Arif Jetha

Unpacking Early Work Experiences of Young Adults With Rheumatic Disease: An Examination of Absenteeism, Job Disruptions, and Productivity Loss

To examine work absenteeism, job disruptions, and perceived productivity loss and factors associated with each outcome in young adults living with systemic lupus erythematosus (SLE) and juvenile arthritis (JA).

Management of work disability in rheumatic conditions: A review of non-pharmacological interventions

Because of its substantial personal social and economic costs, workforce participation among individuals with rheumatic diseases has received considerable research attention. This chapter reviews non-pharmacological employment interventions for people with rheumatic diseases, focussing on the comprehensiveness of interventions, whether they have been targeted to those groups identified as most at risk, and intervention outcomes and effectiveness. Findings highlight that early diagnosis and treatment of rheumatic diseases may not be enough to keep individuals employed and that comprehensive work interventions may have positive psychological effects, as well as result in increased work participation. However, we lack data addressing the optimum time to intervene and subgroup analyses to determine whether some groups are at increased risk for poor work outcomes. Consistent inclusion of behavioural and psychological outcomes to evaluate interventions and compare studies is also needed, along with cost-benefit studies, to determine the long-term feasibility of work interventions.

The impact of arthritis on the early employment experiences of young adults: A literature review

BACKGROUND Young adulthood is an important transitional life phase that can determine a persons career trajectory. To date, little research has examined the influence of arthritis on early work experiences. OBJECTIVES This literature review aims at examining the impact of arthritis on the early career phase of young adults and identifying the barriers to employment. METHODS Two independent reviewers searched bibliographic databases for arthritis conditions and a series of employment-related keywords and subject headings. Information on authors, publication year; study design, sample characteristics (e.g., number of participants, age, gender, arthritis type); work outcomes measured; and specific barriers to employment was recorded. RESULTS Nine studies were uncovered in the review. All studies examined young people with juvenile arthritis (9 of 9 studies) and consisted of sample sizes with less then 150 participants (6 of 9 studies) who were primarily recruited from clinics (7 of 9 studies). All were cross-sectional designs. Employment status was primarily examined and ranged from 11% to 71%. Although not always statistically significant, young adults with arthritis were less likely to be employed when compared to their healthy peers. Greater disease severity, less educational attainment and being female were related to not participating in paid work. CONCLUSION This review brings to light the paucity of studies examining the early employment experiences of young adults with arthritis. There is a need to expand research to contribute to recommendations for sustained and productive employment across the working life course.

Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions

Objective: The aim of this study was to compare the association between age and disability length across common chronic conditions. Methods: Analysis of 39,915 nonwork-related disability claims with a diagnosis of arthritis, diabetes, hypertension, coronary artery disease, depression, low back pain, chronic pulmonary disease, or cancer. Ordinary least squares regression models examined age-length of disability association across chronic conditions. Results: Arthritis (76.6 days), depression (63.2 days), and cancer (64.9 days) were associated with longest mean disability lengths; hypertension was related to shortest disability lengths (41.5 days). Across chronic conditions, older age was significantly associated with longer work disability. The age–length of disability association was most significant for chronic pulmonary disease and cancer. The relationship between age and length of work disability was linear among most chronic conditions. Conclusions: Work disability prevention strategies should consider both employee age and chronic condition diagnosis.

Transitioning to Employment with a Rheumatic Disease: The Role of Independence, Overprotection, and Social Support

Objective. To examine perceived independence, overprotection, and support, and their association with the employment participation of young adults with rheumatic disease. Methods. One hundred and forty-three young adults, ages 18 to 30 years, with systemic lupus erythematosus (54.5%) and juvenile arthritis (45.5%) completed a 30-min online questionnaire of their work and education experiences. Information collected was demographic, health (e.g., pain, fatigue, disease activity), work context (e.g., career satisfaction, helpfulness of job accommodation/benefits, and workplace activity limitations), and psychosocial (e.g., independence, social support, and overprotection). Log-Poisson regression analysis examined factors associated with employment status. Results. Over half of respondents were employed (59%) and 26% were enrolled in school. Respondents reported moderate to high perceptions of independence and social support. However, 27% reported that “quite a bit” to “a great deal” of overprotection characterized their relationships with those closest to them. At the bivariate level, employed participants and those indicating greater perceived independence reported greater social support and less overprotection. Multivariable analysis revealed that being employed was associated with older age, more job accommodations/benefits perceived as being helpful, and greater perceived independence. Conclusion. This is one of the first studies examining the employment of young adults with rheumatic diseases. Findings highlight the importance of psychosocial perceptions such as independence and overprotection, in addition to support related to working. Additional research is needed to better understand the role of those close to young adults with rheumatic diseases in supporting independence and encouraging employment.

Longitudinal examination of temporality in the association between chronic disease diagnosis and changes in work status and hours worked

Objectives To examine the longitudinal relationship between incidence of diagnosed chronic disease and work status and hours worked. Methods A dynamic cohort approach was taken to construct our study sample using the Canadian National Population Health Survey. Participant inclusion criteria included being employed and without a chronic health condition in the survey cycle prior to diagnosis, and participation in consecutive surveys following diagnosis. Each respondent was matched with up to 5 respondents without a diagnosed health condition. The direct and indirect associations between chronic disease and work status and hours worked following diagnosis were examined using probit and linear regression path models. Separate models were developed for arthritis, back problems, diabetes, hypertension and heart disease. Results We identified 799 observations with a diagnosis of arthritis, 858 with back pain, 178 with diabetes, 569 with hypertension and 163 with heart disease, which met our selection criteria. An examination of total effects at time 1 and time 2 showed that, excluding hypertension, chronic disease diagnosis was related to work loss. The time 2 effect of chronic disease diagnosis on work loss was mediated through time 1 work status. With the exception of heart disease, an incident case of chronic disease was not related to changes in work hours among observations with continuous work participation. Conclusions Chronic disease can result in work loss following diagnosis. Research is required to understand how modifying occupational conditions may benefit employment immediately after diagnosis.

Transitions that matter: life course differences in the employment of adults with arthritis

Abstract Purpose: To understand the similarities and differences in the employment participation of people living with arthritis across the life course. Method: Focus groups and interviews were conducted with young (ages 18–34 years, n = 7), middle-aged (ages 35–54 years, n = 13) and older adults (>55 years, n = 25) with arthritis. Participants were asked about the impact of arthritis on employment, experiences with health-related changes, career progression and social role involvement. A modified grounded theory approach was used to inductively analyze the data. Results: Young adults indicated the school-to-work transition as being influential in their employment and described the need to direct their time and energy toward finding work that accommodated health and met career aspirations. Middle-aged adults described how the transition from good health to an arthritis diagnosis disrupted involvement in diverse social roles. However, they often downplayed the impact of arthritis on employment. Older adults described the work-to-retirement transition and their decline in physical functioning as contributing to changing involvement in the labor market. Conclusion: Transitions related to health, career progression and social role involvement shaped employment experiences, and represent opportunities for future research and practice that is tailored to life course issues. Implications for rehabilitation Little is known about the work experiences of young- and middle-aged adults with arthritis and how they compare to their older counterparts. Life course theory offers an important framework for research and practice by providing a perspective to enhance our understanding of how employment participation differs across phases of life. Salient and diverse changes related to health, career and social role involvement were identified at each life phase and shaped employment. Rehabilitation practitioners should pay special attention to a client’s age, life phase and work history as a strategy to enhance the delivery of interventions that promote work participation.

Education and Employment Participation in Young Adulthood: What Role Does Arthritis Play?

To examine the association between arthritis diagnosis and education and employment participation among young adults, and to determine whether findings differ by self‐rated health and age.

Increased Incidence of Tuberculosis in Zimbabwe, in Association with Food Insecurity, and Economic Collapse: An Ecological Analysis

Background Zimbabwe underwent a socioeconomic crisis and resultant increase in food insecurity in 2008–9. The impact of the crisis on Tuberculosis (TB) incidence is unknown. Methods Prospective databases from two mission hospitals, which were geographically widely separated, and remained open during the crisis, were reviewed. Results At the Howard Hospital (HH) in northern Zimbabwe, TB incidence increased 35% in 2008 from baseline rates in 2003–2007 (p<0.01) and remained at that level in 2009. Murambinda Hospital (MH) in Eastern Zimbabwe also demonstrated a 29% rise in TB incidence from 2007 to 2008 (p<0.01) and remained at that level in 2009. Data collected post-crisis at HH showed a decrease of 33% in TB incidence between 2009 to 2010 (p<0.001) and 2010/2011 TB incidence remained below that of the crisis years of 2008/2009 (p<0.01). Antenatal clinic HIV seroprevalence at HH decreased between 2001(23%) to 2011(11%) (p<0.001). Seasonality of TB incidence was analyzed at both MH and HH. There was a higher TB incidence in the dry season when food is least available (September-November) compared to post harvest (April-June) (p<0.001). Conclusion This study suggests that an epidemic of TB mirrored socioeconomic collapse and recovery in Zimbabwe. The seasonal data suggests that food security may have been associated with TB incidence both annually and during the crisis in this high HIV prevalence country.

132 Accommodations best served soft: supporting the needs of disabled young adults in the workplace

Introduction A disability may add to the challenges faced by young adults during the school-to-work transition. Few studies have examined differences in soft (e.g., scheduling modification) and hard accommodation need (e.g., ergonomic adaptation) among disabled young adults, and the factors associated with accommodation need. Methods An online survey was conducted of 155 Canadian disabled young adults (mean age=25.8±5.1). Respondents were either employed or seeking employment, and recruited using a registry from a national disability organisation. Respondents were asked about their need for 16 soft and hard accommodations. Demographic (e.g., gender), health (e.g., disability type, work limitations), and work characteristics (e.g., work status, hours worked/week, permenant vs short-term contract) were collected. Participants were also asked about perceived barriers to accessing accommodations using eight items (e.g., disclosure difficulites, cost of accommodation). Multivariable logistic analyses were conducted to examine the factors associated with soft and hard accommodation need. Result Most participants reported psychological (79%) and learning disabilities (45%), and 68% had >1 disability. Over half (55%) were employed at the time of the survey, and 80% worked in non-standard employment conditions (e.g., part-time or short-term work). An average of five perceived accommodation barriers were indicated. More soft accommodations (mean=6.3, 95% CI: 6.00 to 6.30) were needed than hard accommodations (mean=4.9, 95% CI: 4.60 to 5.20). Soft accommodation need was associated with less perceived accommodation barriers (OR=−0.83, 95% CI: 0.73 to 0.94), not working (OR=−0.39, 95% CI: 0.16 to 0.91) and greater work limitations (OR=1.1, 95% CI: 1.01 to 0.12). Hard accommodation need was associated with less perceived accommodation barriers (OR=−0.88, 95% CI: 0.78 to 0.99). Discussion Offering soft accommodations may be a particularly important strategy for organisations to support the employment of disabled young adults. Interventions that address perceived barriers to accessing accommodations may result in a greater requirement for workplace supports that benefit the school-to-work transition.