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Biomedical subjects

E S Gibson

Publications and source records attributed to E S Gibson.

9 recordsLinked to original sources

Increased absenteeism from work after detection and labeling of hypertensive patients.

A study of hypertension in an industrial setting allowed us to confirm and explore an earlier retrospective finding that the labeling of patients as hypertensive resulted in increased absenteeism from work. After screening and referral, we found that absenteeism rose (mean +/- 1 S.E.) 5.2 +/- 2.3 days per year (P less than 0.025); this 80 per cent increase greatly exceeded the 9 per cent rise in absenteeism in the general employee population during this period. The main factors associated with increased absenteeism were becoming aware of the condition (P less than 0.01) and low compliance with treatment (P less than 0.001). Subsequent absenteeism among patients unaware of their hypertension before screening was not related to the degree of hypertension, whether the worker was started on therapy, the degree of blood-pressure control achieved or exposure to attempts to promote compliance. These results have major implications for hypertension screening programs, especially since absenteeism rose among those previously unaware of their condition, regardless of whether antihypertensive therapy was begun.

Absenteeism

Normative standards of plasma cholesterol and triglyceride concentrations in Canadians of working age.

Fasting plasma cholesterol and triglyceride concentrations were determined for 6407 working Canadian adults aged 20 to 69 years in Toronto and Hamilton. Means, medians and 5th and 95th percentiles were ascertained from the data for men, women taking oral contraceptives or estrogen preparations, and women not taking such medication. Mean plasma cholesterol values (mg/dL) ranged in men from 168.3 at ages 20 to 24 years to 211.5 at ages 45 to 49 years, and in women using hormone preparations from 180.3 at ages 20 to 24 years to 224.2 at ages 50 to 54 years; corresponding values in women not using these preparations were 164.9 and 220.6. Plasma triglyceride means (mg/dL) ranged in men from 108.7 at ages 20 to 24 years to 166.7 at ages 40 to 44 years, in women using hormone preparations from 115.4 at ages 20 to 24 years to 145.3 at ages 45 to 59 years, and in women not using these preparations from 77.5 at ages 20 to 24 years to 112.4 at ages 50 to 54 years.

Adult

Improvement of medication compliance in uncontrolled hypertension.

38 hypertensive Canadian steelworkers who were neither compliant with medications nor at goal diastolic blood-pressure six months after starting treatment were allocated either to a control group or to an experimental group who were taught how to measure their own blood-pressures, asked to chart their home blood-pressures and pill taking, and taught how to tailor pill taking to their daily habits and rituals; these men were also seen fortnightly by a highschool graduate with no formal health professional training who reinforced the experimental manoeuvres and rewarded improvements in compliance and blood-pressure. Six months later, average compliance had fallen by 1.5% in the control group but rose 21.3% in the experimental group. Blood-pressures fell in 17 of 20 experimental patients (to goal in 6) and in 10 of 18 control patients (to goal in 2).

Antihypertensive Agents

Randomised clinical trial of strategies for improving medication compliance in primary hypertension.

230 Canadian steelworkers with hypertension took part in a randomised trial to see if compliance with antihypertensive drug regimens could be improved. For care and follow-up these men were randomly allocated to see either their own family doctors outside working-hours or industrial physicians during work shifts; the same men were randomly allocated to receive or not receive an educational programme aimed at instructing them about hypertension and its treatment. Surprisingly, the convenience of follow-up at work had no effect upon these men's compliance with antihypertensive drug regimens. Similarly, although men receiving health education learned a lot about hypertension, they were not more likely to take their medicine.

Antihypertensive Agents

Vascular diseases in employed males: a perspective on preventive and remedial programs in industry.

Simple morbidity and mortality surveillance procedures have been applied at a large steel mill for several years. Analyses arising from these data are presented demonstrating, as a case in point, that vascular diseases are among the leading causes of absenteeism and are the leading cause of death among male employees. Furthermore, the strong association of hypertension with vascular mortality is clearly displayed. Finally, attempts to initiate treatment for hypertensive employees through referral to their family physicians met with rather disappointing success as only 22 of 200 referrals resulted in patient-physician interactions. Several suggestions and conclusions can be drawn from this work. First, simple surveillance procedures can be easily implemented in occupational settings and meaningful results derived. Industrial sites offer unique opportunities for epidemiologic studies. Second, vascular diseases have a devastating effect on working age males and it would appear that hypertension, as a controllable "risk factor", is a logical target for intervention programs. Third, while our information is rather limited, it would seem that traditional referrals of patients "at risk" to their family physicians is not an effective way to arrange for their treatment. For much the same reasons that industrial sites may be useful in epidemiologic studies, they may also provide a base for intervention programs for certain disease conditions. Before such programs are undertaken, however, research into their feasibility and effectiveness is required and we are hopeful that our own studies, now underway, will provide some insight in this area.

Absenteeism