Unemployment In Patients Research Articles

Level and Determinants of Physical Activity in Chronic Hemodialysis Patients at the Donka National Hemodialysis Center

Introduction: Regular physical activity plays a protective role over the cardiovascular system and also against cardiovascular risk factors, and improves the prognosis of patients. The aim of this study was to assess the overall level of physical activity in chronic hemodialysis patients and the factors associated with low levels of activity. Research subjects and methods: A four-month long cross-sectional descriptive and analytical study was performed on chronic hemodialysis patients of all ages, regardless of sex, who agreed to take part in the study. There were both quantitative and qualitative variables in this study, and the Baecke questionnaire was used. Results: Out of 237 hemodialysis patients, 211 were included in our study, i.e., a frequency of 89.02%. The work activity index was low in 91% of cases, the sports activity index was low in 19 out of 20 patients, and the leisure activity index was low in 63% of patients. Meanwhile, the overall physical activity level was low in 76.8% of patients. In our study, low physical activity was significantly correlated with the gender of patients, unemployment of patients since starting dialysis, diabetic nephropathy, diabetes, obesity, dilated cardiomyopathy, a sedentary lifestyle, or interdialytic weight gain ≥ 3kg. Conclusion: The assessment of patients’ physical activity should be integrated into hospital practices for better management of chronic hemodialysis patients.

Association of Unmet Social Needs With Level of Capability in People With Persistent Knee Pain.

Musculoskeletal providers are increasingly recognizing the importance of social factors and their association with health outcomes as they aim to develop more comprehensive models of care delivery. Such factors may account for some of the unexplained variation between pathophysiology and level of pain intensity and incapability experienced by people with common conditions, such as persistent nontraumatic knee pain secondary to osteoarthritis (OA). Although the association of one's social position (for example, income, employment, or education) with levels of pain and capability are often assessed in OA research, the relationship between aspects of social context (or unmet social needs) and such symptomatic and functional outcomes in persistent knee pain are less clear. (1) Are unmet social needs associated with the level of capability in patients experiencing persistently painful nontraumatic knee conditions, accounting for sociodemographic factors? (2) Do unmet health-related social needs correlate with self-reported quality of life? We performed a prospective, cross-sectional study between January 2021 and August 2021 at a university academic medical center providing comprehensive care for patients with persistent lower extremity joint pain secondary to nontraumatic conditions such as age-related knee OA. A final 125 patients were included (mean age 62 ± 10 years, 65% [81 of 125] women, 47% [59 of 125] identifying as White race, 36% [45 of 125] as Hispanic or Latino, and 48% [60 of 125] with safety-net insurance or Medicaid). We measured patient-reported outcomes of knee capability (Knee injury and Osteoarthritis Outcome Score for Joint Replacement), quality of life (Patient-Reported Outcome Measure Information System [PROMIS] Global Physical Health and PROMIS Global Mental Health), and unmet social needs (Accountable Health Communities Health-Related Social Needs Survey, accounting for insufficiencies related to housing, food, transportation, utilities, and interpersonal violence), as well as demographic factors. After controlling for demographic factors such as insurance status, education attained, and household income, we found that reduced knee-specific capability was moderately associated with experiencing unmet social needs (including food insecurity, housing instability, transportation needs, utility needs, or interpersonal safety) (standardized beta regression coefficient [β] = -4.8 [95% confidence interval -7.9 to -1.7]; p = 0.002 and substantially associated with unemployment (β = -13 [95% CI -23 to -3.8]; p = 0.006); better knee-specific capability was substantially associated with having Medicare insurance (β = 12 [95% CI 0.78 to 23]; p = 0.04). After accounting for factors such as insurance status, education attained, and household income, we found that older age was associated with better general mental health (β = 0.20 [95% CI 0.0031 to 0.39]; p = 0.047) and with better physical health (β = 0.004 [95% CI 0.0001 to 0.008]; p = 0.04), but effect sizes were small to negligible, respectively. There is an association of unmet social needs with level of capability and unemployment in patients with persistent nontraumatic knee pain. This finding signals a need for comprehensive care delivery for patients with persistent knee pain that screens for and responds to potentially modifiable social risk factors, including those based on one's social circumstances and context, to achieve better outcomes. Level II, prognostic study.

Poor Sleep Quality and Other Risk Factors for Unemployment Among Patients on Opioid Agonist Treatment

Purpose:Patients with opioid use disorder (OUD) face high rates of unemployment, putting them at higher risk of treatment nonadherence and poor outcomes, including overdose death. The objective of this study was to investigate sleep quality and its association with other biopsychosocial risk factors for unemployment in patients receiving opioid agonist treatment (OAT) for OUD.Methods:Using a cross-sectional survey design, participants from 3 OAT programs for OUD completed questionnaires to measure sleep quality (Pittsburgh Sleep Quality Index [PSQI]); pain disability; catastrophic thinking; injustice experience; quality of life; and self-assessed disability. Spearman’s rank correlation was used to test for associations between sleep quality and other study variables.Results:Thirty-eight participants completed the study, with mean age 45.6 ± 10.9 years, 27 (71.1%) males, and 16 (42.1%) reporting a high school diploma/equivalent certification as the highest level of academic attainment. Poor sleep quality (defined as PSQI > 5) was identified in 29 participants (76.3%) and was positively correlated with pain disability (r = 0.657, P < .01), self-assessed disability (r = 0.640, P < .001), symptom catastrophizing (r = 0.499, P < .001), and injustice experience (r = 0.642, P < .001), and negatively correlated with quality of life (r = −0.623, P < .001).Conclusions:There was a high prevalence of poor sleep quality in patients with OUD on OAT and this was associated with multiple known risk factors for unemployment. These findings warrant the consideration of regular screening for sleep problems and the inclusion of sleep-related interventions to improve sleep quality, decrease the unemployment rate, and enhance the recovery process for individuals with OUD undergoing OAT.

Changes in Work Ability after Weight-Loss Surgery: Results of a Longitudinal Study of Persons with Morbid Obesity before and after Bariatric Surgery

Introduction: Bariatric surgery is a life-changing treatment, but knowledge of its influence on changes in work ability is still limited. We hypothesized that self-reported work ability improves in response to surgery-induced weight loss and sociodemographical variables (e.g., age, sex, and marital status), and that psychosocial characteristics (e.g., depressive symptoms and dysfunctional eating) may have predictive value as to patients’ work ability. Methods: A total of 200 participants scheduled for bariatric surgery were recruited between September 2015 and June 2018. They completed several self-report measures at the preoperative examination (t1) and at 6- (t2) and 12 months (t3) after bariatric surgery. A repeated-measures analysis of variance was calculated to detect any changes in the work ability and body mass index (BMI) among the 3 time points. Further, a hierarchical multiple regression analysis was used to determine whether any demographical and psychosocial characteristics at (t1) would predict work ability at (t3). Results: Participants (82% of whom were women) were middle-aged and showed a BMI of nearly 46 at the preoperative medical examination. Excess weight loss at (t2) and at (t3) was 49 and 66%, respectively. Work ability increased toward a moderate level after weight-loss surgery. Work ability and dysfunctional eating at (t1) showed significant predictive value with respect to work ability at (t3). Discussion: The results suggest that weight-loss surgery has a positive impact on work ability, and indicate a predictive value for the extent of weight loss and dysfunctional eating behavior. Against our hypothesis and in contrast to former research, a predictive value for depressive symptoms and age was not revealed. Further research must show how interventions can support and maintain improvements in work ability after bariatric surgery, in order to reduce sick leave and unemployment in patients with preoperative morbid obesity.

Importance of detecting clinical and cognitive variables to mitigate unemployment in patients with Multiple Sclerosis in Argentina (4173)

Importance of detecting clinical and cognitive variables to mitigate unemployment in patients with Multiple Sclerosis in Argentina (4173)

Environmental Characteristics of HIV/AIDS Affected Households in a Nigerian Rural Community.

A study of environmental attributes of HIV/AIDS affected households in Ijesa region, Nigeria (N = 297). Data from both primary and secondary sources were used to establish the relationship between socio-economic and environmental characteristics at different rural community zones; namely traditional core, post traditional and contemporary. There were more female HIV/AIDS patients, located in traditional core zones (78.1%) with high house density, living in shared apartments where residents shared sleeping and bath/toilet rooms. Thus, rape was significantly associated with the design and habitation density of households. In addition, widowhood, young age, informal education, menial jobs and unemployment of patients did not correlate with most environmental variables related to HIV/AIDS in contemporary zone compared with traditional zone. However, wealth status and quality education in relation to good housing environment and decent house density were significant in contemporary zone respectively. The study concluded that policies on HIV/AIDS prevalence at rural community level should focus more on high density areas having poor socio-economic and environmental characteristics.

S223. DETERMINANTS OF SUSTAINED UNEMPLOYMENT IN FORMERLY EMPLOYED SCHIZOPHRENIA PATIENTS

BackgroundVocational drift, or the suggestion that severe mental illness leads to reductions in occupational attainment, has been repeatedly observed in schizophrenia. Neurocognition, social functioning, education, environment, and previous work experience have been implicated in patients’ ability to acquire and maintain a job. Interestingly, some patients with successful prior work histories can develop chronic unemployment. In this study, we analyzed a sample of schizophrenic individuals with varying histories of obtaining and sustaining employment to examine vocational drift through the lens of vocational deterioration. We hypothesized that 1) social cognitive variables would be more impaired in patients with a long duration of unemployment and 2) neurocognitive deficits would be more prominent in patients who were never employed.Methods396 patients between 18 and 70 years old with a diagnosis of Schizophrenia, Schizoaffective Disorder, or First Episode Spectrum Disorder were included in this analysis. Measures included comprehensive clinical, neurocognitive, social cognitive, and functional assessments. Samples were divided into groups based on their employment history.Although our original sample included currently employed patients, the following groups were examined as a function of vocational drift: a) Never (n=150), individuals who have never had a job and b) Formerly employed (n=138), individuals who had a job for at least two years in the past but are currently unemployed. Among unemployed patients, we identified those with Short (less than 2 years; n=65), Intermediate (2 to 5 years; n=87), and Extended (more than 5 years; n=136) unemployment.ResultsIn the overall comparison of Formerly employed patients, those with Short and Intermediate duration of unemployment did not differ from each other on any variables and performed better than Extended duration unemployment patients on measures of premorbid intelligence (WRAT, p<.01), processing speed (Symbol coding, p<.01), emotion recognition (BLERT, p<.01 and ER-40, p<.01), theory of mind (Hinting test, p<.05) and hostile cognitive bias (AIHQ Blame, p<.01). Interestingly, patients with Extended unemployment had less depression (BDI total, p<.01) compared to patients who Never worked. The Extended unemployment patients performed worse than the Never employed patients on premorbid intelligence (WRAT, p<.01), processing speed (Symbol coding, p<.05), emotion recognition (BLERT, p<.01 and ER-40, p<.01), theory of mind (Hinting test, p<.05), social inference (TASIT, p<.01), hostile cognitive bias (AIHQ Blame, p<.01), and had higher clinical ratings on PANSS Blunted affect (P<.01) and Poor Rapport (p<.01).DiscussionThe development of long-term unemployment in patients with schizophrenia is associated with multiple neurocognitive and social cognitive deficits, particularly when compared to patients who have never been employed. These deficits were also notable when compared to patients with a shorter duration of unemployment. It is not possible to determine if these long-term unemployed patients always exhibited these deficits, suggesting additional support for vocational drift among patients with schizophrenia. The possible deterioration in neurocognitive and social cognitive performance over time may be driving the development of long-term unemployment in previously employed patients, who in many ways, underperformed compared to patients who had never worked.

Impact of Out-of-Pocket Costs, Lost Wages, and Unemployment in Patients With Breast Cancer Undergoing Breast Surgery

Impact of Out-of-Pocket Costs, Lost Wages, and Unemployment in Patients With Breast Cancer Undergoing Breast Surgery

Relationship Between Opioid Analgesic Prescription and Unemployment in Patients Seeking Acupuncture for Chronic Pain in Urban Primary Care.

The widespread use of opioid analgesics to treat chronic nonmalignant pain has contributed to the ongoing epidemic of opioid-related morbidity and mortality. Previous studies have also demonstrated a relationship between opioid analgesic use and unemployment due to disability. These studies have been limited to mainly white European and North American populations. The objective of this study is to explore the relationship between opioid analgesic use for chronic nonmalignant pain in an urban, mainly black and Hispanic, low-income population. This is a cross-sectional observational study. Subjects were recruited from six urban primary care health centers. Adults with chronic neck, back, or osteoarthritis pain participating in an acupuncture trial were included. Survey data were collected as a part of the Acupuncture Approaches to Decrease Disparities in Pain Treatment two-arm (AADDOPT-2) comparative effectiveness trial. Participants completed a baseline survey including employment status, opioid analgesic use, the Brief Pain Inventory, the global Patient Reported Outcomes Measurement Information Systems quality of life measure, the Patient Health Questionnaire-9 (PHQ-9), and demographic information. A multivariable logistic regression model was built to examine the association between opioid analgesic use and unemployment. Opioid analgesic use was associated with three times the odds of unemployment due to disability while controlling for potential confounders, including depression, pain severity, pain interference, global physical and mental functioning, and demographic characteristics. This study adds to the growing body of evidence that opioid analgesics should be used with caution in chronic nonmalignant pain.

Excess costs of alcohol-dependent patients in German psychiatric care compared with matched non-alcohol-dependent individuals from the general population: a secondary analysis of two datasets

ObjectivesHeavy alcohol use can cause somatic and mental diseases, affects patients’ social life and is associated with social isolation, unemployment and reduced quality of life. Therefore, societal costs of alcohol...

The influence of coping styles on long-term employment in multiple sclerosis: A prospective study

Background: The aim was to investigate predictive values of coping styles, clinical and demographic factors on time to unemployment in patients diagnosed with multiple sclerosis (MS) during 1998–2002 in Norway. Method: All patients (N = 108) diagnosed with MS 1998–2002 in Hordaland and Rogaland counties, Western Norway, were invited to participate in the long-term follow-up study in 2002. Baseline recordings included disability scoring (Expanded Disability Status Scale (EDSS)), fatigue (Fatigue Severity Scale (FSS)), depression (Beck Depression Inventory (BDI)), and questionnaire assessing coping (the Dispositional Coping Styles Scale (COPE)). Logistic regression analysis was used to identify factors associated with unemployed at baseline, and Cox regression analysis to identify factors at baseline associated with time to unemployment during follow-up. Results: In all, 41 (44%) were employed at baseline. After 13 years follow-up in 2015, mean disease duration of 22 years, 16 (17%) were still employed. Median time from baseline to unemployment was 6 years (±5). Older age at diagnosis, female gender, and depression were associated with patients being unemployed at baseline. Female gender, long disease duration, and denial as avoidant coping strategy at baseline predicted shorter time to unemployment. Conclusion: Avoidant coping style, female gender, and longer disease duration were associated with shorter time to unemployment. These factors should be considered when advising patients on MS and future employment.

Multiple Sclerosis, Cognitive Profile and Cognitive Testing: Predictability of SDMT and Computerized Cognitive Testing in Differentiating Employment versus Unemployment in Patients with Multiple Sclerosis (P5.207)

Multiple Sclerosis, Cognitive Profile and Cognitive Testing: Predictability of SDMT and Computerized Cognitive Testing in Differentiating Employment versus Unemployment in Patients with Multiple Sclerosis (P5.207)

Spotlight on the September 23 Issue

The authors found a 2–3 times higher risk of unemployment in patients who had a stroke between the ages of 18 and 50 years, compared to the general population. The risk for unemployment among stroke patients was highest in patients who had a stroke between 35 and 44 years of age. In poststroke care for young patients, attention should be given to the social consequences that they may encounter. See p. 1132 From editorialists Singhal & Lo: “Perhaps we need to start incorporating ‘return to work’ as a global outcome measure that assesses …

Long-term increased risk of unemployment after young stroke: a long-term follow-up study.

To investigate the prevalence, excess risk, and risk factors of unemployment in patients after a TIA, ischemic stroke, or intracerebral hemorrhage at ages 18 through 50 years, compared with nationwide controls. We performed a hospital-based cohort study among 694 patients, aged 18-50 years, with a first-ever TIA, ischemic stroke, or intracerebral hemorrhage. After a mean follow-up duration of 8.1 (SD 7.7) years, we used logistic regression analysis to calculate odds ratio (OR) with 95% confidence interval (CI) for being unemployed as a young stroke patient, compared with the Dutch population of vocational age (n = 7,803,000), with subsequent assessment of risk factors of unemployment. Young stroke patients had a higher risk of being unemployed than their peers in the Dutch population: women OR 2.3 (1.8-2.9), men OR 3.2 (2.5-4.0). A higher NIH Stroke Scale score at admission (OR 1.1 [95% CI 1.0-1.1]) and a longer follow-up duration (middle tertile OR 2.8 [95% CI 1.7-4.7], upper tertile OR 3.4 [95% CI 1.9-6.1]) were associated with a higher risk of being unemployed. Young stroke patients had a 2-3 times higher risk of unemployment after 8 years of follow-up. Return-to-work programs should be developed, adjusted, and evaluated in order to diminish the negative effects that unemployment can have on patients' life satisfaction and to limit the socioeconomic consequences.

Affiliation to the work market after curative treatment of head-and-neck cancer: A population-based study from the DAHANCA database

Objectives. Survivors of squamous cell carcinoma of the head and neck (HNSCC) are more severely affected in regard to affiliation to the work market than other cancer survivors. Few studies have investigated associations between socioeconomic and disease-related factors and work market affiliation after curative treatment of HNSCC. We investigated the factors for early retirement pension due to disability and unemployment in patients who had been available for work one year before diagnosis. Methods. In a nationwide, population-based cohort study, data on 2436 HNSCC patients treated curatively in 1992–2008 were obtained from the Danish Head and Neck Cancer Group database and linked to Danish administrative population-based registries to obtain demographic and socioeconomic variables. We used multivariate logistic regression models to assess associations between socioeconomic factors (education, income and cohabitating status), cancer-specific variables such as tumour site and stage, comorbidity, early retirement pension and unemployment, with adjustment for age, gender and year of diagnosis. Results. Short education [odds ratio (OR) 4.8; 95% confidence interval (CI) 2.2–10.4], low income (OR 3.2; 95% CI 1.8–5.8), living alone (OR 3.0; 95% CI 2.1–4.4) and having a Charlson comorbidity index score of 3 or more (OR 5.9; 95% CI 3.1–11) were significantly associated with early retirement overall and in all site groups. For the subgroup of patients who were employed before diagnosis, the risk pattern was similar. Tumour stage was not associated with early retirement or unemployment. Conclusions. Cancer-related factors were less strongly associated with early retirement and unemployment than socioeconomic factors and comorbidity. Clinicians treating HNSCC patients should be aware of the socioeconomic factors related to work market affiliation in order to provide more intensive social support or targeted rehabilitation for this patient group.

Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a US sample

Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. Participants (n=181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

Cognitive impairment and employment status in systemic lupus erythematosus: A prospective longitudinal study

To determine the relationship between cognitive impairment and employment in patients with systemic lupus erythematosus (SLE). A total of 167 consecutive patients with SLE were prospectively evaluated, and underwent standardized neuropsychological tests. Multivariate logistic regression was used to determine the likelihood of being unemployed, adjusting for sociodemographic characteristics, employment status at study entry, disease activity, disease duration, damage scores, and depression. At study entry, 118 (70.7%) of 167 patients were employed. In the multivariate analysis, after adjusting for confounders, unemployment was predicted by the number of cognitive domains impaired (odds ratio [OR] 1.76, 95% confidence interval [95% CI] 1.58-6.72), depression (OR 1.3, 95% CI 1.1-3.1), fewer years of education (OR 0.12, 95% CI 0.02-0.34), and the presence of anticardiolipin antibodies (OR 1.43, 95% CI 1.2-6.1). Complex attention (OR 1.7, 95% CI 1.2-3.6), memory (OR 3.1, 95% CI 1.5-6.2), and executive functions (OR 2.4, 95% CI 1.9-6.1) were predictors of unemployment at study entry. After 3 years, 61 (51.7%) of 118 patients were employed (OR 2.25, 95% CI 1.38-3.68; P = 0.001). The likelihood of being unemployed after 3 years was predicted by the number of cognitive domains impaired (OR 3.8, 95% CI 2.5-7.71), depression (OR 2.31, 95% CI 1.01-5.21), fewer years of education (OR 0.09, 95% CI 0.01-0.42), and the presence of anticardiolipin antibodies (OR 2.1, 95% CI 1.2-4.9). Complex attention (OR 2.2, 95% CI 1.1-3.8), memory (OR 3.6, 95% CI 2.1-6.4), executive functions (OR 1.8, 95% CI 1.2-7.3), and reasoning/problem solving (OR 1.9, 95% CI 1.4-7.2) were associated with unemployment after 3 years. The number of cognitive spheres, and especially attention, memory, and executive functions, are important factors associated with unemployment in patients with SLE.

Long-term risk factors for impaired burn-specific health and unemployment in patients with thermal injury

The success of acute burn therapy has led to an increased demand for high-quality rehabilitation. When optimizing burn care programs, knowledge of long-term risk factors associated with impaired health and unemployment of the patient may be significant. The health and work status of 95 patients (82.1% males; mean age 43.7 (S.D.: 14.5) years; mean total body surface burn 18.5 (S.D.: 14.2) % were assessed 47.0 (S.D.: 23.8) months after injury, using the Norwegian version of the abbreviated burn-specific health scale (BSHS-N) and a questionnaire asking for socio-demographic and medical characteristics. A regression model demonstrated that the BSHS-N total score was significantly reduced by chronic pain ( P < 0.001), psychological illness ( P < 0.001), and living alone ( P = 0.030), as well as full-thickness facial ( P = 0.011) and foot ( P = 0.013) burns. Unemployment was significantly associated with housing and economic problems ( P = 0.001), chronic pain ( P = 0.001), the extent of full-thickness injury ( P = 0.005), the presence of deformities ( P = 0.037), the number of operations ( P = 0.001) and the length of hospital stay ( P = 0.016). Thus, socio-demographic factors, non-burn-related morbidity and the injury itself significantly impaired long-term physical and psychosocial health and work status.

High rates of disability and unemployment in patients with fistulizing Crohn’s Disease

High rates of disability and unemployment in patients with fistulizing Crohn’s Disease

Neurocognition as a Determinant of Employment Status in Schizophrenia

Chronic unemployment is a major problem faced by many persons with schizophrenia. In this article, the author first reviews reasons why employment is an important goal for patients with schizophrenia. Employment appears to improve the clinical symptoms of schizophrenia. Employment also reduces the economic costs of the illness to society. The author then discusses predictors of positive employment outcomes in schizophrenia. Clinical symptoms, especially positive symptoms, do not appear to play a large role in predicting occupational functioning in schizophrenia. The author than reviews the evidence for the role of cognitive impairment in unemployment in patients with schizophrenia. In seven of the eight studies reviewed, significant relationships between cognitive functioning and work status/work behaviors were reported. These studies provide the basis for identifying those patients most at risk for the poorest occupational outcomes as well as those most likely to benefit from focused intervention.