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PubMed2006

The contribution of musculoskeletal disorders and physical workload to socioeconomic inequalities in health.

OBJECTIVES: The objective of the study was to examine whether the association of physical workload with musculoskeletal disorders might explain occupational social class inequalities in self-rated health. METHODS: Participants of the study were 40-60 years old employees of the City of Helsinki. The data (n = 3740) were derived from several sources, including mail survey designed by the researchers and health check-ups carried out by occupational health care. Prevalence data and logistic regression were used in the analyses. RESULTS: An occupational class gradient was found for musculoskeletal disorders. The gradient in musculoskeletal disorders was largely explained by physical demands at work in both genders. The contribution of physical demands to occupational class gradient in self-rated health was considerable in women, but smaller in men. The contribution of musculoskeletal disorder to the occupational class gradient in self-rated health was weak for both genders. CONCLUSION: Physical workload is likely to considerably contribute to inequalities in health. Mediation of this effect through musculoskeletal disorder to generic health, however, could not be demonstrated. Different mechanisms are likely to cause inequalities in different health outcomes.

Adult↗

PubMed1999

Do postal questionnaires change GPs' workload and referral patterns?

OBJECTIVE: We aimed to determine changes in workload in general practice associated with the postal administration of a health needs questionnaire. METHOD: We carried out controlled before-and-after intervention study of the effects of delivering a postal questionnaire to assess needs for care for patients with arthropathies of the hip and knee, groin hernia and varicose veins, and to assess health service utilization, general health status and risk factors for cardiovascular disease. The setting was a seven-partner, fundholding, group practice in Avon. The subjects were patients registered with an NHS group practice situated in Backwell and Nailsea, Avon. The outcome measures were the frequency of consultation, home visits and night visits, reasons for consultation, referral to specialist agencies and patterns of prescribing. RESULTS: There was no significant difference between the study and control group in the year before and the year after the postal administration of the questionnaire with respect to changes in overall frequency of consultation, frequency of referral (including type of referral) and frequency of prescribing of non-steroidal anti-inflammatory drugs. In the study group there was a significant (P<0.05) reduction in the number of daytime home visits and prescriptions written for analgesics. Analysis of the records of those who had received a medical examination, in addition to a postal questionnaire, showed that there was no significant difference between the study and control group with respect to frequency of consultation, referral to outside agencies or items prescribed. CONCLUSION: Administration of a health needs questionnaire to patients registered with this general practice was not associated with an increase in consultation frequency or referral, or a change in prescribing patterns. No plausible explanation could be identified for the significant reduction in the number of home visits and prescriptions written for analgesics. It was concluded that these results were a statistical artefact. On the basis of the evidence from this study, GPs can be reassured that the administration of health needs questionnaires of the type used in this study will not result in any increase in workload or costs of care incurred by increased referrals to outside agencies or increased prescribing.

Adult↗

PubMed2000

Workload generated by a living donor programme for renal transplantation.

BACKGROUND: The ethical and medical implications of live kidney donation result in a comprehensive work-up process. The aim of this study was to determine the magnitude of the workload and the yield of renal transplants generated by a live donor programme. METHODS: Referrals to the Leicester live donor programme over the five-year period 1994-1998 were retrospectively assessed. These were initiated by nephrology referral and subsequently investigated in a stepwise manner. Patients were counselled and baseline tests performed prior to consultant surgeon review and assessment of donor renal function/anatomy. RESULTS: One hundred and fifty referrals consisting of 150 recipients with 269 potential donors were originally made. This resulted in 32/120 (27%) related and 3/30 (10%) unrelated recipients (P=0.06) and 32/220 (15%) related and 3/49 (6%) unrelated donors proceeding to live donor transplantation, with a mean work-up time (+/-SD) of 9 (+/-7) months. One hundred and fifteen recipients (77%) and 234 (87%) donors failed to proceed at various stages of assessment, for a variety of immunological, medical and social reasons. A large number of expensive immunological investigations were required for potential donors, the majority of which did not proceed to transplantation. However as a result of performing these in the early stages of assessment the number of more invasive tests is kept to a minimum. CONCLUSIONS: There is a relatively low yield of transplants from live donor referrals, particularly those between unrelated individuals. The vast majority of referrals fail to proceed for legitimate reasons, but as a result, create a significant workload with notable staffing and financial implications.

Health Care Costs↗

PubMed1994

Workload and cardiovascular risk factors in executives and non-executives of the same company.

The lifestyle of executives purportedly differs from that of their employees who are not in an executive position, with respect to workload, amount of travelling, and eating habits. These aspects of lifestyle and cardiovascular (CV) risk factors in blood were compared in 22 executives and a matched sample of non-executives in an insurance company in Norway. The mean age was 42.8 years in both groups and the mean body mass index was 25.5 and 24.8 kg/m2 in executives and non-executives, respectively. Executives travelled more and worked more hours than non-executives, but smoking habits, levels of physical activity, diet habits and blood pressure were comparable in the two groups. The blood lipoprotein estimates of total cholesterol, high density lipoprotein cholesterol, apolipoproteins and two compound lipoprotein indices of CV risk, as well as liver enzymes, were also of the same magnitude in both groups. The executive lifestyle as such, compared to that of non-executives, does not imply an elevated CV risk in this study, as judged from CV risk factors in blood. The efforts of the occupational health service to improve health, including the opportunity for executives to choose their workload, may have contributed to this 'negative' finding. This may indicate that preventive health programmes in the company could have been acting as intended for all groups of employees. However, somewhat high mean levels of total cholesterol (> 6.0 mmol/l) and of a compound atherogenic index in both groups suggest that continued action by the occupational health service is required.

Adult↗

PubMed2000

An investigation of the relationship between psychological health and workload among managers.

BACKGROUND: Anecdotally, many workers complain of stress at work. However, the relationship between work and stress needs clarification to allow risk assessment and risk management of this hazard in the workplace. OBJECTIVES: To examine relationships between working hours, perceived work stressors, and psychological health in a group of managers. METHODS: Managers at two factories were invited to participate in an anonymous cross-sectional survey. All were asked to complete a work diary for a period of 1 week and a questionnaire comprising the 30-item General Health Questionnaire, an anxiety and depression scale, and questions identifying perceived workplace stressors. RESULTS: Over 60% of managers were above the threshold of caseness on at least one measure of psychological health. No statistically significant relationship was demonstrated between actual hours of work and psychological health. A relationship was demonstrated between some perceived workplace stressors and actual hours worked, and between some perceived workplace stressors and psychological health. CONCLUSIONS: A large proportion of managers in a typical production environment appeared at risk of developing psychological illness. Hours of work were not directly related to psychological health, but were significantly associated with individual perception of some work stressors which, in turn, were associated with measures of psychological health. Perceived workload appeared more important in determining psychological health than actual workload.

Analysis of Variance↗

PubMed2003

Workload implications of identifying patients with ischaemic heart disease in primary care: population-based study.

BACKGROUND: The aims of this study were to develop ischaemic heart disease (IHD) registers in three primary care groups (PCGs) in SW London; to determine what proportion of patients with IHD were already identified; and to estimate the workload in producing an IHD disease register. METHODS: A population-based cross-sectional study was carried out in 46 out of 49 general practices in three PCGs in SW London, using computerized and paper medical records. Outcome measures were proportion of patients with IHD on existing disease registers, and workload and cost of producing complete registers. RESULTS: Of 3803 patients with a pre-existing IHD Read code, 570 (15 per cent) were found to have no evidence of IHD, leaving 3233 patients with confirmed or probable IHD. A search of 7726 patients prescribed one of five cardiovascular drugs but not already coded as having IHD identified a further 1447 confirmed or probable cases. On average, coders spent 4.9 hours per 1000 list size verifying IHD cases or finding uncoded cases. Each additional IHD case required about 0.68 hours (41 minutes) of coder's time to identify and one case of IHD was identified or confirmed for about every five sets of notes examined. The cost of each additional case identified was about pounds sterling 10.20. At practice level, there was a wide variation in the proportion of IHD patients already on the register or wrongly coded as having IHD. CONCLUSIONS: A centralized search programme can identify patients with IHD efficiently and at relatively low cost. As the identification of cases is an essential first step in implementing effective secondary prevention, other primary care trusts may also find this method useful in improving the management of patients with IHD.

Aged↗

PubMed1994

Effect of national health service reforms on outpatient rheumatology workload. South West Regional Advisory Committee for Rheumatology.

In order to compare the rheumatology outpatient workload in the South West Regional Health Authority in the years before and after implementation of the NHS reforms in April 1991, surveys were undertaken to collect and compare data from all NHS outpatient consultations during November in 1988, 1990, 1991 and 1992. All patients seen in consultation at all hospital rheumatology outpatient clinics in the South Western Regional Health Authority were included. Results were adjusted for both the number of working days in each month and the inclusion of one new centre in 1992. There was an increase of 33% in total consultations (2663 to 3551) between 1988 and 1992, mostly occurring following implementation of the NHS reforms. This increase related to both follow-up consultations and new patient consultations which increased by 26%. Conversely, waiting time from referral to a new patient consultation increased by 22% (65 days to 79 days). The case mix in most centres showed a proportional reduction in new patients with polyarthritis (43 to 34%) and an increase in back problems (10 to 15%) and OA (14 to 18%) but polyarthritis continued to dominate follow-up cases (75 and 72%). The overall follow-up: new ratio increased from 3.7 to 4.1. Contrary to early fears amongst rheumatologists, their workload has substantially increased during the time of this survey, and the waiting time for new referrals has also increased. While the proportion of new referrals with polyarthritis was reduced, the absolute number of such referrals has increased. As these patients are currently managed by long-term follow-up they make increased demands on hospital resources.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthritis↗

PubMed1997

Differential clinical workloads among faculty at a major academic health center.

OBJECTIVE: The authors analyzed patient care (1981-1995) and financial data (1991-1996) to determine if differential workloads existed at a major academic health center. SUMMARY BACKGROUND DATA: Academic health centers differ markedly from community-based medical centers, but they are required to compete with others who have a more circumscribed mission and a responsibility for providing less complex care. Changes in health care systems may lessen incentives to generate clinical revenue and may adversely affect educational and research programs. METHODS: Patient care data at the University of Michigan Health System were analyzed by discipline for level of activity from 1981 to 1995 and were compared to professional and institutional financial data from 1991 to 1995. RESULTS: Surgeons represented 11% of the total full-time physicians throughout the period of the study (94 of the 836 Medical Center physicians, 1995). They accounted for 33% of hospital admissions (11,616 of 35,101) and 16% of outpatient visits (92,364 of 568,738). Since 1981, surgeons experienced a 249% increase in total operative workload (6799-16,909 procedures), representing a 30% increase in operations/surgeon (138-180 operations). Surgical efforts in 1995 accounted for 29% of the total professional fee revenue and $240 million of the $512-million University of Michigan Hospital revenue. CONCLUSIONS: Surgeons had a greater collective and individual responsibility than did nonsurgeons for clinical activity and the financial viability of the academic health centers studied. Many proposals for financing health care delivery systems have the potential to exacerbate this differential. Restructuring of academic health centers must address this fact, lest their academic mission and scholarly activity be compromised.

Academic Medical Centers↗

PubMedDate not supplied

Definition of a responder: analysis of behavioral, cardiovascular, and endocrine responses to varied workload in air traffic controllers.

Individual differences in behavioral, cardiovascular, and endocrine responses to varying workload among 381 air traffic controllers were assessed using random regression modeling. Although most men showed significant increases in behavioral arousal associated with increasing planes, there were major individual differences in response in systolic and diastolic blood pressure, heart rate, and cortisol. Approximately 20% to 25% of those studied had large increases in each of these domains, along with a smaller group showing inverse responses in heart rate and cortisol. There was also evidence of a smaller number of enhanced responders within the highest groups, who tended to have more missing values at higher levels of workload. There was convergence in the definition of responders using three statistical strategies: random regression, correlational analyses, and ANOVA. Response in one physiological/behavioral domain was essentially independent of response in another, supporting the conclusion of specificity, rather than a global tendency to respond to increasing work load.

Adult↗

PubMed1992

Low back and neck/shoulder pain in construction workers: occupational workload and psychosocial risk factors. Part 2: Relationship to neck and shoulder pain.

The prevalence rate of neck and shoulder trouble and considerable neck and shoulder pain in a randomly selected sample of 1773 construction workers were studied. The relationship to physical and psychosocial factors was analyzed. The workers answered a postal questionnaire. Workload was measured by means of eight manual materials handling indices and ten psychosocial indices, based on results from factor analyses. The 1-year prevalence rate of considerable neck and shoulder trouble was 56% and of neck and shoulder pain 12%. To work with hands above shoulder level showed a dose-response relationship to both neck and shoulder trouble and neck and shoulder pain. The psychosocial factors were more prominently associated with neck and shoulder trouble and neck and shoulder pain than the physical workload factors. The psychosocial indices; psychosomatic and psychic symptoms, stress and job satisfaction showed the highest age-standardized prevalence rate ratios for both neck and shoulder trouble and neck and shoulder pain.

Adult↗

PubMed2004

Stress lactate in mitochondrial myopathy under constant, unadjusted workload.

As it is under debate if determination of lactate during cycle ergometry (lactate stress testing, LST) under a continuous, unadjusted, low workload is a valuable diagnostic tool for mitochondrial myopathy (MMP), the present study aimed to investigate how sensitive the LST is in a large cohort of patients with indications for MMP (MMP patients). Serum lactate was determined once before, three times during, and once after a 15-min, constant 30 W-workload on a bicycle ergometer in 115 healthy controls, 166 patients with neurological disorders other than MMP, and 291 MMP patients. Serum lactate's upper reference limit at rest, 5, 10, 15 min after starting, and 15 min after finishing the exercise was 2.0, 2.0, 2.1, 2.0 and 1.7 mmol/l, respectively. Resting lactate was increased in 75 MMP patients (26%). The specificity of resting lactate determination was 84%. The sensitivity of the LST was 66% and the specificity 84%. Among the 192 MMP patients with abnormal LST, 120 (63%) had a normal resting lactate. The LST is abnormal in two thirds of the MMP patients. The sensitivity of the LST is higher than that of resting lactate determination. The LST is a simple and cheap but effective and reliable screening method for detecting the impaired oxidative metabolism in MMP.

Adolescent↗

PubMed2002

The impact of an assisted conception unit on the workload of a general gynaecology unit.

The burden placed on a hospital by the presence of an assisted conception unit has been emphasised only in terms of its impact on neonatal services. This paper examines the previously neglected subject of the gynaecological workload generated by a tertiary fertility centre that provides treatments by assisted conception. As many IVF units operate independently this additional workload may not be appreciated. It has, however, significant practical and financial implications for neighbouring hospitals and trusts. This is of particular relevance in view of the move towards more uniform health service funding of assisted conception throughout the United Kingdom.

Emergencies↗

PubMed1995

Skiing injuries: the increasing workload.

All skiing injuries presenting to a fracture clinic during the period December 1992 to April 1993 were studied. Fifty five patients with 59 injuries were treated during this period. Thirty (54.5%) were male and 25 (45.5%) female. The mean age was 34 years (range 9-61). The anatomical distribution of injuries seen corresponded very closely with those seen in much larger studies abroad. There were 35 upper limb injuries (59.3%), 22 lower limb injuries (37.3%), with only two spine and trunk injuries (3.4%). While only two patients underwent surgery abroad, a further 12 needed surgical intervention on return, requiring a total stay of 61 'inpatient days'. The bulk of the workload was, however, on an outpatient basis, with a total of 172 appointments. Many advances have been made towards improving the safety of skiing. However with skiing becoming increasingly popular we can expect an increasing workload and cost associated with such injuries.

Adolescent↗

PubMed1992

Workload of general practitioners before and after the new contract.

OBJECTIVE: To assess changes in general practitioners' workload associated with the new contract introduced in April 1990. DESIGN: Weekly workload diary completed during four weeks in February-March 1990 and during the same period in 1991. SETTING: Sheffield, United Kingdom. SUBJECTS: All 300 general practitioners on Sheffield Family Health Services Authority list as principals in 1990 and 1991. MAIN OUTCOME MEASURES: Mean number of hours worked per week, number of patients seen each week, and mean time spent per patient. RESULTS: 181 (60%) general practitioners responded in 1990 and 163 (54%) in 1991. Of these, 18 (10%) were not working in 1990 and 14 (7%) in 1991. General medical service work increased during a "normal working week" from a mean of 38.6 hours a week in 1990 to 40.6 hours in 1991, and non-general medical service work decreased from 5.4 hours a week to 4.5 hours. Hours spent on call were similar before and after the contract. For the 99 general practitioners who responded in both years, time spent on general medical service duties increased significantly (40.5 h in 1990 v 42.5 h [corrected] in 1991; p = 0.033), mainly due to more time being spent in clinics. Significantly more patients were being seen in clinics (9 v 14; p = 0.001); the average time spent per patient remained at about 8 1/2 minutes during surgeries and 16 minutes for a home visit, and rose from 13 to 14 minutes for patients seen in clinics. The time spent on practice administration fell but not significantly. CONCLUSION: Since the new contract there has been a significant increase in general medical services work, mainly due to more patients being seen in clinics, with no reduction in the time spent per patient.

Contract Services↗

PubMed1993

The role of activity-related groups in assessing workload in the accident and emergency department.

Workload of the Accident & Emergency (A&E) Department at Barnet General Hospital was studied over a 1-year period. All new patients were divided into Activity-Related Groups (ARGs). Doctor work hours, for the year, were calculated utilizing the ARGs. This provided an estimate of the minimum required staffing level. ARGs are a potentially useful tool in auditing workload of individual doctors and the department as a whole.

Emergency Service, Hospital↗

PubMed1997

Workload management in A&E: counting the uncountable and predicting the unpredictable.

The development of a workload management system for use in the accident and emergency department is described. The system is capable of capturing the work all professional groups, allowing the user to roster staff according to anticipated workload, and gives accurate information on whether staffing requirements are sufficient to provide the desired standard of care.

Emergency Service, Hospital↗

PubMed1994

Geographical variation in hospital admission rates: an analysis of workload in the Oxford region, England.

OBJECTIVE: To measure variation in hospital admission rates between health districts in part of the English NHS, comparing a wide range of medical and surgical conditions. DESIGN: Retrospective analysis of interdistrict variation using linked routine hospital admission data. Comparisons were also made with levels of variation reported from the USA. SETTING: Oxford Regional Health Authority, 1979-86. SUBJECTS: Six district health authorities--total study population 2.1 million people, 1.6 million hospital admissions. MAIN MEASURES: Age and sex standardised hospital admission rates for resident populations for individual operations and diagnoses; systematic components of variation (SCV). RESULTS: Of 118 standard operation groups, 38 (26% of surgical workload) showed high variation (SCV 16 or more) and 40 (36% of surgical workload) showed low variation (SCV < 4). Operations (SCV) with very low levels of variation included prostatectomy (0.1), inguinal herniorraphy (0.9), and cholecystectomy (1.3). Rates were more variable for myringotomy (3.7), hysterectomy (4.3), dilatation and curettage (5.6), and tonsillectomy (6.2). The SCV was high for only four of the 40 commonest medical causes of admission, and was low for 18 of them. CONCLUSIONS: Most admissions in the Oxford region were for conditions that did not show a great deal of variation in admission rates. The level of variation for many surgical procedures was less than that reported in studies from the USA. Variation was no greater for medical causes of admission than for surgical conditions. Large scale variation may not be an inevitable consequence of autonomous clinical practice.

Age Factors↗

PubMed1996

Predicting the workload in urban general practice in The Netherlands from Jarman's indicators of deprivation at patient level.

STUDY OBJECTIVE: General practitioners (GPs) working in deprived areas supposedly have higher workloads. In the UK, this has led to a higher payment per patient from deprived areas, based on eight indicators of deprivation proposed by Jarman. This paper aimed to examine the applicability of the Jarman index (indicators and attached weights) at patient level in an urban GP setting outside the UK. DESIGN: Data on all GP contacts were collected from 5121 residents aged 16 and over by interview. SETTING: Amsterdam, The Netherlands, 1992-93. MAIN RESULTS: Results showed that six out or eight of the Jarman indicators of deprivation were indeed associated with higher GP contact rates in adults in Amsterdam, though some of them without statistical significance. The relative importance of the indicators, however, differed largely from Jarman's weights. In particular, people in poor housing, unskilled earners, and people born in a foreign country had higher contact rates. Furthermore, some indicators were highly inter-related at patient level. CONCLUSIONS: It is concluded that most of the Jarman indicators can be used to predict Amsterdam GP workload at patient level, but that their relative weights should be adapted for this aim. The applicability of the Jarman index (indicators and attached weights) in other European countries requires additional study.

Adolescent↗