Factors that influence the use and perceptions of employee assistance programs at six worksites

Employee assistance programs (EAPs) have gained significant importance in contemporary worksites. This article uses data from 6 case studies to examine several research questions regarding the relationship between worker demographic (e.g., gender, job tenure, and marital status), substance use, and workplace policies and the actual and potential use of the company EAP. Unlike in most of the existing literature, the authors did not find that gender, marital status, or job dissatisfaction are statistically related to actual or potential EAP use at most worksites. However, job tenure and some substance use behaviors were related to actual EAP use in a positive and statistically significant way. Another important finding, underlying the credible integration of EAPs into worksite culture, is the positive and robust relationship between employee trust and confidence in the EAP and actual use. The results of our study both reinforce some long-established principles in the EAP field and encourage further consideration of other beliefs.     

Comparison of cardiology training programs in Canada and the United States

To compare the composition of cardiology training programs in Canada and the USA, we surveyed the directors of all Canadian and American training programs. We found that Canadian trainees performed significantly fewer procedures than USA trainees and that the chief determinants of numbers of procedures performed are duration of time spent in a rotation and the type of hospital where the program is based.     

Cumulative trauma disorders among apparel manufacturing employees in the southeastern United States

Factors associated with cumulative trauma disorders (CTDs) of the upper extremities were studied retrospectively, using data from three apparel manufacturing plants in the southeastern United States. Reported CTDs among the employees at risk during fiscal years 1991 and 1992 were analyzed focusing on individual and plant variables. Results showed that CTD rates increased from 1991 to 1992 and fluctuated in a cyclical pattern each year, peaking during January, March, and August. Employee age and duration of employment were associated with CTD rates. Employees aged 45 to 49 had higher CTD rates than those in any other age groups. Employees with 1 to 3 years' experience had higher CTD rates than employees with more years of service.     

Physical activity and women in the United States: an overview of health benefits, prevalence, and intervention opportunities

Despite decades of physical activity research and interventions conducted on men, very little is known about the patterns of physical activity among US women. Rates from several national surveys show much lower rates of physical activity for women than for men. Among women, rates may vary by socioeconomic status. Studies relating physical activity and experience with heart disease, cancer, osteoporosis, and mental health are discussed. Interventions in the workplace and the community may increase the level of physical activity among US women. A history of not participating in exercise and lack of time for this activity appear to be important constraints for many women. The Surgeon General's Report on physical activity sanctioned future research on specific groups, such as women. Applied research coupled with community and workplace policies that support women's efforts to be more physically active may decrease the rates of some chronic diseases in this population.     

Self-reported rectal bleeding in a United States community: prevalence, risk factors, and health care seeking

OBJECTIVE: Little data on rectal bleeding in the U.S. population are available. We therefore sought to assess the prevalence of different types of rectal bleeding, their association with potential risk factors including other colonic symptoms, and predictors of health care seeking in a U.S. community. METHODS: We used a crossectional survey by mail, applying a previously validated self-report symptom questionnaire. Our population comprised an age- and gender-stratified random sample of Olmsted County, Minnesota residents aged 20-64 yr. RESULTS: In total, 1643 responded (77%). Rectal bleeding was reported by 235 subjects (age- and gender-adjusted prevalence, 15.5 per 100; 95% confidence interval [CI], 13.6-17.4); 218 found blood on wiping, 74 noted blood coating the stools, and 46 reported dark blood mixed in the stools. The prevalence of rectal bleeding was significantly higher in younger persons (18.9%, 20-40 yr vs 11.3% > 40 yr; p < 0.001). By stepwise logistic regression analysis, constipation (odds ratio [OR] = 3.03; 95% CI, 2.09-4.41) and diarrhea (OR = 1.90; 95% CI, 1.25-2.84) were independent predictors of rectal bleeding. Among those with rectal bleeding, 13.9% (95% CI, 9.6-19.1%) had visited a physician for bowel problems in the prior yr; only a history of abdominal surgery was an independent predictor of physician visits but this explained just 15.9% of the deviance. CONCLUSIONS: In otherwise healthy young and middle-aged persons, approximately one in seven have a history of rectal bleeding and this is more frequent in younger people; only a minority seek health care and this is not related to symptom status.     

Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

OBJECTIVE: To provide a single source for the best available estimates of the national prevalence of arthritis in general and of selected musculoskeletal disorders (osteoarthritis, rheumatoid arthritis, juvenile rheumatoid arthritis, the spondylarthropathies, systemic lupus erythematosus, scleroderma, polymyalgia rheumatica/giant cell arteritis, gout, fibromyalgia, and low back pain). METHODS: The National Arthritis Data Workgroup reviewed data from available surveys, such as the National Health and Nutrition Examination Survey series. For overall national estimates, we used surveys based on representative samples. Because data based on national population samples are unavailable for most specific musculoskeletal conditions, we derived data from various smaller survey samples from defined populations. Prevalence estimates from these surveys were linked to 1990 US Bureau of the Census population data to calculate national estimates. We also estimated the expected frequency of arthritis in the year 2020. RESULTS: Current national estimates are provided, with important caveats regarding their interpretation, for self-reported arthritis and selected conditions. An estimated 15% (40 million) of Americans had some form of arthritis in 1995. By the year 2020, an estimated 18.2% (59.4 million) will be affected. CONCLUSION: Given the limitations of the data on which they are based, this report provides the best available prevalence estimates for arthritis and other rheumatic conditions overall, and for selected musculoskeletal disorders, in the US population.     

The prevalence of cervical cancer screening iin the United States in 1970

Peripheral receptors signalling in both the 3 main divisions of the trigeminal nerves and in the glossopharyngeal nerves are most likely involved in the onset of the apnea in diving ducks. Since the response also takes place when ducks are submerged in mercury, these peripheral receptors are hardly specific to water. Neither any of the 3 main groups of trigeminal, nor the glossopharyngeal receptors are alone responsible for the initiation of the apnea. Most likely the apnea takes place when the total impact on the 'respiratory centre' in the brain exceeds a certain treshold value, due to activation of a certain number of both trigeminal and glossopharyngeal peripheral receptors. However, even very local stimulation of the glottal area invariably evoked apnea, indicating a higher density of receptors there than for example on the beak or in the nares. This idea is supported by the fact that not even heavy rain evokes any response at all. It is unlikely that the cardiovascular adjustments displayed by diving ducks are directly coupled to the apnea response (i.e. to stimulation of peripheral receptors). Rather they are supposed to be components in orienting and chemoreceptor reflexes.     

Health economics and cost implications of anxiety and other mental disorders in the United States

BACKGROUND: Mental disorders impose a multi-billion dollar burden on the economy each year; translating the burden into economic terms is important to facilitate formulating policies about the use of resources. METHODS: For direct costs, data were obtained from national household interview and provider surveys; for morbidity costs, a timing model was used that measures the lifetime effect on current income of individuals with mental disorders, taking into account the timing of onset and the duration of these disorders, based on regression analysis of Epidemiologic Catchment Area study data. RESULTS: The total economic costs of mental disorders amounted to US$147.8 billion in 1990. Anxiety disorders are the most costly, amounting to $46.6 billion, or 31.5% of the total; schizophrenic disorders accounted for $32.5 billion, affective disorders for $30.4 billion, and other mental disorders for $38.4 billion. CONCLUSIONS: Mental illnesses, especially anxiety disorders, are costly to society. Although anxiety disorders have a higher prevalence than affective disorders and schizophrenia, use of medical care services is lowest for anxiety disorders. Anxiety disorders appear to be under-recognised and untreated even though treatment interventions have been shown to be effective and can be delivered in a cost-efficient manner.     

An estimate of the cost of in vitro fertilization services in the United States in 1995

OBJECTIVE: To estimate the cost of adding IVF treatment to a standard health care benefits package. In vitro fertilization cost is defined as the average charge for a single cycle of treatment in an existing IVF program. DESIGN: Cost analysis. SETTING: Two hundred sixty IVF centers active in the United States in 1993. MAIN OUTCOME MEASURES: In vitro fertilization utilization and outcomes for 1993 were estimated from data in an existing registry. In vitro fertilization charges were determined from a 1993 survey of IVF clinics. The resulting expenditures for benefits and premiums were projected to 1995 together with the additional cost if utilization were to increase by 300% or 500%. RESULTS: In the United States in 1993 there were 31,718 IVF cycles for which the average charge was $6,233, leading to a total expenditure of approximately $197.70 million for IVF services in 1993. The projected cost of adding IVF services to a typical employer health plan in 1995 would be $2.79 per annum and the premium would be $3.14. Benefits and premium costs for a 300% utilization increase were $8.37 and $9.41, respectively, and for a 500% increase, $13.95 and $15.69, respectively. CONCLUSIONS: The cost of IVF services would be a minute fraction of the annual cost of a typical family benefits program ($3,393). Savings from reduced utilization of alternative treatments would offset a portion of this increase. Increases in utilization rates should be controlled by clinical criteria.     

Negligible prevalence of antibodies against Trypanosoma cruzi among blood donors in the southeastern United States

The ultrastructure of alpha-bacteroids in relation to the fat-body cells of the lantern bug Pyrops candelaria was described. The fat-body-cell cytoplasm contained numerous mitochondria, rough endoplasmic reticula, vacuoles, and storage granules. Its nucleus had scattered chromatin materials. The alpha-bacteroid was enveloped by three membrane layers, namely, the plasma membrane, the cell wall, and the membrane envelope. Its cytoplasm contained amorphous dense bodies. The bacteroid reproduced by binary fission. Tracheoles were also found among fat-body cells.     

Cesarean delivery in the United States, 1990

Information now available on method of delivery from birth certificates confirms past findings on the groups at highest risk of cesarean delivery and greatly expands our knowledge of the demographic and health characteristics associated with cesarean delivery. Mothers who live in the South, who are in the oldest years of childbearing, having their first birth, married, or who have high educational attainment are all at increased risk of a cesarean delivery. Very short gestations, low or high birthweights, multiple delivery, the presence of certain complications of pregnancy, labor and/or delivery, abnormal conditions of the newborn, and the use of some obstetric procedures are also associated with elevated cesarean rates. Several recent studies (28,29) have concluded that advanced maternal age in and of itself may be an independent risk factor for cesarean delivery, due to physician and patient concern over pregnancy outcome for older women. Many of the characteristics examined in this study are highly related to maternal age (for example, marital status and educational attainment). Therefore, for these variables, mother's age is also taken into account to determine if age itself is the underlying reason for differences in rates of cesarean delivery. The importance of the role of maternal age in the risk of cesarean delivery is clearly demonstrated throughout this report: Older mothers are more likely to deliver by cesarean regardless of race, Hispanic origin, parity, marital status, or educational attainment. The overall rate of cesarean delivery is only slightly lower for black than for white mothers (22.1 percent compared with 23.0 percent), despite the generally lower educational attainment of black mothers and the higher percentage who are unmarried or in their teen years, all factors that tend to substantially lower the risk of cesarean delivery. However, there are many offsetting factors that tend to raise the cesarean rate for black mothers. A relatively high proportion of black births occur in the South, which has the highest cesarean rate of all regions; the incidence of low and very low birthweight is far higher for black births; and premature delivery is twice as frequent for black babies. Also, although rates of cesarean delivery for most medical risk factors, complications of labor and or delivery, and abnormal conditions of the infant are about the same for both races, the incidence of a number of these conditions is substantially higher for black mothers and babies, and that has the effect of increasing the overall cesarean rate for black mothers.(ABSTRACT TRUNCATED AT 400 WORDS)     

Admission requirements, acceptance rates, and financial assistance in clinical psychology programs: Diversity across the practice-research continuum.

129 directors (80% response) of APA-accredited clinical psychology programs provided information pertaining to admission requirements, acceptance rates, financial assistance, and theoretical orientations. Summary data are presented and comparisons are made among 4 types of clinical programs: PsyD programs, practice-oriented PhD programs, equal-emphasis PhD programs, and research-oriented PhD programs. Clinical doctoral programs held similar expectations for undergraduate preparation in psychology, but robust differences emerged on preferred Graduate Record Examination scores, acceptance rates, and financial assistance. In the most extreme comparison (PsyD vs research-oriented PhD programs), students were 4 times more likely to gain acceptance but 6 times less likely to receive full financial assistance in PsyD programs. Implications of these results for potential graduate students and for the future of applied psychology programs are briefly discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ambulatory and inpatient procedures in the United States, 1996

OBJECTIVES: This report presents estimates of surgical and nonsurgical procedures performed in the United States during 1996. Data are presented by characteristics of patients, region of the country, and procedure categories for ambulatory and inpatient procedures separately and combined. METHODS: Estimates in this report are based on data collected from the National Hospital Discharge Survey (NHDS) and the National Survey of Ambulatory Surgery-(NSAS). NHDS provides data on hospital inpatient care, and NSAS provides data on ambulatory surgery in hospitals and in freestanding ambulatory surgery centers. For NHDS, data were collected for approximately 282,000 discharges from 480 non-Federal short-stay hospitals (95 percent response rate). For NSAS, data were collected for approximately 125,000 ambulatory surgery discharges from 488 hospitals and freestanding ambulatory surgery centers (81 percent response rate). RESULTS: An estimated 71.9 million procedures were performed on 39.9 million discharges from hospitals and freestanding ambulatory surgery centers during 1996: 40.4 million procedures were for inpatients, and 31.5 million were for ambulatory patients. Females had more procedures than males, and the rate of procedures increased with age in ambulatory and inpatient settings. The leading procedures for ambulatory surgery patients and inpatients combined were arteriography and angiocardiography, endoscopy of small intestine, endoscopy of large intestine, and extraction of lens.     

Needs assessment and implementation of an employee assistance program: promoting a healthier work force

1. The functions of a continuous quality improvement tool used by Deming--the Plan, Do, Check, Act Cycle--can be applied to the assessment, implementation, and ongoing evaluation of an Employee Assistance Program (EAP). 2. Various methods are available to assess the need for an EAP. As much data as possible should be collected to qualify and quantify the need so that management can make an informed decision and develop measures to determine program effectiveness. 3. Once an EAP is implemented, it should be monitored continually against the effectiveness measures initially developed. Using a continuous quality improvement process, the occupational health nurse and the EAP provider can establish a dynamic relationship that allows for growth beyond the original design and increased effectiveness of service to employees.     

Basic characteristics of radiology groups in the United States: results of a 1991-1992 census

OBJECTIVE: The American College of Radiology (ACR), the principal professional organization of United States radiologists, receives numerous requests for information on the characteristics of radiology groups. This report describes the basic characteristics of radiology groups in the United States. We defined radiology groups as any practice with two or more radiologists or radiation oncologists, including academic departments, units in multispecialty groups, and staff of government facilities. MATERIALS AND METHODS: To collect basic information on radiology groups, the ACR conducted a mail census of all identified radiology groups in the United States during late 1991 and early 1992. Follow-up was conducted by mail and telephone. To make the responses accurately representative of all radiology groups, we weighted the approximately 2000 responses to correspond to known control totals for the number of groups of each of seven size categories in each of the four census regions (Northeast, Midwest, South, and West). These control totals were obtained from the ACR's 1990 Manpower Survey, which showed a total of approximately 3200 radiology groups. RESULTS: Approximately one fourth of all groups have two radiologists, one fourth have three or four radiologists, one fourth have five to seven radiologists, and one fourth have eight or more radiologists. Academic groups were relatively large; almost 50% had 11 or more radiologists. Nonmetropolitan areas had very few large groups, and metropolitan center cities had relatively few small groups. Ninety-two percent of all groups practiced at hospitals, and 73% of all groups practiced at nonhospital offices or centers. The median number of practice sites for all groups was three, including both hospital and nonhospital sites. Eighty-eight percent of all groups provided diagnostic radiology services, 23% provided radiation oncology, 12% offered both, and 11% were oncology-only groups. Relatively many academic groups (25%) were oncology-only groups; very few radiology groups (2%) in multispecialty practices were oncology-only groups. The diagnostic radiology techniques available from the largest percentages of groups were general radiography (plain film), sonography, mammography, and CT. One eighth of academic groups that provided diagnostic services did not report providing mammography, compared with only a few percent of all groups in the United States that provided diagnostic services. CONCLUSION: Half of all groups have two to four radiologists, and this has not changed since at least 1986. A substantial percentage of groups that perform diagnostic radiology do not provide MR, interventional, or nuclear medicine services. This is particularly true of relatively small groups. These characteristics may become the source of some problems as managed care becomes more prominent and larger groups, offering a full range of services and practicing at several sites, are favored by managed care organizations that seek to contract with one group for all their radiology services.