F. Curtis Breslin

Questioning the stability of sense of coherence

Abstract.Background:Much debate exists about the stability of the sense of coherence measure. This study examined changes in sense of coherence (SOC), and the variables associated with these changes, over a 4-year period, in a representative sample of the Canadian labour force (n=6,790).Methods:Two methods were used to assess change in SOC: (1) Change outside of that which could be considered as indistinguishable from measurement error, and (2) Change of more than 10%, which was originally proposed by Antonovksy, the scales designer.Results:Over the study period, 35.4% of the population reported changes in SOC outside the range we consider possible due to measurement error, with 58% reporting change greater than 10%. Unskilled occupations were associated with declines in SOC, with household income demonstrating a curvilinear relationship with decline in SOC in the female population only. None of the variables used predicted increases in SOC.Conclusions:Given the degree of change in SOC, and the representativeness of the study sample, we suggest that SOC has a large state component. Given this lack of stability, we recommend caution if using the SOC to represent a stable global orientation within a causal context.

Course, Diagnosis, and Treatment of Depressive Symptomatology in Workers Following a Workplace Injury: A Prospective Cohort Study

Objectives: To estimate prevalence, incidence, and course of depressive symptoms and prevalence of mental health treatment following a workplace injury, and to estimate the association between depressive symptoms and return-to-work (RTW) trajectories. Method: In a prospective cohort study, workers filing a lost-time compensation claim for a work-related musculoskeletal disorder of the back or upper extremity were interviewed 1 month (n = 599) and 6 months (n = 430) postinjury. A high level of depressive symptoms was defined as 16 or more on the self-reported Center for Epidemiologic Studies—Depression (CES-D) Scale. The following estimates are reported: prevalence of high depressive symptom levels at 1 and 6 months postinjury; incidence, resolution, and persistence of high depressive symptom levels between 1 and 6 months; and prevalence of self-reported mental health treatment and depression diagnosis at 6 months postinjury. Results: Prevalence of high depressive symptom levels at 1 month and 6 months postinjury were 42.9% (95% CI 38.9% to 46.9%) and 26.5% (95% CI 22.3% to 30.7%), respectively. Among participants reporting high depressive symptom levels at 1 month postinjury, 47.2% (95% CI 39.9% to 54.5%) experienced a persistence of symptoms 6 months postinjury. By 6 months, 38.6% of workers who never returned to work or had work disability recurrences had high depressive symptom levels, compared with 17.7% of those with a sustained RTW trajectory. At 6–month follow-up, 12.9% (95% CI 5.8% to 20.1%) of participants with persistently high depressive symptom levels self-reported a depression diagnosis since injury and 23.8% (95% CI 14.7% to 32.9%) were receiving depression treatment. Conclusions: Depressive symptoms are pervasive in workers with musculoskeletal injuries, but transient for some, and seldom diagnosed as depression or treated.

The Effects of Alcohol, Gender, and Sensation Seeking on the Gambling Choices of Social Drinkers

The preference-reversal, or the reflection, effect occurs when the valence of the decision option influences risk preference (A. Tversky & D. Kahneman, 1981). The present study examined 3 possible moderators of gambling choices-alcohol, gender, and sensation seeking-among 108 healthy male and female volunteers. After receiving a moderate dose of alcohol, a placebo, or a no-alcohol control beverage, participants completed a betting task in which they could risk a monetary bonus by selecting and playing out a potential gain and a potential loss. Results indicated a preference-reversal effect among high sensation seekers only. The finding that individual differences moderated gambling choices is more consistent with L. L. Lopess (1987) security-potential/aspiration (SP/A) theory of decision making than with prospect theory. As in previous experimental studies, no significant effects were found for a moderate dose of alcohol. Using SP/A and risk homeostasis theory, the methodological and conceptual reasons for a consistent lack of an effect of alcohol on gambling choices across several studies are discussed.

The relationship between job tenure and work disability absence among adults: a prospective study.

Little population-based, prospective research has been conducted to examine the demographic and work-related determinants of occupational injury or illness. This study examined the relative contribution of sociodemographic characteristics and work factors to the likelihood of a work-related disability or illness. In a representative sample of adult Canadians 25-70 years old from a prospective survey, a hazard modelling approach of time to work disability absence from the start of a new job was estimated with the following predictors: age, gender, type of job (manual, non-manual, and mixed), hours worked, highest education achieved, multiple concurrent job, job tenure, school activity, union membership and living in a rural or urban area. Workers holding manual or mixed jobs and having a low education level were factors independently associated with the increased likelihood of a work disability absence. Gender was not independently associated with work disability absences. A strong job tenure gradient in the unadjusted work disability absence rates was virtually eliminated when controlling for demographic/individual and other work factors. In multivariate analyses, work-related factors remained predictors of work disability absence whereas individual characteristics such as gender did not. The exception was workers with less education who appeared to be particularly vulnerable, even after controlling of physical demands on the job. This may be due to inadequate job training or increased hazard exposure even in the same broad job category.

Effectiveness of health and safety in small enterprises: a systematic review of quantitative evaluations of interventions.

Introduction This systematic review was conducted to identify effective occupational health and safety interventions for small businesses. Methods The review focused on peer-reviewed intervention studies conducted in small businesses with 100 or fewer employees, that were published in English and several other languages, and that were not limited by publication date. Multidisciplinary members of the review team identified relevant articles and assessed their quality. Studies assessed as medium or high quality had data extracted, which was then synthesized. Results Five studies were deemed of medium or high quality, and proceeded to data extraction and evidence synthesis. The types of interventions identified: a combination of training and safety audits; and a combination of engineering, training, safety audits, and a motivational component, showed a limited amount of evidence in improving safety outcomes. Overall, this evidence synthesis found a moderate level of evidence for intervention effectiveness, and found no evidence that any intervention had adverse effects. Conclusions Even though there were few studies that adequately evaluated small business intervention, several studies demonstrate that well-designed evaluations are possible with small businesses. While stronger levels of evidence are required to make recommendations, these interventions noted above were associated with positive changes in safety-related attitudes and beliefs and workplace parties should be aware of them.

Depression and activity limitations : examining gender differences in the general population

BackgroundThis study examines the relationship between major depression, subclinical depressive symptomatology and activity limitation in a representative sample of Canadian men and women, with a particular emphasis on examining gender differences.MethodsOver a 4-year period, the three waves of data were collected from a representative sample of Canadian adults aged 18–60 beginning in 1994. A brief diagnostic interview for major depression, current limitations in home, work, and other activities (e.g., leisure), presence of each of 13 chronic medical conditions, and other sociodemographic information were gathered. Regression analyses adjusted for potential confounding of time-dependent and time-invariant covariates. These analyses were performed separately for men and women.ResultsMajor depression had a significant adverse impact on all types of activities for the entire community sample, and this impact was generally robust when controlling for potential confounders. Gender differences were observed for leisure activities with depressed men showing a higher likelihood of limitation in these activities than depressed women.ConclusionsThe findings provide further evidence that major depression leads to impairments in a range of daily activities. Gender differences in the impact of depression on leisure activities may be important to consider in depression treatment.

An ecological study of regional variation in work injuries among young workers.

BackgroundThe investigation of geographic variation in occupational injuries has received little attention. Young workers 15 to 24 years are of particular concern because they consistently show elevated occupational injury rates compared to older workers. The present study sought to: (a) to describe the geographic variation of work injuries; (b) to determine whether geographic variation remained after controlling for relevant demographic and job characteristics; (c) to identify the region-level factors that correlate with the geographic variation.MethodsUsing workers compensation claims and census data, we estimated claim rates per 100 full-time equivalents for 15 to 24 year olds in 46 regions in Ontario. A total of 21 region-level indicators were derived primarily from Census and Labour Force Survey data to reflect social and material deprivation of the region as well as demographic and employment characteristics of youth living in those areas.ResultsDescriptive findings showed substantial geographic variation in young worker injury rates, even after controlling for several job and demographic variables. Region-level characteristics such as greater residential stability were associated with low work injury rates. Also, regions with the lowest claim rates tended to have proportionally fewer cuts and burns than high-claim-rate regions.ConclusionThe finding of substantial geographic variation in youth claim rates even after controlling for demographic and job factors can aid in targeting prevention resource. The association between region-level indicators such as residential stability and youth work injury suggests that work injury prevention strategies can be integrated with other local economic development measures. The findings partially support the notion that work safety measures may be unevenly distributed with respect to regional socio-economic factors.

Work Injury Risk Among Young People With Learning Disabilities and Attention-Deficit/Hyperactivity Disorder in Canada

OBJECTIVES We sought to gain a better understanding of the relationship between learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and risk of occupational injury among young workers. METHODS We assessed 15- to 24-year-old workers (n = 14 379) from cycle 2.1 of the Canadian Community Health Survey (CCHS). We gathered data on demographic characteristics, work-related factors, and presence of learning disabilities or ADHD. We conducted a multivariate logistic regression analysis to assess occurrences of medically attended work injuries. RESULTS There was an 89% adjusted increase in work injury risk among workers with self-reported dyslexia (a type of learning disability) relative to workers reporting no learning disabilities, although this result did not meet traditional statistical significance criteria. Being out of school, either with or without a high school diploma, was associated with a significantly increased risk of work injury, even after control for a number of demographic and work-related variables. CONCLUSIONS Our findings underscore the notion that individual differences salient in the education system (e.g., learning disabilities, school dropout) need to be integrated into conceptual models of injury risk among young workers.

Using self-help materials to motivate change at assessment for alcohol treatment.

The utility of a brief self-help booklet provided at assessment for alcohol treatment was evaluated using a quasi-experimental design (booklet provided to all clients for one month at a time, interspersed by one month of no booklets, for a 6-month period). While the booklet did not result in any significant reduction in client attrition, clients who received the booklet at their assessment were drinking less by the 6-month follow-up than those who did not receive the booklet. Limitations of this study, including the quasi-experimental design and the impact of the low baseline attrition rates, are discussed.

Examining job tenure and lost-time claim rates in Ontario, Canada, over a 10-year period, 1999–2008

Objective We sought to examine the association between job tenure and lost-time claim rates over a 10-year period in Ontario, Canada. Methods Data were obtained from workers’ compensation records and labour force survey data from 1999 to 2008. Claim rates were calculated for gender, age, industry, occupation, year and job tenure group. A multivariate analysis and examination of effect modification were performed. Differences in injury event and source of injury were also examined by job tenure. Results Lost-time claim rates were significantly higher for workers with shorter job tenure, regardless of other factors. Claim rates for new workers differed by gender, age and industry, but remained relatively constant at an elevated rate over the observed time period. Conclusions This study is the first to examine lost-time claim rates by job tenure over a time period during which overall claim rates generally declined. Claim rates did not show a convergence by job tenure. Findings highlight that new workers are still at elevated risk, and suggest the need for improved training, reducing exposures among new workers, promoting permanent employment, and monitoring work injury trends and risk factors.