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Biomedical subjects

B C Amick

Publications and source records attributed to B C Amick.

18 recordsLinked to original sources
PubMed2001

Predictors of outcomes of carpal tunnel release.

OBJECTIVE: To identify factors that are predictive of the outcomes of greatest importance to patients-i.e., symptom relief, functional improvement, and satisfaction with the outcomes of surgery-following carpal tunnel release. METHODS: We analyzed data from the Maine Carpal Tunnel Study, a community-based study of the outcomes of treatment for carpal tunnel syndrome. In a cohort of patients who underwent carpal tunnel release, a preoperative physical examination was performed and questionnaires were completed preoperatively and at 6, 18, and 30 months postoperatively. The questionnaires assessed symptom severity, upper extremity functional limitations, mental health, general physical health status, the relative severity of individual symptoms, satisfaction with the results of surgery, sociodemographic factors, and for those subjects who were in the workforce, aspects of the work environment. The associations between preoperative factors and the 3 principal outcomes (symptom severity, upper extremity functional limitations, and satisfaction with the results of surgery, all evaluated at 18 months postoperatively) were assessed with bivariate and multivariate linear regression and logistic regression analyses. RESULTS: Two hundred forty-one subjects were enrolled and 188 (78%) completed followup surveys 18 months postoperatively. Two-thirds of the patients reported being completely or very satisfied with the outcomes of surgery at 6, 18, and 30 months postoperatively. A range of clinical and work-related variables were associated with outcomes. In multivariate analyses, greater preoperative upper extremity functional limitation was predictive of greater functional limitations postoperatively. Worse mental health status was significantly associated with more severe symptoms and lower satisfaction. Alcohol use was also associated with more severe symptoms and lower satisfaction. Among workers, involvement of an attorney was significantly associated with greater functional limitation, more severe symptoms, and lower satisfaction. Recipients of worker's compensation who did not hire an attorney had generally good outcomes. Of note, physical examination parameters were not predictive of the outcomes of surgery. CONCLUSION: The outcomes of carpal tunnel release in community-based practices are excellent. Predictors of the outcomes of surgery are disease-specific and generic clinical factors as well as work-related factors. The strongest predictors of less favorable outcomes are worse scores on patient-reported measures of upper extremity functional limitation and mental health status, alcohol use, and the involvement of an attorney. Clinicians should carefully evaluate patients' functional status, mental health status, health habits, and attorney involvement prior to performing carpal tunnel release, and discuss with patients the prognostic implications of these parameters.

Adult↗
PubMed2001

The social context of health selection: a longitudinal study of health and employment.

Health selection out of the labour force has received considerable attention by analysts attempting to disentangle the "true" biological dimensions of ill-health from its social meaning. Rejecting this dualistic separation, we argue that the effect of health on labour force participation is an inherently social process reflecting differential access to material and symbolic rewards that are structured by social position. Using longitudinal data from the US-based Panel Study of Income Dynamics, we examine the extent to which structural arrangements, including those designated by gender, race, education and age, differentially affect the risk of a labour market exit when health is compromised. Individuals employed at entry into the study (from 1984-1990) were followed for the duration of the study or until they left the labour force. Analyses were stratified by gender and age (25-39 and 40-61 years at baseline). We found suggestive evidence that the hazard of labour market exit in the context of perceived ill-health depended on gender, race and education, but in ways that were not constant across each of these social positions. For example, men may be more vulnerable to the labour market effects of poor health, but only in the younger group, black men were less likely to leave the labour force than white men, and education mattered, but only among younger women and older men. While these patterns may reflect differential access to disability pensions or other work-related benefits, we suggest that a more detailed analysis of trajectories of health and employment. as well as the meaning of health states would be useful in further elucidating the social dimensions of health selection.

Adult↗
PubMed2001

The Work Limitations Questionnaire.

OBJECTIVE: The objective of this work was to develop a psychometrically sound questionnaire for measuring the on-the-job impact of chronic health problems and/or treatment ("work limitations"). RESEARCH DESIGN: Three pilot studies (focus groups, cognitive interviews, and an alternate forms test) generated candidate items, dimensions, and response scales. Two field trials tested the psychometric performance of the questionnaire (studies 1 and 2). To test recall error, study 1 subjects were randomly assigned to 2 different questionnaire groups, a questionnaire with a 4-week reporting period completed once or a 2-week version completed twice. Responses were compared with data from concurrent work limitation diaries (the gold standard). To test construct validity, we compared questionnaire scores of patients with those of healthy job-matched control subjects. Study 2 was a cross-sectional mail survey testing scale reliability and construct validity. SUBJECTS: The study subjects were employed individuals (18-64 years of age) from several chronic condition groups (study 1, n = 48; study 2, n = 121) and, in study 1, 17 healthy matched control subjects. MEASURES: Study 1 included the assigned questionnaires and weekly diaries. Study 2 included the new questionnaire, SF-36, and work productivity loss items. RESULTS: In study 1, questionnaire responses were consistent with diary data but were most highly correlated with the most recent week. Patients had significantly higher (worse) limitation scores than control subjects. In study 2, 4 scales from a 25-item questionnaire achieved Cronbach alphas of > or = 0.90 and correlated with health status and self-reported work productivity in the hypothesized manner (P < or = 0.05). CONCLUSIONS: With 25 items, 4 dimensions (limitations handling time, physical, mental-interpersonal, and output demands), and a 2-week reporting period, the Work Limitations Questionnaire demonstrated high reliability and validity.

Adult↗
PubMed2001

Career paths in diagnostic radiology: scope and effect of part-time work.

PURPOSE: To determine the extent and consequences of part-time work in radiology. MATERIALS AND METHODS: A survey was mailed to 1,500 male and 1,500 female radiologists. Questions assessed part-time work and its effect on professional and family issues. The effects of education, radiology practice characteristics, organizational support, human resource practices, and family responsibilities on career and professional satisfaction were studied. RESULTS: Ten and a half percent of the radiologists surveyed--7.4% of the men and 30.2% of the women--were working part-time. The part-time radiologists reported earning 56.3% of the income earned by full-time radiologists and working 56.9% of the hours worked by their full-time counterparts, with disproportionately fewer benefits. Part-time private practice radiologists were significantly less likely to be partners. For academic radiologists, having worked part-time at any time was significantly associated with lower academic rank. CONCLUSION: The motivation for working part-time differed significantly according to gender and age. Benefits were disproportionate, and radiologists who had worked part-time were less likely to be partners or full professors.

Adult↗
PubMed2000

A national survey of health-related work limitations among employed persons in the United States.

PURPOSE: To estimate the total prevalence of health-related work limitations among working people in the United States (US) as well as their condition-specific prevalence. METHODS: A new questionnaire measuring limitations in ability to perform specific work demands was administered to 940 employed people in a national household survey. The prevalence of specific work limitations is reported as are condition-specific risk estimates (odds ratios) based on logistic regression. RESULTS: In the US, 19.3% of working people (CI = 14.0, 24.6) were limited in their abilities to perform physical work demands; 24.1% (CI = 18.9, 29.2) were limited in performing psychosocial work demands; and 13.8% (CI = 8.3, 19.3) were limited in their abilities to function without difficulty within the ambient work environment. With successive increments in the number of conditions, the odds of having a limitation increased significantly. CONCLUSIONS: This study contributes new information concerning the implications of chronic health problems for working people and the significant risks for workers with multiple chronic conditions.

Adult↗
PubMed2000

Adolescents' understanding of social class: a comparison of white upper middle class and working class youth.

PURPOSE: Social class is increasingly being recognized as an important factor in the development of population-based variation in health among teens. However, little consensus exists regarding its measurement or conceptualization. METHODS: This study examined beliefs about social class of 48 working class and 50 upper middle class 16-year-old, white teens. RESULTS: Working class teens were more likely to misclassify themselves with regard to social class position. Significant class differences were present in beliefs regarding social mobility, parents' equity, equality of opportunity within society, and financial status as adults. How this conceptualization of social class translates into population-based variation in health remains an important area for further inquiry.

Adolescent↗
PubMed1999

The migraine work and productivity loss questionnaire: concepts and design.

Our objectives were to: (1) develop a self-report questionnaire for measuring the impact of migraine headache on work; and (2) qualitatively assess aspects of its performance. Two samples of migraine sufferers provided the data. Sample 1 (n = 18) participated in a structured discussion group designed to elicit examples of migraine's on-the-job impact. Sample 2 (n = 11) completed a mail survey and participated in in-depth phone interviews. Interviews addressed item comprehensibility, consistency of interpretation, the cognitive processes by which certain answers were generated and response burden. The participants were currently employed men and women, at least 18 years of age, who met the International Headache Society (IHS) criteria for migraine headache [1]. Discussion group participants indicated that migraine attacks substantially diminished their job performance. Pain, photophobia, phonophobia, mental impairment and fatigue were perceived as interfering with even routine or relatively simple job tasks. The Migraine Work and Productivity Loss Questionnaire, Version 1.0 (MWPLQ) was written. Next, it was assessed in the context of the in-depth interviews. Result indicated that the MWPLQ was comprehended without difficulty, interpreted consistently and easy to complete. Thus, qualitative results provide initial support for the new questionnaire.

Adult↗
PubMed1998

The Angina-related Limitations at Work Questionnaire.

This report describes initial experience with a new self-report questionnaire, the 17 item Angina-related Limitations at Work Questionnaire. Forty employed individuals with chronic stable angina pectoris completed the questionnaire which retrospectively examined the subjects' difficulty in performing specific work activities during the preceding 4 week period. The questionnaire performed well in this study and there was initial evidence of its validity and reliability. More than one-half of the respondents (52.5%) indicated at least some difficulty in performing one or more of the 17 work items due to angina during the preceding 4 weeks, with the greatest difficulty experienced in physically exerting tasks, handling stressful situations and feeling a sense of accomplishment. In contrast, only one-quarter of the sample missed any work time. In tests of convergent validity, the degree of work limitation correlated significantly with SF-36 physical and mental health component scores and with self-reports of angina symptoms. The questionnaire had internal reliability, with item to total score correlations of 0.75 or higher for 14 of the 17 items. In summary, the Angina-related Limitations at Work Questionnaire offers promise for quantifying work limitations among individuals with chronic stable angina.

Angina Pectoris↗
PubMed1998

Relationship of job strain and iso-strain to health status in a cohort of women in the United States.

OBJECTIVE: This study examined the relationships of job strain and iso-strain psychosocial work-environment exposures to health status in a cohort of working women in the United States. METHODS: In a cross-sectional survey, 33689 women responded to the Karasek job content and the MOS SF-36 health status questionnaires. The psychosocial work-environment exposures were characterized using the job strain and iso-strain frameworks. Health status was assessed with the following 6 scales: physical functioning, vitality, freedom from pain, mental health, role limitations due to physical health, and role limitations due to emotional health. RESULTS: When compared with active work, high-strain work (high job demands and low job control) was associated with lower vitality, mental health, higher pain, and increased risks of both physical and emotional role limitations. Iso-strain work (high strain and low work-related social support) increased the risks further. Job insecurity was also associated with lower health status. CONCLUSIONS: The analyses supported the hypothesis that the psychosocial work environment is an important determinant of health status among working women. The findings suggest that incorporating social conditions at work into the measurement of psychosocial work-environment exposure improves the identification of high-risk work arrangements.

Adult↗
PubMed1997

Influences of gender and social class on adolescents' perceptions of health.

OBJECTIVE: To explore how gender and social class affect perceptions of health status among 16-year-old adolescents. DESIGN: Cross-sectional survey. SETTING: University psychology laboratory. PARTICIPANS: Fifty upper-middle-class and 48 working-class adolescents stratified by gender. MAIN OUTCOME MEASURES: The general health perceptions (GHP) scale of the Medical Outcomes Survey 36-Item Short Form Health Survey (SF-36). The other self-reported health status domains and 3 measures of different aspects of psychological well-being were included as covariates in analysis of variance models. RESULTS: Upper-middle-class females reported the lowest and upper-middle-class males the highest GHP (76.7 vs 88.4, P=.003). A multivariate regression model (adjusted R2=0.08) revealed significant gender (P=.03) differences in GHP, but not a social class effect, and an interaction effect between gender and class (P=.01). With addition of psychological well-being covariates (P<.001), gender remained significant (P=.04) and a significant portion of the interaction effect (P=.13) was explained. When the self-reported physical health status scales (P<.001) were added to the model (adjusted R2=0.51), gender remained significant (P=.03) and the interaction effect was partially explained (P=.07). CONCLUSIONS: Gender is a crucial factor in understanding the complex relationships between sociostructural inequalities and health differentials. These data suggest that psychological well-being and self-reported physical health status mediate the effects of gender and the gender and social class interaction in explaining variation in GHP. Contrary to the social class gradient hypothesis, upper-middle-class females reported the lowest GHP. These results suggest that the paradigms applicable to early childhood and adulthood may not be appropriate to understand the complex dynamics of adolescence.

Adolescent↗
PubMed1996

Racial and ethnic disparities in self-assessed health status: evidence from the National Survey of Families and Households.

We examined racial and ethnic disparities in global health assessment and functional limitations of daily activities among whites, blacks and Hispanics, and within the Hispanic origin among Mexicans, Puerto Ricans, Cubans, and 'Others'. Logistic regression were employed to estimate the log odds of reporting 'poor health' and 'having functional limitations' among 12,814 respondents from the 1987-1988 National Survey of Families and Households. Compared with whites, blacks had an increased risk of reporting poor health and functional limitations. Hispanics had even a higher risk of reporting poor health, but did not have an increased risk of reporting functional limitations. Among Hispanics, Mexicans were more likely than whites to report poor health, whereas Puerto Ricans were more likely than whites to experience functional limitations. Both race and ethnicity remain important factors in explaining the disparities in self-assessed health status independent of socioeconomic status (SES). Meanwhile, the way self-assessed health status varies with ethnicity is importantly stratified by SES as measured by income and education. These results suggest that future research should analyze the interplay between ethnicity and SES rather than assuming measuring either captures all the important variation.

Activities of Daily Living↗
PubMed1996

Race and self assessed health status: the role of socioeconomic factors in the USA.

STUDY OBJECTIVE: To estimate relative odds ratios and to ascertain the relative contribution of each socioeconomic covariate in explaining racial disparities in self assessed health status (for example, global health perceptions and functional limitations of daily activities). DESIGN: National representative data from the 1987-88 national survey of families and households, a multistage, stratified probability sample of non-institutionalised American adults age 19 and older, were used. Logistic regression models enabled a multistage building strategy to be used in the analyses. PARTICIPANTS AND SETTING: The study included three racial groups: whites (n = 9419), blacks (n = 2391), and Hispanics (n = 1004). While face to face interviews were carried out with each respondent, some portions of the interview were self administered to collect sensitive information. MAIN RESULTS: Compared with whites, blacks and Hispanics were more likely to assess health as poor and report having functional limitations of daily activities. Socioeconomic factors tended to play a different role in explaining racial disparities in self assessed health status. In global health, education tended to play a significant role in accounting for health disparities between whites and Hispanics. In functional limitations, none of the covariates explained racial differences for blacks, whereas for Hispanics, education and marital status explained racial differences. CONCLUSIONS: The debate over whether race is a proxy for socioeconomic conditions or race influences health independent of socioeconomic factors depends on the measure of health and racial group included in the study. Future studies should examine separately the differential impacts of various socioeconomic factors on varying domains of health.

Activities of Daily Living↗
PubMed1991

Structural determinants of the psychosocial work environment: introducing technology in the work stress framework.

To extend current models of psychosocial work stress research into organizational structure, technology is introduced. An exploratory model is developed combining research from ergonomics, epidemiology, and organizational science. It is hypothesized that technology influences a worker's health by structuring the job, and the relationship between the job and a worker's health is mediated by attitudes at work. To test the model, data are used from a 1978 NIOSH survey of postal workers sorting mail (N = 4903). Path analysis shows technology is indirectly associated with job satisfaction and psychosomatic symptoms by how it structured the job. A machine-paced technological system of work is associated with greater job demands, less control in the job, and less co-worker support but not with supervisor support. The implications of this model for prevention strategies at the workplace are discussed suggesting that influencing supervisor support is the most effective way to affect a person's job satisfaction and level of psychosomatic symptomology.

Adult↗
PubMed1985

Factors influencing the diagnosis of mental disorder among primary care patients.

Understanding the role primary care physicians play in the recognition and management of mental disorder among their patients is a research topic that has assumed considerable importance because of the high prevalence combined with low recognition of mental morbidity in primary care settings. Patient characteristics that influence diagnostic patterns have been one important focus of this research. This paper presents data from a study in two primary care departments in a large comprehensive health care clinic in central Wisconsin. During a 3-month period, 1,452 attenders at these clinics were assessed using a brief psychiatric screening scale, and special study forms were completed by the primary care clinicians. Consistent with previous research, reason for visit, psychiatric symptoms, and prior knowledge of the patient are significant predictors of physician diagnosis of mental disorder. Additionally, pattern of physician practice, as represented by differences between the two types of clinics, was a strong predictor of both diagnosis and treatment. The lack of significant effects of sex and previous medical utilization is contrary to previous research. Key words: mental disorders; diagnosis; primary care.

Adult↗
PubMedDate not supplied

Racial/ethnic disparities in health: the interplay between discrimination and socioeconomic status.

In the past decade, racial/ethnic discrepancy in health status has drawn increased attention from academicians, policy makers and planners, service providers, and community advocates. While the field has witnessed a growth in research projects and intervention programs, the gap in health status among racial/ethnic groups persists, which suggests that future research should incorporate a focus on one neglected area, ie, the health implications of discrimination. Using the National Survey of Functional Health (N=1,659), a nationally representative sample of English-speaking persons 18 years of age and older living in non-institutional arrangements within the United States, we analyzed how self-perceived unfairness (discrimination due to racial identity or to low socioeconomic status [SES]) was linked to self-assessed health status. The study found that racial and class discrimination were rather pervasive in the United States. Experiences of discrimination tended to have a strong negative association with health and accounted for some racial/ethnic differences in health status. The study also revealed a complex relationship between experiences of discrimination and social class, suggesting that future research should focus on specifying the social distribution of discrimination and assessing its subsequent association with health.

Adult↗