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Schwarz B, Banaschak H, Heyme R, von Kardorff E, Reims N, Streibelt M, Bethge M. A Mega-Ethnography of Qualitative Meta-Syntheses on Return to Work in People with Chronic Health Conditions. DIE REHABILITATION 2024; 63:39-50. [PMID: 37604194 PMCID: PMC10857889 DOI: 10.1055/a-2129-2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE The aim of this study was to synthesize the findings of qualitative meta-syntheses (QMS) on return to work (RTW) of people with different chronic illnesses and to develop a generic RTW model that can provide advice on how to improve RTW interventions and strategies. METHODS We conducted a systematic literature search in PubMed, Epistemonikos, CENTRAL, and PsycARTICLES to find relevant QMS, published in English or German between 2000 and 2021, and adapted the meta-ethnographic approach of Noblit and Hare to synthesize their findings. RESULTS Nineteen QMS (five focusing on musculoskeletal disorders or chronic pain, four on acquired or traumatic brain injuries, four on cancer, two on mental disorders, one on spinal cord injury, and three on mixed samples) met our inclusion criteria for the meta-ethnographic synthesis. Through systematic comparison and reciprocal translation of the single QMS findings, we could identify a set of key cross-cutting themes/concepts, which formed the basis for four RTW principles and a generic RTW model. CONCLUSIONS RTW is a multifactorial and highly interactive multistakeholder process, embedded in an individual's life and working history, as well as in a determined social and societal context. It runs parallel and interdependently to the process of coping with the disease and realigning one's own identity, thus emphasizing the significance of RTW for the person. Besides symptoms and consequences of the disease, individual coping strategies, and RTW motivation, the course and success of RTW are strongly affected by the adaptability of the person's working environment and the social support in their private and working life. Thus, RTW is not only a problem of the individual, but also a matter of the social environment, especially the workplace, requiring a holistic, person-centered, and systemic approach, coordinated by a designated body, which considers the interests of all actors involved in the RTW process.
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Affiliation(s)
- Betje Schwarz
- Institute for Quality Assurance in Prevention and Rehabilitation (iqpr
GmbH), German Sport University Cologne, Cologne, Germany
| | - Hannes Banaschak
- Institute of Social Medicine and Epidemiology, University of Luebeck,
Luebeck, Germany
| | - Rebekka Heyme
- Department of Rehabilitation, German Federal Pension Insurance, Berlin,
Germany
| | | | - Nancy Reims
- Institut for Employment Research, Nuremberg, Germany
| | - Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension
Insurance, Berlin, Germany
| | - Matthias Bethge
- Institute of Social Medicine and Epidemiology, University of Luebeck,
Luebeck, Germany
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van de Ven D, Robroek SJW, Burdorf A, Schuring M. Inequalities in the impact of having a chronic disease on entering permanent paid employment: a registry-based 10-year follow-up study. J Epidemiol Community Health 2023; 77:474-480. [PMID: 37221045 PMCID: PMC10314056 DOI: 10.1136/jech-2022-219891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 05/02/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND This study aimed to investigate among unemployed persons (1) the impact of having a chronic disease on entering paid employment and obtaining a permanent contract and (2) whether these associations differed by educational attainment. METHODS Register data from Statistics Netherlands on employment status, contract type, medication and sociodemographic characteristics were linked. Dutch unemployed persons between 18 and 64 years (n=667 002) were followed up for 10 years (2011-2020). Restricted mean survival time analyses (RMSTs) were used to investigate differences in average months until entering paid employment and until obtaining a permanent contract between persons with and without cardiovascular diseases, inflammatory conditions, diabetes, respiratory illness, common mental disorders and psychotic disorders. Interaction terms were included for education. RESULTS One-third of the unemployed persons at baseline entered paid employment during follow-up. Persons with chronic diseases spent more months in non-employment compared with persons without chronic diseases (difference ranging from 2.50 months (95% CI 1.97 to 3.03 months) to 10.37 months (95% CI 9.98 to 10.77 months)), especially for persons with higher education. Conditional on entering paid employment, the time until a permanent contract was longer for persons with cardiovascular diseases (4.42 months, 95% CI 1.85 to 6.99 months), inflammatory conditions (4.80 months, 95% CI 2.02 to 7.59 months) and diabetes (8.32 months, 95% CI 4.26 to 12.37 months) than for persons without these diseases. These latter differences were similar across educational attainment. CONCLUSIONS Having a chronic disease is a barrier to entering permanent paid employment. The findings underline the need to prevent chronic diseases and promote an inclusive workforce.
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Affiliation(s)
- David van de Ven
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Suzan J W Robroek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alex Burdorf
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Hijdra RW, Robroek SJW, Burdorf A, Schuring M. The influence of onset of disease on exit from paid employment among workers in The Netherlands: A longitudinal register-based study with 9 years follow-up. Scand J Work Environ Health 2023; 49:33-42. [PMID: 36265177 PMCID: PMC10549911 DOI: 10.5271/sjweh.4064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES This study investigates the influence of onset of disease on exit from paid employment and whether this differs across diseases and sociodemographic groups. METHODS Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010 and who did not use medication for the selected disease in 2009 (N=5 889 036) were followed-up over nine years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, common mental disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Early exit from paid employment was defined as exiting paid employment before retirement age. Cause-specific Cox proportional hazards regression analyses were performed, with interaction terms for age, sex, and migration background. RESULTS Onset of disease increased the likelihood of exit from paid employment, with the strongest associations for psychotic disorders [hazard ratio (HR) 2.88, 95% confidence interval (CI) 2.78-2.98] and common mental disorders (HR 2.00, 95% CI 1.97-2.03). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of common mental and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males. CONCLUSION Onset of diseases, especially mental health disorders, is a risk for exiting paid employment before the retirement age. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment.
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Affiliation(s)
- Roos W Hijdra
- Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
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Murray ET, Head J, Shelton N, Beach B, Norman P. Does it matter how we measure the health of older people in places for associations with labour market outcomes? A cross-sectional study. BMC Public Health 2022; 22:2252. [PMID: 36460979 PMCID: PMC9719185 DOI: 10.1186/s12889-022-14661-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. METHODS We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years). An additional two health indicators (life expectancy at birth and infant mortality rate) were included as test indicators to determine if associations were limited to the health of older people in a place. These nine health indicators were then linked with the LS sample aged 16-74y with data on employment outcomes and pertinent demographic and individual health information. Interactions by gender and age category (16-49y vs. 50-74y) were also tested. FINDINGS For all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the 'unhealthiest' older population, had higher odds of not being in paid work, including all four types of economic inactivity. The strongest associations were seen for the health-in-a-place measures that were self-reported, long-term illness (Odds Ratio 1.60 [95% Confidence Intervals 1.52, 1.67]) and self-rated health (1.60 [1.52, 1.68]). Within each measure, associations were slightly stronger for men than women and for the 16-49y versus 50-74y LS sample. In models adjusted for individual self-rated health and gender and age category interactions, health-in-a-place gradients were apparent across all economic inactivity's. However, these same gradients were only apparent for women in part-time work and men in full-time work. CONCLUSION Improving health of older populations may lead to wider economic benefits for all.
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Affiliation(s)
- Emily T. Murray
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Jenny Head
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Nicola Shelton
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Brian Beach
- grid.83440.3b0000000121901201Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Paul Norman
- grid.9909.90000 0004 1936 8403School of Geography, University of Leeds, 10.11 Irene Manton, 6 Clarendon Way, Woodhouse, Leeds, LS2 9NL UK
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Kuncewicz K, Schiff I, Liszka J, Akinfie S, McLurcan N, Madan I, Naleem S, Parsons V. Attitudes and practices of ophthalmology doctors in London (UK) on the importance of discussing work as a clinical outcome with patients during consultations: A cross sectional survey. PLoS One 2022; 17:e0268997. [PMID: 35679260 PMCID: PMC9182630 DOI: 10.1371/journal.pone.0268997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Limited research suggests that non-occupational health doctors rarely discuss occupation with their patients. There is a gap in research regarding the attitudes and practices of doctors towards discussing patient occupation and return to work. The aim of this work was to explore the attitudes of ophthalmology doctors towards work as a clinical outcome and assess the need for occupational health training among participants (doctors).
Methods
A cross-sectional survey among doctors working in ophthalmology in two London teaching hospitals. The survey focused on the attitudes of doctors towards ‘work’ as a clinical outcome, their practices of asking patients about occupation, their perceived level of competency in this area of clinical practice and the level of training doctors had received in this field. Descriptive data analysis was undertaken and results presented as frequencies and proportions.
Results
The response rate was 30/72 (42%). Approximately a quarter (8/30;27%) of doctors ‘always’ discussed return to work during care planning whilst the majority (25/30;87%) of doctors agreed or strongly agreed that this should always be the case. Over half of the doctors had received no formal OH training on how to discuss or assess the impact of health on work and only 17/30 (57%) considered themselves competent in discussing these work outcomes with patients. Over half agreed that additional training would be useful, with the majority believing that it would be most useful at all stages of medical training.
Conclusion
We found the majority of ophthalmology doctors regard ‘return to work’ as an important clinical outcome yet most do not routinely discuss work outcomes with patients to inform care planning. Majority of doctors lack training in how to discuss issues relating to work and would benefit from additional OH training.
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Affiliation(s)
- Katherine Kuncewicz
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Isabelle Schiff
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Jaroslaw Liszka
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Sheni Akinfie
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Nadia McLurcan
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Ira Madan
- Occupational Health Service, Guy’s and St Thomas NHS Foundation Trust, St Thomas Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Shairana Naleem
- Occupational Health Service, Guy’s and St Thomas NHS Foundation Trust, St Thomas Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Vaughan Parsons
- Occupational Health Service, Guy’s and St Thomas NHS Foundation Trust, St Thomas Hospital, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
- * E-mail:
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Jennen JGM, Jansen NWH, van Amelsvoort LGPM, Slangen JJM, Kant IJ. Chronic conditions and self-perceived health among older employees in relation to indicators of labour participation and retirement over time. Work 2021; 71:133-150. [PMID: 34924423 PMCID: PMC8842761 DOI: 10.3233/wor-210436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: A significant proportion of older employees leave the labour market early, amongst others via unemployment or disability benefits, implying that health might affect possibilities to extend working life. OBJECTIVE: This study 1) examined associations between chronic conditions (subtypes) and self-perceived health (SPH), independently, and indicators of labour participation and retirement over six-year follow-up among older employees, and 2) explored the impact of differences between prevalent and incident presence of chronic condition(s) in this relation. METHODS: Older workers (aged > 45 years) included in the Maastricht Cohort Study were studied (n = 1,763). The Health and Work Performance Questionnaire assessed chronic conditions and one item from the Short Form health survey-36 assessed SPH. Cox regression analyses assessed associations between chronic conditions and SPH, independently, and retirement intentions, employment status, decreasing working hours, and changes in work over time. RESULTS: Employees with coexistent physical-mental chronic conditions showed higher risks to lose employment and to receive a disability benefit (HR 1.85, 95% CI 1.23–2.78; HR 8.63, 95% CI 2.47–30.11) over time compared to healthy employees. No statistically significant associations were found between SPH and indicators of labour participation and retirement over time. Having chronic condition(s) was cross-sectionally associated with lower SPH scores and larger proportion of part-timers –compared to healthy employees. CONCLUSIONS: Chronic condition(s) among older employees were substantially associated with indicators of labour participation and retirement over time. The role of SPH was mainly instantaneous. Findings provide valuable input for preventive measures aiming to prevent an early labour market exit of older employees.
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Affiliation(s)
- Jacqueline G M Jennen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicole W H Jansen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Ludo G P M van Amelsvoort
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jos J M Slangen
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - IJmert Kant
- Department of Epidemiology, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
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