Sickness Benefits Research Articles

Impact of pre-pandemic sick leave diagnoses on the length of COVID-19-related sick leave: a nationwide registry-based study

BackgroundThe COVID-19 pandemic has caused difficulties and changes in many aspects of people’s health and lives. Although infection affected work capacity, during the first wave policies for sick leave due to COVID-19 were unclear. The aim of this study was to investigate the impact of sick leave diagnoses in the year before the COVID-19 diagnosis on sick leave duration due to COVID-19 in a nationwide non-hospitalised population.MethodsData from three Swedish registries were analysed for sick leave commencing between 1 March and 31 August 2020, with a follow-up period of 4 months. Sick leave due to COVID-19 was considered the number of days that sickness benefits were used and included at least one registered COVID-19 diagnosis. Sick leave in the year before COVID-19 diagnosis were categorised into five diagnostic groups and one reference group (participants without prior sick leave).ResultsThe study comprised 8935 individuals who received sickness benefits due to COVID-19 in Sweden during the first pandemic wave (mean age 46.7 years, 67% females, and 24% had diagnoses for sick leave in the year before COVID-19 diagnosis). The duration of sick leave due to COVID-19 was significantly higher in the groups with prior sick leave owing to musculoskeletal system diseases (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 1.01–1.15); respiratory system diseases (OR: 1.22, 95% CI: 1.14–1.31); all other isolated diagnoses (OR: 1.08, 95% CI: 1.03–1.14); and multiple diagnoses (OR: 1.32, 95% CI: 1.21–1.43).ConclusionsThe results of this nationwide registry-based study indicate that individuals with premorbid conditions are more prone to longer sick leave durations due to COVID-19. Prediction of sick leave duration during the first wave of the COVID-19 pandemic is complex and several factors played a role.

Perceived stress in adolescence and labour market participation in young adulthood - a prospective cohort study

BackgroundAdolescence is a key-developmental stage for physical, neurological, psychological, and social changes. In this developmental stage, a large number of people struggle with mental health problems like stress, anxiety, or depression. Psychological vulnerability in adolescence has previously been found to be negatively related to future low labour market participation. However, studies are lacking that investigate the impact of stress during adolescence on labour market participation in early adulthood using register data. The aim of this prospective study was therefore to examine the association between perceived stress during adolescence and labour market participation in young men and women in early adulthood.MethodsA Danish cohort of 3038 participants born in 1989 was followed with use of questionnaires from age 15 to age 28. The exposure, self-reported perceived stress, was collected by questionnaires at ages 15, 18, and 21. The outcome, labour market participation, was based on register information on social benefits, such as unemployment benefits, sickness benefits, and disability benefits, collected on a weekly basis during a 4-year period. Information about the socioeconomic confounders was also gleaned from registers.ResultsThe study found consistent associations between perceived stress from age 15 to age 21 and low labour market participation from age 25 to age 29 in both women and men after adjusting for mental health and socioeconomic confounders. The strongest associations between perceived stress and low labour market participation were seen among men who reported stress several times during adolescence.ConclusionsThe results indicate that although, women in general, reported being more stressed than men during adolescence and had lower labour market participation in early adulthood, there was a small group of men who had experienced stress during adolescence who were at particularly high risk of being marginalised in the labour market.

Support for Sick and Unemployment Benefits in Sweden: On Class, Unions, and Anti-Immigration Attitudes

Support for Sick and Unemployment Benefits in Sweden: On Class, Unions, and Anti-Immigration Attitudes

Is information on social rights accessible to cancer patients?

Brazilian legislation provides for rights for cancer patients in order to assist with their treatment and mitigate the expenses they face during their illness. This study aimed to calculate the proportion of individuals undergoing cancer treatment at a Brazilian Unified National Health System (SUS) referral center who reported being aware of 15 specific legal rights, according to the population subgroup eligible to request each right. All adult cancer patients starting treatment at the Juiz de Fora Women's Association for Preventing and Fighting Cancer Hospital (ASCOMCER), Minas Gerais State, from March to July 2022, were interviewed (n = 62). About 60% of these patients had incomplete primary education or were illiterate, around 75% lived in households with a per capita income below one minimum wage, and 91.9% received treatment from the SUS. For nine of the 15 selected rights, the proportion of eligible patients was higher than 10%, ranging from 17.7% for "Withdrawal from the Severance Pay Fund (FGTS)" to 100% for "priority in the processing of procedures". However, the only one of these rights known to at least 50% of eligible patients was "sickness benefit" (70.6%). The respective proportions were below 5% in three rights, including "exemption from property tax", "exemption from income tax on retirement, pension, and retirement", and "priority in the processing of cases". Cancer patients need to have their comprehensive care strengthened. Therefore, it is crucial to enhance the availability of information regarding the benefits cancer patients may receive from a democratic state that respects the rule of law.

Research on Cancer Screening Promotion and Employment Support for Employees with Cancer at Business Establishments.

Increasing cancer screening rates among working-age populations and providing employment support for employees with cancer are issues that need to be addressed in Japan. Therefore, this study aimed to clarify the situation regarding cancer screening promotion and employment support for employees with cancer at business establishments and the support they seek from medical professionals regarding these issues. This survey covered 1,058 business establishments and included the following items: attributes of the business establishments, cancer screening rate, support for employees to promote cancer screening, support sought by business establishments from medical professionals to promote cancer screening, presence of employees with cancer, support programs for employees with cancer, awareness of the resources available for employment support for employees with cancer, difficulties in supporting employees with cancer in the workplace, and support sought by business establishments from medical professionals in providing employment support for employees with cancer. Data analysis was primarily conducted using summary statistics. This study included 153 establishments. The median cancer screening rate ranged from 50.00 to 99.15. Employee support for promoting cancer screening ranged from approximately 30% to 40% for "ensuring time for screening" and from 20% to 30% for "providing full subsidies for cancer screening cost." The median screening rate for breast and cervical cancers was 50.00, and support for promoting screening was less than 30% for each. Business establishments sought support from medical professionals regarding cancer and study sessions on cancer prevention to promote cancer screening. Regarding support systems for employees with cancer, 49.7% of the establishments offered sickness benefits, and 42.5% offered paid leave on an hourly basis. Less than 10% were aware of the websites provided by public organizations regarding employment support for patients with cancer. Approximately 50% of the establishments reported difficulties regarding treatment policies and duration uncertainties. Business establishments sought the provision of relevant knowledge and specific information to increase cancer screening rates and provide employment support for employees with cancer. Furthermore, this study suggests that employees with cancer need to manage the information they provide their establishments.

INCAPACIDADE PARA O TRABALHO POR TRANSTORNOS MENTAIS E DO COMPORTAMENTO NO INSS: UMA ANÁLISE TEMPORAL

This article presents a cross-sectional study that analyzed the temporal evolution of granting sickness benefits related to mental and behavioral disorders in Brazil, between 2006 and 2021. illness and absence from work.

Factors influencing return to work after surgery for ulnar nerve compression at the elbow

Ulnar nerve compression at the elbow (UNE) frequently affects people of working age. Surgically treated patients may not immediately return to work (RTW) postoperatively. In 2008, the Swedish Social Insurance Agency reformed the national insurance policy. We aimed to examine RTW postoperatively for UNE, variations among surgical methods, and potential risk factors for prolonged RTW (sick leave > 6 weeks). Surgically treated cases of UNE (n = 635) from two time periods (2004–2008 and 2009–2014) and two healthcare regions (Southern and South-eastern) were studied retrospectively regarding age, sex, comorbidities, occupation, type of surgery and time to RTW. A sub-analysis of the exact number of weeks before RTW (n = 201) revealed longer RTW for unemployed cases compared to employed cases. Prolonged RTW was seen among younger, manual workers and after transposition or revision surgery. Prolonged RTW was approximately four times more likely after transposition than after simple decompression. Comparisons before and after 2008 showed occupational differences and differences in RTW, where cases operated before 2008 more often had permanent sickness benefit, but the reform of the social insurance system did not seem to influence RTW. In conclusion, unemployment, younger age at surgery, manual labour, transposition, and revision surgery were related to prolonged RTW.

Return to work after surgical clipping versus endovascular treatment for ruptured intracranial aneurysms - A nationwide registry-based study.

The aim of this study was to assess return to work following aneurysmal subarachnoid haemorrhage (SAH) and compare working status after open surgical clipping and endovascular treatment. This nationwide registry-based study included all adult patients in working age treated for a ruptured intracranial aneurysm in Norway between 2008 and 2018 who had a record of sickness leave on the day of treatment. Data from The Norwegian Patient Registry and The Norwegian Labour and Welfare Administration were linked on an individual level. Daily sickness and disability benefits recipiency one year preoperatively to one year postoperatively was analysed. Return to work after endovascular treatment and surgical clipping was compared. 183 patients were included in the study. Among patients who worked at one year preoperatively, 57% had returned to work one year after treatment. Mean number of days from treatment to the first day back at work in a continuous 3-month working period was 298 (95% CI: 276-321) vs. 319 (95% CI: 299-339) for patients who underwent endovascular treatment compared to patients treated with clipping (p = 0.365). Older patients were less likely to return to work after treatment (hazard ratio 0.977 per year of age, 95% CI 0.956-1.000, p = 0.046). There was no significant association between return to work and patient sex or location of the aneurysm. Aneurysmal SAH profoundly affects patient working status. This study found no significant difference in time to return to work after treatment between patients treated with endovascular techniques compared to patients undergoing open surgery.

Constructing and validating an Occupational Mechanical Job Exposure Index based on five Norwegian nationwide Surveys of Living Conditions on work environment

BackgroundThe overall aim of this study was to examine essential aspects of reliability and validity of a constructed Occupational Mechanical Job Exposure Index for use in analyses of Norwegian register data. MethodsWe utilized data from the Norwegian nationwide Survey of Living Conditions on work environment in 2006, 2009, 2013, 2016 and 2019. Occupations were classified on a 4-digit level based on the Norwegian version of the International Standard Classification of Occupations (ISCO-88). We constructed a 4-digit correspondence table between the occupational codes used in the 2006 and 2009 surveys (STYRK-98) and the codes used in 2013, 2016 and 2019 (STYRK-08). The mechanical exposures were collected by Statistics Norway using telephone interviews. As for reliability, we examined the agreement between the individual- and the occupational-based mechanical exposures using Cohen’s kappa, sensitivity and specificity measures. Construct, concurrent and predictive validity pertaining to the Occupational Mechanical Job Exposure Index were analysed using both survey data and nationwide register data.ResultsThe analysis shows a fair-to-moderate overlap between occupational-based mechanical exposures and the individually reported exposures. Construct validity of the Occupational Mechanical Job Exposure Index, as estimated by a confirmatory factor analysis using the occupational-based mechanical exposures, showed that the 8 exposures formed one underlying factor. When assessing the concurrent value of the Occupational Mechanical Job Exposure Index to the index based on the individual reported exposures, the occupational mechanical index showed lower and reproducible associations with lower back pain for both men and women. For long-term sick leave, the occupational mechanical index showed higher and reproducible associations for both genders. As for predictive validity, the register data analysis shows that the occupational mechanical index was associated with disability and a higher number of long-term sickness benefits periods for both men and women. For men the index also predicted higher mortality.ConclusionOur tests of reliability and validity of the Occupational Mechanical Job Exposure Index indicate that the index overall has acceptable statistical properties and will be useful in analyses of Norwegian register data where individual information on these types of exposures is missing.

Relationship between Precarious Employment and Unmet Dental Care Needs among Korean Workers: A Longitudinal Panel Study.

Background and Objectives: Precarious workers experience certain conditions, such as low income, instability in employment, and lack of social security. Precarious employment has increased barriers to the use of dental care services, resulting in more unmet dental care needs. The aim of this study was to identify unmet dental care needs among precarious workers in Korea's labor market, using data from the Korea Health Panel Survey (2011-2017). Materials and Methods: Based on job and income security criteria, four groups were formed: Group A (individuals with job and income security), Group B (individuals reporting job security with income insecurity), Group C (individuals reporting job insecurity with income security), and Group D (individuals with job and income insecurity). We measured self-reported unmet dental need or the inability to receive necessary dental care owing to the past economic burdens. Panel logistic regression analyses were performed to determine the effect of precarious employment on unmet dental care needs for all participants. Results: Approximately 16% of the respondents reported having unmet dental care needs. Unmet dental care needs owing to economic reasons were higher among male workers in groups C and D than among male workers in Group A. In particular, male workers aged 50 years and above in Group B were 3.36 times more likely to have unmet dental care needs than those in Group A. In Group D, female workers showed a high probability of having dental care needs owing to economic reasons. Moreover, female workers aged 18-49 years witnessed an increase in unmet dental care needs. Conclusions: Korean workers with unstable employment and/or income are at a higher risk of having unmet dental care needs owing to financial factors. The findings suggest an urgent need to implement robust national health insurance policies to improve efforts aimed at reducing unmet dental care needs that potentially decreases the disparity in oral health among precariously employed workers. Furthermore, it is necessary to implement comprehensive labor market policies such as sickness benefits for those in precarious employment.

The paid sick leave and sickness benefits for universal health coverage: a scoping review

Abstract Background The countries with paid sick leave (PSL) and sickness benefits (SB) mostly provide the benefit coverage to specific categories of workers, which results in health inequalities among employees in COVID-19. The PSL and SB are key factors to achieve universal health coverage (UHC) in that they protect access to healthcare and improve population health. This study attempted to investigate whether the policies helped achieve the UHC when they were expanded. Methods This review followed the scoping review protocol of PRISMA-ScR. On April 6, 2021, we extracted the literature using the keywords ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ from PubMed and Web of Science and added two studies through hand-search. All articles were written in English. We did not limit the publication date. Results Forty-four selected studies were based in four single countries and the European Union. Most of the studies were published after 2010 (84.1%) and were conducted as cross-sectional (72.7%) studies. Not only workers who use PSL and SB but also children whose parents use PSL and SB increased their use of healthcare services and getting flu shots. Also, using PSL and SB decreased their unmet healthcare needs and emergency use. The various health status factors, such as infectious disease incidence, mortality, and presenteeism, also decreased. Conclusions The provisions of PSL and SB offer individual and public health benefits by allowing employees and their families to use healthcare services. Group of employees, we can expect similar public health impacts on newly covered groups, thus contributing to achieving the UHC. Since more than 90% of articles are published from the United States, future studies need to evaluate the outcomes of health effects in various European or Asian countries. Key messages • The provision of PSL and SB positively affects employees and their families by allowing them to use healthcare services. • The expansion of PSL and SB contributes to the UHC by guaranteeing indirect medical costs that enable universal access to essential healthcare services.

Paid Sick Leave and Sickness Benefits for employees’ economic and job security: A Scoping Review

Abstract In health emergencies, such as in the COVID-19 pandemic, the need to expand or introduce the Paid sick leave(PSL) and Sickness benefits(SB) increases. They are key components of the universal health coverage(UHC) and active labor market policies(ALMPs) that enable workers to take care of their health and guarantee return-to-work after recovery. This study examines effects those policies in achieving economic stability and job security of covered workers through a scoping review. Studies were selected using the search terms ‘paid sick leave', ‘sickness benefits', ‘paid sick day', and ‘earned sick leave’ in PubMed and Web of Science. Our search conducted on 6th April 2021 yielded 1,030 articles, of which 22 articles were included in the review. All articles were analyzed by the 4 sub-groups(employees, families, employers, and government) and we investigated indicators of socio-economic impacts on their lives. Articles are largely PSL(90.9%)-focused. PSL guarantees not only workers’ job security by securing employment agreement, but also their income security by promising part of wages enough to afford healthcare and living expenses during the medical treatment and recovery. Additionally, PSL attenuates employers’ financial risk, as it reduces presenteeism while increasing the return-to-work rate. Moreover, PSL and SB reduce the total healthcare and social security expenditures of the government. To sum up, PSL and SB guarantee health and labor rights by ensuring income and job security to employees while assuring financial stability to both employers, and the government. However, as the previous studies paid less attention on the equity of these impacts at the system levels, future research should more focus on the dimension. Key messages • PSL and SB guarantee health and labour rights by ensuring income and job security for employees, while assuring financial stability for both employers and the government. • The previous studies that examined the effects of PSL and SB paid less attention on the equity of ensuring income and employment security, therefore future studies should focus more on this dimension.

A Sick Benefit Scheme Reduces Unmet Healthcare Needs: An Natural Experiment in Seoul

Abstract South Korea experiences four times more unmet healthcare needs than OECD countries (11.6% and 2.6% respectively). Unmet healthcare needs are caused by the double burden of direct and indirect costs including income loss, and OECD countries operate a sickness benefit scheme to resolve sudden loss of pay. Seoul introduced the first sickness benefit system, Seoul-Type Paid Sick Leave Support (hereinafter Seoul Sick Leave), for self-employed national healthcare insurance subscribers to reduce the rate of unmet healthcare needs. By comparing the amount of increasing medical expenses between the beneficiary and non-beneficiary before (2018) and after (2019-2020) the introduction of the system, the study was intended to confirm the reduced unmet healthcare needs. This study used data from the National Health Information Database (NHID) and the difference in differences (DID) analytic framework. 96 and 121 patients were included in benefit and non-benefit cohorts, respectively. As a result, the beneficiary group’s expenses were smaller than those of the non-beneficiary group (coef.=-1.24, p = 0.026). However, the beneficiary group had a greater amount of increase in hospitalization expenses before and after the introduction than the non-beneficiary group did (coef.=1.66, p = 0.005). Our finding showed that the Seoul Sick Leave helped the precarious workers as they were able to use inpatient services when they needed. If it is to be scaled up to the national level, it should be applied all people to enhance universal health insurance in Korea. Key messages • Identified the effectiveness of the first sickness benefit system as it helped the precarious workers as they were able to use inpatient services when they needed. • By financially supporting them, the Seoul Sick Leave support can achieve health promotion through early detection and treatment.

Healthcare utilization among aging Latvians with diminished activities of daily living

Abstract The population in Latvia is aging. Independence in performing activities of daily living (ADL) is a core aspect of functioning, and the elderly frequently experience limitations in functioning. Little is known about the utilization of healthcare of elderly Latvians with functional difficulties. The purpose of this study was to determine the relationship between functional difficulties and utilization of healthcare among the elderly in Latvia. This study had three overall objectives: (i) to investigate the determinants of utilization of health care for elderly Latvians with functional difficulties; (ii) examine the relationship between predisposing characteristics, enabling resources, and need with specific measures of access to care using the Behavioral Model for Vulnerable Populations and to (iii) identify the nature and existence of health disparities among the elderly in Latvia, with and without functional difficulties. Data from the 2017 Survey of Health, Ageing and Retirement in Europe (SHARE) survey, with a sample size of 1479 was utilized. There was a statistically significant difference in the utilization of healthcare between individuals with and without functional disabilities (F(4,1) =759.615, p < 0.01), with a higher utilization of healthcare among individuals with functional difficulties (p< .01). The results of Automatic Linear Modeling indicate that significant (p < 0.05) factors in predicting utilization of healthcare include factors such as age, public sickness benefit and disability pension, and overall health status. This study is significant because it fills critical gaps in knowledge that exist with respect to healthcare utilization for elderly Latvians with functional disabilities. Key messages • This study contributes to our understanding of healthcare utilization of aging Latvians. • This study provides insight into the functional limitations of the aging Latvian population.

Integrated mental health care and vocational rehabilitation intervention to improve return to work rates for people on sick leave due to common mental and functional disorders (IBBIS-II)—a study protocol for a randomized clinical trial

BackgroundMental illness has an estimated financial burden on the Danish economy of 3.4% of the gross national product every year due to lost productivity, social benefits, and healthcare costs, and approximately 50% of people receiving long-term sickness benefits have a common mental illness. Furthermore, a significant treatment gap exists where less than 30% are treated for their mental illness. The primary objective of the randomized trial is to examine whether people on sick leave with a diagnosis of anxiety, depression, stress, personality disorders, or functional disorders return to work faster and have higher job retention if they receive an integrated and optimized vocational rehabilitation and mental health care intervention, compared to people who receive the standard mental health care and vocational rehabilitation service.MethodsThe trial is designed as an investigator-initiated, randomized, two-group parallel, assessor-blinded, superior trial. A total of 900 participants with a common mental illness will randomly be assigned into two groups: (1) IBBIS-II, consisting of integrated mental health care and vocational rehabilitation, or (2) service as usual (SAU), at two sites in Denmark. The primary outcome is the difference between the two groups in time to return to work (RTW) at 12 months using data from the Danish Register for Evaluation of Marginalization (DREAM) database.DiscussionThis study will contribute with new knowledge on vocational recovery and integrated vocational and health care interventions in a Scandinavian context.Trial registrationClinicalTrials.govNCT04432129. Registered on June 16, 2020

Assessing sick-listed clients’ work ability: A moral mission?

Judging the extent to which sick-listed clients’ disabilities qualify them for sickness benefits is increasingly part of frontline work. However, we lack knowledge about the discretional process of assessing work ability. Institutional ethnographic research of caseworkers in the Norwegian Labour and Welfare Administration revealed that they emphasised clients’ residual work ability – meaning what clients could perform despite their medical diagnoses – as well as their inner motivations and work ethic. We argue that frontline praxis is influenced by efforts to fit clients into a category of the deserving ‘sick-listed yet work-capable client’. Because caseworkers lack guidelines to combine health and work, they increasingly apply their ‘moral selves’ in the assessment process resulting in scepticism towards clients’ feigning, or exaggerating symptoms to obtain financial benefits or avoid work. We question whether our findings represent a shift of the Norwegian universalistic welfare model to a more liberal and incentive-strengthening type.

Treatment Patterns and Healthcare Resource Utilization Among Patients with Atopic Dermatitis: A Retrospective Cohort Study Using German Health Claims Data.

IntroductionAtopic dermatitis (AD) is a common inflammatory skin disease. Many patients are initiating a systemic therapy, if the disease is not adequately controlled with topical treatment only. Currently, there is little real-world evidence on the AD-related medical care situation in Germany. This study analyzed patient characteristics, treatment patterns, healthcare resource utilization and costs associated with systemically treated AD for the German healthcare system.MethodsIn this descriptive, retrospective cohort study, aggregated anonymized German health claims data from the InGef research database were used. Within a representative sample of four million insured individuals, patients with AD and systemic drug therapy initiation (SDTI) in the index year 2017 were identified and included into the study cohort. Systemic drug therapy included dupilumab, systemic corticosteroids (SCS) and systemic immunosuppressants (SIS). Patients were observed for one year starting from the date of SDTI in 2017.Results9975 patients were included (57.8% female, mean age 39.6 years [SD 25.5]). In the one-year observation period, the most common systemic drug therapy was SCS (> 99.0%). Administrations of dupilumab (0.3%) or dispensations of SIS were rare (cyclosporine: 0.5%, azathioprine: 0.6%, methotrexate: 0.1%). Median treatment duration of SCS, cyclosporine and azathioprine was 27 days, 102 days, and 109 days, respectively. 2.8% of the patients received phototherapy; 41.6% used topical corticosteroids and/or topical calcineurin inhibitor. Average annual costs for medications amounted to € 1237 per patient. Outpatient services were used by 99.6% with associated mean annual costs of € 943; 25.4% had at least one hospitalization (mean annual costs: € 5836). 5.3% of adult patients received sickness benefits with associated mean annual costs of € 5026.ConclusionsDespite unfavorable risk–benefit profile, this study demonstrated a common treatment with SCS, whereas other systemic drug therapy options were rarely used. Furthermore, the results suggest a substantial economic burden for patients with AD and SDTI.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00773-3.

Koordynatsiia system sotsialnoho zabezpechennia u sferi sotsialnoho strakhuvannia v yevropeiskomu soiuzi: instytutsiino-pravovi zasady

The article analyses the content and institutional and legal framework for the coordination of social welfare systems in the European Union. Analysing documents in particular, EU Acts and Regulations, as well as taking into account modern scientific research, the material substantiates the existence of a separate area of scientific and practical activities in the European Union, namely, social welfare. It is specified that «social welfare» as a theoretical construct and direction of public policy should be considered within the concept of «social security». In a narrower context, social security can be interpreted as a basic social standard, which in most cases is implemented through social insurance. The social welfare coordination system in the European Union is quite complex and undergoing constant change. The need for modernization in view of changes in working conditions in the modern world has been updated in the period of the coronavirus pandemic. According to European Union regulations, the main areas of social welfare in the EU cover payments in connection in specific situations. Such situations are included: sickness benefits, maternity and paternity benefits, invalidity benefits, old-age benefits, survivors’ benefits, benefits related to accidents at work and occupational diseases, and benefits in connection with death, unemployment benefits, pre-retirement benefits and family benefits. The article identifies the basic principles of coordination of social welfare systems in the European Union. Among others, the most important of these is equal treatment of all people; free movement of people; unity of legislation applicable in this field in different countries; the provision that rights acquired in one country are retained in another; and the idea that insurance periods acquired in other countries summed up. In addition, the material offers a comprehensive analysis of all major EU legal acts coordinating social security systems at national levels.

Use of sickness benefits by patients with metastatic breast cancer-A Swedish cohort study.

ObjectiveThe objective of this study is to determine the prevalence and predictors of sickness absence (SA) and disability pension (DP) in women with metastatic breast cancer (mBC).MethodsData were obtained from Swedish registers concerning 1,240 adult women diagnosed 1997–2011 with mBC, from 1 year before (y−1) to 2 (y1) and 2 (y2) years after diagnosis. SA and DP prevalence was calculated. Odds ratios (AOR) were determined for factors associated with using long‐term (SA > 180 days or DP > 0 days) sickness benefits.ResultsPrevalence of SA and DP was 56.0% and 24.8% during y−1, 69.9% and 28.9% during y1, and 64.0% and 34.7% during y2, respectively. Odds of using long‐term sickness benefits were higher y1 and y2 in patients using long‐term sickness benefits the year before diagnosis (AOR = 3.82, 95% CI 2.91–5.02; AOR = 4.31, 95% CI 2.96–6.29, respectively) and y2 in patients with mBC diagnosis 1997–2000 (AOR = 1.84, 95% CI 1.10–3.08) and using long‐term sickness benefits the year after diagnosis (AOR = 22.10, 95% CI 14.33–34.22).ConclusionsThe prevalence of sickness benefit utilisation was high and increased after mBC diagnosis, particularly for patients using long‐term sickness benefits prior to diagnosis. Additional study is needed to determine factors that might reduce the need for sickness benefits and enhance work ability in these patients.

The working conditions for personal support workers in the Greater Toronto Area during the COVID-19 pandemic: a mixed-methods study.

ObjectiveDuring the height of the COVID-19 pandemic, personal support workers (PSWs) were heralded as healthcare ‘heroes’ as many of them cared for high-risk, vulnerable older populations, and worked in long-term care, which experienced a high number of COVID-19 outbreaks and deaths. While essential to the healthcare workforce, there is little understanding of PSW working conditions during the pandemic. The aim of our study was to examine the working conditions (including job security, work policies, and personal experiences) for PSWs in the Greater Toronto Area during the COVID-19 pandemic from the perspectives of PSWs.MethodsThis study used a mixed-methods design. From June to December 2020, we conducted a survey of 634 PSWs to understand their working conditions during the COVID-19 pandemic. Semi-structured interviews with 31 survey respondents were conducted from February to May 2021 to understand in greater depth how working conditions were impacting the well-being of PSWs.ResultsWe found PSWs faced a range of challenges related to COVID-19, including anxiety about contracting COVID-19, reduced work hours, taking leaves of absences, concerns about job security, and losing childcare. While the COVID-19 pandemic highlighted the PSW workforce and their importance to the healthcare system (especially in the long-term care system), pre-existing poor work conditions of insecure jobs with no paid sick days and benefits exacerbated COVID-19–related challenges. Despite these hardships, PSWs were able to rely on their mental resilience and passion for their profession to cope with challenges.ConclusionSignificant changes need to be made to improve PSW working conditions. Better compensation, increased job security, decreased workload burden, and mental health supports are needed.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-022-00643-7.