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Nguyen NAT, Auquier P, Beltran Anzola A, d'Oiron R, Biron-Andréani C, Lienhart A, Rauch A, Baumstarck K, Boucekine M, Milien V, Rosso-Delsemme N, Tabele C, Giraud N, Sannié T, Chambost H, Resseguier N. Occupational integration of adults with severe haemophilia (INTHEMO): A study based on the FranceCoag registry. Haemophilia 2022; 28:962-976. [PMID: 35858674 DOI: 10.1111/hae.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Health of people with severe haemophilia (PwSH) improves thanks to the advancements in haemophilia care, giving them more opportunities in occupational integration. However, there is little literature on the occupational integration of PwSH. OBJECTIVES The main objective of our study was to assess the occupational integration of PwSH and to compare it with that of the general population. The secondary objective was to study the association between individual characteristics (sociodemographic, clinical and psycho-behavioural) and occupational integration of PwSH. METHODS A multicentre, non-interventional, cross-sectional study was conducted in 2018-2020 on PwSH, aged over 18 and under 65 years and included in the FranceCoag registry. Measurements included indicators of occupational integration, sociodemographic, clinical and psycho-behavioural characteristics. The indicators of occupational integration were compared with those of the general population, using indirect standardization. The data of the general population were available from the National Institute of Statistics and Economic Studies (INSEE). Determinants of occupational integration were explored using structural equation modelling. RESULTS Of 1262 eligible people, 588 were included. PwSH had a lower employment rate than the general population (standardized ratio, .85; 95% CI, .77-.94). There were more PwSH at tertiary education level than expected (standardized ratio, 1.38; 95% CI, 1.17-1.61). HIV infection, poor physical health and mental health concerns were associated with a higher risk of unemployment in PwSH. CONCLUSION Employment rate of PwSH is lower than that of the general population despite their higher education level. Target interventions focusing on determinants of difficult occupational integration could be helpful for PwSH.
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Affiliation(s)
- Ngoc Anh Thu Nguyen
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Pascal Auquier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Any Beltran Anzola
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
| | - Roseline d'Oiron
- Haemophilia Treatment Centre, Bicêtre Hospital, University Hospital of Paris (APHP), Kremlin-Bicêtre, France
| | | | - Anne Lienhart
- Haemophilia Treatment Centre, Hospital Edouard Herriot, University Hospital of Lyon, Bron, France
| | - Antoine Rauch
- Haemophilia Treatment Centre, University Regional Hospital of Lille, Lille, France
| | - Karine Baumstarck
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Mohamed Boucekine
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France.,FranceCoag Network, Marseille, France
| | - Vanessa Milien
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Natacha Rosso-Delsemme
- Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Clemence Tabele
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,FranceCoag Network, Marseille, France
| | - Nicolas Giraud
- Association française des hémophiles (AFH), Paris, France
| | - Thomas Sannié
- Association française des hémophiles (AFH), Paris, France
| | - Hervé Chambost
- FranceCoag Network, Marseille, France.,Haemophilia Treatment Centre, Timone Hospital, University Hospital of Marseille (APHM), Marseille, France
| | - Noémie Resseguier
- CEReSS - Health Services and Quality of Life Research, Aix Marseille University, Marseille, France.,Methodological Support Unit for Clinical and Epidemiological Research, University Hospital of Marseille (APHM), Marseille, France
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Smith N, Lane SJ, King J, Waterhouse L, Bartholomew C, Jackson S. Vocational experiences and career support opportunities among Canadian men with moderate and severe haemophilia. Haemophilia 2019; 25:441-446. [PMID: 30817061 DOI: 10.1111/hae.13701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/19/2018] [Accepted: 01/21/2019] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this research was to provide haemophilia treatment centres (HTCs) with guidance for the potential development of appropriate and timely interventions related to employment and vocational counselling and supports. METHODS A multi-method approach was employed, where initial focus groups (n = 13) and review of the literature were used to construct a structured survey instrument (n = 75). RESULTS Focus group participants made choices about employment with keen awareness of how their bleeding disorder might limit them physically; they described the role of social networks in career choices; and they wrestled with issues of disclosure. Among survey respondents, 47% per cent of respondents reported that haemophilia had a small negative impact, 27% felt that it had a moderate negative impact and 13% indicated that it had a very large negative impact. One-third of respondents had at some point received employment-related advice from a member of their haemophilia treatment centre team. Roughly two-thirds of respondents suggested that vocational advice would be "somewhat" or "very" useful at present. CONCLUSION Canadian men with haemophilia continue to experience challenges related to employment and career development. There appears to be an opportunity for HTCs to incorporate additional supports on these topics into the range of services which they currently provide.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shannon J Lane
- Department of Medicine, McMaster Centre for Transfusion Research, McMaster University, Hamilton, Ontario, Canada
| | - Jennifer King
- Saskatchewan Bleeding Disorders Program, LiveWell Chronic Disease Management - Saskatoon, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada
| | - Linda Waterhouse
- McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | | | - Shannon Jackson
- Division of Hematology, Department of Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Holstein K, von Mackensen S, Bokemeyer C, Langer F. The Impact of Bleeding Disorders on the Socioeconomic Status of Adult Patients. Hamostaseologie 2018; 38:150-157. [PMID: 30261520 DOI: 10.5482/hamo-16-12-0047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The impact of inherited bleeding disorders on the socioeconomic status (SES) of affected individuals is not clear. The SES of adult patients with congenital bleeding disorders (PWBD) from a centre in Germany (age 42.3 ± 15.0 years) was compared to that of a gender- and age-matched control group of patients with thrombophilia or a thrombotic event (PWT). Patients completed a questionnaire including aspects of SES, impact of the disease on their lives, and health-related quality of life (HRQoL). Forty-five patients were enrolled in each group; 71 % of PBWD had a severe form of the bleeding disorder (FVIII/IX activity < 1 % or VWD type 3), and 60 % of all PWBD were treated on-demand. PWBD had a lower monthly income (p = 0.029) and a worse occupational status (p = 0.047) than PWT, but there was no difference regarding the project-specific SES index. PWBD also reported a worse HRQoL in the physical summary component score of the SF-36 (p < 0.001). More PWBD (69.8 %) reported a high impact of the disease on their lives than PWT (33.3 %, p < 0.001). In summary, PWBD had a worse occupational status, monthly income, health behaviour, HRQoL, and impact of the disease on their lives compared to PWT, but not a significantly different SES in general.
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Affiliation(s)
- Katharina Holstein
- II. Medical Department, Haemophilia Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Sylvia von Mackensen
- Institute of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- II. Medical Department, Haemophilia Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Langer
- II. Medical Department, Haemophilia Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Chu WM, Ho HE, Wang JD, Chan WC, Liou YS, Ho WC, Hu SY, Tsan YT. Risk of major comorbidities among workers with hemophilia: A 14-year population-based study. Medicine (Baltimore) 2018; 97:e9803. [PMID: 29419677 PMCID: PMC5944666 DOI: 10.1097/md.0000000000009803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Multiple comorbidities, especially musculoskeletal dysfunction and cerebrovascular disease, remain barriers to normal social participation among persons with hemophilia (PWH). However, the relative health effects of such comorbidities on workers with hemophilia have seldom been explored. In this study, we investigated the incidence of comorbidities and their risk factors among workers with hemophilia.The study compared the incidence and risk factors of the major comorbidities of 411 workers with hemophilia enrolled in Taiwan's National Health Insurance Research Database between 1997 and 2010 with an age- and sex-matched general population.Compared with the general population, workers with hemophilia had higher risks for hemorrhagic stroke, arthritis/arthropathy, and knee/hip replacement among workers with hemophilia after multivariate adjustment, with hazard ratios (95% CI) of 4.60 (2.81-7.53), 4.03 (3.34-4.87), and 1.29 (1.10-1.41), respectively.Disorder of joints, hemophilia-related arthritis/arthropathy, hemorrhagic stroke, and knee/hip replacement remain significant comorbidities among workers with hemophilia, which will result in increased social burden. Policymakers and employers should apply appropriate interventions to help prevent productivity losses, reduced workforce participation, sick leave, and work disability among hemophilia workers.
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Affiliation(s)
- Wei-Min Chu
- Institute of Medicine, Chung Shan Medical University, Taichung
- Department of Family Medicine, Taichung Veterans General Hospital, Chiayi Branch, Chia-Yi
- School of Medicine, National Yang-Ming University, Taipei
| | - Hsin-En Ho
- Department of Family Medicine, Taichung Armed Forces General Hospital
| | - Jiaan-Der Wang
- Center for Rare Disease and Hemophilia, Department of Pediatrics, Taichung Veterans General Hospital
- School of Medicine, China Medical University, Taichung
| | - Wei-Cheng Chan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City
| | - Yi-Sheng Liou
- School of Public Health, National Defense Medical Center, Taipei
- Department of Family Medicine, Taichung Veterans General Hospital
| | - Wen-Chao Ho
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Sung-Yuan Hu
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City
- Department of Nursing, College of Health, National University of Taichung Science and Technolog
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Tse Tsan
- Division of Occupational Medicine, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung City
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Curtis R, Baker J, Riske B, Ullman M, Niu X, Norton K, Lou M, Nichol MB. Young adults with hemophilia in the U.S.: demographics, comorbidities, and health status. Am J Hematol 2015; 90 Suppl 2:S11-6. [PMID: 26619192 DOI: 10.1002/ajh.24218] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/13/2015] [Indexed: 12/19/2022]
Abstract
Improvements in hemophilia care over the last several decades might lead to expectations of a near-normal quality of life for young adults with hemophilia. However, few published reports specifically examine health status indicators in this population. To remedy this knowledge gap, we examined the impact of hemophilia on physical and social functioning and quality of life among a national US cohort of 141 young men with hemophilia aged 18-34 years of age who received care at 10 geographically diverse, federally funded hemophilia treatment centers in 11 states between 2005 and 2013 and enrolled in the Hemophilia Utilization Group Studies. Indicators studied included educational achievement, employment status, insurance, health-related quality of life, and prevalence of the following comorbidities: pain, range of motion limitation, overweight/obesity, and viral status. The cohort was analyzed to compare those aged 18-24 to those aged 25-34 years. When compared to the general US adult population, this nationally representative cohort of young US adults with hemophilia experienced significant health and social burdens: more liver disease, joint damage, joint pain, and unemployment as well as lower high-school graduation rates. Nearly half were overweight or obese. Conversely, this cohort had higher levels of health insurance and equivalent mental health scores. While attention has typically focused on newborns, children, adolescents, and increasingly, on older persons with hemophilia, our findings suggest that a specific focus on young adults is warranted to determine the most effective interventions to improve health and functioning for this apparently vulnerable age group.
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Affiliation(s)
| | - Judith Baker
- The Center for Comprehensive Care & Diagnosis of Inherited Blood Disorders, Orange, CA and University of California Los Angeles; California
| | - Brenda Riske
- University of Colorado, Hemophilia and Thrombosis Center; Aurora Colorado
| | - Megan Ullman
- Gulf States Hemophilia & Thrombophilia Center, University of Texas Health Science Center at Houston; Texas
| | - Xiaoli Niu
- University of Southern California; Los Angeles California
| | - Kristi Norton
- University of Colorado, Hemophilia and Thrombosis Center; Aurora Colorado
| | - Mimi Lou
- University of Southern California; Los Angeles California
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Holstein K, von Mackensen S, Bokemeyer C, Langer F. The impact of social factors on outcomes in patients with bleeding disorders. Haemophilia 2015. [DOI: 10.1111/hae.12760] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- K. Holstein
- II. Medical Department; Haemophilia Centre; University Medical Centre; Hamburg Germany
| | - S. von Mackensen
- Institute of Medical Psychology; University Medical Centre; Hamburg Germany
| | - C. Bokemeyer
- II. Medical Department; Haemophilia Centre; University Medical Centre; Hamburg Germany
| | - F. Langer
- II. Medical Department; Haemophilia Centre; University Medical Centre; Hamburg Germany
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Abstract
The introduction of replacement therapy in the 1960s has improved medical and social circumstances gradually. The availability of prophylactic treatment has further increased the possibilities of a “normal” life for patients with hemophilia. We examined whether social participation and health-related quality of life (HRQol) of today's hemophilia patients differs from the general male population. There were a total of 721 participants in the Hemophilia in the Netherlands 5 study (HiN-5 study) ages 16 to 64 years. Patients with severe hemophilia participated less in full-time work compared with the general population. Occupational disability was reported by 35% of patients with severe hemophilia between ages 31 and 64 years, compared with 9% in the general population. HRQol of patients with severe hemophilia between ages 31 and 64 years was lower than of the general population. The differences with the general population in HRQol were least pronounced for patients between ages 16 and 30 years. Despite major improvements in treatment during the last decades, patients with hemophilia are still less involved in full-time paid work and suffer more from occupational disability than men from the general population. After the introduction of prophylactic treatment, the number of patients who are occupationally disabled is reduced.
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Varekamp I, Smit C, Rosendaal FR, Bröcker-Vriends A, Briët E, van Dijck H, Suurmeijer TP. Employment of individuals with haemophilia in The Netherlands. Soc Sci Med 1989; 28:261-70. [PMID: 2919313 DOI: 10.1016/0277-9536(89)90269-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A study was performed to determine whether improvements in the treatment of haemophilia over the past 20 years have influenced the prospects of these patients in the labour market. Surveys on the medical and social situation of haemophiliacs in The Netherlands were carried out in 1972, 1978 and 1985. Most of the patients participated in these surveys. Trends in employment do not show either an increase in the number of employed haemophiliacs or a decrease in the number administratively defined as disabled. However, considering the influence of the economic recession on the position of the chronically sick on the labour market and the rise in the number administratively defined as disabled in the Dutch population, haemophiliacs perform well. Sick leave has decreased considerably. Although the employment rate for the group of haemophiliacs is lower than that for the general male population, the level of employment in relation to educational achievements is high and most of the employed do not feel limited in their daily job activities by the haemophilia. Physical mobility is a main factor influencing the employment status but other factors, such as the type of occupation or former occupation and prejudice against people with haemophilia, have to be considered.
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Affiliation(s)
- I Varekamp
- Department of Medical Sociology, State University Groningen, The Netherlands
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