2010-04-01 12:00 - Messages

Are immigrants, ethnic and linguistic minorities over-represented in jobs with a high level of compensated risk? Results from a Montréal, Canada study using census and workers' compensation data
Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level.

Methods
We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations.

Results
The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive.

Conclusions
Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language.

Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level. We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations. The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive. Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language.

Source: http://www3.interscience.wiley.com/journal/123397147/abstract?CRETRY=1&SRETRY=0

The burden of occupational cancer in Great Britain

Cette étude publiée par le Health and Safety Executive (HSE) de Grande-Bretagne présente une série de données épidémiologiques sur les cancers professionnels et l'impact économique de ces derniers. Le résumé de cette étude est disponible sur le site du HSE, ainsi que le rapport détaillé:

http://www.hse.gov.uk/research/rrhtm/rr800.htm

The Necessity of Professional Disclosure and Informed Consent for Rehabilitation Counselors

Within the rehabilitation counseling arena, professional disclosure and informed consent are critical concepts for the rehabilitation counselor to understand. Once understood, they become key components of a rehabilitation counselor's daily practice. Counselors need to provide sufficient prior information about their evaluation and services to respect the individual's right to make an informed choice about participating in the activities. This is one of the most important steps for the counselor to make at the outset of the relationship and thereafter. Yet, inconsistency abounds among rehabilitation counselors when it comes to providing a full and adequate disclosure, thereby ensuring the individual's right to informed consent. This article addresses the history of these issues, the manner by which earlier versions of the Code of Professional Ethics for Rehabilitation Counselors addressed them, and the changes regarding disclosure and informed consent within the revised 2010 code. Because the code now requires written disclosure, this article provides guidance to rehabilitation counselors for incorporating proper professional disclosure and informed consent protocols into their daily professional activities.

Source: http://rcb.sagepub.com/cgi/content/abstract/0034355210368567v1?rss=1

Follow-up of neck and shoulder pain among sewing machine operators: The Los Angeles garment study

BACKGROUND: The aim of the present study is to explore factors affecting or modifying self-reported neck/shoulder pain in sewing machine operators. METHODS: We investigated self-report neck/shoulder pain in 247 workers who participated in a 4-month prospective intervention study for musculoskeletal disorders. All participants were immigrants. We examine the influence of individual and work-related factors on changes in neck/shoulder pain during follow-up employing linear mixed models with time-spline functions. RESULTS: We observed a dramatic decline (72%) in self-reported pain intensity in the first month of follow-up, followed by a small increase from the first to fourth month (4% per month). Workers who perceived and reported their physical workload as high or worked overtime experienced less overall pain reduction. Higher baseline pain intensity, being of Hispanic ethnicity (vs. Asian), and taking cumulative daily rest time during work of 35 min or more allowing for muscles to rest were associated with a larger pain reduction in the first month, but not thereafter. CONCLUSION: Our findings indicate that some work-related factors may be of clinical relevance for reducing neck/shoulder pain. Having lower physical workloads and less overtime work should be considered when treating patients or planning workplace interventions for managing work-related musculoskeletal disorders in this underserved immigrant population.

Source: http://www3.interscience.wiley.com/journal/123215695/abstract

Recovery Expectations Predict Recovery in Workers With Back Pain but Not Other Musculoskeletal Conditions

Study Design: Prospective cohort study. Objective: We examined whether recovery expectations predict future return-to-work in workers filing injury claims for a variety of musculoskeletal conditions. Summary of Background Data: Recovery expectations seem to influence recovery and return-to-work after back pain, but their role in other compensable conditions is uncertain. Methods: All workers' compensation claimants receiving time-loss benefits for a musculoskeletal condition and undergoing return-to-work assessment were enrolled. Claimants completed a work-related recovery expectations questionnaire. Outcomes during the 1-year follow-up included surrogate indicators of timely return-to-work (days until suspension of time-loss benefits) and recovery (claim closure). Analysis included multivariable Cox regression. Results: The sample consisted of 1040 claimants of whom 298 (29%) had back pain, 461 (44%) had sprains, strains, or pain of other body parts besides the back, 234 (23%) had specific injuries such as fracture, dislocation, or amputation, and 47 (5%) had other compensable conditions such as carpal tunnel syndrome or knee internal derangement. The majority of participants had chronic conditions (mean duration >6 mo). Negative work-related recovery expectations were consistently associated with slower suspension of time-loss benefits (Hazard Ratio 0.83) and slower claim closure (Hazard Ratio 0.84) in claimants with back pain, but associations in other diagnostic groups were inconsistent and not statistically significant. Associations were slightly larger within the group of claimants with back pain of less than 3-month duration. onclusions: Recovery expectations provide some information for predicting future recovery in workers filing injury claims for back pain, but do not seem to predict recovery in claimants with other musculoskeletal conditions.

Source: http://journals.lww.com/jspinaldisorders/Abstract/publishahead/Recovery_Expectations_Predict_Recovery_in_Workers.99917.aspx

Return to work following disabling occupational injury – facilitators of employment continuation

Return to work following occupational injury is an important rehabilitation milestone; however, it does not mark the end of the return-to-work process. Following a return to the workplace, workers can experience difficulties that compromise their rehabilitation gains. Although there has been investigation of factors related to a return to the workplace, little attention has been paid to understanding what facilitates continued return-to-work success as this paper aims to do. Methods This study used data gathered during one-on-one telephone interviews with 146 people who experienced a work-related injury that resulted in their being unable to return to their pre-injury job, but who returned to work following an extended period of absence and the receipt of vocational services. Results Numerous return-to-work facilitators were reported, including features of the workers' environmental and personal contexts, as well as body function, activities, and participation. Influences that stood out included a perception that the work was appropriate, supportive workplace relationships, and a sense of satisfaction/achievement associated with being at work. Conclusions The findings support the contention that initiatives aimed at improving return-to-work outcomes can go beyond the removal of barriers to include interventions to circumvent difficulties before they are encountered. Together with providing ideas for interventions, the study's findings offer an insight into research and theoretical development that might be undertaken to further the understanding of the return-to-work process and the factors that impact upon it.

Source: http://www.sjweh.fi/show_abstract.php?abstract_id=2986

Cluster Analysis of Symptoms Among Patients with Upper Extremity Musculoskeletal Disorders

Introduction Some musculoskeletal disorders of the upper extremity are not readily classified. The study objective was to determine if there were symptom patterns in self-identified repetitive strain injury (RSI) patients. Methods Members (n = 700) of the Dutch RSI Patients Association filled out a detailed symptom questionnaire. Factor analysis followed by cluster analysis grouped correlated symptoms. Results Eight clusters, based largely on symptom severity and quality were formulated. All but one cluster showed diffuse symptoms; the exception was characterized by bilateral symptoms of stiffness and aching pain in the shoulder/neck. Conclusions Case definitions which localize upper extremity musculoskeletal disorders to a specific anatomical area may be incomplete. Future clustering studies should rely on both signs and symptoms. Data could be collected from health care providers prospectively to determine the possible prognostic value of the identified clusters with respect to natural history, chronicity, and return to work.

Source: http://www.springerlink.com/content/b5g1687610t33u66/

The effectiveness of walking as an intervention for low back pain: a systematic review

As current low back pain (LBP) guidelines do not specifically advocate walking as an intervention, this review has explored for the effectiveness of walking in managing acute and chronic LBP. CINAHL, Medline, AMED, EMBASE, PubMed, Cochrane and Scopus databases, as well as a hand search of reference lists of retrieved articles, were searched. The search was restricted to studies in the English language. Studies were included when walking was identified as an intervention. Four studies met inclusion criteria, and were assessed with a quality checklist. Three lower ranked studies reported a reduction in LBP from a walking intervention, while the highest ranked study observed no effect. Heterogeneity of study design made it difficult to draw comparisons between studies. There is only low–moderate evidence for walking as an effective intervention strategy for LBP. Further investigation is required to investigate the strength of effect for walking as a primary intervention in the management of acute and chronic LBP.

Source: http://www.springerlink.com/content/gu2r245w344wlw5w/

Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain...

Objectives: To determine whether exercise is more effective than usual care to reduce work disability in patients with non-acute non-specific low back pain, and if so, to explore which type of exercise is most effective.
Methods: Systematic review and meta-analysis of randomized controlled trials investigating the effectiveness of exercise in non-acute non-specific low back pain, and reporting on work disability. Data sources: MEDLINE, EMBASE, PEDro, Cochrane Library databases, NIOSHTIC-2, and PsycINFO until August 2008. Work disability data were converted to odds ratios. Random effects meta-analyses were conducted.
Results: A total of 23 trials met the inclusion criteria, 20 of which were suitable for inclusion in meta-analysis allowing 17 comparisons of exercise interventions with usual care and 11 comparisons of 2 different exercise interventions. A statistically significant effect in favour of exercise on work disability was found in the long term (odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48–0.92) but not in the short (OR = 0.80, 95% CI 0.51–1.25) and intermediate term (OR = 0.78, 95% CI 0.45–1.34). Meta-regression indicated no significant effect of specific exercise characteristics.
Conclusion: Exercise interventions have a significant effect on work disability in patients with non-acute non-specific low back pain in the long term. No conclusions can be made regarding exercise types.

Source: http://jrm.medicaljournals.se/article/abstract/10.2340/16501977-0524

Determinants of early return to work after first stroke in Japan

Objective: To examine the time to return to work after first stroke and identify determinants of early return to work in Japan.
Design: A multicentre, prospective cohort study on the association between characteristics at admission and early return to work after first stroke.
Subjects: Among 464 patients after first stroke, 325 were registered in this study. All participants were younger than 65 years and engaged in paid work at the time of the stroke.
Methods: Data collected prospectively for 18 months were analysed using the Kaplan–Meier method for time trends, and then a multiple logistic regression model for odds ratio of early to late return to work was conducted.
Results: Of the 325 registered patients (mean age 55.1, standard deviation (SD) 7.4 years), 253 (78%) were available for follow-up, and 138 (55%) returned to work. The curve of proportion of return to work was non-linear. Significant determinants of early return to work were gender, function of hemiplegic hand, and ability to perform activities of daily living independently.
Conclusion: The curve of time to return to work was influenced by the follow-up days. Patients after stroke who were male and/or had milder physical disabilities tended to return to work earlier.

Source: http://jrm.medicaljournals.se/article/abstract/10.2340/16501977-0503

Therapeutic Engagement: A Proposed Model of Engagement in Medical Rehabilitation

A major goal of physical medicine and rehabilitation is the recovery of function after an injury or the underlying medical condition that has caused impairment in one's daily functioning. The rehabilitation process involves a complex interplay of many factors that influence how well a person benefits from medical rehabilitation. There is burgeoning evidence that for patients to maximize rehabilitation benefits, they must be actively involved or engaged in the process. In this article, the construct of therapeutic engagement is defined, and a theoretical model is proposed to illustrate how and why individuals engage in medical rehabilitation treatment. It is hoped that such a model can form the basis for further research on therapeutic engagement that facilitates the understanding of the process variables that play a role in rehabilitation outcomes. Areas for future research and the implications for clinical application are discussed.

Source: http://journals.lww.com/ajpmr/pages/articleviewer.aspx?year=2010&issue=05000&article=00010&type=abstract

The Adequacy of Chronic Pain Management Prior to Presenting at a Tertiary Care Pain Center: The Role of Patient Socio-Demographic Characteristics

The Pain Management Index (PMI) is used to assess pain medication adequacy in black and white chronic pain patients (18–50 years) at referral to tertiary pain care. Using WHO guidelines for pain treatment, PMI was calculated from pain severity and drug analgesic potency. From 183 patients recruited, 128 provided treatment information for analyses (53% white, 60% female). Most (51.6%) had adequate PMI. Blacks were prescribed fewer pain medications (P = .03); fewer women had adequate medication strength (P = .04). In hierarchical regression, PMI was predicted at entry by female gender, lower MPI, higher affective MPQ, and a genderXage interaction. Younger men experienced better pain management, reducing toward the PMI level of women by age 50. In the final block, black race, being married, affective pain, and genderXage were associated with higher PMI, female gender and being employed were associated with lower PMI. Women, particularly younger women, were at higher risk for inadequate pain management in a primary care environment. These results support variability in chronic pain care and the need for research focusing on whether these disparities persist with specialized pain care.

Source: http://www.jpain.org/article/PIIS1526590009008335/abstract?rss=yes

Medical Assessments of the Years 2004 and 2005 at the Diagnostic Medical Department MEDAS, University Clinic Basel - A Critical Analysis

Les expertises commandées par l'assurance invalidité (AI) concernant des patients demandant à bénéficier d'une rente AI constituent un volet important des prestations de MEDAS/asim, Bâle. L'analyse de 593 expertises effectuées en 2004/2005 avait pour but de fournir des précisions sur les caractéristiques de cette catégorie de patients. Dans le cadre de ce travail, des données relatives à la sociodémographie, aux diagnostics et à la capacité de travail attestée ont été collectées rétrospectivement et exploitées. La majorité des patients étaient des immigrants (61%) de l'Europe du sud et du sud-est, dont 86% souffraient de douleurs chroniques et de dépressions. Lors de l'examen de leur dossier, seules 101 personnes, soit 17%, exerçaient encore une activité professionnelle à plein temps ou à temps partiel. Le dernier jour de travail dans des emplois en majeure partie non qualifiés remontait à quelques mois, voire à plusieurs années; dans 38% des cas, ce laps de temps était compris entre 1,5 et 2,5 ans.

(article en langue allemande seulement; résumés allemand, anglais et français disponibles)

Source: http://www.verlag-hanshuber.com/zeitschriften/journal.php?abbrev=PRX&show=abstract&abstract=26987

Outcome measures in chronic low back pain

The purpose of this prospective, single site cohort quasi-experimental study was to determine the responsiveness of the numerical rating scale (NRS), Roland–Morris disability questionnaire (RMDQ), Oswestry disability index (ODI), pain self-efficacy questionnaire (PSEQ) and the patient-specific functional scale (PSFS) in order to determine which would best measure clinically meaningful change in a chronic low back pain (LBP) population. Several patient-based outcome instruments are currently used to measure treatment effect in the chronic LBP population. However, there is a lack of consensus on what constitutes a “successful” outcome, how an important improvement/deterioration has been defined and which outcome measure(s) best captures the effectiveness of therapeutic interventions for the chronic LBP population. Sixty-three consecutive patients with chronic LBP referred to a back exercise and education class participated in this study; 48 of the 63 patients had complete data. Five questionnaires were administered initially and after the 5-week back class intervention. Also at 5 weeks, patients completed a global impression of change as a reflection of meaningful change in patient status. Score changes in the five different questionnaires were subjected to both distribution- and anchor-based methods: standard error of measurement (SEM) and receiver operating characteristic (ROC) curves to define clinical improvement. From these methods, the minimal clinically important difference (MCID) defined as the smallest difference that patients and clinicians perceive to be worthwhile is presented for each instrument. Based on the SEM, a point score change of 2.4 in the NRS, 5 in the RMDQ, 17 in the ODI, 11 on the PSEQ, and 1.4 on the PSFS corresponded to the MCID. Based on ROC curve analysis, a point score change of 4 points for both the NRS and RMDQ, 8 points for the ODI, 9 points for the PSEQ and 2 points for the PSFS corresponded to the MCID. The ROC analysis demonstrated that both the PSEQ and PSFS are responsive to clinically important change over time. The NRS was found to be least responsive. The exact value of the MCID is not a fixed value and is dependent on the assessment method used to calculate the score change. Based on ROC curve analysis the PSFS and PSEQ were more responsive than the other scales in measuring change in patients with chronic LBP following participation in a back class programme. However, due to the small sample size, the lack of observed worsening of symptoms over time, the single centre and intervention studied these results which need to be interpreted with caution.

Source: http://www.springerlink.com/content/gv0106uvmq7r635m/

The adaptation process after traumatic brain injury An individual and ongoing occupational struggle to gain a new identity

The aim of this study is to understand better how individuals with traumatic brain injury make sense of their adaptation process and their performance of occupations within this process. For this study, four participants were interviewed twice. Thereafter analyses following a narrative approach led to the construction of four individual narratives. The results indicate that the adaptation process following traumatic brain injury is (1) a necessary struggle to gain a new identity; (2) facilitated by engagement in familiar occupations in familiar environments; (3) a protracted learning process that continues long after rehabilitation ends; (4) individual and situated. The results suggest that healthcare professionals including occupational therapists should: allow individuals with traumatic brain injury to test and practise their abilities within their own home environments; provide them with the necessary space to practise on their own; guide them in using their own and new strategies in a way that is both efficient and personally satisfying. Finally, this study discusses whether rehabilitation services should be offered over a protracted period of time. Professional support following the rehabilitation period—precisely the period in which they are trying to establish a meaningful existence with their disabilities—could be a more useful path to follow.

Source: http://informahealthcare.com/doi/abs/10.3109/11038121003645985

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