Differences In Employment Status Research Articles

Self-reported cognitive function mediates the relationship between employment status and cognitive functioning in persons with multiple sclerosis

BackgroundCognitive impairment (CI) is common in people with MS (PwMS). Evidence is lacking for the self-reported CI's mediation effect on employment status and objective cognitive performance. Self-reported CI was found to be unreliable and seemed to be more associated with depression rather than formal cognitive performance. We hypothesized that the link between subjective and objective assessments of cognitive functions, mood, and employment status may be more complex in PwMS than previously reported. ObjectiveThe aims of this study are the following: (Romero-Pinel et al., 2022) to determine whether employment status could affect performance in cognitive function testing and (Rao et al., 1991) whether their relationship may be mediated by self-reported CI; and (Deluca et al., 2013) to determine whether self-reported depression interacts with self-reported CI in influencing performance in various cognitive domains in PwMS. MethodologyA retrospective study was performed involving PwMS who completed the self-report Multiple Sclerosis Neuropsychological Questionnaire (MSNQ), Hospital Anxiety and Depression Scale-depression scale (HADS-D), Minimal Assessment of Cognitive Function in MS (MACFIMS) and had data regarding employment status. Included PwMS were classified as employed or unemployed. A structural equation modeling (SEM) approach was taken due to the advantage of examining multiple cognitive outcomes simultaneously while accounting for shared associations. First, a latent factor of memory and executive functioning modeled the error-free associations between both factors and a processing speed task (SDMT). Next, the model tested for the indirect effect of self-reported cognition (MSNQ) on employment status differences in each outcome (memory, speed, and executive functioning). Finally, we tested interactions between MSNQ and HADS-D on each of the outcomes. ResultsWe included 590 PwMS: 72.5% female, mean age 44.2 years (SD = 10.5), mean disease duration 8.6 years (SD 9.0). The majority (n = 455, 77.1%) had relapsing MS; 357 (60.5%) were employed. About half (n = 301, 51%) did not report CI on the MSNQ; of those, 213 (70.8%) were employed. The mean MSNQ for employed PwMS was 24.5 (SD = 10.7) and 29.8 (SD = 11.2) for unemployed PwMS. Employed PwMS had significantly better memory (β = .16, p < .05), executive functioning (β = .25, p < .05), and processing speed (β = .22, p < .05). MSNQ partially indirectly mediated the effect of employment status on memory (Δβ = .03, p < .05) and executive functioning (Δβ = .03, p < .05) and processing speed (Δβ = .04, p < .05), indicating that self-report CI partially explains the influence of employment status on these cognitive domains. The association between MSNQ with both memory and executive functioning was moderated by depression, meaning that in PwMS with high HADS-D scores, MSNQ was more strongly related to worse memory and executive functioning. The final model was an acceptable fit to the data (χ2(87) = 465.07, p < .05; CFI = .90, RMSEA = .08, 90% CI [.06, .09], SRMR = .05) explaining 41.20%, 38.50% and 33.40% of the variability in memory, executive functioning, and processing speed, respectively. ConclusionSelf-reported CI partially explains the associations between employment status and objective cognitive assessment in PwMS. Depression may moderate the relationship between self-reported cognitive assessment and objective cognitive performance. Thus, employment status and mood may guide the interpretation of self-reported CI.

Initial Development and Validation of the Brief Internalized Heterosexist Racism Scale for Gay and Bisexual Black Men: A Measure of Internalized Heterosexist Racism.

We introduce internalized heterosexist racism (IHR), or the internalization of damaging stereotypes, harmful beliefs, and negative attitudes about being a sexual minority person of color. We also present the initial development and validation of the Brief Internalized Heterosexist Racism Scale for gay and bisexual Black men (IHR-GBBM), a unidimensional, 10-item measure of IHR. Exploratory factor analyses on an internet-obtained sample of gay and bisexual Black men (N = 312; Mean age = 30.36 years) show that the IHR-GBBM had evidence of good internal consistency, and good convergent, discriminant, concurrent, and incremental validity. The IHR-GBBM was positively correlated with internalized racism, internalized heterosexism, and discrimination (racist, heterosexist). IHR was also negatively correlated with race stigma consciousness, weakly positively correlated with sexual identity stigma consciousness, but not correlated with either race identity, sexual identity, or social desirability. Hierarchical regressions showed that the IHR-GBBM explained an additional variance of 2.8% and 3.1% in anxiety symptoms and substance use coping, respectively, after accounting for (1) sociodemographics, (2) internalized racism and internalized heterosexism, and (3) an interaction of internalized racism and internalized heterosexism. Older participants and those who were "out" about their sexual identity reported lower IHR. Those who did not know/want to report their HIV status reported greater IHR. Results revealed no sexual identity, sexual position, relationship status, income, education, or employment status differences in IHR. We hope the development of the IHR-GBBM spurs future research on predictors and consequences of IHR. We discuss limitations and implications for the future study of internalized heterosexist racism.

Prevalence of HIV Infection in Pregnant Women Attending Ante Natal Care at Lugbe Clinic, Abuja, Federal Capital Territory: A 3-Year Retrospective Study

This is a 3-year (2019 -2021) retrospective study of Human Immunodeficiency Virus (HIV) infection in pregnant women attending Lugbe clinic for ante natal care. Of the 4, 023 pregnant women that attended the clinic for Anti Natal Care (ANC) during this period, 3818 that have complete information in their files were enlisted for the study. Overall prevalence of HIV in the pregnant women was 2.7% (102/3818). Yearly prevalence of 1.6% (21/1329), 3.0% (36/1196) and 3.5% (45/1293) in 2019, 2020 and 2021 respectively were obtained. There was no statistical significance (p&gt;0.05) in the prevalence of HIV among pregnant women in the period under study. The highest prevalence rate of 38.2% was observed in the age category of 29–33 years. Monthly trend analysis of the prevalence showed infection was highest in July, 2020. Pregnant women with secondary school level of education had the highest prevalence, 4.4% (20/454). This study revealed that divorcees had the highest prevalence of 3.5% (43/1243). There was no significant (p&gt;0.05) difference in the infection rate of 2.7% (57/2109) with primigravids compared to multigravida 2.6% (45/1709). This result further showed that pregnant women in polygamous marriages had higher prevalence of HIV infection, 3.5% (56/1596) compared to monogamous ones, 2.1% (46/2222). Differences in employment status of the subjects under study revealed that unemployed pregnant women had higher prevalence of HIV, 3.3% (60/1979) than those employed, 2.1% (42/1979). The increased prevalence of HIV in pregnant women in this study is an indication of declining impact of campaign against the scourge of HIV especially in FCT. There is therefore need for a change in the strategy to minimize or stop the spread of this disease.

Long working hours and self-rated health in the national Brazilian working population: gender and employment status differences, 2019

BackgroundThe regulation of working hours is governed by legal standards in formal employment. While the association between long working hours and various health outcomes has been extensively studied, there is limited evidence regarding Brazil. The objective of this study was to investigate the association among working hours, employment status, and self-rated health (SRH), taking into account differences between men and women in a national representative sample of the working population in Brazil.MethodsA cross-sectional study was conducted among a representative sample of 33,713 workers in Brazil to assess self-rated health (SRH). We examined the associations between working hours and employment status, categorizing working hours as standard (40–44 h per week) or long (> 44 h per week), and employment status as formal or informal. Logistic regression models were employed, adjusting for sociodemographic, occupational characteristics, and health behaviors. Probabilities of negative SRH were calculated for men and women in different exposure profiles. Results were stratified by gender, and 95% confidence intervals (CIs) were applied to the findings.ResultsThe prevalence of long working hours was higher among informal workers for both men and women. Adjusted odds ratio (AOR) results revealed that informal employment (AORwomen = 1.53; 95% CI: 1.13–2.07 and AORmen = 1.55; 95% CI: 1.22–1.96) and long working hours (AORwomen = 1.23; 95% CI: 1.06–1.43 and AORmen = 1.14; 95% CI: 1.00-1.30) were independently associated with negative SRH. Significant interactions between long working hours and informal employment were observed. Among individuals with the same exposure profile, women who engaged in long working hours had a higher probability of reporting negative SRH compared to men.ConclusionsThe results of this study are in line with the literature, as differences between men and women in the likelihood of negative self-rated health were observed. The adverse health effects underscore the importance of implementing intersectoral actions to inform the revision of regulations concerning weekly working hours and the expansion of informal employment in low- and middle-income countries.

Telaah Implikasi Pembedaan Status Kepegawaian PPPK dan Pemenuhan HAM dalam Payung Hukum PPPK di Indonesia

This research is based on the presence of Government Employees with Work Agreements (PPPK) in the horizon of the civil service, who are one of the civil servants besides the State Civil Servants (PNS). PPPK holds the same position as PNS, but in terms of employment status, PPPK has a different employment status. This distinction in work status has effects on everything from the length of the employment contract to the fulfillment of human rights obligations, which are different from other civil servants as stated in the regulatory framework related to PPPK in Indonesia. This research aims to identify any regulations related to PPPK that identify status and positional differentiation, which would have negative effects on PPPK, as well as to ascertain whether Indonesian regulations or legal frameworks pertaining to PPPK are consistent with the principles of human rights. This study is a normative research using statute and conceptual approaches related to PPPK regulations, as well as the theory of legal certainty by Gustav Radbruch, and examines several legal sources. Therefore, the discussion and research results will focus more on the differences in employment status and the fulfillment of rights for PPPK within the legal framework governing PPPK in Indonesia.

Assessment of hesitancy to COVID-19 vaccine in patients with rheumatic arthritis.

The COVID-19 pandemic caused by SARS-CoV-2 in 2019 has greatly impacted global health, leading to high morbidity and mortality rates. Rheumatoid arthritis (RA) patients have faced numerous challenges during the pandemic, including concerns about infection, limited medical resources, and shortages of medication. While vaccination is a crucial strategy against COVID-19, the reasons behind vaccine hesitancy (VH) among people with RA remain largely unexplored. We conducted a cross-sectional, single-arm study in China from July 18 to August 18, 2021. Using a self-administered questionnaire and a convenient sampling method, we investigated vaccine attitudes and VH among RA patients. The questionnaire developed by the investigators was validated by two public health experts and one senior rheumatologist. It covered sociodemographics, disease-related variables, vaccination attitudes, and willingness, etc. We employed Chi-squared and regression analyses to identify factors associated with VH toward COVID-19 vaccination. A total of 184 RA patients were enrolled in the survey, with 113 (61.41%) expressing unwillingness to be vaccinated. The Chi-squared test revealed significant differences in employment status and related systemic damage (p < 0.05). Among the unvaccinated RA patients, 71.68% believed COVID-19 vaccination might impact their disease. Binary and multicollinearity logistic regression analyses showed that the acute stage of RA (p < 0.001, OR = -3.165, 95% CI: 0.035 - 0.164) and fear of disease development caused by drug discontinuation during vaccination (p < 0.001, OR = -3.591, 95% CI: 0.005 - 0.157) were the restricting factors influencing the COVID-19 vaccine inoculation rate in RA patients. The COVID-19 vaccination rate among RA patients in China is low due to limited knowledge, misconceptions, and insufficient promotion. Boosting confidence and understanding of the vaccine's effectiveness and safety is crucial to improve vaccination success.

Difference in employment status and onset of disability among Japanese community-dwelling older adults: a prospective cohort study.

This prospective cohort study investigates the relationship between the onset of disability and employment status. We investigated 3,741 community-dwelling adults aged 70 or older, who participated in a population-based cohort study in Japan. Their onset of disability was monitored monthly using the long-term care insurance certification registration system, for five years from baseline. Based on an employment status questionnaire, we categorized participants into three groups: (1) employee, (2) self-employed, and (3) not working. Covariates included demographic information, medical history, number of medications, educational level, living alone, social group engagement, smoking status, walking speed, instrumental activities of daily living, global cognitive function, and depressive symptoms. Missing values were managed using multiple imputation. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident disability risk by employment status. The disability incidence rates were 15.3/1,000 (95% CIs: 10.7-22.0) person-years among employees, and 33.0/1000 (95% CIs: 24.4-44.6) and 39.6/1000 (95% CIs: 36.5-43.0) person-years among self-employed and non-working participants, respectively. The adjusted HRs for the onset of disability among non-working and self-employed participants were 1.69 (95% CIs: 1.16-2.46, p = 0.007) and 1.63 (95% CIs: 1.01-2.62, p = 0.044) compared with employees, respectively. Similar results were found among men. Among women, disability onset was not associated with employment status. Older adults' risk of disability onset differed according to their employment status. Older employees had a lower risk of disability onset than those not working or self-employed.

0023 Circadian fragmentation and stability distinguish employment status

Abstract Introduction This analysis used data from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study to compare differences in employment status on activity variability, as an indicator of circadian fragmentation and stability. Circadian fragmentation refers to frequency of alterations between rest and activity relative to the daily rhythm and stability refers to day-to-day similarity. High fragmentation and low stability have been linked to a number of negative health outcomes including depression, obesity, and heightened mortality risk. Methods The sample consisted of 155 participants that included 702 total cases (n = 434 employed, n = 268 unemployed) assessed over 18 months. Participants were required to have involuntarily lost their jobs in the last 90 days. Employment status was determined for all participants at each visit based on demographic surveys. Daily activity patterns were assessed via actigraphy (Actiwatch-Spectrum) at 30 second epochs for 14 days. The nonparametric measures of intradaily variability (IV) and interdaily stability (IS) were used as measures of circadian fragmentation and stability. Several subsampling intervals were considered for IV, ranging from 5 minutes to 4 hours. Results Unemployment was associated with higher IV (for 1 hour subsampling intervals, t=5.23, p &amp;lt; .001) and lower IS than employment (t=2.38, p &amp;lt;.05). The same is true with changes in the subsampling interval for IV, with highest significance at 45 minutes to 1.5 hours. Significant findings remained even for 5 minute (t=2.15, p &amp;lt; .05) and 4 hour (t = 4.07, p&amp;lt;.001) intervals. Conclusion In a sample of adults with variable employment status, employment was associated with less circadian fragmentation and more stability than unemployment. These findings suggest that circadian fragmentation and instability may be two mechanisms by which job loss increases negative health risk. Future planned studies examining prospective changes in circadian fragmentation/stability during employment transitions will help answer this question. Support (if any) NIH #1R01HL117995-01A1, NSF DMS 1937229, NSF CCF 1740858

Declines in Work Productivity in Persons With Multiple Sclerosis by PDDS Score (P13-3.005)

<h3>Objective:</h3> To describe differences in employment status and work productivity by Patient Determined Disease Steps (PDDS) score. <h3>Background:</h3> The PDDS scale measures patient-reported disability in persons with MS (pwMS). Evidence suggests that reported increases in MS symptom severity adversely impact work productivity (Glanz 2012); it is unknown how employment status varies by disability level (Bessing 2021). Examining work productivity by PDDS provides a better understanding of disease burden in pwMS. <h3>Design/Methods:</h3> The sample included all participants aged 18–62 years in the US who responded to North American Research Committee on Multiple Sclerosis survey at least once in Fall 2017–Fall 2019 and reported PDDS score and employment status. If multiple surveys were available, the most recent was analyzed. Employment outcomes in the 6 months before the survey, including employment status, hours worked per week, any cutback in hours, number of missed workdays and receipt of disability benefits, were summarized overall and by PDDS score. <h3>Results:</h3> The sample included 3870 pwMS across all PDDS scores (normal, 21%; mild, 17%; moderate, 11%; gait disability, 13%; early cane, 12%; late cane, 8%; bilateral support: 8%, wheelchair/scooter, 10%; bedridden, 1%). Overall, 47% of pwMS were employed full/part-time in the prior 6 months. The proportion of pwMS who were employed declined from 81% in pwMS with a normal PDDS score and 69% with mild disability to 12% in pwMS with wheelchair/scooter and 0% in bedridden pwMS. Among all employed pwMS, 73% worked &gt;30 hours/week, 16% cutback hours and 38% missed workdays in the prior 6 months. Receipt of disability benefits increased rapidly from 9% in pwMS with normal scores to 96% in bedridden pwMS. <h3>Conclusions:</h3> PwMS with more disability were less likely to be employed and reported lower work productivity. Interventions that can address MS disability may result in slower declines in work productivity. <b>Disclosure:</b> Dr. Geiger has received personal compensation for serving as an employee of Genentech, Inc. Dr. Geiger has stock in Moderna. Dr. Geiger has stock in Abbott Laboratories. Dr. Geiger has stock in Gilead Sciences. Dr. Geiger has stock in Amgen. Dr. Geiger has stock in Roche. Dr. Geiger has received research support from National Science Foundation. Mrs. Bonine has received personal compensation for serving as an employee of Genentech. Mrs. Bonine has stock in Genentech. Dr. Di Felice has received personal compensation for serving as an employee of Genentech. Dr. Salter has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.

Characterizing Cancer and Work Disparities Using Electronic Health Records

Advancements in cancer diagnosis and treatment have resulted in improvements in survivor outcomes; however, cancer survivors are more likely to experience adverse employment outcomes such as job loss, reduced working hours, and early retirement. The purpose of this study was to examine employment disparities among cancer survivors. Our study collected data from 29,136 cancer survivors (ages 18-65) between 2015 and 2021 using electronic health records (EHR) and linked to cancer registry data. Of those with employment information (n = 7296), differences in employment status were explored by race, ethnicity, sex, geography, marital status, education, age, and cancer site. Of the patients with employment status available, 61% were employed, 28% were not employed, 9% were disabled, 2% were retired. Logistic regression results revealed adjusted effects: a positive association between employment and marriage, while racial and ethnic minority adults, rurality, and certain age categories were less likely to be employed. Unadjusted results showed a positive association between employment and education. These results contribute to an emerging body of literature showing adverse employment outcomes for cancer survivors.

Examining Employment Conditions During the COVID-19 Pandemic in Pasifika Communities.

Introduction:Pasifika (Native Hawaiian and Pacific Islander) people living in the United States experience health, economic, and social inequities, and a disproportionate burden of COVID-19 cases and deaths. This study examines employment among Pasifika living in the 10 US states with the largest Pasifika populations during the COVID-19 pandemic.Methods:We use the Current Population Survey to examine racial differences in employment status, paid work from home (PWFH), and industry telework friendliness. We use data from the Washington Office of Fiscal Management and the Washington State (WA) Employment Security Department to examine county-level unemployment claims.Results:Nationally, Pasifika did not self-report unemployment significantly more than Black, Latino, Asian, and American Indian/Alaska Native respondents, but in WA counties with high Pasifika concentrations, unemployment insurance claim rates were higher compared with all other racial groups, particularly Whites and Asians. Surprisingly, Pasifika had more PWFH opportunities, but worked in less telework-friendly industries nationally.Discussion:This study demonstrates the complexity of employment among Pasifika during the COVID-19 pandemic. The findings correspond with national reports of racialized communities impacted by unemployment, including Pasifika. Marginally significant differences in unemployment nationally may be due to Pasifika working largely in essential industries requiring workplace attendance.Health Equity Implications:Although overlooked or overshadowed by size, our findings highlight the need for continued advocacy to support data disaggregation and Pasifika data sovereignty. This can be achieved through collaborations between researchers as well as local and community organizations to address data needs of Pasifika communities.

The Extent of Endorsement of Distal to Proximal Dysfunctional Cognitions in Individuals with Alcohol Dependence: A Comparative Cross-Sectional Study in the Indian Context.

Background:Dysfunctional basic cognitions have been suggested as potential vulnerability markers for alcohol dependence (AD). Although there is a growing body of research on the role of distal cognitive vulnerability factors such as early maladaptive schema in the development of AD, little is known about the role of proximal cognitive factors such as cognitive distortions, dysfunctional attitude, and negative automatic thoughts.Methods:This comparative cross-sectional study aimed to examine dysfunctional cognitions in individuals with AD (n = 84) in comparison with healthy individuals (n = 60). The dysfunctional cognitions were assessed on the Young Schema Questionnaire third version of Short Form, Cognitive Distortion Scale, Dysfunctional Attitude Scale-Form A, and Automatic Thought Questionnaire. Multivariate analysis of covariance was conducted to analyze the group differences in dysfunctional cognitions.Results:After controlling for the group difference in employment status, 12 of 18 schemas were more prevalent in individuals with AD than in healthy individuals. Individuals with AD also scored higher on seven of 10 cognitive distortions, as well as in terms of dysfunctional attitude and negative automatic thoughts.Conclusion:Dysfunctional cognition may play a significant role in developing AD. The findings may enhance our understanding of the nature and severity of dysfunctional cognitions in the development of AD. The information may further assist the clinicians in implementing adequate intervention strategies to manage dysfunctional cognitions in individuals with AD.

The Impact of Gender and Sociodemographic Characteristics on Dentists' Practice Patterns, Employment Status, and Workforce Participation

Research ObjectiveGender diversification is rapidly occurring within the dental profession. Gender differences in practice choice (eg, employment vs practice ownership) and practice participation (eg, part‐time vs full‐time work hours) have been reported. It is important to understand how changes in the delivery system including workforce participation and preferences might impact the availability of services especially for underserved populations. The objectives of this study were to evaluate the variation in practice preferences among female and male dentists and to assess potential associations with socioeconomic and family factors.Study DesignThe current study used data from the Census Bureau's American Community Survey (ACS). The variables extracted describe dentists' sociodemographic characteristics including gender, age, race/ethnicity, presence of children or elders in the household, household income, and marital status, as well as dental practice characteristics such as employment status, practice setting, and work hours.Population StudiedThe 5‐year Public Use Microdata Sample data (2014–2018) from the ACS were utilized. Person‐level data collected through the questionnaire contain demographic, social, and economic information. The analytical sample consisted of 9993 dentists and 520,925 people living in the dentists' households. Survey data was weighted to generate unbiased estimates representative for the US population.Principal FindingsFemale dentists were younger (mean 43.3 years vs 53.6; P &lt; 0.001), more racially and ethnically diverse (58.1% vs 78.6% White, non‐Hispanic; P &lt; 0.001), and proportionally more foreign‐born (35.2% vs 17.7%; P &lt; 0.001) compared to male dentists. Female dentists were more likely to report being employed (55.1% vs 34.8%; P &lt; 0.001) or working part‐time (less than 30 hours per week) in dental practice (15.5% vs 11.0%; P = 0.001) than male dentists. Female dentists with children were more likely to report being an employee (64.3% vs 52.8%; P &lt; 0.001) and working part‐time (19.5% vs 14.3%; P &lt; 0.001) compared to female dentists without children in their care. Proportionally fewer female dentists left the workforce (ie, retired) in the past 12 months than male dentists (2.4% vs 3.6%; P = 0.002). Average income in the past 12 months was significantly lower (P &lt; 0.001) for female dentists (mean = $141,267; 95% Confidence Interval [CI] = $ 135,452 ‐$147,082) compared to male dentists (mean = $185,923; 95% CI = $135,452–$147,082).ConclusionsThe data indicate that the dental workforce is diversifying in gender and by race/ethnicity. The data about dental practice by gender is consistent with the current literature; female dentists were significantly more likely to be employed than to be self‐employed/a practice owner. This preference is consistent with evolving practice models including consolidations of smaller practices into group practices and changing business models for the profession. The wage gap by gender, which has been previously researched, is notable and difficult to explain.Implications for Policy or PracticeThe percentage of women entering and graduating from dental schools has increased over recent years achieving equity in numbers in dental schools in the US. Differences in employment status and workforce participation by gender are important preferences that should be monitored over time to ascertain if availability of services is affected by these trends.Primary Funding SourceHealth Resources and Services Administration.

Impact of Chorea on Self-care Activity, Employment, and Health-care Resource Use in Patients with Huntington's Disease.

Background: Chorea is recognized as a prototypic motor feature of Huntington’s disease (HD), but its effect on health-related quality of life (HRQoL) has not been fully explored. This study describes the impact of chorea on HRQoL in patients with HD.Objective: To determine the impact of HD-related chorea on employment, self-care activities, activities of daily living, and health-care resource utilization (HCRU).Methods: Data were drawn from the Adelphi HD Disease Specific Programme, a real-world point-in-time survey of 144 neurologists and 427 patients in the United States between July and October 2017. HD patients with and without chorea were identified and examined for differences in employment status, reasons for employment changes, self-care activities, and modifications to cope with involuntary movements. Bivariate tests and inverse probability weighted regression adjustment methods were used to determine differences in outcomes between patients with and without chorea.Results: HD patients with (n=287) and without (n=140) chorea were identified. Patients with chorea were less likely to be employed full-time (16.7% vs 25.7%; P<0.04) and more likely to be on long-term sick leave (17.4% vs 5.0%; P<0.01). The onset of motor symptoms in HD-related chorea patients coincided with a change in employment status (42.7% vs 20.8%; P<0.01). Among those still working (n=145), more than two-fifths of patients with chorea required changes to their workplace and required these changes more frequently (45% vs 17%; P<0.001). HD patients with chorea required aid to help them get around significantly more frequently than those without chorea (55% vs 34%; P<0.001).Discussion: These results demonstrate that HD patients with chorea experienced greater negative impact to employment, self-care activities, and HCRU than patients without chorea experienced. These patients were more likely to stop working due to motor, cognitive, and behavioral symptoms; require modifications in the home and workplace; and need more assistance from caregivers than patients without chorea.Conclusions: Patients with HD-related chorea have greater detriments to emotional, interpersonal, and professional functioning that could be improved by reducing chorea.

Impact of Chorea on Self-care Activity, Employment, and Health-care Resource Use in Patients with Huntington’s Disease

Background: Chorea is recognized as a prototypic motor feature of Huntington’s disease (HD), but its effect on health-related quality of life (HRQoL) has not been fully explored. This study describes the impact of chorea on HRQoL in patients with HD. Objective: To determine the impact of HD-related chorea on employment, self-care activities, activities of daily living, and health-care resource utilization (HCRU). Methods: Data were drawn from the Adelphi HD Disease Specific Programme, a real-world point-in-time survey of 144 neurologists and 427 patients in the United States between July and October 2017. HD patients with and without chorea were identified and examined for differences in employment status, reasons for employment changes, self-care activities, and modifications to cope with involuntary movements. Bivariate tests and inverse probability weighted regression adjustment methods were used to determine differences in outcomes between patients with and without chorea. Results: HD patients with (n=287) and without (n=140) chorea were identified. Patients with chorea were less likely to be employed full-time (16.7% vs 25.7%; P&lt;0.04) and more likely to be on long-term sick leave (17.4% vs 5.0%; P&lt;0.01). The onset of motor symptoms in HD-related chorea patients coincided with a change in employment status (42.7% vs 20.8%; P&lt;0.01). Among those still working (n=145), more than two-fifths of patients with chorea required changes to their workplace and required these changes more frequently (45% vs 17%; P&lt;0.001). HD patients with chorea required aid to help them get around significantly more frequently than those without chorea (55% vs 34%; P&lt;0.001). Discussion: These results demonstrate that HD patients with chorea experienced greater negative impact to employment, self-care activities, and HCRU than patients without chorea experienced. These patients were more likely to stop working due to motor, cognitive, and behavioral symptoms; require modifications in the home and workplace; and need more assistance from caregivers than patients without chorea. Conclusions: Patients with HD-related chorea have greater detriments to emotional, interpersonal, and professional functioning that could be improved by reducing chorea.

남편의 자녀양육참여율이 남편과 아내의 결혼만족도에 미치는 영향 - 맞벌이 부부의 고용형태 차이의 조절효과를 중심으로 -

본 연구는 유아기 자녀를 둔 남편과 아내의 결혼만족도에 영향을 미치는 남편의 자녀양육참여율에 대한 맞벌이 부부의 고용형태 차이의 조절효과를 확인하고자 한다. 결혼만족도는 결혼에 대한 본인의 기대가 얼마나 충족되었는지에 따라 결정되기 때문에 개인의 기대 수준 충족에 따라 만족도는 다르게 나타날 수 있다. 자녀양육에 대한 책임과 기대수준은 맞벌이 부부의 고용형태 차이에 따라 다를 수 있다. 그렇기에 본 연구는 남편의 자녀양육참여율이 결혼만족도에 미치는 영향이 맞벌이 부부의 고용형태 차이에 따라 그 영향이 어떻게 달라지는지를 밝혀내고자 한다. 이를 확인하기 위하여 아동패널조사 5차년도 참여자 중 맞벌이를 하고 있는 285가구의 부부를 대상으로 분석을 진행하였다. 분석결과에 따르면 남편의 자녀양육참여율은 아내의 결혼만족도에는 유의한 영향을 미치지만 남편의 결혼만족도에는 통계적으로 유의한 영향을 미치지 않는 것으로 나타났다. 다음으로 맞벌이 부부의 고용형태 차이에 따라서 남편의 자녀양육참여율이 남편과 아내의 결혼만족도에 미치는 영향이 어떻게 다른지 확인해 보기 위하여 남편과 아내의 결혼만족도에 대한 남편의 자녀양육참여율과 부부의 고용형태 차이의 상호작용효과를 살펴보았다. 분석결과에 의하면 오직 아내의 결혼만족도에 대해 남편은 정규직이고 아내는 비정규직인 경우에만 남편의 주말 양육참여의 상호작용이 통계적으로 유의한 것으로 확인되었다. 이러한 연구 결과를 바탕으로 하여 맞벌이 가정에서 아내의 결혼만족도에 영향을 미치는 남편의 자녀양육참여율에 대한 협상력 증대를 위해 노동시장에서의 여성의 지위 향상이 필요하다는 함의를 도출하였다.

Freedom From Seizures Might Be Key to Continuing Occupation After Epilepsy Surgery.

Introduction: We hypothesized that epilepsy surgery for adult patients with temporal lobe epilepsy (TLE) who obtained freedom from seizures could provide opportunities for these patients to continue their occupation, and investigated continuity of occupation to test this postulation.Methods: Data were obtained from patients who had undergone resective surgery for medically intractable TLE between October 2009 and April 2019 in our hospital. Inclusion criteria were as follows: (1) ≥16 years old at surgery; (2) post-operative follow-up ≥12 months; (3) seizure-free period ≥12 months. As a primary outcome, we evaluated employment status before and after surgery, classified into three categories as follows: Level 0, no job; Level 1, students or homemakers (financially supported by a family member); and Level 2, working. Neuropsychological status was also evaluated as a secondary outcome.Results: Fifty-one (87.9%) of the 58 enrolled TLE patients who obtained freedom from seizures after surgery continued working as before or obtained a new job (employment status: Level 2). A significant difference in employment status was identified between before and after surgery (p = 0.007; Wilcoxon signed-rank test). Twenty-eight patients (48.3%) were evaluated for neuropsychological status both before and after surgery. Significant differences in Wechsler Adult Intelligence Scale-III scores were identified between before and after surgery (p < 0.05 each; paired t-test).Conclusion: Seizure freedom could be a factor that facilitates job continuity, although additional data are needed to confirm that possibility. Further investigation of job continuity after epilepsy surgery warrants an international, multicenter study.

Young adults undergoing ACDF surgery exhibit decreased health-related quality of life in the long term in comparison to the general population

The leading surgical treatment of cervical radiculopathy is anterior cervical discectomy and fusion (ACDF). However, it has been suggested that ACDF procedures could lead to accelerated degeneration of the adjacent cervical discs (adjacent segment disease, or ASD) and the effect of ACDF surgery on neck symptoms and quality of life in the long term is not fully understood. Patients operated on at young ages generally have a long life expectancy and a long number of working years ahead of them. Thus, this patient group is of special interest when considering the accumulation of cervical problems due to possible ASD, the overall progressive nature of cervical degeneration in the long term, and their effects on related quality of life. Our goal was to study the health-related quality of life in the long-term follow-up after ACDF surgery in the young adult population between the ages of 18 and 40. A retrospective cohort study with propensity matched controls. All patients between 18 and 40 years of age at the time of the surgery who underwent ACDF due to degenerative cervical disease at Helsinki University Hospital between the years 1990 and 2005 who had filled in the quality of life questionnaires 12 to 28 years after the surgery (281 patients), and a propensity matched control cohort of the general population selected based on age, sex, and smoking status. Quality of life measured by the EuroQol questionnaire (EQ-5D-3L and EQ-VAS). The medical records of all patients who underwent ACDF due to degenerative cervical disease at the age of 18 to 40 years at Helsinki University Hospital between 1990 and 2005 were analyzed retrospectively. The EuroQol questionnaire was sent to all patients whose contact information could be obtained (443 patients) at the end of the follow-up (median 17.5 years) to assess their current quality of life. A total of 281 patients returned the questionnaires and were included in this study. Quality of life was compared to that in the general Finnish population using a similar sized control cohort selected through propensity matching. The patients who had undergone ACDF surgery reported significantly more problems than the general population cohort in three out of five dimensions that were assessed in the EQ-5D questionnaire, including mobility, usual activities, and pain/discomfort. Similarly, the overall EQ-5D-3L index calculated from the dimensional values was lower (0.74 vs. 0.83, p=.000), depicting a generally decreased health-related quality of life among patients. Spondylosis as a primary diagnosis, clinical myelopathy, and further cervical surgeries were associated with lower quality of life in the subgroup analyses of the patients. Similarly, in the EQ-VAS assessment, patient subgroups with spondylosis as a primary diagnosis, at least one reoperation, operation on more than one level, and clinical myelopathy were associated with lower scores and lower quality of life. The mean EQ-VAS score among patients was 73%. Regardless of the decreased health-related quality of life, there was no statistically significant difference in the concurrent employment status between the patient and control groups. The health-related life quality measured by the EQ-5D-3L was lower in the patient population than in the general population. Patients had more problems with mobility and usual activities and more pain/discomfort. However, satisfaction with the surgery was very high, and there was no significant difference in employment status between the patients and the control population. Patients with spondylosis as a primary diagnosis had lower quality of life compared to patients with disc herniation. Also, clinical myelopathy and further cervical surgeries during follow-up were associated with lower quality of life in the subgroup analyses of the patients. It must also be kept in mind that we do not know what the situation could have been without surgery and with conservative treatment only.

Why do Gender Differences in Daily Mobility Behaviours persist among workers?

Gender is commonly identified as a key explanatory factor for travel behaviour. Since women’s role in societal structure has changed in the past few decades, the question arises as to whether the “gender” factor still plays a decisive role in differences in mobility within the working population. The aim of this paper is to extend the research on gendered differences in mobility by providing an in-depth analysis of how the main determinants of daily mobility affect male and female workers differently. Unlike previous research, our econometric models included terms that express the interactions between the explanatory variables (socioeconomic variables and transport mode access) and a dichotomous gender variable, to accurately identify the marginal impact of gender on mobility indicators. Based on the Rhône-Alpes regional household travel survey (2012–2015), which includes France’s second largest urban area, the results show that even if gender differences in employment status and access to the private car are eliminated, differences in travel patterns between men and women would still be observed because the two genders do not have identical factor sensitivities. From a policy perspective, these results suggest that authorities have to adopt a gender perspective to ensure that in the future urban mobility policies provide gender equity in the context of the sustainable development of transport networks.

Situation professionnelle à long terme après un cancer : étude réalisée à partir de registres de population

Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15years after cancer diagnosis. From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. At 5, 10 or 15years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.