Socioeconomic inequalities in health in the working population: the contribution of working conditions.
BACKGROUND: The aim was to study the impact of different categories of working conditions on the association between occupational class and self-reported health in the working population. METHODS: Data were collected through a postal survey conducted in 1991 among inhabitants of 18 municipalities in the southeastern Netherlands. Data concerned 4521 working men and 2411 working women and included current occupational class (seven classes), working conditions (physical working conditions, job control, job demands, social support at work), perceived general health (very good or good versus less than good) and demographic confounders. Data were analysed with logistic regression techniques. RESULTS: For both men and women we observed a higher odds ratio for a less than good perceived general health in the lower occupational classes (adjusted for confounders). The odds of a less than good perceived general health was larger among people reporting more hazardous physical working conditions, lower job control, lower social support at work and among those in the highest category of job demands. Results were similar for men and women. Men and women in the lower occupational classes reported more hazardous physical working conditions and lower job control as compared to those in higher occupational classes. High job demands were more often reported in the higher occupational classes, while social support at work was not clearly related to occupational class. When physical working conditions and job control were added simultaneously to a model with occupational class and confounders, the odds ratios for occupational classes were reduced substantially. For men, the per cent change in the odds ratios for the occupational classes ranged between 35% and 83%, and for women between 35% and 46%. CONCLUSIONS: A substantial part of the association between occupational class and a less than good perceived general health in the working population could be attributed to a differential distribution of hazardous physical working conditions and a low job control across occupational classes. This suggests that interventions aimed at improving these working conditions might result in a reduction of socioeconomic inequalities in health in the working population. (+info)
Frequency of major adverse cardiac events within one month of coronary angioplasty: a useful measure of operator performance.
OBJECTIVES: To test one-month outcomes in a single center for their statistical power to corroborate conclusions derived from large multicenter databases. BACKGROUND: Only with large, multicenter databases has it been possible to demonstrate more frequent occurrences of complications in patients treated by "low-volume operators." Critics feel that such analyses mask excellent performance by many "low-volume operators." METHODS: In a high-volume cardiac catheterization laboratory in a large, nonuniversity teaching hospital, baseline clinical and angiographic characteristics were collected for a consecutive series of 1,029 patients treated by 37 percutaneous transluminal coronary intervention (PTCI) operators over a four-month period. One-month follow-up was obtained in 967 (94%) patients who form the basis for this analysis. RESULTS: Only the group of operators performing <50 cases annually had a major adverse cardiac event (MACE) (death, myocardial infarction or symptom-driven revascularization) rate at one month significantly greater than predicted from baseline characteristics. (Observed rate: 15.1%, expected: 9.7%, 95% confidence interval [CI]: 4.7%, 14.6%.) The difference was driven by the significantly more frequent rate at which repeat revascularization was performed in patients treated by that group of operators (observed: 13.8%, expected: 7.1%, 95% CI: 2.8%, 11.4%). CONCLUSIONS: As is true of analyses of large multicenter databases, lower volume operators as a group have less good outcomes than those performing more. The greater statistical power provided by one-month MACE rate offers advantages over the use of in-hospital complications for the analysis of operator performance. (+info)
People and work: some contemporary issues.
In advanced industrial societies social, economic, and technological changes are accompanied by changing values and attitudes to work, symptomatic of what some see as the transition to a post-industrial era. As a result existing job definitions and traditional forms of organization are being challenged and attempts made to restructure work so that it becomes meaningful and rewarding in the fullest sense, to the individual, to the enterprise, and to society. These range from programmes of job enlargement and job enrichment, within the framework of existing technologies, to experiments in the design of organizations as a whole in which fewer constraints are accepted as given. They entail and require a multidisciplinary approach as well as awareness of and commitment to the underlying values. The possibilities and benefits of restructuring work in these various ways have been demonstrated sufficiently to encourage interest at governmental level as well as by employers and trade unions. There are, however, no simple prescriptions or principles of universal application. Knowledge is still tentative and partial but there is consensus that the search for new ways of dealing with the organization of work and the allocation of resources is of fundamental importance. (+info)
High throughput Comet assay using 96-well plates.
The single-cell gel electrophoresis or Comet assay is becoming established as an industrial genotoxicity screening test. The aim of this study was to increase the throughput of compounds tested and to minimize the amount of test compound needed for an assay. We modified practical aspects of our standard protocol and designed an experimental procedure suitable for use with 96-well plates. By using a suspension culture rather than attached cells, the modified protocol enabled parallel testing of four compounds on a single microplate (10 duplicate concentrations per compound). A significant reduction in work time was achieved by replacing the previously used Trypan blue dye exclusion (TBDE) test by an automated measurement of ATP levels as the concurrent viability test. The rapid and easy to perform ATP test was carried out towards the end of the 3 h treatment. In this way we were able to select for further analysis and slide preparation only those concentrations which induced the desired range of cytotoxicity. The suitability of the modified test conditions and reproducibility of test results was demonstrated by results obtained with standard mutagens and eight drug candidates tested at various concentrations. In each case the results obtained with the standard and the modified protocols were comparable. By introducing the changes to our standard protocol, combined with automated image analysis, we were able to more than double our previous throughput. (+info)
Economy of effort in electron microscope morphometry.
Statistical techniques known as the analysis of variance make it possible for the electron microscopist to plan work in such a way as to get quantitative data with the greatest possible economy of effort. This paper explains how to decide how many measurements to make per micrograph, how many micrographs per tissue block, how many blocks per experimentally treated organ, and how many organs per experimental treatment group. (+info)
Definition and assessment of specific occupational demands concerning lifting, pushing, and pulling based on a systematic literature search.
AIMS: (1) To find a universal strategy for the identification of specific demands of a job or task, focusing on occupations in which there may be an increased risk for health complaints owing to these specific demands. (2) To select reliable and valid tests concerning lifting, pushing, and pulling, which consider the relation between occupational work demands and the assessment of the maximally acceptable load on an individual level. METHODS: Literature search was performed using Medline (1988 to May 2001), Embase (1966 to May 2001), and NIOSHTIC (1971-98). RESULTS: No universal strategy was found for the definition of specific occupational demands. Therefore a "three step strategy" was formulated for defining specific occupational demands in a job or a task in order to prevent health complaints on an individual level. Many tests were found in the literature concerning lifting, but only a few concerning pushing and pulling. None of the tests concerning pushing, pulling, or lifting considered the relation between work demands and the assessment of the maximally acceptable load on an individual level. Furthermore, none of the tests met the criteria of reliability and prognostic value for musculoskeletal complaints completely. Only for the prognostic value of relative strength capacity tests concerning pushing pulling and lifting, did there appear to be limited proof for the development of musculoskeletal complaints. CONCLUSIONS: In general, for the prevention of work related health complaints, it can be suggested that more attention should be paid to: (1) the definition of specific occupational demands; (2) the assessment of specific occupational demands; and (3) the quality of tests for specific occupational demands. (+info)
Radical simplification: Disaster Relief Medicaid in New York City.
In the four months following the 11 September 2001 attacks on the World Trade Center, nearly 350,000 people signed up for Disaster Relief Medicaid. The process was quick and simple; applicants completed a one-page form and got a decision on the spot or the next day. While the program's success stemmed in part from the unique circumstances facing New Yorkers in the fall of 2001, Disaster Relief Medicaid was an experiment in radical simplification that demonstrated a new way of thinking about how to design a simple, effective public health insurance program stripped of the vestiges of welfare. (+info)
The impact of automation on organizational changes in a community hospital clinical microbiology laboratory.
The diagnosis of infectious diseases and the role of the microbiology laboratory are currently undergoing a process of change. The need for overall efficiency in providing results is now given the same importance as accuracy. This means that laboratories must be able to produce quality results in less time with the capacity to interpret the results clinically. To improve the clinical impact of microbiology results, the new challenge facing the microbiologist has become one of process management instead of pure analysis. A proper project management process designed to improve workflow, reduce analytical time, and provide the same high quality results without losing valuable time treating the patient, has become essential. Our objective was to study the impact of introducing automation and computerization into the microbiology laboratory, and the reorganization of the laboratory workflow, i.e. scheduling personnel to work shifts covering both the entire day and the entire week. In our laboratory, the introduction of automation and computerization, as well as the reorganization of personnel, thus the workflow itself, has resulted in an improvement in response time and greater efficiency in diagnostic procedures. (+info)