title: Productivity impact of headache on a heavy-manufacturing workforce in Turkey.
abstract: BACKGROUND
  Headache disorders cause substantial productivity losses through absenteeism and impaired effectiveness at work (presenteeism). We measured productivity losses from both causes at a heavy-manufacturing company with a largely male workforce in north-western Turkey.
  
  
  METHODS
  We used the HALT Index as the survey instrument. We first assessed productivity losses by surveying the entire workforce. Because we anticipated much non-participation, we also applied HALT at the annual health-checks provided to all employees by the company's on-site health clinic.
  
  
  RESULTS
  Mean age of the workforce (N = 7,200) was 31 yr. About two thirds (90% male) were manual workers rotating weekly through early, late and night shifts. One third (50% male) were clerical/managerial, working a standard 5-day week. In the first assessment, 3,939 questionnaires (54.7%) were returned with usable data. In the previous 3 months, absenteeism of ≥1 day was reported by 360 respondents (9.1%), of whom 4 (0.10%) recorded ≥45 days (average per worker: 0.92 days/yr). Presenteeism equivalent to ≥1 day's absence was reported by 1,187 respondents (29.4%) (average per worker: 6.0 days/yr). We estimated that 23,519 days/yr were lost in total among respondents (2.3% of workforce capacity). In the first 6 months of annual health-checks, 2,691 employees (37.4%) attended (94.4% male). Absenteeism was reported by 40 (1.5%), with 74 days lost, presenteeism by 348 (12.9%), with 1,240 days lost. We estimated that, altogether, 41,771 man-days/yr were lost in the entire workforce (2.4% of capacity; 94% due to presenteeism), closely matching the earlier estimate. A small minority (5.7%) of those with headache, who were only 2.5% of the workforce, accounted for >45% of presenteeism-related lost productivity.
  
  
  CONCLUSIONS
  The high productivity losses in a largely male workforce were surprising. Possible factors were the nature of the work - manual labour for two thirds, often heavy - and the recurring schedule disturbances of shift-work. There was a highly-disabled minority.
authors.forename: Macit H
authors.initials: MH
authors.lastname: Selekler
authors.forename: Gürsel
authors.initials: G
authors.lastname: Gökmen
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
mesh_terms: D000041:Absenteeism; D000328:Adult; D006233:Persons with Disabilities; D004526:Efficiency; D005260:Female; D006261:Headache / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016272:Occupational Health; D011795:Surveys and Questionnaires; D014421:Turkey; D055815:Young Adult