Cancer survivors at work : Work-related problems and factors associated with their employment, work ability and social support from the work community

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are willing to return to work after their treatment. It is generally believed, however, that people with cancer are either unemployed, stay at home, or retire more often than people without cancer. This study investigated the problems that cancer survivors experience on the labour market, as well as the disease-related, sociodemographic and psychosocial factors at work that are associated with the employment and work ability of cancer survivors. The impact of cancer on employment was studied combining the data of Finnish Cancer Registry and census data of the years 1985, 1990, 1995 or 1997 of Statistics Finland. There were two data sets containing 46 312 and 12 542 people with cancer. The results showed that cancer survivors were slightly less often employed than their referents. Two to three years after the diagnosis the employment rate of the cancer survivors was 9% lower than that of their referents (64% vs. 73%), whereas the employment rate was the same before the diagnosis (78%). The employment rate varied greatly according to the cancer type and education. The probability of being employed was greater in the lower than in the higher educational groups. People with cancer were less often employed than people without cancer mainly because of their higher retirement rate (34% vs. 27%). As well as employment, retirement varied by cancer type. The risk of retirement was twofold for people having cancer of the nervous system or people with leukaemia compared to their referents, whereas people with skin cancer, for example, did not have an increased risk of retirement. The aim of the questionnaire study was to investigate whether the work ability of cancer survivors differs from that of people without cancer and whether cancer had impaired their work ability. There were 591 cancer survivors and 757 referents in the data. Even though current work ability of cancer survivors did not differ between the survivors and their referents, 26% of cancer survivors reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organization, or a good social climate at work, reported impairment less frequently. The aim of the other questionnaire study containing 640 people with the history of cancer was to examine extent of social support that cancer survivors needed, and had received from their work community. The cancer survivors had received most support from their co-workers, and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). More support was especially needed by men who had lymphoma, had received chemotherapy or had a low education level. The results of this study show that the majority of the survivors are able to return to work. There is, however, a group of cancer survivors who leave work life early, have impaired work ability due to their illness, and suffer from lack of support from their work place and the occupational health services. Treatment-related, as well as sociodemographic factors play an important role in survivors' work-related problems, and presumably their possibilities to continue working.Useat syöpään sairastuneet ovat halukkaita palaamaan työelämään sairautensa jälkeen, mutta on mahdollista, että he kohtaavat fyysisiä ja sosiaalisia ongelmia työelämässä sairautensa seurauksena. Tutkimuksessa selvitettiin syövän vaikutusta työllisyyteen, työkykyyn ja työelämästä saatuun tukeen ja sen tarpeeseen. Syövän vaikutusta työllisyyteen selvitettiin rekistereiden avulla. Tutkimusaineistoista ensimmäisessä oli 46,312 ja toisessa 12,542 työikäistä syöpään sairastunutta ja sama määrä syöpää sairastamattomia vertailuhenkilöitä. Tulosten mukaan syövällä on jonkin verran vaikutusta työllisyyteen. Työllisyys oli 2 3 vuotta sairastumisen jälkeen 64 %, kun se syöpää sairastamattoman vertailuryhmän keskuudessa oli 73 %. Työllisyysprosentti oli ennen sairastumista kummassakin ryhmässä yhtä suuri (78 %). Työllisyys vaihteli koulutuksen ja syöpätyypin mukaan. Korkeasti koulutetut olivat todennäköisemmin töissä kuin alemman koulutustaustan omaavat. Syöpään sairastuneet olivat vertailuhenkilöitä useammin eläkkeellä (34 % syöpään sairastuneista ja 27 % vertailuhenkilöistä). Eri syöpää sairastavien väliset erot eläköitymisessä olivat kuitenkin suuret. Leukemiaan ja keskushermostosyöpään sairastuneilla oli kaksinkertainen riski jäädä eläkkeelle vertailuhenkilöihin nähden, kun esimerkiksi melanoomaa sairastaneiden ja heidän vertailuhenkilöidensä välillä ei havaittu eroja eläkkeelle siirtymisessä. Kyselytutkimuksen kaksi aineistoa käsitti 640 syöpään sairastunutta ensimmäisessä, ja 591 syöpään sairastunutta ja 757 vertailuhenkilöä toisessa aineistossa. Ensimmäisessä kyselytutkimuksessa selvitettiin syöpään sairastuneiden saamaa ja toivomaa emotionaalista ja käytännön tukea työtovereilta, esimiehiltä ja työterveyshuollosta. Lisää tukea toivottiin erityisesti työterveyshuollosta (39 % naisista ja 29 % miehistä). Eniten lisätukea toivoivat lymfoomaa sairastaneet tai kemoterapiaa saaneet sekä vain peruskoulun käyneet miehet. Toisessa kyselyaineistoon perustuvassa tutkimuksessa selvitettiin syövän vaikutusta työkykyyn ja lisäksi sitä, oliko työkyky huononnut syövän vuoksi. Syöpään sairastuneiden yleinen työkyky ei poikennut syöpää sairastamattomien vertailuhenkilöiden työkyvystä. Kuitenkin 26 % raportoivat fyysisen työkykynsä ja 19 % henkisen työkykynsä huononneen syövän vuoksi. Syöpään sairastuneet, joilla oli useita muita sairauksia tai olivat saaneet kemoterapiaa kokivat useimmin työkykynsä huononneen kun taas sairastuneet, jotka olivat sitoutuneita työpaikkaansa ja jotka kokivat työilmapiirinsä hyväksi, harvemmin raportoivat huononemista. Tutkimuksen tulokset osoittavat, että suurin osa syöpään sairastuneista palaa työelämään. Kuitenkin on olemassa joukko sairastuneita, jotka siirtyvät varhain eläkkeelle, kokevat työkyvyn huononemista eivätkä saa riittävästi sosiaalista tukea työelämässä. Sairauteen liittyvät tekijät, kuten syöpätyyppi, samoin kuin sosiodemograafiset tekijät kuten esimerkiksi koulutus ja ammatti, ovat merkittävimpiä sairastuneiden työelämän ongelmiin vaikuttavia tekijöitä. Hoitoihin liittyviin tekijöihin, samoin kuin työpaikan voimavaratekijöiden vaikutukseen syöpään sairastuneiden työhön paluussa tulisi kiinnittää tulevaisuudessa enemmän huomiota

"Elämää ihmispelkona" : Tuberkuloosipotilaan leimautuminen parantolahoidon Suomessa

Only abstract. Paper copies of master’s theses are listed in the Helka database (http://www.helsinki.fi/helka). Electronic copies of master’s theses are either available as open access or only on thesis terminals in the Helsinki University Library.Vain tiivistelmä. Sidottujen gradujen saatavuuden voit tarkistaa Helka-tietokannasta (http://www.helsinki.fi/helka). Digitaaliset gradut voivat olla luettavissa avoimesti verkossa tai rajoitetusti kirjaston opinnäytekioskeilla.Endast sammandrag. Inbundna avhandlingar kan sökas i Helka-databasen (http://www.helsinki.fi/helka). Elektroniska kopior av avhandlingar finns antingen öppet på nätet eller endast tillgängliga i bibliotekets avhandlingsterminaler.Tuberkuloosi oli Suomessa aina 1950-luvulle hyvin leimaava sairaus, joka asetti sitä sairastaneet ihmiset marginaaliseen asemaan asemaan yhteiskunnassa. Tutkimuksen tarkoitus on selvittää, miten tämä leima ilmeni ja minkälaisia muotoja se sai. Tutkimuksen keskiössä ovat tuberkuloosia sairastaneet ihmiset. Kuinka he marginaalisen asemansa kokivat ja millaisia selviytymiskeinoja he käyttivät. Tutkimusongelmaa lähestytään sosiologisessa tutkimusperinteessä paljon käytetyn Erwing Goffmanin stigmateorian kautta. Tärkeimpänä tutkimusaineistona ovat Parantolaperinne-kilpailun kirjoitukset. Analyysimenetelmänä on Glaserin ja Straussin kehittämä ja myöhemmin Straussin ja Corbinin tarkentama Grounded theory. Tuberkuloosi oli hyvin voimakkaita mielikuvia herättänyt sairaus. Ennen 1900-lukua tuberkuloosia koskevat mielikuvat olivat luonteeltaan romanttisia, mutta 1900-luvulle tultaessa sairauden negatiiviset mielikuvat tulivat yhä tavallisemmiksi. Negatiivisilla mielikuvilla oli suuri merkitys leiman syntymiseen. Keskeisellä sijalla tutkimuksessa onkin kysymys siitä, mikä tuberkuloosin luonteessa oli sellaista, että se leimasi siihen sairastuneet. Negatiivisten mielikuvien alkuperää etsitään tuberkuloosin lääketieteellisestä luonteesta ja sairauden hoitotavoista. Varsinkin tuberkuloosia koskevalla terveysvalistuksella oli yksilöä syyllistävä ja leimaava vaikutuksensa. Myös parantolahoidolla oli merkityksensä leimautumisessa, koska viimeistään parantolassa olo teki tuberkuloottisen ihmisen sairaudesta kiistattoman tosiasian muiden ihmisten silmissä. Sairastumiskokemus jaetaan tutkimuksessa neljään eri ajanjaksoon perustuen sairastuneiden itsensä tapaan jäsentää sairautensa kulku. Nämä neljä ajanjaksoa olivat: sairastuminen, parantolassa olo, toipuminen ja elämä sairauden jälkeen. Sairastuminen ja elämä sairauden jälkeen olivat yksilöllisiä kokemuksia, mutta parantolassa olo sai kertomuksissa niin samankaltaisia merkityksiä, että voidaan puhua parantola-ajan kollektiivisesta muistamisesta. Tuberkuloottisia sairastaneilla ihmisillä oli runsaasti erillaisia leimautumiskokemuksia, jotka ilmenivät konkreettisesti sairauden jälkeen mm. asunnon ja työpaikan saannin vaikeutena. Selviytyäkseen jokapäiväisessä elämässään tuberkuloosipotilaat käyttivät erillaisia selviytymiskeinoja. Tutkimuksessa käytetään soveltaen Agnes Milesin kehittelemää, alunperin vammaisia ihmisiä koskevaa, selviytymisstrategioiden luokitusta. Miles jakaa strategiat neljään eri luokkaan, jotka ovat: peittely, eristäytyminen, normalisointi ja taistelu. Tuberkuloosia sairastaneiden ihmisten kohdalla esille tulivat salailu ja välttely hetkellisinä selviytymiskeinoina. Koko elämää kattavana selviytymiskeinona normalisointi oli kaikista keinoista yleisin. Vähitellen sairaus alkoi menettää merkitystään, ja elämään tuli tärkeämpiä, sitä uudelleen jäsentäviä tekijöitä. Tällaisia olivat esimerkiksi perheen perustaminen ja lasten saaminen. Toisin kuin Milesin esittämässä taistelustrategiassa, missä korostetaan leimautuneiden ihmisten mahdollisuuksia vaikuttaa asioihinsa järjestön kautta, tuberkuloosia sairastaneiden ihmisten kohdalla korostui henkilökohtaisen taistelun merkitys. Yhteistä kertomuksille olikin yksilöllisten ratkaisujen korostuminen sairaudesta selviytymisessä

The progress and outcomes of black and minority ethnic (BME) nurses through the Nursing and Midwifery Council's "Fitness to Practise" process: Final report

BACKGROUND This is the first investigation of the relationship between ethnicity and regulation of the nursing profession conducted internationally. The study was commissioned by the Nursing and Midwifery Council which is the regulator of the professions in the UK. AIMS OF THE STUDY “To establish whether the progress and outcomes of Black and minority ethnic (BME) nurses in relation to fitness to practice, from the point of referral to the point of case closure, is different from that of White nurses and midwives (N&M); and whether we can from the data account for any differences identified” (Call for research, NMC 2015). The study was designed to investigate whether BME N&M nurses are more likely to be referred and whether they were more likely to progress through the stages of the Fitness to Practise (FtP) process (screening, investigation or adjudication) and whether they were more likely to receive a severe penalty at the end of the process. DATA The NMC made available a copy of the register which had socio-demographic information on 681,258 nurses and midwives between April 2012 and December 2014 as well as data on referrals from April 2012 to December 2014 which totalled 5,851. Over that period the total number of cases that went to adjudication was 946. VARIABLES The main independent variable is ethnicity which we divided into Black, Asian, White, Other and Unknown. The latter category accounted for 40% of all referrals. The outcomes studied were rates of referral, the imposition of interim orders (where the referred individual is not allowed to work, progression through screening, investigation, adjudication and final outcome, which was dichotomised into “can work” or “cannot work”. The regression models also controlled for: age, gender, source of referral (9 categories), region of qualification (Africa, Asia, Europe, Other, UK), country of referral (4 counties of the UK) and whether or not the individual referred had a representative, such as a Union. METHODS OF ANALYSIS Descriptive statistics, cross-tabulation analysis, logistic regression and ordinal logistic regression FINDINGS Descriptive statistics showed that BME nurses are more likely to be referred than white nurses and to progress through the FtP process. Having trained in Africa is also a risk factor for referral. Older N&M and males are more likely to be referred. Most referrals come from employers but members of the public are also an important source of referral. Inferential statistics show that relative to Whites, being Asian, Black or of Unknown ethnicity is associated with progressing through FtP process. However, when “source of referral” is entered into the regression model only the “Unknown ethnicity” category remains significantly more likely to progress than White N&M. Males are more likely to progress through the FtP process but age, though positive, is not significant. There were few significant differences among the countries of the UK. The imposition of interim orders did not vary by ethnicity. The presence of a representative seems to reflect the stage of the FtP process rather than being a factor that contributes to the outcome. Finally, at adjudication, being Asian or Black is associated with a less severe penalty than White. Only those of Unknown ethnicity are more likely than Whites to get a severe penalty. These results are not altered by controlling for the source of referral. STRENGTHS AND WEAKNESSES OF THE STUDY The strengths include: the fact that this is the first study of its kind, the datasets analysed are large and the statistics are appropriate. Weakness include the fact that in 40% cases the ethnicity of the referred individual is not known. Some of the registered N&M may not be working which means that their risk of being referred to the NMC is low which could be a threat to the comparison of different ethnic groups. The administrative data which we analysed did not provide information about the specialty (e.g. mental health, maternity), job setting (care home, acute hospital) or level of seniority (staff nurse or Director of Nursing of the individuals referred were not amenable to analysis. RECOMMENDATIONS The analysis reported here could be enhanced in the future if the information on ethnicity, the setting in which the referred individual is working and their grade is made available. Some jobs may simply carry a higher risk of referral to the NMC and BME nurses may disproportionately occupy those positions. The main finding, which is that the relationship between ethnicity and FtP is mediated by referral by the employer, directs our attention to the need for further research to understand how the working environment leads to an over-representation of BME nurses in the FtP process. Within the NMC, further research needs to be conducted to understand why White nurses are more likely to be given a severe penalty at adjudication even though they are underrepresented in referrals and less likely to progress through the process. With the introduction of the NMC code and revalidation, the collection of data by the NMC and the FtP process will undoubtedly change. At the same time, the NHS has introduced policies to directly affect the working environment of BME nurses and midwives. This means that this study should be repeated to take account of these changes in the wider environment

Workplace policy and management practices to improve the health of employees Evidence Review 3

The National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health to develop guidance on management practices to improve the health of employees, with a particular emphasis on the role of line managers and organisational context. The guidance will cover support for managers, their training, and awareness of employee health issues including managing sickness absence, as well as policies and the organisational context. The Institute for Employment Studies (IES) in partnership with The Work Foundation (TWF) and Lancaster University have been contracted to undertake a series of evidence reviews of relevant effectiveness and qualitative studies and an economic analysis to support the production of this guidance. This report presents the third of these evidence reviews and is a qualitative review of non-intervention studies which explore the workplace factors that facilitate or constrain the ability of line managers to enhance the well-being of the people they manage. The first review examined the evidence on the effectiveness of interventions taken by supervisors that could enhance the well-being of the people they manage and the second examined the evidence on the effectiveness of organisational interventions that aim to support line managers to enhance the well-being of the people they manage

Erratum to: A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists - The RedPharm study

Following publication of this article [1], it has come to our attention that the author, Susan MacAskill, has had her name captured incorrectly. The correct spelling is the aforementioned

Methods to improve recruitment to randomised controlled trials : Cochrane systematic review and meta-analysis

Peer reviewedPublisher PD

Verotus lentoliikenteen päästöohjauksessa : Esiselvitys

Tutkimuksen tavoitteena oli arvioida, millaisia toteutusvaihtoehtoja lentoverolle olisi Suomessa, millainen vaikutus päästöjen määrään vaihtoehdoilla olisi, sekä millaisia taloudellisia vaikutuksia näillä olisi. Yksityiskohtaisempaan tarkasteluun valittiin kolme vaihtoehtoa: lippuvero (lentolipun hintaan lisättävä matkan pituuden mukaan porrastuva vero), nousuvero (kiinteä lentokohtainen vero) ja polttoainevero. Toteutusvaihtoehtojen arvioidaan vähentävän lentomatkustusta 1,6–2,8 % ja lentojen määrää 2,6–5,6 %. Lentoliikenteen päästöjen arvioidaan vähenevän 1,8–2,3 %. Toteutusvaihtoehtojen negatiivinen vaikutus kansantuotteeseen on 0,02–0,05 %. Vaikutuksen suuruus on riippuvainen siitä, palautetaanko vero kotitalouksille neutraaleina tulonsiirtoina. Toimialoista vaikutus on suurin lentoliikenteen palveluihin ja yksityisiin palveluihin. Alueelliset vaikutukset keskittyvät Uudellemaalle, jossa myös matkailutulon menetys on suurin. Lentoveron avulla saavutettavan päästövähennyksen kansantaloudellinen kustannus on 470–710 €/CO2t, jos vero palautetaan kotitalouksille, ja 870–1 000 €/CO2t, jos veroa ei palauteta. Tarkastelluista vaihtoehdoista lippuvero on kustannustehokkain molemmissa tapauksissa. Toisaalta polttoaineveroon liittyy vahvuuksia, joita tutkimuksessa käytetty kysyntä- ja tarjontamallinnusmenetelmä ei huomioi. Julkaisu on läpikäynyt ulkopuolisen tieteellisen arvioinnin.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Antenatal and neonatal risk factors in very preterm children were associated with language difficulties at 9 years of age

Aim: This Finnish study compared language and reading abilities between schoolchildren born at a very low gestational age (VLGA) of <32 weeks and at term and analysed any associations between antenatal and neonatal risk factors and language skills in the VLGA group. Methods: We prospectively followed 76 children born at a VLGA and 50 children born at term when they reached a mean age of 9.0 (8.1–10.0) years. They attended mainstream schools and had no severe neurosensory disabilities. Receptive language ability, rapid naming and word reading were evaluated using standardised tests. Results: Children in the VLGA group had lower scores for receptive language abilities (median 55.0 vs. 57.0, p = 0.01) and word reading (mean 4.4 vs. 5.1, p = 0.03) than the children in the term group. In the VLGA group, foetal growth restriction was associated with lower scores for rapid naming, early intraventricular haemorrhage was associated with poor word reading and respiratory distress syndrome was associated with poor rapid naming (p < 0.05). Conclusion: Schoolchildren born at a VLGA had more difficulties with receptive language abilities and word reading than children born at term. Foetal growth restriction and early neonatal morbidities were associated with language difficulties.publishedVersionPeer reviewe

A mixed methods feasibility study of nicotine-assisted smoking reduction programmes delivered by community pharmacists – The RedPharm study

BACKGROUND: Pivotal trials have established that, among people who have no immediate intention to quit smoking, nicotine replacement therapy (NRT) helps people reduce and eventually stop smoking. The prime aim of this trial was to investigate the feasibility of implementing such a programme in community pharmacies. In addition, we investigated the effectiveness of providing behavioural support compared with self-help methods and of shorter compared with standard length reduction programmes. METHODS: Pharmacists were trained to deliver a smoking reduction programme and opportunistically invite people to participate in the programme. In a 2 × 2 factorial design, eligible volunteers were randomised to either receive in-person behavioural support or a self-help booklet. In both cases, participants were supported to set targets to reduce their smoking and use behavioural techniques to assist reduction. In addition, participants were randomised to cut down and stop over 4 weeks or over 16 weeks, but in either case continue NRT for up to nine months. We assessed uptake and adherence to the programme and smoking cessation four weeks and six months after a quit day and reduction in the three months following programme end and incorporated a qualitative processes assessment. RESULTS: Only 68 of the planned 160 smokers could be recruited. Pharmacists were deterred by the bureaucracy of trial enrolment and that many smokers did not return for further support. Pharmacists sometimes subverted the randomisation or provided support to participants in the self-help arm. Smokers stayed in the programme for an average of 6 weeks rather than the 9 months envisaged. Rates of follow-up declined to around 20% of participants by 12 months. There was insufficient evidence to assess whether support or speed of reduction enhanced cessation or reduction but cessation and reduction were less common overall than in the pivotal trials for licensing NRT for this indication. CONCLUSIONS: This programme of smoking reduction and the trial design to assess its effectiveness proved unpopular to potential participants and pharmacists. As a result, the trial produced no evidence on the effectiveness of behavioural support or speed or smoking reduction. A trial of this programme in this context is unfeasible

Establishing the added benefit of measuring MMP9 in FOB positive patients as a part of the Wolverhampton colorectal cancer screening programme

<p>Abstract</p> <p>Background</p> <p>Bowel cancer is common and a major cause of death. The NHS is currently rolling out a national bowel cancer screening programme that aims to cover the entire population by 2010. The programme will be based on the Faecal Occult Blood test (FOBt) that reduces mortality from colon cancer by 16%. However, FOB testing has a relatively low positive predictive value, with associated unnecessary cost, risk and anxiety from subsequent investigation, and is unacceptable to a proportion of the target population. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP9) have been found to be associated with colorectal cancer, and this can be measured from a blood sample. MMP9 has potential for detecting those at risk of having colorectal cancer. The aim of this study is to assess whether MMP9 estimation enhances the predictive value of a positive FOBt.</p> <p>Methods and design</p> <p>FOBt positive people aged 60–69 years attending the Wolverhampton NHS Bowel Cancer Screening Unit and providing consent for colonoscopy will be recruited. Participants will provide a blood sample prior to colonoscopy and permission for collection of the clinical outcome from screening unit records. Multivariate logistic regression analyses will determine the independent factors (patient and disease related, MMP9) associated with the prediction of neoplasia.</p> <p>Discussion</p> <p>Colorectal cancer is a major cause of morbidity and mortality. Pilot studies have confirmed the feasibility of the national cancer screening programme that is based on FOBt. However, the test has high false positive rates. MMP9 has significant potential as a marker for both adenomas and cancers. This study is to examine whether using MMP9 as an adjunct to FOBt improves the accuracy of screening and reduces the number of false positive tests that cause anxiety and require invasive and potentially harmful investigation.</p