Impact of smoking status on workplace absenteeism and productivity.

OBJECTIVES: To: evaluate the impact of smoking status on objective productivity and absenteeism measures; evaluate the impact of smoking status on subjective measures of productivity; and assess the correlation between subjective and objective productivity measures. DESIGN: Prospective cohort study in a workplace environment. SUBJECTS: Approximately 300 employees (100 each of former, current, and never smokers) at a reservation office of a large US airline. MAIN OUTCOME MEASURES: Objective productivity and absenteeism data were supplied by the employer. Subjective assessments of productivity were collected using a self report instrument, the Health and Work Questionnaire (HWQ). RESULTS: Current smokers had significantly greater absenteeism than did never smokers, with former smokers having intermediate values; among former smokers, absenteeism showed a significant decline with years following cessation. Former smokers showed an increase in seven of 10 objective productivity measures as compared to current smokers, with a mean increase of 4.5%. While objective productivity measures for former smokers decreased compared to measures for current smokers during the first year following cessation, values for former smokers were greater than those for current smokers by 1-4 years following cessation. Subjective assessments of "productivity evaluation by others" and "personal life satisfaction" showed significant trends with highest values for never smokers, lowest for current smokers, and intermediate for former smokers. CONCLUSIONS: Workplace productivity is increased and absenteeism is decreased among former smokers as compared to current smokers. Productivity among former smokers increases over time toward values seen among never smokers. Subjective measures of productivity provide indications of novel ways of productivity assessment that are sensitive to smoking status.

Quality-of-life assessment in acute, chronic, and cancer pain: a pharmacist's guide.

OBJECTIVE: To describe instrumentation, or measures, available for use in assessing the impact of pain on the quality of life (QOL) of patients, and methods to evaluate the appropriateness of these QOL measures. DATA SOURCES: MEDLINE, PSYCHLit, and CANCERLit were searched from 1980 through 1997 to identify QOL instruments that included a pain subscale or pain-related items. DATA SYNTHESIS: Given the high prevalence of chronic diseases or conditions that include pain as a primary or secondary symptom, pharmacists should understand how pain affects the QOL of patients. Over the past two decades, emphasis has increased on developing instruments that assess health-related QOL concerns, including pain. Scores of measures--including utility measures--are available to measure general QOL in patients with conditions involving pain. Condition-specific instruments have also been developed to measure the impact of specific conditions, such as arthritis, on QOL. Guidelines are presented for evaluating QOL instrumentation, and existing measures used to evaluate the QOL of patients with acute and chronic pain are described. Pharmacists can use these guidelines to evaluate the usefulness of existing instruments for assessing the QOL of patients with pain. CONCLUSION: Using QOL measures in everyday practice may assist pharmacists in gaining insight into the effects of pain on their patients' QOL. This information may be useful in developing treatment programs that minimize pain and its associated side effects while maximizing patients' well-being.

The impact of metrifonate therapy on caregivers of patients with Alzheimer's disease: results from the MALT clinical trial. Metrifonate in Alzheimer's Disease Trial.

OBJECTIVE: To assess the impact on burden reported by caregivers of patients with mild to moderate Alzheimer's disease (AD) who were treated with metrifonate during a randomized double blind clinical trial. DESIGN: Randomized clinical trial, with a 2-week screening period and a 26-week double blind, placebo controlled, treatment phase. Caregivers were assessed at baseline, at 12 weeks, and at end of trial. SETTING: Caregivers were interviewed at clinics as part of the assessment of the patients. PARTICIPANTS: Six hundred and three caregivers of AD patients who were enrolled in the MALT trial; 591 (98%) provided data suitable for analysis at baseline, and 546 (91%) provided data allowing for inclusion in the analysis of change scores. MEASUREMENTS: The Caregiver Burden Assessment consisted of the Screen for Caregiver Burden, including both subjective (SCB-subj) and objective (SCB-obj) scores; the cognitive subscale of Poulshock and Deimling (PD); an abridged version of the Relatives Stress Scale (aRSS); assessments of time spent in providing care, including the Caregiver Activity Time Scale (CATS); and demographic and background variables on both the patient and caregiver. RESULTS: Treatment of mild to moderate AD patients with metrifonate for a duration of 26 weeks significantly reduced the psychological burden of care to the caregivers, as measured by the SCB-subj, the PD, and the aRSS. There were no statistically significant differences on the measures assessing the time spent in caregiving, except for the caregiver's subjective impression of the change in time spent providing care during the trial. When comparing individual dose groups, most of the measures of burden showed the largest benefits in burden for the 60/80 mg group, followed by the 40/50 mg group, and then the placebo group. However, there was no statistically significant dose effect. CONCLUSIONS: This study provides the first evidence from a randomized clinical trial of any acetylcholinesterase inhibitor used in the treatment of AD demonstrating a positive impact on the patient's caregiver as well as benefits to the patient. These results were shown consistently across several measurement scales and were observed after six months of treatment. These findings reinforce the clinical significance of research that has shown that metrifonate has beneficial impacts on the cognitive, behavioral, and functional abilities of AD patients. Because caregiver burden is a leading factor in the decision for institutional care placement, the ability to favorably impact that burden through pharmacological treatment of the patient is important.

Cancer pain management: barriers, trends, and the role of pharmacists.

OBJECTIVES: To describe barriers to optimal cancer pain management, activities that have been implemented in recent years to partially overcome these barriers, and the importance of the pharmacist's role in the cancer pain management process. SUMMARY: Cancer pain management remains a formidable challenge. Barriers in the United States include inadequate provider training; patients' reluctance to report pain; and deficiencies within the health care infrastructure, such as restrictive regulation of controlled substances and inadequate insurance coverage. Despite these barriers, recent efforts have raised awareness of the gap between suboptimal and optimal cancer pain management. These include: the development of guidelines (and the conduct of scientific studies) to educate providers about pain management or gaps in the cancer pain management process; regulation that has lessened provider restrictions in prescribing analgesics; the emergence of patient and provider advocacy groups; and the development of pain assessment instruments. Because of their clinical and pharmacologic expertise, pharmacists are crucial to the shaping and success of cancer pain management strategies in the United States today. CONCLUSION: Despite its high prevalence and the increasing awareness of the effects of pain on quality of life, cancer pain management remains secondary to treatment of the disease itself. Refining the cancer pain management process in the United States will depend on continued education and emphasis on pain assessment and a proactive approach to pain management, provider groups' effective collaboration with each other and with patients, and overcoming legal, regulatory, and cost barriers.

The relation of patient satisfaction with treatment of otitis externa to clinical outcomes: development of an instrument.

This survey was undertaken to develop a short, comprehensive measure of patient satisfaction with pharmacologic treatment for otitis externa and to assess the relationships between satisfaction, disease symptoms, and medication side effects. Otitis externa was diagnosed in 41 patients recruited from 6 sites; 34 patients completed and returned the study instruments and were included in the study. Patients or their caregivers administered polymyxin/neomycin/hydrocortisone ear drops prescribed by a physician and completed a daily diary for 10 days and a satisfaction questionnaire at the end of the treatment period. The main outcome measures were the subscale scores for patient satisfaction and their relation to medication side effects, symptoms of ear infection, activity limitations, pain, and adherence to prescription regimens. The questionnaire and its subscales demonstrated good psychometric properties (ie, reliability coefficients >0.75, except for 1 subscale). Overall satisfaction was found to be significantly correlated with relief of symptoms, ability to return to normal activities, ease of administration, and medication side effects. Satisfaction subscale scores were correlated with patient-reported severity of medication side effects and disease symptoms. More than half the patients took drops for more than the prescribed number of days, and one third took more than the prescribed number of drops per administration (ie, overadherence). The relation between satisfaction and adherence was weak, perhaps due to the high rates of overadherence. Our results demonstrate that patient satisfaction with otic medication can be assessed across various aspects of satisfaction and that it is correlated with reported disease symptoms and medication side effects. This type of multifaceted assessment may help physicians select between medications with different side-effect profiles and administration schedules. Larger studies are needed to evaluate the relationship between satisfaction with an otic medication and adherence to a medication regimen.

A Multidimensional Scaling Study Of Person Perception In Children.

Anglo and Black children at two age levels and of both sexes judged the similarity of twelve stimulus persons, using a proximity setting technique. The stimuli consisted of cardboard caricatures of individuals representing the roles of policemen, male and female teachers, parents, male and female peers, and self. Where appropriate, stimuli of both Black and Anglo races were present. The judgments were used as inputs for an individual difference multidimensional scaling program. The resultant dimensions of social perception were interpreted as racial identification, sex, and age. Some differences in perception between subjects were obtained. Implications of the present investigation for future research were discussed.

Multidimensional Perceptions Of The 1972 Presidential Election.

Five separate multidimensional scaling analyses, with a total of 2231 subjects and with measurement occasions varying from election day to about 14 months after election day, resulted in two stable dimensions of political perception. These dimensions were identified as Republican and Democratic evaluative dimensions. Significant changes in the saliencies of these dimensions over time were noted for the pro-McGovern subjects, but no such changes were found for the pro-Nixon subjects. Most of these findings were consistent with the previous literature in political perception. The publicity surrounding Watergate apparently did not affect the stability of the political perceptions.

THE PERCEPTION OF POLITICIANS AND POLITICAL ISSUES : A MULTIDIMENSIONAL SCALING APPROACH.

The multidimensional scaling (MDS) of both attitude statements and political candidates in the same multidimensional space was considered to have several ramifications. First, the position of the attitude statements would explicate the nature of the factorial structure of politicians; second, the underlying dimensions would demonstrate whether candidates are perceived in terms of relevant political dimensions. Third, the scaling would reveal the extent of individual differences, especially those based on political affiliation; and last, as a descriptive tool the scaling is of interest in its own right. One hundred fifteen subjects were recruited from various sources, including local campus political clubs. Tucker's (1972) three-mode model of MDS was used to analyze the similarity judgments of these subjects. Results indicated that politicians are perceived in terms of the relevant issues, and that Republicans and Democrats differ markedly in their perception of the political arena. The present experimental paradigm was suggested as a potentially useful method for a number of research problems.

INDIVIDUAL DIFFERENCES IN SEMANTIC SPACE: A REPLICATION AND EXTENSION.

Using a rating task and a method of analysis which allows for individual differences in the use of semantic differential scales, substantial individual differences were found to emerge. In addition, the group average structure corresponded closely to that which has been found in traditional semantic differential research. These two findings replicate previous results. To test the usefulness of an individual differences approach, evaluative scores based on an individual's own evaluative dimension and evaluative scores based on the group average evaluative dimension were used to predict political preferences. Although both sets of scores were highly correlated with preferences, predictive power was not improved by the individual difference approach.