United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study

STUDY DESIGN

Qualitative study using realist review.

OBJECTIVES

To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation.

SETTING

New Zealand Spinal Unit.

METHODS

People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods.

RESULTS

We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work.

CONCLUSIONS

To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment.

SPONSORSHIP

This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

Stakeholder views on young adults with intellectual disabilities as a workforce: A qualitative study on students' performance in upper secondary education and their employment potential

People with intellectual disabilities are the most disadvantaged group among all disability types when it comes to employment. In Sweden, special needs upper secondary schools prepare students with intellectual disabilities for the labour market using practice periods at workplaces. This study targets stakeholder involved in their school-to-work transition (i.e. teachers, employers, employment agency officials). The aim is to identify how they view: (1) the working capabilities of students during practice periods and (2) their employment potential. We base the analysis on interview data with the stakeholders using Grounded Theory. Our results identify three student types whose preparedness for the labour market differs considerably. One student type performs well during the practice period and represents a high potential to enter the workforce. The other two student types have the lower working capability and employment potential. Our study highlights stakeholders as resources to improve the labour market preparations of students with intellectual disabilities.

Maternal Employment and Infant BMI z Score in a US Birth Cohort

OBJECTIVE

The purpose of this study was to investigate the association between maternal employment and infant BMI z score.

METHODS

Longitudinal data from 520 mother-infant dyads participating in the Nurture Study, an observational cohort in the southeastern United States, were leveraged. Women were categorized as employed or nonemployed at 3, 6, 9, and 12 months, and measured anthropometrics were used to calculate infants' BMI z scores at the corresponding time points. BMI z score was defined using the World Health Organization standard. Household income was an effect modifier. Therefore, income-stratified (≤$40,000/y vs. >$40,000/y) linear regression models, with individual fixed effects, were used to examine associations between change in maternal employment status and BMI z scores among infants aged 3 to 12 months. Fixed effects controlled for time-invariant confounders (race/ethnicity, infant gender). This study also controlled for marital status and infant age.

RESULTS

More women from higher-income (68.4%) versus lower-income households (52.6%) were employed. Among lower-income households, change from nonemployment to employment was associated with higher infant BMI z scores (β = 0.12; 95% CI: -0.01 to 0.25, P = 0.07). Among higher-income households, change in maternal employment status was associated with lower infant BMI z scores (β = -0.72; 95% CI: -1.17 to -0.27, P = 0.02).

CONCLUSIONS

Maternal employment was related to infant adiposity. The direction of the association varied by household-level income.

Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa

BACKGROUND

Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers.

METHODS

The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method.

RESULTS

Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace.

CONCLUSION

Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.

Newly Credentialed Athletic Trainers' Perceptions of Their Transition to Practice

CONTEXT

Newly credentialed athletic trainers (ATs) have reported stress and role ambiguity during the transition to practice. Previous researchers focused on their qualitative experiences, yet no investigators have explored how characteristics such as the setting or type of educational program affect the transition to practice.

OBJECTIVE

To determine how newly credentialed ATs perceived their transition to practice.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PATIENTS OR OTHER PARTICIPANTS

Of 1835 newly credentialed ATs (18%) certified and employed between January and September, 332 completed the survey within 3 months of employment (129 men, 203 women; age = 23.58 ± 2.54 years).

MAIN OUTCOME MEASURE(S)

The survey consisted of demographic information (eg, employment setting, job title) and 3 sections: (1) comfort level during the transition (CL), (2) feelings of mentorship and support (MS), and (3) feelings of organizational transition. Participants identified their feelings of nervousness, support, and understanding organizational values using a Likert scale (1 = strongly disagree, 4 = strongly agree). Descriptive statistics were calculated for each survey item. Mann-Whitney U and Kruskal-Wallis (H) tests were used to determine associations between different demographic characteristics and responses regarding orientation and CL, MS, and feelings of organizational transition.

RESULTS

Most participants agreed or strongly agreed that they felt nervous (n = 264, 79.2%) and that the transition was stressful (n = 227, 68.1%) but they felt prepared for their job (n = 262, 78.7%). No differences in CL were present among settings (H = 5.64, P = .228), job titles (H = 4.88, P = .087), or types of professional program (U = 6488, P = .279). Respondents who were assigned a mentor reported better perceptions of MS (U = 6250, P < .001). Most participants felt that supervisors adequately explained administrative procedures during orientation (n = 169, 54.3%) and felt they were adequately oriented to organizational values (n = 252, 75.7%).

CONCLUSIONS

New ATs felt nervous when entering their new role, but having a mentor and receiving a detailed orientation helped alleviate stress during the transition to practice.

The Effectiveness of Rehabilitation Interventions on the Employment and Functioning of People with Intellectual Disabilities: A Systematic Review

Purpose This systematic review analyzed the effectiveness of rehabilitation interventions on the employment and functioning of people with intellectual disabilities (ID), as well as barriers and facilitators of employment. Methods This was a systematic review of quantitative, qualitative, and mixed methods studies. The outcomes were employment, transition to the open labor market and functioning. The review included qualitative studies of employment barriers and facilitators. The population comprised people with ID aged 16-68 years. Peer-reviewed articles published in English between January 1990 and February 2019 were obtained from the databases Cinahl, the Cochrane Library, Embase, Eric, Medic, Medline, OTseeker, Pedro, PsycInfo, PubMed, Socindex, and the Web of Science. We also searched Google Scholar and Base. The modified selection instrument (PIOS: participants, intervention, outcome, and study design) used in the selection of the articles depended on the selection criteria. Results Ten quantitative (one randomized controlled, one concurrently controlled, and eight cohort studies), six qualitative studies, one multimethod study, and 21 case studies met the inclusion criteria. The quantitative studies showed that secondary education increases employment among people with ID when it includes work experience and personal support services. Supported employment also increased employment in the open labor market, which sheltered work did not. The barriers to employment were the use of sheltered work, discrimination in vocational experience, the use of class teaching, and deficient work experience while still at school. The facilitators of employment were one's own activity, the support of one's family, job coaching, a well-designed work environment, appreciation of one's work, support form one's employer and work organization, knowledge and experience of employment during secondary education, and for entrepreneurs, the use of a support person. Conclusions The employment of people with ID can be improved through secondary education including proper teaching methods and personal support services, the use of supported work, workplace accommodations and support from one's family and employer. These results can be utilized in the development of rehabilitation, education, and the employment of people with ID, to allow them the opportunity to work in the open labor market and participate in society.

An exploration of undergraduate nursing assistant employment in aged care and its value to undergraduate nursing education

AIMS

To explore the types of nursing skills that are learnt through work as nursing assistants in aged care; and determine how these skills help to prepare novice nurses for new graduate practice as a Registered Nurse.

BACKGROUND

Issues surrounding patient care currently plague the aged care sector in Australia. Undergraduate Assistants in Nursing are undergraduate nursing students who work in a variety of clinical settings, including aged care facilities. The employment of nursing students in aged care is not well explored.

DESIGN

This paper presents the findings from an open-response question in the Preparation for Clinical Practice survey. The survey represented the first stage of a larger sequential mixed-methods study that explored how undergraduate Assistant in Nursing employment in aged care contributed to the preparation of new graduate Registered Nurses for clinical practice.

SETTING

Data were predominantly collected online via an online survey platform. Social media and snowball sampling methods were utilised to distribute the survey nation-wide.

PARTICIPANTS

New graduate nurses (n = 108) who were previously employed as undergraduate Assistants in Nursing in an aged care facility during their Bachelor of Nursing program.

METHODS

Thematic analysis was used to analyse data from the open-response question in the survey.

FINDINGS

Three main themes were created: developing communication skills, prioritising patient care, and professional growth through immersion.

CONCLUSIONS

Undergraduate Assistant in Nursing employment in aged care prepared novice nurses for new graduate practice, developing higher-order nursing skills in communication, time management, understanding various aspects of care from the patient's unique experiences, and understanding the structure of the healthcare organisation.

Measuring precarious employment in Sweden: translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES)

OBJECTIVES

Precarious employment (PE) is a determinant of poor health and health inequality. However, the evidence of health consequences and mechanisms underlying the associations, are still limited due to a lack of a comprehensive multidimensional definition and measurement instrument. The Employment Precariousness Scale (EPRES) is a Spanish, multidimensional scale, developed to measure degree of PE. The aim of this study was to translate the EPRES-2010 into Swedish, adapt it to the Swedish context and to assess the psychometric properties of the Swedish EPRES.

METHOD

EPRES was translated, adapted and implemented for data collection within the research project PRecarious EMployment in Stockholm (PREMIS). During 2016-2017, questionnaire data were collected from 483 non-standard employees in Stockholm, Sweden, sampled with web-based respondent-driven sampling. Analyses included item descriptive statistics, scale descriptive statistics and exploratory factor analysis.

RESULTS

The final EPRES-Se (Swedish version of the EPRES),consisted of six dimensions and 23 items. There was a high response rate to all items and response options. Global Cronbach's alpha was 0.83. Subscales 'vulnerability', 'rights' and 'exercise rights' had reliability coefficients between α=0.78-0.89 and item-subscale correlations between r=0.48-0.78. 'Temporariness' had poor reliability (α=-0.08) and inter-item correlation (r=-0.04), while 'disempowerment' showed acceptable psychometric properties (α=0.5; r=0.34). Exploratory factor analysis confirmed the original EPRES factor structure.

CONCLUSIONS

'Vulnerability', 'wages', 'rights', 'exercise rights' and 'disempowerment' worked in the Swedish context; however, 'temporariness' would need revising before implementing the EPRES-Se in further research. Continued work and validation of EPRES-Se is encouraged. In order to enable international comparisons and multinational studies, similar studies in other European countries are also called for.

Parent Expectations and Preparatory Activities as Adolescents with ASD Transition to Adulthood

Community stakeholders, researchers, and providers are increasingly focused on individual, family, and systemic factors that contribute to positive outcomes for adults on the autism spectrum. Parent expectations for their youth's future are associated with adult outcomes (e.g., employment, school success, independence), yet the mechanism for this effect remains unclear. This study investigated how expectations were related to parent transition-related activities in a sample of 298 parents of adolescents on the autism spectrum (48% female adolescents), stratified by parent-reported IQ (average or above, borderline, or below 70). Parent expectations for the future predicted engagement in some activities intended to enhance adult outcomes when controlling for IQ, gender, age, and household income. The results have implications for how providers discuss expectations and support families in preparing for adulthood.

Improving the job-retention strategies in multiple sclerosis workers: the role of occupational physicians

Several studies evaluated whether a person with multiple sclerosis is employed or not and investigated the main symptoms that hinder the job performance. However, despite occupational physicians are fundamental in managing disabled subjects, there is a serious lack of data regarding their role in improving employability of these workers. In this regard, we assessed occupational physicians' professional activity and training/updating needs in order to identify and develop management tools, operative procedures and training programs helpful to support and implement adequate job-retention strategies. Four hundred three Italian occupational physicians compiled a self-administered questionnaire to evaluate individual demographics, health surveillance system, fitness for work and training needs. Our findings confirmed the suitability to adopt environmental adjustments at workplace (particularly referring to the ergonomics of workstation, the typology of occupational risk factors and the working time) to accommodate individual's needs in order to improve working ability among multiple sclerosis workers. Moreover, training events discussing operational guidelines and standardized instruments and/or methodologies to adequately manage the disable workers should be fostered. Therefore, in this regard, occupational physicians could play a key role but they need more high-quality training especially concerning the different tools that are currently available to assess the work issues in multiple sclerosis patients.

Systematic review: chronic obstructive pulmonary disease and work-related outcomes

Background

Several studies have assessed the impact of chronic obstructive pulmonary disease (COPD) on work ability and work productivity; however, this relationship is poorly understood.

Aims

To undertake a systematic review to assess the effects of COPD on employment, absenteeism and presenteeism.

Methods

A comprehensive search using CINAHL, Embase, MEDLINE and the Cochrane Library was conducted to include epidemiological studies from 1937 to August 2017. One reviewer screened all citations. Shortlisted full-text articles were independently assessed by a second reviewer. Data were extracted by one reviewer with a random sample of papers (45%) checked by a second reviewer.

Results

Forty-four studies were included; the majority of evidence was from cross-sectional studies, and some cohort studies. COPD patients had lower employment rates than those without COPD. Among those in work, most studies showed patients with COPD took more time off work than those without and reported poorer work performance (presenteeism), although evidence for this association was weaker. The influence of disease severity on these outcomes was unclear; however, it appeared that increasing severity of airflow obstruction was associated with reduced likelihood of being employed. A number of methodological limitations were found among the evidence, including the lack of adjustment for important confounders.

Conclusions

Future studies are required which assess the impact of COPD on presenteeism using validated presenteeism instruments and consistent reporting methods. Robust studies are now needed to identify modifiable factors associated with these poorer working outcomes to inform future interventions aimed at improving work productivity among those with COPD.

An assessment of the relationship between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status

INTRODUCTION

A study was conducted to assess if there is an association between pharmacy students' perceptions of their preparedness to contribute to emergency responses and their current work status.

METHODS

A cross-sectional analysis was conducted using data from a student perception survey completed by third-year pharmacy students. The survey collected demographic information on age, gender, level of education, ethnicity, and pharmacy-related work experience. A series of Likert scale items were used to assess students' perceptions regarding their competency in specific skills areas essential for participation in emergency responses. An independent samples t-test was used to compare mean scores for Likert scale items between working and nonworking students. Multivariate linear regression models were developed to determine if work status was an independent predictor of students' self-reported competencies after adjusting for covariates.

RESULTS

Sixty-six of 69 (95.7%) students completed the student perception survey. Students currently working in a pharmacy reported higher mean scores on several of the measured competencies. After covariates adjustment, current work status was associated with higher scores on self-reported competencies related to proficiency in evaluating information from patient assessment and collaborating with other individuals to develop processes related to the optimizing flow of care.

CONCLUSIONS

These results suggest that students who are working tend to have more confidence in their ability to contribute to emergency responses as well as work better in a team setting. Incorporating cases related to emergency response readiness in pharmacy curriculum may be needed to enhance skills and confidence of non-working pharmacy students.

Understanding work enjoyment among older workers: The significance of flexible work options and age discrimination in the workplace

Although the number of older workers in the U.S. is increasing, there is a gap in knowledge on whether or not they actually enjoy working. This study, based on a conceptual framework focusing on job resources and demands, explored likely workplace determinants of work enjoyment among older workers aged 50 or over. Using the 2012 wave of the Health and Retirement Study, a partial proportional odds model was used to detect determinants of work enjoyment. Results showed that higher levels of work enjoyment were significantly and negatively associated with the level of perceived retirement pressure and promotion preference for younger workers, and positively associated with moving to less demanding positions. Self-employment showed a noticeable enhancement of work enjoyment. This study highlights the significance of flexible work options and age discrimination in the workplace in understanding work enjoyment later in life.

What makes clinical labour different? The case of human guinea pigging

Each year thousands of individuals enrol in clinical trials as healthy volunteers to earn money. Some of them pursue research participation as a full-time or at least a part-time job. They call themselves professional or semiprofessional guinea pigs. The practice of paying healthy volunteers raises numerous ethical concerns. Different payment models have been discussed in literature. Dickert and Grady argue for a wage-payment model. This model gives research subjects a standardised hourly wage, and it is based on an assumption that research participation is morally indistinguishable from other forms of unskilled labour. In this paper, I will challenge this assumption. I will argue that human guinea pigging has particular characteristics which taken together make it significantly different from other forms of labour. (1) Participation in research is skill-independent. Healthy volunteers are valuable not because they are skilful persons, but because they are human bodies. (2) The role of research volunteers is mainly passive. They are not asked to produce goods or deliver services. They are paid for enduring unpleasant, painful and risky interventions performed by investigators. (3) Research volunteering involves inherent risks and uncertainties, and subjects have little or no control over their minimisation and materialisation. I conclude that participation in clinical research is a specific kind of activity. It is more like renting out one's body to strangers, than working. Thus, research participation should not be treated on par with other forms of employment.

A Study and Development of Workplace Facilities and Working Environment to Increase the Work Efficiency of Persons with Disabilities: A Case Study of Major Retail and Wholesale Companies in Bangkok

This research aims to improve the work effectiveness of people with physical disabilities in department stores, retail and wholesale companies in Bangkok. It focuses on the environment and facilities needed by people with three types of disabilities, visual impairment, hearing impairment, and wheelchair users. A mixed research method was used (questionnaires, interviews, and observations). The results were applied to a design process based on the needs of people with physical disabilities and addressed solving their work problems, increasing their work effectiveness, and bringing the results of the design to a group discussion. The group was made up of 15 experts who were supervisors, representatives of the people with each type of physical disability, instructors, and personnel from the university knowledgeable about universal design for people with disabilities. Architects and designers helped to brainstorm ideas and develop designs that led to production and product testing. Testing was conducted to compare pretest and posttest results using designed products to evaluate the work effectiveness of the people with physical disabilities using statistical analysis (paired t-tests). The results using developed products showed a higher average posttest score than pretest. This indicated a statistically higher work effectiveness (α =0.05) and supports the research hypothesis.

How to Find an Academic Position After Residency: Who, What, When, Where, Why, and How

Introduction

Transitioning from trainee to practicing physician is a process that is not frequently discussed during postgraduate training, but such a discussion is necessary if the number of academic physicians is to increase and physicians from underrepresented communities are to gain insight about the varied opportunities to join academe. This workshop combines a case-based format in its didactic portion with a step-by-step guide and time line to introduce the process for securing an academic position postresidency.

Methods

Kern's six-step model was used as the framework for the workshop's design, delivery, and assessment. The workshop was presented to medical students and residents at a series of programs fostering the development of the next generation of academic physicians that were offered at host medical schools across the US between July 2016 and May 2017.

Results

Evaluation data were collected from 64 participants from nine academic medicine conferences across the nation. In comparing pre- and postworkshop responses, there was a statistically significant increase in confidence to find an academic position after residency (1.95 vs. 3.18, paired-sample t test, p < .001). More than 90% of respondents agreed or strongly agreed that the workshop's three objectives were met. Participants commented that they appreciated discussions on contracts and the steps they should take following residency in order to successfully obtain an academic position.

Discussion

This workshop may assist trainees in making better-informed decisions about considerations that are important for finding and retaining an academic position long-term.

Will Analytics Suppress a Diversity of Ideas in Psychological Science?

In this article, I suggest that an overreliance on analytics to assess faculty productivity and the diffusion of ideas may inadvertently suppress innovation. Even when these productivity-diffusion metrics are used to promote an individual's work, the use of such external guideposts may bias scientific choices and curb a psychological scientist's earnest inclination to synthesize or take scientific risks. Analytics are not inert but can change the path and progress of science itself, potentially reducing the diversity of ideas in psychological science. This potential harm may most affect new scholars at the beginning of their independent research careers.

VR Employment Outcomes of Individuals with Autism Spectrum Disorders: A Decade in the Making

This study utilized hierarchical linear modeling analysis of a 10-year extant dataset from Rehabilitation Services Administration to investigate significant predictors of employment outcomes for vocational rehabilitation (VR) clients with autism. Predictor variables were gender, ethnicity, attained education level, IEP status in high school, secondary disability status, and total number of VR services. Competitive employment was the criterion variable. Only one predictor variable, Total Number of VR Services, was significant across all 10 years. IEP status in high school was not significant in any year. The remaining predictors were significant in one or more years. Further research and implications for researchers and practitioners are included.

Predictors of transitions from single to multiple job holding: Results of a longitudinal study among employees aged 45-64 in the Netherlands

Objectives

To construct prediction models for transitions to combination multiple job holding (MJH) (multiple jobs as an employee) and hybrid MJH (being an employee and self‐employed), among employees aged 45‐64.

Methods

A total of 5187 employees in the Netherlands completed online questionnaires annually between 2010 and 2013. We applied logistic regression analyses with a backward elimination strategy to construct prediction models.

Results

Transitions to combination MJH and hybrid MJH were best predicted by a combination of factors including: demographics, health and mastery, work characteristics, work history, skills and knowledge, social factors, and financial factors. Not having a permanent contract and a poor household financial situation predicted both transitions. Some predictors only predicted combination MJH, e.g., working part‐time, or hybrid MJH, e.g., work‐home interference.

Conclusions

A wide variety of factors predict combination MJH and/or hybrid MJH. The prediction model approach allowed for the identification of predictors that have not been previously studied.

Job retention vocational rehabilitation for employed people with inflammatory arthritis (WORK-IA): a feasibility randomized controlled trial

BACKGROUND

Inflammatory arthritis leads to work disability, absenteeism and presenteeism (i.e. at-work productivity loss) at high cost to individuals, employers and society. A trial of job retention vocational rehabilitation (VR) in the United States identified this helped people keep working. The effectiveness of this VR in countries with different socioeconomic policies and conditions, and its impact on absenteeism, presenteeism and health, are unknown. This feasibility study tested the acceptability of this VR, modified for the United Kingdom, compared to written advice about managing work problems. To help plan a randomized controlled trial, we tested screening, recruitment, intervention delivery, response rates, applicability of the control intervention and identified the relevant primary outcome.

METHODS

A feasibility randomized controlled trial with rheumatoid, psoriatic or inflammatory arthritis patients randomized to receive either job retention VR or written information only (the WORK-IA trial). Following three days VR training, rheumatology occupational therapists provided individualised VR on a one to one basis. VR included work assessment, activity diaries and action planning, and (as applicable) arthritis self-management in the workplace, ergonomics, fatigue and stress management, orthoses, employment rights and support services, assistive technology, work modifications, psychological and disclosure support, workplace visits and employer liaison.

RESULTS

Fifty five (10%) people were recruited from 539 screened. Follow-up response rates were acceptable at 80%. VR was delivered with fidelity. VR was more acceptable than written advice only (7.8 versus 6.7). VR took on average 4 h at a cost of £135 per person. Outcome assessment indicated VR was better than written advice in reducing presenteeism (Work Limitations Questionnaire (WLQ) change score mean: VR = -12.4 (SD 13.2); control = -2.5 (SD 15.9), absenteeism, perceived risk of job loss and improving pain and health status, indicating proof of concept. The preferred primary outcome measure was the WLQ, a presenteeism measure.

CONCLUSIONS

This brief job retention VR is a credible and acceptable intervention for people with inflammatory arthritis with concerns about continuing to work due to arthritis.

TRIAL REGISTRATION

ISRCTN 76777720 . Registered 21.9.12.

Employment and choice-making for adults with intellectual disability, autism, and down syndrome

BACKGROUND

Adults with disabilities are employed at a significantly lower rate than adults without disabilities. Of adults with disabilities in the workforce, more individuals work in a facility setting rather than a community setting, despite efforts to improve community inclusion. Choice-making has been proposed as a predictive factor for employment for individuals with disabilities.

AIMS

The purpose of this research was to examine the current state of employment for three groups of adults with intellectual disability (ID): individuals with autism spectrum disorder (ASD), individuals with Down syndrome (DS), and individuals with idiopathic ID. Choice-making and its relation to improved employment outcomes was explored.

METHODS

This study used National Core Indicator's Adult Consumer Survey datasets from years 2011-2012 and 2012-2013. Factor analyses revealed latent variables from six choice-making questions in the Adult Consumer Survey. Ordinal logistic regression was used to identify factors related to employment status.

RESULTS

Adults with DS had the highest rates of paid community jobs, but adults with ID had the highest rates of choice-making. ID severity level and short-term choice-making had the greatest effects on employment status in all three groups.

CONCLUSIONS

Employment rates remain low despite national efforts to find jobs for people with disabilities. Choice-making is a unique factor that was found to be associated with employment status and provides a target for interventions to increase employability.

Costs and Effectiveness of Treating Homeless Persons with Cocaine Addiction with Alternative Contingency Management Strategies

BACKGROUND

Between 1990 and 2006 in Birmingham, Alabama USA, 4 separate randomized controlled studies, called "Homeless 1" through "Homeless 4", treated cocaine substance abuse among chronically homeless adults, largely black men, many with non-psychotic mental health problems. The 4 studies had 9 treatment arms that used various counseling methods plus, in some arms, the provision of housing and work therapy usually with a contingent requirement of urine-test verified abstinence from substances. Participants in the abstinent-contingent arms who lapsed on abstinence were removed from housing and sent to an evening public shelter from which they were daily transported to day treatment until they returned to abstinence.

AIMS OF THE STUDY

This paper compares the cost effectiveness of the treatment arms.

METHODS

Societal cost per participant (in 2014 dollars) for each arm is defined as direct treatment cost plus cost of jail or hospital plus societal expense of public shelter use by lapsed participants. An untreated Base Case is defined as 5 percent abstinence with 95 percent usage of a public shelter. Incremental Cost Effectiveness Ratios (ICERs) for paired arms are defined as the change in cost per participant divided by the change in abstinence. Bootstrapping estimates confidence intervals.

RESULTS

Average cost per participant at the end of 6 months of active treatment in 7 arms with comparable data ranged from USD 10,447 to USD 36,194 with corresponding average weeks abstinent ranging from 6.1 to 15.3 out of a possible 26 weeks. In contrast, the Base Case would cost USD 6,123 for 1.3 weeks of abstinence. Compared to the Base Case, the least expensive "DT2" treatment has an ICER of USD 901 (95% CI = USD 571 to USD 1,681) per additional week of abstinence and the most expensive "CMP4" has an ICER of USD 2,147 (95% CI = USD 1,701 to USD 2,848). Additionally, the Homeless 3 study found that the abstinent contingent housing (ACH3) treatment compared to the Non Abstinent Contingent Housing (NAC3), analogous to "Housing First", achieved better abstinence (12.1 v. 10 weeks) at higher average cost (USD 22,512 v. USD 17,541) yielding an ICER for this comparison of (USD 2,367, 95% CI=USD -10,587 to USD 12,467). Similar results are found at 12 months (6 months after active treatment).

DISCUSSION

More intensive methods of counseling improved abstinence but 4 of the 7 treatments were inefficient ("dominated"). Bootstrapping shows that results are sensitive to which individuals were randomly assigned to each arm. A limitation of the analysis is that it does not consider the full societal cost of lost wages, crime costs beyond jail expenses and deterioration of neighborhood quality of life. Additionally, populations treated by Housing First programs may differ from the Birmingham Homeless studies in the severity of addiction or co-occuring psychological problems.

IMPLICATIONS FOR TREATMENT

The Homeless studies show that abstinent contingent safe housing with counseling can substantially improve abstinence for homeless cocaine abusers. Incremental costs rise sharply with more intensive counseling; modest programs of counseling may be more cost effective in a stepped treatment strategy.

Employment implications of informal cancer caregiving

PURPOSE

Previous research describing how informal cancer caregiving impacts employment has been conducted in small samples or a single disease site. This paper provides population-based estimates of the effect of informal cancer caregiving on employment and characterizes employment changes made by caregivers.

METHODS

The samples included cancer survivors with a friend or family caregiver, participating in either the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Survey (ECSS) (n = 458) or the LIVESTRONG 2012 Survey for People Affected by Cancer (SPAC) (n = 4706). Descriptive statistics characterized the sample of survivors and their caregivers' employment changes. Multivariable logistic regression identified predictors of caregivers' extended employment changes, comprising time off and changes to hours, duties, or employment status.

RESULTS

Among survivors with an informal caregiver, 25 % from the ECSS and 29 % from the SPAC reported that their caregivers made extended employment changes. Approximately 8 % of survivors had caregivers who took time off from work lasting ≥2 months. Caregivers who made extended employment changes were more likely to care for survivors: treated with chemotherapy or transplant; closer to diagnosis or end of treatment; who experienced functional limitations; and made work changes due to cancer themselves compared to caregivers who did not make extended employment changes.

CONCLUSIONS

Many informal cancer caregivers make employment changes to provide care during survivors' treatment and recovery.

IMPLICATIONS FOR CANCER SURVIVORS

This study describes cancer caregiving in a prevalent sample of cancer survivors, thereby reflecting the experiences of individuals with many different cancer types and places in the cancer treatment trajectory.