Workforce Status Research Articles

Is there a volume-quality relationship within the independent treatment centre sector? A longitudinal analysis

BackgroundThe number of independent treatment centres (ITCs) has grown substantially. However, little is known as to whether the volume-quality relationship exists within this sector and whether other possible organisational factors mediate this relationship. The aim of this study is to gain a better understanding of such possible relationships.MethodsData originate from the Dutch Health and Youth Care Inspectorate (IGJ) and the Dutch Patients Association. We used longitudinal data from 4 years (2014–2017) including three different quality measures: 1) composite of structural and process indicators, 2) postoperative infections, and 3) patient satisfaction. We measured volume by the number of invasive treatments. We adjusted for three important organisational characteristics: (1) size of workforce, (2) chain membership, and (3) ownership status. For statistical inference, random effects analysis was used. We also ran several robustness checks for the volume-quality relationship, including a fractional logit model.ResultsITCs with higher volumes scored better on structure, process and outcome (i.e. postoperative infections) indicators compared to the low-volume ITCs – although only marginally on outcome. However, ITCs with higher volumes do not have higher patient satisfaction. There is a decreasing marginal effect of volume – in other words, an L-shaped curve. The effect of the intermediating structural factors on the volume-quality relationship (i.e. workforce size, chain membership and ownership status) is less clear. Our findings suggest that chain membership has a negative influence on patient satisfaction. Furthermore, for-profit providers scored better on the Net Promoter Score.ConclusionsOur study shows with some certainty that the quality of care in low-volume ITCs is lower than in high-volume ITCs as measured by structural, process and outcome (i.e. postoperative infection) indicators. However, the size of the effect of volume on postoperative infections is small, and at higher volumes the marginal benefits (in terms of lower postoperative infections) decrease. In addition, volume is not related to patient satisfaction. Furthermore, the association between the structural intermediating factors and quality are tenuous.

보건소 표준 업무 분류체계 개발

Objectives: The purpose of this study is to analyze the work area of the public health center and to establish a standard work classification system. Methods: We analyzed the general workforce status and Full Time Equivalent using public health information system. At first phase we classified the work of public health center considering Regional public health act and public health functions. Finally, we considered the establishment of sub-organizations in the public health center and classified them into essential tasks and transferable tasks. Results: The work of public health center was classified into policy development, evaluation and research, creating healthy environment and ensuring essential health services. Conclusions: This study suggest a new standard work classification system of public health center in response to change in healthcare environment.

디자인 분야 및 디자인 업무유형별 디자인 인력 현황 분석: 한국, 영국, 미국을 중심으로

디자인 분야 및 디자인 업무유형별 디자인 인력 현황 분석: 한국, 영국, 미국을 중심으로

Upscaling the pharmacy profession in Lebanon: workforce distribution and key improvement opportunities

BackgroundThe critical role pharmacists play in the healthcare system necessitates close monitoring of their supply, distribution, and competencies. This is especially relevant considering the global increase in the demand for pharmacists. In Lebanon, the pharmacy profession is facing several challenges related to the unplanned supply of pharmacists. The aim of the study is to analyze the Order of Pharmacists registration database and generate workforce distribution over the last six decades.MethodsThis study entailed a detailed database analysis of a deidentified subset of the Order of Pharmacists in Lebanon registration records for years 1954–2018. The analysis generated workforce distribution in terms of growth in number, distribution by gender, age distribution, geographic location, workforce status, sector of employment, and employment position. A descriptive analysis was carried out with cross-tabulations to identify distribution across selected variables.ResultsThe pharmacy profession in Lebanon witnessed significant growth over the period of analysis. The “Community” was the most common employment sector (63%), followed by “Pharmaceutical Sector” (24%) and “Hospitals” (5%). The high ratio of pharmacists to 10 000 population (20.3) was contrasted by a low ratio of hospital pharmacist per hospital and per 100 hospital beds (1.9 and 1.7, respectively).The high pharmacist to population ratio is indicative of an oversupply of pharmacists precipitated by poor workforce planning. While oversupply did not result in high unemployment, it may have negatively affected the income of pharmacists and their adherence to the professional and ethical requirements of their job. Despite the large number of pharmacists in Lebanon, findings elicit concerns over the adequacy and safety of pharmacists’ services in hospitals with a low ratio of hospital pharmacists to 100 hospital beds.ConclusionThis study unearthed several opportunities and concerns related to planning the supply, distribution, regulation, and the professional scope of practice of pharmacists in Lebanon. A concerted multi-stakeholder effort to address some of the identified challenges will not only improve the professional status of pharmacists but will also enhance the safety and efficiency of pharmaceutical care in the country.

Does the density of the health workforce predict adolescent health? A cross-sectional, multilevel study of 38 countries.

Scant evidence exists on the relation between the availability of health professionals and adolescent health, and whether the size of the health workforce equally benefits adolescents across socioeconomic strata. We conducted a cross-sectional analysis of adolescent health in 38 countries. Data from 218 790 adolescents were drawn from the 2013/2014 Health Behavior in School-aged Children survey. We used multilevel regression analyses to examine the association between the density of the health workforce and psychosomatic and mental health symptoms with differences in country wealth and income inequality controlled. A higher density of psychologists was associated with better self-reported mental health in adolescents (P = 0.047); however, this finding was not robust to sensitivity analyses. The densities of physicians and psychiatrists were not significantly associated with better adolescent psychosomatic or mental health. Cross-level interactions between the health workforce and socioeconomic status did not relate to health, indicating that larger health workforces did not reduce socioeconomic differences in adolescent health. This study found that adolescents in countries with a higher density of health providers do not report better psychosomatic or mental health. Other social or structural factors may play larger roles in adolescent health.

A 2015–2016 Survey of American Board of Cardiovascular Perfusion Certified Clinical Perfusionists: Perfusion Profile and Clinical Trends

To document the current perfusion workforce status and to anticipate the future demands of an ever-changing perfusion workplace environment, a valid survey is needed to help guide the future of the perfusion workforce. The American Board of Cardiovascular Perfusion (ABCP) sponsored a survey of Certified Clinical Perfusionist (CCP) demographic and clinical trends that was linked electronically to the 2015–2016 ABCP online recertification process. Of 3,875 eligible CCP’s, 3,056 (78.9%) responded to the survey. The 12 survey questions covered the topics of gender, age, education levels, years of clinical experience, annual clinical activity exposure, high fidelity simulation experience, recertification requirement satisfaction and professional activity requirement contentment. The results of the ABCP annual survey are being published in accordance with the ABCP’s commitment to establish and maintain interactive communication with the community of CCPs. The goal of this survey is to present the perfusion and health-care community with important statistics related to the current field of perfusion and establish trends to guide the future of perfusion.

Economic Burden of Relapsed or Refractory Multiple Myeloma: Results from an International Trial

Background: The direct (medical utilization) cost of relapsed or refractory multiple myeloma (RRMM) has been documented; recent studies are now exploring indirect costs as well (Goodwin et al, Cancer Nurs 2013;36(4):301-8; Moreau et al, Haematologica 2014;99(suppl 1):214-5). Healthcare decision makers are interested in identifying meaningful cost offsets from new therapies providing substantially better clinical outcomes (Cook, J Manag Care Pharm 2008;14(7 Suppl):19-25).Methods: Data from a patient economic questionnaire inquiring about recent disease-specific medical utilization, workforce status, and caregiver burden was analyzed from RRMM patients in a Phase 2, multi-site, international, randomized, controlled study (n = 307; Orlowski et al, Am J Hematol 2015;90(1):42-9). Direct and indirect costs of illness were characterized using standard descriptive statistics among those at study entry who were randomized and subsequently completed a baseline economic questionnaire. Patient-reported health questionnaires included the Brief Pain Inventory (BPI) pain intensity and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scales; severity thresholds based on literature and developer recommendations for each were applied in analysis.Results: Patients who answered the questionnaire (n = 267) were 54% male, 92% Caucasian, mean and median age of 63 years, and median ECOG status of 1; while 31% reported moderate to severe pain, 71% reported moderate to severe fatigue. At least 1 hospital visit was reported by 107 (42%) respondents over the last 6 months, while 185 (71%) and 86 (33%) reported specialist and family physician visits, respectively, over the last 3 months (Table). While only 11% of the reporting population was working, 48% of these who weren't working indicated it was due to their disease and 39% of those working reported disease-driven absenteeism of at least 1 day over the last 4 weeks. Of the 80% that were retired, 32% indicated it was an early retirement caused by RRMM.Conclusions: These data document the substantial direct medical costs for RRMM patients but also the notable indirect, social costs associated with this disease. The clinical and demographic profile of these patients were similar to other multi-site, international RRMM studies, suggesting these results are broadly applicable (Richardson et al, Blood 2014;123(12):1826-32; Siegel et al, Blood 2012;120(14):2817-25; Kumar et al, Leukemia 2012;26(1):149-57). Longitudinal studies tracking treatment impact on economic outcomes, including direct and indirect cost offsets, are needed to understand the full social impact of new therapies in MM (Cook, 2008;14(7 Suppl):19-25).TablePatient-reported Economic Impact of RRMMN (%) of patientsDisease-driven hospital visits (prior 6 months)0: 151 (58%)≥ 1: 107 (42%)Disease-driven specialist visits (prior 3 months)0: 75 (28.9%)≥ 1: 185 (71.1%)Disease-driven family practice visits (prior 3 months)0: 174 (66.9%)≥ 1: 86 (33.1%)Working nowYes: 28 (11.6%)No: 236 (89.4%)Disease driven absentee days (prior 4 weeks)0: 17 (61%)≥ 1: 10 (39%)Not working now due to diseaseYes: 113 (48.7%)No: 119 (51.3%)RetiredYes: 188 (80%)No: 47 (20%)Early retirement due to diseaseYes: 61 (32.4%)No: 127 (67.6%)Disease-driven disability compensationYes: 96 (36.9%)No: 164 (63.1%)Working days missed by caregiver0: 201 (80.1%)≥ 1: 50 (19.9%) DisclosuresRobinson:Janssen: Employment. Orlowski:Janssen: Membership on an entity's Board of Directors or advisory committees; Onyx Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; Acetylon Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Bristol-Myers Squibb: Membership on an entity's Board of Directors or advisory committees, Research Funding; Array Biopharma: Membership on an entity's Board of Directors or advisory committees, Research Funding; Millennium Pharaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Spectrum: Research Funding; Biotheryx: Membership on an entity's Board of Directors or advisory committees; Forma Therapeutics: Membership on an entity's Board of Directors or advisory committees; Genentech: Membership on an entity's Board of Directors or advisory committees. He:Janssen: Employment. Lam:Janssen: Employment. Zhao:Janssen: Employment. Cakana:Janssen: Employment.

The current workforce status of prehospital care in china

The Chinese Emergency Medicine System is primarily composed of three sectors; prehospital care, emergency department in a city hospital, and intensive care unit ward. While all sectors are integral to the system, the prehospital care system is less developed than the others. There are many possible contributors to the under-development of the prehospital care system, however, workforce issues may play a significant role. Firstly, there is no officially recognised paramedic profession in China. The staff members working in the prehospital care system are medical doctors, registered nurses, patient-carriers, and drivers. Secondly, these doctors and nurses are either over-qualified or under-qualified for practicing in the prehospital care system. Lastly, Chinese health professionals have taken actions to improve the current workforce status with initiatives such as short-term training workshops for doctors and nurses, implementation of a trial unit in a university, and development of a Major Degree of Emergency Medicine in a medical university. All of these actions are important steps toward improving the current workforce status in the prehospital care system. However, a long term workforce development plan is still essential for the Chinese system, and implementation of a professional paramedic education system in a medical university/college in China, may provide the solution.

An Instrumental Variable Probit (IVP) analysis on depressed mood in Korea: the impact of gender differences and other socio-economic factors.

Depression is a mental health state whose frequency has been increasing in modern societies. It imposes a great burden, because of the strong impact on people's quality of life and happiness. Depression can be reliably diagnosed and treated in primary care: if more people could get effective treatments earlier, the costs related to depression would be reversed. The aim of this study was to examine the influence of socio-economic factors and gender on depressed mood, focusing on Korea. In fact, in spite of the great amount of empirical studies carried out for other countries, few epidemiological studies have examined the socio-economic determinants of depression in Korea and they were either limited to samples of employed women or did not control for individual health status. Moreover, as the likely data endogeneity (i.e. the possibility of correlation between the dependent variable and the error term as a result of autocorrelation or simultaneity, such as, in this case, the depressed mood due to health factors that, in turn might be caused by depression), might bias the results, the present study proposes an empirical approach, based on instrumental variables, to deal with this problem. Data for the year 2008 from the Korea National Health and Nutrition Examination Survey (KNHANES) were employed. About seven thousands of people (N= 6,751, of which 43% were males and 57% females), aged from 19 to 75 years old, were included in the sample considered in the analysis. In order to take into account the possible endogeneity of some explanatory variables, two Instrumental Variables Probit (IVP) regressions were estimated; the variables for which instrumental equations were estimated were related to the participation of women to the workforce and to good health, as reported by people in the sample. Explanatory variables were related to age, gender, family factors (such as the number of family members and marital status) and socio-economic factors (such as education, residence in metropolitan areas, and so on). As the results of the Wald test carried out after the estimations did not allow to reject the null hypothesis of endogeneity, a probit model was run too. Overall, women tend to develop depression more frequently than men. There is an inverse effect of education on depressed mood (probability of -24.6% to report a depressed mood due to high school education, as it emerges from the probit model marginal effects), while marital status and the number of family members may act as protective factors (probability to report a depressed mood of -1.0% for each family member). Depression is significantly associated with socio-economic conditions, such as work and income. Living in metropolitan areas is inversely correlated with depression (probability of -4.1% to report a depressed mood estimated through the probit model): this could be explained considering that, in rural areas, people rarely have immediate access to high-quality health services. This study outlines the factors that are more likely to impact on depression, and applies an IVP model to take into account the potential endogeneity of some of the predictors of depressive mood, such as female participation to workforce and health status. A probit model has been estimated too. Depression is associated with a wide range of socio-economic factors, although the strength and direction of the association can differ by gender. Prevention approaches to contrast depressive symptoms might take into consideration the evidence offered by the present study.

Mental Health and Wellbeing of Older Workers in Australia

Population ageing has catalyzed worldwide social and political reform to encourage continued work and delayed retirement. These changes necessitate an understanding of the impact of working later in life on mental health and wellbeing. The aim of this study was to examine the relationship of age and work force status (working full time, part time, or retired) with mental health and wellbeing in Australian men and women past the average retirement age of 60. The effects of potential covariates (i.e., marriage, physical health, and financial stress) were also examined, and the impact of low qualification levels and physically demanding occupations were explored. A total of 2,149 men and women aged 60–79 from the 2007 National Survey of Mental Health and Wellbeing were included in the analyses. Results indicated that older age groups, people working part time, and men reported the best mental health and wellbeing outcomes. A minority of the significant main effects became be nonsignificant after controlling for marriage, financial stress, and physical health conditions in the models. Qualification levels and physically demanding occupations were not significant predictors for mental health and wellbeing. Taken together, these results suggest that there does not appear to be categorically beneficial or harmful outcomes for men and women working later in life, nor for those who have retired. People working part time later in life consistently reported the best mental health and wellbeing outcomes. Implications of the results are discussed in the context of the literature.

Early childhood policy and practice in England: twenty years of change

This article offers a chronological account and critical appraisal of changes to early childhood education and care (ECEC) services in England over the past 20 years. It describes the policy initiatives, educational interventions and research programmes introduced by successive governments that have effected significant changes to ECEC since 1990. The article covers four key areas: policies designed to reduce social inequality; the professionalisation of the children's workforce and changing status of adults employed in preschool education and care settings; changes to early years pedagogy and the early years curriculum and finally how major research programmes such as the Effective Provision of Preschool Education project and the Millennium Cohort Study have informed our understanding of the effects of social disadvantage and the characteristics of ‘high-quality’ preschool provision that can alleviate this. There is now persuasive evidence that investment in state-maintained early education is highly cost effective, particularly for disadvantaged children. The current government, however, is shifting the burden of funding for professional training and high-quality integrated services for children and families from the state to the private and voluntary sectors. Time will tell if this is a backward step or movement in the right direction.

Estimation of nursing staff in selected hospitals of ilam and ahvaz provinces, Western iran.

The nurses as the largest group among different groups of hospital workforce play a crucial role in success of the hospital activities and promotion of community health. This study aimed to obtain an estimation of the necessary nursing workforce status in educational hospitals affiliated to Ilam and Ahvaz University of Medical Sciences based on the scientific formula. This research was a cross sectional-descriptive study, which was done in hospitals affiliated to Ilam and Ahvaz University of Medical Sciences during 2010. Using three researcher-made forms, data was collected from all clinical, para-clinical, financial, administrative and support departments of hospitals. Data was analyzed in accordance to the standards of Iran's Ministry of Health and Medical Education using the Excel software. The results showed that the nursing staffs in the 42 wards (89.5 %) were lower than the standards, only one ward (2 %) matched the standards and the rest of the wards (8.5%) were higher than the standards. The organizational dislocation (utilization of nurses in non-related jobs) of nursing staffs obtained for Imam Khomeini of Ilam, Mostafa Khomeini, Taleghani, Razi and Imam Khomeini of Ahvaz Hospitals were 8, 5, 3, 8 and 21, respectively. Generally, the studied hospitals were faced with a lack of nursing manpower and distribution of manpower was not appropriate. Proper planning and management of manpower in accordance with the lack of personnel, compensates and achieves the standards required for hospital's nursing manpower and this would lead to an increase in the efficiency of hospitals activities and can provide satisfaction for the nursing staff.

Health&WealthMOD2030: A Microsimulation Model of the Long Term Economic Impacts of Disease Leading to Premature Retirements of Australians Aged 45-64 Years Old.

Policymakers in Australia, like in most OECD countries, have recognised the importance of early retirement due to ill health on individuals and families, as well as on the budget balance when planning for the health needs of an ageing population. In order to understand these effects, a unique microsimulation model, called Health&WealthMOD2030, was built to estimate the impacts of early retirement due to ill health on labour force participation, personal and household income, economic hardship (poverty), and government taxation revenue, spending and GDP in the years 2010, 2015, 2020, 2025 and 2030. This paper describes the construction of Health&WealthMOD2030. The model cap tures the long term projections of demographic change, changing labour force participation patterns, real wages growth and trends in major illnesses affecting the older working age population. The base population of Health&WealthMOD2030 are the individuals aged 45-64 years with information on their workforce status and health from the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (SDAC) 2003 and 2009. Projected estimates of income, taxation, income support payments, savings and superannuation from the National Centre for Social and Economic Modelling (NATSEM's) dynamic microsimulation model Australian Population and Policy Simulation Model (APPSIM) were synthetically matched with the base population. Health&WealthMOD2030 project forward the economic impacts of early retirement from ill health to 2030. This will fill substantial gaps in the current Australian evidence of health conditions that will keep older working age Australians out of the labour market over the long-term.

Is the reporting timeliness gap for avian flu and H1N1 outbreaks in global health surveillance systems associated with country transparency?

BackgroundThis study aims to evaluate the length of time elapsed between reports of the same incidents related to avian flu and H1N1 outbreaks published by the WHO and ProMED-mail, the two major global health surveillance systems, before and after the amendment of the International Health Regulations in 2005 (IHR 2005) and to explore the association between country transparency and this timeliness gap.MethodsWe recorded the initial release dates of each report related to avian flu or H1N1 listed on the WHO Disease Outbreak News site and the matching outbreak report from ProMED-mail, a non-governmental program for monitoring emerging diseases, from 2003 to the end of June 2009. The timeliness gap was calculated as the difference in days between the report release dates of the matching outbreaks in the WHO and ProMED-mail systems. Civil liberties scores were collected as indicators of the transparency of each country. The Human Development Index and data indicating the density of physicians and nurses were collected to reflect countries’ development and health workforce statuses. Then, logistic regression was performed to determine the correlation between the timeliness gap and civil liberties, human development, and health workforce status, controlling for year.ResultsThe reporting timeliness gap for avian flu and H1N1 outbreaks significantly decreased after 2003. On average, reports were posted 4.09 (SD = 7.99) days earlier by ProMED-mail than by the WHO. Countries with partly free (OR = 5.77) and free civil liberties scores (OR = 10.57) had significantly higher likelihoods of longer timeliness gaps than non-free countries. Similarly, countries with very high human development status had significantly higher likelihoods of longer timeliness gaps than countries with middle or low human development status (OR = 5.30). However, no association between the timeliness gap and health workforce density was found.ConclusionThe study found that the adoption of IHR 2005, which contributed to countries’ awareness of the importance of timely reporting, had a significant impact in improving the reporting timeliness gap. In addition, the greater the civil liberties in a country (e.g., importance of freedom of the media), the longer the timeliness gap.

How Do Educational Attainment and Occupational and Wage-Earner Statuses Affect Life Satisfaction? A Gender Perspective Study

The main objective of this paper is to analyze the impact of education on life satisfaction once indirect effects through income, health, participation in the workforce or professional status are controlled for. The focus is placed on gender differences, thus studying whether the effects of education on life satisfaction differ for women and men and whether occupational variables and the individual’s role in the household may mediate this relationship. Among the results, we find that gender differences in life satisfaction tend to disappear when account is taken of the individuals’ role as primary wage earner in the household. Regarding education, our results suggest that its impact on satisfaction with life differs for women and men: both direct and indirect effects of education are found for women whereas no direct effects of education appear in the case of men, but only indirect effects through enhanced job opportunities and professional status.

The World Health Organization Disability Assessment Scale, WHODAS II: Reliability and validity in the measurement of activity and participation in a spinal cord injury population

To evaluate the reliability and validity of WHODAS II within the spinal cord injury population. Sixty-three people with traumatic spinal cord injury. The World Health Organization Disability Assessment Scale II (WHODAS II), Craig Handicap Assessment and Reporting Technique, and Medical Outcomes Study 36-item Short-Form Health Survey (MOS SF-36) were administered at 2 years post discharge from rehabilitation. Distribution, reliability, discriminant validity, and convergent/divergent validity were evaluated using classical tests. Rasch analyses were applied to assess dimensionality, item spread, and person/item reliability. Cronbach's alpha coefficients ranged from 0.61 (getting around) to 0.97 (participation). Ceiling effects were present in 4 out of 6 domains. WHODAS II discriminated between levels of impairment and work force status on 'self-care', 'getting around', 'life activities', and total score. Correlations with MOS SF-36 supported convergent/divergent validity. Five items didn't fit the Rasch model. The item/person map reveald a shortage of items able to differentiate the more able person. WHODAS II demonstrated good person and item separation and reliability. This study provides preliminary support for reliability and validity of WHODAS II in a spinal cord injured population. Limitations were noted for dimensionality and item person distribution. Findings need to be confirmed in larger samples.

The association of pain with labor force participation, absenteeism, and presenteeism in Spain

Objectives:The aims of this paper are to generate estimates of the association between the severity and frequency of pain in Spain and (i) labor force participation and workforce status and (ii) patterns of absenteeism and presenteeism for the employed workforce.Methods:Data are from the internet-based 2010 National Health and Wellness Survey (NHWS). This survey covers both those who report experiencing pain in the last month as well as the no-pain population. An estimated 17.25% of adults in Spain report experiencing pain in the past month. A series of regression models are developed with the no-pain group as the reference category. The impact of pain, categorized by severity and frequency, is assessed within a labor supply framework for (i) labor force participation and (ii) absenteeism and presenteeism. Both binomial and multinomial logistic models are estimated.Results:The results demonstrate that severe and moderate pain has a significant, substantive, and negative association with labor force participation and, together with the experience of mild pain, a substantive impact on absenteeism and presenteeism within the employed workforce. Compared to no-pain controls, the strongest association is seen in the case of severe pain, notably severe daily pain and labor force participation (odds ratio 0.363; 95% CI: 0.206–0.637). The association of severe pain with labor force participation is also significant (odds ratio 0.356; 95% CI: 0.217–0.585). There is a clear gradient in the association of pain severity and frequency with labor force participation. The impact of pain is far greater than the potential impact of other health status measures (e.g., chronic comorbidities and BMI). Labor force participation is also adversely associated with pain experience. Persons reporting severe daily pain are far more likely not to be in the labor force (relative probabilities 0.339 vs 0.611). The experience of pain, notably severe and frequent pain, also outstrips the impact of other health status factors in absenteeism and presenteeism. In the former case, the odds ratio associated with severe daily pain is 16.216 (95% CI: 5.127–51.283), which contrasts to the odds ratio for the Charlson comorbidity index of 1.460 (95%CI: 1.279–1.666). Similar results hold for presenteeism. The contribution of moderate and mild pain to absenteeism and presenteeism is more marked than for labor force participation.Conclusions:The experience of pain, in particular severe daily pain, has a substantial negative impact both on labor force participation in Spain as well as reported absenteeism and presenteeism. As a measure of health status, it clearly has an impact that outstrips other health status measures. Whether or not pain is considered as a disease in its own right, the experience of chronic pain, as defined here, presents policy-makers with a major challenge. Programs to relieve the burden of pain in the community clearly have the potential for substantial benefits from societal, individual, and employer perspectives.

The impact of pain on labor force participation, absenteeism and presenteeism in the European Union

Objectives:The aims of this paper are to generate estimates of the association between the experience and burden of pain, by severity and frequency, with (1) labor force participation and workforce status in five EU countries (the UK, France, Spain, Germany and Italy) and (2) patterns of absenteeism and presenteeism for the employed workforce.Methods:Data are from the internet-based 2008 National Health and Wellness Survey (NHWS). This survey covers both those who report experiencing pain in the last month as well as the no pain population. A series of regression models are developed with the no pain group as the reference category. The impact of pain, categorized by severity and frequency reported, is assessed within a labor supply framework for (1) labor force participation and (2) absenteeism and presenteeism. In the former case both binomial and multinomial logistic models are estimated; in the latter case ordered logit models are estimated.Results:The results demonstrate that, in the context of health status, the experience of frequent severe and moderate pain has a dominant, independent and negative association with labor force participation and employment status as well as absenteeism and presenteeism. The presence of severe daily pain is associated with a 20-point reduction in the probability of being employed full-time; with moderate daily pain associated with a 10-point reduction. The impact of pain is far greater than the potential impact of other health status measures (e.g., chronic comorbidities and BMI). The experience of pain, notably severe and frequent pain, also outstrips the impact of other health status factors in absenteeism and presenteeism.Conclusions:The experience of pain, in particular severe daily pain, has a substantial negative association with labor force participation in these five European countries as well as reported absenteeism and presenteeism. As a measure of health status, it clearly outweighs other health status measures. Whether or not pain is considered as a disease in its own right, the experience of chronic pain, as defined here, presents policy makers with a major challenge. Programs to relieve the burden of pain in the community clearly have the potential for substantial benefits from societal, individual and employer perspectives.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Improving Credit Card Operations with Data Mining Techniques

ABSTRACT Consumer credit is ubiquitous and lending poses credit risk--the risk of economic loss due to the failure of a borrower to repay according to the terms of his or her contract with the lender. And so, managing credit risk entails estimating the potential ability of borrowers to repay their debts. Researchers have sought to identify factors that contribute to consumer risk, by using quantitative models. However, the presence of data mining techniques to identify credit risk cannot be ignored. There is a paucity of research to demonstrate the use of data mining techniques in this context, and such studies could be instructive to practitioners and academicians. This study fills that void. Using a data mining tool, this study shows that consumers can be segmented by their characteristics such as education, income, years on the job, and payment habits. The study showed that the rich were highly educated and always paid in full. Delinquency experiences were more frequent in the lower income segments. Knowledge about the risk of delinquency can be useful for lenders to price for credit risk and therefore to expand the reach of credit to consumers without having to compromise on profitability. INTRODUCTION Scott (2007) reports that the average United States household has 8 credit cards, which are used to charge nearly $2 trillion in goods and services annually. Further the study reports that consumers use credit cards inappropriately and spend beyond their means thereby accumulating inessentials that they cannot reasonably afford. According to the Federal Reserve Board's survey of consumer finances done in 2004, 76% of U.S. families carried some form of debt. Credit use was prevalent among families of all types regardless of their age, race, ethnicity, housing status, net worth and work-force status of the household head. Further, the percentage of families holding credit cards issued by banks rose from 16% in 1970 to about 71% in 2004. Debt was carried by 90% of the families in the top income groups and 53% in the lower income groups. The amount of outstanding debt was over $900 billion on bank-type credit cards at the end of 2006 (Scott, 2007). Further, about 1.56 million households, or about 1.4% of all U.S. households, filed for bankruptcy. Job loss was reported as one of the reasons for filing for bankruptcy. Until the late 1970s state usury laws established limits on the interest rates credit card issuers could charge on outstanding balances, which limited issuers' ability to price for credit risk. But after that, legislation relaxed the restrictions on credit card interest rates, and it allowed national banks to charge market-determined rates throughout the country. This reduction in legal impediments, along with improvements in information technology, allowed for the development of risk-based pricing nationally and contributed to the growth of revolving consumer credit. (1) Therefore, estimating the risk of potential borrowers is very important. Risky customers are those who have been delinquent. Credit card companies need to identify low-risk and high-risk customers because card rates are set based on the degree of risk that consumers reflect. For instance, Citigroup claims that it added 5.99% to the prime rate (which was 6.28%) in the case of low-risk customers, and in the case of high-risk customers it added 9.99% to the prime rate (Peng, Kou, Shi, Wise & Xu, 2005; Hsing, Gibson, Lin & Wallace, 2003). Determining and managing credit card rates are a challenge for credit card companies, and they must do well in this challenge if they are to survive in this competitive sector (Park, 2004; Hogarth, Hilgert & Kolodinsky, 2004). There is immense competition among firms, as some firms try to offer very low teaser rates to attract potential customers. Offering low rates can lead to rising charge-offs, increase in delinquency rates and declining credit quality. …