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This paper examines the compensation process for work-related injuries and illnesses by assessing the trajectories of a sample of immigrant and non-immigrant workers ( n = 104) in Montreal. Workers were interviewed to analyze the complexity associated with the compensation process. Experts specialized in compensation issues assessed the difficulty of the interviewees’ compensation process. Immigrant workers faced greater difficulties with medical, legal, and administrative issues than non-immigrants did. While immigrant workers’ claim forms tended to be written more often by employers or friends (58% vs. 8%), the claims were still more often contested by employers (64% vs. 24%). Immigrant workers were less likely to obtain a precise diagnosis (64% vs. 42%) and upon returning to work were more likely to face sub-optimal conditions. Such results throw into relief issues of ethics and equity in host societies that are building their economy with migrant workers. [ABSTRACT FROM AUTHOR]

Language barriers are often cited as a factor contributing to ethnic inequalities in occupational health; however, little information is available about the mechanisms at play. The authors describe the multiple ways in which language influences occupational health in a large garment factory employing many immigrants in Montreal. Between 2004 and 2006, individual, semi-structured interviews were conducted with 15 women and 10 men from 14 countries of birth. Interviews were conducted in French and English, Canada's official languages, as well as in non-official languages with the help of colleague-interpreters. Observation within the workplace was also carried out at various times during the project. The authors describe how proficiency in the official languages influences occupational health by affecting workers' ability to understand and communicate information, and supporting relationships that can affect work-related health. They also describe workers' strategies to address communication barriers and discuss the implications of these strategies from an occupational health standpoint. Along with the longer-term objectives of integrating immigrants into the linguistic majority and addressing structural conditions that can affect health, policies and practices need to be put in place to protect the health and well-being of those who face language barriers in the short term. [ABSTRACT FROM AUTHOR]

Objective: To estimate the current levels and trends in the proportion of US adults with high blood cholesterol based on guidelines from the second report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP II).Design: Nationally representative cross-sectional surveys.Setting/participants: Data for 7775 participants 20 years of age and older from phase 1 of the third National Health and Nutrition Examination Survey (NHANES III) (data collected from 1988 through 1991) and for 9797 participants 20 through 74 years of age from NHANES II (data collected from 1976 through 1980) were used.Results: From the data collection period in NHANES II (1976 through 1980) to the period in NHANES III (1988 through 1991), the proportion of adults with high blood cholesterol levels (> or = 240 mg/dL [6.21 mmol bd) fell from 26% to 20%, while the proportion with desirable levels (< 200 mg/dL [5.17 mmol/L]) rose from 44% to 49%. Currently, using the ATP II guidelines and NHANES III data, 40% of all adults 20 years of age and older would require fasting lipoprotein analysis; and 29% of all adults would be candidates for dietary therapy (as compared with 36%, using NHANES II data). Based on 1990 population data, it is estimated that approximately 52 million Americans 20 years of age and older would be candidates for dietary therapy. Assuming that dietary intervention would reduce low-density lipoprotein (LDL) cholesterol levels by 10%, as many as 7% of all adult Americans (approximately 12.7 million) might be candidates for cholesterol-lowering drugs. This estimate reflects approximately 4 million adults with established coronary heart disease, of whom half are aged 65 years and older, and up to 8.7 million adults without established coronary heart disease, of whom up to 3.1 million are aged 65 years and older.Conclusions: Substantial progress has been made in reducing the prevalence of high blood cholesterol; yet a large proportion of all adults, approximately 29%, require dietary intervention for high blood cholesterol. [ABSTRACT FROM AUTHOR]

The rates of rat liver microsomal and mitochondrial activation of the Δ to Δ cis-octadecenoate positional isomers have been investigated. The fatty acid to protein ratios required for maximum activation of the Δ, Δ and Δ isomers were much lower than the corresponding ratios required for maximum activation of the cis-octadecenoates with double bonds at either end of the fatty acid molecule. Also, as the incubation temperature was raised from 22-38 C the Δ and Δ isomers exhibited little change in their rates of activation, while large increases in activation rates of the isomers with the double bond at either end of the fatty acid chain were observed. Differential inhibition of the activation of the various positional isomers was observed when anionic, cationic, or nonionic detergents were included in the incubation medium. The different responses to fatty acid concentration, temperature and detergents are attributed to enzyme specificity and to differences in solution properties of the cis-octadecenoates, rather than to the presence of separate rat liver enzymes that catalyze acyl-CoA ester formation of the various positional isomers. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to explore how workers' compensation policies related to healthcare provision for workers with musculoskeletal injuries can affect the delivery and trajectories of care for injured workers. The principal research question was: What are the different ways in which workers' compensation (WC) policies inform and transform the practices of healthcare providers (HCPs) caring for injured workers?, Methods: We conducted a cross-jurisdictional policy analysis. We conducted qualitative interviews with 42 key informants from a variety of perspectives in the provinces of Ontario and Quebec in Canada, the state of Victoria in Australia and the state of Washington in the United States. The main methodological approach was Framework Analysis., Results: We identified two main themes: (1) Shaping HCPs' clinical practices and behaviors with injured workers. In this theme, we illustrate how clinical practice guidelines and non-economic and economic incentives were used by WCs to drive HCP's behaviours with workers; (2) Controlling workers' trajectories of care. This theme presents how WC policies achieve control of the workers' trajectory of care via different policy mechanisms, namely the standardization of care pathways and the power and autonomy vested in HCPs., Conclusions: This policy analysis shed light on the different ways in which WC policies shape HCP's day-to-day practices and workers' trajectories. A better understanding and a nuanced portrait of these policies' impacts can help support reflections on future policy changes and inform policy development in other jurisdictions., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose Work injury and return to work processes can have adverse effects on injured workers and their families. Family members may experience increased workloads, role reversals, dissolution of marriages or changes in relationships with children, as well as financial strain from loss of income. How these associations interact when the injured worker is precariously employed, however, is unknown. The aim of this study was to explore the impacts of work-related injury or illness as well as subsequent compensation and return to work processes on families and relationships of precariously employed workers. Methods Interviews were conducted with fifteen precariously employed injured workers recruited through on-line advertising, injured worker groups, and social media platforms in Ontario. Situational analysis was used to identify how family members were affected and their role throughout the injury process. Results Precariously employed injured workers felt caught between self-interested employers and disinterested workers' compensation. In some cases, this led to deteriorated mental health and well-being. The worker's difficulties with RTW challenged financial security of families and affected their day-to-day normal routines. While some workers received emotional and instrumental support from their family members, others had their families fall apart when chronic disability and unemployment proved to be too much. Conclusions This study addressed the complex ways that work injury and illness among precariously employed workers interact with family life and relationships. Findings illustrate how the income and employment insecurity associated with precarious employment has ripple effects on workers and their families when they become injured.

Background: First-line health care providers are the primary access point for workers' benefits. However, little is known about their impact on quality of care and return-to-work. Our objective was to critically compare literature on the practices of first-line providers for workers with musculoskeletal injuries in Ontario and Quebec (Canada), Washington State (United States), and Victoria (Australia)., Methods: A critical interpretive synthesis of peer-reviewed scientific literature was conducted. The search across six databases yielded 59 relevant publications that were critically appraised., Results: Three themes emerged: 1) how policies about first-line health care providers' modulate worker access to care, 2) how these providers' roles, practices, and training shape disability management, and 3) how the quality of care and disability outcomes are evaluated., Conclusions: First-line health care providers have a critical influence on workers' trajectories of care. A focus on their role while taking the complexity of the context into account will help orient future policy changes., (© 2019 Wiley Periodicals, Inc.)

Introduction: It is not known whether out-of-province Canadians, who travel to Alberta for work, are at increased risk of occupational injury., Methods: Workers' compensation board (WCB) claims in 2013 to 2015 for those injured in Alberta were extracted by home province. Denominator data, from Statistics Canada, indicated the numbers from Alberta and Newfoundland and Labrador (NL) employed in Alberta in 2012. Both datasets were stratified by industry, age, and gender. Logistic regression estimated the risk of a worker from NL making a WCB claim in 2013 or 2014, stratified by time lost from work. Bias from under-reporting was examined in responses to injury questions in a cohort of trades' workers across Canada and in a pilot study in Fort McMurray, Alberta., Results: Injury reporting rate in workers from NL was lower than those from Alberta, with a marked deficit (odds ratio [OR] = 0.17; 95% confidence interval [CI], 0.12-0.27) for injuries resulting in 1 to 30 days off work. Among the 1520 from Alberta in the trades' cohort, 327 participants reported 444 work injuries: 34.5% were reported to the WCB, rising to 69.4% in those treated by a physician. A total of 52 injuries in Alberta were recorded by 151 workers in the Fort McMurray cohort. In logistic regression, very similar factors predicted WCB reporting in the trades and Fort McMurray cohorts, but those from out-of-province or recently settled in Alberta were much less likely to report (OR = 0.02; 95% CI, 0.00-0.40)., Conclusion: Differential rates of under-reporting explain in part the overall low estimates of injuries in interprovincial workers but not the deficit in time-loss 1 to 30 days., (© 2019 Wiley Periodicals, Inc.)

Background: This study sought to identify impacts of compensation system characteristics on doctors in Québec and Ontario., Methods: (i) Legal analysis; (ii) Qualitative methods applied to documentation and individual and group interviews with doctors (34) and other system participants (31); and (iii) Inter-jurisdictional transdisciplinary analysis involving cross-disciplinary comparative and integrative analysis of policy contexts, qualitative data, and the relationship between the two., Results: In both jurisdictions the compensation board controlled decisions on work-relatedness and doctors perceived the bureaucratic process negatively. Gatekeeping roles differed between jurisdictions both in initial adjudication and in dispute processes. Québec legislation gives greater weight to the opinion of the treating physician. These differences affected doctors' experiences., Conclusions: Policy-makers should contextualize the sources of the "evidence" they rely on from intervention research because findings may reflect a system rather than an intervention effect. Researchers should consider policy contexts to both adequately design a study and interpret their results. Am. J. Ind. Med. 59:1070-1086, 2016. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: Involvement in a compensation process following a motor vehicle collision is consistently associated with worse health status but the reasons underlying this are unclear. Some compensation systems are hypothesised to be more stressful than others. In particular, fault-based compensation systems are considered to be more adversarial than no-fault systems and associated with poorer recovery. This study compares the perceived fairness and recovery of claimants in the fault-based compensation system in New South Wales (NSW) to the no-fault system in Victoria, Australia., Methods: One hundred eighty two participants were recruited via claims databases of the compensation system regulators in Victoria and NSW. Participants were > 18 years old and involved in a transport injury compensation process. The crash occurred 12 months (n = 95) or 24 months ago (n = 87). Perceived fairness about the compensation process was measured by items derived from a validated organisational justice questionnaire. Health outcome was measured by the initial question of the Short Form Health Survey., Results: In Victoria, 84 % of the participants considered the claims process fair, compared to 46 % of NSW participants (χ(2) = 28.54; p < .001). Lawyer involvement and medical assessments were significantly associated with poorer perceived fairness. Overall perceived fairness was positively associated with health outcome after adjusting for demographic and injury variables (Adjusted Odds Ratio = 2.8, 95 % CI = 1.4 - 5.7, p = .004)., Conclusion: The study shows large differences in perceived fairness between two different compensation systems and an association between fairness and health. These findings are politically important because compensation processes are designed to improve recovery. Lower perceived fairness in NSW may have been caused by potential adversarial aspects of the scheme, such as liability assessment, medical assessments, dealing with a third party for-profit insurance agency, or financial insecurity due to lump sum payments at settlement. This study should encourage an evidence informed discussion about how to reduce anti-therapeutic aspects in the compensation process in order to improve the injured person's health.

This article reports on the results of an empirical study of working conditions including psychological harassment (workplace bullying) in the province of Québec, Canada, the first North American jurisdiction to regulate psychological harassment in its labor legislation. All empirical data provided in this article was drawn from the Québec Survey on Working, Employment and Occupational Health and Safety Conditions, conducted through 5071 telephone interviews of a representative sample of Québec workers, including the self-employed. Here we focus on employees, and provide bivariate and multivariate analyses. All analyses were stratified by gender. We provide a portrait of exposure to psychological harassment, and exposure to other psychosocial factors in the workplace associated with exposure to psychological harassment. Results show associations between exposure to psychological harassment and negative health measures including psychological distress, symptoms of depression, traumatic work accidents, musculoskeletal disorders and negative perception of health status. We report on steps taken by employees to put an end to the harassment. Gender similarities and differences in exposure, associated risk factors, health measures and strategies are presented and discussed in light of the legal context in which the study took place. We conclude with recommendations for prevention strategies that take into consideration the gender composition of the workplace., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Emerging fields such as environmental health have been challenged, in recent years, to answer the growing methodological calls for a finer integration of sex and gender in health-related research and policy-making., Methods: Through a descriptive examination of 25 peer-reviewed social science papers published between 1996 and 2011, we explore, by examining methodological designs and theoretical standpoints, how the social sciences have integrated gender sensitivity in empirical work on Multiple Chemical Sensitivities (MCS). MCS is a "diagnosis" associated with sensitivities to chronic and low-dose chemical exposures, which remains contested in both the medical and institutional arenas, and is reported to disproportionately affect women., Results: We highlighted important differences between papers that did integrate a gender lens and those that did not. These included characteristics of the authorship, purposes, theoretical frameworks and methodological designs of the studies. Reviewed papers that integrated gender tended to focus on the gender roles and identity of women suffering from MCS, emphasizing personal strategies of adaptation. More generally, terminological confusions in the use of sex and gender language and concepts, such as a conflation of women and gender, were observed. Although some men were included in most of the study samples reviewed, specific data relating to men was undereported in results and only one paper discussed issues specifically experienced by men suffering from MCS. Papers that overlooked gender dimensions generally addressed more systemic social issues such as the dynamics of expertise and the medical codification of MCS, from more consistently outlined theoretical frameworks. Results highlight the place for a critical, systematic and reflexive problematization of gender and for the development of methodological and theoretical tools on how to integrate gender in research designs when looking at both micro and macro social dimensions of environmental health conditions., Conclusions: This paper contributes to a discussion on the methodological and policy implications of taking sex and gender into account appropriately in order to contribute to better equity in health, especially where the critical social contexts of definition and medico-legal recognition play a major role such as in the case of MCS.

Objectives: We examined underestimation of nontraumatic work-related musculoskeletal disorders (WMSDs) stemming from underreporting to workers' compensation (WC)., Methods: In data from the 2007 to 2008 Québec Survey on Working and Employment Conditions and Occupational Health and Safety we estimated, among nonmanagement salaried employees (NMSEs) (1) the prevalence of WMSDs and resulting work absence, (2) the proportion with WMSD-associated work absence who filed a WC claim, and (3) among those who did not file a claim, the proportion who received no replacement income. We modeled factors associated with not filing with multivariate logistic regression., Results: Eighteen percent of NMSEs reported a WMSD, among whom 22.3% were absent from work. More than 80% of those absent did not file a WC claim, and 31.4% had no replacement income. Factors associated with not filing were higher personal income, higher seniority, shorter work absence, and not being unionized., Conclusions: The high level of WMSD underreporting highlights the limits of WC data for surveillance and prevention. Without WC benefits, injured workers may have reduced job protection and access to rehabilitation.

Purpose: Social service programmes that offer consumer choices are intended to guide service efficiency and customer satisfaction. However, little is known about how social service consumers actually make choices and how providers deliver such services. This article details the practical implementation of consumer choice in a Canadian workers' compensation vocational retraining programme., Method: Discourse analysis was conducted of in-depth interviews and focus groups with 71 injured workers and service providers, who discussed their direct experience of a vocational retraining system. Data also included procedural, policy and administrative documents., Results: Consumer choice included workers being offered choices about some service aspects, but not being able to exercise meaningful discretion. Programme cost objectives and restrictive rules and bureaucracy skewed the guidance provided to workers by service providers. If workers did not make the "right" choices, then the service providers were required to make choices for them. This upset workers and created tension for service providers., Conclusions: The ideal of consumer choice in a social service programme was difficult to enact, both for workers and service providers. Processes to increase quality of guidance to social service consumers and to create a systematic feedback look between system designers and consumers are recommended. Implications for Rehabilitation Consumer choice is an increasingly popular concept in social service systems. Vocational case managers can have their own administrative needs and tensions, which do not always align with the client's choices. Rehabilitation programmes need to have processes for considering what choices are important to clients and the resources to support them.

Background: Workers' compensation systems are among the most generous disability insurance systems in North America, although they are also known to be potentially adversarial and may have iatrogenic effects on claimants. This article examines issues to be considered to ensure fair compensation provided in a way that respects the dignity of workers., Methods: An overview of the literature on characteristics and effects of workers' compensation systems is followed by an analysis based on classic legal methods, including those of comparative law, complemented with interview data to examine three models of disability compensation., Results: The first part of the article identifies cross cutting issues to be considered in the examination of the equity of compensation systems and the protection of the dignity of claimants. These include three underpinnings of workers' compensation: the links between a "no-fault" system and the adversarial process, the appropriate use of medical and scientific evidence in the determination of compensability and the application of appropriate measures for promoting return to work. The second part looks at accident compensation in New Zealand, where compensation is available regardless of the cause of the accident, and disability insurance in the Netherlands, where compensation is available regardless of the cause of the disability. It then describes a composite of characteristics favorable to equity drawn from the thirteen workers' compensation systems in Canada., Conclusion: Systems that succeed in reducing opportunities for adversarial interactions and that provide substantive protection could better promote the dignity of claimants., (Copyright © 2012 Wiley Periodicals, Inc.)

The first part of this article describes regulatory interventions, drawn from different Canadian jurisdictions, designed to reduce worker exposure to psychosocial hazards, including occupational violence, and to protect workers' mental health. It also addresses legislative provisions providing workers' compensation for mental health problems and regulatory provisions supporting the return to work of those who have been absent from work because of work-related mental health problems. The second part of the article, relying on illustrations from case law in which workers' compensation claims for mental health problems have been accepted, examines ways in which law and policy can actually contribute directly or indirectly to behaviours that may lead to increasing illness and disability associated with mental health problems., (Copyright © 2011 Longwoods Publishing.)

Objectives: Few Canadian data sources allow the examination of disparities by ethnicity, language, or immigrant status in occupational exposures or health outcomes. However, it is possible to document the mechanisms that can create disparities, such as the over-representation of population groups in high-risk jobs. We evaluated, in the Montréal context, the relationship between the social composition of jobs and their associated risk level., Methods: We used data from the 2001 Statistics Canada census and from Québec's workers' compensation board for 2000-2002 to characterize job categories defined as major industrial groups crossed with three professional categories (manual, mixed, non-manual). Immigrant, visible, and linguistic minority status variables were used to describe job composition. The frequency rate of compensated health problems and the average duration of compensation determined job risk level. The relationship between the social composition and risk level of jobs was evaluated with Kendall correlations., Results: The proportion of immigrants and minorities was positively and significantly linked to the risk level across job categories. Many relationships were significant for women only. In analyses done within manual jobs, relationships with the frequency rate reversed and were significant, except for the relationship with the proportion of individuals with knowledge of French only, which remained positive., Conclusions: Immigrants, visible, and linguistic minorities in Montréal are more likely to work where there is an increased level of compensated risk. Reversed relationships within manual jobs may be explained by under-reporting and under-compensation in vulnerable populations compared to those with knowledge of the province's majority language., ((c) 2010 Wiley-Liss, Inc.)

This article reports on a study of the legal and policy framework governing access, in Canada, to workers' compensation benefits for workers who are work disabled because of mental health problems attributed to stressful working conditions and events. It also provides a brief description of legislation regulating psychological harassment in Quebec and Saskatchewan. Applying classic legal methodology, the article examines the legal situation in Canada, relying on federal and provincial legislation and case law. While many of the jurisdictions studied explicitly restrict compensability to the consequences of traumatic incidents, application of this legislation is very different from one province to the next. In some provinces, legal exclusions are applied emphatically, whereas in others the workers' compensation appeal tribunals interpret the legislative exclusions much more narrowly, allowing for some access to compensation despite the legislative exclusions. Other provinces have no such exclusions and accept claims for both acute and chronic stress, although access to compensation remains more difficult for claimants with mental health problems than for those who are physically injured, regardless of where they live. The article concludes by offering an analysis of the consequences of the current situation from a public policy and public health perspective, notably underlining the negative consequences, particularly for women, of current workers' compensation policy in most Canadian provinces.

In 2007, a Filipina organization in Quebec (PINAY) sought the help of university researchers to document the workplace health and safety experiences of domestic workers. Together, they surveyed 150 domestic workers and produced a report that generated interest from community groups, policy-makers, and the media. In this article, we-the university researchers-offer a case study of community-university action research. We share the story of how one project contributed to academic knowledge of domestic workers' health and safety experiences and also to a related policy campaign. We describe how Quebec workers' compensation legislation excludes domestic workers, and we analyze the occupational health literature related to domestic work. Striking data related to workplace accidents and illnesses emerged from the survey, and interesting lessons were learned about how occupational health questions should be posed. We conclude with a description of the successful policy advocacy that was possible as an outcome of this project.

Introduction: The Work Disability Prevention (WDP) Canadian Institutes of Health Research (CIHR) Strategic Training Program was developed in 2001 and is a unique program in the world. The main objective of this program is to help future researchers develop transdisciplinary knowledge, skills and attitudes regarding WDP. The purpose of this paper is to present a descriptive portrait of the program's performance over the past 5 years, as well as the trainees' and alumni's perspectives on the WDP CIHR Training Program., Methods: Data on the program's performance were collected from documents in the program records. The trainees' opinions on the WDP training program were obtained through focus groups and telephone interviews. The data collected were compiled and divided into themes to summarize the qualitative findings pertaining to each question., Results: From 2003 to 2007, five successive summer sessions have been offered, involving 44 high-caliber applicants from nine countries, 34 mentors and collaborators, 29 guest speakers and 15 stakeholders. Overall, trainees appreciated the networking, the opportunity to interact with people from different disciplines and countries, the openness, and the international perspective and uniqueness of the program. The least appreciated aspects concerned mainly the e-learning course, evaluations and information on optional courses. The coordination and logistics were judged appropriate and several topics were suggested to improve the program quality., Conclusion: In general, the program implementation went well, with good participation from mentors, speakers and stakeholders; the program was appreciated by the trainees and alumni. This paper underscores the importance of the international perspective, the transdisciplinarity and the scientific networking established through the program.

Background: When research results concerning occupational health are expressed ambiguously, compensation and prevention can be affected. This study examined the language used by scientists to discuss the relation between work and musculoskeletal disorders (MSDs)., Methods: Language regarding work and MSDs in twenty articles from two peer-reviewed journals was compared with that in 94 messages on MSDs posted by published scientists to an internet list., Results: Almost all the articles found some link between work and MSDs. However, few articles expressed belief in such a link unambiguously in the title or abstract, and language on links was often hard for a non-health scientist to interpret. Language and methods gave excess weight to negative results. On the listserve, many scientists expressed unambiguous views on linkages between work and MSDs., Conclusions: Scientists must express their opinions more forthrightly if they wish their results to be used to favour prevention and to foster access to workers' compensation.

This article reports on a Canadian qualitative study designed to examine the workers' experience of the workers' compensation process and to look at the effects of the process on the physical and mental health of claimants. Eighty five in depth individual interviews of injured workers in Québec and six group interviews with workers and worker advocates from Québec, Ontario and British Columbia were analysed to determine the positive and negative impact on claimant health of various steps of the workers' compensation process and of behaviours of significant actors in that process. While superior access to health care and access to economic support both contributed to claimant well-being, various facets of the process undermined the mental health of workers, and in some cases, also had a negative impact on physical health. Primary characteristics of the process that influenced outcomes included stigmatization of injured workers and the significant power imbalance between the claimants and the other actors in the system; the effect of both these mechanisms was tempered by social support. The article describes how caseworkers, physicians, appeal tribunals, employers and compensation boards contribute to the positive or negative impacts on worker health and concludes with recommendations designed to promote the therapeutic aspects of workers' compensation and to curtail those facets that are harmful to worker health. It also has implications for researchers who wish to consider the role of lawyers or compensation in the development or prevention of disability.