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1.
Mymensingh Med J ; 29(1): 142-148, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31915350

RESUMEN

Hypertension (HTN) is an important cause of cardiovascular mortality and the prevalence of hypertension is increasing particularly in middle- and low-income countries including Bangladesh. No data are available for the prevalence of hypertension among the government employees in Bangladesh. In this cross-sectional study, conducted from 30 October to 31 December 2016, 1219 government employees aging ≥18 years working in Rangpur city were evaluated for the presence of HTN and its risk factors. Socio-demographic and anthropometric data, data on the presence of various known risk factors of hypertension were collected. Hypertension was defined with systolic BP ≥140mmHg and/or diastolic BP ≥90mmHg or those getting treatment for hypertension. Statistical analysis was done by using SPSS version 23.0; odds of hypertension among subjects with risk factors were calculated and p ≤0.05 was considered to be statistically significant. The prevalence of hypertension was 38.3% among the study subjects. Significantly higher odds of having hypertension were observed in study subjects with the age groups of 35-49 (OR 2.12, 95% CI: 1.51-2.99, p<0.001) and ≥50 (OR: 4.96, 95% CI: 3.43-7.18, p<0.001) years than age group <35 years. Employees who were averagely satisfied and not satisfied for their jobs also had higher odds (OR: 1.38, 95% CI: 1.00-1.91, p=0.049 and OR: 1.48, 95% CI: 3.43-7.18, p=0.337) of having hypertension than fully satisfied ones. Having diabetes mellitus was found to increase the odds (OR 2.12, 95% CI: 1.51-2.99, p<0.001) of hypertension. Male gender, urban/suburban residence, not doing physical exercise, sedentary/light working habit, overweight/obesity also increased the odds of having hypertension though these were not statistically significant. There is a high burden of hypertension among the government employees in Rangpur city. Age, job satisfaction and diabetes were independent risk factors of hypertension.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus/epidemiología , Empleados de Gobierno/estadística & datos numéricos , Hipertensión/epidemiología , Obesidad/epidemiología , Adulto , Bangladesh/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Distribución por Sexo , Población Suburbana/estadística & datos numéricos , Población Urbana/estadística & datos numéricos
2.
Obes Facts ; 12(5): 564-574, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31484183

RESUMEN

OBJECTIVE: Childhood disadvantage is associated with a higher risk of adult obesity, but little is known about its associations with body mass index (BMI) trajectories during adulthood. This study aimed first to identify adulthood BMI trajectories, and second to investigate how childhood disadvantage is associated with trajectory group membership. METHODS: Data from the Helsinki Health Study, a longitudinal cohort study of initially 40- to 60-year-old employees of the City of Helsinki in Finland, were used. The baseline survey was conducted in 2000-2002, and similar follow-up surveys in 2007, 2012, and 2017. Based on self-reported BMI, participants' (n =5,266; 83% women) BMI trajectories, including their retrospectively reported BMI at the age of 25 years, were examined. Data on childhood disadvantage, including parental education and 7 types of childhood adversity (their own serious illness; parental divorce, death, mental disorder, or alcohol problems; economic difficulties at home; and peer group bullying) before the age of 16 years, were obtained from the baseline survey. Group-based trajectory modeling was used to identify BMI trajectories, and multinomial logistic regression to analyze the odds for trajectory group membership for the disadvantage variables. RESULTS: Four ascending BMI trajectories in women and men were found: persistent normal weight (trajectory 1; women 35% and men 25%), normal weight to overweight (trajectory 2; women 41% and men 48%), normal weight to class I obesity (trajectory 3; women 19% and men 23%) and overweight to class II obesity (trajectory 4; women 5% and men 4%). Compared to trajectory 1, women with multiple adversities and repetitive peer bullying in childhood had greater odds of belonging to trajectories 3 and 4, whereas men with parental alcohol problems had greater odds of belonging to trajectory 4. For women and men, a low level of parental education was associated with a higher-level BMI trajectory. CONCLUSIONS: Low parental education for both genders, multiple adversities and repetitive peer bullying in childhood among women, and parental alcohol problems among men increased the odds of developing obesity during adulthood. Further studies are needed to clarify how gender differences modify the effects of childhood disadvantage on adult BMI trajectories.


Asunto(s)
Experiencias Adversas de la Infancia/estadística & datos numéricos , Índice de Masa Corporal , Trayectoria del Peso Corporal , Carencia Cultural , Empleados de Gobierno/estadística & datos numéricos , Gobierno Local , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Encuestas y Cuestionarios , Poblaciones Vulnerables/estadística & datos numéricos
3.
BMC Public Health ; 19(1): 863, 2019 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-31269927

RESUMEN

BACKGROUND: With increasing demand for red meat in Tanzania comes heightened potential for zoonotic infections in animals and humans that disproportionately affect poor communities. A range of frontline government employees work to protect public health, providing services for people engaged in animal-based livelihoods (livestock owners and butchers), and enforcing meat safety and food premises standards. In contrast to literature which emphasises the inadequacy of extension support and food safety policy implementation in low- and middle-income countries, this paper foregrounds the 'street-level diplomacy' deployed by frontline actors operating in challenging contexts. METHODS: This research is based on semi-structured interviews with 61 government employees, including livestock extension officers/meat inspectors and health officers, across 10 randomly-selected rural and urban wards. RESULTS: Frontline actors combined formal and informal strategies including the leveraging of formal policy texts and relationships with other state employees, remaining flexible and recognising that poverty constrained people's ability to comply with health regulations. They emphasised the need to work with livestock keepers and butchers to build their knowledge to self-regulate and to work collaboratively to ensure meat safety. Remaining adaptive and being hesitant to act punitively unless absolutely necessary cultivated trust and positive relations, making those engaged in animal-based livelihoods more open to learning from and cooperating with extension officers and inspectors. This may result in higher levels of meat safety than might be the case if frontline actors stringently enforced regulations. CONCLUSION: The current tendency to view frontline actors' partial enforcement of meat safety regulations as a failure obscures the creative and proactive ways in which they seek to ensure meat safety in a context of limited resources. Their application of 'street-level diplomacy' enables them to be sensitive to local socio-economic realities, to respect local social norms and expectations and to build support for health safety interventions when necessary. More explicitly acknowledging the role of trust and positive state-society relations and the diplomatic skills deployed by frontline actors as a formal part of their inspection duties offers new perspectives and enhanced understandings on the complicated nature of their work and what might be done to support them.


Asunto(s)
Diplomacia , Inocuidad de los Alimentos , Empleados de Gobierno/psicología , Carne/normas , Salud Pública/métodos , Animales , Femenino , Empleados de Gobierno/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ganado , Masculino , Pobreza , Salud Pública/normas , Investigación Cualitativa , Tanzanía , Confianza , Zoonosis/prevención & control
4.
Occup Environ Med ; 76(4): 230-235, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30674604

RESUMEN

OBJECTIVE: This study examined the associations between changes in common mental disorders (CMD) and subsequent diagnosis-specific sickness absence (SA) among midlife and ageing municipal employees. METHODS: Data from the Helsinki Health Study phase I (2000-2002) and phase II (2007) surveys among employees of the City of Helsinki, Finland, were linked with prospective register data from the Social Insurance Institution of Finland on diagnosis-specific (mental, musculoskeletal, other causes) SA (n=3890). Associations between change in CMD (General Health Questionnaire 12) from phase I to phase II and the first SA event in 2007-2014 were analysed using Cox regression modelling. Sociodemographic, work and health-related covariates from phase I, and SA from the year preceding phase I were controlled for. RESULTS: Having CMD at one or two time points, that is, favourable and unfavourable change in CMD and repeated CMD, were all associated with a higher risk of SA due to mental, musculoskeletal and other diagnoses compared with women and men with no CMD. Favourable change in CMD reduced the risk of SA when compared with repeated CMD. The strongest associations were observed for repeated CMD (HR range: 1.44 to 5.05), and for SA due to mental diagnoses (HR range: 1.15 to 5.05). The associations remained after adjusting for the covariates. CONCLUSIONS: Changing and repeated CMD increased the risk of SA due to mental, musculoskeletal and other diagnoses. CMD should be tackled to prevent SA and promote work-ability among ageing employees.


Asunto(s)
Absentismo , Empleados de Gobierno/psicología , Trastornos Mentales/clasificación , Adulto , Femenino , Finlandia , Estudios de Seguimiento , Empleados de Gobierno/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sistema de Registros/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Encuestas y Cuestionarios
5.
Int Arch Occup Environ Health ; 92(3): 337-345, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30511342

RESUMEN

PURPOSE: We developed a job exposure matrix (JEM) to study the association between long-term exposure to heavy physical effort or heavy lifting and carrying at work with disability pension due to musculoskeletal disorders and premature all-cause mortality. METHODS: Exposure to heavy physical effort at work during 1996-2005 was estimated with JEM developed for this study population, where the exposure was based on occupational titles of the participants. We included all employees of the City of Helsinki, Finland, who had annual data of exposure for 8-10 years (1996-2005, n = 18387). The outcome variables were register-based, and the follow-up was from 2006 until 2015. The risk estimates were evaluated using competing risk survival analysis. RESULTS: There were 530 (3%) disability pension events due to musculoskeletal disorders during the 10-year follow-up. After adjustment for sex, age, education and chronic diseases, employees in the second (SHR = 1.46, 95% CI 1.05-2.05), third (SHR = 2.73, 95% CI 2.00-2.29), and the highest exposure quartile (SHR = 2.56, 95% CI 1.88-3.50) had a higher risk of musculoskeletal disability pension than employees in the lowest quartile. A total of 110 (4%) men and 266 (2%) women died during the follow-up. Men in the third quartile (SHR = 2.29, 95% CI 1.23-4.24), and women in the highest exposure quartile (SHR = 1.54, 95% CI 0.99-2.41) had a higher risk of premature mortality than those in the lowest quartile. CONCLUSIONS: Eight to ten years of exposure to heavy physical effort at work is strongly associated with disability pension due to musculoskeletal disorders. This exposure also increases the risk of premature mortality, particularly among men.


Asunto(s)
Mortalidad , Enfermedades Musculoesqueléticas/epidemiología , Exposición Profesional/estadística & datos numéricos , Pensiones/estadística & datos numéricos , Adulto , Estudios de Cohortes , Personas con Discapacidad/estadística & datos numéricos , Femenino , Finlandia/epidemiología , Estudios de Seguimiento , Empleados de Gobierno/estadística & datos numéricos , Humanos , Elevación , Masculino , Persona de Mediana Edad , Enfermedades Profesionales/epidemiología , Esfuerzo Físico , Carga de Trabajo
6.
Int Arch Occup Environ Health ; 92(3): 327-335, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30519967

RESUMEN

OBJECTIVES: To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. METHODS: Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. RESULTS: Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. CONCLUSIONS: After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1-3 years.


Asunto(s)
Exposición Profesional/efectos adversos , Ausencia por Enfermedad/estadística & datos numéricos , Terrorismo/psicología , Adulto , Anciano , Estudios de Cohortes , Femenino , Empleados de Gobierno/estadística & datos numéricos , Humanos , Masculino , Trastornos Mentales/epidemiología , Persona de Mediana Edad , Noruega/epidemiología , Estudios Prospectivos , Estudios Retrospectivos , Encuestas y Cuestionarios , Lugar de Trabajo
7.
PLoS One ; 13(10): e0204879, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30281660

RESUMEN

BACKGROUND: Hypertension is a globally recognized threat to social and economic development with premature morbidity and mortality. In middle and low-income countries hypertension appears to be increasing. However, sufficient data on this silent-killer is not available in Ethiopia. Therefore, this study examined the magnitude and risk factors for hypertension among public servants in Tigray, Ethiopia. METHODS: We used a cross-sectional survey from May-June 2016 among 1525 public servants in Tigray region. Field workers collected data using a pre-tested, standardized questionnaire. A multivariate logistic regression analysis conducted to identify risk factors for hypertension. Statistical significance was declared using a p-value<0.05 and 95% of confidence interval (CI) for an adjusted odds ratio (AOR). RESULTS: The overall prevalence of hypertension was 16% (95% CI: 13.10-21.9) and the proportion of awareness (96.7%), treatment (31.3%) and control of hypertension (40.1%) among employees. Being male [AOR = 2.06, 95%CI:1.49, 2.84], ages groups of 30-49 years [AOR = 2.21, 95%CI:1.25, 3.89] and >50years [AOR = 3.61, 95% CI:1.93, 6.69], Body Mass Index(BMI); underweight [AOR = 0.40, 95% CI; 0.20, 0.78], overweight [AOR = 1.70, 95%CI; 1.22, 2.33] and obesity [AOR = 3.20, 95% CI; 1.78, 5.78] were determinants for hypertension. CONCLUSION: The prevalence of hypertension is relatively high in Mekelle city compared with previous reports. This study revealed that male sex, age-group, and BMI were evidenced as risk factors for hypertension. Policy makers need to consider sector wise integrating prevention and control of hypertension. Skilled based information, education and communication strategies should be designed and implemented to avoid unhealthy lifestyles, investing in workforces to eliminate the modifiable risk factors for non-communicable diseases and promote healthy practices.


Asunto(s)
Empleados de Gobierno/estadística & datos numéricos , Hipertensión/epidemiología , Sobrepeso/epidemiología , Delgadez/epidemiología , Adulto , Índice de Masa Corporal , Estudios Transversales , Etiopía/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Adulto Joven
8.
Artículo en Inglés | MEDLINE | ID: mdl-30262726

RESUMEN

Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration for temporary disabilities is associated with non-work-related illnesses (NWRI), a historical cohort study was carried out of workers at a Brazilian University. The Charlson Comorbidity Index (CCI) was obtained from the most prevalent diagnoses in each expert examination and from the corresponding days of sick leave per episode, adjusting simple and multiple Cox regression models. As a result, 70% of the NWRI temporary disabilities were due to depressive disorders, convalescence, and dorsalgia with a sick leave duration between 4 and 320 days. The factors of protection for sick leave durations until the rehabilitation were non-insulin-dependent diabetes mellitus and hypertension. Long-term sick leaves were observed in the cases that required rehabilitation of those workers diagnosed with recurrent depressive disorders, conjunctivitis, acute sinusitis, skin disorders, calculus of kidney and ureter, abdominal and pelvic pain, and same-level fall accidents. It is also worth noting that even in a disease that can justify long-term sick leaves, such as breast cancer, the duration may be shorter according to the worker's capacity and self-efficacy.


Asunto(s)
Absentismo , Personas con Discapacidad/estadística & datos numéricos , Empleados de Gobierno/estadística & datos numéricos , Ausencia por Enfermedad/estadística & datos numéricos , Universidades/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales
9.
Can J Public Health ; 109(1): 79-88, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29981058

RESUMEN

OBJECTIVES: Policy and legislation that prohibits workplace harassment and discrimination, including that which is disability related, has been in place in Canada for many years. The study objective was to examine associations between disability and workplace harassment and discrimination in the current Canadian context, as well as the intersection of disability with age, gender, and ethnicity. METHODS: Cross-sectional data from the 2014 Canadian Public Service Employee Survey was analyzed (n = 175,742) using logistic regression to investigate the relationship between self-reported disability and workplace harassment and discrimination in the last 2 years. Age, gender, and ethnicity were included as potential confounders and effect modifiers. Additive and multiplicative effect modifications were examined using linear binomial and logistic regression, respectively. RESULTS: Overall, 18 and 8% of the sample of Canadian public service employees reported workplace harassment and discrimination, respectively. The prevalence was higher for workers with disability (37 and 26%). Disability was significantly associated with an increased odds of harassment (odds ratio (OR) = 2.80; 95% confidence interval (CI), 2.68-2.92) and discrimination (OR = 4.97; 95% CI, 4.72-5.23) in models adjusted for confounders. Significant positive additive effect modification was observed for (1) age in the harassment and discrimination models and (2) ethnicity in the discrimination model. CONCLUSION: Findings from a 2014 census of the Canadian federal public service suggest that additional efforts are needed to address workplace harassment and discrimination beyond those already in place. Consideration should be given to workers with disability, as well as the intersectional impacts for older workers, visible minorities, and Aboriginal peoples.


Asunto(s)
Acoso Escolar/estadística & datos numéricos , Personas con Discapacidad/estadística & datos numéricos , Empleados de Gobierno/estadística & datos numéricos , Discriminación Social/estadística & datos numéricos , Lugar de Trabajo , Adulto , Factores de Edad , Canadá , Estudios Transversales , Grupos Étnicos/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Factores Sexuales , Discriminación Social/legislación & jurisprudencia , Encuestas y Cuestionarios , Lugar de Trabajo/legislación & jurisprudencia , Adulto Joven
10.
JNMA J Nepal Med Assoc ; 56(209): 497-503, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30058632

RESUMEN

INTRODUCTION: Non-communicable diseases have along duration and slow progression. It is estimated that the attribution of NCDs in mortality has been rising gradually in Nepal. This study aimed to estimate the prevalence and factors associated with NCDs in Biratnagar, Nepal. METHODS: A cross-sectional study was conducted among government employees in Biratnagar, Nepal from August to December 2016. We used self-administrated modified WHO STEPS survey questionnaire and distributed to all government employees of Biratnagar Sub-Metropolitan. We used complete filled 323 questionnaires to analyze and draw the results. RESULTS: The prevalence of NCDs was found 72 (22.3%). Hence, 322 (99.6%)government employees had exposed at least one established risk factor of the NCDs. The prevalence of use of any type of tobacco products was 60 (18.5%) and consumption of alcoholic products was 187 (57.9%). More than two-thirds respondents answered that they consumed fruits once a week. Most government employees consumed vegetable regularly.The majority 193 (59.6%) respondents used motorcycle and electric rickshaw as means of transportation. Out of the total participants 60 (18.6%), 19 (5.9%), and 6 (1.9%) reported hypertension, diabetes, and cardiovascular diseases respectively. CONCLUSIONS: Prevalence of Non-Communicable Diseases has been seen in Government Employees in Biratnagar, Nepal. Most of them had at least one associated factor related to NCD was found.


Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Enfermedades Cardiovasculares/epidemiología , Diabetes Mellitus/epidemiología , Empleados de Gobierno/estadística & datos numéricos , Enfermedades no Transmisibles/epidemiología , Fumar/epidemiología , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Prevalencia , Factores de Riesgo , Encuestas y Cuestionarios
11.
Prev Chronic Dis ; 15: E28, 2018 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-29494331

RESUMEN

We examined the relative importance of 23 community issues among elected officials and health directors in Connecticut in 2016. For this cross-sectional study, 74 elected officials (40.7% response rate) and 47 health directors (62.7% response rate), who were purposively sampled, completed a questionnaire to rate their perceived importance of 23 community issues. Eight of these issues were related to active living, healthy eating, or obesity. We used χ2 tests to evaluate differences in responses. Compared with elected officials, health directors significantly more often perceived obesity, access to healthy groceries, poor nutrition, lack of pedestrian walkways, and pedestrian safety as important. Elected officials significantly more often than health directors perceived lack of good jobs, quality of public education, and cost of living as important. Health advocates should work with both groups to develop and frame policies to address both upstream (eg, jobs, education) and downstream (eg, healthy eating policies) determinants of obesity.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Política de Salud , Obesidad/prevención & control , Connecticut/epidemiología , Estudios Transversales , Ejercicio Físico , Empleados de Gobierno/psicología , Empleados de Gobierno/estadística & datos numéricos , Humanos , Obesidad/epidemiología , Encuestas y Cuestionarios
12.
BMC Public Health ; 18(1): 419, 2018 03 27.
Artículo en Inglés | MEDLINE | ID: mdl-29587689

RESUMEN

BACKGROUND: Each year, more than millions of under-five children die due to under-nutrition, and many of these deaths are associated with inappropriate feeding practices. This study aimed to assess complementary feeding practices in Damot Weydie District, South Ethiopia. METHODS: A community-based cross-sectional study was conducted among four-hundred and one mothers who had children aged 6-23 months in Damot Weydie District. A pretested structured questionnaire was used to collect data using a face-to-face interview. Data were entered into Epi-Data version 3.1 and analysis was done by using Statistical Package for Social Sciences (SPSS) version 20. Multivariable logistic regressions were conducted to determine independent factors associated with complementary feeding practices. RESULTS: More than half (50.6%) of children were given complementary foods at six months of age. Only 8.5% of young children aged 6-23 months were fed with appropriate complementary foods. The proportion of mothers who reported that they know that a baby of 6-23 months old should be fed two or three times was only 75.8%. Government-employed mothers (adjusted odds ratio (AOR) = 0.14(0.04, 0.50) and mothers who attended postnatal care (AOR = 0.19(0.05, 0.70) were less likely to practice inappropriate complementary feeding. Mothers having children with birth intervals less than 35 months were more likely to practice inappropriate complementary feeding when compared to mothers of children with birth intervals greater than 35 months (AOR = 2.67 (1.22, 5.83). CONCLUSIONS: Considerable proportions of infants and young children were not appropriately fed with complementary foods as per WHO recommendations. Being a government employee mother, attending postnatal care and having a child with birth interval greater than 3 years were associated with appropriate complementary feeding. Therefore, it is important to encourage postnatal care utilization and incorporate complementary feeding advice during postnatal visits. It is critical to raise the awareness of the community about optimal complementary feeding practices with special attention to unemployed and less educated mothers. Additionally, inter-sectoral collaboration should be strengthened to increase the variety of food groups available.


Asunto(s)
Conducta Alimentaria , Fenómenos Fisiológicos Nutricionales del Lactante , Madres/psicología , Intervalo entre Nacimientos/estadística & datos numéricos , Estudios Transversales , Etiopía/epidemiología , Femenino , Empleados de Gobierno/estadística & datos numéricos , Humanos , Lactante , Masculino , Madres/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Embarazo , Factores Socioeconómicos , Encuestas y Cuestionarios
13.
J Med Econ ; 21(6): 564-570, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29359606

RESUMEN

AIMS: To examine the comorbidity and economic burden among moderate-to-severe psoriasis (PsO) and/or psoriatic arthritis (PsA) patients in the US Department of Defense (DoD) population. MATERIALS AND METHODS: This retrospective cohort claims analysis was conducted using DoD data from November 2010 to October 2015. Adult patients with ≥2 diagnoses of PsO and/or PsA (cases) were identified, and the first diagnosis date from November 2011 to October 2014 was defined as the index date. Patients were considered moderate-to-severe if they had ≥1 non-topical systemic therapy or phototherapy during the 12 months pre- or 1 month post-index date. Patients without a PsO/PsA diagnosis during the study period (controls) were matched to cases on a 10:1 ratio based on age, sex, region, and index year; the index date was randomly selected. One-to-one propensity score matching (PSM) was conducted to compare study outcomes in the first year post-index date, including healthcare resource utilization (HRU), costs, and comorbidity incidence. RESULTS: A total of 7,249 cases and 72,490 controls were identified. The mean age was 48.1 years. After PSM, comorbidity incidence was higher among cases, namely dyslipidemia (18.3% vs 13.5%, p < .001), hypertension (13.8% vs 8.7%, p < .001), and obesity (8.8% vs 6.1%, p < .001). Case patients had significantly higher HRU and costs, including inpatient ($2,196 vs $1,642; p < .0016), ambulatory ($8,804 vs 4,642; p < .001), emergency room ($432 vs $350; p < .001), pharmacy ($6,878 vs $1,160; p < .001), and total healthcare costs ($18,311 vs $7,795; p < .001). LIMITATIONS: Claims data are collected for payment purposes; therefore, such data may have limitations for clinical research. CONCLUSIONS: During follow-up, DoD patients with moderate-to-severe PsO and/or PsA experienced significantly higher HRU, cost, and comorbidity burden.


Asunto(s)
Empleados de Gobierno/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Psoriasis/economía , Adulto , Factores de Edad , Artritis Psoriásica/economía , Comorbilidad , Femenino , Recursos en Salud/economía , Servicios de Salud/economía , Servicios de Salud/estadística & datos numéricos , Humanos , Revisión de Utilización de Seguros/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Características de la Residencia , Estudios Retrospectivos , Factores Sexuales , Factores Socioeconómicos , Estados Unidos
14.
Workplace Health Saf ; 66(8): 367-372, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29308721

RESUMEN

Occupational health nurses motivate employees to engage in healthy behaviors. Both clinicians and researchers need strong theories on which to base decisions for health programs (e.g., healthy diet) and experimental interventions (e.g., workplace walking). The self-determination theory could be useful as it includes concepts of individual autonomy, competence to perform healthy behaviors, and relationships as predictors of health behaviors and outcomes. In this article, the self-determination theory is described and evaluated using Walker and Avant's criteria. The theory is applied to a population of federal employees who smoke. By increasing employees' ability to autonomously choose smoking cessation programs, support their competence to stop smoking, and improve their relationships with both others who smoke and employee health services, smoking cessation should increase.


Asunto(s)
Empleados de Gobierno/psicología , Salud Laboral , Teoría Psicológica , Cese del Hábito de Fumar/psicología , Prevención del Hábito de Fumar/métodos , Adulto , Gobierno Federal , Femenino , Empleados de Gobierno/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
15.
Int J Equity Health ; 17(1): 1, 2018 01 04.
Artículo en Inglés | MEDLINE | ID: mdl-29301537

RESUMEN

BACKGROUND: Many low- and middle-income countries are reforming their health financing mechanisms as part of broader strategies to achieve universal health coverage (UHC). Voluntary social health insurance, despite evidence of resulting inequities, is attractive to policy makers as it generates additional funds for health, and provides access to a greater range of benefits for the formally employed. The South African government introduced a voluntary health insurance scheme (GEMS) for government employees in 2005 with the aim of improving access to care and extending health coverage. In this paper we ask whether the new scheme has assisted in efforts to move towards UHC. METHODS: Using a cross-sectional survey across four of South Africa's nine provinces, we interviewed 1329 government employees, from the education and health sectors. Data were collected on socio-demographics, insurance coverage, health status and utilisation of health care. Multivariate logistic regression was used to determine if service utilisation was associated with insurance status. RESULTS: A quarter of respondents remained uninsured, even higher among 20-29 year olds (46%) and lower-skilled employees (58%). In multivariate analysis, the odds of an outpatient visit and hospital admission for the uninsured was 0.3 fold that of the insured. Cross-subsidisation within the scheme has provided lower-paid civil servants with improved access to outpatient care at private facilities and chronic medication, where their outpatient (0.54 visits/month) and inpatient utilisation (10.1%/year) approximates that of the overall population (29.4/month and 12.2% respectively). The scheme, however, generated inequities in utilisation among its members due to its differential benefit packages, with, for example, those with the most benefits having 1.0 outpatient visits/month compared to 0.6/month with lowest benefits. CONCLUSIONS: By introducing the scheme, the government chose to prioritise access to private sector care for government employees, over improving the availability and quality of public sector services available to all. Government has recently regained its focus on achieving UHC through the public system, but is unlikely to discontinue GEMS, which is now firmly established. The inequities generated by the scheme have thus been institutionalised within the country's financing system, and warrant attention. Raising scheme uptake and reducing differentials between benefit packages will ameliorate inequities within civil servants, but not across the country as a whole.


Asunto(s)
Empleados de Gobierno/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Sector Privado/estadística & datos numéricos , Sector Público/estadística & datos numéricos , Cobertura Universal del Seguro de Salud/estadística & datos numéricos , Adulto , Anciano , Estudios Transversales , Femenino , Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Estado de Salud , Humanos , Cobertura del Seguro/estadística & datos numéricos , Seguro de Salud/estadística & datos numéricos , Entrevistas como Asunto , Modelos Logísticos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Calidad de la Atención de Salud , Seguridad Social , Factores Socioeconómicos , Sudáfrica , Encuestas y Cuestionarios , Cobertura Universal del Seguro de Salud/economía , Adulto Joven
16.
J Gerontol B Psychol Sci Soc Sci ; 73(3): 447-456, 2018 03 02.
Artículo en Inglés | MEDLINE | ID: mdl-28475772

RESUMEN

Objectives: Early old age and the period around retirement are associated with a widening in socioeconomic inequalities in health. There are few studies that address the stress-biological factors related to this widening. This study examined whether retirement is associated with more advantageous (steeper) diurnal cortisol profiles, and differences in this association by occupational grade. Method: Data from the 7th (2002-2004), 8th (2006), and 9th (2007-09) phases of the London-based Whitehall II civil servants study were analysed. Thousand hundred and forty three respondents who were employed at phase 8 (mean age 59.9 years) and who had salivary cortisol measured from five samples collected across the day at phases 7 and 9 were analysed. Results: Retirement was associated with steeper diurnal slopes compared to those who remained in work. Employees in the lowest grades had flatter diurnal cortisol slopes compared to those in the highest grades. Low-grade retirees in particular had flatter diurnal slopes compared to high-grade retirees. Discussion: Socioeconomic differences in a biomarker associated with stress increase, rather than decrease, around the retirement period. These biological differences associated with transitions into retirement for different occupational groups may partly explain the pattern of widening social inequalities in health in early old age.


Asunto(s)
Empleados de Gobierno/estadística & datos numéricos , Hidrocortisona/análisis , Jubilación/psicología , Factores Socioeconómicos , Biomarcadores/análisis , Ritmo Circadiano , Femenino , Empleados de Gobierno/psicología , Humanos , Hidrocortisona/fisiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Jubilación/estadística & datos numéricos , Saliva/química , Estrés Psicológico/epidemiología , Estrés Psicológico/fisiopatología , Reino Unido/epidemiología
17.
Hipertens Riesgo Vasc ; 35(1): 15-23, 2018.
Artículo en Español | MEDLINE | ID: mdl-29107556

RESUMEN

INTRODUCTION: OSAHS is associated with an increased risk of cardiovascular disease and stroke. Arterial hypertension is a key risk factor to consider due to its impact on health. METHOD: Cross-sectional study carried out on Spanish public service workers. The nocturnal apnoea risk using the Epworth and STOP-Bang questionnaires and their influence on the mean values of blood pressure are assessed. RESULTS: The detection of OSAHS using the Epworth test and, particularly with the STOP-Bang shows a significant relationship with the mean values of blood pressure, with differences between both questionnaires. CONCLUSION: The Epworth and STOP-Bang questionnaires are useful for the initial detection of OSAHS and a higher prevalence of high blood pressure. Both can be used in screening procedures in occupational health.


Asunto(s)
Presión Sanguínea , Hipertensión/etiología , Medicina del Trabajo/métodos , Apnea Obstructiva del Sueño/fisiopatología , Encuestas y Cuestionarios , Adulto , Anciano , Estudios Transversales , Femenino , Empleados de Gobierno/estadística & datos numéricos , Humanos , Hipertensión/epidemiología , Hipertensión/prevención & control , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Polisomnografía , Prevalencia , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/diagnóstico , Apnea Obstructiva del Sueño/epidemiología , Fumar/epidemiología , Clase Social , España/epidemiología , Adulto Joven
18.
BMC Res Notes ; 10(1): 773, 2017 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-29282116

RESUMEN

BACKGROUND: Sickness absence, work disability associated with illness or injury, is a major public health problem worldwide. Some studies have investigated determinants of sickness absence among workers with shorter job tenure, but have only focused on certain diagnostic groups. Although it is well established that job tenure has an inverse relationship with work injury rate, less is known about its association with sickness absence for other disorders. Therefore, this study aimed to investigate the risk factors for incidence and duration of sickness absence according to diagnosis over a 7-year period. A dynamic cohort consisting of all permanent civil servants hired from 2005 to 2011 by the Goiania municipality-Brazil. Data of certified sickness absences longer than 3 days were analyzed. The incidence density was calculated per 1000 person-years in each ICD-10 category. The association between sickness absence and socio-demographic and occupational characteristics was examined using negative binomial regression models. RESULTS: 18,450 workers, mean age of 32 years, accumulated 14,909 episodes of sickness absence. Overall, the incidence density was 234.6 episodes per 1000 person years. Diagnostic groups with the highest incidence density of sickness absences were injuries (49.1), musculoskeletal disorders (31.3) and mental disorders (29.2). Factors predicting any sickness absence were female gender, older age, low education, being a health professional, multiple jobs and full-time employment. Mental health disorders were more common among education professionals, musculoskeletal disorders among blue collar workers and injuries among inspection workers. Prolonged time on sick leave was associated with male gender, older age groups, low education and income, blue-collar workers, more than one job contract and full time employment. CONCLUSIONS: These findings demonstrate a substantial sickness absentee burden and they provide relevant information for targeting prevention and health promotion policies to the most vulnerable occupational groups.


Asunto(s)
Absentismo , Trastornos Mentales/epidemiología , Enfermedades Musculoesqueléticas/epidemiología , Ausencia por Enfermedad/estadística & datos numéricos , Heridas y Traumatismos/epidemiología , Adulto , Factores de Edad , Brasil/epidemiología , Estudios de Cohortes , Escolaridad , Femenino , Empleados de Gobierno/educación , Empleados de Gobierno/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Salud Laboral/tendencias , Factores de Riesgo , Factores Sexuales
19.
Artículo en Inglés | MEDLINE | ID: mdl-29271881

RESUMEN

Sick building syndrome (SBS) is a combination of symptoms that can be attributed to exposure to specific building conditions. The present study recruited 389 participants aged 20-65 years from 87 offices of 16 institutions to examine if personal factors, work-related psychosocial stress, and work environments, were associated with five groups of SBS symptoms, including symptoms for eyes, upper respiratory tract, lower respiratory tract, skin, and non-specific systems. Indoor environmental conditions were monitored. Data were analyzed using multivariate logistic regression (MLR) analyses and were reported as adjusted Odds Ratios (aOR). SBS symptoms for eyes were associated with older age, sensitivity to tobacco, and low indoor air flow. Upper respiratory symptoms were related to smoking, low social support, longer work days, and dry air. High indoor air flow was associated with reduced upper respiratory symptoms (aOR = 0.29; 95% confidence interval (CI) = 0.13-0.67). Lower respiratory symptoms were associated with high work pressure, longer work hours, chemical exposure, migraine, and exposure to new interior painting. Recent interior painting exposure was associated with a high estimated relative risk of low respiratory symptoms (aOR = 20.6; 95% CI = 2.96-143). Smoking, longer work days, low indoor air flow, indoor dryness, and volatile organics exposure, were associated with other non-specified symptoms including headache, tiredness, difficulty concentrating, anger, and dizziness. In conclusion, there are various SBS symptoms associated with different personal characteristics, psychosocial, and environmental factors. Psychosocial factors had stronger relationships with lower respiratory symptoms than with other types of SBS symptoms. Good ventilation could reduce risk factors and may relieve SBS symptoms.


Asunto(s)
Contaminación del Aire Interior/efectos adversos , Exposición a Riesgos Ambientales/efectos adversos , Empleados de Gobierno/estadística & datos numéricos , Exposición Profesional/estadística & datos numéricos , Síndrome del Edificio Enfermo/etiología , Ventilación , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Psicología , Factores de Riesgo , Síndrome del Edificio Enfermo/epidemiología , Taiwán/epidemiología , Adulto Joven
20.
Int J Equity Health ; 16(1): 158, 2017 08 30.
Artículo en Inglés | MEDLINE | ID: mdl-28854972

RESUMEN

BACKGROUND: This study assessed willingness to pay for National Health Insurance Fund (NHIF) among public servants in Juba City. NHIF is the proposed health insurance scheme for South Sudan and aims at achieving universal health coverage for the entire nation's population. One compounding issue is that over the years, governments' spending on healthcare has been decreasing from 8.4% of national budget in 2007 to only 2.2% in 2012. METHODS: A cross-sectional study design using contingent evaluation was employed; data on willingness to pay was collected from 381 randomly selected respondents and 13 purposively selected key informants working for the national, state and Juba County in September 2015. Qualitative data were analysed using conceptual content analysis. T-tests and linear regressions were performed to determine association between WTP for NHIF and independent variables. RESULTS: Up to 381 public servants were interviewed, of which 68% indicated willingness to pay varying percentages of total monthly individual income for NHIF. Over two-thirds (67.8%) of those willing to pay could pay up to 5% of their total monthly income, 22.9% could pay up to 10% and the rest could pay 25%. Over 80% were willing to pay up to 50 SSP (1 USD = 10 SSP) premiums for medical consultation, laboratory services and drugs. The main factors influencing the respondents' decisions were awareness, alternative sources of income, household size, insurance cover and religion. CONCLUSIONS: Willingness to pay is mainly influenced by awareness, alternative sources of individual income, household size, insurance cover and religion. Most of the public servants were aware of and willing to pay for NHIF and prefer a premium of up to 5% of total monthly income. There is need to create awareness and reach out to those who do not know about the scheme in addition to a detailed analysis of other stakeholders. Consideration could be made by the Government of South Sudan to start the scheme at the earliest opportunity since the majority of the respondents were willing to contribute towards it.


Asunto(s)
Financiación Personal/economía , Financiación Personal/estadística & datos numéricos , Empleados de Gobierno/psicología , Programas Nacionales de Salud/economía , Adolescente , Adulto , Ciudades , Estudios Transversales , Femenino , Empleados de Gobierno/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Factores Socioeconómicos , Sudán del Sur , Adulto Joven
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