Headache and Health-Related Job Loss among Disadvantaged Women

Annual indirect costs secondary to headache disability in Brazil

Background

Disability imposed by headache disorders constitutes an expressive economic burden, mostly from indirect costs due to absenteeism and presenteeism.

Objective

To estimate indirect costs from absenteeism and presenteeism due to headache disorders in Brazil.

Methods

In a secondary, descriptive analysis of two nationwide databases, we estimated indirect costs based on headache-related disability and socioeconomic data.

Results

In the first database analyzed (n = 3838), 12.8% of the employed population with headache disorders missed at least 1 day of work in the last 3 months (mean, 95% CI = 4.2 days [3.7–4.6]). Based on the prevalence of headache disorders, days lost due to headaches and income data, R$ 40.4 billion (Int$ 20 billion) are lost due to headache-related absenteeism annually. For presenteeism, 26.2% of the employed population with headache disorders worked at least 1 day in the last 3 months with 50% reduced productivity (mean, 95% CI = 5.7 days [5.3–6.2]), amounting to R$ 27.3 billion (Int$ 13.5 billion) of financial loss annually. In the other database analysed (n = 205,546), 14,052 (6.8%) respondents missed work/school or household duties in the past 2 weeks due to some disease. Of these, 4.7% attributed their days lost to headaches disorders in the economically active population, which ranked 4th as main cause of days lost due to disease, among 23 common diseases.

Conclusions

The economic burden of headache disorders in Brazil, mostly due to migraine (55.4%), may cost up to R$ 67.6 billion (Int$ 33.5 billion) annually, and headache disorders represent a leading cause of absenteeism due to disease.

Workplace health and safety intervention for child care staff: Rationale, design, and baseline results from the CARE cluster randomized control trial

BACKGROUND

Low-wage workers suffer disproportionately high rates of chronic disease and are important targets for workplace health and safety interventions. Child care centers offer an ideal opportunity to reach some of the lowest paid workers, but these settings have been ignored in workplace intervention studies.

METHODS

Caring and Reaching for Health (CARE) is a cluster-randomized controlled trial evaluating efficacy of a multi-level, workplace-based intervention set in child care centers that promotes physical activity and other health behaviors among staff. Centers are randomized (1:1) into the Healthy Lifestyles (intervention) or the Healthy Finances (attention control) program. Healthy Lifestyles is delivered over six months including a kick-off event and three 8-week health campaigns (magazines, goal setting, behavior monitoring, tailored feedback, prompts, center displays, director coaching). The primary outcome is minutes of moderate and vigorous physical activity (MVPA); secondary outcomes are health behaviors (diet, smoking, sleep, stress), physical assessments (body mass index (BMI), waist circumference, blood pressure, fitness), and workplace supports for health and safety.

RESULTS

In total, 56 centers and 553 participants have been recruited and randomized. Participants are predominately female (96.7%) and either Non-Hispanic African American (51.6%) or Non-Hispanic White (36.7%). Most participants (63.4%) are obese. They accumulate 17.4 (±14.2) minutes/day of MVPA and consume 1.3 (±1.4) and 1.3 (±0.8) servings/day of fruits and vegetables, respectively. Also, 14.2% are smokers; they report 6.4 (±1.4) hours/night of sleep; and 34.9% are high risk for depression.

CONCLUSIONS

Baseline data demonstrate several serious health risks, confirming the importance of workplace interventions in child care.

Social withdrawal as a self-management behavior for migraine: implications for depression comorbidity among disadvantaged women

Disadvantaged women with migraine headaches have a particularly high risk of developing comorbid depression and often isolate themselves from others-or socially withdraw-to manage these disorders. Despite this, little is known about whether or how social withdrawal as a self-management strategy for episodic migraine might contribute to the more severe symptom burden in this group. In this article, we explore the potentially cumulative, deleterious effect that this strategy may have in modulating migraine-depression symptom severity in this population and argue that further theoretical and empirical work from nursing and complexity science perspectives is needed to better understand this phenomenon.