[Factors associated with caregiver burden in primary caregivers of older adults with type2 diabetes]

OBJECTIVE

To characterize the profile of the informal primary caregiver (IPC) of adult patients with type2 diabetes (T2D) and the possible factors associated with caregiver collapse (CC).

DESIGN

Observational, descriptive, cross-sectional and analytical study. SITE: Ambulatory Care Medical Unit.

PARTICIPANTS

Mexican CPIs of adult patients with T2D.

MAIN MEASUREMENTS

Data were collected through a prolective design using the Zarit scale and a structured survey on sociodemographic factors. A descriptive statistical analysis and univariate and multivariate logistic regression models were performed.

RESULTS

The CPI profile is assumed by: women, people aged 36-58, daughters, people with a secondary and high school educational level, married, Catholic, with income <8,900 Mexican pesos, own home, inhabited by a maximum of 5 inhabitants, with support networks, who have dedicated >5years to the care of their patient, without training and with chronic diseases. The risk factors that increase the risk of CC are: being a woman (OR=11.03; 95%CI: 1.49-81.95), having a history of more than 5years of having assumed the role of caregiver (OR=2, 65; 95%CI: 1.07-6.55), living in one's own house (OR=3.03; 95%CI: 1.04-8.82), with 6 or more inhabitants (OR=2.41; 95%CI: 1.08-5.38). The support of other family members and/or friends was associated as a protective factor (OR=0.15; 95%CI: 0.07-0.33).

CONCLUSIONS

Prevention programs are required to avoid CC and complications, as well as interventions to improve the quality of life of the CPI and patients in care, incorporating strategies to generate and/or increase their family and social support networks.

Trapped in vicious cycles: unraveling the health experiences and needs of adults living with socioeconomic insecurity

BACKGROUND

This study explores the role of health in daily life and needs of Dutch adults (aged 25-49) experiencing one or more forms of socioeconomic insecurity stemming from their financial, housing, or employment situations.

METHODS

28 in-depth, semi-structured interviews were conducted in the Netherlands between October 2022 and February 2023. The interview guide included questions on participants' socioeconomic situation, the role of health in their daily lives, their health-related and broader needs. Data was interpreted using inductive reflexive thematic analysis. An advisory board consisting of adults with lived experiences of socioeconomic insecurity were consulted at multiple stages of the study (recruitment, interview guide, interpretation of results).

RESULTS

Housing insecurity was widely experienced by participants. When asked about their financial situation, most participants expressed having no issues getting by, but later on, described vigorous efforts to minimize expenses. Participants' narratives revealed four key themes in relation to the role of health in daily life and associated needs. Firstly, socioeconomic insecurity led to diminished control over life, which led to the disruption of routines. Secondly, experiencing socioeconomic insecurity compelled participants to prioritize stress reduction and mental health improvement through calming yet potentially damaging coping mechanisms. Thirdly, those who experienced little opportunity for improvement in their already long-lasting socioeconomic insecurity shared a sense of stagnation in life, which co-occurred with stagnation in unhealthy routines and diminished well-being. Fourthly, participants expressed the need for someone to speak with. This support may help participants regain control over their lives, identify opportunities for more socioeconomic security, and focus on increased health and well-being.

CONCLUSIONS

This study sheds light on the challenges individuals face in dealing with socioeconomic insecurity, how it may affect their health, and their needs. Gaining perspective for improved socioeconomic security and having accessible professional support tailored to self-identified needs could have health-promoting effects for individuals living with socioeconomic insecurity. It is recommended to integrate professional support and assistance regarding social security into health policies and interventions. In future research, measures of financial strain should be adjusted to include the effort needed to get by.

Predicting the risk of becoming eligible for the disability pension: Machine learning methods applied to French health data

Introduction

Benefiting from the disability pension implies morbid (physical and psychological) and social (fall in income) implications for the person. It also has economic consequences for society, with increasing expenses since 2011 (+4.9% on average per year). Investing in preventive actions against the loss of the ability to work should limit these consequences, but it requires targeting people at risk. The development of artificial intelligence opens up prospects in this regard.

Purpose of the Research

To target, using supervised machine learning methods, those people with a high probability of becoming eligible for the disability pension over the course of the year based on their socio-demographic and medical characteristics (pathologies, work stoppages, drugs taken, and medical procedures).

Method

Among the beneficiaries of the French public welfare system aged 20–64 in 2017, we compared the socio-demographic and medical characteristics between 2014 and 2016 of those who received a disability pension in 2017 and not before, and those who did not receive a disability pension from 2014 to 2017. The determination of the boundary between these two groups was tested using logistic regression, decision trees, random forests, naive Bayes classifiers, and support vector machines. The models’ performance was compared with respect to accuracy, precision, sensitivity, specificity, and AUC (area under the curve). Finally, the predictive power of each factor was measured by AUC too.

Results

The boosted logistic regression had the best performance for three of the five criteria, but low sensitivity. The best sensitivity was obtained with the support vector machines, with an accuracy close to that of the boosted logistic regression, but a lower precision and specificity. Random forests offered the best discriminatory ability. The naive Bayes classifier had the worst performance. The most predictive factors in becoming eligible for the disability pension were having 30 days or more off sick in 2014, 2015, and 2016 and being aged 55 to 64.

Conclusion

Supervised learning methods have appeared relevant for identifying people with the highest probability of becoming eligible for the disability pension and, more broadly, for steering public and social policies.

The Exit Strategy: Preparing for Retirement

Retiring from any occupation is difficult, especially one that you love. The majority of cardiothoracic surgeons love what they do every day. It has been said that if you choose a job you love, you never have to work another day in your life. Once a date is determined, preparation, particularly financial, is paramount for a successful outcome. Thoughtful decisions need to be made regarding health benefits and retirement plans [401(k)/403(b)]. Transitions to retirement programs have been instituted in several schools of medicine. Establishing an academy for retired faculty can be an enriching experience for the members and a resource for the institution.

Whoever wants better healthcare simply pays more: citizens' perception about voluntary private health insurance in Colombia

OBJECTIVES

To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems.

METHODS

A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines.

RESULTS

We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities.

CONCLUSIONS

These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

The economic impact of stroke in Brazil, 2010-2019: Increase in public expenses of Unified Health System

OBJECTIVES

To economically analyze the impact that outpatient and inpatient spending of the Unified Health System and social security expenses of the General Regime of Social Security generated to the Brazilian public system, between 2010 and 2019.

MATERIALS AND METHODS

Observational research, in which public data from the SUS Department of Informatics and the Social Security Historical Database were used, according to 10ª International Classification of Diseases code, I-64 (Stroke, not specified if hemorrhagic or ischemic). The Kruskal-Wallis test, complemented by Dunn's post-hoc test, and Spearman's bivariate correlation test were used to check for differences and correlations between variables. The expenditures were adjusted for inflation for the year 2019 and presented in american dollar s(U$).

RESULTS

Stroke public spending impacted an average of 120 million dollars per year and increased 15% during the historical series. Eighty-nine percent of these expenditures originated from hospital spending (p<0.05). On average, stroke accounted for 7.3% of spending on cardiovascular diseases and 0.72% of spending on the other codes of 10ª International Classification of Diseases. Total spending showed a positive correlation with the historical series (r=.702; p<0.05), with the increase in the elderly population (over 60 years of age) (r=.676; p<0.05) and with Gross Domestic Product per capita (r=.784; p<0,05).

CONCLUSIONS

The impact that stroke generated on public spending increased over the historical series, mainly due to hospital spending and by the prospect of increasing elderly population in Brazil, public spending tends to rise.

Is there a sexual difference in the relationship between sociodemographic information and the unmet dental care needs of disabled adults? An analysis from a national survey on persons with disabilities

BACKGROUND

Health status and health care utilization in people with disabilities are more likely to be poorer than those without disabilities. Previous studies showed that there were gaps in health-related conditions by sociodemographic information and gender but the association between these factors was not explained. This study aims to analyze the relationship between sociodemographic information and the unmet dental care needs of people with disabilities and explore the effect of sex within this relationship.

METHODS

The 2014 national survey on persons with disabilities was used, which separated unmet healthcare needs into medical and dental services. Unweighted samples included 6,824 people with disabilities in total and 6,555 (96.1% of the total, weighted as 6,583) people aged 20 years or older were selected as the study population. Frequency and chi-square tests were conducted to determine differences in the prevalence of unmet dental needs based on socioeconomic information, chronic diseases, and behavioral factors after applying weights. Logistic regressions were performed using an adjusted model with sociodemographic information, chronic diseases, and behavioral variables. All analyses were performed using IBM SPSS Statistics for Windows, version 26 (IBM Corp., Armonk, N.Y., USA).

RESULTS

Analysis of the sociodemographic factors related to unmet dental care revealed that they were higher in women and the elderly. In the fully adjusted logistic model, most of the sociodemographic information was significantly associated with unmet dental needs. The lowest group was 4.18 times more likely to have unmet dental care needs than the richest group, and females and middle-school graduates were almost twice as likely to experience unmet dental care needs than males and university graduates. Considering the interaction effect of age on unmet dental needs depending on sex differences, the odds ratio decreased for females with every annual increase in both models. Compared with the younger group, the older group showed a lower risk of having unmet dental needs, especially in females.

CONCLUSIONS

The factor most closely related to the unmet dental care needs of disabled people was socioeconomic problems. Its influence also differed by sex and age. Therefore, economic support measures and sexual differences are needed for long-term policy consideration to reduce the unmet dental care needs of disabled people.

Spatial variation in livelihood security among livestock-based agricultural farming systems in climatically vulnerable Indian Sundarbans

Farm households in the UNESCO World Heritage site Sundarbans face serious problems, including increased soil salinity, frequent extreme weather events, seawater intrusion and flood damage, all of which cause distress to the livelihoods of the farm families. Policymakers commonly acknowledge livestock as a crucial resource for mitigating economic losses caused by crop failures due to extreme weather events. Despite Sundarbans' vulnerability to extreme weather events, smallholder farmers' livelihoods vary across the region. Identifying spatial livelihood variations aids in targeted strategies to address climate extremes. We chose the highest cow- and buffalo-populated blocks among the 19 blocks in the Sundarbans to assess variations in livelihood dimensions, including nutritional, economic, social and infrastructural security. We used dummy variable regression models to examine the differences in livelihood security dimensions among households living in different locations. The study found that Namkhana had the highest livelihood security score among the blocks studied, while Gosaba had the lowest score because it's in a remote area with limited infrastructure. The study found a significant difference in the overall livelihood security score among the blocks we examined, indicating the need for a location-specific, cluster-based approach for the overall development of the Sundarbans. The study can shape a policy framework for socio-economic development in the Indian Sundarbans through its findings on location-specific livelihood security. For securing smallholder farmers' livelihoods in the vulnerable Sundarbans region, policymakers must give priority to improving infrastructure, viz., roads, marketing facilities and animal healthcare centers.

Transition between social protection systems for workers with long term health problems: A controlled retrospective cohort study

Many nations have established workers' compensation systems as a feature of their social protection system. These systems typically provide time-limited entitlements such as wage replacement benefits and funding for medical treatment. Entitlements may end for workers with long-term health conditions before they have returned to employment. We sought to determine the prevalence of transitions to alternative forms of social protection, specifically social security benefits, among injured workers with long-term disability, when workers' compensation benefits end. We linked Australian workers' compensation and social security data to examine receipt of social security payments one year before and after workers' compensation benefit cessation. Study groups included (1) injured workers whose workers' compensation benefits ceased due to reaching a 260-week limit introduced by legislative reform (N = 2761), (2) a control group of injured workers with at least 104 weeks workers compensation income support (N = 3890), and (3) a matched community control group (N = 10,114). Adjusted binary logistic regression examined the odds of transitions to social security in the injured worker groups relative to the community control group. Within 12 months of workers' compensation benefit cessation, 60% (N = 1669) of the exposed group received social security payments, of which 41% (N = 1120) received the unemployment allowance and 19% (N = 516) the disability pension. Among the work injured control group, 42% (N = 1676) received social security payments after workers compensation benefits ceased. Transitions to social security payments were significantly more common than community levels for both exposed (OR 25.0, 95%CI = 20.7, 30.1) and work injured control groups (OR 4.7, 95%CI = 4.2, 5.3). Many injured workers with long-term health problems transition to social security when their workers' compensation benefits cease. Transitions were more common among workers whose claims ended due to legislative reform which time-limited benefits. Design and implementation of system level policy reform should consider the social and economic impacts of transitions between separate social protection systems.

Evaluación de riesgos y mejora de la seguridad biológica y radiológica en la toma de radiografía torácica a pacientes con COVID-19

INTRODUCTION

Health workers are at high risk of becoming infected with COVID-19. The objective of the study was to evaluate the risks and improve the biological and radiological safety measures for taking chest X-rays in patients with COVID-19 in a Social Security hospital in Utcubamba (Peru).

MATERIAL AND METHODS

Quasi-experimental intervention study type before and after without a control group, carried out between May and September 2020. A process map and an analysis of failure modes and effects (FMEA) of radiological care were prepared. The gravity (G), occurrence (O), and detectability (D) values ??were found and the risk priority number (RPN) was calculated for each failure mode (FM). FM with RPN ≥ 100 and G ≥ 7 were prioritized. Improvement actions were implemented based on the recommendations of recognized institutions and the O and D values ??were re-evaluated.

RESULTS

The process map consisted of 6 threads and 30 steps. 54 FM were identified, 37 of whom had RPN ≥ 100 and 48 had G ≥ 7. Most of the errors occurred during the examination 50% (27). After entering the recommendations, 23 FM had RPN ≥ 100.

CONCLUSIONS

Although none of the measures applied through the FMEA made the failure mode impossible, they made it more detectable and less frequent and reduced the RPN for each failure mode; however, a periodic update of the process is necessary.

[Analysis of the prevalence and social security situation of pneumoconiosis in non-coal mine industry in Jiangsu Province]

Objective: To understand the social security situation of current cases of pneumoconiosis in non-coal mine industries in Jiangsu Province, and to provide reference for the treatment and security work of pneumoconiosis patients. Methods: From January to October 2020, a follow-up survey was conducted on 4038 cases of pneumoconiosis in non-coal mine industries of the province from October 1949 to December 2019. The age, type of pneumoconiosis, industry type, and social security status of the patients were collected. Namely, work-related injury insurance, employer compensation, basic medical insurance for urban and rural residents, major illness insurance, etc. SPSS 19.0 was used for statistical description and analysis. Results: The cases of pneumoconiosis in non-coal mine industries in Jiangsu Province ranged in age from 36 to 105 (70.78±8.43) years old, and had been exposed to dust for 1 to 55 (19.27±9.29) years. Silicosis was the main form (3875 cases, 95.96%), and non-metallic mining and dressing industry was the main form (2618 cases, 64.83%). A total of 3991 cases (98.84%) of pneumoconiosis patients enjoyed social security, most of them were urban and rural residents with basic medical insurance (3624 cases, 89.75%), but there were still 47 patients without any social security. 15 cases (0.37%) enjoyed the subsistence allowance, with the monthly allowance amount ranging from 104 to 3960 yuan, with the average amount of 954.87 yuan/month. Conclusion: In Jiangsu Province, the proportion of pneumoconiosis patients in non-coal mine industries enjoying social security is relatively high, but there are still patients who do not enjoy any social security, and the difference in the amount of subsistence allowance is slightly larger. It is necessary to further improve the medical security of pneumoconiosis patients and improve their quality of life.

Self-employment, illness, and the social security system: a qualitative study of the experiences of solo self-employed workers in Ontario, Canada

BACKGROUND

Today's labor market has changed over time, shifting from mostly full-time, secured, and standard employment relationships to mostly entrepreneurial and precarious working arrangements. Thus, self-employment (SE) has been growing rapidly in recent decades due to globalization, automation, technological advances, and the recent rise of the 'gig' economy, among other factors. Accordingly, more than 60% of workers worldwide are non-standard and precarious. This precarity profoundly impacts workers' health and well-being, undermining the comprehensiveness of social security systems. This study aims to examine the experiences of self-employed (SE'd) workers on how they are protected with available social security systems following illness, injury, and income reduction or loss.

METHODS

Drawing on in-depth interviews with 24 solo SE'd people in Ontario (January - July 2021), thematic analysis was conducted based on participants' narratives of experiences with available security systems following illness or injury. The dataset was analyzed using NVIVO qualitative software to elicit narratives and themes.

FINDINGS

Three major themes emerged through the narrative analysis: (i) policy-practice (mis)matching, (ii) compromise for a decent life, and (iii) equity in work and benefits.

CONCLUSIONS

Meagre government-provided formal supports may adversely impact the health and wellbeing of self-employed workers. This study points to ways that statutory social protection programs should be decoupled from benefits provided by employers. Instead, government can introduce a comprehensive program that may compensate or protect low-income individuals irrespective of employment status.

What is the potential of compensation funds for addressing COVID-related personal injury?

The COVID-19 pandemic continues to present new challenges at the frontiers of social risk. Its significant societal impact has prompted the consideration of alternative frameworks like compensation funds to better allocate the risks and impacts of COVID-related injury. Although there has been discussion about the potential of alternative liability structures for vaccine-related injury, there has been less analysis of the right way to compensate other types of injury, such as long-term illness, disability and death, associated with the SARS-CoV-2 virus. In France, a universal compensation fund for COVID-19-related injuries, designed similarly to asbestos-related schemes, was considered by the parliament. With an eye on scientific knowledge of the best practice in the development and operation of compensation frameworks, this paper analyses the design of such funds in Europe as applied to COVID-19 injury and considers the position of compensation funds in relation to tort law, private insurance and social security models.

Predictors of national health insurance membership among the poor with different education levels in Indonesia

BACKGROUND

Indonesia has made significant progress in expanding universal health coverage (UHC) through its National Health Insurance (NHI) mechanism. However, in the context of NHI implementation in Indonesia, socioeconomic disparities caused its subpopulations to have different literacy of NHI concepts and procedures, increasing the risk of healthcare access inequities. Hence, the study aimed to analyse the predictors of NHI membership among the poor with different education levels in Indonesia.

METHODS

This study used the secondary dataset of the nationwide survey "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in implementing National Health Insurance in Indonesia in 2019" by The Ministry of Health of the Republic of Indonesia. The study population was the poor population in Indonesia and included a weighted sample of 18,514 poor people. The study used NHI membership as a dependent variable. Meanwhile, the study analysed seven independent variables: wealth, residence, age, gender, education, employment, and marital status. In the final step of the analysis, the study used binary logistic regression.

RESULTS

The results show that the NHI membership among the poor population tends to be higher among those who have higher education, live in urban areas, are older than 17 years old, are married and are wealthier. The poor population with higher education levels is more likely to become NHI members than those with lower education. Their residence, age, gender, employment, marital status, and wealth also predicted their NHI membership. Poor people with primary education are 1.454 times more likely to be NHI members than those without education (AOR 1.454; 95% CI 1.331-1.588). Meanwhile, those with secondary education are 1.478 times more likely to be NHI members than those with no education (AOR 1.478; 95% CI 1.309-1.668). Moreover, higher education is 1.724 times more likely to result in being an NHI member than no education (AOR 1.724; 95% CI 1.356-2.192).

CONCLUSION

Education level, residence, age, gender, employment, marital status, and wealth predict NHI membership among the poor population. Since significant differences exist in all of those predictors among the poor population with different education levels, our findings highlighted the importance of government investment in NHI, which must be supported with investment in the poor population's education.

A behavioral economics assessment of social security disability insurance earnings reporting documents

BACKGROUND

Social Security Disability Insurance (SSDI) beneficiaries who work are often overpaid, with a median overpayment amount of over $9000. These overpayments occur when the Social Security Administration (SSA) pays benefits to beneficiaries not entitled to them because of work; beneficiaries are required to repay the debt to SSA. Work-related overpayments most often occur because beneficiaries work but do not follow SSDI program rules to report earnings and evidence suggests that SSDI beneficiaries are often unaware of reporting requirements.

OBJECTIVE

To assess written earnings reporting reminders that SSA makes available to SSDI beneficiaries as a way of diagnosing a potential barrier to earnings reporting that contributes to overpayments.

METHODS

Using insights from the behavioral economics literature, this article provides a comprehensive diagnosis of SSA's written communications that include earnings reporting reminders.

RESULTS

Beneficiaries are infrequently notified or reminded of requirements, especially at points in time when that information is actionable; the content is not always clear, salient, and urgent; relevant text can be hard to find; and communications rarely emphasize how easy it is to report, what needs to be reported, deadlines for reporting, and the consequences of failing to report.

CONCLUSIONS

Potential shortcomings in written communications may contribute to limited awareness about earning reporting. Policymakers should consider the benefits of improving communications about earnings reporting.

Social Insurance Literacy of Dutch Workers Receiving Disability Benefits and its Associations with Socio-Economic Characteristics

Purpose This study explores the concept social insurance literacy (SIL) and corresponding questionnaire (SILQ) among workers receiving disability benefits and the comprehensibility of the social security institute (SSI), and examines associations with socio-economic characteristics. Methods 1753 panel members of the Dutch SSI were approached to complete the SILQ-NL37. This measure was based on the original SILQ. The SILQ-NL37 contains domains for obtaining, understanding and acting upon information for both individual SIL and system comprehensibility. A higher score means better SIL or comprehensibility. Data on age, gender, education, living situation, Dutch skills and time receiving disability benefits were also collected. With k-means clustering, groups with adequate and limited SIL were created. Associations with socio-economic characteristics were examined with independent t-tests and linear regression analyses for both the total scores and within domain scores. Cronbach α and Spearman rho's indicated measurement properties were good to acceptable for the SILQ-NL37. Results Thirty-five percent of the 567 participants were in the group with limited SIL. Higher individual SILQ-NL37 scores were associated with having a partner (p = 0.018) and northeastern living region (p = 0.031). Higher scores for obtaining (p = 0.041) and understanding (p = 0.049) information were associated with female sex, and for acting on information with younger age (p = 0.020). People with limited Dutch skills (p = 0.063) and a partner (p = 0.085) rated system comprehensibility higher. Conclusions According to the SILQ-NL37 scores, about 35% of the panel members have limited ability to obtain, understand and act upon social insurance systems information. Limited SIL is associated with several socio-economic factors. Future researches should study the concept in a more representative sample, and in different countries and social insurance contexts.

Waiting time from identification to recognition an occupational disease in Spain

OBJECTIVE

To estimate the waiting time since a suspected an occupational disease (OD) is identified, notified and recognized in Spain.

METHOD

A series of 34 patients attended at Occupational Diseases Unit (ODU) of Hospital del Mar in Barcelona were follow up since their identification until final resolution by the National Institute of Social Security (INSS). Median, and 25 and 75 percentiles (interquartile range [IQR]) were calculated in weeks by total time (n=27), ODU time (n=34), patient time (n=31) and INSS time (n=27).

RESULTS

Total time was 51 weeks (IQR: 33.6 and 122.6), of which 42 weeks (17.6-99.5) corresponded to the waiting period at the INSS.

CONCLUSIONS

The disproportionately long waiting time since INSS receives a case could impact on the under-recognition of OD. Urgent improvement of the administrative process is needed to reduce the patient waiting time for the recognition of OD.

[Study on the current situation of social security for pneumoconiosis in China]

Pneumoconiosis is a serious occupational disease with the largest number of patients in China. Social security provides strong support for the treatment of pneumoconiosis patients, but there are few reports on the implementation of social security for pneumoconiosis in China. Through literature review, this paper systematically combs the relevant reports of pneumoconiosis social security, understands the current situation and problems of social security for pneumoconiosis in China, and provides a scientific basis for improving security policy for the pneumoconiosis patient.

[Longer Unemployment Insurance Benefits in Times of Crisis? Covid-19 and the Appropriate Maximum Benefit Duration]

This article deals with the question of which unemployment benefit durations are considered fair for which groups. In addition, it examines the extent to which individuals consider longer unemployment insurance benefit durations to be appropriate in times of economic crisis, such as the current situation during the Covid-19 pandemic. Longer reference periods can stabilize the income situation of benefit recipients and can provide time to search for an adequate job and thus increase matching quality. However, they also initially reduce the pressure to look for a job, and they lengthen the period of unemployment in the longer term. Using survey data from two online surveys done in November 2019 and during the crisis in May 2020, we examine which unemployment benefit durations employees consider appropriate. For this purpose, we presented vignettes to the survey participants describing hypothetical unemployed people whose characteristics varied randomly. The results show that the same respondents considered similar reference periods to be appropriate at both dates. In addition, the respondents took into account criteria of contribution as well as neediness when assessing the appropriate duration of benefits for the unemployed. Characteristics such as the age of the unemployed and any existing culpability, life benefits, or contribution periods influenced the duration of the benefit receipt that respondents judged to be appropriate.

The dynamic relationship between cancer and employment-related financial toxicity: an in-depth qualitative study of 21 Australian cancer survivor experiences and preferences for support

BACKGROUND

People with a cancer diagnosis experience physical and emotional impacts that may affect employment. Alongside cancer care costs, reduced ability to generate an income is a key contributor to financial toxicity which is associated with poor emotional wellbeing, quality of life, treatment adherence and survival. This study aimed to explore people's experiences of changes to employment and their suggestions for how cancer survivors can be better supported.

METHODS

Semi-structured telephone interviews were conducted with a purposive sample of 21 cancer survivors identified as part of a larger study of emotional distress. Purposive sampling was used to include a diverse group of people across age, gender, tumour type, self-reported financial difficulties and employment status. Interviews were inductively and iteratively coded by two independent coders and analysed using thematic analysis.

RESULTS

There is a dynamic relationship between a person's cancer treatment and their employment. For some, employment was disrupted due to physical or emotional impacts of cancer, or workplace stigma and discrimination. Others continued to work at the detriment of their health. Participants wished they had been made aware earlier how cancer might impact their capacity to work, their finances and their health. There was a lack of knowledge on the financial supports that may be available to them.

CONCLUSIONS

Healthcare professionals may have a role in minimising the financial impact of a cancer diagnosis through early assessment, communication of patients' potential work capacity and appropriate referrals to occupational therapy to aid return to work or financial planning. A robust government social support system specifically for households experiencing cancer is urgently required.

Locked out of livelihoods: impact of COVID-19 on single women farmers in Maharashtra, India

This article examines the impact of COVID-19 on the livelihoods of widows and other single women farmers from the most backward districts of Maharashtra, a state in western India. COVID-19 led to food insecurity, loss of farm incomes, decline in employment opportunities and increased debt traps for single women farmers. The paper highlights how agrarian distress and pre-existing inequalities of class, caste and gender in access to food, incomes, credit, land, markets, and decision making, were exacerbated during the pandemic, further impoverishing these women farmers. To trace these effects, the paper draws on two types of evidence gathered in Maharashtra by MAKAAM, an informal all-India women farmer's forum: observations during multiple rounds of interactions with over a hundred women farmers during the COVID-support work of providing ration and seeds undertaken by MAKAAM during India's national lockdown in 2020, and a subsequent large-scale survey covering about a thousand women. The paper also focuses on the inadequacy of state response, both in terms of providing relief and in its ability to partner with women's collectives and grassroots organisations for better outcomes. The article makes a case for strengthening social security measures for women farmers and enhancing their access to productive resources, agricultural programmes and decision-making spaces in relevant institutions.

[The re-emergence of silicosis as an occupational disease in Spain, 1990-2019.]

OBJECTIVE

The presence of new sources of occupational exposure to crystalline silica has contributed to an increased incidence of silicosis. Spain was one of the first countries to identify new occupational risk sectors such as quartz agglomerates. The objective of this work was to describe the incidence of silicosis in Spain between 1990 and 2019 and to determine the main occupational sectors affected.

METHODS

Data on occupational disease cases were obtained from the Spanish Ministry of Inclusion, Social Security and Migration. Disease rates were computed by occupational sector, and analyses were conducted of their time course and their geographical, sex and age distributions.

RESULTS

Data were available on 4,418 cases (96.1% male). The mean annual number of cases was 1,223% higher between 2015 and 2019 than between 1990 and 1995. By occupational sector, 50% were in "Fabrication of other mineral non-metallic products", 18.5% in "Extraction of non-metallic non-energetic minerals", 10.2% in "Construction", 6.1% in "Metallurgy", 3.1% in "Coal mining" and 12% in other sectors. Galicia registered the greatest number of cases (32.9%), followed by Castile and León (14%), Andalusia (10%) and the Basque Country (9.1%). The greatest increase in its incidence was in coal mining, possibly due to the dismantling of this sector and drastic reduction in the workforce.

CONCLUSIONS

Our results suggest the importance of the manufacturing, machining and installation of quartz agglomerates in the re-emergence of silicosis in Spain.

Content Validation of a Practice-Based Work Capacity Assessment Instrument Using ICF Core Sets

PURPOSE

A shift from providing long-term disability benefits to promoting work reintegration of people with remaining work capacity in many countries requires new instruments for work capacity assessments. Recently, a practice-based instrument addressing biopsychosocial aspects of functioning, the Social Medical Work Capacity instrument (SMWC), was developed. Our aim was to examine the content validity of the SMWC using ICF core sets.

METHODS

First, we conducted a systematic search to identify relevant ICF core sets for the working age population. Second the content of these core sets were mapped to assess the relevance and comprehensiveness of the SMWC. Next, we compared the content of the SMWC with the ICF-core sets.

RESULTS

Two work-related core sets and 31 disease-specific core sets were identified. The SMWC and the two work-related core sets overlap on 47 categories. Compared to the work-related core sets, the Body Functions and Activities and Participation are well represented in the new instrument, while the component Environmental factors is under-represented. Compared to the disease-specific core sets, items related to the social and domestic environmental factors are under-represented, while the SMWC included work-related factors complementary to the ICF.

CONCLUSION

The SMWC content seems relevant, but could be more comprehensive for the purpose of individual work capacity assessments. To improve assessing relevant biopsychosocial aspects, it is recommended to extend the instrument by adding personal and environmental (work- and social-related) factors as well as a more tailored use of the SMWC for assessing work capacity of persons with specific diseases or underlying illness.

Analysis of work-related accidents and ill-health in Brazil since the introduction of the accident prevention factor

BACKGROUND

Since 2004, Brazil has had a national policy for occupational health and safety. This policy means companies' tax burden is altered according to the numbers of work-related accidents and ill-health amongst their workers. In 2010, a multiplication factor was introduced to this policy, called the Accident Prevention Factor. The idea of this new multiplication factor is to encourage individual employers to take initiatives to prevent accidents and ill health in the workplace. This study was designed to investigate the incidence of work-related accidents and ill-health in Brazil according to their causes, their severity, and the economic activity in which they occur, and to compare the data before and after the introduction of the Accident Prevention Factor.

METHODS

An ecological study was conducted by analyzing the time series of work-related accidents/ill-health between 2008 and 2014 from the Brazilian social security system (Previdência Social) statistical yearbooks. Incidences were calculated per cause, economic activity, and severity of the accident/ill-health. Data from before and after the introduction of the Accident Prevention Factor were compared using the Mann-Whitney test per cause and per economic activity. Statistical analyses were made using the SPSS software, with significance set at 5%.

RESULTS

A reduction in the incidence of work-related accidents/ill-health was found across all the groups of causes analyzed, except for the groups "external causes of morbidity and mortality" and "factors influencing health status and contact with health services." Greater reductions were found for diseases of the musculoskeletal system and connective tissue and diseases of the nervous system. Reductions in work-related accidents/ill-health were found in the different economic activities and in the different severity groups. The highest reduction after the introduction of the Accident Prevention Factor was in manufacturing and production (p < 0.05).

CONCLUSIONS

Overall, the incidence of accidents/ill-health was found to be on decline, except those with external causes of morbidity and mortality and those involving factors influencing health status and contact with health services. The biggest reduction was found in manufacturing and production. However, generally speaking progress still needs to be made in accident prevention and occupational health across a whole range of work environments.

Effects of social security policy reforms on mental health and inequalities: A systematic review of observational studies in high-income countries

Evidence increasingly shows that changes to social security policies can affect population mental health. Thus, in the context of rising burden of mental illness, it is of major importance to better understand how expansions and contractions to the social security system may impact on mental health of both adults and children. The aim of this systematic review is to provide a synthesis of observational literature on the effects on mental health and inequalities in mental health of social security reforms. We conducted a systematic review of quantitative observational studies of specific national and regional social security policy changes in high-income countries and summarised the mental health effects of these policies. We searched seven electronic databases, including Medline, PsychInfo, Embase, CINAHL, ASSIA (Proquest), Scopus and Research Papers in Economics from January 1979 to June 2020. We included both objective and subjective mental health and wellbeing measures. The study quality was assessed using the Validity Assessment tool for econometric studies. We identified 13,403 original records, thirty-eight of which were included in the final review. Twenty-one studies evaluated expansionary social security policies and seventeen studies evaluated contractionary policies. Overall, we found that policies that improve social security benefit eligibility/generosity are associated with improvements in mental health, as reported by fourteen of the included studies. Social security policies that reduce eligibility/generosity were related to worse mental health, as reported by eleven studies. Ten studies found no effect for either policies contracting or expanding welfare support. Fourteen studies also evaluated the impact on mental health inequalities and found that contractionary policies tend to increase inequalities whereas expansionary policies have the opposite effect. Changes in social security policies can have significant effects on mental health and health inequalities across different recipient groups. Such health effects should be taken into account when designing future social policy reforms.

Urgent Medical Aid and Associated Obstetric Mortality in Belgium

Most Belgian citizens are covered by comprehensive medical insurance (AMI). Due to recent and significant undocumented immigration, an increasing number of patients have no health coverage. They may, however, qualify for "Urgent Medical Aid" (AMU). Still, some patients have no health insurance of any kind (no coverage). This study, conducted in a hospital which cares for a large number of undocumented immigrants, looked at the proportion of women benefiting from either "AMI" or "AMU" and those who have "No coverage" and addressed obstetrical outcomes in each of the three groups. Design: retrospective observational study. We collected data of all singleton pregnancies and deliveries from the CHU St Pierre maternity ward, between 1.10.2015 and 31.3.2016. Women were classified, prospectively, by our social workers, as having access to AMI, AMU or having "No coverage". Demographic, obstetrical and perinatal data were systematically collected and validated on a day-to-day basis and comparisons were then made between the three groups of women. During the follow up period, 1.439 women had access to regular social security (AMI) (87%), 142 women (10%) to AMU and 38 (3%) had no coverage. Women who benefited from AMU were younger and their first prenatal consultation occurred later in the pregnancy than it did for women with AMI. There were no significant differences in obstetrical outcomes between the three groups of women. Urgent medical aid (AMU) confers a certain normalisation of obstetrical care to pregnant women who would otherwise have no access to health care coverage.

COVID-19 implications on household income and food security in Kenya and Uganda: Findings from a rapid assessment

This study assessed implications of the Coronavirus Disease 19 (COVID-19) pandemic on household income and food security in two East African countries - Kenya and Uganda, using online survey data from 442 respondents. Results show that more than two-thirds of the respondents experienced income shocks due to the COVID-19 crisis. Food security and dietary quality worsened, as measured by the food insecurity experience scale and the frequency of consumption of nutritionally-rich foods. The proportion of food insecure respondents increased by 38% and 44% in Kenya and Uganda respectively, and in both countries, the regular consumption of fruits decreased by about 30% during the COVID-19 pandemic, compared to a normal period (before the pandemic). Results from probit regressions show that the income-poor households and those dependent on labour income were more vulnerable to income shock, and had poorer food consumption during the COVID-19 pandemic compared to other respondent categories. As such, they were more likely to employ food-based coping strategies compared to those pursuing alternative livelihoods, who generally relied on savings. Farmers were less likely to experience worsened food security compared to other respondent categories who depended to a great extent on market sources for food. In both countries, participation in national social security schemes was less likely to mitigate respondents' income shock during the COVID-19 period. Conversely, membership in savings and loan groups was correlated with less likelihood of suffering income shocks and reduction in food consumption. The results suggest that ongoing and future government responses should focus on structural changes in social security by developing responsive packages to cushion members pushed into poverty by such pandemics while building strong financial institutions to support the recovery of businesses in the medium term, and ensuring the resilience of food supply chains particularly those making available nutrient-dense foods.

Promoting factors and barriers to participation in working life for people with spinal cord injury

BACKGROUND

It is still difficult for people with physical impairments to be and remain equally integrated into the labour market. For this reason, the question of occupational activity has explicitly been examined by the German Spinal Cord Injury Survey (GerSCI) in order to identify barriers and facilitators for labour market participation.

METHODS

Cross-sectional explorative observational study. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI). Using survey data from persons recruited at eight specialised SCI-centres in Germany.

PARTICIPANTS

1.479 persons with Spinal Cord Injury (SCI) aged 18 years and older.

RESULTS

In a self-disclosure questionnaire, persons with SCI show themselves as a professionally well-educated and highly motivated group with most of them aiming at gainful employment and considering themselves fit for work. Many changeable and non-changeable factors have been found, which showed a high correlation with the return to work after acquired SCI.

CONCLUSION

Education and pain belong to the most critical factors and thereby possible approaches to increase the level of employment, which is essential and highly relevant not only for earning money but also for self-confidence and social integration. SCI has many dimensions in itself; support also should be multidimensional. Study results might help to improve participation.

Rumor detection based on propagation graph neural network with attention mechanism

Rumors on social media have always been an important issue that seriously endangers social security. Researches on timely and effective detection of rumors have aroused lots of interest in both academia and industry. At present, most existing methods identify rumors based solely on the linguistic information without considering the temporal dynamics and propagation patterns. In this work, we aim to solve rumor detection task under the framework of representation learning. We first propose a novel way to construct the propagation graph by following the propagation structure (who replies to whom) of posts on Twitter. Then we propose a gated graph neural network based algorithm called PGNN, which can generate powerful representations for each node in the propagation graph. The proposed PGNN algorithm repeatedly updates node representations by exchanging information between the neighbor nodes via relation paths within a limited time steps. On this basis, we propose two models, namely GLO-PGNN (rumor detection model based on the global embedding with propagation graph neural network) and ENS-PGNN (rumor detection model based on the ensemble learning with propagation graph neural network). They respectively adopt different classification strategies for rumor detection task, and further improve the performance by including attention mechanism to dynamically adjust the weight of each node in the propagation graph. Experiments on a real-world Twitter dataset demonstrate that our proposed models achieve much better performance than state-of-the-art methods both on the rumor detection task and early detection task.

A decomposition analysis to examine the change in the number of recipients in the comprehensive social security assistance (CSSA) system

Social security is an important social and public policy measure to help address poverty in any contemporary society. The Comprehensive Social Security Assistance (CSSA) system in Hong Kong provides a safety net for those aged children and adults below 65 years old who cannot support themselves financially. It is designed to bring their income up to a prescribed level to meet their basic needs. The rapid increase in social welfare expenditure in the last decade has become a concern to the Hong Kong SAR Government. The overall social welfare expenditure has accounted for nearly 15.6% of government expenditure in 2018, with the total amount increasing from $58 billion to $90 billion (an increase of 72.4%) for the period 2014-2018. However, the amount spent on CSSA only increased from $20.7 billion to $22.3 billion with an increase of 7.7% only for the same period. The much slower magnitude of increase is related to the reduction in the number of CSSA recipients, which decreased from 237,501 to 185,528 over the period. A decomposition method was used to assess the changes in the number of people in the CSSA system. It showed that the rate of arriving into the system has been decreasing due to a robust economy with a very low unemployment rate; whereas moving out of the system has also been decreasing in the past 5 years. This phenomenon can be partly attributed to the widening of the income gap in the community in the period. Despite the increase in population size, as long as employment conditions remain strong and the momentum of leaving the system can be maintained, the number of CSSA recipients will continue to decrease. However, the results also suggested that a certain proportion of CSSA recipients will not be able to move out of the system and have been trapped. Some innovative methods to help them out of CSSA are discussed. In view of the poor economic outlook arising from the COVID-19 pandemic, it is important for the Government to have effective measures to keep people in their jobs. If the unemployment rate will does not substantially increase and then increase of in CSSA recipients can be contained.

Relaxing household liquidity constraints through social security

More than a quarter of working-age households in the United States do not have sufficient savings to cover their expenditures after a month of unemployment. Recent proposals suggest giving workers early access to a small portion of their future Social Security benefits to finance their consumption during the COVID-19 pandemic. We empirically analyze their impact. Relying on data from the Survey of Consumer Finances, we build a measure of households' expected time to cash shortfall based on the incidence of COVID-induced unemployment. We show that access to 1% of future benefits allows 75% of households to maintain their current consumption for three months in case of unemployment. We then compare the efficacy of access to Social Security benefits to already legislated approaches, including early access to retirement accounts, stimulus relief checks, and expanded unemployment insurance.

Diagnosis-specific sickness absence and disability pension before and after multiple sclerosis diagnosis: An 8-year nationwide longitudinal cohort study with matched references

BACKGROUND

Multiple sclerosis (MS) typically onsets when of working age and may reduce work capacity. Previous studies have examined the risk of sickness absence (SA) and disability pension (DP) among MS patients, however, limited knowledge is available on whether MS patients have an excess risk for SA/DP when compared with the general population in Sweden. Moreover, no information exists on the actual diagnoses for SA and DP among MS patients and whether the patterns of SA/DP diagnoses differs to those without MS. We aimed to explore diagnosis-specific SA and DP among working-aged MS patients both before and after MS diagnosis, in comparison to the levels and distributions of SA and DP diagnoses of a matched reference group and analyze the risk of diagnosis-specific DP.

MATERIALS AND METHODS

Longitudinal Swedish register data of the 2567 MS patients diagnosed with MS in 2009-2012 when aged 25-59 and 10,268 population-based matched references (matched on sex, age, educational level, type of living area, and country of birth) were analysed regarding annual diagnosis-specific SA and DP in the four years before and four years after MS diagnosis. Annual differences in the mean numbers of SA and/or DP net days were calculated with 95% confidence intervals (CI). Hazard ratios (HR) with 95% CI from Cox proportional hazard models were used to compare risks for new all-cause and diagnosis-specific DP after MS diagnosis among the MS patients and references.

RESULTS

The mean SA/DP net days/year increased among MS patients over follow-up, due to both MS and other diagnoses. During follow-up, around 50% of MS patients had some SA/DP compared to 20% of references. The mean days of SA/DP among the MS patients compared to references increased from 10.3 more days (95% CI: 6.6-14.2) four years prior to MS diagnosis to 68.9 days (62.8-75.1) 4 years after MS diagnosis. Although most new DP among MS patients were due to MS, 15% were not. The adjusted HR for all-cause DP was 23.1 (18.1-29.5). MS patients also had higher risks of new DP due to all diagnoses except MS (HR 3.4; 2.4-4.8), musculoskeletal (HR 2.6; 1.1-6.0) and mental (HR 2.0; 1.1-3.6) diagnoses compared with references.

CONCLUSION

MS patients had higher levels of SA/DP days/year than the references, already 4 years before the MS diagnosis, and increasingly so thereafter. The excess of SA/DP prior to MS diagnosis could be related to MS onset. However, the excess of SA/DP days were not all due to MS diagnoses, even after being diagnosed with MS. MS patients had a higher risk of having a new DP after being diagnosed with MS in total, but also for diagnoses other than MS.

Work Experiences During and After Treatment Among Self-Employed People with Cancer

Purpose The proportion of self-employed people in the workforce is growing. However, most research on work participation among cancer survivors has focused on salaried workers. We aimed to explore how self-employed people experience work during and after cancer treatment. Methods In this qualitative study, we conducted semi-structured interviews with seven self-employed people who had been treated for cancer. To provide a variety of perspectives on work-related aspects of self-employed cancer survivors we also interviewed seven counselors in the Norwegian Labour and Welfare Administration (NAV) who had long experience in supporting self-employed people and cancer patients around work participation. The interviews were transcribed verbatim and thematic analysis was undertaken. Results Five themes related to owning a business during and after cancer treatment emerged: entrepreneurship and engagement; cancer treatment and late-effects; business-related worries; shame; and support. Because of high job engagement and high autonomy the self-employed survivors often worked during treatment. While working could provide a sense of normalcy and a distraction from cancer, it was also essential to keep the business running. Survivors struggled with several work-related issues (e.g. high work demands, low work ability), but financial issues related to running their business caused particular worry. Getting cancer and, consequently, struggling with financial problems elicited a sense of shame that was closely connected to their strong identity as (successful) self-employed business (wo)men. Conclusion To support self-employed cancer survivors to retain work following a cancer diagnosis it is necessary to focus on the specific challenges faced by this group of workers, particularly related to financial issues and keeping the business afloat. Support measures to secure production and thus prevent loss of customers and bankruptcy are needed. It is important for health and social care personnel to be aware that self-employed cancer survivors may suffer from shame related to the cancer, low work ability and financial struggles, but that they may have difficulties talking about this shame.

Piloting an empirical approach to link the international classification of functioning, disability, and health to job demand classification

BACKGROUND

The Social Security Administration has a thorough disability claims process, though one goal is to process claims more efficiently. This pilot described the creation and trial of a web-based tool to assist this process.

OBJECTIVE

To empirically link the International Classification of Functioning, Disability and Health (ICF) model to the Occupational Information Network (O*NET) with a self-reported activity measure (physical domain).

METHODS

ICF Activity domains and item difficulty calibrations were obtained from a self-reported ICF-Activity Measure. Three work/disability experts matched measurement constructs, job names, and item difficulties with job demands. Item difficulties were linked for "Positioning and Transfer" with O*NET data values of "Stamina"; "Trunk Strength", and "Walking and Moving" with O*NET data values of "Stamina." The system was then pilot tested with 14 adults with more than one activity challenges.

RESULTS

An average total of 613 jobs were generated per participant and each job was categorized into one of 16 job clusters. Person ability measures and constructs were significant predictors for numbers of job (R2 = 0.92, p < 0.05). Participants demonstrated moderate satisfaction with program usability, and reported capability in performing jobs.

CONCLUSIONS

The system provides a feasible means to assist disability examiners and claimants in identifying relevant job abilities and options.

[Investigation on social security of pneumoconiosis patients in Chongqing]

Objective: To investigate the living conditions, insurance coverage, and assistance of pneumoconiosis patients diagnosed in Chongqing from May 2006 to May 2018. Methods: A cross-sectional survey was conducted in July 2018, and 40 890 pneumoconiosis patients from occupational diseases report management agency were obtained. 34 625 cases meeting the inclusion criteria were investigated, and descriptive statistical analysis was performed on the data. Results: There were 34 625 cases of pneumoconiosis patients alive in Chongqing, and 22730 (65.6%) had participated in work-related injury insurance, 6 308 (18.2%) had participated in basic medical insurance for urban employees which were still effective. 27 056 (78.1%) had participated in cooperative insurance for urban and rural residents which were still effective. 4 393 (12.7%) received assistance for the residents in need in urban and rural areas. 5827 (16.8%) benefited the policy of "Xiangyu Railway". There were 7 961 cases (2.4%) whose work-related injury insurance had expired did not get one-off compensation, and did not receive any assistance. Conclusion: Most of the patients with pneumoconiosis in Chongqing obtained protection in terms of work-related injury insurance, medical insurance, civil assistance and poverty alleviation to a certain extent, but the strength of the guarantee is not enough. Patients with pneumoconiosis might suffer from poverty caused by illness. It is recommended to improve the system of work-related injury insurance benefits, establish special funds for pneumoconiosis patients, strengthen health education and health promotion for pneumoconiosis patients, and strengthen the management of pneumoconiosis patients.

[Analysis on social security of pneumoconiosis patients in two areas of Chongqing from 2006 to 2018]

Objective: To investigate the current status of social security among pneumoconiosis patients from two areas of Chongqing, China with different economic levels from 2006 to 2018, and to provide a reference for the development of security policy for pneumoconiosis patients. Methods: The current status of social security was analyzed for pneumoconiosis patients from A and B counties of Chongqing who were diagnosed from 2006 to 2018, and a comparative analysis was performed. Results: From 2006 to 2017, there was a significant increase in the number of newly diagnosed pneumoconiosis patients in A county, while the number of newly diagnosed pneumoconiosis patients remained relatively stable in B county. As of May 2018, there were 5738 pneumoconiosis patients in A county and 4155 pneumoconiosis patients in B county. Among the 5738 pneumoconiosis patients in A county, 5335 (93%) had employers, and among these patients, 2729 (47.6%) received one-time compensation from occupational injury insurance, and currently 1884 (32.8%) were covered by the insurance. Among the 4155 pneumoconiosis patients in B county, 2482 (59.7%) received one-time compensation from occupational injury insurance, and currently 3062 (73.7%) were covered by the insurance. The social security rate of pneumoconiosis patients was 71.0% in A county and 81.4% in B county, and there was a significant difference in the distribution of social security among pneumoconiosis patients between the two counties (χ(2)=4704.9, P<0.01) . Conclusion: Strict implementation of social security policies for pneumoconiosis patients by local governments is the key to solving social assistance for pneumoconiosis patients and improving their quality of life and social security level.

[Distance caregiving: an issue among sociopolitical actors?]

BACKGROUND

Caregiving from a distance is understudied as well as rarely sociopolitically debated in Germany. Accordingly, distance caregiving is a type of informal care work that has been little acknowledged in social law.

OBJECTIVE

This article addresses the issue of how aware sociopolitical experts in Germany are of distance caregiving. Moreover, it points out the challenges the experts perceive in the legal framework and which solutions they can identify.

MATERIAL AND METHODS

Guided interviews were conducted with six experts from sociopolitical areas in Germany with points of connection to care politics (ministries, associations, organizations). The interviews were analyzed based on the method of summarizing qualitative content analysis (according to Mayring).

RESULTS

Even though distance caregiving has played a minor role among the sociopolitical experts, they were aware of individual aspects of this topic, mostly based on having been personally affected. Due to this experience they argued for a broader understanding of care including for example organizational support. They criticized the lack of sociopolitical consideration of distance caregivers and among other things demanded a functioning local support system.

CONCLUSION

The interviews indicated a specific and personal awareness of distance caregiving; however, the findings pointed to stronger criticism of the overall situation regarding caregiving relatives. Thus, despite all recent reforms in distance caregiving there is still a need for action on the topic of caregiving relatives.

The joint effect of health shocks and eligibility for social security on labor supply

This paper investigates whether or not suffering a health shock, and becoming eligible for social security, have a joint effect on labor supply. Despite millions of people experiencing both of these events each year, no paper has focused exclusively on the joint effect that these events may have on work outcomes. This is surprising given that experiencing a health shock may impact on how a worker responds to becoming eligible for social security. With data from the Health and Retirement Study, I model weekly hours of work as a function of health shocks, social security eligibility, and their interaction. I find that this interaction leads to a 3-4 h reduction in weekly hours of work for men, but has no effect for women. The results are robust to using different work outcomes, age groups, health shock definitions, subgroups, as well as falsification and placebo tests. The results appear to be driven by men who would have had to return to work with impaired health. Policies that promote a more flexible work situation for older men may alleviate these problems in the future.

Work Disability in Australia: An Overview of Prevalence, Expenditure, Support Systems and Services

Purpose This study sought to describe Australian systems of income support for people with work disability. Specific aims were to summarise and compare the features of the income support systems, including the rehabilitation and employment services funded or provided by those systems, and factors affecting transition between systems. Further objectives were to estimate the prevalence of work disability in Australia and the national expenditure on work disability income support. Methods A mixed methods project involving collation and analysis of existing publicly available documentation and data, and interviews with 25 experts across ten major systems of income support. The prevalence of work disability and expenditure in each system, and in total, was estimated using publicly accessible data sources. System features and service models were synthesised from data sources, tabulated and compared qualitatively. Results In Australia during the 2015/2016 financial year an estimated 786,000 people with work disability received income support from a Commonwealth, state, territory or private source. An additional 6.5 million people accessed employer provided leave entitlements for short periods of work incapacity. A total of $37.2 billion Australian dollars was spent on income support for these people during the year. This support was provided through a complex array of government authorities, private sector insurers and employers. Service models vary substantially between systems, with case management the only service provided across all systems. Healthcare and return to work services were provided in some systems, although models differed markedly between systems. Income support ranged from 19 to 100% of earnings for a person earning the average weekly Australian wage pre-disability. There is a paucity of information relating to movement between systems of support, however it is likely that many thousands of people with long periods of work disability transition between systems annually. Conclusions This study demonstrates the substantial financial and human impact of work disability on Australian society. Findings indicate multiple opportunities for reducing the burden of work disability, including aligning case management and healthcare service models, and engaging employers in prevention and rehabilitation. The findings suggest a need for greater interrogation and evaluation of Australian work disability support systems.

The growing American health penalty: International trends in the employment of older workers with poor health

Many countries have reduced the generosity of sickness and disability programs while making them more activating - yet few studies have examined how employment rates have subsequently changed. We present estimates of how employment rates of older workers with poor health in 13 high-income countries changed 2004-7 to 2012-15 using HRS/SHARE/ELSA data. We find that those in poor health in the USA have experienced a unique deterioration: they have not only seen a widening gap to the employment rates of those with good health, but their employment rates fell per se. We find only for Sweden (and possibly England) signs that the health employment gap shrank, with rising employment but stable gaps elsewhere. We then examine possible explanations for the development in the USA: we find no evidence it links to labor market trends, but possible links to the USA's lack of disability benefit reform and wider economic trends.

The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies

BACKGROUND

Expert psychiatrists conducting work disability evaluations often disagree on work capacity (WC) when assessing the same patient. More structured and standardised evaluations focusing on function could improve agreement. The RELY studies aimed to establish the inter-rater reproducibility (reliability and agreement) of 'functional evaluations' in patients with mental disorders applying for disability benefits and to compare the effect of limited versus intensive expert training on reproducibility.

METHODS

We performed two multi-centre reproducibility studies on standardised functional WC evaluation (RELY 1 and 2). Trained psychiatrists interviewed 30 and 40 patients respectively and determined WC using the Instrument for Functional Assessment in Psychiatry (IFAP). Three psychiatrists per patient estimated WC from videotaped evaluations. We analysed reliability (intraclass correlation coefficients [ICC]) and agreement ('standard error of measurement' [SEM] and proportions of comparisons within prespecified limits) between expert evaluations of WC. Our primary outcome was WC in alternative work (WC_{alternative.work}), 100-0%. Secondary outcomes were WC in last job (WC_last.job), 100-0%; patients' perceived fairness of the evaluation, 10-0, higher is better; usefulness to psychiatrists.

RESULTS

Inter-rater reliability for WC_{alternative.work} was fair in RELY 1 (ICC 0.43; 95%CI 0.22-0.60) and RELY 2 (ICC 0.44; 0.25-0.59). Agreement was low in both studies, the 'standard error of measurement' for WC_{alternative.work} was 24.6 percentage points (20.9-28.4) and 19.4 (16.9-22.0) respectively. Using a 'maximum acceptable difference' of 25 percentage points WC_{alternative.work} between two experts, 61.6% of comparisons in RELY 1, and 73.6% of comparisons in RELY 2 fell within these limits. Post-hoc secondary analysis for RELY 2 versus RELY 1 showed a significant change in SEM_{alternative.work} (- 5.2 percentage points WC_{alternative.work} [95%CI - 9.7 to - 0.6]), and in the proportions on the differences ≤ 25 percentage points WC_{alternative.work} between two experts (p = 0.008). Patients perceived the functional evaluation as fair (RELY 1: mean 8.0; RELY 2: 9.4), psychiatrists as useful.

CONCLUSIONS

Evidence from non-randomised studies suggests that intensive training in functional evaluation may increase agreement on WC between experts, but fell short to reach stakeholders' expectations. It did not alter reliability. Isolated efforts in training psychiatrists may not suffice to reach the expected level of agreement. A societal discussion about achievable goals and readiness to consider procedural changes in WC evaluations may deserve considerations.

Work-Related Outcomes in Self-Employed Cancer Survivors: A European Multi-country Study

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22-261 self-employed/101-1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusion Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries.

Socioeconomic inequalities in survival of children with acute lymphoblastic leukemia insured by social security in Mexico: a study of the 2007-2009 cohorts

BACKGROUND

Although acute lymphoblastic leukemia (ALL) 5 years survival in minors has reached 90%, socioeconomic differences have been reported among and within countries. Within countries, the difference has been related to the socioeconomic status of the parents, even in the context of public health services with universal coverage. In Mexico, differences in the mortality of children with cancer have been reported among sociodemographic zones. The Instituto Mexicano del Seguro Social (IMSS), the country's main social security institution, has reported socioeconomic differences in life expectancy within its affiliated population. Here, the socioeconomic inequalities in the survival of children (< 15 years old) enrolled in the IMSS were analyzed.

METHODS

Five-year survival data were analyzed in cohorts of patients diagnosed with ALL during the period 2007-2009 in the two IMSS networks of medical services that serve 7 states of the central region of Mexico. A Cox proportional risk model was developed and adjusted for the socioeconomic characteristics of family, community of residence and for the clinical characteristics of the children. The slope of socioeconomic inequality of the probability of dying within five years after the diagnosis of ALL was estimated.

RESULTS

For the 294 patients studied, the 5 years survival rate was 53.7%; the median survival was 4.06 years (4.9 years for standard-risk diagnosis; 2.5 years for high-risk diagnosis). The attrition rate was 12%. The Cox model showed that children who had been IMSS-insured for less than half their lives had more than double the risk of dying than those who had been insured for their entire lives.

CONCLUSIONS

We did not find evidence of socioeconomic inequalities in the survival of children with ALL associated with family income, educational and occupational level of parents. However, we found a relevant gradient related social security protection: the longer children's life insured by social security, the higher their probability of surviving ALL was. These results add evidence of the effectiveness of social security, as a mechanism of wealth redistribution and a promoter of social mobility. Extending these social security benefits to the entire Mexican population could promote better health outcomes.

Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age

To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49-60, based on multiple measures of morbidity, than cohorts who could retire earlier.

Access to social security benefits among multiple sclerosis patients in Italy: A cross-sectional study

BACKGROUND

Knowledge concerning the predictors of social security benefits and the proportion of Multiple Sclerosis (MS) patients receiving these benefits is very limited.

OBJECTIVE

To estimate the likelihood of receiving social security benefits for Italian MS patients.

METHODS

From September 2014 to November 2015, we interviewed MS outpatients from two Italian MS clinics to collect information regarding their personal data, clinical and working history, and access to social security benefits. We performed both univariate and multivariable analyses to evaluate the predictors for receiving social security benefits.

RESULTS

We interviewed 297 patients, with a mean age of 49.5 (± 10.7) years; 71.4% were females. About 73% of patients had a relapsing-remitting (RR) course and the median EDSS score was 2.5 (IQR 1.5-6). About 75% of MS patients received a full exemption from co-payments, while the proportions of people who enjoyed each of the other social security benefits were lower, ranging from 8.8% (car adaptation) to 32% (disable badge). At multivariable analysis, the probability of obtaining each of the benefits was significantly associated with the EDSS score: walking aids (OR 3.9), care allowance (OR 3.6), disabled badge (OR 2.4), exemption from co-payment (OR 1.6) and allowed off work permit (OR 1.7). Only the probability of obtaining an allowed off work permit was also influenced by comorbidities (OR 2.9) and a higher education (OR 2.2).

CONCLUSION

Except for full exemption from co-payments, the proportions of MS patients who enjoyed social security benefits seem to be limited in our study sample. The EDSS score is the strongest predictor of the probability of receiving all the benefits. Only a small proportion of patients received care allowance and working permits, probably because such benefits are only granted to people with a high level of disability. On the other hand, the low proportion of patients who enjoyed fiscal benefits for home and car adaptations could have been influenced by the way such benefits are granted in our country.

[Welfare State and public health: the role of occupational health]

In the context of the current crisis of the Welfare State, occupational health can contribute significantly to its sustainability by facilitating decent and healthy employment throughout the working life. To this end, occupational health must take on the challenge of promoting health, preventing and managing injuries, illnesses and disability, based on better coordination of prevention services, mutual insurance companies, and health services, as well as by empowering the leadership in prevention of companies and the active participation of those who work.

Introducing Motivational Interviewing in a Sickness Insurance Context: Translation and Implementation Challenges

Purpose Motivational interviewing (MI) is a conversational method to support clients in need of behavioral change. In an organizational reform, most Swedish sickness insurance officials were trained in MI to promote clients' return to work (RTW) after sick leave. The aim of this article is to investigate experiences of introducing MI as a tool to promote clients' RTW within a sickness insurance context, with special focus on the translation and implementation of the method. Methods A qualitative approach, comprising 69 interviews with officials, managers, and regional coordinators on two occasions. The material was analyzed through qualitative content analysis. Results Officials were positive about MI, but the application was limited to using certain tools with extensive individual variation. Officials struggled with translating MI into a sickness insurance context, where the implementation strategy largely failed to offer adequate support, due to low managerial priority, competing initiatives, and a high workload. Results of the educational intervention could therefore be seen on an individual but not an organizational level. Conclusions In order to translate MI into a sickness insurance context, training needs to be supported by organizational approaches that promote collective learning and sharing of experiences among officials. The results also illustrate how a method cannot be assumed to be implemented simply because training has been provided. Consequently, the application of the method needs to be carefully monitored in studies of interventions where MI is claimed to be used, in order to measure its effectiveness.

Comparing predictors of employment in Individual Placement and Support: A longitudinal analysis

Individual Placement and Support (IPS) is an evidence-based model of supported employment for people with serious mental illness. We assessed the effects and relative contributions of predictors of employment among IPS recipients using measures of baseline client characteristics, local economic context, and IPS fidelity. A recent work history, less time on the Social Security rolls, greater cognitive functioning, and a lower local unemployment rate were associated with greater probability of employment. The ability of the model to discriminate between outcomes was limited, and substantial improvements in our understanding of IPS employment outcomes will require the study of novel client, environmental, and IPS implementation factors.

Automatic address validation and health record review to identify homeless Social Security disability applicants

OBJECTIVE

Homeless patients face a variety of obstacles in pursuit of basic social services. Acknowledging this, the Social Security Administration directs employees to prioritize homeless patients and handle their disability claims with special care. However, under existing manual processes for identification of homelessness, many homeless patients never receive the special service to which they are entitled. In this paper, we explore address validation and automatic annotation of electronic health records to improve identification of homeless patients.

MATERIALS AND METHODS

We developed a sample of claims containing medical records at the moment of arrival in a single office. Using address validation software, we reconciled patient addresses with public directories of homeless shelters, veterans' hospitals and clinics, and correctional facilities. Other tools annotated electronic health records. We trained random forests to identify homeless patients and validated each model with 10-fold cross validation.

RESULTS

For our finished model, the area under the receiver operating characteristic curve was 0.942. The random forest improved sensitivity from 0.067 to 0.879 but decreased positive predictive value to 0.382.

DISCUSSION

Presumed false positive classifications bore many characteristics of homelessness. Organizations could use these methods to prompt early collection of information necessary to avoid labor-intensive attempts to reestablish contact with homeless individuals. Annually, such methods could benefit tens of thousands of patients who are homeless, destitute, and in urgent need of assistance.

CONCLUSION

We were able to identify many more homeless patients through a combination of automatic address validation and natural language processing of unstructured electronic health records.

Interventions to address household food insecurity in high-income countries

Household food insecurity is a serious public health concern in high-income countries. Canada and the USA regularly monitor household food insecurity, while in other countries, such as the UK, it has been the rapid rise of food bank usage that has drawn increased attention to this longstanding, but largely overlooked, problem. This review evaluates evidence on interventions intended to reduce household food insecurity in high-income countries. Research on social protection interventions suggests both cash transfers and food subsidies (e.g. the US Supplement Nutrition and Assistance Programme) reduce household food insecurity. In contrast, research on community-level interventions, such as food banks and other food programmes, suggests limited impacts. Although food banks have become a common intervention for food insecurity in high-income countries, evidence suggests their reliance on donations of volunteer time and food make them inevitably limited in the assistance they are able to provide. The stigma people feel using food banks may also make them untenable. Alternatives to, or enhanced, food banks such as community shops or community kitchens, have become common, but evidence also suggests they may be limited in effectiveness if they do not reach people experiencing food insecurity. This review highlights the difficulty of trying to address household food insecurity with community-based food interventions when solutions likely lie upstream in social protection policies.