What Really Matters for Returning to Work After Breast Cancer? A 6-month Longitudinal Study and a Multidimensional Approach

Purpose. Return to work (RTW) after breast cancer (BC) may easily impact on women recovery and quality of life. Literature on RTW hightlighed several factors associated to RTW after BC, and there is still some concern for exploring the main sociodemographic, clinical, psychological and work-related predictors of RTW after BC treatments especially when considering the first 6 months. The present study aims to explore which baseline factors are associated with RTW at 6-month after BC surgery. Methods. A 6-month follow-up study was performed among patients recruited from a Hospital in Northern Italy after their cancer-related surgery. Partecipants filled in a battery of questionnaires at baseline and at 6-month follow-up. Measurements were on job stress, work engagement, quality of life, anxiety, depression and resilience. Moreover, sociodemographic, clinical and work-related data were collected. Univariate and multivariate analyses were performed. Results. We recruited a sample of 149 patients, whose 73.9% returned to work after surgery. The women who returned to work were more likely to be not in a relationship, nor to have children. Also, they were not treated by chemiotherapy, and had higher scores in expectations of job changes after illness, RTW expectations, perception of physical quality of life and psychological resilience. In the multivariate model, chemiotherapy and women’s RTW expectations resulted as significant predictors of RTW at 6-month after BC surgery. Conclusion Most patients returned to work within first 6 months from breast surgery. Return to work was influenced by chemiotherapy and RTW expectations at baseline. A carefully individual screening of risk factors at baseline can prevent from occupational disability and long sickness absence.

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

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

Primary repair of multiligament knee injury with InternalBrace ligament augmentation

Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

Working After Loss: How Bereavement Counsellors Experience Returning to Therapeutic Work After the Death of Their Parent

Despite increased interest in the impact of external events on counsellors, surprisingly little has been written on counsellor bereavement. To address the research question: How do bereavement counsellors experience therapeutic work after the death of their parent? Interviews were conducted with four bereaved counsellors who reflected on its impact on their work. Data were analysed using Interpretative Phenomenological Analysis (IPA). Three major themes emerged; how decisions about returning to work were informed by colleagues and supervision; the benefits of returning to work and the use of ‘bracketing’; long-term implications for practice including heightened empathy with clients’ and disclosure of loss. In addition, participants felt they had insufficient guidance regarding fitness to practice. The possible limitations of the study were that self-selection may have introduced an element of bias to the results. These findings support existing literature and also revealed potential gaps in grief and loss training for counsellors and supervisors. A particular training issue for supervisors might be identifying and discussing fitness to practice issues with supervisees. There are also implications for counsellors in terms of the use of self-disclosure in therapy. Suggested further research to explore the use of self-disclosure in greater depth.

The Complexity of Decreased Work Ability: Individuals’ Perceptions of Factors That Affect Returning to Work after Sickness Absence

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.

Return to work: does cardiac rehabilitation make a difference? Danish nationwide register-based study

Aim: to assess whether participation in cardiac rehabilitation affects the probability of returning to work after ischaemic heart disease. Methods: the study population consisted of 24,509 patients (18–70 years of age) discharged from an inpatient admission at a Danish hospital during 2014–2018 and who were working before their admission. Only patients with a percutaneous coronary intervention or coronary artery bypass grafting surgery procedure and ICD-10 codes I20–I25 as their main diagnosis or ICD-10 codes I21, I240, I248 or I249 as secondary diagnosis during an emergency admission were included. Exposure was defined as participation in cardiac rehabilitation ( N = 15,742), and binary indicator of being at work in the last week of a given month were used as primary outcomes. Coarsened exact matching (CEM) of exposed and unexposed patients was used to reduce selection bias. Logistic regression models were applied on the matched population ( N = 15,762). Results: Less deprived and less comorbid patients were more likely to receive cardiac rehabilitation. CEM succeeded in arriving at a population where this selection was reduced and in this population we found that patients who received cardiac rehabilitation had a lower probability of returning to work after 3 months (OR 0.81, 95%CI: 0.77–0.84), a higher but insignificant probability after 6 (OR 1.02, 95%CI: 0.97–1.08), and a higher probability after 9 (OR 1.08, 95%CI: 1.02–1.15) and 12 months (OR 1.20, 95%CI: 1.13–1.28). Conclusions: Deprived and comorbid patients have lower use of cardiac rehabilitation. In a matched population where this bias is reduced, cardiac rehabilitation will increase the probability of returning to work.

Langdurige Covid: de contouren worden langzaam duidelijk

Long Covid: what is already known about this new condition? Long COVID affects people who have experienced a severe form of COVID-19, as well as patients who suffered a mild form. Six months after infection with the coronavirus, at least 1 out of 7 patients still have symptoms. These symptoms are very diverse and are probably related to a combination of different mechanisms: direct organ damage due to the viral infection, abnormal immune and inflammatory responses that can lead to dysfunctions on several levels (microcirculation, coagulation, fibrosis, autoimmunity, metabolism), consequences of the hospitalisation (muscle atrophy, post-intensive care syndrome) or worsening of existing comorbidities. The Belgian Healthcare Knowledge Centre (KCE) surveyed the experience of Belgian patients by means of an extensive online survey of 1,320 people, followed by an online forum and in-depth interviews. It showed that the perception of the symptoms was very diverse, with a clear reduction in the quality of life, some loss of autonomy and difficulties when returning to work. The psychological consequences could be severe. Based on the current state of science, it is not known which treatments are effective for long COVID. A symptom-oriented approach, focused on gradual multidisciplinary rehabilitation, seems appropriate. Therefore, the main recommendation of the KCE is to investigate the possibility of introducing an ‘interdisciplinary bilan’ for patients with different and interrelated complaints.

Preservice kindergarten teachers’ narratives during the COVID-19 pandemic

Purpose The purpose of this current study is to follow the development of preservice kindergarten teachers during the practicum phase of their teacher education studies in the time of the COVID-19 pandemic and following the first period of lockdown. Design/methodology/approach The sample included 38 preservice kindergarten teachers in their third and final year of studies who worked in kindergartens as student teachers. Data were collected using reflective journals written by the participants during their studies, after returning to work following the first lockdown. The author analyzed the data using the life-story narrative method. Findings The analysis identified four different types of early education preservice teachers based on their ability to cope with the shift in work conditions. The discussion offers insight into participants’ ability to effectively implement the professional tools they had acquired in the program and during the practicum. Research limitations/implications Limitations include reliance on data from reflective journals, which may be missing details that would have been collected face-to-face. The study has important implications for the functioning of kindergarten teachers in times of crisis, which should be taken into account in the design of the teachers’ training programs. Originality/value The effect of the pandemic on the quality of the preservice kindergarten teachers’ training process, and its implications for functioning in other types of crises are discussed.

“To have and then lose the safety net” –Female cancer survivors’ experiences of the process of becoming ready to return to work

BACKGROUND: Validation studies have not been able to confirm the stage-specific understanding as operationalised in the readiness for return to work (RRTW) questionnaire. OBJECTIVE: To explore retrospectively how working female cancer survivors experienced the process of becoming ready to RTW during and beyond participation in an occupational rehabilitation intervention and thereby expand the understanding of the RRTW construct. METHODS: A qualitative research design was employed. Thirteen female cancer survivors were included for semi-structured interviews one to two years after they had completed active treatment and returned to work. The RRTW construct guided data generation and analysis. Content analysis was performed in four analytical steps that combined a concept-driven and a data-driven analytic strategy. RESULTS: Three themes were identified; “To have and then lose the safety net”, “Realise a changed life situation”, “Strive to balance work and everyday life”. In a time span of approximately one to two years (from receiving treatment, being enrolled in an intervention and to gradually returning to work); the identified themes were interdependent of each other as one theme gradually evolved to the next theme in the process of engaging in sustained work participation. CONCLUSIONS: The present study points towards continuous development of the RRTW construct and whether the addition of a preparedness dimension would improve validity.