INTRODUCTION: To summarize evidence on workplace-based work disability prevention (WDP) interventions in workers with common mental health conditions (CMHCs). Primary outcomes of interest were work absence duration and work functioning; secondary outcomes were quality of life, and economic costs.
METHODS: We conducted a systematic literature search in 5 electronic databases (MEDLINE, EMBASE, CINAHL, PsychINFO, Web of Science) for studies published from 2007 to 2009. Two reviewers screened for studies: (1) Targeting workers with CMHCs absent from, or struggling at, work; (2) evaluating workplace-based WDP interventions; (3) assessing our primary outcome(s); and (4) with controlled trials. Quality assessment (using 29 criteria) was performed by two reviewers.
RESULTS: Our search yielded 671 abstracts: 8 eligible studies and of sufficient quality. We identified three main intervention elements: (a) Facilitation of access to clinical treatment; (b) Workplace-based high-intensity psychological intervention; and (c) Facilitation of navigation through the disability management system. Moderate evidence was found that facilitation of treatment improved work functioning, quality of life and economic outcomes, with limited evidence for work absence duration. Moderate evidence was found that psychological interventions, primarily cognitive-behavioral therapy, improved work functioning, quality of life, and economic outcomes. Moderate evidence indicated that facilitation of navigation through the disability management system improved work absence duration.
CONCLUSIONS: Workplace-based interventions could improve work disability outcomes for workers with CMHCs. Facilitation of access to clinical treatment, and workplace-based high-intensity psychological intervention were most effective in improving work functioning and quality of life, and in reducing costs.
OBJECTIVE: To evaluate the impact of worker and workplace factors and of their relationships on work absence duration. METHODS: Structural equation modeling of 11,762 female, Canadian nurses from the 2005 National Survey of the Work and Health of Nurses. RESULTS: Worker and workplace factors were associated with prolonged work absence. Key proximal predictors were pain-related work interference, depression, pain severity, and respect and support at work. More distal predictors were multimorbidity, abuse at work, and organizational culture. CONCLUSIONS: Worker health and workplace factors are important in explaining work absence duration. Self-management for pain and mood, adapted to the work context, may be useful for nurses with chronic pain or depression. Policy makers and administrators should focus on creating respect and support at work, and improving organizational culture.
As of June 22, 2011, influenza A/H5N1 has caused a reported 329 deaths and 562 cases in humans, typically attributed to contact with infected poultry. Influenza H5N1 has been described as seasonal. Although several studies have evaluated environmental risk factors for H5N1 in poultry, none have considered seasonality of H5N1 in humans. In addition, temperature and humidity are suspected to drive influenza in temperate regions, but drivers in the tropics are unknown, for H5N1 as well as other influenza viruses. An analysis was conducted to determine whether human H5N1 cases occur seasonally in association with changes in temperature, precipitation and humidity. Data analyzed were H5N1 human cases in Indonesia (n = 135) and Egypt (n = 50), from January 1, 2005 (Indonesia) or 2006 (Egypt) through May 1, 2008 obtained from WHO case reports, and average daily weather conditions obtained from NOAA's National Climatic Data Center. Fourier time series analysis was used to determine seasonality of cases and associations between weather conditions and human H5N1 incidence. Human H5N1 cases in Indonesia occurred with a period of 1.67 years/cycle (p<0.05) and in Egypt, a period of 1.18 years/cycle (p≅0.10). Human H5N1 incidence in Egypt, but not Indonesia, was strongly associated with meteorological variables (κ(2)≥0.94) and peaked in Egypt when precipitation was low, and temperature, absolute humidity and relative humidity were moderate compared to the average daily conditions in Egypt. Weather conditions coinciding with peak human H5N1 incidence in Egypt suggest that human infection may be occurring primarily via droplet transmission from close contact with infected poultry.
INTRODUCTION: Approximately 20% of healthcare workers in high-income countries such as Australia, Canada and the USA work in rural areas. Healthcare workers are known to be vulnerable to occupational injury and poor work disability outcomes; given their rural-urban distribution, it is possible to compare work disability prevention in rural and urban areas. However, little attention has been paid to work disability prevention issues specific to rural workers, including rural healthcare workers. A comprehensive review of the literature was conducted to identify rural-urban differences in work disability outcomes (defined as the incidence of occupational injury and the duration of associated work absence), as well as risk factors for poor work disability outcomes in rural healthcare workers.
METHODS: The databases MEDLINE, CINAHL, and EMBASE were searched, as were relevant research centers and government agencies, to identify all quantitative and qualitative English-language studies published between 1 January 2000 and 6 October 2009 that discussed occupational injury, work absence duration, work disability management, or risk factors for poor work disability outcomes, for rural workers specifically, or in comparison with urban workers. To ensure inclusion of studies of healthcare workers as a distinct group among other sector-specific groups, a broad search for literature related to all industrial sectors was conducted.
RESULTS: Of 860 references identified, 5 discussed work disability outcomes and 25 discussed known risk factors. Known risk factors were defined as factors firmly established to be associated with poor work disability outcomes in the general worker population based on systematic reviews, well-established conceptual models of work disability prevention, and public health literature. Although somewhat conflicting, the evidence suggests that rural healthcare workers experience higher rates of occupational injury compared with urban healthcare workers, within occupational categories. Rural workers also appear to be more vulnerable to prolonged work absence although the data are limited. No studies directly compared risk factors for work disability prevention outcomes between rural and urban healthcare workers. However, potential risk factors were identified at the level of the environment, worker, job, organization, worker compensation system and healthcare access. Important methodological limitations were noted, including unclear definitions of rurality, inadequate methods of urban-rural comparisons such as comparing samples from different countries, and a paucity of studies applying longitudinal or multivariate designs.
CONCLUSIONS: There is a notable lack of evidence about work disability prevention issues for healthcare workers in rural areas. Available evidence supports the hypothesis that rural healthcare workers are vulnerable to occupational injury, and suggests they are vulnerable to prolonged work absence. They may be particularly vulnerable to poor work disability prevention outcomes due to complex patient needs in the context of risk factors such as heavy workloads, long hours, heavy on-call demands, high stress levels, limited support and workplace violence. Additional vulnerability may occur because their work conditions are managed in distant urban administrative centers, and due to barriers in their own healthcare access. Although rural healthcare workers seem generally at greater risk of injury, one study suggests that urban emergency medical service workers experience a high vulnerability to injury that may outweigh the effects of rurality. Additional research is needed to document rural-urban disparities in work disability outcomes and to identify associated sources and risk factors. Other issues to address are access to and quality of healthcare for rural healthcare workers, streamlining the compensation system, the unique needs of Aboriginal healthcare workers, and the management of prolonged work absence. Finally, occupational injury and work absence duration programs should be tailored to meet the needs of rural workers.
We propose a feature vector approach to characterize the variation in large data sets of biological sequences. Each candidate sequence produces a single feature vector constructed with the number and location of amino acids or nucleic acids in the sequence. The feature vector characterizes the distance between the actual sequence and a model of a theoretical sequence based on the binomial and uniform distributions. This method is distinctive in that it does not rely on sequence alignment for determining protein relatedness, allowing the user to visualize the relationships within a set of proteins without making a priori assumptions about those proteins. We apply our method to two large families of proteins: protein kinase C, and globins, including hemoglobins and myoglobins. We interpret the high-dimensional feature vectors using principal components analysis and agglomerative hierarchical clustering. We find that the feature vector retains much of the information about the original sequence. By using principal component analysis to extract information from collections of feature vectors, we are able to quickly identify the nature of variation in a collection of proteins. Where collections are phylogenetically or functionally related, this is easily detected. Hierarchical agglomerative clustering provides a means of constructing cladograms from the feature vector output.
We have previously cloned the human Na+/H+ exchanger NHE2 gene and its promoter region. In the present study, the regulatory elements responsible for the constitutive expression of NHE2 were studied. Transient transfection assays revealed that the -40/+150 promoter region contains the core promoter responsible for the optimal promoter activity. A smaller fragment, -10/+40, containing the TIS (transcription initiation site) showed minimal activity. We identified a palindrome that overlaps the TIS and binds to the transcription factors Sp1 and Sp3. Mutations in the 5' flank of the palindrome abolished the Sp1/Sp3 interaction and reduced promoter activity by approx. 45%. In addition, a conserved GC-box centered at -25 was found to play a critical role in basal promoter activity and also interacted with Sp1 and Sp3. An internal deletion in the GC-box severely reduced the promoter activity. Sp1/Sp3 binding to these elements was established using gel-mobility shift assays, confirmed by chromatin immunoprecipitation and co-transfections in Drosophila SL2 cells. Furthermore, we identified two positive regulatory elements in the DNA region corresponding to the 5'-UTR (5'-untranslated region). The results in the present study indicate that Sp1 and Sp3 are required for constitutive NHE2 expression and that the positive regulatory elements of the 5'-UTR may co-operate with the 5'-flanking region to achieve the optimal promoter activity.