A Preliminary Investigation of Health and Work-Environment Factors on Presenteeism in the Workplace.

OBJECTIVE: This study investigates the health and work-environment factors that are associated with presenteeism. METHOD: A self-report survey that measured presenteeism, 13 health conditions (eg, stress and allergies), and nine work-environment factors (eg, job strain and leadership) was completed by 229 workers. RESULTS: The most common health condition was stress, while the most common work-environment factor was job strain. Allergies, asthma, and high blood pressure along with work-life imbalance, poor leadership, and a lack of development opportunities were associated with presenteeism. Finally, several inter-relationships between the health and work-environment factors were also reported. CONCLUSION: Interventions targeted at the points of intersection among the health conditions and work-environment factors could be a cost-effective way to improve employees' overall well-being at work, and thus reduce presenteeism.

Explaining variations in the findings of presenteeism research: A meta-analytic investigation into the moderating effects of construct operationalizations and chronic health.

The purpose of the present study is to theorize and test the moderating effects of two variables-the way presenteeism is operationalized and the presence of a preexisting chronic health condition-on the relationships between presenteeism and its antecedents (i.e., physical health, mental health, work factors, social factors, and personal factors). A meta-analysis of 116 studies (N = 301,402) investigated the impact of both moderator variables while controlling for the country of the sample and publication source. As expected, the magnitude of the relationships between presenteeism and its antecedents varied depending on the type of operationalization of presenteeism. Specifically, the average mean correlations reported in previous studies were larger when presenteeism was operationalized using both a behavior and an outcome (e.g., productivity loss stemming from attending work while ill) as compared with when presenteeism was operationalized as a behavior only (e.g., attending work while ill). Furthermore, we found that the associations between presenteeism and its antecedents were stronger for those workers with a preexisting chronic health condition (e.g., osteoarthritis), as compared with healthier workers. These findings have important implications for research and theory. In particular, they suggest that the way presenteeism is operationalized can artificially inflate the observed effect sizes between presenteeism and its antecedents. This is a significant contribution, as it may shape future measures of presenteeism. Theoretically, the findings are also important, as they provide a framework for understanding why some workers are more prone to presenteeism than others (e.g., because individuals with chronic health problems may be more resilient). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The moderating impact of temporal separation on the association between intention and physical activity: a meta-analysis.

Previous meta-analyses have estimated that the intention-behaviour association in physical activity (PA) is large in magnitude. However, these prior meta-analyses have also revealed a large degree of heterogeneity, suggesting the presence of moderating variables. This study examines the impact of one such moderator, testing the hypothesis that the magnitude of the association between intention and behaviour decreases as the temporal separation between the two increases. A systematic literature search was used to identify published and unpublished studies that met the inclusion criteria. A random-effects meta-regression was conducted to test the study hypothesis. A total of 78 journal articles and 11 unpublished dissertations were identified, yielding 109 effect sizes. The mean number of weeks between the measurement of intention and behaviour was 5.4 (SD = 6.6, range = .43, 26). The average correlation between intention and behaviour was r = 0.51. In line with theoretical predictions, temporal separation was a significant moderator of the intention-behaviour correlation (B = -.014, p < .001) and explained 24% of the between-study variance. This result remained unchanged when entered simultaneously with several control variables. The results of this analysis have important implications both for researchers and for intervention designers aiming to increase rates of PA.

Relationships between work environment factors and presenteeism mediated by employees' health: a preliminary study.

OBJECTIVE: This study investigates a research framework for presenteeism, in particular, whether work environment factors are indirectly related to presenteeism via employees' health. METHODS: A total of 336 employees, 107 from a manufacturing company in Europe and 229 from various locations across North America, completed a self-report survey, which measured the association between presenteeism (dependent variable) and several health and work environment factors (independent variables). These relationships were tested using path analysis with bootstrapping in Mplus. RESULTS: Presenteeism was directly related to health burden (r = 0.77; P = 0.00) and work environment burden (r = 0.34; P = 0.00). The relationship between work environment burden and presenteeism was partially mediated by health burden (ß = 0.08; 95% confidence interval, 0.002 to 0.16). CONCLUSIONS: These findings suggest both a direct and an indirect relationship between work environment factors and presenteeism at work.

The American Academy of Neurology's top five choosing wisely recommendations.

OBJECTIVE: To discuss the American Academy of Neurology (AAN)'s Top Five Recommendations in the Choosing Wisely campaign promoting high-value neurologic medicine and physician-patient communication. The AAN published its Top Five Recommendations in February 2013 in collaboration with the American Board of Internal Medicine Foundation and Consumer Reports. METHODS: A Choosing Wisely Working Group of 10 AAN members was formed to oversee the process and craft the evidence-based recommendations. AAN members were solicited for recommendations, the recommendations were sent out for external review, and the Working Group members (article authors) used a modified Delphi process to select their Top Five Recommendations. RESULTS AND RECOMMENDATIONS: The Working Group submitted 5 neurologic recommendations to the AAN Practice Committee and Board of Directors; all 5 were approved by both entities in September 2012. Recommendation 1: Don't perform EEGs for headaches. Recommendation 2: Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms. Recommendation 3: Don't use opioids or butalbital for treatment of migraine, except as a last resort. Recommendation 4: Don't prescribe interferon-ß or glatiramer acetate to patients with disability from progressive, nonrelapsing forms of multiple sclerosis. Recommendation 5: Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (<3%).

Evidence-based guideline: treatment of painful diabetic neuropathy--report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation.

The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL.

Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.

OBJECTIVE: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). METHODS: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; and non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" RESULTS AND RECOMMENDATIONS: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulphate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

Australian women's awareness of ovarian cancer symptoms, risk and protective factors, and estimates of own risk.

OBJECTIVE: To examine Australian women's perceived risk of ovarian cancer, reasons for perceived risk levels, and knowledge of ovarian cancer symptoms at two timepoints (2003 and 2007). METHODS: A computer-assisted telephone (CATI) survey of 2,954 Australian women with no history of ovarian cancer was conducted. RESULTS: Approximately 60% of women perceived their risk of ovarian cancer was similar to other women of their age; 10% indicated an increased risk, and 30% indicated a lower risk. These figures were similar in 2003 and 2007. Logistic regression found that lower income, increased age, being born overseas, and being retired were significantly associated with lower perceived risk (accounted for only 7.5% of the variance). Common reasons for higher perceived risk included family history of ovarian/other cancers, increasing age, and having had other types of cancer or health problems. Reasons for lower than average risk included absence of family history, having a hysterectomy, and having regular Pap smears (indicating confusion between ovarian and cervical cancer). There appeared to be substantial confusion in women's understanding of ovarian cancer symptoms; this was similar in 2003 and 2007. CONCLUSION: The observed misperceptions and confusion regarding ovarian cancer symptoms and risk factors suggest ongoing public education campaigns are needed to improve knowledge and awareness.

Examining the pathways linking chronic sleep restriction to obesity.

A growing number of studies have identified chronic sleep restriction as a potential risk factor for obesity. This could have important implications for how obesity is prevented and managed, but current understanding of the processes linking chronic sleep restriction to obesity is incomplete. In this paper, we examined some of the pathways that could underlie the relationship between chronic sleep restriction and obesity. This involved exploring some of the potential environmental, health, behavioral, and sociodemographic determinants of chronic sleep restriction, which require further investigation in this context. Three pathways that could potentially link chronic sleep restriction to obesity were then examined: (1) altered neuroendocrine and metabolic function, (2) impaired glucose regulation, and (3) waking behavior. The selected pathways linking chronic sleep restriction to obesity reviewed in this paper are presented in a schematic representation; this may be used to guide future research in this area. This area of research is important because it may lead to more effective interventions and strategies to combat the present obesity epidemic.

Content analysis of disease awareness advertisements in popular Australian women's magazines.

OBJECTIVE: To examine the nature of disease awareness advertising (DAA). DESIGN: Therapeutic advertisements in six popular Australian women's magazines were monitored between April 2006 and March 2007. A subset of advertisements was included in the study based on criteria derived from a definition of DAA. Unique advertisements were analysed by four independent coders. MAIN OUTCOME MEASURES: Types of advertisements and their sponsors, the types of disease information present, and the persuasive techniques utilised. RESULTS: Of 711 advertisements identified, 60 met the inclusion criteria for DAA, and 30 of these were unique. Over one-third of the advertisements were classified as "unbranded product advertisements", which promote a product without referring directly to a brand. DAA sponsored by pharmaceutical companies most often provided treatment and prevalence information. Most (22/30) advertisements used emotional appeals; 15 of these used "happiness/healthiness/wellbeing". CONCLUSIONS: The educational value of industry-sponsored DAA could be improved if regulations and guidelines stipulated disease information requirements, such as inclusion of risk-factor and symptom information. Regulators should provide guidelines for "unbranded product advertisements" and the acceptability of other persuasive techniques. Further research into DAA is required and should consider advertisements in a range of media, and behavioural responses.

Factors associated with short and long sleep.

OBJECTIVE: Short (<7 h) and long sleep durations (> or = 9 h) have recently been linked with increased mortality in the US, Europe and Asia, but little is known about the sleep patterns of Australian adults. The present study examined the sleep habits of Australian adults and identified socio-demographic and health-related factors associated with short and long sleep. METHODS: This study analyzed cross-sectional and self-reported data from 49,405 Australian adults aged 45 to 65 years collected between 2006 and 2008. Socio-demographic and health-related factors were entered into multinomial logistic regression models predicting self-reported sleep duration. RESULTS: Short and long sleep were reported by 16.6% and 13.9% of participants respectively. Short sleep was associated with long working hours (odds ratio [OR]=1.17, 95% confidence interval (CI): 1.08, 1.28) and obesity (OR=1.29, 95% CI: 1.19, 1.41); long sleep was associated with recent treatment for cancer (OR=1.64, 95% CI: 1.34, 2.02) and heart attack/angina (OR=1.58, 95% CI: 1.19, 2.09). CONCLUSIONS: Short and long sleep were common in this sample of middle aged Australian adults. The determinants of short sleep have potential public health implications and could be targeted to prevent morbidity and mortality associated with short sleep.

Dermatomyositis with inclusion body myositis pathology.

The pathogenic role of inflammation in inclusion body myositis (IBM) remains uncertain. A 63-year-old man developed a severe, rapidly progressive myopathy with clinical features typical of dermatomyositis (DM), but muscle pathology was typical of IBM. Treatment with prednisone and methotrexate resulted in complete remission of symptoms. Together with two similar cases reported previously, this case suggests that the inflammatory process of DM may trigger the pathologic changes of IBM.

The 2003 Australian Breast Health Survey: survey design and preliminary results.

BACKGROUND: The Breast Health Surveys, conducted by the National Breast Cancer Centre (NBCC) in 1996 and 2003, are designed to gain insight into the knowledge, attitudes and behaviours of a nationally representative sample of Australian women on issues relevant to breast cancer. In this article, we focus on major aspects of the design and present results on respondents' knowledge about mammographic screening. METHODS: The 2003 BHS surveyed English-speaking Australian women aged 30-69 without a history of breast cancer using computer-assisted telephone interviewing. Questions covered the following themes: knowledge and perceptions about incidence, mortality and risk; knowledge and behaviour regarding early detection, symptoms and diagnosis; mammographic screening; treatment; and accessibility and availability of information and services. Respondents were selected using a complex sample design involving stratification. Sample weights against Australian population benchmarks were used in all statistical analyses. Means and proportions for the entire population and by age group and area of residence were calculated. Statistical tests were conducted using a level of significance of 0.01. RESULTS: Of the 3,144 respondents who consented to being interviewed, 138 (4.4%) had a previous diagnosis of breast cancer and were excluded leaving 3,006 completed interviews eligible for analysis. A majority of respondents (61.1%) reported ever having had a mammogram and 29.1% identified mammography as being the best way of finding breast cancer. A majority of women (85.9%) had heard of the BreastScreen Australia (BSA) program, the national mammographic screening program providing free biennial screening mammograms, with 94.5% believing that BSA attendance was available regardless of the presence or absence of symptoms. There have been substantial gains in women's knowledge about mammographic screening over the seven years between the two surveys. CONCLUSION: The NBCC Breast Health Surveys provide a valuable picture of the knowledge of Australian women about a range of issues. The present analysis shows significant gains in knowledge and behaviours relating to mammographic screening, while identifying additional areas for targeted improvement, as in the need to better communicate with women about screening and diagnostic services. Further analysis of additional core topic areas (eg., incidence, mortality, risk and treatment) will provide equally noteworthy insight.

Depression and quality of life in cancer survivors: is there a relationship with physical activity?

BACKGROUND: Evidence is growing on the benefit of physical activity to improve well-being following a cancer diagnosis. This study examined changes in physical activity from pre to post diagnosis and explored this relationship with quality of life and depression. METHODS: Participants were recruited by posters and by letter of invitation. The questionnaire was completed by 59 prostate and 32 breast cancer survivors. RESULTS: Physical activity decreased by 72 minutes per week from pre to post diagnosis, although 20.9% reported having increased activity post diagnosis. Over 30% were considered depressed. Breast cancer participants who increased physical activity post diagnosis reported higher scores for Physical Wellbeing subscale (26 versus 21; F[1,29] = 5.19, p < .03), Emotional Wellbeing subscale (22 versus 19; F[1,30] = 4.57, p < .04) and Functional Wellbeing subscale (26 versus 19; F[1,30] = 9.03, p < .001). A greater proportion of participants taking part in no physical activity were depressed (55.6%; chi2 = 6.83, p < .04). CONCLUSION: Over 25% of participants identified with emotional and/or well being problems, and more than half reported insufficient physical activity to yield benefits. Future research needs to gain a better understanding of why cancer survivors decrease their physical activity following a cancer diagnosis and what is necessary for them in order to retain or increase their physical activity.

MRI detection of cysts of the knee causing common peroneal neuropathy.

In 10 consecutive patients with footdrop due to common peroneal neuropathy without an obvious cause, MRI of the knee showed pathology at the fibular head in 6, including 5 patients with clinically unsuspected cysts of the tibiofibular joint. All 6 of the patients improved with surgery.

Review and critique of the quality of exercise recommendations for cancer patients and survivors.

The benefit of exercise for cancer patients is starting to become recognized. The purposes of this paper were to review the literature to examine whether research findings are being converted into guidelines for patients and survivors and to examine the quality of evidence on which they were based. A computer search of major health databases was conducted for peer-reviewed literature and books on exercise and cancer, and an Internet search was conducted for cancer websites reporting any exercise guidelines/recommendations for cancer patients. Seven peer-reviewed articles, eight books and eight cancer websites were identified that suggested exercise guidelines for cancer patients and survivors. None of the published guidelines identified appeared to have been developed via a process that would allow them to be cited as evidence-based guidelines. Based on the studies to date, no direct cancer-specific evidence about the best type, frequency, duration or intensity of exercise is currently available in the peer-reviewed literature. It is currently not known what would be most beneficial for which cancers, at which stage of disease or treatment. Given the current interest in cancer and exercise, there is an urgent need for an evidence-based set of exercise guidelines to be developed.

The impact of computerized clinical reminders on physician prescribing behavior: evidence from community oncology practice.

The objective of this study is to examine the impact of a clinical reminder generated by an electronic medical record (EMR) system on physician prescribing behavior in community oncology practice setting. A case-control trial assessing the prescribing rates of erythropoietin by physicians is used. The participants and setting involves a total of 11,644 physician-patient encounters in 2 community oncology practices in the United States during a 21-month period. The intervention is a clinical reminder generated in real time during a physician-patient encounter by an EMR identifying cancer patients with low hemoglobin (Hgb) levels (ie, anemic), that is, patients with Hgb less then 12 g/dL. The main outcome measure is to determine the frequency of erythropoietin prescription by physicians to cancer patients with low Hgb levels. Implementation of a clinical reminder generated by way of an EMR significantly improved the likelihood of low-Hgb patients receiving treatment with erythropoietin. Low-Hgb patients in the experimental clinic during the time that the clinical reminder system was in place were almost twice as likely (ie, adjusted odds ratio = 1.92, P = .008) to have been treated with erythropoietin. The data support the effectiveness of clinical reminders as a way to influence physician prescribing behaviors and potentially improve the quality of patient care. However, we feel that there is a need to investigate the use of reminders in other aspects of cancer care that may be undertreated or when new drugs may be available but are underused.

Physician Communication Skills: Results of a Survey of General/Family Practitioners in Newfoundland.

PURPOSE: To describe the attitudes related to communication skills, confidence in using communication skills, and use of communication skills during the physician-patient encounter among a population-based sample of family physicians. PROCEDURES: A mailed survey, distributed to all family physicians and general practitioners currently practicing in Newfoundland. The questionnaire was designed to collect data in five general areas-participant demographics, physician confidence in using specific communication strategies, perceived adequacy of time spent by physicians with their patients, physician use of specific communication strategies with the adult patients they saw in the prior week, and physician use of specific communication strategies during the closing minutes of the encounters they had with adult patients in the prior week. MAIN FINDINGS: A total of 160 completed surveys was received from practicing family physicians/ general practitioners in Newfoundland, yielding an adjusted response rate of 43.1%. Most of the respondents (83.8%) indicated their communication skills are as important as technical skills in terms of achieving positive patient outcomes. Between one-third and one-half of the respondents, depending on the educational level queried, rated their communications skills training as being inadequate. Fewer than 20% of the respondents rated the communications skills training they received as being excellent. Physicians indicated a need to improve their use of 8 of 13 specific communication strategies during patient encounters, and reported using few communication strategies during the closing minutes of the encounter. Interactions that occurred during a typical encounter tended to focus on biomedical versus psychosocial issues. CONCLUSIONS: Family physicians/general practitioners recognize a need to improve their communications skills. Well-designed communications skills training programs should be implemented at multi-levels of physician training in order to improve patient satisfaction with their encounters with family/general practitioners, and to increase the likelihood of positive patient outcomes.