Relationship of disability prevention to patient health status and satisfaction with primary care provider.

A sample of 625 patients aged 18 to 65 with primary care visits was used to explore the relationship of disability prevention to patient health status and satisfaction with health care provider. Disability prevention and the patient-provider relationship, the latter a potential mediating factor, were measured using reliable and valid scales. The joint effects of disability prevention and a strong patient-provider relationship were associated with decreased risks for poor physical health, as measured by the Medical Outcomes Study 12-item short-form health survey, decreased restricted activity days, and overall satisfaction with their primary care provider. Patient-provider relationship was independently associated with increased patient satisfaction with the provider overall and endorsement of the provider to family or friends. The evidence questions the conventional wisdom among some primary care providers that incorporating disability prevention principles into their daily practice jeopardizes patient satisfaction. These results suggest that primary care providers with strong patient-provider relationships can successfully add disability prevention to their practice.

Disability prevention principles in the primary care office.

The simple request for a sick note can disguise important medical, psychologic or social issues. Disability may be influenced by social and cultural factors as well as by patient expectations. Assessment of impairment and subsequent disability is best made on the basis of objective data by use of a biopsychosocial model to ensure that the expression of disability does not mask other unaddressed psychologic or social issues. Enabling prolonged disability in such a situation can be a dysfunctional physician response to a maladaptive process. The physician's role is to treat the condition, to fulfill the appropriate role of patient advocate, to facilitate health (including resumption of activity), to offer proactive advice on the basis of prognosis, to be familiar with the patient's social obligations and resources and to provide education about the therapeutic benefits of returning to optimal function. This factual, medical-based approach offers an effective preventive strategy that will save many patients from unnecessary disability and morbidity.

The cost of work-related physical assaults in Minnesota.

OBJECTIVE: To describe the long-term productivity costs of occupational assaults. DATA SOURCES/STUDY SETTING: All incidents of physical assaults that resulted in indemnity payments, identified from the Minnesota Department of Labor and Industry (DLI) Workers' Compensation system in 1992. Medical expenditures were obtained from insurers, and data on lost wages, legal fees, and permanency ratings were collected from DLI records. Insurance administrative expenses were estimated. Lost fringe benefits and household production losses were imputed. STUDY DESIGN: The human capital approach was used to describe the long-term costs of occupational assaults. Economic software was used to apply a modified version of Rice, MacKenzie, and Associates' (1989) model for estimating the present value of past losses from 1992 through 1995 for all cases, and the future losses for cases open in 1996. PRINCIPAL FINDINGS: The total costs for 344 nonfatal work-related assaults were estimated at $5,885,448 (1996 dollars). Calculation of injury incidence and average costs per case and per employee identified populations with an elevated risk of assault. An analysis by industry revealed an elevated risk for workers employed in justice and safety (incidence: 198/100,000; $19,251 per case; $38 per employee), social service (incidence: 127/100,000; $24,210 per case; $31 per employee), and health care (incidence: 76/100,000; $13,197 per case; $10 per employee). CONCLUSIONS: Identified subgroups warrant attention for risk factor identification and prevention efforts. Cost estimates can serve as the basis for business calculations on the potential value of risk management interventions.

Preplacement assessments. Impact on injury outcomes.

Evaluation of the impact of preplacement assessments is important given the resources companies and occupational health nurses allocate to screening and the ambiguity of the literature about the effectiveness of such assessments. This study examined the effects of preplacement assessments on employee injuries. All individuals screened by an occupational health clinic in the upper Midwest and given work restrictions during a 3 year period were identified as cases (n = 67). Cases were matched with controls without work restrictions (n = 264) on the basis of employer, gender, and job. Age was controlled for statistically. Chi-square analysis, used to test differences in percent distribution of injuries between cases and controls, found no statistically significant differences in musculoskeletal injuries between the groups. Work restrictions recommended as a result of preplacement assessments appear to protect vulnerable workers.

Work-related physical assault.

Violence in the workplace is a serious public health problem. Yet, to date, little has been documented relevant to non-fatal events associated with physical assault. The aim of the present study was to identify the magnitude of work-related physical assault in Minnesota and to identify potential risk factors; both fatal and non-fatal cases were included. Minnesota workers' compensation records, relevant to assault, were used to identify 712 cases involving more than three days of lost work time for 1992; six homicide cases were included. Assault rates were calculated by industry and occupation. Women had an assault rate twice that of men (51 versus 26 per 100,000 workers). Workers in industries of social services (340), health services (202), and transportation (914) had the highest rates of assault per 100,000 full-time employees. The fact that in addition to overall workers' compensation costs of $1.6 million, the average lost time for closed compensated cases was 54 days (median, 14 days) and time to reach maximum medical improvement for 44% of the cases reporting was 156 days (median, 83 days), indicates a major problem. The findings suggest that specific groups of workers are at risk for physical assault on the job. Further research is essential to identify specific risk factors that will enable the development of appropriate prevention strategies.

Time off work and the postpartum health of employed women.

OBJECTIVES: Parental and maternity leave policies are a popular fringe benefit among childbearing employed women and a benefit employers frequently are required to offer. However, few rigorous evaluations of the effect of maternal leave on maternal health exist. METHODS: Using a hybrid of the household and health production theories of Becker and Grossman and a sample of women identified from state vital statistics records, a nonlinear relationship between maternal postpartum health and time off work after childbirth was estimated. RESULTS: For women taking more than 12 weeks leave, time off work had a positive effect on vitality. With more than 15 weeks leave, time off work had a positive effect on maternal, mental health, and with more than 20 weeks leave, time off work had a positive effect on role function. Subjects' mental health scores were comparable and vitality scores slightly lower than age- and gender-specific norms; 70% of women studied reported role function limitations. CONCLUSIONS: Findings suggest employed women experience problems in well-being at approximately seven months postpartum. Variables associated with improved health include: longer maternity leaves, fewer prenatal mental health symptoms, fewer concurrent physical symptoms, more sleep, increased social support, increased job satisfaction, less physical exertion on the job, fewer infant symptoms, and less difficulty arranging child care.

Tuberculosis in physicians: compliance with surveillance and treatment.

BACKGROUND: Physicians have historically shown poor compliance with tuberculosis (TB) skin testing and treatment after infection. Studies showed that nearly one half of physicians had positive skin test results, but one half to two thirds of physicians with negative tuberculin skin test results did not undergo annual skin testing despite significant exposure to patients with TB. Compliance with chemoprophylaxis after skin test conversion was worse; only 8% to 10% of physicians with a positive tuberculin skin test result received antituberculous therapy. The Centers for Disease Control and Prevention published guidelines on prevention of tuberculosis transmission recommending that all health care workers (including physicians) comply with regular skin testing and get appropriate follow-up care. The Occupational Safety and Health Administration has adopted the guidelines as part of its strategy to prevent occupationally acquired TB. OSHA's requirement provided the opportunity to study the effect on physicians of hospital-wide attempts to apply those guidelines. No previous study has looked at the differences in compliance between physicians in training, full-time staff physicians, and part-time staff (associate physicians). Understanding these differences will enable the hospital's administration to target efforts to improve compliance with TB surveillance and medical therapy after skin test conversion. METHODS: Two hundred eighty-four physicians (189 staff physicians, 65 resident physicians, and 30 associate physicians) responded to a questionnaire that asked about demographic and professional characteristics, current status of tuberculin skin test results, and follow-up of physicians with positive skin test results. RESULTS: We found that 71% of resident and full-time physicians were current in their tuberculin skin test status, whereas 66% of associate physicians were up to date. Thirteen percent of the resident and full-time physicians had positive TB skin test results, compared with 20% of associate physicians. Female physicians had a lower prevalence of positive skin test results than did male physicians. The departments of pathology, surgery, and pediatrics had the highest prevalence of positive test results, followed by radiology, emergency medicine, and obstetrics and gynecology. Family practice and internal medicine were among the departments with the lowest prevalence of positive skin test results. Physicians obtained their skin tests from multiple sources and had their test results interpreted in multiple facilities; hence, the test procedure was not uniform. Compliance with disease prophylaxis was 55% among the resident physicians with positive Mantoux test results, 44% among the full-time staff physicians, and only 17% among the associate physicians. More than half of the physicians with positive Mantoux test results remained untreated. CONCLUSION: Physicians have unique issues in complying with TB surveillance that need to be specifically addressed by hospitals in light of guidelines enforceable by the Occupational Safety and Health Administration. Resident physicians were the most compliant with TB surveillance and treatment after infection. Staff and associate staff physicians had poor compliance with treatment. Although this study shows some improvement when compared with prior studies on physician compliance, hospital follow-up and enforcement may be necessary to bring about significant behavioral change among physicians.

An epidemiologic study of carpal tunnel syndrome and hand-arm vibration syndrome in relation to vibration exposure.

No Minnesota workers' compensation claims have been filed for permanent partial disability benefits with a diagnosis of hand-arm vibration syndrome (HAVS). A cross-sectional study was undertaken to evaluate 519 compensation claimants following carpal tunnel surgery. Workers with significant vibration exposure and symptoms compatible with HAVS were identified within the group. The results show that some workers are not diagnosed as having HAVS even though they meet the diagnostic criteria. This suggests that HAVS should be considered in the differential diagnosis when a worker presents with neural and/or vascular symptoms of the hands and fingers.

Copper catalyzed oxidation of ascorbate: chemical and ESR studies.

Cu-catalyzed oxidation of ascorbate has been studied in the absence and the presence of superoxide dismutase, catalase, mannitol, glycerol, ethanol, formate, and thiourea. None of these agents except thiourea inhibited the reaction. Therefore, the role of the Haber-Weiss reaction in the ascorbate oxidation could not be demonstrated. Electron spin resonance studies demonstrated that the preventive effect of the thiol is primarily due to the chelation of the reduced copper ions with the sulphur atom. The oxidation was also prevented by the chelation of copper with physiological levels of bovine serum albumin. These observations are consistent with the concept that a metal-oxygen complex is perhaps directly involved in the oxidative process. Measurements of the peroxide produced during oxidation indicated that significant amounts of this compound accumulates only at lower levels of ascorbate and in the absence of a protein or other chelating agents. At higher ascorbate levels no peroxide accumulation takes place. These results are, thus, useful in predicting the conditions under which the nutrient may act as a pro-oxidant or as an anti-oxidant. The observations suggest that under normal conditions low levels of ascorbate may act as a pro-oxidant through H2O2 production if the system has transition metal ions devoid of chelating agents. At higher concentrations ascorbate acts predominantly as an antioxidant.

Out-of-hospital coronary death in an urban population--validation of death certificate diagnosis. The Minnesota Heart Survey.

To assess the validity of death certificate diagnoses of out-of-hospital coronary heart disease deaths, the authors studied a one-third random sample of out-of-hospital deaths occurring in 1979 in Minneapolis-St. Paul, Minnesota, residents. Death certificates with diagnoses possibly containing coronary heart disease deaths were enumerated, and cause of death was recorded from the certificate in two ways: as the first listed ("immediate") cause and as the "underlying cause" assigned by a trained nosologist. Validation was performed by standardized physician review of information obtained about the death, which included one or more of the following: an interview with a relative or friend, physician report, autopsy report, medical record, and/or nursing home record. Missing information was frequent, but cases with at least an informant interview and/or autopsy report (82%) were representative and could be used for validation. The sensitivity and specificity of the underlying cause of coronary heart disease (International Classification of Diseases, Ninth Revision, codes 410-414, 427) on the death certificate were 90.3% and 82.7%, respectively, compared with the physician-assigned diagnosis. For the immediate cause, sensitivity and specificity were 90.3% and 67.9%, respectively. These findings suggest that the validity of death certificates for out-of-hospital coronary heart disease death is high, as assessed by this method of retrospective physician review.

Low back pain in nurses: the relative importance of medical history, work factors, exercise, and demographics.

Although low back pain (LBP), a major problem for nurses, is presumed to be caused by the physical demands of work, little scientific information supports this view. In this study, registered nurses were surveyed regarding LBP, demographics, medical history, exercise, and work variables. Univariate and multivariate analyses indicated previous LBP or back pain in another location of the spine were strongly associated with LBP during the study year. Aerobic dance exercise was less strongly associated. In contrast, lifting patients was only weakly associated, and other occupational variables not at all. Although results must be interpreted cautiously in light of study limitations, the findings suggest that factors unrelated to work may be more important to LBP than previously thought.