Marginal employment and health in Britain and Germany: does unstable employment predict health? Effects of a tailored health promotion program for female blue-collar workers: health works for women. A 3-year follow-up of a multidisciplinary rehabilitation programme for back and neck pain. Individual flexibility: an essential prerequisite in arranging shift schedules for midwives. Does early intervention with a light mobilization program reduce long-term sick leave for low back pain: a 3-year follow-up study.
This study examines the possible health impact of marginal employment, including both temporary and part-time employment schemes. It addresses three research questions: (1) Are employed people with a fixed-term contract or no contract more likely to report poor health than those who hold jobs with permanent contracts? (2) Are part-time employed respondents (even when they hold jobs with permanent contracts) more likely to report poor health than full-time workers? (3) Does change in employment stability (i.e., from employment with permanent contract to fixed-term or no contract employment and vice-versa) have an impact on health status? Logistic regression models were used to analyze panel data from Britain and Germany (1991-1993), available in the Household Panel Comparability Project data base. We included 10,104 respondents from Germany and 7988 from Britain. A single measure of perceived health status was used as the dependent variable. Controlling for background characteristics, the health status of part-time workers with permanent contracts is not significantly different from those who are employed full-time. In contrast, fulltime employed people with fixed-term contracts in Germany are about 42 per cent more likely to report poor health than those who have permanent work contracts. In Britain, only part-time work with no contract is associated with poor health, but the difference is not statistically significant. We conclude that monitoring the possible health effects of the increasing number of marginal employment arrangements should be given priority on the social welfare research agenda. This study assessed the effects of the Health Works for Women (HWW) intervention on improving multiple behaviors including nutrition and physical activity among rural female blue-collar employees in North Carolina.
                Nine small to mid-size workplaces were randomly assigned to either intervention or delayed intervention conditions. After a baseline survey, an intervention consisting of two computer-tailored magazines and a natural helpers program was conducted over 18 months. Delayed worksites received one tailored magazine. Approximately 77 and 76% of baseline respondents completed follow-up surveys at 6 and 18 months, respectively, and 538 women (63%) completed all three surveys.
                At the 18-month follow-up, the intervention group had increased fruit and vegetable consumption by 0.7 daily servings compared to no change in the delayed group (P < 0.05). Significant differences in fat intake were observed at 6 months (P < 0.05) but not at 18 months. The intervention group also demonstrated improvements in strengthening and flexibility exercise compared to the delayed group. The rates of smoking cessation and cancer screening did not differ between study groups.
                The HWW project was a successful model for achieving certain health behavior changes among blue-collar women.
                (C)2002 American Health Foundation and Elsevier Science (USA). The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain. The irregular shift system in Finnish hospitals with schedules traditionally planned for short 3-week periods creates problems in the social life of the personnel. Current backward rotation with 'quick returns' and rest periods between the shifts which are too short cause fatigue. The possibilities provided by legislation for individual and functional flexibility in the planning of schedules have not been utilized because of the hierarchical structure of hospital organizations. This study was aimed at finding measures to reduce the strain caused by irregular shift work. It consisted of two parts: a survey of midwives doing a three-shift work in hospitals (n = 366), and an intervention in six maternity wards (n = 45). During the 6-month intervention the influence potential of the personnel increased, and the number of quick returns fell. As a result, the mental strain of the work decreased and the stress levels fell. The positive effects were evident especially among the elderly midwives: their work became less strenous and their social interaction improved. Despite the positive effects of the intervention, 55% preferred the former system with longer continuous free time. The physiological criteria for a good shift system were outweighed by the demands of social life, emphasizing the importance of individual flexibility and participation in the planning process. A randomized clinical trial.
                To evaluate long-term clinical and economical effects of a light mobilization program on the duration of sick leave for patients with subacute low back pain.
                Twelve-month follow-up results from a previous study showed that early intervention with examination at a spine clinic, giving the patients information, reassurance, and encouragement to engage in physical activity as normal as possible had significant effect in reducing sick leave. At 12-month follow-up, 68.4% in the intervention group were off sick leave, as compared with 56.4% in the control group. Patients in this study were followed-up for a period of 3 years to investigate possible long-term effects.
                Four hundred fifty-seven patients placed on a sick list for 8 to 12 weeks for low back pain were randomized into two groups: an intervention group (n = 237) and a control group (n = 220). The intervention group was examined at a spine clinic and given information and advice to stay active. The control group was not examined at the clinic but was treated within the primary health care.
                Over the 3 years of observation, the intervention group had significantly fewer days of sickness compensation (average 125.7 d/person) than the control group (169.6 d/person). This difference is mainly caused by a more rapid return to work during the first year. There was no significant difference for the second or third year. In particular, there is no increased risk for reoccurrence of illness from early return to work. At 6-month follow-up, patients in the intervention group were less likely to use bed rest and more likely to use stretching and walking to cope with their back pain compared with the control group. This effect diminished. At 12-month follow-up, the only significant difference between the groups was in the use of stretching. Economic returns of the intervention were calculated in terms of increases in the net present value of production for the society because of the reduction in number of days on sick leave. Net benefits accumulated over 3 years of treating the 237 patients in the intervention group amount to approximately 2,822 dollars per person.
                For patients with subacute low back pain, a brief and simple early intervention with examination, information, reassurance, and encouragement to engage in physical activity as normal as possible had economic gains for the society. The effect occurred during the first year after intervention. There were no significant long-term effects of the intervention. The initial gain obtained during the first year does not lead to any increased costs or increased risks for reoccurrence of illness over the next 2 years.
The findings of this review tentatively suggest that flexible working interventions that increase worker control and choice (such as self-scheduling or gradual/partial retirement) are likely to have a positive effect on health outcomes. In contrast, interventions that were motivated or dictated by organisational interests, such as fixed-term contract and involuntary part-time employment, found equivocal or negative health effects. Given the partial and methodologically limited evidence base these findings should be interpreted with caution. Moreover, there is a clear need for well-designed intervention studies to delineate the impact of flexible working conditions on health, wellbeing and health inequalities.