Ageing and disability: Job satisfaction differentials across Europe

This article analyses the levels of job satisfaction reported by older workers (aged 50-64) with and without disabilities at a European level. Using data from the Survey of Health, Ageing and Retirement in Europe (2004 and 2007), we estimate job satisfaction equations for non-disabled, non-limited disabled and limited disabled workers, and decompose the observed job satisfaction gap by using the widely-used Oaxaca-Blinder methodology. The results show that after controlling for some variables, older workers with disabilities who are limited in their daily activities are less likely to be satisfied with their jobs as compared to their non-disabled counterparts. However, after estimating separate models for each group and doing the Oaxaca-Blinder decomposition, we found that older workers with limiting disabilities have greater returns in terms of job satisfaction from their job characteristics (such as wages, tenure and working in the private sector) as compared to non-disabled individuals. This finding supports the hypothesis of lower expectations about jobs of disadvantaged groups (e.g. limited disabled population) and has important public policy implications.     

Work capacity and re-entry into the workforce for the cardiac patient

BACKGROUND: Treatment and rehabilitation of patients with heart disease is focused on survival, work resumption, achievement of a state of subjective well-being and compliance with behavioural changes in order to prevent progression of the atherosclerotic process. OBJECTIVES: To propose a specific job fitness evaluation method for workers with heart disease, based on analysis of occupational factors influencing the cardiovascular system and the definition of a clinical and functional profile of the patient, with special regard to aspects influencing vocational attitude. METHODS: A literature review was performed. RESULTS AND CONCLUSION: Although resumption of work is not the sole objective in the rehabilitation process, it remains an important goal not only for economic reasons, but also because it is beneficial for most patients' psychological well-being. However, it must be admitted that specific job fitness evaluation is rarely performed during rehabilitation programmes of cardiac patients and this can cause problems at the time of return to work. Doubts and uncertainties are also due to the lack of standardized evaluation methods and to the clinical peculiarity of these patients, mainly due to the risk of sudden disability. The job fitness evaluation method used in this study allows physicians to perform assessments based on objective data, so improving patients' confidence in their work capacity. To achieve a satisfactory application of the method, close cooperation between the cardiologist and the occupational physician is necessary.     

Disability at Work: A Look Back and Forward

Purpose This article presents new evidence on employment barriers and workplace disparities facing employees with disabilities, linking the disparities to employee attitudes. Methods Analyses use the 2006 General Social Survey to connect disability to workplace disparities and attitudes in a structural equation model. Results Compared to employees without disabilities, those with disabilities report: lower pay levels, job security, and flexibility; more negative treatment by management; and, lower job satisfaction but similar organizational commitment and turnover intention. The lower satisfaction is mediated by lower job security, less job flexibility, and more negative views of management and co-worker relations. Conclusion Prior research and the present findings show that people with disabilities experience employment disparities that limit their income, security, and overall quality of work life. Technology plays an increasingly important role in decreasing employment disparities. However, there also should be increased targeted efforts by government, employers, insurers, occupational rehabilitation providers, and disability groups to address workplace barriers faced by employees with disabilities, and by those with disabilities seeking to return to work.     

Employment rehabilitation: outcome and prediction

Several factors have been shown to influence return to work after chronic disability, but little is known about their independent effect. There is also some disagreement about what constitutes successful resettlement in work. To establish the predictors of an early return to stable employment, 1,565 rehabilitees discharged from two employment rehabilitation centers in England were followed for at least 1 year. Nineteen entry characteristics and six outcome measures were analyzed by the canonical correlation method. Results in the two groups of rehabilitees were fairly similar. Three variables contributed most to the outcome measure: getting a job, delay in starting work, and employment status at the time of follow-up. Factors associated with a successful outcome were motivation, a low level of physical disability, short duration of unemployment before rehabilitation, completion of rehabilitation course, and a low level of general unemployment in the home area of the rehabilitee.     

昆明市五华区持证残疾人基本情况及康复需求调查分析

目的通过分析昆明市五华区持证残疾人目前面临的基本问题和康复需求,为今后全市的残疾人康复工作收集一些参考数据,为康复政策的制定提供理论依据。方法对五华区的7 537名持证的残疾人现状与康复需求进行问卷调查。结果男性有4 175名,占55.4%,女性3 362名,占44.6%;年龄3~99岁,平均50岁,肢体残疾占较大比例42.9%,其次视力残疾者(16.2%),智力残疾(12.2%),精神残疾(10.1%);49.4%的残疾人无劳动能力,39.2%能从事轻体力劳动;生活需求方面:对康复救助的需求最多(23.3%),其次是社会救助(17.2%)和申请低保(17.5%);在康复需求方面:视力残疾人主要的康复需求主要为视力功能训练(91.5%)、盲人定向行走训练(83.4%)和辅助器具需求(80.6%);听力残疾人主要的康复需求为听觉言语能力训练(80.2%);语言残疾人主要对听觉言语能力训练的需求(88.1%);肢体残疾人主要需求为运动功能训练(92.0%)、生活自理训练(64.0%)、作业治疗训练(79.4%);智力残疾人主要需求为感知认知能力训练(90.7%);精神残疾人主要需求为感知认知能力训练(32.0%),多重残疾人对各项康复训练都有需求。不同残疾类型残疾人对生活和康复的需求有所不同。结论昆明市五华区持证残疾人涵盖各类残疾,残疾人就业范围局限,就业率偏低,不同残疾类型的残疾人对生活和康复的需求有所不同,残疾人的生产生活水平偏低,需要政府和社会根据不同残疾人的康复需求给予全方位救助。     

Ill health retirement in Scottish teachers: process, outcomes and re-employment

Objectives: To assess the process, causes and outcomes of ill health retirement (IHR) in teachers in Scotland. Perceptions and experience of occupational health services (OHS), access to rehabilitation and redeployment, current health, post retirement experience and predictors of re-employment were identified. Methods: 537 teachers who retired due to ill health between April 1998 and March 2000 were mailed our IHR questionnaire by the Scottish Public Pensions Agency. Results: The most common cause of IHR was mental disorders (37%), followed by diseases of the musculoskeletal system (18%). 11% of teachers attended an OHS prior to IHR. 9% of teachers were offered part-time work and 5% were offered alternative work. 63% of retired teachers stated their health had improved and 48% said they would like to work again. 36% of the surveyed teachers have found re-employment since their retirement. On unadjusted analyses, re-employment of teachers after IHR was significantly associated with sex, having dependants, job group, cause of IHR, health having improved and wanting to work again. Multiple logistic regression analyses showed three variables as independent predictors of re-employment: having dependants, job group and cause of IHR. Conclusion: This is the first comprehensive study investigating teachers’ experiences of IHR in Scotland. The findings highlight substantial lack of support for teachers in a number of areas which need to be addressed by managers and employers. Our study confirms the need for rehabilitation and teacher support services in order to try and retain experienced teachers in the profession.     

Does job satisfaction predict early return to work after coronary angioplasty or cardiac surgery?

Purpose

Few studies have analyzed the relationship between job satisfaction and return to work (RTW) in cardiac patients. The aim of this paper was to investigate whether job satisfaction predicted early RTW in patients sick listed after cardiac invasive procedures.

Methods

A 6-month prospective study was carried out in a sample of 83 patients in working age who had recently been treated with angioplasty or cardiac surgery. Job satisfaction was measured using the scale from the Occupational Stress Indicator during cardiac rehabilitation. Time to RTW was assessed at the 6-month occupational physician examination. Logistic regression analyses were used to study the association between job satisfaction at baseline and early RTW at follow-up, adjusted for socio-demographic, medical (type of cardiac intervention, ejection fraction) and psychological (depression, locus of control, illness perception) factors.

Results

Participants with high job satisfaction were more likely to return early to work, with an odds ratio (OR) of 5.92 (95 % CI, 1.69–20.73) in the most-adjusted model, compared to participants with low job satisfaction. Satisfaction with organizational processes was the job satisfaction component most strongly associated with early RTW (OR, 4.30; 95 % CI, 1.21–15.03).

Conclusions

To the best of our knowledge, this is the first prospective study that investigated whether job satisfaction predicts time to RTW after cardiac interventions. The results suggested that when patients are satisfied with their job and positively perceived their work environment, they will be more likely to early RTW, independently of socio-demographic, medical and psychological factors.     

北京市0～6岁五类残疾儿童家长对儿童残疾的知晓情况及影响因素

目的:了解北京市残疾儿童家长对儿童残疾状况的知晓情况,并初步探讨影响家长知晓的主要因素。方法:按照病例-对照研究的设计,对相关因素进行单因素和多因素分析。结果:五类残疾中智力残疾的家长对儿童残疾状况知晓情况最差;影响残疾儿童家长对儿童残疾状况知晓的独立因素有:居住在农村地区、男童、年龄小、母亲文化程度低、单一残疾和残疾程度轻。结论:北京市残疾儿童的家长对儿童残疾的知晓状况相对不足;儿童保健部门和残疾康复部门应大大加强儿童残疾预防和识别等方面的健康教育,同时加强对基层儿童保健工作人员的培训工作,提高他们在残疾预防和早期识别方面的知识和对家长的指导能力。     

Continuing medical education and primary physicians' job stress, burnout and dissatisfaction

OBJECTIVES: The association between opportunities for continuing medical education (CME) and primary physicians' job stress, burnout and job dissatisfaction has not been investigated. It was hypothesized that participation in CME activities and perceived opportunities at work for keeping up-to-date with medical and professional developments would be correlated negatively with job stress and burnout, and positively with job satisfaction. METHOD: 309 primary care physicians (183 family physicians and 126 paediatricians) employed in health maintenance organizations in Israel responded to a mailed questionnaire. The independent variables were the extent of engagement in CME activities and perceived opportunities at work for professional updating. The dependent variables were job stress, burnout and job satisfaction. Multiple regression analyses were employed. RESULTS: After controlling for age, sex and professional status, participation in CME activities was associated negatively with job stress and positively with job satisfaction, among family physicians. Among paediatricians, CME was associated negatively with burnout. Perceived opportunities for professional updating were associated negatively with burnout and (marginally) with stress among family physicians, and negatively with stress and positively with satisfaction among paediatricians. A third of the paediatricians and a quarter of the family physicians wanted to increase their involvement in CME. DISCUSSION: In this cross-sectional study, causality cannot be established and the CME measures should be refined. However, the results are consistent with the study's hypotheses and suggest that opportunities for CME and professional updating may reduce physicians' job distress and dissatisfaction.     

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain

Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.     

Chronic back pain and work disability: Vocational outcomes following multidisciplinary rehabilitation

Studies indicate that work disabled chronic back pain patients out of work for longer than three months have a reduced probability of returning to work. The escalating personal and economic costs (indemnity and health care) associated with such long term disability have facilitated efforts at multiple levels to prevent and more effectively manage work disability. Multidisciplinary rehabilitation (MDR) targeted at return to work represents one such approach. The approach is based upon a multidimensional conceptualization of work disability and integrates medical, physical, psychological, educational and vocational interventions to increase physical function, reduce pain, increase stress coping skills and facilitate return to work. Seven outpatient multidisciplinary rehabilitation outcome studies for chronic back pain were identified that met the following selection criteria: 1) diagnosis of back pain, low back pain, spinal disorder (specific and nonspecific diagnosis), 2) chronic back pain of either longer than three months since injury or longer than three months absence from work, 3) use of an outpatient multidisciplinary rehabilitation approach that included some combination of medical management, physical conditioning, pain and stress management, vocational counseling/placement and education regarding back safety and health, and 4) work reentry was the primary focus of outcome. These were reviewed to determine the effectiveness of MDR in terms of return to work outcome. Analyses revealed that an average of 71 percent of work disabled chronic back pain patients who completed a multidisciplinary rehabilitation program were working or involved in vocational rehabilitation efforts at 12 month follow-up in contrast to an average of 44 percent in corresponding comparison groups. While these studies suggest the clinical utility of a multidisciplinary approach as compared to usual care in facilitating return to work for chronic back pain patients, the literature was characterized by several methodological limitations including the absence of randomization in the majority of studies, use of insurance company denials as control groups, heterogenous samples in terms of duration of work disability, job availability at discharge, extent of impairment and disability, age and duration of pain disorder, lack of specification as to exact treatment delivered in the control or usual care groups and varying definitions of return to work outcome. Research on predictors of return to work outcome following MDR were identified and included variables in five categories: demographics, medical history, physical findings, pain and psychological characteristics. The literature provides support for the use of integrated approaches that target the medical, physical, ergonomic and psychosocial factors that can exacerbate and/or maintain work disability. Future research should address current methodological limitations in the literature and focus on: 1) identifying critical treatment components of such approaches, 2) developing innovative screening methods to identify high risk cases to facilitate earlier more targeted efforts to assist such individuals, and 3) consider variations in the staging of various combinations of interventions in an effort to develop more cost-effective variations in the multidisciplinary approach.     

Facilitating factors for work return in unemployed with disabilities: A qualitative study

Despite the fact that equal services are offered to all disabled jobseekers who apply for jobs through jobcentres, only a small number of them return to work while the others remain unemployed. The aim of this study was to explore which factors disabled jobseekers, who had managed to get a job experienced had been important for their work return. A qualitative research method, Grounded Theory, was chosen. Ten thematized in-depth interviews were conducted. The narratives reflected that a common feature in the informants was a strong worker identity. They emphasized the importance of remaining as an active jobseeker despite disability and unemployment. Measures offered by the jobcentres such as timing, individual support, and a period of adjusted work were experienced to be empowering and enhanced the ability to continue job seeking. In parallel with these empowering measures the informants expressed a process of personal development (reorientation). The reorientation included concepts such as “adjusting to disability” and “finding a new work identity”.     

Early discharge and return to work following myocardial infarction

Individuals who have experienced a myocardial infarction (MI) account for the largest component of all hospitalization costs and foregone earnings due to cardiac disease. Early return to full employment and premorbid activity level should be the focus of cost-effective rehabilitative programs. Yet the economic benefits of vocational rehabilitation have not been directly researched. Therefore, issues of import regarding activity after MI include the timing of ambulation, discharge and return to work.Studies of early mobilization and discharge are contrasted in terms of methodology and outcome. These cite economic, social and psychological advantages, yet these factors are examined in isolation of other variables. A review of the literature reveals that there is a reluctance by many health professionals to institute such practices based in part on the dilemma surrounding selection of specific indicators and risk factors. Yet analysis reveals that the contention surrounding these exclusion criteria is perhaps unfounded, as the variance is less than is commonly assumed.Recurrent themes likewise emerge regarding the multiplicity of variables associated with the timing of resumption of employment, which is considered to be the most precise index of recovery following an MI. Of these, only early intense rehabilitation, directed at attitudinal and behavioural change, is amenable to modification by health professionals. Related research endeavours have examined employment following aortocoronary bypass surgery, risk factors in the work environment and work stressors which occur following MI. Controversy arises regarding the correlation of age and personality factors with return to work. Discrepancies in research findings are attributed to the diverse approaches to data collection, obstacles encountered in measuring psychological states, lack of operational definitions, differences in degree of rehabilitation and length of follow-up and the absence of controlled trials. Clearly, experimental research focusing on the job-related economic and human cost impact of specific rehabilitation programs must be conducted.Three strategies are identified which should facilitate return to premorbid levels of activity, including (1) the definition, development and integration of roles of diverse professionals within the interdisciplinary health care team, (2) the early detection and modification of psychological problems, physical disability and inappropriate occupations which would prevent MI patients from returning to their former occupations and (3) prompt follow-up and comprehensive structured rehabilitation programs which incorporate education, exercise and emotional support at the individual, family and community level.This analytical survey supports the principle of early mobilization, discharge and return to employment or premorbid state, yet operational definitions and deadlines are only in the infancy stage. Multidisciplinary experimental efforts must be directed toward the detection of significant variables and generalizable rehabilitation mechanisms. The process of programs requires testing as do the emotional, physical and health outcomes.     

Job accommodations for HIV/AIDS: practical tips and case law

Employers need to make accommodations for all disabled employees, including those with HIV/AIDS. Companies will face an increasing need to make these accommodations as more patients respond well to new drug treatments and are able to return to the work force. Workers with HIV and AIDS pose special challenges to employers: their confidentiality must be protected, their health status changes need to be taken into consideration, and their coworkers need to be counseled. Employers need to be flexible and creative in providing extra time off, flexible work scheduling, or a place to rest. Guidelines are included for determining whether the job accommodations are reasonable or impose an undue burden on the business.     

A randomized control trial of cardiac rehabilitation

A randomized trial using controls tested whether psycho-social rehabilitation of acute myocardial infarction (MI) patients would improve significantly their return to work rate and assessed the importance of various psychological, social, occupational, socio-demographic, and medical factors in facilitating or impeding rapid return to work. Eighty-nine patients were assigned randomly to participate in an experimental cardiac rehabilitation program (rehab care), and 91 patients were controls who received conventional hospital rehabilitation (usual care). By the first follow-up interview at three months, patients assigned to experimental treatment were significantly less distressed psychologically and less dependent on family support than controls (P = 0.04 and P = 0.05, respectively). By the final follow-up interview at 13 months, there was a marginally significant difference in favor of the experimental group in the frequency of reported deterrents to work resumption (P = 0.07). However, the intervention did not result in a statistically significant difference in the return to work rate (P greater than 0.10). In each group, 88% were back at work by approximately the first year after infarction. In addition, the two groups were similar in the amount of time patients remained out of the workforce (median days rehab care = 75, usual care = 81; P greater than 0.10). A multi-stage data analysis procedure utilizing the Cox regression technique indicated that while several independent variables had significant univariate associations with the length of time patients convalesced, outcome was most influenced by the patient's initial cardiological status and clinical course, by the patterns of family support, and by the several variables measuring the presence of obstacles to resuming work. Our findings suggest that rehabilitation programs intervening on multiple levels (psychological, social, occupational, and physical) may best meet the needs of chronically ill cardiac patients. Results indicate that implementing measures addressing the patient's general psycho-social adjustment to MI may improve existing programs.     

Return to work after cardiologic rehabilitation

Summary Return to work in patients after cardiac rehabilitation Objectives: The objectives of the present study were to determine prospectively return to work and its predictors in patients after cardiac rehabilitation. Methods: Patients were enrolled at admission to inpatient cardiac rehabilitation centres (n = 18). Primary indications for admission were myocardial infarction, coronary artery bypass grafting or percutaneous transluminal coronary angioplasty. Results: We included 2441 consecutive patients (1907 men, mean age: 60 ± 10 years; 534 women, mean age: 65 ± 10 years). A total of 43% of all patients had been actively employed before the event. Of these patients, 65% had returned to work six months and 67% 12 months after cardiac rehabilitation. Successful return to work after 12 months was significantly predicted by younger age, non-manual work, self-employment, a higher physical and mental quality of life, and a better exercise ECG result. Conclusions: Return to work is predicted by sociodemographic factors, quality of life, and the exercise ECG at the rehabilitation centre. The determination of early predictors for return to work may aid to identify patients particularly at risk for failure to return to work.

     

Return to work: A critical aspect of care coordination for younger dual eligibles

BackgroundAnnual health care costs for dual eligibles now top $300 billion. Many dual eligibles are under age 65 and their needs differ significantly from retired elderly dual eligibles. For younger dual eligibles, successful return to work is an important objective for coordinated care.ObjectivesTo assess relative rates of dual eligibility by age group and program enrollment (SSDI or OASI), and to identify the prevalence among these subgroups of factors associated with return to work.MethodsPopulation estimates and logistic regression analysis of the 2010 Medicare Current Beneficiary Survey (MCBS).ResultsAlthough they make up only 16% of the total Medicare beneficiary population, disabled workers under age 65 constitute 42% of all dual eligibles. SSDI beneficiaries under age 45 have 20 times greater odds of receiving Medicaid benefits compared to retirees (AOR = 19.8, 95% CI = 16.2–24.2). The youngest dual eligible adults are more likely to work, have fewer chronic conditions, and report better health status than other dual eligibles. However, they are more likely to report problems with obtaining health care and be dissatisfied with the quality of the care they receive.ConclusionsDual eligible workers with disabilities are an important target population for coordinated services because of their high lifetime program costs – many will receive SSDI, SSI, Medicare, and Medicaid benefits for decades. Return to work and continued employment are important policy objectives for younger dual eligibles and should provide the greatest return in terms of reduced dependence on federal disability programs.     

Worksite disability management model for effective return-to-work planning

The growth of disability management programs represents a paradigm shift from traditional clinic-based rehabilitation services to worksite-based interventions that dramatically reduce lost time and costs. Supportive policies and steps in the return-to-work process are illustrated, from the point of worker injury and early intervention, through work ability assessment, return-to-work planning, job-site accommodation, and successful return to work. Creative return-to-work options, including "job banks," are discussed as practical methods to facilitate the worker's gradual return to full duty status while completing the medical recovery process. Worker, worksite, and community resource factors related to return-to-work outcomes are discussed.     

Factors related to outcome following a work hardening program

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.