Work Accommodations Research Articles

Sustained employment, work disability and work functioning in CKD patients: a cross-sectional survey study

IntroductionKidney failure negatively affects opportunities for work participation. Little is known about work functioning of employed CKD patients. This study investigates work-related outcomes, and examines associations between patient characteristics and employment status.MethodsWe performed a cross-sectional survey study in nine nephrology outpatient clinics in the Netherlands among working age (18–67 years) CKD Stage G3b-G5, dialysis and transplant patients (n = 634; mean age 53.4 years (SD 10); 53% male; 47% Stage G3b-G5, 9% dialysis, 44% transplantation). We assessed employment status, work disability, work-related characteristics (i.e., work situation, working hours, job demands), work functioning (i.e., perceived ability to work, productivity loss, limitations in work), work environment (i.e., work accommodations, psychosocial work environment), as well as health status and fatigue.ResultsSixty-five percent were employed reporting moderate work ability. Of those, 21% received supplementary work disability benefits, 37% were severely fatigued, 7% expected to drop out of the workforce, and 49% experienced CKD-related work limitations. Work accommodations included reduced working hours, working at a slower pace, adjustment of work tasks or work schedule, and working from home. Multivariable analysis of sustained employment showed associations with younger age, male gender, higher level of education, better general and physical health and pre-emptive transplantation. Transplant patients had the highest work ability and highest expectation to maintain work. Dialysis patients had the highest productivity loss and perceived the most limitations regarding functioning in work. Stage G3b-G5 patients reported the lowest social support from colleagues and highest conflict in work and private life.ConclusionsEmployed CKD patients experience difficulties regarding functioning in work requiring adjustment of work or partial work disability. In addition to dialysis patients, stage G3b-G5 patients are vulnerable concerning sustained employment and work functioning.

An interactive mobile application versus an educational booklet to promote job retention in women undergoing adjuvant chemotherapy for breast cancer: a randomized controlled trial

BackgroundJob loss after a cancer diagnosis can lead to long-term financial toxicity and its attendant adverse clinical consequences, including decreased treatment adherence. Among women undergoing (neo)adjuvant chemotherapy for breast cancer, access to work accommodations (e.g., sick leave) is associated with higher job retention after treatment completion. However, low-income and/or minority women are less likely to have access to work accommodations and, therefore, are at higher risk of job loss. Given the time and transportation barriers that low-income working patients commonly face, it is crucial to develop an intervention that is convenient and easy to use.MethodsWe designed an intervention to promote job retention during and after (neo)adjuvant chemotherapy for breast cancer by improving access to relevant accommodations. Talking to Employers And Medical staff about Work (TEAMWork) is an English/Spanish mobile application (app) that provides (1) suggestions for work accommodations tailored to specific job demands, (2) coaching/strategies for negotiating with an employer, (3) advice for symptom self-management, and (4) tools to improve communication with the medical oncology team. This study is a randomized controlled trial to evaluate the app as a job-retention tool compared to a control condition that provides the app content in an informational paper booklet. The primary outcome of the study is work status after treatment completion. Secondary outcomes include work status 1 and 2 years later, participant self-efficacy to ask an employer for accommodations, receipt of workplace accommodations during and following adjuvant therapy, patient self-efficacy to communicate with the oncology provider, self-reported symptom burden during and following adjuvant therapy, and cancer treatment adherence.DiscussionThis study will assess the use of mobile technology to improve vulnerable breast cancer patients’ ability to communicate with their employers and oncology providers, work during treatment and retain their jobs in the long term, thereby diminishing the potential consequences of job loss, including decreased treatment adherence, debt, and bankruptcy.Trial registrationClincalTrials.gov NCT03572374. Registered on 08 June 2018.

Sociodemographic and occupational factors associated with receipt of work accommodations among employed breast cancer survivors.

231 Background: Many cancer survivors face occupational challenges when staying in or returning to work after treatment yet little is known about sociodemographic and work-related factors associated with receipt of work accommodations (e.g. flexible work time, reduced workload). Methods: We analyzed data from the PinkWorks study (n = 154 female breast cancer survivors), a cross-sectional online survey. Participants were: ≥18+ years, speak English, ended treatment within 36 months, and working ≥20 hours per week at both the time of diagnosis and currently. Due to small n’s in strata, we performed descriptive analyses (frequencies, Chi-Square tests) to identify possible univariate associations between occupational factors and granting of work accommodations. An exploratory multiple Logistic Regression was performed with receipt of accommodations (yes, no) as the dependent variable. Results: Among participants, 43.8% received work accommodations from employers, and 11% reported that their physicians had a direct conversation with their employer. Participants who were native English speakers were more likely to receive work accommodations compared to those where English is a second language (44.8%, 22.2%, respectively, n.s.). Workers who held executive positions were more likely to receive accommodations compared to those in either supervisory or non-supervisory roles (60.0%, 43.1%, 42.9%, respectively, n.s.). We observed a higher prevalence of work accommodations among participants who reported that a discussion between the physician and employer occurred compared to those who did not report such a conversation (58%, 41.9%, respectively, n.s.) An exploratory logistic regression controlling for age and educational attainment was consistent with descriptive findings regarding language and type of position. Conclusions: Less than half of employed breast cancer survivors were provided work accommodations. Suggestive disparities in the receipt of accommodations were observed among those who were not native English speakers or in non-executive positions. The occurrence of a conversation between the participant’s physician and employer was linked to a higher prevalence of accommodations but the cross-sectional design of the study limits interpretation. Additional multivariate analyses are recommended to further explore these relationships, including structural equation modeling to address the strong interconnections among the study variables.

Policing while pregnant: examining the need for standardized pregnancy-related work accommodations for women in policing

ABSTRACT This study used a survey to gather information regarding workplace accommodations for pregnant police officers and the experiences of women who have worked under these policies. Thirty-six current and former female police officers from Canada and the United States were included in this analysis (including 24 who had been pregnant, and one who was currently pregnant at the time of participation). Eleven respondents who had never been pregnant were also included to control for work-related pain scores (rather than pregnancy-related pain scores) and to gather more entries with respect to departmental pregnancy policies. Experience with on-the-job pregnancy accommodations varied, with some expressing satisfaction with their accommodations, while others were deeply dissatisfied. Results suggest that blanket policies requiring pregnancy-related reassignment to light-duty does not consistently relieve pregnancy-related discomfort and may not always benefit the female officer. Officers indicated that improved policies may be a solution to retain and recruit female officers.

Organizational strategies to address posttraumatic stress injuries among Canadian paramedics.

Paramedics are a high-risk occupational group for posttraumatic stress injuries (PTSI), and increasingly, evidence suggests that organizational factors play a significant role. While several resources for paramedic services to address PTSI exist, there is limited knowledge as to which PTSI-related programs and practices are implemented and how they are perceived in the workplace. This research aimed to explore key informants' perspectives on existing and desired organizational-wide initiatives for, as well as the challenges and potential solutions to, the primary prevention, early detection and intervention, and disability management of PTSI in Canadian paramedic services. Semi-structured interviews were conducted with 12 key informants from jurisdictions across Canada who have over five years of work experience in prehospital care. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. Eight recurrent organizational elements (themes) for addressing PTSI emerged: psychologically safe and healthy work culture; consistent supervisor support, mental health training and awareness, opportunities for recovery and maintaining resiliency, recognition of PTSI and its diverse risk factors, access to a variety of support initiatives for PTSI, communication during medical leave, and meaningful work accommodations. While organizational-wide initiatives were in place for the primary prevention, early detection and intervention, and disability management of PTSI, systemic challenges with coordination, resource allocation, and worker engagement were also identified. These challenges prevented paramedic services from optimally addressing PTSI in their workplace. Integrating considerations from the eight organizational elements to address PTSI into broader existing management systems may have merit in overcoming the systemic challenges.

Current Topics in Health Care Law

Current Topics in Health Care Law

The Perceived Impact of COVID-19 on Functional Activities Among Canadian Education Workers: A Cross-Sectional Study.

ObjectiveThis cross-sectional study examined the self-perceived impact of the COVID-19 pandemic on 2,378 education workers in Ontario, Canada, during the second wave.MethodsWe examined six domains of functioning as per the short version of the World Health Organization Disability Assessment Schedule-2.0. Participants selected if their functioning had improved, remained unchanged or worsened during the pandemic for each item.ResultsEducational workers described a general worsening of functional activities since the beginning of the pandemic. Moderate-to-extreme challenges were reported for all six functional domains. These challenges appeared to aggravate functional challenges for workers with disability, as indicated by pre-existing work accommodations. Older participants reported worse mobility than younger participants; however, they appeared to have better coping skills in learning new tasks and maintaining friendships. Women were more likely to report difficulties in maintaining household responsibilities.ConclusionsWe consider the role of mental health challenges and pre-existing inequality as predictors of pandemic-related difficulties. Recommendations include more longitudinal research in this population and policymakers to incorporate a health promotion lens to support their education workers more proactively.

The relationship between chronic health conditions and employment transitions among survivors of childhood cancer: A report from the Childhood Cancer Survivor Study (CCSS).

10051 Background: Chronic health conditions are prevalent among adult survivors of childhood cancer. The impact of health on maintaining full-time (FT) employment, a common indicator of socioeconomic independence, has not been studied in this population. Methods: Self-reported employment status (FT, part-time [PT], unemployed [any reason], not in labor force) was assessed at two timepoints (2002-04 [T1] and 2015-16 [T2]) in adult (≥25y old) survivors of childhood cancer diagnosed between 1970-86. Sex-stratified Poisson regression, adjusted for race and ages at diagnosis and T2, was used to study associations between timing and severity of chronic health conditions (graded per the CTCAE v4.03) and transitions from FT to PT or unemployed. Results: Survivors employed FT at T1 (males=1712, median age [min-max]: 34y [25-53]; females=1337, 33y [25-53]) who reported employment status at T2 were included. At T2 (median time from T1 11.5y [9.4-13.8]), 83% males and 70% females remained employed FT, but 4% and 10% transitioned to PT, and 11% and 12% to unemployed (additional 2% and 8% left the labor force), respectively. Male and female survivors with grade 2 or 3-4 neurologic conditions acquired before T1 or between T1-T2 were at a higher risk of moving from FT to PT or unemployed compared to those with grade 0-1 conditions. Males and females with grade 3-4 respiratory conditions prior to T1 and cardiac and musculoskeletal conditions acquired between T1-T2 were also at higher risk for moving to PT or unemployed (Table). Additional predictors for males included grade 2 vision (before T1 RR 2.3, 95% CI 1.5-3.3; between T1-T2 RR 1.7, 95% CI 1.1-2.7) and endocrine (before T1 RR 1.4, 95% CI 1.1-1.9; between T1-T2 RR 1.7, 95% CI 1.3-2.3) conditions. Conclusions: A substantial portion of adult survivors of childhood cancer with health conditions of varying severity leave FT employment. Increased awareness of all stakeholders may facilitate access to clinical counseling and occupational provisions for flexible and supportive work accommodations to reduce work-related barriers for childhood cancer survivors. [Table: see text]

Breast cancer survivorship and employment in Ireland: Legislative systems and the return to work of women with breast cancer.

Breast cancer is the most common invasive cancer in females worldwide. While work is important for well-being, 84% of women in Ireland temporarily or permanently cease working up to six months post-breast cancer diagnosis. Under Irish law, there is a right to reasonable work accommodations, however paid sick leave has only recently been state-mandated. Legislation internationally varies across nations. The aim of this study was to explore the experiences of women who have had breast cancer returning to, and/or remaining in work, in the context of employment legislation. Fifteen women with breast cancer, fifteen healthcare professionals, and nine employers nationwide participated in a qualitative-descriptive design, using semi-structured interviews. Interviews were audio-recorded, transcribed, and data analysed using thematic analysis. Thirty-nine participants were recruited. A prominent theme from interviews was that most women with breast cancer and healthcare professional cohorts were not aware of employment rights in the context of cancer diagnoses. This is in contrast to employers. Experiences of sick leave and pay entitlements varied amongst women with breast cancer with financial pressure and expediated the return to work evident for some participants. Most women did not report any discrimination on returning to the workplace, although there were examples of indirect discrimination where unfair expectations were being placed on women by colleagues. Education and awareness on employment rights and entitlements during and after cancer treatment is warranted. This could be incorporated into work-focused interventions to support those living with and beyond cancer to transition back into the workplace.

Return to work of Italian cancer survivors: A focus on prognostic work-related factors.

Return to work (RTW) enhances the general well-being and social participation of cancer survivors (CSs). To describe the predictive value of work-related factors on the RTW process of CSs. The work accommodations, the perceived workload, and the barriers and facilitations of RTW are also reported. This population-based cross-sectional survey was conducted in the Province of Reggio Emilia from July 2016 to July 2017. CSs who were 20-59 years old, first diagnosed with cancer, and employed at diagnosis were recruited. The majority of CSs (140/266, 53%) returned to work without difficulties, 42% reported difficulties, and 5% did not RTW. CSs who were shift workers (sex and age-adjusted Relative Risk [adj-RR] 1.30; 95% CI 0.94 -1.78) and who worked at night (adj-RR 1.36 95% CI 0.99 -1.86), in the evening (adj-RR 1.23; 95% CI 0.95 -1.57) and on Sundays (adj-RR 1.15; 95% CI 0.81 -1.63) perceived more difficulties. Physically demanding work and a long commute seemed to negatively impact RTW. Accommodations in work tasks (37%) or schedule (26%) were implemented. Workload was not acceptable for 18% of CSs. The main barriers concerned energy and drive functions, whereas remunerative employment was the foremost facilitation. Healthcare professionals should address work-related factors that might influence RTW with personalized interventions of vocational rehabilitation.

Swedish managers’ experience-based understanding of the Capacity to work in employees with Common Mental Disorders: a Focus Group Study

PurposeUnderstanding of the capacity to work among employees with common mental disorders (CMDs) is important, but contemporary knowledge on this issue lacks the managers’ perspective. The aim of this study was to explore and describe managers’ experience-based understanding of capacity to work in employees with CMD.MethodsA qualitative focus group study was designed. Managers with experience in supporting employees with CMD were recruited via organizations and networks. Eight focus group interviews with 31 participants took place.ResultsThe analysis resulted in five categories. (1) Capacity to mentally focus on work tasks decreases or disappears, with negative consequences for work output. (2) Capacity to commit to continuous and coherent task changes, making tasks that span longer periods of time difficult. (3) Capacity to independently adapt to the needs of the situation decreases, and employees need more guidance and instructions than usual. (4) Capacity to keep up professional appearances is reduced, and the employees struggle with the professional role. (5) Ability to interact socially and professionally decreases, which potentially causes conflicts at the workplace.ConclusionsThis study adds managers’ perspective to the increasing knowledge on how capacity to work is influenced by CMDs. Managers understand CMDs in employees as changed, reducing the capacities needed for occupational functioning. A deeper understanding of reduced capacity to work is needed to adapt workplaces, and our findings can facilitate work accommodations for employees with CMDs.

Corrigendum to Work accommodations and sustainable working: The role of social partners and industrial relations in the employment of disabled and older people in Estonia, Hungary and Poland

Corrigendum to Work accommodations and sustainable working: The role of social partners and industrial relations in the employment of disabled and older people in Estonia, Hungary and Poland

Numerical approach for melting of paraffin inside a duct containing multi sinusoidal PCM containers

New design of system for providing cold air within the building was recommended in this study. Mixture of TiO2 (with fraction of 0.04) and RT25 was applied as NEPCM and three-lobed ducts were filled with them. Air become warmer outside the building owing to sun radiation and with moving along the channel, its temperature reduces because of melting procedure. Homogeneous model for NEPCM has been incorporated in equations of paraffin zone which contain laminar flow. Also, the range of inlet velocity contains the turbulent flow at air flow with Re = 6e3 to 1e4. The temperature of inlet air (Tin) was assumed as another active parameter. Irreversibility of system has been analyzed, too. Testing the exactness of procedure of modeling was applied according to previous published work and good accommodation has been reported. To decline the computing price, size of grid and time step were analyzed to find the optimized values. With adding TiO2 particles, the temperature of paraffin enhances and speeds of charging increases. At t = 5hr, dispersing nano-powders makes temperature and LF to grow around 0.19% and 0.79%, respectively. The required time declines around 31.26% and 40.78% with rise of Re and Tin.

Exploring Employer Perspectives on Their Supportive Role in Accommodating Workers with Disabilities to Promote Sustainable RTW: A Qualitative Study.

Employers play an important role in facilitating sustainable return to work (RTW) by workers with disabilities. The aim of this qualitative study was to explore how employers who were successful in retaining workers with disabilities at work fulfilled their supportive role, and which facilitators were essential to support these workers throughout the RTW process. We conducted a semi-structured interview study among 27 employers who had experience in retaining workers with disabilities within their organization. We explored the different phases of RTW, from the onset of sick leave until the period, after 2-years of sick-leave, andwhen they can apply for disability benefit. We analyzed data by means of thematic analysis. We identified three types of employer support: (1) instrumental (offering work accommodations), (2) emotional (encouragement, empathy, understanding) and (3) informational (providing information, setting boundaries). We identified three facilitators of employer support (at organizational and supervisor levels): (1) good collaboration, including (in)formal contact and (in)formal networks; (2) employer characteristics, including supportive organizational culture and leadership skills; and (3) worker characteristics, including flexibility and self-control. Employers described three different possible types of support for the worker with disabilities: instrumental, emotional, and informational. The type and intensity of employer support varies during the different phases, which is a finding that should be further investigated. Good collaboration and flexibility of both employer and worker were reported as facilitators of optimal supervisor/worker interaction during the RTW process, which may show that sick-listed workers and their supervisors have a joint responsibility for the RTW process. More insight is needed on how this supervisor/worker interaction develops during the RTW process.

Risk Factors for Occupational Falls among Middle-aged and Elderly Farm Workers in Nan Province, Thailand

ABSTRACT As the workforce ages, the incidence of occupational falls is increasing. However, risk factors for occupational falls in farm workers have not been evaluated in detail. The current study sought to identify the risk factors for occupational falls among middle-aged and elderly farm workers in Thailand. We conducted a cross-sectional study using a self-administered questionnaire among 419 farm workers aged ≥40 years in Nan province, Thailand. Multiple logistic regression analysis was used to examine the factors associated with occupational falls. Occupational falls were experienced by 25.5% of participants. Men had 2.22 times higher odds of occupational falls than women (95% confidence interval [CI]: 1.19–4.13). Participants aged ≥60 years were less likely to experience occupational falls compared with those aged 40–49 years (odds ratio [OR]: 0.44; 95% CI: 0.20–0.96). Fruit growers were 2.72 times more likely to experience occupational falls than rice growers (95% CI: 1.33–5.55). Individuals with body mass index ≥30 kg/m2 and over were 3.05 times more likely to experience occupational falls than those with body mass index <25 kg/m2 (95% CI: 1.11–8.40). The sex- and age-related trends in fall risk may indicate that elderly individuals and women in agriculture tend to be assigned lighter duties through work accommodation. To prevent falls during agricultural work, it is necessary to pay attention to farm-specific tasks and work environments, such as working at a height in fruit cultivation, as well as instability of walking caused by obesity.

A Standpoint Approach to Return-to-Work Coordination: Understanding Union Roles.

Purpose This study examined how the participation of union representatives impacted return-to-work (RTW) processes, and explored key activities undertaken by union representatives involved in return-to-work coordination. Methods Forty-seven RTW coordinators (RTWCs) participated in in-depth, semi-structured interviews in 2018 as part of a cross-Canadian study investigating their strategies for managing challenges in the RTW process. The study included RTWCs from a variety of organisation types, including unionized organizations. Audio-recordings were transcribed, coded, and analysed using constant case comparison and deviant case analysis leading to the development of findings themes. Results Our findings highlight the role of union representatives in RTW processes and how their activities are seen by other parties involved with work accommodation. First, we describe Union RTWC's administrative functions and the extent of their involvement in RTW accommodation negotiations. Second, we examine how Union and Non-union RTWCs framed the same RTW processes differently, according to their own accountabilities. Finally, we identify the positive ways that union participation figured into the RTW process, including playing a role in identifying viable modified work and serving as a trusted party to help reluctant workers engage with RTW plans. Conclusions We introduce a standpoint perspective to shed light on how Union and Non-union RTWCs approached accommodation issues and consider acknowledgement of power relations as a starting point for managing divergent interests.

The fate of a Military Pilot in Malaysia: Lingering on the ground after young stroke

Strokes in young pilots can result in the devastating loss of productive years of life, especially for pilots at the peak of their careers. A 32-yr-old male military helicopter pilot was diagnosed with superior sagittal sinus thrombosis and bilateral parietal hemorrhages secondary to protein S deficiency after 15 years in military service. Two years post-stroke, he was carefully evaluated for a possible return to work after aeromedical assessment and the 1 percent rule being considered. A decision was made by the medical board for him to be disqualified to fly and grounded with work accommodation. The authors recommend that there is a need for reassessment up to two years using the objective PULHEEMS method for young pilots who failed aeromedical assessment due to stroke for returning to work as their experiences and knowledge is highly valuable.

728 Discrepancies in reported work accommodations by workers with disabilities and their supervisors and the associations with return to work

728 Discrepancies in reported work accommodations by workers with disabilities and their supervisors and the associations with return to work

Canadian Social Work Field Education During a Global Pandemic

The COVID-19 pandemic has significantly affected all aspects of social work education, including field education. The Transforming the Field Education Landscape (TFEL) partnership conducted two national online surveys to determine the impacts of the pandemic on social work field education. The first survey explored the perspectives of students and received responses from 367 Bachelor of Social Work (BSW) and Master of Social Work (MSW) students. The second survey was designed to gather the perspectives of field instructors, with 73 field instructors completing the survey. The article examines the impacts of the pandemic on social work practice, field supervision, practicum flexibility and accommodations in placement, the shift to remote learning, perceptions of future career prospects and the effects on wellness and mental health. This article contributes to an increased understanding of the strengths and challenges facing social work field education, and informs field planning and responses in a pandemic. The findings will be of interest to social work field education programmes, field education coordinators and directors, field instructors, field agencies and undergraduate and graduate social work students. Recommendations for social work field education are offered.

Learning to Work With Chronic Health Conditions: How Time Since Diagnosis Affects Older Workers' Vitality and Worries

Background. Chronic health conditions (CHCs) pose stark detrimental effects on the health and abilities of older workers. The extent of these effects depend on the CHC, the time since its diagnosis and the type of health measure: a rarely explored combination of heterogeneities. Objective. This study examined how four existing and newly diagnosed CHCs influences older workers’ vitality and worries about enduring physically and mentally until retirement age. Method. Data from two waves of the NIDI Pension Panel survey conducted in the Netherlands in 2015 and 2018 were used. We analyzed a sample of 1,894 older workers between the ages of 60-62 years at wave 1 using conditional change ordinal least square regression models. Results. Having a CHC at wave 1 was associated with lower levels of vitality and higher levels of worries at wave 2. These effects of CHCs on vitality and worries were much larger for older workers who were newly diagnosed with CHCs compared to those who experienced CHCs for longer. Intriguingly, the new diagnosis of physically disabling conditions increased worries about physical endurance at wave 2, while the new diagnosis of mentally disabling conditions increased worries about mental endurance at wave 2. Conclusion. By distinguishing the effects of four existing and newly diagnosed CHCs on vitality and worries, this study allows the identification of vulnerable groups of older workers. The findings may inform work accommodations and interventions which could improve both the quality and sustainability of work lives, while promoting healthy ageing of older workers.