Biomedical subjects
Publications and source records attributed to D C Walsh.
Appendicitis is now commonly diagnosed and treated using laparoscopic techniques. Laparoscopic appendicectomy has the potential to result in incomplete removal of the appendix stump and subsequent risk of stump appendicitis. This article reports such a case, requiring laparotomy 5 months after the original appendectomy.
The development of healthy schools to support and nature the well-being of students, teachers, and staff is proposed as a first step toward the goal of comprehensive health education. A focus on healthy schools incorporates elements of an expanded concept of comprehensive health education that demands careful consideration of the physical, psychological, and social environment of the nation's schools--worksite to 51 million (students, teachers, and staff). The active participation of all stakeholders in environmental assessments, health and safety audits, and restructuring of schools is an essential part of the school reform movement. A healthy worksite concept supports the transformation of the school environment to increase "productivity" by enhancing the ability of teachers, staff, and students to function well.
Following the introduction and widespread acceptance of laparoscopic cholecystectomy, laparoscopic techniques have been applied to an increasing variety of general surgical procedures. Recently, laparoscopic procedures for resection of malignancy have begun to emerge, in particular laparoscopic assisted colectomy for carcinoma of the colon. In the cases reported here, metastatic tumour in the laparoscopy port sites is described as a potentially serious complication of laparoscopic procedures for resection of malignancy.
Marketing techniques and tools, imported from the private sector, are increasingly being advocated for their potential value in crafting and disseminating effective social change strategies. This paper describes the field of social marketing as it is used to improve the health of the public. A disciplined process of strategic planning can yield promising new insights into consumer behavior and product design. But the "technology" cannot simply be transferred without some translation to reconcile differences between commercial marketing and public health.
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OBJECTIVE: To study whether alcoholic workers had seen physicians during the year they were identified by their company, whether they recalled physicians' warnings about drinking, and whether such warnings affected outcomes 2 years later. DESIGN: Workers were interviewed at intake and 2 years later: subgroups who did and did not see physicians and who did and did not recall warnings were compared. SETTING: A company-union employee assistance program. PARTICIPANTS: Two hundred problem drinkers, newly identified on the job, predominantly male, blue-collar workers. OUTCOMES: Drinking, drunkenness, average daily alcohol consumption, and impairment score. RESULTS: Among the 200 participants, 74% saw physicians in the index year; only 22% recalled warnings. Recall of a warning was associated with liver disease, continued drinking while ill, supervisors' job warnings, older age, and marijuana use. Two years later, those warned were more likely to be abstaining, and sober, and were less impaired. CONCLUSIONS: Recalling a physician's warning at intake into alcoholism treatment was associated with better prognosis 2 years later. However, among this group of employees whose drinking was serious enough to be identified on the job, fewer than a quarter recalled physicians' warnings, even though more than three quarters had seen physicians in the year preceding intake.
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A corporate health ethic, forged in U.S. industry in the 20th century, clearly demarcated boundaries between private and workplace health concerns. This article advances evidence that the boundary is blurring, and argues that trends in workplace initiatives, including employee assistance, wellness programs, and drug screening, are giving shape to a new corporate health ethic. The new ethic emphasizes workers' lifestyles on and off the job, engendering a shift in corporate jurisdiction over employee health and behavior. Economic arguments such as "health care cost containment" are commonly offered as explanations for these new health initiatives. But the authors see the new ethic as a deeper response to a changing corporate environment and, more fundamentally, as emblematic of changes in the social control of work and productivity. They argue that the new health ethic may be a harbinger of new forms of social control in the workplace.
BACKGROUND: Employee-assistance programs sponsored by companies or labor unions identify workers who abuse alcohol and refer them for care, often to inpatient rehabilitation programs. Yet the effectiveness of inpatient treatment, as compared with a variety of less intensive alternatives, has repeatedly been called into question. In this study, anchored in the work site, we compared the effectiveness of mandatory in-hospital treatment with that of required attendance at the meetings of a self-help group and a choice of treatment options. METHODS: We randomly assigned a series of 227 workers newly identified as abusing alcohol to one of three rehabilitation regimens: compulsory inpatient treatment, compulsory attendance at Alcoholics Anonymous (AA) meetings, and a choice of options. Inpatient backup was provided if needed. The groups were compared in terms of 12 job-performance variables and 12 measures of drinking and drug use during a two-year follow-up period. RESULTS: All three groups improved, and no significant differences were found among the groups in job-related outcome variables. On seven measures of drinking and drug use, however, we found significant differences at several follow-up assessments. The hospital group fared best and that assigned to AA the least well; those allowed to choose a program had intermediate outcomes. Additional inpatient treatment was required significantly more often (P less than 0.0001) by the AA group (63 percent) and the choice group (38 percent) than by subjects assigned to initial treatment in the hospital (23 percent). The differences among the groups were especially pronounced for workers who had used cocaine within six months before study entry. The estimated costs of inpatient treatment for the AA and choice groups averaged only 10 percent less than the costs for the hospital group because of their higher rates of additional treatment. CONCLUSIONS: Even for employed problem drinkers who are not abusing drugs and who have no serious medical problems, an initial referral to AA alone or a choice of programs, although less costly than inpatient care, involves more risk than compulsory inpatient treatment and should be accompanied by close monitoring for signs of incipient relapse.
Increases in cocaine use have created a new and challenging cohort of problem drinkers with dual or multiple addictions. As part of a randomized trial comparing alternative alcoholism treatments at a 10,000-employee industrial plant, we interviewed 224 new alcoholic clients of an employee assistance program (EAP); 40% used cocaine during the 6 months just prior to EAP intake. Compared to employees reporting no recent cocaine use, the cocaine users were younger, less often married and reported heavier drinking and more alcohol-related problems, on the job and off. Even after controlling for demographic and occupational factors, and drinking indicators, cocaine users reported more binges (being drunk 24 hours or more), more blackouts (marginally significant, p = .06), more absenteeism and more warnings about unacceptable job performance. Alcoholic EAP clients who use cocaine appear to engage in riskier drinking and to have more trouble on the job than do those who report no cocaine use, and this seems to be a difference specifically attributable to their use of cocaine.
The "second public health revolution" targets factors in the environment, together with lifestyle, to prevent illness and untimely death. Yet the growth of the "wellness movement" has driven a wedge between public health advocates who argue for environmental solutions and those whose major focus is individual behavior. This tension is nowhere more evident than in the workplace, where the new wellness professionals are at odds with specialists in occupational health and industrial hygiene. This paper reports findings from a cross-sectional survey of a sizeable sample of workers at six New England facilities of a very large American manufacturing firm, assessing their perceptions of risk in the two domains: environmental exposures and lifestyle risks. Multiple regression analyses reveal that both job risks and life risks are associated with a variety of potentially costly and disruptive health problems, even after controlling for demographic and occupational factors. This analysis suggests that wellness programs in the workplace will be more effective if they integrate environmental protection with efforts to reduce lifestyle risk.
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This paper briefly reviews the evolution of worksite smoking policies and programs, beginning with the goals and objectives from which they have sprung. Workplace smoking deterrents are shown to involve three different types of strategies: 1) legalistic approaches use policies and rules to restrict or foreclose smoking on the job; 2) economic strategies create incentives and disincentives, often through the employee health benefit plan; and 3) educational programs seek to motivate smokers to quit and to supply them with information and skill that may facilitate that process. The three types of intervention are combined in a broad public health approach that some companies are now developing. Research is needed on the efficacy of a range of possible approaches and attention should be paid to the ethical and policy issues of tensions and contradictions between health goals and cost containment.
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