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Economic costs of influenza-related work absenteeism.

BACKGROUND: Influenza vaccinations are currently advocated only for individuals over age 50. However, vaccination of all working-age people may be warranted based on reduced absenteeism from work. OBJECTIVE: This study aims to quantify the association between lost workdays and influenza, controlling for other factors. A secondary aim of the study is to assess the net benefit of expanded vaccination in a workplace setting. RESEARCH DESIGN: Multivariate regression analyses of the 1996 Medical Expenditure Panel Survey Household Component are used to estimate the number of workdays missed because of influenza-like illness (ILI) when controlling for other health, demographic, and employment factors. Mean productivity costs are measured in terms of absences from work and valued in dollar terms. The net benefit of influenza vaccination is estimated using a simple decision analysis. SUBJECTS AND MEASURES: Health, demographic, and employment data for employed individuals between the ages of 22 and 64 years are analyzed. RESULTS: The average number of workdays missed due to ILI was 1.30 days, and the average work loss was valued at 137 US dollars per person. The vaccine strategy was not preferred in the baseline analysis; however, this result was sensitive to assumptions regarding the incidence of influenza, the cost of delivering the vaccine, and the productivity impact of worker absenteeism. Moreover, nonproductivity benefits of vaccination were omitted. CONCLUSIONS: The economic attractiveness of expanded investment in influenza vaccination hinges on employer- and population-specific assumptions. Our analysis provides a simple framework within which competing considerations of disease epidemiology, worker productivity, and economic cost may be weighed.

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Incidence of work-related disorders and absenteeism as tools in the implementation of work environment improvements: the Sweden Post strategy.

In 1989, a comprehensive, five-year work environment project (Postal Work Environment [PWE] 2000) was launched by Sweden Post (SP). Its purpose was to identify the jobs and employees with the most exposed work environments and, in conjunction herewith, to initiate remedial programmes. Standardized interviews with a selection of employees and statistical and epidemiological evaluation of illness absenteeism and occupational injuries served as input data for devising different measures of work-related ill health (subjective complaints, symptoms, illness, illness absenteeism, and occupational injury). The results provided an incentive to regional action programmes, in which 'risk areas and risk occupations' were correlated with the load factors, primarily in ergonomic and work organization areas, cited in interview replies. In its regional efforts. PWE 2000 served as a stimulus/catalyst in the implementation of various regional action programmes.

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Consequences of person-environment incongruence: absenteeism, frustration, and stress.

Two correlational studies using English nurses and working adults are reported that examined the relationship between the three measures of person-environment (P-E) fit as derived from Holland's (1973) theory and three dependent work-related variables. In the first study, the P-E fit measures of congruence, consistency, and differentiation were correlated with two measures of absenteeism, frustration, and various demographic variables. Contrary to predictions, two measures of absenteeism were positively correlated with congruence and consistency. In accordance with the hypothesis, however, frustration was highly negatively correlated with congruence and consistency. In the second study, consistency, but not congruence or differentiation, was significantly negatively correlated with stress, as predicted. These studies provide some support for Holland's theses, although not all hypotheses were supported, both for methodological and theoretical reasons. It is argued that P-E fit measures are useful predictors of occupational behavior in conjunction with other major determinants.

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Studies of inactivated influenza virus vaccines in hospital employees: reactogenicity and absenteeism.

The impact of a mass influenza vaccination program on the operation of a major medical center was evaluated in adult volunteer employees who were given either ether-split or whole-virus bivalent influenza vaccine in a double-blind manner by jet-injector gun. Each volunteer completed a reaction information form, nurses monitored temperatures, and data on absenteeism of the employees of the Nursing Service and the Building Management Service were collected. The results of this study demonstrated that the mass campaign did not adversely affect absenteeism. However, the whole-virus vaccine caused significantly more local, systemic, and febrile reactions thant the split-virus vaccine. Purified inactivated influenza virus vaccines can be given in a mass campaign to hospital personnel without adversely affecting the operation of the hospital.

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Leisure time physical activity and sickness absenteeism; a prospective study.

AIM: To establish whether workers with frequent leisure time physical activities are at higher or lower risk of sickness absence compared to inactive workers. METHOD: Self reported and company recorded sickness absence data were collected during 18 months of follow-up for 8902 workers. Frequency of leisure time physical activities was queried at baseline. RESULTS: Overall, we found that workers active in their leisure time twice or more each week reported significantly less sickness absence compared to inactive workers (14.8 versus 19.5 days/year), mainly due to a decrease in sick leave because of musculoskeletal disorders. CONCLUSION: Demotivating sports participation by making workers liable for workdays lost due to sporting injuries might be counter-productive in decreasing absenteeism and its related costs. Promoting worker participation in sport might lead to reduced absenteeism.

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Air pollution and school absenteeism among children in Mexico City.

To determine the acute effects of ozone exposure, the authors conducted a short follow-up study of respiratory illness in a population of 111 preschool children frequently exposed to ozone levels that regularly exceed 0.120 parts per million (ppm). The children attended a private kindergarten in the southwestern part of Mexico City. Parents completed a questionnaire on demographic data, medical history, and potential sources of indoor air pollution. To determine the relation of ozone and respiratory-related school absenteeism, the authors used a logistic regression model for longitudinal data. During the 3-month follow-up, 50% of the children had at least one respiratory-related absenteeism period, and 11.7% had two or more. Children exposed for 2 consecutive days to high ozone levels (> or = 0.13 ppm) had a 20% increment in the risk of respiratory illness. For children exposed for 2 consecutive days to a high ozone level and the previous day to low temperature (< or = 5.1 degrees C), the risk reached 40% (odds ratio = 1.44, 95% confidence interval 1.37-1.52). This study suggests that ozone exposure might be positively associated with the risk of respiratory illness in children and that it may have an interactive effect with low temperature exposure.

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Depression-induced absenteeism in relation to antihyperlipidemic treatment: a study using GAZEL cohort data.

We examined the relation between overall 1-year exposure to diet and drugs prescribed for hyperlipidemia and the occurrence of medically certified absence from work with depression during the year of exposure (N = 289). The 17,244 persons studied are middle-aged employees of a national company who volunteered as cohort participants. Depression was more prevalent among those exposed to an antihyperlipidemic diet (N = 1,614) than among those unexposed. After stratification by sex and professional status, we found a prevalence ratio (PR) of 1.83 [95% confidence interval (CI) = 1.30-2.58]. Exposure to simvastatin (N = 376) produced comparable results, with a prevalence ratio of 2.18 (95% CI = 1.18-4.03). For subjects who were not cases in the year of exposure assessment, the hypolipidemic treatments are not associated with depression-induced absenteeism the following year. Our results point to a possible role of prescribed diet and simvastatin in depression-related absenteeism.

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Gambling away absenteeism.

Current conditions in health care make the battle against absenteeism critical. Of all the various methods devised, one seems to be consistently effective: positive reinforcement through a simple lottery incentive system. The authors describe this system's impact on reducing absenteeism.

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Sickness absenteeism in members of health maintenance organizations and open-market health insurance plans.

"Process" evaluations of health maintenance organizations (HMOs), as compared with conventional medical practice, have been numerous; relatively few such evaluations, however, have been based on "outcome" measurements. Considering sickness absenteeism from work as an outcome measurements, this study examines the 1979 experience of 6,600 employees of the California Department of Transportation. About 58 per cent of these were enrolled in HMOs (predominantly the Kaiser-Permanente Health Plan) and 42 per cent in open-market health insurance (OHI). Analysis by age, sex, occupational category, and geographic location show no significant differences in sickness absenteeism between the two populations. A earlier study of Californians showed that persons joining HMOs have generally higher sickness risk than those enrolling in OHI programs. These combined findings suggest that HMO programs maintain the health of their enrollees as well or perhaps better than conventional medical practice.

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The role of physical exercise and inactivity in pain recurrence and absenteeism from work after active outpatient rehabilitation for recurrent or chronic low back pain: a follow-up study.

STUDY DESIGN: An observational follow-up. OBJECTIVES: To analyze the role of physical exercise and inactivity on the long-term outcome after active outpatient low back rehabilitation. SUMMARY OF BACKGROUND DATA: There is considerable evidence documenting the efficacy of exercise in the conservative treatment of chronic low back pain, but the role of exercises after the guided treatment period on the long-term success and maintenance of the results is not known. METHODS: One hundred twenty-five patients with low back pain, who had participated in a 12-week active low back rehabilitation program, were asked about subjective pain and disability on the average of 14 months after the treatment. The outcomes were defined as a recurrence of persistent pain and work absenteeism, and a survival or failure analysis was performed between those who had continued exercising and who had been physically inactive. RESULTS: Recurrences of persistent pain during the follow-up period were fewer (P = 0.03) among those who had maintained regular exercise habits after the treatment than among those who had been physically inactive. Similarly, work absenteeism was less (P < 0.01) among physically active than among physically inactive persons. However, patients with good outcome in pain reduction after low back pain rehabilitation were more likely to participate in physical exercise. CONCLUSIONS: Exercises are beneficial after guided treatment in the maintenance of the results of active treatment for recurrent chronic low back pain in the long term, but those with less favorable outcome in rehabilitation are less likely to participate in exercises afterward. In active treatment programs, it is recommended that exercises be incorporated after the guided treatment.

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The effects of behavioral risks on absenteeism and health-care costs in the workplace.

The impact of behavioral risk factors on absenteeism and health-care costs was analyzed among 45,976 employees in a large, diversified industrial work force. A cross-sectional design was used to evaluate health risk appraisal and physical-examination data collected from 1984 through 1988. Employees with any of six behavioral risks had significantly higher absenteeism (range = 10% to 32%) compared with those without risks. These differences led to significantly higher illness costs (defined as compensation, health care, and non-health care benefits) for those with risks compared with those without risks. Annual excess illness costs per person at risk were smoking, $960; overweight, $401; excess alcohol, $389; elevated cholesterol, $370; high blood pressure, $343; inadequate seatbelt use, $272; and lack of exercise, $130. Only one factor, lack of exercise, was not significant after adjusting for age, education, pay category, and the six other behavioral risks. The total cost to the company of excess illness was conservatively estimated at $70.8 million annually. These findings suggest that the cost of key behavioral risks provides an opportunity to manage health-care cost increases through health promotion, financial incentives for healthy lifestyle, and environmental changes that affect health behaviors.

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Impact of regular relaxation training and psychosocial working factors on neck-shoulder tension and absenteeism in hospital cleaners.

Occupational stress in hospital cleaners (n = 50), and the effect of relaxation training (n = 25, age matched, randomized), were studied by recording the electrical activity of the upper trapezius muscle at rest and during working conditions at the beginning, middle, and end of a 6-month follow-up period. A short (15-minute) relaxation program was practiced daily at the workplace to provide stress management. The amount of sick leave was counted, and the extent of depression and some psychosocial working factors were screened. Intercorrelations were found between the neck-shoulder tension, psychosocial factors, depression, and the absentee rate. The relaxation training diminished tension in the neck-shoulder region efficiently; nevertheless, the decrease in absenteeism might have been related mainly to the social support offered by the research maneuver itself.

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Effects of work-site health promotion on illness-related absenteeism.

This study examined the effects of work-site health promotion on employee absenteeism. Thirty-two work sites were randomized to programs for weight control and smoking cessation or to no treatment for 2 years. The prevalence of self-reported absences from work was assessed at baseline and follow-up. Results using work site as the unit of analysis showed a net reduction in the percent of workers reporting a sick day in the last month in treatment versus control work sites of 3.7% (P = .04) and 3.4% (P = .06) in cross-sectional and cohort analysis, respectively. Further analyses found that the rate of participation in smoking (P = .09) but not weight programs (P = .72) was positively associated with change in sick day prevalence and that this effect was strongest in baseline smokers (P = .002). It is concluded that work-site smoking cessation programs may yield important short-term economic benefits by reducing employee absenteeism.

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Early workplace intervention for employees with musculoskeletal-related absenteeism: a prospective controlled intervention study.

Sickness absenteeism caused by musculoskeletal disorders (MSDs) is a persistent and costly occupational health challenge. In a prospective controlled trial, we compared the effects on sickness absenteeism of a more proactive role for insurance case managers as well as workplace ergonomic interventions with that of traditional case management. Patients with physician-diagnosed MSDs were randomized either to the intervention group or the reference group offered the traditional case management routines. Participants filled out a comprehensive questionnaire at the initiation of the study and after 6 months. In addition, administrative data were collected at 0.6, and 12 months after the initiation of the project. For the entire 12-month period, the total mean number of sick days for the intervention group was 144.9 (SEM 11.8) days/person as compared to 197.9 (14.0) days in the reference group (P < 0.01). Compared with the reference group, employees in the intervention group significantly more often received a complete rehabilitation investigation (84% versus 27%). The time for doing this was reduced by half (59.4 (5.2) days versus 126.8 (19.2), P < .01). The odds ratio for returning to work in the intervention group was 2.5 (95% confidence interval 1.2-5.1) as compared with the reference group. The direct cost savings were USD 1195 per case, yielding a direct benefit-to-cost ratio of 6.8. It is suggested that the management of MSDs should to a greater degree focus on early return to work and building on functional capacity and employee ability. Allowing the case managers a more active role as well as involving an ergonomist in workplace adaptation meetings might also be beneficial.

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Adolescents with chronic illnesses: school absenteeism, perceived peer aggression, and loneliness.

Frequent school absence is often cited as a risk factor for peer relationship problems in youngsters with chronic illnesses, but this assumption has not been subjected to quantitative empirical examination. This issue was examined in the present study by exploring the relationship between school absenteeism, peer aggression, and loneliness in adolescents with chronic illnesses. Forty-one adolescents with chronic illnesses completed a modified version of the Direct and Indirect Aggression Scale and the Asher Loneliness Scale. Details of school absences and hospitalizations were obtained from parents and school and hospital records. No evidence was found to support the notion that peer aggression and loneliness are related to absenteeism, but social aggression (for both boys and girls) and verbal aggression (more markedly for girls) were associated with loneliness. Of the group, 19% reported experiencing verbal aggression and 12% social aggression at least weekly; informal qualitative data suggesting that such aggression is often related to limited sporting ability and appearance. Interventions at both the individual and school community level are warranted.

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Improving subjective health and reducing absenteeism in a natural work life-intervention.

A natural one-year work-life intervention to improve occupational health and reduce absenteeism was designed as a field experiment. The intervention allowed the employees in the health care sector of a municipality to take up to five days of self-administered sick leave with full financial compensation up to four times a year. 165 employees in the intervention group and 100 employees in the control group filled out a questionnaire before and after the intervention. The result showed no evidence of misuse of this sick-leave option and some positive subjective health effects were found among those who used the option. Slight improvements were found in musculoskeletal problems and for cold/influenza. There were no effects on overall absenteeism. The question of the impact of local cultures on interventions to improve occupational health is also discussed.

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Absenteeism and sickness absence.

The majority of time lost from work as a result of absenteeism is classified as due to sickness although only a small proportion of the total can be regarded as a result of unfitness for work for medical reasons. An occupational health service assists a business in minimizing absenteeism by promoting an early return to work, assists general practitioners and hospital specialists in tailoring return to work packages, and assists employees by liaising with both management and their medical specialists to facilitate a return to normal work.

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Handwashing education can decrease illness absenteeism.

A handwashing program for elementary school students was developed and implemented by the school nurse in a suburban elementary school. The program consisted of surveying teachers, inspecting handwashing facilities, and providing classroom presentations and follow-up activities. Absenteeism records indicated a significant decrease in absenteeism for illness during the two months following the presentations.

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