RESUMEN
BACKGROUND: A comprehensive understanding of workplace organizational risk factors for illness and injury and interventions to alleviate these factors is important for workplace prevention efforts. METHODS: We summarize the evidence for the role of workplace organizational factors and work factors in occupational health and safety (OHS). To the extent possible, we concentrate on factors at the level of the workplace, rather than the level of the individual. RESULTS: Three types of outcomes are considered: injuries, ill-health, and musculoskeletal problems; and we note the evidence for their relationship to work. We review workplace interventions intended to alleviate each type of outcome and note methodological limitations of previous research. CONCLUSIONS: Despite the methodological limitations, the balance of the literature supports the work-relatedness of the three types of outcomes, although questions remain about exact mechanisms and the effectiveness of specific interventions. We discuss barriers to and incentives for creating safer and healthier workplaces.
Asunto(s)
Enfermedades Musculoesqueléticas , Enfermedades Profesionales , Salud Laboral , Accidentes de Trabajo , Humanos , Enfermedades Musculoesqueléticas/etiología , Enfermedades Musculoesqueléticas/prevención & control , Enfermedades Profesionales/etiología , Enfermedades Profesionales/prevención & control , Factores de Riesgo , Lugar de TrabajoRESUMEN
PURPOSE: Alternatives to axillary lymph node dissection (ALND) are being developed amid controversy surrounding the therapeutic benefit and overall utility of this routine surgical procedure. Although potential negative side effects associated with ALND are known, we set out to examine whether these side effects contribute significantly to patient reports of quality of life and mental health. PATIENTS AND METHODS: We surveyed 222 women who had received an ALND as part of breast cancer surgery. All women underwent a physical therapy assessment of range of arm/shoulder motion and completed the Modified Post-operative Pain Questionnaire, the Pain Disability Index, the McGill Pain Questionnaire (short form), the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, and the Mental Health Inventory. RESULTS: Seventy-two percent of the women experienced arm/shoulder pain, weakness, or numbness in the week before the interview, and range of motion of the affected arm/shoulder was impaired in 73% of the women. Severity of pain was reported to be low to moderate, and younger patients experienced greater pain than older patients. Pain severity correlated positively with the number of lymph nodes removed and receipt of chemotherapy and was not significantly related to length of time since surgery or receipt of radiation therapy. Generally high levels of cancer-specific quality of life and mental health were reported. Quality of life was significantly predicted by the McGill Pain Questionnaire, and mental health was significantly predicted by the Pain Disability Index and the physical therapy assessment. CONCLUSION: Surgery-related symptoms after ALND persist for a majority of women with breast cancer and are not significantly related to time since surgery or receipt of radiation therapy. These symptoms and associated disability are significantly predictive of cancer-specific quality of life and mental health.
Asunto(s)
Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático/efectos adversos , Salud Mental , Calidad de Vida , Axila , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Dolor/etiología , Dolor Postoperatorio , Rango del Movimiento Articular , Articulación del Hombro , Encuestas y CuestionariosRESUMEN
BACKGROUND: Intravenous methylprednisolone (IVMP) is the treatment of choice for multiple sclerosis (MS) patients undergoing acute exacerbation of disease symptoms and yet its cost has not been accurately determined. Determination of this cost in different settings is also pertinent to consideration of cost-saving alternatives to in-patient treatment. METHODS: Cost analysis from the point of view of the health care system of IVMP treatment of MS patients receiving treatment in association with a selected Toronto teaching hospital in fiscal year 1994/95 was carried out. Costs of any concurrent treatments were excluded. RESULTS: Total cost for 92 patients, based on a 4 dose regime, was estimated to be $78,527. The the cost per patient was $1,1181.84 for in-patients (IP), $714.64 for out-patients of the MS Clinic (OP) and $774.21 for patients whose treatment was initiated in the Clinic, but completed in the home (HC). Sensitivity analyses indicated: 1) IP treatment was in all cases more expensive than that of OP or HC; 2) the cost savings of OP vs. HC was sensitive to assumptions made regarding Clinic overhead, Clinic nursing costs and Home Care Program overhead. CONCLUSION: Alternatives to in-patient care must be considered carefully. In this study, both out-patient and in-home treatment were cost-saving alternatives to in-patient treatment, but large differences in the cost of hospital out-patient vs. in-home care could not be demonstrated.