Occupational Health Care Setting Research Articles

Validation of the PHQ-15 for Somatoform Disorder in the Occupational Health Care Setting

Introduction Within the occupational health setting, somatoform disorders are a frequent cause of sick leave. Few validated screening questionnaires for these disorders are available. The aim of this study is to validate the PHQ-15 in this setting. Methods In a cross-sectional study of 236 sicklisted employees, we studied the performance of the PHQ-15 in comparison with the Mini International Neuropsychiatric Interview (MINI) as golden reference standard. We approached employees who were sick listed for a period longer than 6 weeks and shorter than 2 years for participation. This study was conducted on one location of a large occupation health service in the Netherlands, serving companies with more than 500 employees. All employees who returned the PHQ-15 were invited for the MINI interview. Specificity and sensitivity were calculated for optimal cut point and a receiver operating characteristic (ROC) was constructed. Results A total of 107 participants consented to participate in the MINI interview. A non-response analysis showed no significant differences between groups. According to the MINI, the prevalence of somatoform disorders was 21.5%, and the most frequent found disorder was a pain disorder. The PHQ-15 had an optimal cut point of 9 (patients scoring 9 or higher (≥9) were most likely to suffer from a somatoform disorder), with specificity and sensitivity equal to 61.9 and 56.5%, respectively. ROCs showed an area under the curve (AUC) of 0.63. Conclusion The PHQ-15 shows moderate sensitivity but limited efficiency with a cut point of 9 and can be a useful questionnaire in the occupational health setting.

Return to work among employees with mental health problems: Development and validation of a self-efficacy questionnaire

Because of the costs to both the organization and the individual, it is important that employees who are sick-listed with mental health problems are facilitated in their return to work (RTW). In order to provide adequate interventions, it is necessary to obtain a better understanding of the RTW process of people with mental health problems. Work-related self-efficacy (SE) might play a key role within this process. This paper describes the development and validation of the return-to-work self-efficacy’ scale (RTW-SE) for employees with mental health problems. Three Dutch samples of sick-listed employees were used to validate the 11-item instrument (N=2214). Based on the factor structure and reliability results, RTW-SE was conceptualized as a unitary construct. The associations with general SE, locus of control, coping, physical workload and mental health problems support the construct validity of this scale. Most importantly, RTW-SE proved to be a robust predictor of actual return to work within three months. The encouraging preliminary psychometric properties of the scale make it a potentially valuable tool in research and in clinical practice and occupational health care settings, both before and after employees have returned to work.

Health Disparities Among Health Care Workers

In this article we describe the process of an interdisciplinary case study that examined the social contexts of occupational and general health disparities among health care workers in two sets of New England hospitals and nursing homes. A political economy of the work environment framework guided the study, which incorporated dimensions related to market dynamics, technology, and political and economic power. The purpose of this article is to relate the challenges encountered in occupational health care settings and how these could have impacted the study results. An innovative data collection matrix that guided small-group analysis provided a firm foundation from which to make design modifications to address these challenges. Implications for policy and research include the use of a political and economic framework from which to frame future studies, and the need to maintain rigor while allowing flexibility in design to adapt to challenges in the field.

Promoting Women's Heart Health by Screening for Vascular Risk Factors Among Middle-Aged Women: Methods and Baseline Results from a Preventive Trial

The aim of this trial was to test the feasibility of a screening method based on the well-known risk factors of cardiovascular disease (CVD), and to evaluate the efficacy of 2 preventive strategies to lower the level of risk factors. Par- ticipants (n = 755) were female employees contacted during their health check visit at the age of 40, 45, 50, or 55 years. The risk-index consisted of body mass index, total serum cholesterol level, blood pressure, smoking and exercise activity. Psychosocial factors (e.g. vital exhaustion, optimism-hopelessness) were assessed with self-report questionnaires. High- risk women were invited to participate in a preventive intervention. Simple crossover design was used to evaluate the effi- cacy of personal feedback and health education as compared with feedback and group-based intervention programme. Fol- low-ups were completed at 6 and 12 months. Nearly one third (29.0 %) of the participants scored over the previously es- tablished risk-limit. Indicators of negative affectivity, i.e. vital exhaustion and hopelessness, associated significantly with the risk index after controlling for age and education. The feasibility of the screening method in an occupational health care setting proved to be good. The proportion of high-risk women was higher than expected but remained clearly lower than the 41 % prevalence in corresponding male cohorts. Results suggest that the screening method offers a good starting point for prevention.

Drinking habits and prevalence of heavy drinking among occupational healthcare patients

Objective. To estimate the proportion of heavy drinkers among occupational healthcare patients and evaluate their characteristics. Design. Patients visiting their doctor in six occupational health clinics were asked to complete a questionnaire containing the Alcohol Use Disorders Identification Test (AUDIT) and other questions concerning health. Setting. Occupational health services. Subjects. A total of 757 patients participated in the study. Main outcome measure. Heavy drinking was defined as having a score of 10 or more (men) or 8 or more (women) in the AUDIT questionnaire. Results. Of the men 114 (29%) and of the women 48 (13%) were heavy drinkers. Only smoking differentiated both male and female heavy drinkers from moderate drinkers among the clinically relevant characteristics. Conclusion. There are a considerable number of heavy drinkers among occupational healthcare patients. Heavy drinkers do not have any particularly specific characteristics except for the drinking that distinguish them from other patients. Thus, screening is necessary to identify heavy drinkers in occupational healthcare settings.

Prevalence of Obesity and Abdominal Obesity in Swedish Primary Care and Occupational Health Clinics

Background: The objective of this study was to describe the prevalence of obesity and abdominal obesity in the Swedish primary and occupational health care setting. Patients and Methods: Weight, height, and waist circumference (WC) were measured in 1,583 consecutive patients, aged between 18–65 years (46.4 ± 12.7 years), in 39 primary care and occupational health practices in Sweden, in 2006. The National Cholesterol Education Program (NCEP) WC reference values were used to define abdominal obesity (102 and 88 cm for men and women, respectively). Results: The distribution across obesity categories differed significantly between men and women with close to 70 and 55% of men and women, respectively, having a body mass index (BMI) ≧ 25. More men than women were overweight (BMI 25–29.9; 45.1 vs. 31.1%) and obese (BMI 30–34.9; 19.8 vs. 12.9%), but less men than women were morbidly obese (4.0 vs. 8.9%; BMI ≧ 35). Increasing prevalence with age was seen until age 60 for both overweight and obesity. More women than men were abdominally obese (42.5 vs. 32.7%; p < 0.001). Only 48 and 64% of the abdominally obese women and men, respectively, had a BMI ≧ 30. Conclusion: Compared to national Swedish data, the prevalence of overweight and obesity was higher in primary and occupational health care settings. Both morbid obesity and abdominal obesity were highly prevalent and more common in women, implying that awareness of sex differences may be important or that recommended cut-offs are not comparable across sex. Furthermore, a large fraction of the abdominally obese had a BMI < 30. Both BMI and WC may therefore be important to determine routinely and incorporate into treatment guidelines, in order not to miss patients at risk of obesity-related morbidity.

Prognostic Factors for Duration of Sick Leave Due to Low-Back Pain in Dutch Health Care Professionals

Information on prognostic factors for duration of sick leave due to low-back pain (LBP) is growing. In this prospective cohort study prognostic factors for duration of sick leave and course of disability were identified in a very early stage of sick leave due to LBP in an occupational health care setting. A total of 615 workers calling in sick from work due to LBP at an occupational health service (OHS) of one institution completed a questionnaire. Duration of follow-up was 26 weeks. Prognostic factors were identified by means of Cox regression analysis and multiple linear regression analysis, and explained variance was calculated. Median time to first return to work (RTW) was 5 days (Inter Quartile Range (IQR) = 2-12). Median time to lasting return to work (LRTW) was 6 days (IQR = 3-13). The final model for delayed RTW included self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, diminished mobility, and the interaction between care-seeking and diminished mobility. The final model for LRTW included: self-reported expected duration of sick-leave, treatment by GP or specialist, care-seeking, the interaction between the self-reported expected duration of sick-leave and seeking care at OHS, complaints due to job stress, diminished mobility, and the interactions between expected duration of more then 10 days and seeking OP care and diminished mobility. Median total days on sick leave (TDSL) was 6 days (IQR = 3-13 days). The final model for TDSL included: age, expected duration of sick leave, treatment by GP or medical specialist, seeking OP care, complaints due to physical load, and diminished mobility. Explained variance (R2) of these models ranged from 30 to 35%. Poor prognosis for duration of sick leave can be identified by means of a simple questionnaire administered on the first day of sick leave. Workers at high risk for longer duration of sick leave (all outcomes) expected to stay off work longer, were already being treated by a MD, sought OP care, and had diminished mobility. In case of delayed LRTW workers reported job stress as a possible cause of sick leave. Interactions were found in both RTW and LRTW between care-seeking and diminished mobility and in LRTW between expected duration of sick leave and seeking OP care. Older age increased TDSL with borderline significance.

Dutch practice guidelines for managing adjustment disorders in occupational and primary health care.

Stress-related disorders, especially adjustment disorders, are widespread among working populations and are responsible for high costs in terms of suffering, sick leave, disability, and economic losses. Despite their high prevalence, there has been relatively little research on the effectiveness of treatments in an occupational health care setting. Guidelines for occupational physicians and general practitioners in relation to mental health problems were recently developed in The Netherlands and are discussed in this article. The guidelines provide a classification based on terms that are already used in the profession and are consistent with the diagnosis "adjustment disorder". They give recommendations for guidance and treatment on the basis of existing evidence, experience in adjacent fields, and consensus procedures. They are based on cognitive behavioral principles, mainly stress inoculation training and graded activity, and aim to enhance the problem-solving capacity of patients in relation to the work environment. The aim of this paper is to contribute to the exchange of and a discussion on methods and good practices in primary and occupational health care.

Occupational health guidelines for the management of low back pain: an international comparison

Background: The enormous socioeconomic burden of low back pain emphasises the need for effective management of this problem, especially in an occupational context. To address this, occupational guidelines have been...

The Depression Anxiety Stress Scales (DASS): detecting anxiety disorder and depression in employees absent from work because of mental health problems

Aims: To (1) evaluate the psychometric properties and (2) examine the ability to detect cases with anxiety disorder and depression in a population of employees absent from work because of...

Complying with the Health Insurance Portability and Accountability Act

The Privacy Rule: Limits the use and disclosure of PHI to purposes of treatment, payment, or routine health care operations. Requires covered entities to provide advance notice to the public of its policy governing disclosure of PHI. Requires entities covered by the Standard to secure general client consent to use and to disclose PHI for treatment, payment, or routine health care operations and to obtain specific client authorization to use or to disclose PHI for all other purposes unless the disclosure is specifically permitted without consent or authorization (e.g., a covered entity may disclose PHI to a health care oversight agency such as the Office of the Inspector General without first obtaining client authorization). In certain situations, a covered entity need only obtain client agreement to disclose PHI which may be oral or inferred from the circumstances surrounding the disclosure. For example, a covered entity could disclose PHI to a relative caring for the individual who is the subject of the health information. Expects covered entities to take measures to protect PHI from both inadvertent and deliberate misuse and disclosure. Requires, except in certain circumstances, the amount of PHI disclosed on any occasion to be limited to the minimum necessary to achieve the purpose of the disclosure. Gives individuals more control of their health information by permitting them to review and amend health information pertaining to themselves and to demand an accounting of persons to whom their health information has been disclosed. Establishes terms under which a covered entity may disclose PHI to a business associate. Permits states to maintain state laws that are more stringent than the Privacy Rule. The statute provides for significant civil and criminal penalties for failure to comply with the Standards. Violations are punishable by fines as much as $250,000 and 10 years imprisonment. The HHS, Office of Civil Rights is charged with enforcing the Standards. The HHS is expected to issue a single Enforcement Rule applicable to all three of the HIPAA Administrative Simplification Standards. Many worksite records will not be protected under the HIPAA Privacy Rule because employers are not covered entities and few occupational health professionals meet the criteria of being considered a covered entity. Nevertheless, occupational health professionals need to be knowledgeable about the application of HIPAA in the occupational health care setting. Furthermore, given that the Rule does not preempt state privacy laws that are more stringent than the Standards, occupational health professionals should monitor legislative activity related to privacy in the states in which they practice. To date, Oregon, Texas, and New Jersey have broadened HIPAA's definitions to create more covered entities and services.

Women's knowledge of osteoporosis

Osteoporosis affects one in four women over the age of 65 and is a major cause of hip fractures that place women in nursing homes. In this study of 247 women, their knowledge of osteoporosis was assessed with the Facts on Osteoporosis Quiz. The instrument measured their responses to questions about self-care practices related to risk factors and preventive behavior associated with osteoporosis. Respondents came from occupational and primary health care settings and a health fair. The women ranged in age from 22 to 84 years. Findings indicated that the majority of women had inadequate knowledge of osteoporosis risk factors and preventive behavior.

Cardiovascular risk determination: discrepancy between total cholesterol evaluation and two compound laboratory indices in Norway.

To compare group classification of cardiovascular risk by two compound laboratory indices with classification according to the serum total cholesterol concentration alone. Healthy employees were defined as low and high cardiovascular risk subjects according to their total cholesterol concentration or two compound indices of blood lipid components-the total cholesterol: high density lipoprotein (HDL) cholesterol ratio and an atherogenic index defined as ([total cholesterol-HDL cholesterol]*[apolipoprotein B])/([HDL cholesterol]*[apolipoprotein A-I]). Cut off values to distinguish between low and high risk subjects were as follows: total cholesterol 6.5 mmol/l, HDL cholesterol 0.9 mmol/l, apolipoprotein A = 1.8 g/l, and apolipoprotein B = 1.3 g/l. These gave total: HDL cholesterol ratio and atherogenic index cut off values of 7.2 and 4.5 respectively. An occupational health service in a non-manufacturing company in Norway. A total of 112 male and 117 female employees. The mean body mass index values were 25.6 and 23.6 kg/m2 and the mean ages 39.8 and 40.1 years in men and women respectively. Those with cardiovascular, diabetic, or renal diseases were excluded. Serum total cholesterol, HDL cholesterol, apolipoproteins A-I and B, lipid peroxidation, blood pressure, smoking, physical activity, and fruit, vegetables, and salt in the diet were determined. The cut off values allocated 19%, 7%, and 40% as high risk subjects according to total cholesterol, total: HDL cholesterol, and the atherogenic index respectively. The mean age was two to four years higher in the high risk groups. Cardiovascular risk in siblings and no reported physical activity were more prevalent in those high risk groups defined by the compound indices than by total cholesterol alone, as was a high body mass index and a measure of lipid peroxidation. Grouping according to total cholesterol failed to allocate heavy smokers mainly to the high risk group. Diet variables did not demarcate clearly between indices. There is considerable variability in classification into high and low risk subjects when using the total cholesterol concentration alone compared with compound risk indices. Smoking was more prevalent in the high risk groups defined by the compound indices than by total cholesterol. These findings call for caution when total cholesterol is used to estimate cardiovascular risk in epidemiological studies, and even more so at individual counselling in occupational or primary health care settings.

Psychosocial stress and job satisfaction in female office employees with and without neck-shoulder symptoms

Abstract The objective of this research performed in a Finnish occupational health care setting was to describe the annual prevalence of neck and shoulder symptoms in female office employees and to test whether or not these symptoms were associated with psychosocial stress, job satisfaction and health locus of control. The subjects consisted wholly of female office employees (n = 232) at one local bank and three insurance offices, chosen on a voluntary basis. The annual prevalence of disturbing neck-shoulder symptoms among female office employees was 43.3%. An association of these symptoms with psychosomatic symptoms, poor general job satisfaction and its two subdimensions, work content and perception of the healthiness of the working environment, was noticed. The subjects with neck-shoulder symptoms had a significantly higher score of feelings of external control (fatalism) than those without symptoms. The results lead to the conclusion that neck-shoulder symptoms are common amongst female office employe...

Multidimensional Assessment of Mental State in Occupational Health Care—Combined Application of Three Questionnaires: Tokyo University Egogram (TEG), Time Structuring Scale (TSS), and Profile of Mood States (POMS)

We attempted to develop a brief test battery to assess mental state for use in occupational health care settings. As a first step, we focused on the following three psychosocial aspects: ego state, behavioral pattern, and mood state which were considered to be closely related to mental state. To evaluate these parameters, we selected three established self-rating questionnaires: the Tokyo University Egogram for ego state, the Time Structuring Scale for behavioral pattern, and the Profile of Mood States for mood state. The combination of these three questionnaires was applied on 300 healthy company employees and school teachers (170 males and 130 females). Five ego-state factors (Critical Parents, Nurturing Parents, Adult, Free Child, and Adapted Child), five behavioral pattern factors (Withdrawal, Rituals and Pastimes, Activities, Intimacy, and Games), and six mood state factors (Tension–Anxiety, Depression–Dejection, Anger–Hostility, Vigor–Activity, Fatigue–Inertia, and Confusion–Bewilderment) were scored. Of 85 correlations between test factors, 49 in males and 61 in females were not significant, indicating that each test in this battery assessed aspects of mental state rather independent of those assessed by the others. However, significant correlations ( P < 0.05) were observed for remaining pairs of test factors, indicating that these three parameters were also interrelated with each other, indicating that mental state could be elucidated more comprehensively by assessing all three psychosocial parameters than by assessing only one. The possibility that this battery could be used in the future in worksite health promotion programs is discussed.

Occupational Health Hazards

Nurses from occupational health care settings around the world, interpreting the theme “Communication, Health Care, and the Community,” presented papers at the First International Conference on Occupational Health Nursing in Edinburgh, Scotland in October, 1986. In keeping with AAOHN's commitment to an international perspective, this is the fifth in a five part series of articles printed in the AAOHN Journal.

Haematologic parameters as risk factors for cardiac infarction, in an occupational health care setting

It is still controversial, whether moderately high haematocrit (Ht) and haemoglobin (Hb) values are risk factors for coronary heart disease. Using the computerized data-system of the Periodical Medical Examination (PME) of Phillips' International Electrical Company, a- case-control study was carried out. Cases were male workers ( n = 104, from 50 to 60 years of age) who had suffered a first, non-fatal myocardial infarction, and who had had a PME prior (on the average 16 months) to the occurrence of infarction. For each case two age-matched healthy controls were selected from the PME-attendancy list (=208). For each subject information was abstracted from the PME-records about haematologic parameters and covariates (smoking, cholesterol, blood pressure, pulse-rate, weight, height, FEV 5 consumption of antihypertensive agents). After dichotomizing the haematocrit and haemoglobin values at their whole sample means (0.461/1 and 9.7 mmol/l respectively) in “low” (lower than or equal to the mean) and “high” (greater than the mean), crude odds-ratio's of 2.7 (95% Cl: 1.6-4.6) and 2.1 (95% CI: 1.2–3.6) were found for Ht and Hb respectively, when comparing “high” with “low” levels. The associations between Ht and Hb, and the occurrence of myocardial infarction were still present after controlling for covariates using multiple logistic regression models, entering the continuous variables with their exact values. After adjustment, mean corpuscular volume (MCV) also appeared to be correlated with infarction. Our results confirm the hypothesis that moderately high haematocrit and—to a lesser extent—haemoglobin and MCV-values are risk factors for the occurrence of myocardial infarction.

Traditional and Modern Medicine in Worker Health Care

Nurses from occupational health care settings around the world, interpreting the theme “Communication, Health Care, and the Community,” presented papers at the First International Conference on Occupational Health Nursing in Edinburgh, Scotland in October, 1986. In keeping with AAOHN's commitment to an international perspective, this article is Part II of a five part series of articles that will be printed in the AAOHN JOURNAL. Next month, Part III of the series will feature, “Occupational Health Nursing World Wide.”

Health Education in the Workplace

Nurses from occupational health care settings around the world, interpreting the theme “Communication, Health Care, and the Community,” presented papers at the First International Conference on Occupational Health Nursing in Edinburgh, Scotland in October, 1986. In keeping with AAOHN's commitment to an international perspective, this article is Part I of a five part series of articles that will be printed in the AAOHN JOURNAL. Next month, Part II of the series will feature, “Traditional and Modern Medicine in Worker Health Care.”

Protocols: guidelines for practice in occupational health care settings.

Protocols: guidelines for practice in occupational health care settings.