Status Of Care Workers Research Articles

Risk of venous thrombotic events and thrombocytopenia in sequential time periods after ChAdOx1 and BNT162b2 COVID-19 vaccines: A national cohort study in England.

SummaryBackgroundThrombosis with thrombocytopenia, or thrombocytopenia on its own, have been reported after Covid-19 vaccines. We assessed the risk after ChAdOx1 adenovirus-vector and BNT162b2 mRNA vaccines in a national cohort study in England.MethodsHospital admissions for a cerebral venous thrombosis (CVT), other venous thrombosis or thrombocytopenia between 30th November 2020 and 18th April 2021 were linked to the national Covid-19 immunisation register. The incidence of events by dose in pre-defined post-vaccination risk periods relative to the unvaccinated cohort was estimated after adjustment for age, gender, co-morbidities, care home residency and health/social care worker status. Elevated relative incidence (RI) estimates with p<0.001 were considered strong evidence of an association.FindingsThe RI for CVT after a first ChAdOx1 dose in 15-39 and 40-64 year olds was 8.7 (95% confidence interval 5.8-13.0) and 2.2 (1.4-3.2) respectively, p<0.001. The elevated risk period in 15-39 year olds was highest 4-13 days post-vaccination (16.3, 9.9-27.0). The attributable risk (AR) was 16.1 per million doses for 15-39 and 3.2 per million for 40-64 year olds. RIs for other thrombosis admissions were elevated in these age groups with ARs of 36.3 and 16.4 per million respectively as were RIs for thrombocytopenia, with ARs of 11.3 and 10.1 per million respectively. No elevated RIs were found for 65+ year olds or after a second ChAdOx1 dose, nor for BNT162b2 vaccine recipients of any age.InterpretationThis epidemiological study shows an increased risk of thrombotic episodes and thrombocytopenia in adults under 65 years of age within a month of a first dose of ChAdOx1 vaccine but not after the BNT162b2 vaccine.FundingEM receives support from the National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine in partnership with Public Health England (Grant Reference NIHR200929).

Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

Insiders and outsiders: policy and care workers in Taiwan's long-term care system

ABSTRACTAs in many developed countries, foreign care-givers have made up a short-term labour force to help shoulder the responsibilities of older adult care in Taiwan since 1992. This study uses the dual labour market and the occupational segregation theoretical frameworks and a mixed-method approach to examine whether foreign care-givers are supplementary or have replaced Taiwanese care-givers in Taiwan's long-term care (LTC) industry, and to understand better the status of care workers and their influx into the secondary labour market. As of 2012, 189,373 foreign workers joined the care services, compared to 7,079 Taiwanese, indicating they are no longer supplementary. The gap between the dual care system and workforce regulation has resulted in occupation segregation, and the secondary care labour market has been divided into ‘institutional’ and ‘home’ spheres, segregating care-givers into three levels: all Taiwanese care-givers, foreign institutional care-givers, and foreign home care-givers, the latter being the cheapest, most obedient and most adaptable LTC products. This case exhibits the ‘particularistic’ associations between nationality and care-givers’ workplace, which should be abolished. Only by squarely facing the changes and impacts caused by importing workers into the secondary labour market can one propose concrete, effective LTC labour plans and retention policies.

SY15-4 * PRESCRIPTION OPIOIDS IN SOUTHERN EUROPE: FRANCE

Background. Prescription opioid misuse in an increasing public health in many countries. The objective is to assess the prevalence of prescription opioid misuse in four European countries. Data from France are presented. Methods. Cross-sectional study. The rates of prescription drug misuse have been assessed using patient self-report at treatment program intake. Patients have been asked to self-report the use of use and injection history for European-market prescription opioids, prescription stimulants, and heroin, during the past 30-day. Also, basic demographic information, treatment history, and health care worker status have been recorded. Results. In France, a final sample of 144 subjects (77% males; 38,9years old) was recruited. The were 62,5% in treatment for heroin dependence; the rest (7) has as a main drug buprenorphine, codeine, methadone, morphine, fentanyl and tramadol. The main opioid abused drug during the last month was heroin, followed by buprenorphine, codeine, methadone and morphine. Those previously in treatment endorsed significantly less drugs, and less past 30-day use of buprenorphine. Buprenorphine is the preferred first line medication for French opioid rehabilitation patients. Conclusions. Preliminary data show that besides heroin, there is a concomitant abuse of prescription opioids. The knowledge of drug use patterns can provide useful information to develop effective prevention and treatment.

SY15-3 * PRESCRIPTION OPIOIDS IN SOUTHERN EUROPE: SPAIN

Background. Prescription opioid misuse in an increasing public health in many countries. The objective is to assess the prevalence of prescription opioid misuse in four European countries: France, Germany, Italy and Spain. Data form Sapin are presented Methods. Cross-sectional study. The rates of prescription drug misuse have been assessed using patient self-report at treatment program intake. Patients have been asked to self-report the use of use and injection history for European-market prescription opioids, prescription stimulants, and heroin, during the past 30-day. Also, basic demographic information, treatment history, and health care worker status have been recorded. Results. In Spain, a final sample of 125 subjects (78% males; 39 + 10 years old) was recruited. The 94% were in treatment for heroin dependence; the rest (7) has as a main drug methadone, tramadol, codeine, pethidine and opium. The main opioid abused drug during the last month was heroin (63%), followed by methadone, tramadol, codeine, pethidine, fentanyl, buprenorphine, morphine and metylphenidate. Conclusions. Preliminary data show that besides heroin, in Spain, there is a concomitant abuse of prescription opioids. The knowledge of drug use patterns can provide useful information to develop effective prevention and treatment.

Hierarchization and Segmentation of Informal Care Markets in Slovenia

The article is the result of qualitative research of informal care markets in Slovenia in the field of childcare, elder care, and cleaning. The author assesses Slovenia's position in the “global care chain” and finds that “local care chains” prevail in the field of childcare and elder care, while a co-occurrence of female gender, “other” ethnicity, and poverty is typical in the field of household cleaning. The main emphasis of the article is on the analysis of hierarchization of the informal market of care work according to following two criteria: social reputation of individual type of care work and citizenship status of care workers.

Forced to care: coercion and caregiving in America

The United States faces a growing crisis in care. The number of people needing care is growing while the ranks of traditional caregivers have shrunk. The status of care workers is a critical concern. Evelyn Nakano Glenn offers an innovative interpretation of care labor in the United States by tracing the roots of inequity along two interconnected strands: unpaid caring within the family; and slavery, indenture, and other forms of coerced labor. By bringing both into the same analytic framework, she provides a convincing explanation of the devaluation of care work and the exclusion of both unpaid and paid care workers from critical rights such as minimum wage, retirement benefits, and workers' compensation. Glenn reveals how assumptions about gender, family, home, civilization, and citizenship have shaped the development of care labor and been incorporated into law and social policies. She exposes the underlying systems of control that have resulted in women - especially immigrants and women of color - performing a disproportionate share of caring labor. Finally, she examines strategies for improving the situation of unpaid family caregivers and paid home healthcare workers. This important and timely book illuminates the source of contradictions between American beliefs about the value and importance of caring in a good society and the exploitation and devalued status of those who actually do the caring.

Tuberculosis among urban health care workers: a study using restriction fragment length polymorphism typing.

Cases of tuberculosis identified during 1992-1994 through an active tuberculosis surveillance network among six hospitals that serve New York City (the TBNetwork) were analyzed according to the occupational status of the patients. Clinical data were obtained by review of medical records, and restriction fragment length polymorphism (RFLP) typing of Mycobacterium tuberculosis isolates was performed. No known nosocomial outbreaks of tuberculosis occurred at these hospitals in the study period. Occupational status was known for 142 of 201 patients whose isolates were available for strain typing. Patients infected by organisms with a clustered strain typing pattern, as determined by RFLP analysis, were presumed to have recently acquired disease. RFLP typing revealed that isolates from 13 (65%) of 20 health care workers and 50 (41%) of 122 non-health care workers had a clustered RFLP pattern. The strains infecting eight (89%) of nine health care workers seropositive for human immunodeficiency virus (HIV) had a clustered RFLP pattern. Multivariate analysis of 75 patients with known HIV and occupational status revealed that HIV status (P = .03) and health care worker status (P = .02; RR = 2.77) were independent risk factors for a clustered RFLP strain. These findings suggest that many of the apparently sporadic cases of tuberculosis among health care workers may be due to unrecognized occupational transmission.