Extended Time Off Research Articles

Balancing act: exploring work-life balance among nursing home staff working long shifts

BackgroundNursing home staff often face challenges in achieving a satisfactory work-life balance, particularly because of the nature of shift work. While long shifts offer extended periods off work, their impact on the delicate balance between work and leisure remains understudied in the context of nursing homes. This study investigated the experiences of nursing home staff in Norway working long shifts lasting 12–14 h and their perceptions of the balance between family life and work.MethodsEighteen nursing home staff members were interviewed following a semi-structured qualitative approach. The participants worked in three types of long shifts and provided insights into their experiences, addressing issues such as work hours, shift patterns, and work-family balance.ResultsThe study revealed four main categories: (1) impact of long shifts on family life—the highs and lows; (2) maximizing time off with long shifts; (3) reducing job stress with long shifts; and (4) full-time work leads to predictable hours and stable income. The participants emphasised the distinct separation between work and leisure during long shifts, acknowledging limited social life during working periods but appreciating extended periods off. Family life posed challenges, especially with young children, but the participants found benefits in the longer periods of family time during days off. Longer rest periods and reduced commuting time were perceived as advantages of long shifts, contributing to better sleep, reduced stress and overall well-being. Long shifts also allowed for more predictable working hours and income, supporting a stable work-life balance.ConclusionBalancing work and family life involves more than just the number of hours spent at work; it also encompasses the quality of those hours both at work and at home. Our findings underscore the complex interplay between work and family life for nursing home staff working long shifts. While challenges exist, benefits such as extended time off, improved sleep, reduced stress, and predictable working hours contribute positively to their work-life balance. Long shifts in nursing homes offer a unique perspective on achieving work-life balance, revealing both the challenges and advantages inherent in such schedules. Understanding the experiences of nursing home staff in this context can inform future innovations in shift scheduling, promoting a more balanced and sustainable work environment for healthcare professionals. For some healthcare staff, extended shifts can lead to a better work-life balance.

Prevalence of and Factors Associated with Financial Toxicity After Pancreatectomy and Gastrectomy.

Financial toxicity (FT) refers to the adverse impact of cancer treatment costs on patients' experiences, potentially leading to poor adherence to treatment and outcomes. However, the prevalence of FT among patients undergoing major upper gastrointestinal cancer operations, as well as factors associated with FT, remain unclear. We conducted a cross-sectional study by sending the Comprehensive Score for financial Toxicity (COST) survey and Surgery-Q (a survey specifically developed for this study) to patients who underwent gastrectomy or pancreatectomy for malignant disease at our institution in 2019-2021. We sent the surveys to 627 patients and received responses from 101 (16%) patients. The FT prevalence (COST score <26) was 48 (48%). Patients likely to experience FT were younger than 50years of age, of non-White race, earned an annual income <$75,000, and had credit scores <740 (all p<0.05). Additionally, longer hospital stay (p=0.041), extended time off work for surgery (p=0.011), and extended time off work for caregivers (p=0.005) were associated with FT. Procedure type was not associated with FT; however, patients who underwent minimally invasive surgery (MIS) had a lower FT probability (p=0.042). In a multivariable analysis, age <50years (p=0.031) and credit score <740 (p<0.001) were associated with high FT risk, while MIS was associated with low FT risk (p=0.024). Patients with upper gastrointestinal cancer have a major risk of FT. In addition to predicting the FT risk before surgery, facilitating quicker functional recovery with the appropriate use of MIS is considered important to reducing the FT risk.

An Innovative Resource to Guide and Track Medical Resident Activity and Wellness During At-Home Assignments.

Background and objectives Medical residents may work from home for various reasons, including study electives, isolation due to exposure to illness, or during parental leave when they choose to work at home instead of taking extended time off. The University of Arkansas for Medical Sciences (UAMS) Little Rock Family Medicine residency program recognized the need for a tool that provided residents with a list of resources and approved activities for at-home work and a means of tracking their performance in those activities. Methods The administration team at the UAMS Little Rock Family Medicine residency program custom-designed a Daily Activities Log that served multiple purposes. Family medicine residents used it to choose what activities to participate in from a comprehensive list of activities and resources including virtual conferences, recorded didactics, modules, and other online materials. The program provided the framework on the log, while residents used it to document time spent on those activities. The log also gave the program a daily update on the resident's health, as one question specifically asked about well-being. Since it was built in an electronic survey format already owned by the residency program, it was completely customizable and available at no additional cost. Results In the two years covered by this project, residents logged a total of 593 hours of at-home work. In response to a survey, 76% of participating residents (N=14) rated the log as extremely or very easy to use; 64% indicated that it was a helpful resource; and 50% said that it simplified the reporting of their daily status. The residency program faculty found that having one source to track all off-site residents was an efficient means of monitoring their well-being and their work. Conclusions The Daily Activities Log is a versatile tool that provides comprehensive information, resources, and approved activities for residents, documents their work, and provides updates to residency management. It can be readily modified for use in other programs that have residents working at home.

Meta-research: justifying career disruption in funding applications, a survey of Australian researchers.

When researchers' careers are disrupted by life events - such as illness or childbirth - they often need to take extended time off. This creates a gap in their research output that can reduce their chances of winning funding. In Australia, applicants can disclose their career disruptions and peer reviewers are instructed to make appropriate adjustments. However, it is not clear if and how applicants use career disruption sections or how reviewers adjust and if they do it consistently. To examine career disruption, we used surveys of the Australian health and medical research community. We used both a random sample of Australian authors on PubMed and a non-random convenience sample. Respondents expressed concerns that sharing information on career disruption would harm their chances of being funded, with 13% saying they have medical or social circumstances but would not include it in their application, with concerns about appearing 'weak'. Women were more reluctant to include disruption. There was inconsistency in how disruption was adjusted for, with less time given for those with depression compared with caring responsibilities, and less time given for those who did not provide medical details of their disruption. The current system is likely not adequately adjusting for career disruption and this may help explain the ongoing funding gap for senior women in Australia. National Health and Medical Research Council Senior Research Fellowship (Barnett).

Effect of surgical abstinence on the risk for posterior capsule rupture during cataract surgery

To evaluate the impact of surgery restrictions on cataract surgery performance. Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom. Retrospective, observational cross-sectional study. A single-center, retrospective review of all patients who underwent phacoemulsification surgery at Moorfields Eye Hospital between September 2019 and January 2021 was conducted. The main outcome measure was posterior capsule rupture (PCR) rate before and after COVID-19-imposed restrictions to elective cataract surgery. A total of 15 688 surgeries were performed by 256 different surgeons in the study period. In the prerestriction period (September 2019 to March 2020), the PCR rate was 0.99%, whereas in the 19-week postrestriction period, the PCR rate spiked to 1.62% (odds ratio 1.65; P = .001; CI 1.24 to 2.20; relative risk: 1.64). The COVID-19 pandemic provided a unique opportunity to assess a large group of surgeons' performances after prolonged surgical abstinence. A 19-week restriction period in surgical activity showed an increased incidence of PCR complications. This is relevant because it can concern any surgeon on the extended time off from work such as sick, sabbatical, research, and parental leave. Supporting strategies should be implemented by associated regulators to minimize this negative impact.

MRI activity in MS and completed pregnancy: Data from a tertiary academic center.

ObjectiveTo evaluate postpartum MRI activity in patients with MS and a completed pregnancy and to compare these results to an age-matched untreated nonpregnant MS cohort.MethodsPatient with MS from a tertiary care MS center between 2006 and 2015, with prepartum and postpartum neurologic follow-ups and MRI scans were analyzed. Clinical activity and inflammatory brain MRI activity (new T2-hyperintense or gadolinium-enhancing [Gd+] lesions) were assessed peripartum. The results were compared with untreated reproductive-age patients with MS from the placebo arm of the clinical trials.ResultsA total of 123 pregnancies in 123 women (median Expanded Disability Status Scale 1.0) were analyzed. Approximately 7.2% relapsed during pregnancy and 48.7% relapsed postpartum. Of pregnancies with prepartum and postpartum gadolinium (Gd)-enhanced MRI (n = 112), 8% had Gd+ lesions prepartum and 33% had new Gd+ lesions postpartum. Overall, 54.4% had either new T2 or Gd+ lesions postpartum. Seventy-nine percent of subjects with postpartum relapse had new MRI activity compared with 37.1% without relapse (p < 0.001). Twenty-five percent had both clinical and radiographic activity and only 24.9% maintained no evidence of disease activity status postpartum. There was no association between postpartum MRI activity and disease-modifying treatments (DMTs) (p > 0.5). MRI and clinical outcomes were also assessed for 126 nonpregnant untreated female patients with MS. Comparing pregnancy and no pregnancy groups, there was no difference in MRI activity at follow-up.ConclusionsThere was a high level of inflammatory radiographic disease activity which was related to relapses in postpartum patients with MS. Further studies are needed to determine whether hormonal fluctuations vs extended time off DMTs may be the underlying cause of our observations.

Oligometastatic breast cancer: where are we now and where are we headed?—a narrative review

Metastatic breast cancer has traditionally been considered incurable, with treatments focused on systemic therapies and palliative local treatment. However, evidence is emerging that in some patients with limited metastatic disease, or "oligometastatic disease," often defined as five or fewer metastases diagnosed on imaging, aggressive metastasis-directed therapy (MDT) with surgery and/or hypofractionated image-guided radiation therapy (HIGRT) improves outcomes and may even be curative. This practice is becoming more common as evidence has grown to support the approach and as technology has made it more feasible. Treatment of certain oligometastatic breast cancers in particular (i.e., hormone receptor positive and bone-only metastases) may be especially useful given the long natural history of the disease in some of these patients. Recently, high quality data supporting ablative MDT in patients with oligometastatic disease has emerged from randomized trials for specific sites such as non-small cell lung cancer and prostate cancer, as well as from histology agnostic studies (i.e., SABR-COMET). However, randomized data in breast cancer specifically is currently lacking. Retrospective series and subgroup analysis from prospective trials have demonstrated improved outcomes with MDT for oligometastatic breast cancer. The ongoing phase II/III NRG BR002 trial seeks to provide the first randomized data to determine whether MDT in oligometastatic breast cancer improves outcomes. This may be especially important as improved systemic therapies such as targeted agents and immunotherapy prolong the disease course. Alternatively, if improved systemic therapies render patients disease free, MDT may not be necessary and only adds toxicity. However, MDT may also provide non-curative benefits for patients such as palliation of symptoms and extended time off systemic therapy. For now, aggressive MDT for certain favorable subgroups of oligometastatic breast cancer such as those with few metastases, hormone positive disease, and/or bone-only metastases is reasonable and may improve outcomes. We eagerly anticipate the results of NRG BR002 to further clarify the role of ablative therapy to all sites of disease in these patients.

Abstract A118: Work changes and predictors of decreased work participation among African American cancer survivors

Abstract Background: Cancer-related financial hardship is common and is associated with lower health-related quality of life, particularly among African American cancer survivors. Employment outcomes during and after cancer treatment may represent modifiable risk factors to reduce financial hardship and improve wellbeing among cancer survivors, but employment outcomes among African American survivors are not well understood. Methods: We utilized data from the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults ages 20-79 were eligible to join the cohort if they were diagnosed with a first primary breast, colorectal, lung, or prostate cancer since January 1, 2013, as identified through the Metropolitan Detroit Cancer Surveillance System cancer registry. The present analyses include 445 survivors who reported being employed before their cancer diagnosis. We estimated prevalence of work-related outcomes, including changes to hours, duties, and schedules; and extended time off. We further estimated the prevalence and identified predictors of decreased work participation (going from being employed at diagnosis to not employed or from full time to part time employment) between diagnosis and ROCS baseline survey (median: 13 months) using modified Poisson regression. Adjusted models controlled for age, household income, and cancer site. Results: One-third (33%) of survivors reported taking at least one month off of work, including 19% who used paid sick time, 8% who used paid vacation, and 21% who took at least one month of unpaid time off. Changes to work schedules (46%), hours worked (40%), or work duties (25%) were also common. Nearly half (47%) of employed survivors experienced a decrease in work participation. A greater proportion of survivors employed full time before diagnosis reported being on disability at ROCS baseline compared with those employed part time (20.4% vs. 14.3%), while unemployment was more common among survivors employed part time before diagnosis (16.9% vs. 7.9%; p&amp;lt;0.001). In adjusted models, older age (RR 65+ vs. &amp;lt;55: 1.5, 95% CI: 1.1, 1.9), lower income (RR $80,000+ vs. &amp;lt;$20,000: 0.3, 95%CI: 0.2, 0.4), cancer site (RR lung vs. breast: 1.6, 95% CI: 1.2, 2.0; RR colorectal vs. breast: 1.3, 95% CI: 1.0, 1.7) and receipt of chemotherapy (RR: 1.4, 95% CI: 1.1, 1.8) were associated with decreased work participation, as were taking at least one month of unpaid time off (RR: 1.4, 95% CI: 1.1, 1.8) and changing work duties related to cancer (RR: 1.4, 95% CI: 1.1, 1.7). Conclusions: Our findings of strong associations between low household incomes and receipt of chemotherapy and decreased employment participation may represent opportunities to improve employment outcomes. Possible interventions focused on rehabilitation or additional policy or employer-level supports could improve employment outcomes among survivors at greatest risk for financial difficulties. Citation Format: Theresa A Hastert, Mrudula Nair, Julia Mantey, Jennifer L Beebe-Dimmer, Stephanie Pandolfi, Tara E Baird, Ann G Schwartz. Work changes and predictors of decreased work participation among African American cancer survivors [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A118.

Quality of life (QOL), financial burden, and perception of care in patients enrolled on clinical trials (CTs).

e19112 Background: We sought to study the longitudinal QOL, financial burden and perception of care (PoC) in patients with multiple myeloma (MM) or lymphoma (LYM) enrolled on CTs vs. those receiving standard care (Non-CT). Methods: QOL was evaluated using the FACT-G questionnaire (baseline, 1, 2, 3, 6 &amp; 12 months). Financial burden was evaluated using 10 questions adapted from the MEPS survey and PoC was evaluated using 6 questions adapted from the CAHPS survey (baseline, 3, 6 &amp; 12 months). Results: 35 (28%) of 123 enrolled patients were treated on CTs. Demographics, QOL and financial burden are shown in the Table. Baseline QOL scores were similar in CT vs non-CT groups. Age, gender and self-reported performance status were significantly associated with baseline QOL, while lines of therapy &amp; cancer type were not. There were no significant differences in change in QOL vs. baseline in patients treated on CTs vs. non-CTs at 1, 2, 3, 6 and 12 months from baseline, including the total FACT-G score and the subdomains of functional, physical, emotional and social well-being. Within each group, there was a decline in QOL over the first 3 months, specifically physical WB, which gradually returned to baseline. Baseline answers to financial burden questions were similar, except patients on CTs reported less need for taking extended time-off from work (22% vs. 46%, p = 0.02). The only statistically significant difference in individual Qs over 1 year was ‘worry about having to pay large medical bills’ at the 6-month timepoint (CT: 0%, non-CT: 52%, p = 0.01). Using a composite score from 4 MEPS questions, financial burden over time was lower in the CT group, though the differences were not statistically significant. There were no significant differences in PoC at baseline, 3, 6 and 12 months in the two groups based on answers to each of the six questions adapted from the CAHPS survey. Conclusions: Over 1 year, patients on CTs experienced a similar QOL and perceived their care to be similar as non-CT patients. Financial burden was lower in the CT group, though differences were not statistically significant. [Table: see text]

Total disability days in interprovincial and home-province workers injured in Alberta, Canada: A mixed-methods study with matched-pair analysis of compensation data and participant interviews.

Workers moving between states or provinces to find employment are reported to take longer to return to work after the injury. The Alberta Workers Compensation Board (WCB) identified all workers from four Canadian Atlantic provinces who sustained a work injury in Alberta resulting in greater than 5 total temporary disability days (TTDDays) from January 2015 to June 2017. Each was matched on sex, age, and injury date with an Alberta claimant also with greater than 5 TTDDays. WCB information extracted included employment, injury, cost and place of treatment, and modified work. Cox regression identified factors associated with TTDDays. Semi-structured interviews were also undertaken. Two-hundred forty pairs were identified and 60 interviews completed. Those from the Atlantic provinces had more TTDDays (median 63 days) than Alberta (median 22 days) with an unadjusted hazard ratio (HR) 0.50 (95% confidence interval [CI], 0.42-0.61). When adjusted for all factors, the HR moved closer to unity (HR = 0.62; 95% CI, 0.50-0.76). Total health care costs were the strongest predictor, with modified work, injury type, and claim status also explanatory factors. Among the Atlantic workers, leaving Alberta for treatment was strongly related to a lower likelihood of ending wage replacement (HR = 0.45; 95% CI, 0.32-0.62). Participants in the interview study emphasized the importance of returning to the family after injury and the financial difficulties of maintaining a second home with reduced income after the injury. The higher costs of wage replacement associated with extended time off work may be inherent to the practice of employing out-of-province workers for jobs for which there is a shortage of local labor.

Mental health crisis among emergency care clinicians

Mental health crisis among emergency care clinicians

Factors affecting time off work in patients with traumatic hand injuries—A bio-psycho-social perspective

Hand injuries are common and can result in a long time off work. To analyse and identify factors affecting time of work, a holistic view on patients is needed. World Health Organization’s International Classification of Functioning, Disability and Health (ICF) with its bio-psycho-social perspective provides such a holistic view. The purpose of this study is to analyse time off work in patients with traumatic hand injuries and to identify factors affecting time off work from a bio-psycho-social perspective. We used factors derived from the ICF Core Set for Hand Conditions to predict time off work by applying Cox regression analyses and Kaplan-Meier method using data of a multicentre prospective study in nine German Level 1 hand trauma centres. In total, 231 study participants with a broad range of hand injuries were included. From these, 178 patients (77%) returned to work within 200 days. Impairments in mobility of joint functions and sensory functions related to temperature and other stimuli as well as higher hand strain at work led to extended time off work. Gender, fine hand use and employment status additionally influenced time off work in sub-models. Our results demonstrate that a bio-psycho-social perspective is recommended when investigating time off work.

Let's Get Technical-How Not to Panic When the Key Employee Needs Extended Time Off

Let's Get Technical-How Not to Panic When the Key Employee Needs Extended Time Off

Cancer survivors' experiences with insurance, finances, and employment: results from a multisite study.

Cancer has significant implications on survivors' insurance coverage, financial status, and employment. We aimed to examine how these outcomes vary for survivors of different cancer types. Using the Cancer Survivorship Supplement of the Medical Expenditures Panel Survey (MEPS), in 2013, we surveyed survivors of five common cancers who were diagnosed during 2003-2008 and were continuously enrolled in one of three health plans in Massachusetts, Colorado, and Washington State. Among 615 eligible respondents, 96% reported having health insurance at the time of or since diagnosis; of those, few reported barriers in coverage to visit doctors or facilities of their choice. Approximately 15% reported experiencing financial hardships due to cancer. Of the 334 who responded as having been employed at the time of or since diagnosis, approximately 25% reported that they or their spouses remained at their jobs due to concerns about losing medical insurance. Further, 63% reported making changes in their jobs or careers (e.g., took extended time off, worked part time, or declined promotion) due to cancer, and 42% reported that cancer interfered with their physical and/or mental tasks at work or reduced productivity. Negative employment and financial implications were most common among those with lung, breast, and colorectal cancer, and those diagnosed before age 65. In this insured population, few experienced restrictions in cancer care coverage, though maintaining health insurance often drove employment decisions. Significant negative effects on finances and employment were observed among specific cancer types and younger survivors. Our study findings emphasize a need to identify ways of supporting survivors and provide tailored resources to reduce the untoward financial and work-related implications of cancer.

When Dad Stays Home Too

Drawing from 85 semi-structured interviews with fathers and mothers in three cities (Montreal, Toronto, and Chicago), I argue that when fathers in heterosexual couples experience the transition to parenthood in ways that are structurally comparable to mothers, they come to think about and enact parenting in ways that are more similar to mothers. I consider the specific role played by extended time off immediately after the birth of a child in structuring that experience. By drawing fathers into the daily realities of child care, free of workplace constraints, extended time off provides the space necessary for fathers to develop the parenting skills and sense of responsibility that then allows them to be active co-parents rather than helpers to their female partners. This shift from a manager-helper dynamic to that of coparenting creates the opportunity for the development of a more gender-equitable division of labor.

A phase II study of intermittent sunitinib (S) in previously untreated patients (pts) with metastatic renal cell carcinoma (mRCC).

4515 Background: S as initial treatment in mRCC is limited by balancing acute and chronic toxicity with clinical benefit. Pre-clinical and retrospective clinical data support that extended treatment breaks are feasible without a reduction in efficacy. Methods: Pts with treatment-naïve clear cell mRCC were enrolled on a prospective phase II trial and initially treated with 4 cycles of S (50 mg 4/2). Pts with ≥ 10% reduction in tumor burden (TB) following 4 cycles had S held, with CT scans approximately every 10 weeks. S was re-initiated for 2 cycles in those pts with an increase in TB by ≥ 10% and again held with ≥ 10% TB reduction. This intermittent S dosing continued until RECIST-defined disease progression while on S. The primary objective was feasibility of intermittent S, defined as the proportion of eligible pts who underwent intermittent therapy. The alternative hypothesis was a feasibility of &gt; 80% vs. a null hypothesis of &lt; 50% (a=0.05; power 80%). Results: Thirty-six pts were enrolled; 70% male, median age 60, 95% PS 0/1 and 32% favorable/65% intermediate by Heng criteria. Twenty pts were eligible for intermittent therapy and all pts (100%) entered the intermittent phase. Pts were not eligible for intermittent S due to PD (n=13); toxicity (n=1) or w/d of consent (n=2) prior to end of cycle #4. Sixteen pts (80%) had ≥ 10% TB increase off S with a median (range) increase of 1.5 cm (1.1-2.5) compared to the TB immediately prior to stopping S, considering all off periods.Four pts did not have ≥ 10% TB increase off S (3 pts after the 1st off period; off for 12, 8 and 5 months to date and 1 pt after the 2nd off period; off for 8 months prior to restarting S). Most pts exhibited a stable saw tooth pattern of TB reduction on S and TB increase off S. No pt had RECIST-defined PD while on S, but 2 pts were taken off extended breaks due to gradual TB increase over time, and 1 pt developed new CNS mets during the 2nd off period.The objective response rate was 53%. Toxicity was typical for S and completely resolved during treatment breaks. Conclusions: S dosing with periodic extended time off drug is feasible and associated with reduction in toxicity during the off periods. Clinical efficacy does not appear to be compromised. Clinical trial information: NCT01158222.

Effects of Hours of Service and Driving Patterns on Motor Carrier Crashes

There is a need to explore the relationship, if any, between the probability of a crash and the hours worked by truck drivers. The need arises from the continued adjustment of federal hours of service regulations for truck drivers. This research used data logs from less-than-truckload carrier operations in 2004 to 2005 and in 2010 to estimate the probability of a crash after a certain amount of time spent driving, given no crashes until that time. Driver logs for 7 days before each crash were used and compared with a random sample (two drivers) of drivers who did not crash and were selected from the same company, terminal, and month. This study involved 686 subjects, including 224 crash-involved drivers. Discrete-time survival analysis models indicated a consistent increase in crash odds as driving time increased beyond the fourth hour. Breaks from driving reduced crash odds by as much as 50% compared with situations of drivers with no breaks. Crash odds were lowest when drivers returned to work during the day without an immediately preceding extended recovery period (but with at least minimum required off-duty time). Drivers returning to work immediately after a 34-h recovery period had crash odds 50% to 150% higher than those for drivers without the recovery immediately before a trip. Drivers had the highest crash odds immediately after returning from the extended time off; the effect then diminished with time.

ISSLS Prize Winner: Early Predictors of Chronic Work Disability

Prospective population-based cohort study. To identify early predictors of chronic work disability after work-related back injury. Identification of early predictors of prolonged disability after back injury could increase understanding concerning the development of chronic, disabling pain, and aid in secondary prevention. Few studies have examined predictors across multiple domains in a large, population-based sample. Workers (N = 1885) were interviewed 3 weeks (average) after submitting a lost work-time claim for a back injury. Sociodemographic, employment-related, pain and function, clinical, health care, administrative/legal, health behavior, and psychological domain variables were assessed via worker interviews, medical records, and administrative databases. Logistic regression analyses identified early predictors of work disability compensation 1 year after claim submission. Significant baseline predictors of 1-year work disability in the final multidomain model were injury severity (rated from medical records), specialty of the first health care provider seen for the injury (obtained from administrative data), and worker-reported physical disability (Roland-Morris disability questionnaire), number of pain sites, "very hectic" job, no offer of a job accommodation (e.g., light duty), and previous injury involving a month or more off work. The model showed excellent ability to discriminate between workers who were/were not disabled at 1 year (area under the receiver operating characteristic curve = 0.88, 95% CI = 0.86-0.90). Among workers with new lost work-time back injury claims, risk factors for chronic disability include radiculopathy, substantial functional disability, and to a lesser extent, more widespread pain and previous injury with extended time off work. The roles of employers and health care providers also seem important, supporting the need to incorporate factors external to the worker in models of the development of chronic disability and in disability prevention efforts.

Work‐life balance is a cross‐generational concern—and a key to retaining high performers at Accenture

AbstractMembers of Generations X and Y are even more insistent than baby boomers are about balancing their professional and personal lives—a potential retention issue exacerbated by the shrinking pool of skilled talent. Three case studies highlight Accenture's successful new work‐life program, Future Leave, which enables high performers to take extended time off for personal reasons without derailing promising or established careers with the company. The author also highlights some differences between the challenges that female and male professionals anticipate they will face over the next several years and cautions that global companies will need to become more adept at tailoring work‐life programs to meet a range of needs in their increasingly diverse global workforces. © 2008 Wiley Periodicals, Inc.

Rotating Shifts Satisfy Workers and Management

The article describes a rotating shift schedule that allows 24‐hour coverage of the water treatment plant but also allows workers to have extended time off between shifts and more free weekends. The struggle to produce an effective rotating work schedule was solved by good worker/management communication. A graphic representation of the schedule is included.