2009-11-01 12:00 - Messages

The moral regulation of the workplace: presenteeism and public health

This paper draws on Durkheimian concepts of moral forces, particularly anomie and fatalism, and the forced division of labour, to argue that the current institutional arrangements to protect and compensate workers in hazardous workplaces are insufficient. This argument is illustrated with interview data from workers at a meatworks in New Zealand which examined workers' responses to illness and injury in the workplace. It is suggested that an imbalance in moral forces leads to pathological outcomes for workers – seen in presenteeism – the phenomenon of staying at work when injured or ill – and workplace injustice. There are state institutions such as worker compensation schemes and occupational safely and health regulations, and other intermediary groups such as unions, that can act as a buffer against anomic and fatalistic forces in the workplace, but at present these countervailing regulatory and advocacy forces are not sufficiently protective of vulnerable workers. Public health advocacy and research could fill the current void.

Source: http://www3.interscience.wiley.com/journal/122443766/abstract?CRETRY=1&SRETRY=0

Social Functioning After Traumatic Brain Injury

Objective: To determine the relationship between adult-onset traumatic brain injury (TBI) and social functioning including employment, social relationships, independent living, recreation, functional status, and quality of life 6 months or longer after injury. Participants: Not applicable. Design: Systematic review of the published, peer-reviewed literature. Primary Measures: Not applicable. Results: Fourteen primary and 25 secondary studies were identified that allowed comparison to controls for adults who were at least 6 months post-TBI. TBI decreases the probability of employment after injury in those who were workers before their injury, lengthens the timing of their return if they do return to work, and decreases the likelihood that they will return to the same position. Those with moderate and severe TBI are clearly affected, but there was insufficient evidence of a relationship between unemployment and mild TBI. Penetrating head injury sustained in wartime is clearly associated with increased unemployment. TBI also adversely affects leisure and recreation, social relationships, functional status, quality of life, and independent living. Although there is a dose-response relationship between severity of injury and social outcomes, there is insufficient evidence to determine at what level of severity the adverse effects are demonstrated. Conclusion: TBI clearly has adverse effects on social functioning for adults. While some consequences might arise from injuries to other parts of the body, those with moderate to severe TBI have more impaired functioning than do those with other injuries alone.

Source: http://journals.lww.com/headtraumarehab/Abstract/2009/11000/Social_Functioning_After_Traumatic_Brain_Injury.6.aspx

Prospective predictors of return to work in the 5 years after hematopoietic cell transplantation

INTRODUCTION: Work return is an indicator of recovery and functional status for cancer survivors. We investigated whether demographic, medical and functional factors predicted full-time work return following hematopoietic cell transplantation (HCT). METHODS: Adults (N = 197), most with hematologic malignancy, completed assessments before their HCT and at intervals over 5 years. Assessments included treatment and demographic factors, and date of return to full-time work. We created binary variables, indicative of major impairment, from the Short Form 36 Health Survey (SF-36) mental (MCS) and physical (PCS) function component scores, dichotomized at 1 SD below population norms (</=40 vs. >40). PCS and MCS were imputed for 16% of the sample. Predictors of work return were analyzed using Cox proportional hazards regression. RESULTS: Of the 130 patients working full-time at pre-HCT, 88 (68%) were alive and relapse-free at 5 years. Of these, 53 (60%) had returned to full-time and 28 (32%) to part-time work. For the primary analyses at 6 month post-HCT, 14 patients had already died or relapsed and 10 had returned to work. Among the remaining 106 patients, those with PCS >40 returned to work faster (Hazard Ratio (HR) 2.38, 95% Confidence Interval (CI) 1.26-4.49). Female survivors were less likely to return to work than males (HR 0.54, 95% CI 0.29-0.99). CONCLUSION: Return to work is a lengthy process for many survivors. Predictors of slower return include physical dysfunction and female gender. IMPLICATIONS FOR CANCER SURVIVORS: Realistic preparation for time off work is essential to long-term health and finances of cancer survivors.

Source: http://www.springerlink.com/content/x72606120q4jr821/?p=6bc7e479b122424e9e45d90de03d4bbb&pi=0

The predictive effect of fear-avoidance beliefs on low back pain among newly qualified health care workers with and without previous low back pain: a prospective cohort study

Health care workers have a high prevalence of low back pain (LBP). Although physical exposures in the working environment are linked to an increased risk of LBP, it has been suggested that individual coping strategies, for example fear-avoidance beliefs, could also be important in the development and maintenance of LBP. Accordingly, the main objective of this study was to examine (1) the association between physical work load and LBP, (2) the predictive effect of fear-avoidance beliefs on the development of LBP, and (3) the moderating effect of fear-avoidance beliefs on the association between physical work load and LBP among cases with and without previous LBP. A questionnaire survey among 5696 newly qualified health care workers who completed a baseline questionnaire shortly before completing their education and a follow-up questionnaire 12 months later. Participants were selected on the following criteria: (a) being female, (b) working in the health care sector (n = 2677). Multinomial logistic regression analysis was used to evaluate the effect of physical work load and fear-avoidance beliefs on the severity of LBP. For those with previous LBP, physical work load has an importance, but not among those without previous LBP. In relation to fear-avoidance beliefs, there is a positive relation between it and LBP of than 30 days in both groups, i.e. those without and with previous LBP. No moderating effect of fear-avoidance beliefs on the association between physical work load and LBP was found among cases with and without LBP. Both physical work load and fear-avoidance beliefs matters in those with previous LBP. Only fear-avoidance beliefs matters in those without previous LBP. The study did not find a moderating effect of fear-avoidance beliefs on the association between physical work load and LBP.

Source: http://www.biomedcentral.com/1471-2474/10/117

Disruption, disbelief and resistance: A meta-synthesis of disability in the workplace

This article presents the findings from a meta-synthesis of qualitative research on the experiences of persons with disabilities in the workplace. The purpose of this review was to explore how organizational culture influences the experiences of people with disabilities in the workplace, and the impact of disability on organizational culture. Findings from seven qualitative peer-reviewed studies on the experiences of people with disabilities at work and organizational culture published between 1995 and 2006 were synthesized using the meta-ethnography approach. The findings highlight how experiences of people with disabilities and organizational culture intersect in the workplace. Specifically, accessibility in the workplace involves more than removing physical barriers. People with disabilities are affected by the degree of acceptance and flexibility in the workplace, and relationships with co-workers and supervisors. However, the presence of disability may be perceived as disruptive to the organization, operation and structure of the workplace, resulting in disbelief and resistance. The findings suggest that attention and resources should be directed supporting the implementation of disability and human rights legislation and increasing tolerance for diversity in the workplace.

Source: http://iospress.metapress.com/content/h63470821vvm77q8/?p=52b9ab193e0848939f0bbcd7491cd328&pi=4

Disruption, disbelief and resistance: A meta-synthesis of disability in the workplace

This article presents the findings from a meta-synthesis of qualitative research on the experiences of persons with disabilities in the workplace. The purpose of this review was to explore how organizational culture influences the experiences of people with disabilities in the workplace, and the impact of disability on organizational culture. Findings from seven qualitative peer-reviewed studies on the experiences of people with disabilities at work and organizational culture published between 1995 and 2006 were synthesized using the meta-ethnography approach. The findings highlight how experiences of people with disabilities and organizational culture intersect in the workplace. Specifically, accessibility in the workplace involves more than removing physical barriers. People with disabilities are affected by the degree of acceptance and flexibility in the workplace, and relationships with co-workers and supervisors. However, the presence of disability may be perceived as disruptive to the organization, operation and structure of the workplace, resulting in disbelief and resistance. The findings suggest that attention and resources should be directed supporting the implementation of disability and human rights legislation and increasing tolerance for diversity in the workplace.

Source: http://iospress.metapress.com/content/h63470821vvm77q8/?p=52b9ab193e0848939f0bbcd7491cd328&pi=4

Researcher perspectives on competencies of return-to-work coordinators

Purpose.Return-to-work (RTW) coordination programs are successful in reducing long-term work disability, but research reports have not adequately described the role and competencies of the RTW coordinator. This study was conducted to clarify the impact of RTW coordinators, and competencies (knowledge, skills, and attitudes) required to achieve optimal RTW outcomes in injured workers. Methods.Studies involving RTW coordination for injured workers were identified through literature review. Semi-structured interviews were conducted with 12 principal investigators to obtain detailed information about the RTW coordinator role and competencies not included in published articles. Interview results were synthesized into principal conceptual groups by affinity mapping. Results.All investigators strongly endorsed the role of RTW coordinator as key to the program's success. Affinity mapping identified 10 groups of essential competencies: (1) individual traits/qualities, (2) relevant knowledge base, (3) RTW focus and attitude, (4) organizational/administrative skills, (5) assessment skills, (6) communication skills, (7) interpersonal relationship skills, (8) conflict resolution skills, (9) problem-solving skills, and (10) RTW facilitation skills. Specific consensus competencies were identified within each affinity group. Most investigators endorsed similar competencies, although there was some variation by setting or scope of RTW intervention. Conclusions.RTW coordinators are essential contributors in RTW facilitation programs. This study identified specific competencies required to achieve success. More emphasis on mentorship and observation will be required to develop and evaluate necessary skills in this area.

Source: http://informahealthcare.com/doi/abs/10.3109/09638280903195278

Moving from full-time healing work to paid employment: Challenges and celebrations

Background: The experiences and barriers associated with the return to paid employment following healing from recurrent suicide attempts related to mental illness have not been addressed in the literature to date. Method: This paper is a collaborative case study between graduates (experts by experience) and facilitators of a psychosocial/psychoeducational group for people with recurrent suicide attempts. The journeys taken by the experts by experience are explored through thematic narrative analysis. Findings/Results: Issues of stigma, disclosure, accommodations, maintaining wellness and coming to re-define a sense of self were consistent themes found throughout all narratives. Conclusions: The paper identified key areas of challenge and celebration, suggesting the need for enhanced support from health care providers, workplace managers, supervisors and colleagues for successful transitions into the workplace.

Source: http://iospress.metapress.com/content/k5w4237044m74567/

Productivity Loss at Work; Health-Related and Work-Related Factors

Introduction Productivity loss is an increasing problem in an aging working population that is decreasing in numbers. The aim of this study is to identify work-related and health-related characteristics associated with productivity loss, due to either sickness absence or reduced performance at work. Methods In this cross-sectional study, data of the Netherlands Working Conditions Survey of 2007 were used, which includes a national representative sample of 22,759 employees aged 15 to 64 years. Demographic characteristics, health-related and work-related factors were assessed with a questionnaire. Logistic regression analyses were carried out to study the relationship of work-related and health-related factors with low performance at work and sickness absence in the past 12 months. Results Poor general health, the number of longstanding health conditions, and most types of longstanding health conditions were associated with productivity loss. Health-related factors were in general stronger associated with sickness absence than with low performance at work. Performance: poor health OR 1.54 CI 1.38–1.71, >1 health conditions OR 1.21 CI 1.09–1.35; sickness absence: poor health OR 2.62 CI 2.33–2.93, >1 health conditions OR 2.47 CI 2.21–2.75. Of the different types of longstanding health conditions, only psychological complaints and to a small extent musculoskeletal symptoms, were associated with low performance (respectively OR 1.54 CI 1.27–1.87; OR 1.09 CI 1.00–1.18). Low performance at work was less likely among employees with high physically demanding work (shift work OR 0.70 CI 0.63–0.76, using force OR 0.78 CI 0.72–0.84, and repetitive movements OR 0.74 CI 0.70–0.79). Psychosocial factors were stronger associated with low performance at work than with sickness absence (performance: job autonomy OR 1.28 CI 1.21–1.37, job demands OR 1.23 CI 1.16–1.31, emotionally demanding work OR 1.73 CI 1.62–1.85; sickness absence: job autonomy ns, job demands OR 1.09 CI 1.03–1.17, emotionally demanding work OR 1.09 CI 1.02–1.16). Conclusion Except for psychological complaints, workers with a longstanding health condition generally perform well while being at work. Nevertheless, the likelihood of taking sick leave is increased. Among work-related factors, psychosocial work characteristics have the strongest relation with productivity loss, mostly with performance while at work.

Source: http://www.springerlink.com/content/t732r26470210276/

Returning Back Pain Patients to Work: How Private Musculoskeletal Practitioners Outside the National Health Service Perceive Their Role

Background Private musculoskeletal practitioners treat a large section of people with back pain, and could play an important role in returning and maintaining patients to work. Method We conducted a qualitative study to explore the self-perceived role of such practitioners in the UK. We interviewed 44 practitioners, including chiropractors, osteopaths and physiotherapists. Results Thematic analysis of the interview transcripts indicated that return to work is a high priority for patients, many of whom are self-employed. Although in general work was perceived as beneficial to health, practitioners perceived work as a threat for some of their back pain patients. They perceived their role as giving ergonomic, postural and exercise based advice, but were more reluctant to address psychosocial problems related to back pain. A common view was that patients’ reluctance to take a break from work impacted badly on their condition, and many practitioners advocated a short time off work duties to focus on rehabilitation. Contact with employers was very limited, and determined by the patients’ request. Conclusion In summary, the study identifies several areas in which further education could expand the role of musculoskeletal practitioners and benefit their back pain patients. However, further study is required to determine whether these results are generalisable beyond the limits of this qualitative study UK based study.

Source: http://www.springerlink.com/content/3mn164271457318x/

Personal experiences of returning to work following stroke: An exploratory study

Objective: A quarter of stroke survivors are of working age; information about the impact of stroke on those who are working is limited. We investigated the expectations and experiences of stroke survivors in relationship to return to work.Design and participants: This qualitative tudy used semi-structured, in-depth interviews with 13 patients working at onset of cerebrovascular disease. Interviews were conducted between 3 months and 8 years post stroke in order to gain an insight into both individuals' initial expectations and their actual experiences in relation to return to work.Results: Full thematic analysis of the interview transcripts was undertaken, findings reported focus on the data relating to work. Work related sub-themes included continuing symptoms affecting plans to return to work, experiences of returning to work (including uncertainty over timing of return and fears about coping at work), changing job or career and the emotional impact of enforced retirement. Conclusion: Information provision, return to work support systems and potential changes in life roles are important aspects to consider when assessing the impact of stroke and managing the consequences in people of working age.

Source: http://iospress.metapress.com/content/l820h41409742n32/?p=80af202f8580452998a0c08a05826c5d&pi=10

Stress at work - causes, signs and symptoms

What is stress? - HSE's formal definition of work related stress is “The adverse reaction people have to excessive pressures or other types of demand placed on them at work.” In these pages we explain what stress is, its causes and the signs and symptoms to watch for.

Source: http://www.hse.gov.uk/stress/furtheradvice/whatisstress.htm

Engagement in patterns of daily occupations and perceived health among women of working age

The aim of the present cross-sectional study was to examine how subjective experiences of engagement in patterns of daily occupations (gainful employment, domestic work, enjoyable and recreational occupations) were associated with perceived health among women of working age. The sample (n=488) was drawn from a longitudinal cohort study of women of working age in Gothenburg, Sweden. Participants were women 38 (n=202) and 50 (n=286) years of age. They completed a questionnaire including questions about occupational experiences in relation to their patterns of daily occupations, perceived health, and socioeconomic factors. The results of the present study showed that a combination of different experience dimensions of patterns of daily occupations was associated with perceived health among women of working age, even when adjusted for socioeconomic factors and age. The results provided occupational pattern-related health indicators, i.e. manageability, personally meaningful occupations, and occupational balance. To combine these health indicators can be a way for occupational therapists to enable women to develop strategies to promote health and to prevent stress and sick leave.

Source: http://informahealthcare.com/doi/abs/10.1080/11038120802572494

Strategies for rehabilitation professionals to move evidence-based knowledge into practice: A systematic review

Rationale: Rehabilitation clinicians need to stay current regarding best practices, especially since adherence to clinical guidelines can significantly improve patient outcomes. However, little is known about the benefits of knowledge translation interventions for these professionals. Objectives: To examine the effectiveness of single or multi-component knowledge translation interventions for improving knowledge, attitudes, and practice behaviors of rehabilitation clinicians. Methods: Systematic review of 7 databases conducted to identify studies evaluating knowledge translation inter­ven­tions specific to occupational therapists and physical therapists. Results: 12 studies met the eligibility criteria. For physical therapists, participation in an active multi-component knowledge translation intervention resulted in improved evidence-based knowledge and practice behaviors compared with passive dissemination strategies. These gains did not translate into change in clinicians' attitudes towards best practices. For occupational therapists, no studies have examined the use of multi-component interventions; studies of single interventions suggest limited evidence of effectiveness for all outcomes measured. Conclusion: While this review suggests the use of active, multi-component knowledge translation interventions to enhance knowledge and practice behaviors of physical therapists, additional research is needed to understand the impact of these strategies on occupational therapists. Serious research gaps remain regarding which knowledge translation strategies impact positively on patient outcomes.

Source: http://jrm.medicaljournals.se/article/full/10.2340/16501977-0451

Factors Related to Return to Work by Women with Breast Cancer in Northern France

Introduction Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France. Objectives This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work. Methods 379 women with breast cancer aged 18–60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work. Results During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work. Conclusion The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment.

Source: http://www.springerlink.com/content/q66r774t0456v356/

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