Suchergebnisse

OBJECTIVES: Policy and legislation that prohibits workplace harassment and discrimination, including that which is disability related, has been in place in Canada for many years. The study objective was to examine associations between disability and workplace harassment and discrimination in the current Canadian context, as well as the intersection of disability with age, gender, and ethnicity. METHODS: Cross-sectional data from the 2014 Canadian Public Service Employee Survey was analyzed (n = 175,742) using logistic regression to investigate the relationship between self-reported disability and workplace harassment and discrimination in the last 2 years. Age, gender, and ethnicity were included as potential confounders and effect modifiers. Additive and multiplicative effect modifications were examined using linear binomial and logistic regression, respectively. RESULTS: Overall, 18 and 8% of the sample of Canadian public service employees reported workplace harassment and discrimination, respectively. The prevalence was higher for workers with disability (37 and 26%). Disability was significantly associated with an increased odds of harassment (odds ratio (OR) = 2.80; 95% confidence interval (CI), 2.68–2.92) and discrimination (OR = 4.97; 95% CI, 4.72–5.23) in models adjusted for confounders. Significant positive additive effect modification was observed for (1) age in the harassment and discrimination models and (2) ethnicity in the discrimination model. CONCLUSION: Findings from a 2014 census of the Canadian federal public service suggest that additional efforts are needed to address workplace harassment and discrimination beyond those already in place. Consideration should be given to workers with disability, as well as the intersectional impacts for older workers, visible minorities, and Aboriginal peoples.

IntroductionMusculoskeletal disorders (MSDs) are the most prevalent chronic condition in Canada, and account for the highest disability costs. Gradual-return-to-work (GRTW) can improve health and labour market outcomes in an aging workforce at risk of MSDs. Linked longitudinal data enables us to generate evidence of GRTW to inform policy needs.
Objectives and ApproachThe objective of this study was to investigate the effectiveness and cost-benefits of GRTW for workers with a work-acquired MSD in British Columbia, Canada. We linked workers' compensation data, health services data, and prescription data from three governing bodies to 1) identify injured workers with an accepted MSD lost-time injury between 2010 and 2015; 2) identify trajectories of RTW states (injury, sickness absence, GRTW, RTW, and non-RTW) and the probability of transitioning between states; and 3) assess the association between workers characteristics and RTW trajectories, and analyze the cost-benefits of GRTW.
ResultsFinal results are expected early 2019. To our knowledge, this will be the first study linking workers' compensation data (in particular detailed RTW data), health services data and prescription data from three different governing bodies for a comprehensive, population-based investigation of work disability experiences over a longitudinal time period and within the Canadian context. Also, using this data for the purpose of assessing the cost-benefits is new, and will help to prioritize prevention resources and strategies to limit the health and economic impact of work-related MSDs on employers, workers' compensation boards and society.
Conclusion/ImplicationsEvaluating the effects of GRTW on work disability is essential to maximize the health and economic benefits for injured workers. The innovation of this project is that is links three population-based databases to capture multiple indicators of health and work status to build RTW trajectories over time.

AbstractIntroductionCoarse exposure assessment and assignment is a common issue facing epidemiological studies of shift work. Such measures ignore a number of exposure characteristics that may impact on health, increasing the likelihood of biased effect estimates and masked exposure–response relationships. To demonstrate the impacts of exposure assessment precision in shift work research, this study investigated relationships between work schedule and depression in a large survey of Canadian nurses.MethodsThe Canadian 2005 National Survey of the Work and Health of Nurses provided the analytic sample (n = 11450). Relationships between work schedule and depression were assessed using logistic regression models with high, moderate, and low-precision exposure groupings. The high-precision grouping described shift timing and rotation frequency, the moderate-precision grouping described shift timing, and the low-precision grouping described the presence/absence of shift work. Final model estimates were adjusted for the potential confounding effects of demographic and work variables, and bootstrap weights were used to generate sampling variances that accounted for the survey sample design.ResultsThe high-precision exposure grouping model showed the strongest relationships between work schedule and depression, with increased odds ratios [ORs] for rapidly rotating (OR = 1.51, 95% confidence interval [CI] = 0.91–2.51) and undefined rotating (OR = 1.67, 95% CI = 0.92–3.02) shift workers, and a decreased OR for depression in slow rotating (OR = 0.79, 95% CI = 0.57–1.08) shift workers. For the low- and moderate-precision exposure grouping models, weak relationships were observed for all work schedule categories (OR range 0.95 to 0.99).ConclusionsFindings from this study support the need to consider and collect the data required for precise and conceptually driven exposure assessment and assignment in future studies of shift work and health. Further research into the effects of shift rotation frequency on depression is also recommended.

LAY SUMMARY This work investigated factors associated with medicinal cannabis authorization dosage among 9,104 Canadian Armed Forces Regular Force Veterans in Canada with a valid Cannabis for Medicinal Purposes reimbursement on Dec. 31, 2020, and identified various socio-demographic, Veterans Affairs Canada (VAC) pensionable conditions, and military service characteristics associated with higher-dose medicinal cannabis authorizations. Among those with higher dose reimbursements were Veterans under the age of 30 years, males, those receiving benefits for health conditions (e.g., hearing loss, musculoskeletal, or mental health conditions), those participating in VAC rehabilitation services, those with an earlier year of reimbursement, those who were released involuntarily from service, and those indicating land military environment service at date of release. In statistical models investigating the impact of multiple factors, some of the strongest associations with higher dosages were observed for Veterans with mental health conditions, those with earlier reimbursements, and province of residence. Introduction: Since 2008, Veterans Affairs Canada (VAC) has provided Canadian Armed Forces Regular Force Veterans with reimbursement of Cannabis for Medical Purposes (CMP) authorizations. The authorized dosage and authorization criteria have changed with time. This study investigated factors associated with CMP authorizations and dosage among CMP-authorized Veterans. Methods: CMP authorizations among 9,104 Veterans residing in Canada on Dec. 31, 2020, were linked with VAC reimbursement, VAC client, and military personnel records. Multivariable logistic regression models were used to examine relationships between CMP dosage and socio-demographic, health, and military characteristics. Results: Among Veterans with CMP authorizations, the strongest associations with a larger authorization dosage (4–10 grams vs. 1–3 grams) were observed for Veterans receiving benefits for mental health conditions in combination with other health conditions (OR = 3.47 compared with those with no mental health conditions). A larger authorization dosage was associated with province of residence (OR = 3.36 for New Brunswick compared with Ontario), earlier year of authorization (OR = 2.19 for 2014) compared with 2016, being male (OR = 1.68), active participation in a rehabilitation program (OR = 1.45), land environment at the time of release from military service (OR = 1.24) compared with air environments, and involuntary release from service (OR = 1.65) and medical release (OR = 1.11) compared with voluntary release. Discussion: Factors associated with larger CMP authorization dosage among military Veterans in Canada appeared multifactorial, spanning socio-demographic, health, and military characteristics. This complexity should be considered by treatment providers and clinicians working with military Veterans.

International research has generated strong evidence that healthcare providers (HCPs) play a key role in the return to work (RTW) process. However, pressure on consultation time, administrative challenges and limited knowledge about a patient's workplace can thwart meaningful engagement. Aim: Our study sought to understand how HCPs interact with workers compensation boards (WCBs), manage the treatment of workers compensation patients and navigate the RTW process. Method: The study involved in-depth interviews with 97 HCPs in British Columbia, Manitoba, Ontario and Newfoundland and Labrador and interviews with 34 case managers (CMs). An inductive, constant comparative analysis was employed to develop key themes. Findings: Most HCPs did not encounter significant problems with the workers compensation system or the RTW process when they treated patients who had visible, acute, physical injuries, but faced challenges when they encountered patients with multiple injuries, gradual-onset or complex illnesses, chronic pain and mental health conditions. In these circumstances, many experienced the workers compensation system as opaque and confusing. A number of systemic, process and administrative hurdles, disagreements about medical decisions and lack of role clarity impeded the meaningful engagement of HCPs in RTW. In turn, this has resulted in challenges for injured workers (IWs), as well as inefficiencies in the workers compensation system. Conclusion: This study raises questions about the appropriate role of HCPs in the RTW process. We offer suggestions about practices and policies that can clarify the role of HCPs and make workers compensation systems easier to navigate for all stakeholders.

Background: Studies of water-related gastrointestinal infections are usually directed at outbreaks. Few have examined endemic illness or compared rates across different water supply and sewage disposal systems. We conducted a cohort study of physician visits and hospitalizations for endemic intestinal infectious diseases in a mixed rural and urban community near Vancouver, Canada, with varied and well-characterized water and sewage systems. Methods: Cohort members and their disease events were defined via universal health insurance data from 1995 through 2003. Environmental data were derived from municipal, provincial, and federal government sources. Logistic regression was used to examine associations between disease events and water and sewage systems, socio-demographic characteristics, and temporal factors. Results: The cohort included 126,499 individuals and approximately 190,000,000 person-days. Crude incidence rates were 1,353 physician visits and 33.8 hospitalizations for intestinal infectious diseases per 100,000 person-years. Water supply chlorination was associated with reduced physician visit incidence (OR: 0.92, 95% CI 0.85-1.0). Two water systems with the highest proportions of surface water had increased incidence (ORs: 1.57, 95% CI 1.39-1.78; and 1.45, 95% CI 1.28-1.64). Private well water and well depth were not associated with increased risk, likely because of residents' awareness of and attention to water quality. There was increased crude incidence with increasing precipitation in the population served by surface water supplies, but this trend did not remain with adjustment for other variables. Municipal sewer systems were associated with increased risk (OR: 1.26, 95% CI 1.14-1.38). Most socio-demographic variables had predicted associations with risk: higher rates in females, in the very young and the elderly, and in residents of low income areas. Increased duration of area residence was associated with reduced risk (OR, duration ≥ 6 years: 0.69, 95% CI 0.60-0.80 vs. < 1 year: 1.16, 95% CI 1.03-1.30). Conclusions: This large cohort study, with objective data on exposures and outcomes, demonstrated associations between endemic infectious intestinal diseases and factors related to water supply, sewage disposal, socio-demographics, and duration of residency. The results did not always follow prior expectations based on studies examining outbreaks and single systems, and underscore the importance of studying factors associated with endemic disease across water and sewage system types. ; Applied Science, Faculty of ; Civil Engineering, Department of ; Pathology and Laboratory Medicine, Department of ; Population and Public Health (SPPH), School of ; Science, Faculty of ; Non UBC ; Medicine, Faculty of ; Resources, Environment and Sustainability (IRES), Institute for ; Reviewed ; Faculty

Abstract Background Studies of water-related gastrointestinal infections are usually directed at outbreaks. Few have examined endemic illness or compared rates across different water supply and sewage disposal systems. We conducted a cohort study of physician visits and hospitalizations for endemic intestinal infectious diseases in a mixed rural and urban community near Vancouver, Canada, with varied and well-characterized water and sewage systems. Methods Cohort members and their disease events were defined via universal health insurance data from 1995 through 2003. Environmental data were derived from municipal, provincial, and federal government sources. Logistic regression was used to examine associations between disease events and water and sewage systems, socio-demographic characteristics, and temporal factors. Results The cohort included 126,499 individuals and approximately 190,000,000 person-days. Crude incidence rates were 1,353 physician visits and 33.8 hospitalizations for intestinal infectious diseases per 100,000 person-years. Water supply chlorination was associated with reduced physician visit incidence (OR: 0.92, 95% CI 0.85-1.0). Two water systems with the highest proportions of surface water had increased incidence (ORs: 1.57, 95% CI 1.39-1.78; and 1.45, 95% CI 1.28-1.64). Private well water and well depth were not associated with increased risk, likely because of residents' awareness of and attention to water quality. There was increased crude incidence with increasing precipitation in the population served by surface water supplies, but this trend did not remain with adjustment for other variables. Municipal sewer systems were associated with increased risk (OR: 1.26, 95% CI 1.14-1.38). Most socio-demographic variables had predicted associations with risk: higher rates in females, in the very young and the elderly, and in residents of low income areas. Increased duration of area residence was associated with reduced risk (OR, duration ≥ 6 years: 0.69, 95% CI 0.60-0.80 vs . < 1 year: 1.16, 95% CI 1.03-1.30). Conclusions This large cohort study, with objective data on exposures and outcomes, demonstrated associations between endemic infectious intestinal diseases and factors related to water supply, sewage disposal, socio-demographics, and duration of residency. The results did not always follow prior expectations based on studies examining outbreaks and single systems, and underscore the importance of studying factors associated with endemic disease across water and sewage system types.