Cutting the costs of migraine: role of the employee health unit.

It is estimated that over 120 million Americans suffer from moderate to severe attacks of migraine characterized by headache and other debilitating symptoms, resulting in impaired functional capacity and diminished quality of life. And, it appears, its prevalence is increasing. Since the prevalence peaks during the ages of 25-55, the prime working years, migraine places a tremendous burden on employers, primarily in the form of lost productivity as well as increased health benefits costs. The fact that migraine is underdiagnosed and undertreated suggests the existence of opportunities for interventions that will reduce that toll. This article focuses on the contributions that employee health units may make to such interventions. In addition to first aid for migraine attacks occurring during working hours, these interventions may include educating occupational health staff, managers, and line supervisors about the management of migraine; identifying migraineurs in the workforce; educating them about their problem and ensuring that they are receiving optimal care; controlling exposures to factors in the workplace that may trigger migraine attacks; and managing disability to minimize loss of productivity. Perhaps most important is encouraging migraineurs to be more aggressive in confronting this problem and empowering them to seek out personal physicians who will guide them to effective treatment and preventive regimens.

Migraine: a "woman's disease?".

Migraine, a chronic disorder characterized by episodes of headache, has a profound effect on the well-being and general functioning of its victims, not only during the acute attacks, but also in terms of impairment of school achievement, work performance, and family/social relationships. Despite staggering social and economic costs, it remains under-diagnosed and under-treated worldwide. Migraine has been labeled a "woman's disease" because it is three times more common in women than men, the attacks tend to be more severe and disabling among women and, in some women, they seem to be modulated by such hormonal "milestones" as menarche, menstruation, pregnancy and menopause. After a brief review of the diagnosis of migraine, this article will examine the nuances responsible for that label and their implications for treatment.

Migraine: a problem for employers and managed care plans.

Headache is probably the most common symptom in the workforce and in the general population. Among the many types of headache, the one with perhaps the greatest impact on well-being and functional capacity is migraine. It disrupts work and leisure activities and engenders significant use of healthcare resources. Migraine cannot be cured, but it can usually be managed. Managed care organizations can facilitate the treatment of migraine through disease management programs. Unfortunately, however, many migraineurs receive substandard, ineffectual, and inappropriate care--or no care at all. This article reviews the diagnosis, epidemiology, and treatment of migraine, with an emphasis on the perspectives of employers and managed care plans, with the hope of encouraging them to become more proactive in dealing with individuals with migraine.

Workplace violence: preventive and interventive strategies.

Violence is pervasive in the workplace. Homicides are a major cause of death among workers, but their impact and cost are considerably outweighed by the prevalence of near-misses, physical assaults, abusive behavior, and threats of violence, much of which remains unreported and unrecognized. Violence is not just a criminal justice problem nor just one involving aberrant behavior attributable to alcohol, drugs, or mental illness. It is often predictable and preventable. This article describes a plan for a coordinated effort by employers, workers, occupational health professionals, and other relevant specialists to develop and implement a coherent set of strategies for prevention and intervention.

Worksite AIDS education: a case study of the New York City police.

The New York City Police Department (NYCPD) offers AIDS education on a continuing basis to all uniformed police personnel. The program consists of a videotape, published materials, lecture with medical experts, and individual counseling available on request. This study focuses on police officers' sources of information about AIDS, comparing the workplace program to other sources, as well as their knowledge about HIV transmission and their attitudes towards co-workers with AIDS. Two precincts were surveyed, one in an area of higher prevalence of AIDS cases and the other in an area of lower prevalence. All employees valued the workplace program as more informative than personal and professional sources, but somewhat less informative than the media and the Surgeon General's pamphlet. While officers in both precincts were knowledgeable about the spread of HIV, those more knowledgeable had more positive attitudes towards infected co-workers. Precinct differences suggest that future programs might take into account site-specific characteristics.

Risk-rated health insurance programs: a review of designs and important issues.

PURPOSE OF THE REVIEW. The purpose of this review is to assist those who work in the field of health promotion when considering the implementation of an individually risk-rated health insurance plan. It does so by introducing the reader to the concept of individually risk-rating health insurance; uncritically reviewing selected risk-rated health insurance plans; and exploring several issues related to plan implementation, administration, and appropriateness. SEARCH METHODS USED. The review is based on the authors' awareness of the literature in the fields of preventive medicine, health promotion, and employee benefits. The six individually risk-rated health insurance programs that are reviewed were chosen because they demonstrate how aspects of the National Association of Insurance Commissioners' Model have been implemented using various combinations of administrative procedures, verification strategies, and types of economic incentives or disincentives. This review is not intended to be a comprehensive review of the literature. SUMMARY OF IMPORTANT FINDINGS. Individually risk-rated health insurance programs have been established using a variety of administrative procedures, verification strategies, and types of economic incentives or disincentives. The frequency with which these programs are being established is increasing. As the number of risk-rated programs grows, it will be increasingly important to address the many issues that implementing such plans generate: How should lifestyle behaviors be verified? Will healthy lifestyles save money? Can employees fully control their risk factors? Is risk-rating socially responsible? MAJOR CONCLUSIONS. As risk-rating becomes more widespread, there will be a continuing need to address the business, medical, ethical, and legal issues these programs create and to refine them accordingly. The health promotion community has both an opportunity and obligation to see to it that individually risk-rated health insurance programs are implemented in a socially acceptable manner and that the outcomes they generate are cost-beneficial.

Knowledge and attitudes about AIDS among corporate and public service employees.

BACKGROUND: We examined the relationship between workplace AIDS education efforts and workers' knowledge about HIV transmission and their attitudes toward coworkers with AIDS. METHODS: Questionnaires were mailed to corporate and public service workers at 12 work sites to ascertain the extent of their knowledge about AIDS and their attitudes toward coworkers with AIDS. Each work site had offered an AIDS education program. The average response rate was 40%; 3460 workers returned questionnaires. RESULTS: Respondents' knowledge was largely consistent with available scientific evidence. However, a substantial minority still believe HIV infection can be transmitted through casual contact. Over 30% endorse the screening of new employees for AIDS, and 23% would fear contagion from an infected coworker. Thirty percent of the respondents expressed skepticism about the veracity of information from government sources and the scientific community. Work site comparisons show that where educational programs are minimal, employees know less about HIV transmission and hold more negative attitudes. CONCLUSION: Comprehensive workplace AIDS education programs can reinforce workers' knowledge about HIV transmission, thereby fostering more favorable views toward coworkers with AIDS.

Supporting the elderly: workplace programs for employed caregivers.

An aging population and extended longevity are increasing the number of older people needing informal and family support. At the same time, women, the traditional caregivers, have entered the work force in record numbers. Consequently, concerns about how to care for dependent family members have become workplace issues. In response to the needs of employees who care for family members, employers have produced an array of policies, benefits, and programs, including flexible work schedules and information and referral services. Although these programs are a valuable complement to community services and government initiatives, relatively few employers have recognized the potential effects of caregiving on absenteeism, productivity, and turnover; even fewer have responded with workplace programs directed to the needs of their caregiving employees. To fill the gap, the government is considering mandating employee benefits, such as leave time for family illness. Community services are increasingly being directed to the needs of older people and their caregivers.

Employees' sources of AIDS information: the workplace as a promising educational setting.

Employees' evaluations of AIDS education in the workplace are related to the nature of the program sponsored by employers. A survey of 3460 employees in eight corporate work sites and four public agencies indicated that workplace programs are more highly valued by employees than are other sources of AIDS information where the programs are extensive. The findings suggest conditions under which employers can be valued as AIDS educators and credible sources of AIDS information.

Occupational stress.

Stress has come to be recognized as one of the most pervasive and potent health hazards in the work environment. This paper describes recent trends in stress-related cases, reviews the changes in workers' compensation legislation and adjudication that have paved the way for the increase, and suggests means that employers, and particularly occupational health professionals, may use to manage this problem more effectively.

Care givers in the workplace: employer support for employees with elderly and chronically disabled dependents.

With increasing demands for dependent care, and more women in the work force, employees may be required to balance work and care giving responsibilities. The New York Business Group on Health survey examines the role of business and industry concerning this issue: employer awareness about problems of employees responsible for the care of elderly or chronically disabled dependent family members, and company programs and policies to deal with employee care giver problems. Findings from this exploratory study of 69 companies in the greater New York area indicate that approximately half are aware of care giver needs, and many have identified employee problems in the workplace (lateness, absenteeism, etc). Few have programs designed specifically for care givers. However, larger companies and those with a predominantly female work force have more policies and programs that can accommodate care giver needs. Various strategies currently being tried by companies to support care givers are described.