Demanding, stressful or insecure jobs may motivate workers to show up even when they should stay home sick, a research review suggests.
Understanding what motivates workers to remain on the job when they’re sick may help employers develop sick-day policies that may be more effective at preventing the spread of contagious diseases in the workplace, study co-author Gary Johns, a business and management researcher at Concordia University in Montreal, said by email.
“In the case of contagious illness, the spread of the illness to co-workers and customers or clients is an obvious concern,” Johns said. “On the other hand, if illness is neither contagious nor debilitating, it might be self-affirming for people to go to work when not perfectly fit.”
Johns and co-author Mariella Miraglia of the Norwich Business School at the University of East Anglia in the U.K. analyzed data from 61 previous studies involving more than 175,000 people in more than 30 countries to assess what might motivate people to come to work when they were sick.
The two researchers refer to working while sick as “presenteeism.”
In the studies they analyzed, presenteeism was often linked to workplace policies to reduce absenteeism, such as disciplinary actions, limited paid sick leave, or medical certification required for sick time, the analysis found.
Job demands also came into play, with heavy workloads, understaffing, overtime and looming deadlines all motivating people to work while sick.
“Tight restrictions on paid sick leave, such as requiring a doctor’s note to validate an employee’s illness,” can limit the effectiveness of giving people paid time off to prevent the spread of disease in the workplace, Dr. Eric Widera, a researcher at the University of California, San Francisco, who wasn’t involved in the study, said by email.
One shortcoming of the analysis is that the researchers lacked data to properly assess the role of depression and mental health in presenteeism, the authors acknowledge in the Journal of Occupational Health Psychology. It’s possible that workers suffering from mental illness might not perceive themselves as working while sick.
Many workers may believe their jobs are on the line if they stay home, or feel that they can’t afford the lost income from an unpaid day off, noted Supriya Kumar, a public health researcher at the University of Pittsburgh who wasn’t involved in the study.
Workers who feel they have no choice but to work while sick can still help prevent the spread of contagious diseases like influenza by avoiding face-to-face conversations with co-workers, and by washing their hands frequently, Kumar said by email.
Still, managers who realize why people work when they’re sick may be able to change policies so employees are motivated to stay home when they’re contagious.
“When people stay home when sick with a contagious disease like influenza, they actually reduce the likelihood of future illness among co-workers and thus reduce absenteeism in the workplace,” Kumar said. “Managers who realize this and promote stay-at-home behavior in cases of infectious illness are likely to have a more healthy workplace.”
SOURCE: bit.ly/1Hvx77L Journal of Occupational Health Psychology, online November 9, 2015.
WASHINGTONU.S. Democratic lawmakers are discussing proposing changes to the "Cadillac tax," a levy on high-cost employer-based healthcare plans passed as part of President Barack Obama's 2010 Affordable Care Act, the Senate's No. 2 Democrat said on Tuesday.
"I'm not proposing eliminating it at this point, I’m open to suggestions for changing it," Illinois Senator Dick Durbin told reporters.
"I don't know if it'll be done this year or next year," Durbin added. "But we're trying to figure out a way to change it or remove it and the impact it would have."
The tax got its nickname because it will apply to premium or "Cadillac" healthcare plans starting in 2018. It would be levied on employer-based coverage that exceeds the thresholds of $10,200 a year for individuals and $27,500 for families.
It was designed to rein in healthcare costs under Obama's healthcare law. Employers could avoid it by replacing expensive plans with cheaper ones.
Congressional Republicans have long sought to repeal the entire Affordable Care Act, also known as Obamacare. Democrats have generally defended the act. But the looming Cadillac tax has grown increasingly unpopular, in part because labor unions say it could encourage employers to cut back on their health insurance plans for workers.
Earlier this autumn, the Democratic front-runner for president, Hillary Clinton, broke with the Obama administration to call for a repeal of the tax. She said the estimated $87 billion in lost revenue from repeal would be offset by her healthcare reform plans.
The leading Senate Democrat, Harry Reid of Nevada, has also said he supports a fix to the Cadillac tax.
The White House on Monday defended the tax, saying it gives employers with high-cost plans an incentive to make the plans more efficient.
But speaking at a news briefing, spokesman Josh Earnest did not rule out changes to the Cadillac tax.
"This law does not take effect until 2018. So we’ll be able to evaluate exactly how it would go into effect. And if in that intervening time there are ideas that are put forward that will strengthen the law, then we’re open to a conversation about that," Earnest said.
Durbin told reporters on Tuesday that "nobody has a clue" among congressional Democrats how the $87 billion in lost revenue from the tax could be replaced.
Many U.S. veterans returning from service in Iraq and Afghanistan may encounter sexual health problems, a new study suggests.
Almost 18 percent of veterans screened positive for sexual dysfunction in initial visits at the post-deployment clinic at a veterans affairs medical center in Houston, researchers say.
It’s possible the actual prevalence of sexual dysfunction is much higher, because veterans, like many other people, may be reluctant to discuss sex with providers they are seeing for the first time, noted study co-author Dr. Drew Helmer, director of the War Related Illness and Injury Study Center at the Department of Veterans Affairs (VA) New Jersey Health Care System in East Orange.
“Patients are more likely to share their sexual health concerns when they trust their provider or when the provider explicitly asks about sexual health concerns,” Helmer said by email.
To assess sexual health, clinicians asked nearly 250 veterans about these issues as part of routine physical and mental health assessments done at the post-deployment clinic in 2011 and 2012.
On average, the veterans in the study were 31 years old. Most were male and more than half didn’t report having a primary romantic partner.
Veterans responded to a five-item questionnaire rating their level of functioning or impairment in various aspects of sexual health including libido and arousal, orgasms and satisfaction, and erections for men and vaginal lubrication for women. Possible total scores for the responses could range from five to 30, with higher scores indicating more severe sexual dysfunction.
One in four of the veterans reported serious impairment in at least one area, or some difficulties with at least three aspects of sexual functioning, the researchers report in the journal Sexual Medicine.
More than half of the veterans in the study had post-traumatic stress disorder (PTSD) and almost one third had depression. About 11 percent had experienced a traumatic brain injury, and roughly 27 percent had a problem with alcohol use.
Veterans were more likely to report sexual dysfunction if they had depression or PTSD, or if they were female.
Stress related to deployment and returning home can also contribute to sexual health problems for veterans and their partners, Helmer said.
Limitations of the study include the potential for PTSD to be over-diagnosed, because the initial screenings are designed to catch any potential cases, and some of these cases are ruled out during follow-up visits, the authors acknowledge.
Researchers also lacked data on the timing of prescription medication use, which might impact sexual functioning to the extent that drugs have sexual side effects.
Even so, the findings add to a growing body of evidence linking post-deployment problems such as depression or PTSD to sexual dysfunction, Dr. Benjamin Breyer, a researcher at the University of California, San Francisco, said by email.
Compared to the civilian population, veterans can face more mental health challenges and have increased rates of PTSD and depression, noted Breyer, who wasn’t involved in the study.
PTSD can lead to decreased sexual satisfaction for both men and women, and medications used to treat depression can lead to erectile dysfunction, decreased libido and delayed ejaculation, he added.
“Compounding these physiologic issues are complex social and relational challenges that meet the veteran when they return home to established relationships,” Breyer said. “If you’re suffering from depression or PTSD, it’s more difficult to relate to your spouse, which can strain the relationship and diminish sexual wellness.”
SOURCE: bit.ly/1Hv8sAf Sexual Medicine, published online November 2, 2015.
(Reuters Health) – There is not enough evidence to support over-the-counter omega-3 fatty acid supplements as a treatment for depression, according to a new review.
“A number of other reviews investigating the impact of omega-3 fatty acids on depression and depressive disorders have also been conducted, and all of these also find discrepancies between studies, and inconsistencies in findings, and essentially find it difficult to draw convincing conclusions,” said lead author Katherine Appleton of the University of Bournemouth in the U.K.
“All reviews also conclude with the need for further evidence,” she said.
The new review included 26 randomized controlled trials involving almost 1,500 adults with major depressive disorder in total. The trials compared people who were given omega-3 fatty acid capsules and people given placebo pills.
Only one study compared omega-3 capsules to an antidepressant medication.
While people who took the omega-3 capsules did report lower levels of depression symptoms compared to the placebo group, there was only a small difference that would likely not be meaningful for most people, the authors write in the Cochrane Library.
Side effects and adverse events may have increased for some people taking omega-3 capsules, but the results varied widely from study to study. The quality of evidence from each study was low to very low, in the authors’ rating.
In the one study including antidepressants, there was no difference between omega-3 fatty acid supplements and antidepressants for depressive symptoms.
The results are “promising, but not conclusive,” said Giuseppe Grosso, a nutritional epidemiologist at the University of Catania in Italy, who was not part of the review.
It’s not clear why, or how, the omega-3 fatty acids naturally found in fish oils would improve depressive symptoms, although inflammation and cell communication changes, among other pathways, have been suggested, Appleton told Reuters Health by email.
“One of the problems with understanding results from clinical trials in general is that they are looking for an average effect, while many experts agree that the ideal approach would be to figure out which subsets of depressed patients could benefit from particular treatments, an approach the (National Institutes of Health) has called 'personalized medicine',” said Dr. Elizabeth Sublette of Columbia University in New York, who was not part of the new review.
“At this stage we don't yet know how to predict which depressed patients will respond to omega-3 supplements,” Sublette told Reuters Health by email. “They remain one potential treatment that may be worth trying, and I would encourage both doctors and patients to keep an open mind about this topic until more evidence of higher quality can be obtained.”
Most omega-3 supplements are composed of natural oils, so there is no evidence to suggest the results of the trials would have been different if the omega-3 acids came from eating fish rather than taking capsules, she said.
A bottle of 50 to 100 capsules of omega-3 fish oil supplement costs between $10 and $20 at most drugstores.
More research is needed to assess the potential positive and negative effects of using these supplements to treat major depressive disorder, Appleton and her colleagues write.
“Many possible treatments for depression are currently being investigated, but the evidence for many of these treatments is still incomplete,” she said.
SOURCE: bit.ly/1HFLp0f The Cochrane Library, online November 5, 2015.
Teens who often weigh themselves may be more likely to have mental health problems, according to a new study.
Girls who said they often weigh themselves were more likely to have depression, weight concerns and self esteem issues, researchers found.
“The findings from this study suggest that for some teens and young adults, self-weighing is associated with poor psychological health and it is important that we use caution when recommending self-weighing or any strategy for weight control that may not be beneficial for some individuals,” said lead author Carly R. Pacanowski, of the University of Minnesota in Minneapolis.
The 10-year study tracked almost 2,000 adolescents, most of whom were female. They were surveyed, weighed and measured in 1998, when they were in middle or high school and then again in 2003 and 2008 as they transitioned into young adulthood.
Overall, few participants agreed that they weighed themselves "often," the researchers reported in the Journal of Nutrition Education and Behavior.
But among women whose reports of self-weighing increased over time, so did their weight concern and symptoms of depression, which can be predictors of eating disorders, researchers found.
For men, as reported self-weighing increased, so did concern about weight, but other psychological variables did not change.
Parents, teachers, aunts, uncles, and friends may want to ask about self-weighing to gather more information if a teen seems overly concerned with her weight, Pacanowski told Reuters Health by email.
“Self-weighing may be easier to talk about initially than self-esteem or depressive symptoms,” Pacanowski said. “From there, getting in touch with a healthcare provider would be the next step.”
Obesity-prevention programs should avoid worsening body dissatisfaction and weight concern by understanding how behaviors like self-weighing affect teens, she said.
Pacanowski also cautioned that the new study can't say whether self-weighing causes low self-esteem, or low self-esteem causes teens or young adults to weigh themselves more frequently.
The new study is also limited by the use of the subjective term "often" to gauge the frequency of self-weighing over time, said Jessica LaRose, a health behavior and policy researcher at Virginia Commonwealth University in Richmond, who was not part of the new study.
“Thus, in terms of clinical implications for pediatricians, we can't determine using these data whether there is a specific threshold or frequency of self-weighing in this age group that could serve as a signal to explore mental health symptoms and well being,” LaRose told Reuters Health by email.
SOURCE: bit.ly/1kK5NrP Journal of Nutritional Education and Behavior, online November 9, 2015.