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PubMed2002

Workforce participation by persons with disabilities: the National Health Interview Survey Disability Supplement, 1994 to 1995.

Using the National Health Interview Survey Disability Supplement of 1994 to 1995, we examined the factors associated with employment among Americans with disabilities. Persons with disabilities who were more educated were more likely to be working. Married men were more likely to work than unmarried men (odds ratio [OR], 1.58). Blacks were less likely to work than whites (OR, 0.56). Persons with disabilities related to cardiovascular disease (OR, 0.23), musculoskeletal disease (OR, 0.37), and respiratory disease (OR, 0.23) were less likely to work than other Americans with disabilities. Among persons with psychiatric disorders, there was considerable variety in the propensity to work. Persons with schizophrenia (OR, 0.24) and paranoid delusional disorder (OR, 0.34) were markedly less likely to work; persons with bipolar disorder (OR, 0.60) and major depression (OR, 0.69) were also less likely to work. Lastly, persons with self-reported alcohol abuse (OR, 1.30) were more likely to work, and persons with self-reported drug abuse (OR, 0.93) were not less likely to work, than others in our study population of Americans with disabilities.

Adolescent↗
PubMed2003

An intervention to promote appropriate management of allergies in a heavy manufacturing workforce: evaluating health and productivity outcomes.

This work presents the evaluation of a first-of-its-kind intervention to improve the management of allergies among workers in a largely blue-collar industrial setting. This intervention implemented eight educational strategies focusing on appropriate medication use in the context of a controlled, nonrandomized, pre-post quasi-experimental study design. Program implementation occurred during summer 2001, with change assessed by means of measures of health and productivity, developed from employee surveys timed to occur at the height of the spring and fall allergy seasons, and measures of contemporaneous adverse events developed from administrative databases. Evidence of improvement was found at one experimental site but not at the other experimental sites or the control site. Tests using exploratory and confirmatory analyses were conducted of two hypotheses linking the gains of this site's allergy group to 1) intervention process changes and 2) changes in allergy severity caused by seasonality. Neither hypothesis is found to fully account for the explained variation between sites. Similar pre-post productivity gains for other disease groups at this site relative to the other sites suggest that the inclusion of other unmeasured variables would improve explanation; e.g., the responses of employees with chronic disease to notably challenging labor negotiations at this site. The implications for promoting behavioral change in the management of the impact of disease on productivity are explored.

Allergens↗
PubMed2006

Effect of health insurance on workplace absenteeism in the U.S. workforce.

OBJECTIVES: The objectives of this study were to examine the relationship between health insurance (HI) and number of missed workdays (MW), and how it is modified by level of access to care (AC) and healthcare use (HC). METHODS: The authors conducted a retrospective study of 1996-1999 Medical Expenditure Panel Survey of U.S. employees. RESULTS: Of 25,676 individuals, 13,957 (54%) reported MW (mean [standard deviation] = 4.3 [0.092]). Having HI was significantly associated with decreased likelihood of MW. Higher level of AC was significantly associated with greater number of MW. HC was significantly associated with increased likelihood of and greater number of MW. CONCLUSIONS: Having HI any time over the year is significantly associated with decreased likelihood of and smaller number of MW. HC use is an important explanatory variable and appears to be a confounder between HI and MW. The benefits to employers of ensuring that employees have health coverage should be explored.

Absenteeism↗
PubMed2005

Physicians with disabilities and the physician workforce: a need to reassess our policies.

People with disabilities make up about 20% of the population, yet only a tiny fraction of matriculants to medical school have disabilities. Attempts to define core technical standards and competencies have not kept pace with technological changes, diverse specialization, and changing practice options. This has resulted in the inappropriate exclusion of some people with disabilities. Medical schools determine how any qualified applicant, regardless of physical or cognitive ability, can be effectively accommodated and counseled in achieving the most appropriate medical career. A serious effort to redefine the technical standards and core competencies of the 21st century medical education at the undergraduate and graduate levels would likely resolve many of the troubling questions regarding medical students with disabilities. We have made some recommendations to organized medicine for constructing an agenda to address these issues.

Attitude to Health↗
PubMed2003

The aging population and its impact on the surgery workforce.

OBJECTIVE: To predict the impact of the aging population on the demand for surgical procedures. SUMMARY BACKGROUND DATA: The population is expanding and aging. According to the US Census Bureau, the domestic population will increase 7.9% by 2010, and 17.0% by 2020. The fastest growing segment of this population consists of individuals over the age of 65; their numbers are expected to increase 13.3% by 2010 and 53.2% by 2020. METHODS: Data on the age-specific rates of surgical procedures were obtained from the 1996 National Hospital Discharge Survey and the National Survey of Ambulatory Surgery. These procedure rates were combined with corresponding relative value units from the Centers for Medicare and Medicaid Services. The result quantifies the amount of surgical work used by an average individual within specific age groups (<15 years old, 15-44 years old, 45-64 years old, 65+ years old). This estimate of work per capita was combined with population forecasts to predict future use of surgical services. RESULTS: Based on the assumption that age-specific per capita use of surgical services will remain constant, we predict significant increases (14-47%) in the amount of work in all surgical fields. These increases vary widely by specialty. CONCLUSIONS: The aging of the US population will result in significant growth in the demand for surgical services. Surgeons need to develop strategies to manage an increased workload without sacrificing quality of care.

Adolescent↗
PubMed1987

The changing composition of the British hospital nursing workforce 1962-1984.

The United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) recently undertook a major project aimed at identifying the most appropriate future nurse staffing patterns. The results presented here were produced at the request of the UKCC in order that the recommendations stemming from their deliberations could be set against a wider backcloth. It proved possible to secure nurse staffing data from three of the countries of the United Kingdom, namely, England, Wales and Scotland. Most were secured from government publications but the appropriate government agencies also provided valuable assistance. The main trends emerging from a processing of the data are a steadily falling ratio of student nurses and midwives to their qualified counterparts and a steadily increasing contribution by state enrolled nurses. A number of other ratios are presented pictorially accompanied, where appropriate, by a commentary. The actual growth in whole time equivalent nurses is seen to be somewhat less than many people imagine when account is taken of the reduction in both the number of weeks and the number of hours per week worked. Indeed, there has been a levelling off of this last figure over the past few years.

Employment↗
PubMed2004

Change, humanity, and the nature of exile: workforce planning and the future of the health service.

There have been many changes in the practice of medicine in the UK in the recent past, including major changes in training and trainees' hours, treatment options and patient expectations. These, in combination with a need for better accountability and improved continuing medical education, have increased the demands on senior doctors, and made apparent the need for increased medical resource. There would seem to be four areas through which this is being addressed - increased production of doctors; changes in medical training; changes in medical practice, and retention of seniors in post. This paper examines some of the perceived advantages and potential disadvantages of these approaches. It concludes that if the health service is to have a viable long-term future, its survival in the short term depends on maintaining within the service the skills of those seniors who have borne the brunt of recent change.

Education, Medical↗