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C Muntaner

Publications and source records attributed to C Muntaner.

At least 37 records · Page 2Linked to original sources
PubMed1999

Injuries in home health care workers: an analysis of occupational morbidity from a state compensation database.

BACKGROUND: Home health services represent one of the fastest-growing segments of the US economy. Home health care workers (HHCWs) might be expected to have a high incidence and increased severity of injury because of inherent difficulty in control over their work environment, and the limited amount of research on injuries in home health care appears to support this hypothesis. METHODS: Using data on workers' compensation claims for 1995-1996 from a large state database, we calculated the incidence, frequency, and types of injuries occurring in this working population. Comparison data were drawn from nursing home (NH) and hospital-based nursing personnel. RESULTS: An incidence of 52 injuries per 1,000 workers per year was calculated; this rate lies between nursing home workers (132/1,000) and hospital-based workers (46/1,000). The percentage of indemnified (> 3 days lost-time) injuries was increased over those occurring in nursing home personnel. Mean number of days lost from work by home health workers was 44, significantly increased from the average 18 and 14 days lost by NH and hospital nursing workers, respectively. Mean indemnity payment was $1,523 and mean medical costs were $1,276 per injury. Permanent partial disability awards were made to 19 (4.9%) of the injured HHCWs during the 2-year study period; back injuries accounted for 63% (12) of these awards. Overexertion injuries and falls accounted for 63% of total injuries in this group of workers, while 13.5% occurred as a result of motor vehicle accidents. The incidence of injury attributed to motor vehicles in HHCWs was 7 per 1,000 workers per year, an order of magnitude greater than in NH and hospital workers. CONCLUSIONS: These data indicate that injuries to HHCWs, though less frequent than in their nursing home counterparts, result in greater lost time from work and accompanying costs, which may indicate greater severity of injury. Characteristics of home health work, including increased intensity and speed of work, adverse working conditions, and the necessity of motor vehicle transportation as a condition of work may be contributors to injury in this setting. Further investigation of determinants of accidents and injuries in home health care, both in the actual setting where the work takes place and in the way it is structured, is warranted.

Accidents, Occupational↗
PubMed1999

Income inequality, social cohesion, and class relations: a critique of Wilkinson's neo-Durkheimian research program.

Wilkinson's "income inequality and social cohesion" model has emerged as a leading research program in social epidemiology. Public health scholars and activists working toward the elimination of social inequalities in health can find several appealing features in Wilkinson's research. In particular, it provides a sociological alternative to former models that emphasize poverty, health behaviors, or the cultural aspects of social relations as determinants of population health. Wilkinson's model calls for social explanations, avoids the subjectivist legacy of U.S. functionalist sociology that is evident in "status" approaches to understanding social inequalities in health, and calls for broad policies of income redistribution. Nevertheless, Wilkinson's research program has characteristics that limit its explanatory power and its ability to inform social policies directed toward reducing social inequalities in health. The model ignores class relations, an approach that might help explain how income inequalities are generated and account for both relative and absolute deprivation. Furthermore, Wilkinson's model implies that social cohesion rather than political change is the major determinant of population health. Historical evidence suggests that class formation could determine both reductions in social inequalities and increases in social cohesion. Drawing on recent examples, the authors argue that an emphasis on social cohesion can be used to render communities responsible for their mortality and morbidity rates: a community-level version of "blaming the victim." Such use of social cohesion is related to current policy initiatives in the United States and Britain under the New Democrat and New Labor governments.

Community Health Planning↗
PubMed1999

The social class determinants of income inequality and social cohesion.

The authors argue that Wilkinson's model omits important variables (social class) that make it vulnerable to biases due to model mis-specification. Furthermore, the culture of inequality hypothesis unnecessarily "psychopathologizes" the relatively deprived while omitting social determinants of disease related to production (environmental and occupational hazards) and the capacity of the relatively deprived for collective action. In addition, the hypothesis that being "disrespected" is a fundamental determinant of violence has already been refuted. Shying away from social mechanisms such as exploitation, workplace domination, or classist ideology might avoid conflict but reduce the income inequality model to a set of useful, but simple and wanting associations. Using a nonrecursive structural equation model that tests for reciprocal effects, the authors show that working-class position is negatively associated with social cohesion but positively associated with union membership. Thus, current indicators of social cohesion use middle-class standards for collective action that working-class communities are unlikely to meet. An erroneous characterization of working-class communities as noncohesive could be used to justify paternalistic or punitive social policies. These criticisms should not detract from an acknowledgment of Wilkinson's investigations as a leading empirical contribution to reviving social epidemiology at the end of the century.

Authoritarianism↗
PubMed1999

Teaching social inequalities in health: barriers and opportunities.

This article examines some of the main threats and new opportunities encountered by teachers of social inequalities in health in contemporary academia. Focusing mostly on the recent US and European experiences, I suggest that lay world views legitimating social inequalities are often in conflict with explanations arising from social epidemiology and medical sociology. The dominance of medicine in public health, through its often implicit assumptions about the biological determinants of human behaviour, is also identified as a barrier to teaching social inequalities in health. Educational elitism, which restricts higher education to members of the upper middle class, is identified as another barrier to teaching social inequalities in health. On the other hand, teachers in this field can benefit from a recent growth of empirical studies during the last decade aimed at understanding the social determinants of health inequalities. Finally, I suggest that familiarity with current critical scholarship within public health, as well as the use of techniques developed by sociologists to teach social stratification, can be valuable resources for teaching social inequalities in health.

Attitude to Health↗
PubMed1998

Arrest among psychotic inpatients: assessing the relationship to diagnosis, gender, number of admissions, and social class.

The present study of psychotic patients investigates the relationship of specific psychotic diagnoses (i.e., psychoactive-substance-induced psychosis, schizophrenia, bipolar disorder, other DSM-III Axis I psychotic disorders), social class, gender, and number of admissions to the rate of arrest in the community. All admissions with psychotic symptoms to hospitals providing inpatient psychiatric services in the Baltimore area were surveyed during a 6-year period. Study participants were assessed using a modified version of the Diagnostic Interview Schedule. During the course of the interview, patients were asked whether they had ever been arrested as a juvenile or as an adult. After adjusting for age, gender, number of admissions, and social class, we found that patients admitted for psychoactive-substance-induced psychosis were more likely to report having been arrested than patients with other psychotic diagnoses. Patients with schizophrenia were not more likely to have an history of arrest than patients with other psychotic disorders. Number of admissions and social class were independent predictors of history of arrest. The relationship between psychotic diagnosis and history of arrest was modified by gender. Psychotic patients with substance-induced diagnosis who were male were more likely to report a prior arrest in the community than their female counterparts. Our results suggest that type of psychotic diagnosis and social class, in addition to gender and number of admissions, are important predictors of differences in arrest-rate histories among psychotic patients. Gender appears to be an effect modifier of the relationship between psychotic diagnosis and history of arrest.

Adolescent↗
PubMed1998

Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders.

This study provides an update on the association between social class and common types of psychiatric disorder in the US. In addition to usual measures of social class, we provide hypotheses for the expectation that assets and organizational control are associated with specific varieties of psychiatric disorders (mood, anxiety, alcohol and drug use disorders). We analyzed two surveys. The National Comorbidity Survey conducted in 1990-1992 yielded 12-month prevalence rates in a probability sample of 8098 respondents in the 48 contiguous states. The Epidemiologic Catchment Area Follow-up conducted in 1993-1996 provided similar rates among 1920 East Baltimore residents. Analyses of the National Comorbidity Survey showed an inverse association between financial and physical assets and mood, anxiety, alcohol, and drug disorders. The Epidemiologic Catchment Area Followup provided additional evidence for the inverse association between financial and physical assets and anxiety, alcohol and drug disorders. Also in the Epidemiologic Catchment Area, lower level supervisors presented higher rates of depression and anxiety disorders than higher level managers. Inequalities in assets and organizational control, as well as typical measures of social class, are associated with specific psychiatric disorders. These constructs can provide additional explanations for why social inequalities in psychiatric disorders occur.

Adolescent↗
PubMed1998

Work organization and atherosclerosis: findings from the ARIC study. Atherosclerosis Risk in Communities.

INTRODUCTION: The aim of this investigation was to examine the extent to which work organization (i.e., occupational stress) is associated with subclinical carotid atherosclerosis. METHODS: For that purpose we used a cross-sectional study of four U.S. community samples conducted between 1987 and 1989. Participants in the study were 10,801 adults aged 45 to 64 years. Subclinical carotid atherosclerosis was assessed by measuring the intima-media thickness (IMT) of the carotid artery wall using B-mode ultrasound. Occupational stress was defined using six indicators: substantive complexity of work, physical demands, job insecurity, skill discretion, decision authority, and physical exertion. Information from U.S. national surveys on occupational stress indicators was linked to the study participants' occupation. RESULTS: We observed negative associations of complexity of work and skill discretion with mean IMT of the carotid artery wall among the four race-gender groups. In addition, physical demands was positively associated with mean IMT among blacks and job insecurity was positively associated with IMT among white women and black men. After adjustment for well-established risk factors, the magnitude of these associations was substantially reduced. CONCLUSIONS: Taken in combination with results from recent European studies, our findings suggest that work organization plays a role in the etiology of atherosclerosis.

Adult↗
PubMed1997

Neighborhood environments and coronary heart disease: a multilevel analysis.

The authors investigated whether neighborhood socioeconomic characteristics are associated with coronary heart disease prevalence and risk factors, whether these associations persist after adjustment for individual-level social class indicators, and whether the effects of individual-level indicators vary across neighborhoods. The study sample consisted of 12,601 persons in four US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, Minnesota; and Jackson, Mississippi) participating in the baseline examination of the Atherosclerosis Risk in Communities Study (1987-1989). Neighborhood characteristics were obtained from 1990 US Census block-group measures. Multilevel models were used to estimate associations with neighborhood variables after adjustment for individual-level indicators of social class. Living in deprived neighborhoods was associated with increased prevalence of coronary heart disease and increased levels of risk factors, with associations generally persisting after adjustment for individual-level variables. Inconsistent associations were documented for serum cholesterol and disease prevalence in African-American men. For Jackson African-American men living in poor neighborhoods, coronary heart disease prevalence decreased as neighborhood characteristics worsened. Additionally, in African-American men from Jackson, low social class was associated with increased serum cholesterol in "richer" neighborhoods but decreased serum cholesterol in "poorer" neighborhoods. Neighborhood environments may be one of the pathways through which social structure shapes coronary heart disease risk.

Black or African American↗
PubMed1997

Does organization matter? A multilevel analysis of the demand-control model applied to human services.

The demand-control model (DC model) in occupational epidemiology suggests that health, an individual attribute, is partly determined by work organization, via the interplay of demand and control, job strain. The objective of this study was empirical assessment of the model's tenet of an organizational determination of individual health. An emerging analytic method, multi-level modelling, permits such an assessment. The study encompasses two large Swedish human service organizations. It was based on a nationally representative sample of 291 local organizational units (level 2) with 8296 employees (level 1), a median of 18 employees per unit. 5730 persons (69.1%) completed the questionnaire. Listwise deletion of missing data left a net study base of 4756 individuals in 284 units. Missing data were largely random. Demand and control were measured by standard questions and combined into a job strain index. Two such indices were calculated, one for quantitative demands and one for emotional demands. Individual attributes included age, gender, marital status, having children, social anchorage, and education. There were two dependent variables, self-assessed psychovegetative symptoms (worry, anxiousness, sadness, sleep difficulties, restlessness, and tension) and exhaustion (fatigue, feelings of being used up and overworked), both measured as summative indices. For psychovegetative health, a null model yielded 2.2% level 2 variance, unchanging when individual attributes were included in a random intercepts model. Inclusion of the strain variables rendered level 2 variance non-significant, decreasing level 1 variance by 23% and level 2 variance by 62%. For exhaustion, level 2 variation was 8.3% in the null model and 1.6% in the final model, with strain variables. The strain variables utilized in the DC-model thus draw a substantial part of their variation from the organizational level. It is concluded that the claim of the DC model to rely on organizational factors receives support.

Adult↗
PubMed1996

Psychosocial work environment in human service organizations: a conceptual analysis and development of the demand-control model.

This paper concerns two models that were introduced in two different research domains during the 1970's. The first model regards human service organizations (HSO) as a specific type of organization. The second model, the demand-control model (DC model), concerns the joint effects of job demands and job control on worker health. In the HSO model, there are analyses of the content of jobs, considering the specific characteristics of HSOs, but little is said about the health effects of such work. Those effects stand in focus in the demand-control model. The aim of this paper is to analyze the relevance of the DC model for human service organizations. The paper argues that the object of human service work-the client relation-makes a difference for demand and control in the job. Demand is analyzed into work load, emotional demands and role conflict. Control is divided into administrative control, outcome control, choice of skills, closeness of supervision, control within and over a situation and ideological control. The conclusion is that in applications on HSOs, the basic concepts of the DC model must be developed.

Adult↗
PubMed1996

Income, social stratification, class, and private health insurance: a study of the Baltimore metropolitan area.

Most studies of inequalities and access to health care have used income as the sole indicator of social stratification. Despite the significance of social theory in health insurance research, there are no empirical studies comparing the ability of different models of social stratification to predict health insurance coverage. The aim of this study is to provide a comparative analysis using a variety of theory-driven indicators of social stratification and assess the relative strength of the association between these indicators and private health insurance. Data were collected in a 1993 telephone interview of a random digit dialing sample of the white population in the Baltimore Metropolitan Statistical Area. Indicators of social stratification included employment status, full-time work, education, occupation, industry, household income, firm size, and three types of assets: ownership, organizational, and skill/credential. The association between social stratification and private health insurance was strongest for those having higher household incomes, having attained at least a bachelor's degree, and working in a firm with more than 50 employees, followed by being an owner or manager, and by being employed. The addition of education and firm size improved the prediction of the household income model. The authors conclude that studies of inequalities in health insurance coverage can benefit from the inclusion of theory-driven indicators of social stratification such as human capital, labor market segmentation, and control over productive assets.

Adult↗
PubMed1996

Social class and behavior: simultaneous class positions yield different amounts of income.

We used data from the Panel Study of Income Dynamics to present preliminary findings on the social class behavior of the poor and general populations in the USA. Analysis supported the potion that individuals are engaged simultaneously in multiple class positions, e.g. self-employed and welfare recipient, that yield different amounts of income. Moreover, no single label or explanation, e.g., "underclass" of "the poor are marginal to the economy," seems appropriate to describe the complexity or the economic behavior of poor individuals.

Hierarchy, Social↗
PubMed1995

Psychosocial dimensions of work and the risk of drug dependence among adults.

The authors used prospectively gathered data to study whether different psychosocial work environments might signal increased risk of drug dependence syndromes. Adult participants were selected by probability sampling from households in five metropolitan areas of the United States. Subjects were sorted into risk sets defined by age and census tracts. Incident cases were identified using case definitions for drug abuse/dependence syndromes involving controlled substances, assessed by the Diagnostic Interview Schedule (DIS) administered during a baseline interview and at follow-up one year later. When the data were adjusted for baseline sociodemographic risk factors, history of alcoholism, and selected work conditions, increased risk of drug abuse/dependence was observed in subjects characterized by high levels of physical demands and low levels of skill discretion (high strain jobs) (relative odds (RO) = 4.92) and in subjects characterized by high levels of physical demands and decision authority (RO = 5.26). Findings from the present study underscore the importance of previously observed associations linking psychosocial work environments to mental health, and the results extend the range of findings to the drug dependence syndromes.

Adult↗