Association between job exposures and employment status 2 years after medical rehabilitation

Abstract Background Research shows an important association between job exposures and various health- and employment-related outcomes. On contrast, little is known about the impact of job exposures on the employment status after medical rehabilitation. Thus, the aim of this study is to investigate the association between job exposures and employment, unemployment, and disability pension entry 2 years after rehabilitation. Methods A retrospective cohort study was performed based on the scientific use file “SUFRSDLV15B” of the German Pension Insurance containing rehabilitation and occupational data at a monthly level. We included n = 597,021 insured persons aged 18 to 63 years completing a medical rehabilitation between 2008 and 2013 in Germany and traced their employment status over a 24-month follow-up period. Job exposures were operationalised with the Overall Job Exposure Index (Kroll, 2015) by applying job-exposure-matrices. Results Persons with high job exposures in comparison to those with low job exposures were less likely to be employed (87.6% vs. 92.6%) and more likely to be unemployed (13.9% vs. 7.7%) and to draw disability pension (4.8% vs. 4.4%) for at least one month in the 2-year-period after rehabilitation. One minus survival curves showed that the differences were already evident in the first month after rehabilitation and further increased during the following 24 months. Cox regressions revealed that these associations remained stable when adjusting for gender, age, and employment status before rehabilitation. Conclusions The results underline the importance of addressing job exposures during rehabilitation to enhance return-to-work and stay-at-work after rehabilitation. These findings could help to identify particularly vulnerable groups of insured persons based on routine data at an earlier stage than has been the case so far and to give them access to structured workplace-oriented medical rehabilitation programmes that have been established in recent years. Key messages • High job exposures are associated with less work participation after medical rehabilitation. • To increase return-to-work, it may be useful to address job exposures in rehabilitation more than before.


Background:
From the beginning of 2020, the COVID-19 pandemic imposed many changes in the organization of our personal and professional life, allowing a shift to teleworking and hybrid working arrangements worldwide. The persistence of this condition determined the integration of these changes in the daily routine, and our aim was to investigate how these changes could affect workers' Quality of Life (QOL) in the long run. Methods: An online questionnaire was administered to 650 workers employed in an Italian company in July 2021. The domains considered were socio-demographic characteristics, QOL (WHOQOL-bref and Healthy Days), lifestyle, health status, physical activity, and work-related factors. Comparisons were performed with non-parametric tests.

Results:
Among the 332 respondents (response rate = 51.1%), 79.2% were white-collar workers. The concern for the pandemic affected workers' QOL, especially in the physical health and the environmental domains (p < 0.001 and p = 0.001, respectively), with lower values in subjects reporting the highest values of concern. A similar effect was found also for healthy days concerning physical and psychological health, and the ability to perform usual activities (p = 0.003, p = 0.003, and p = 0.029, respectively). As well, changes in working arrangements significantly affected the environmental and physical domains (p = 0.023 and p = 0.015, respectively) and the ability to do usual activities (p = 0.011), with lower values in those who interrupted the working activity. Workers whose activity required a shift to teleworking reported higher scores in the physical health domain (p = 0.041) and a higher number of days with good physical health (p = 0.002), while a lower number of days with good psychological health (p = 0.006).

Conclusions:
These preliminary data revealed that organizational strategies adopted in working scenarios to contain the spread of COVID-19 may have an impact on workers' QOL, as well as the concern for the pandemic.

Key messages:
Changes in the working arrangements due to pandemic may negatively affect the workers' Quality of Life, especially for those who had to interrupt their working activity. The shift to telework, even if appearing to be beneficial for physical health perception, seems to negatively affect workers' psychological health.

Background:
Research shows an important association between job exposures and various health-and employment-related outcomes. On contrast, little is known about the impact of job exposures on the employment status after medical rehabilitation. Thus, the aim of this study is to investigate the association between job exposures and employment, unemployment, and disability pension entry 2 years after rehabilitation.

Methods:
A retrospective cohort study was performed based on the scientific use file ''SUFRSDLV15B'' of the German Pension Insurance containing rehabilitation and occupational data at a monthly level. We included n = 597,021 insured persons aged 18 to 63 years completing a medical rehabilitation between 2008 and 2013 in Germany and traced their employment status over a 24-month follow-up period. Job exposures were operationalised with the Overall Job Exposure Index (Kroll, 2015) by applying job-exposure-matrices.

Results:
Persons with high job exposures in comparison to those with low job exposures were less likely to be employed (87.6% vs. 92.6%) and more likely to be unemployed (13.9% vs. 7.7%) and to draw disability pension (4.8% vs. 4.4%) for at least one month in the 2-year-period after rehabilitation. One minus survival curves showed that the differences were already evident in the first month after rehabilitation and further increased during the following 24 months. Cox regressions revealed that these associations remained stable when adjusting for gender, age, and employment status before rehabilitation.

Conclusions:
The results underline the importance of addressing job exposures during rehabilitation to enhance return-to-work and stay-at-work after rehabilitation. These findings could help to identify particularly vulnerable groups of insured persons based on routine data at an earlier stage than has been the case so far and to give them access to structured workplace-oriented medical rehabilitation programmes that have been established in recent years.

Key messages:
High job exposures are associated with less work participation after medical rehabilitation.
To increase return-to-work, it may be useful to address job exposures in rehabilitation more than before.

Conclusions:
Our findings show that mental health risks of supervisors become apparent especially in situations where esteem, job security and promotion opportunities do not match the status expectations of the position. A labor market policy that encourages organizations to have those tasks performed by their own permanent employees (as opposed to outsourcing them), with a focus on a healthy work-life balance and fair remuneration, can benefit the mental health of this group of employees. Key messages: The mental health of employees in higher positions of authority is more vulnerable to situations of effort-reward imbalance.
European labor market policies focused on security for employees, rather than flexibility for employers, can reduce mental illness among the European middle managers and subordinates.

Background:
Discrimination and sexual harassment in the workplace and in higher education institutions are important public health issues. Here we aim at analyzing the prevalence of discrimination and sexual harassment of lecturers and students at one of the largest teaching hospitals in Europe. We assess whether there are differences between lecturers and students, women and men, and different study programs.

Methods:
An online questionnaire was sent to N = 7095 students of all study programs and N = 2528 lecturers at Charité -Universitätsmedizin Berlin. The survey was conducted from November 2018 to February 2019. We investigated experienced or observed discrimination or sexual harassment at the medical faculty. Furthermore, we analyzed frequency, perpetrators, situational factors, attributed reasons and forms of harassment encountered.

Conclusions:
Discrimination and sexual harassment are prevalent in academic medicine. There are differences in the reasons and sources of discrimination and sexual harassment between students and lecturers. Specific programs for lecturers and students are necessary to educate the faculty on how to prevent and respond to it and whom to address. Key messages: National preventive strategies should be implemented to tackle issues of discrimination and harassment in higher education institutions. Special attention should be paid to female students and lecturers.