health care cost reduction.

The cost of absenteeism and short-term disability associated with colorectal cancer: a case-control study.

OBJECTIVE: Examine the incremental impact of absenteeism and short-term disability associated with colorectal cancer (CRC). METHODS: Absenteeism and short-term disability data were used for a case-control analysis of a healthy cohort (controls) compared with CRC patients (cases). Cases were matched to controls on the basis of age, sex, and region of residence. Multivariate regression models examined the costs of absenteeism and short-term disability, controlling for patient characteristics, prior medical costs, and patient general health. RESULTS: Compared with controls, CRC patients experience significantly higher short-term disability costs (mean, $45,716 vs $7367 [P < 0.0001]; median, $35,827 vs $7365 [P < 0.0001]), as well as significantly higher absenteeism costs (mean, $8841 vs $4596 [P < 0.0001]; median, $9971 vs $4795 [P < 0.0001]) in the 1 year after diagnosis of CRC. CONCLUSIONS: Colorectal cancer is associated with significant work-related productivity loss costs in the first year after diagnosis.

Using reporting requirements to improve employer wellness incentives and their regulation.

Employer interest in offering financial incentives for healthy behaviors has been increasing. Some employers have begun to tie health plan-based rewards or penalties to standards involving tobacco use or biometric measures such as body mass index. The Patient Protection and Affordable Care Act attempts to strike a balance between the potential benefits and risks of wellness incentive programs by permitting these incentives but simultaneously limiting their use. Evidence about the implications of the newest generation of incentive programs for health, health costs, and burdens on individual employees will be critical for informing both private and public decision makers. After describing the many pieces of information that would be valuable for assessing these programs, this article proposes more narrowly targeted reporting requirements that could facilitate incentive program development, evaluation, and oversight.

Compensation for occupational injuries and diseases in special populations: farmers and soldiers.

Some types of workers such as farmers and soldiers are at a higher risk of work-related injury and illness than workers from other occupations. Despite this fact, they are not covered under the Industrial Safety Health (ISH) Act or the Industrial Accident Compensation Insurance (IACI) Act. The Safety Aid System for Farmers (SASF) is a voluntary insurance scheme, and it is the only public compensation plan for self-employed farmers. Fifty percent of SASF premiums are subsidized by the Korean government. Soldiers are compensated by the Veterans' Pension (VP) Act. The approval standard of and procedure for the VP Act are provided in the Decree of VP Act, and the Council for VP Benefits determines work-relatedness in the claimed cases. Meanwhile, SASF applies the insurance clause automatically without any expert advice or additional procedures. Furthermore, compared with IACI, these programs pay fewer benefits to workers. Thus, a stronger institutional strategy is needed to maintain a safe work environment, to protect workers' health in unavoidably hazardous environments, and to compensate for work-related injuries and diseases.

Cardiovascular disease prevention and implications for worksite health promotion programs in Brazil.

Economic growth, an aging population, and changes in lifestyle patterns have contributed to the rise in cardiovascular disease (CVD) in Brazil. Worksite health and wellness programs are viewed as a potentially viable means to address the increase in disease burden in Brazil. The purpose of the present review is to investigate actions proposed by the Brazilian Government for CVD prevention and the current state of worksite health promotion. Our review of literature found that the Brazilian Government has been showing a growing interest in developing and promoting CVD preventive strategies, primarily through better control of known risk factors (i.e. smoking, obesity, physical inactivity, high cholesterol, high blood pressure, and high blood glucose). Current initiatives are considered positive steps toward better CVD prevention in Brazil. With respect to worksite health and wellness, additional work is needed to determine optimal program delivery models, financial implications and individual/population compliance with healthier lifestyle choices.

Duloxetine use in employees with low back pain: treatment patterns and direct and indirect costs.

OBJECTIVE: The study aims to examine real-world effects of duloxetine treatment for low back pain (LBP). METHODS: The study identified employees with ≥1 LBP diagnosis and ≥1 duloxetine prescription within a year after LBP diagnosis from a privately insured claims database (2004-2007). Duloxetine-treated employees were propensity score matched to employees initiating another pharmacological/noninvasive treatment in the same month from LBP diagnosis. Treatment patterns and costs were compared over the 6 months following treatment initiation. RESULTS: Relative to controls, duloxetine-treated employees (N = 753) had significantly lower rates of other pharmacological/noninvasive therapies and a similar LBP surgery rate (1.7% vs 2.8%, P = 0.1573). Duloxetine-treated employees, despite higher pharmacy costs, had similar direct (health care) costs ($4,935 vs $5,649, P = 0.2662), and significantly lower indirect (workloss) costs ($1,723 vs $2,198, P = 0.0036). CONCLUSIONS: Duloxetine treatment in LBP employees was associated with reduced rates of many nonsurgical therapies and lower indirect costs. The findings are limited by the observational study design and unmeasured potential confounders.

Presenteísmo e saúde bucal em trabalhadores da indústria de transformação e construção civil / Presentismo and oral health in workers of the transformation and construction industry

O adoecimento e sua relação com a falta de assiduidade ou produtividade no trabalho têm sido alvo de diversos estudos. Com os crescentes desafios impostos pela economia mundial, os empregadores estão em busca de uma maior eficiência e um consequente aumento da sua produtividade. O absenteísmo e o presenteísmo representam altos custos para as instituições tanto públicas quanto privadas e principalmente para o trabalhador. Neste sentido, observa-se que trabalho e saúde são variáveis que influenciam o processo produtivo e são importantes para a qualidade de vida, que, por sua vez, coloca sua centralidade na capacidade de viver sem doenças ou de superar as dificuldades dos estados ou condições de morbidade. Várias comorbidades estão associadas com a ausência ao serviço (absenteísmo) ou com o baixo rendimento no ambiente de trabalho (presenteísmo), dentre elas destacam-se os problemas de ordem circulatória, dores de cabeça e os distúrbios de origem bucal. O artigo aqui apresentado e intitulado "Presenteismo e saúde bucal em trabalhadores da indústria de transformação e construção civil" objetivou analisar o presentísmo relacionado às condições de saúde bucal dos trabalhadores da Indústria do Estado de Pernambuco enfocando problemas como a cárie dentária e doença periodontal através da análise de um banco de dados originidado de um estudo transversal, de base populacional.(AU)

The disease and its relationship to absenteeism or productivity at work have been the subject of several studies. With the increasing challenges posed by the global economy, Absenteeism and presenteeism represent high costs for both public and private, and institutions primarily for the worker. In this sense, it is observed that work and health are variables that influence the production process and are important for quality of life, which, in turn, puts its centrality in the ability to live without disease or overcome the difficulties of states or conditions of morbidity. Several comorbidities are associated with the absence of the service (absenteeism) or to the low yield in the workplace (presenteeism), among which stand out the order circulatory problems, headaches and disorders of oral origin. The article presented here, entitled "presenteeism and oral health workers in the manufacturing and construction industry" aimed to analyze the presenteeism related to oral health status of workers in the State of Pernambuco Industry focusing on problems such as tooth decay and periodontal disease through analysis of a database originidado data from a cross-sectional study, a population-based.(AU)

Investigation of postural edema in the lower extremities of traffic control workers / Investigacao de edema postural de membros inferiores em agentes de transito

OBJECTIVE: Determine the prevalence of postural edema and investigate whether working posture - sitting down or standing up - affect its frequency. METHODS: Sixteen traffic control agents were assessed by water displacement volumetry and the results were analyzed in two groups, depending on working posture. Those who worked standing up for more than 4 hours were allocated to the SU group and those who worked sitting down for more than 4 hours were allocated to the SD group. Each worker was assessed before and after their working shift for three consecutive days. Data were analyzed using ANOVA and the test of equality of two proportions. The significance level was set at p ≤ 0.05. The assessment showed that members of both groups had postural edema of the lower extremities (p ≤ 0.001). RESULTS: When the frequency of postural edema was compared across groups, a trend was observed for greater edema formation in the SU group than in the SD group, although without statistically significant difference. CONCLUSION: It was concluded that traffic control agents suffer postural edema after 4 hours working in either of the postures investigated although with a predominance of edema formation among those who work standing up. .

OBJETIVO: Avaliar a ocorrência de edema postural (EP) e verificar se há diferença na sua formação entre as duas posturas de trabalho adotadas - em pé e sentada. MÉTODOS: Foram avaliados 16 trabalhadores agentes de trânsito por meio da volumetria por deslocamento de água, divididos em dois grupos de acordo com a posição de trabalho adotada. No Grupo em Pé (GP), foram alocados aqueles que trabalhavam em pé e, no Grupo Sentado (GS), aqueles que adotavam a posição sentada, ambos por mais de quatro horas consecutivas. Os dados foram coletados antes e após a jornada de trabalho por três dias consecutivos e tratados com os testes estatísticos ANOVA e Igualdade de duas proporções. O nível de significância adotado foi p ≤ 0,05. A avaliação revelou presença de edema postural de membros inferiores nas duas condições avaliadas (p ≤ 0,001). RESULTADOS: Na análise da diferença na formação de EP entre os grupos, observou-se tendência a maior formação no GP em comparação ao GS, contudo sem diferença estatisticamente significante. CONCLUSÃO: Concluiu-se que existiu EP em agentes de trânsito após quatro horas de trabalho nas duas condições avaliadas com predomínio na formação de edema na postura em pé. .