The Other Side of the Balance Sheet: Work as a Fundamental Determinant of Health

The article discusses a study from Gaffney and colleagues, published within the issue which provides evidence for the fundamental role that workplace transmission played in differences in the risk of COVID-19 infection. Topics include the impact of occupational transmission of COVID-19;reasons for the denial on the role of work in the risk of disease, injury and death;and means by which work as a fundamental determinant of health can be targeted.

Staff quality of working life and turnover intentions in municipal nursing care and social welfare: a cross-sectional study.

BACKGROUND: Nurses and social workers are two common professions with a university degree working within municipal nursing care and social welfare. Both groups have high turnover intention rates, and there is a need to better understand their quality of working life and turnover intentions in general and more specifically during the Covid-19 pandemic. This study investigated associations between working life, coping strategies and turnover intentions of staff with a university degree working within municipal care and social welfare during the Covid-19 pandemic. METHODS: A cross-sectional design; 207 staff completed questionnaires and data were analyzed using multiple linear regression analyses. RESULTS: Turnover intentions were common. For registered nurses 23% thought of leaving the workplace and 14% the profession 'rather often' and 'very often/always'. The corresponding figures for social workers were 22% (workplace) and 22% (profession). Working life variables explained 34-36% of the variance in turnover intentions. Significant variables in the multiple linear regression models were work-related stress, home-work interface and job-career satisfaction (both for the outcome turnover intentions profession and workplace) and Covid-19 exposure/patients (turnover intentions profession). For the chosen coping strategies, 'exercise', 'recreation and relaxation' and 'improving skills', the results (associations with turnover) were non-significant. However, comparing the groups social workers reported that they used 'recreation and relaxation' more often than were reported by registered nurses. CONCLUSIONS: More work-related stress, worse home-work interface and less job-career satisfaction together with Covid-19 exposure/patients (Covid-19 only for turnover profession) increase turnover intentions. Recommendations are that managers should strive for better home-work interface and job-career satisfaction, monitor and counteract work-related stress to prevent turnover intentions.

Disability Evaluations: Common Questions and Answers

Disability is a physical or mental impairment that substantially limits at least one major life activity. Family physicians are often asked to assess patients with disabling conditions that can impact insurance benefits, employment, and ability to access needed accommodations. Disability evaluations are needed for short-term work restrictions following a simple injury or illness and for more complex cases involving Social Security Disability Insurance, Supplemental Security Income, Family and Medical Leave Act, workers' compensation, and personal/private disability insurance claims. Using a stepwise approach built on awareness of the biologic, psychological, and social elements of disability assessment may facilitate this evaluation. Step 1 establishes the role of the physician in the disability evaluation process and the context of the request. In Step 2, the physician assesses impairments and establishes a diagnosis based on findings from an examination and validated diagnostic tools. In Step 3, the physician identifies specific participation restrictions by assessing the patient's ability to perform specific movements or activities and reviewing the employment environment and tasks. Steps 4 and 5 ensure proper documentation, billing, and coding. In complex cases, consultants such as psychiatrists and physical therapists may assist by providing insight into a patient's mental and physical impairments, activity limitations, and response to treatment. (Am Fam Physician. 2023;107(5):490–498. Copyright © 2023 American Academy of Family Physicians.)

A qualitative life course perspective on covid-lockdowns and couples? division of unpaid labour

Covid-19 lockdowns in many countries were characterised by increases in unpaid labour (e.g. home-schooling), as well as changing working conditions (e.g. remote work). Consequently, a large body of research assesses changes in dual earner couples' gender division of unpaid labour. However, despite the increasingly detailed picture of households' division of labour before and after the onset of the pandemic, it remains unclear how dual earner parents themselves perceive their decision-making regarding labour divisions during lockdowns. Conse-quently, using data from 31 individual in-depth interviews in Belgium, this study adopts a biographical -interpretative method to assess variation in narratives regarding the household division of labour before and during lockdown. Results indicate five ideal type narratives which vary in the extent to which lockdown divisions of unpaid labour exhibit path-dependency or constitute new gender dynamics, but also regarding the balance between individual agency and societal factors as determinants of labour divisions. Taken together, narratives discussing new gender dynamics during lockdowns put forward sector-specific changes in working hours and remote work as external and exogenous determinants. However, most importantly, findings indicate that household decision-making regarding unpaid labour during lockdowns is mostly perceived as path-dependent on pre-covid decision-making (e.g. gender specialisation) in the context of structural (e.g. gendered leave schemes) and normative boundaries (e.g. gendered parenting norms). Such path-dependencies in the decision-making underlying quantitatively identifiable divisions of unpaid labour during lockdowns are likely to be neglected in the absence of a qualitative life course perspective.

COVID-19 and Gender Equality: An Abnormal Normality

"A woman has a right to survival, protection, participation, and development." Although much emphasis is being laid worldwide on gender equality, yet deep-rooted discrimination still prevails in society. Forever since, women have been victims of social conventions and are constantly being pulled down in personal, social, economic and political scenarios. History has warned us numerous times that crisis in health and economy can create huge force to put women's solicitude to the back stage. Today, the COVID-19 pandemic is worsening the most pervasive and insidious inequities that women everywhere have been facing in their lives. This paper discusses the different cultural barriers to women's participation and success in a global scenario, and how the pandemic has aggravated the conditions. It begins by discussing the relationship between economic development and female employment and thereafter argues that the traditional cultural norms, which vary across societies, help explain the large differences in female employment universally. The paper examines several gender-based social norms and how they constrain women's development and participation. The arguments are compared and collated with the COVID-19 pandemic situation to efficiently explain the seriousness of the scenario. In conclusion, the paper examples change that must be incorporated into policies that are aimed at overcoming these cultural barriers to female employment and the volume of the impact that they will have in the future.

Causes of School Leaves of Higher Education Students during the Covid-19 Pandemic

This research focuses on leading causes analysis that originate school leaves from the Tecnologico Nacional de Mexico (TecNM)San Luis Potosi campus during the COVID-19 pandemic January-June 2020 until the January-June 2022 semester and what the factors associated with them. It is a study with a quantitative approach, descriptive scope, and cross-sectional design. It analyzed the Database of the Integral Information System (SII) of the institution. The results indicated that the leading causes for which students definitively withdrawals from their studies were: 49% for failing and 51% for other reasons;the subjects that fail most frequently are: Integral Calculus;Differential Calculus;Linear Algebra;and Probability and Statistics, taught in the first three semesters of the different degree programs. The factors associated with the academic situation of the students are the average grade, the degree they study, and the number of semesters studied.

The impact of state paid sick leave policies on weekday workplace mobility during the COVID-19 pandemic.

OBJECTIVES: This study aimed to evaluate whether the Families First Coronavirus Response Act (FFCRA) modified the association between pre-existing state paid sick leave (PSL) and weekday workplace mobility between February 15 and July 7, 2020. STUDY DESIGN: This was a longitudinal, observational study. METHODS: The 50 US states and Washington, D.C., were divided into exposure groups based on the presence or absence of pre-existing state PSL policies. Derived from Google COVID-19 Community Mobility Reports, the outcome was measured as the daily percent change in weekday workplace mobility. Mixed-effects, interrupted time series regression was performed to evaluate weekday workplace mobility after the implementation of the FFCRA on April 1, 2020. RESULTS: States with pre-existing PSL policies exhibited a greater drop in mobility following the passage of the FFCRA (ß = -8.86, 95% confidence interval: -11.6, -6.10, P < 001). This remained significant after adjusting for state-level health, economic, and sociodemographic indicators (ß = -3.13, 95% confidence interval: -5.92, -0.34; P = .039). CONCLUSIONS: Pre-existing PSL policies were associated with a significant decline in weekday workplace mobility after the FFCRA, which may have influenced local health outcomes. The presence of pre-existing state policies may differentially influence the impact of federal legislation enacted during emergencies.

Ethical work climate and the intention to leave the service in emergency medical technicians during the COVID-19 pandemic.

Emergency medical technicians (EMTs) are very likely to leave the profession due to their obligation to work in critical situations such as the COVID-19 pandemic. This study aimed to investigate the relationship between the ethical work climate and the intention to leave the service among EMTs. In this descriptive correlational study, 315 EMTs working in Zanjan province were surveyed using the census method in 2021. The research tools included the Ethical Work Climate and the Intention to Leave the Service questionnaires. Data were analyzed using SPSS software version 21. We found the mean (SD) score of the organization's ethical work climate to be 73.93 (±12.53), and the intention to leave the service 12.54 (±4.52), which are at a moderate level. A statistically significant positive correlation existed between these variables (r = 0.148, P = 0.017). Also, there was a statistically significant relationship between age and employment status among the demographic variables, and the ethical work climate and the intention to leave (P < 0.05). Our findings indicate that ethical work climate is one of the influential but less noticed factors that affect the performance of EMTs. Therefore, it is suggested that managers implement measures to develop a positive ethical work climate to reduce the tendency to leave the service among EMTs.

Sick Leave Due to Ear Diagnoses, a Nationwide Representative Registry of Mexico.

Sickness absence from work is a measure of both poor health and social functioning. In order to assess the frequency of sick leave due to ear-related diagnoses, we performed a retrospective analysis on the registry of paid sick leave certificates supplied by the main social security institution in Mexico during the years 2018 and 2019, just prior to the SARS-CoV-2 pandemic. We observed that, in the two years, 22,053 sick leave certificates due to ear-related diagnoses were provided to 18,033 workers. The most frequent ear-related diagnoses were those of vestibular disorders (94.64%); among them, the most common diagnosis was Benign Paroxysmal Positional Vertigo (75.16%), followed by Labrynthitis and Meniere's disease (circa 8% each). A total of 4.63% of the diagnoses were related to external and middle ear disorders, and 0.71% were mainly related to hearing. Consistently, the highest cumulative days of sick leave required were given for the group of diagnoses related to vestibular disorders; although the less frequent diagnoses required the highest cumulative days per case (e.g., ototoxicity). During 2018 and 2019, the most frequent diagnoses of ear-related sick leave were due to vestibular diagnoses (particularly Benign Paroxysmal Positional Vertigo).

Impact of the COVID-19 pandemic on sick leave among healthcare workers: a register-based observational study.

OBJECTIVES: To assess the impact of the COVID-19 pandemic on sick leave among healthcare workers (HCWs) in primary and specialist care and examine its causes. METHODS: Using individual-level register data, we studied monthly proportions of sick leave (all-cause and not related to SARS-CoV-2 infection) from 2017 to February 2022 for all HCWs in primary (N=60 973) and specialist care (N=34 978) in Norway. First, we estimated the impact of the pandemic on sick leave, by comparing the sick leave rates during the pandemic to sick leave rates in 2017-2019. We then examined the impact of COVID-19-related workload on sick leave, by comparing HCWs working in healthcare facilities with different levels of COVID-19 patient loads. RESULTS: HCWs had elevated monthly rates of all-cause sick leave during the COVID-19 pandemic of 2.8 (95% CI 2.67 to 2.9) and 2.2 (95% CI 2.07 to 2.35) percentage points in primary and specialist care. The corresponding increases for sick leave not related to SARS-CoV-2 infection were 1.2 (95% CI 1.29 to 1.05) and 0.7 (95% CI 0.52 to 0.78) percentage points. All-cause sick leave was higher in areas with high versus low COVID-19 workloads. However, after removing sick leave episodes due to SARS-CoV-2 infections, there was no difference. CONCLUSIONS: There was a substantial increase in sick leave among HCWs during the pandemic. Our results suggest that the increase was due to HCWs becoming infected with SARS-CoV-2 and/or sector-wide effects, such as strict infection control measures. More differentiated countermeasures should, therefore, be evaluated to limit capacity constraints in healthcare provision.

Support Decent Work for All as a Public Health Goal in the United States. (APHA Policy Statement Number 20223, Adopted November 2022).

This policy promotes decent work as a U.S. public health goal through a comprehensive approach that builds upon existing APHA policy statements and addresses statement gaps. The International Labour Organization defines decent work as work that is "productive, delivers a fair income, provides security in the workplace and social protection for workers and their families, offers prospects for personal development and encourages social interaction, gives people the freedom to express their concerns and organize and participate in the decisions affecting their lives and guarantees equal opportunities and equal treatment for all across the entire lifespan." The World Health Organization has emphasized that "health and employment are inextricably linked" and "health inequities attributable to employment can be reduced by promoting safe, healthy and secure work." Here evidence is presented linking decent work and health and action steps are proposed to help achieve decent work for all and, thus, improve public health. In the United States, inadequacies in labor laws, structural racism, failed immigration policies, ageism, and other factors have increased income inequality and stressful and hazardous working conditions and reduced opportunities for decent work, adversely affecting workers' health and ability to sustain themselves and their families. The COVID-19 pandemic highlighted these failures through higher mortality rates among essential and low-wage workers, who were disproportionately people of color. This policy statement provides a strategic umbrella of tactics for just, equitable, and healthy economic development of decent work and proposes research partnerships to develop, implement, measure, and evaluate decent work in the United States.

Paternal Leave Entitlement and Workplace Culture: A Key Challenge to Paternal Mental Health.

Paternal mental health continues to be a health concern in the UK. Paternal leave entitlement and workplace cultures have failed to support fathers in navigating the complexity of fatherhood, which has an impact on fathers' wellbeing. Interviewing twenty fathers in the York area, this study seeks to explore the impact of parental leave entitlements and workplace cultures on fathers' mental health. The findings demonstrate that the influence of gendered norms and hegemonic masculinity perceptions are ingrained in the current leave entitlement and workplace cultures. While fathers are entitled to take leave, the leave is significantly insufficient to allow them to forge a meaningful bond with a newborn or adapt to the change in routine brought about by the birth of a baby. Furthermore, workplace cultures fail to recognise the responsibilities that come with fatherhood and provide insufficient support for fathers. The COVID-19 lockdown presented fathers with a unique opportunity to be available and take on more family responsibilities. Fathers felt they did not have to navigate gendered and hegemonic perceptions to spend more time with the family. This paper challenges structural and cultural barriers that prevent fathers from taking leave and impacting negatively on fathers' mental health. The paper suggests a review of the current paternal leave entitlement and cultural change in the workplace.

Working conditions and well-being in UK social care and social work during COVID-19

Summary : Stress and mental health are among the biggest causes of sickness absence in the UK, with the Social Work and Social Care sectors having among the highest levels of stress and mental health sickness absence of all professions in the UK. Chronically poor working conditions are known to impact employees' psychological and physiological health. The spread of the COVID-19 pandemic has affected both the mode and method of work in Social Care and Social Work. Through a series of cross-sectional online surveys, completed by a total of 4,950 UK Social Care and Social Workers, this study reports the changing working conditions and well-being of UK Social Care and Social Workers at two time points (phases) during the COVID-19 pandemic. Findings : All working conditions and well-being measures were found to be significantly worse during Phase 2 (November–January 2021) than Phase 1 (May–July 2020), with worse psychological well-being than the UK average in Phase 2. Furthermore, our findings indicate that in January 2021, feelings about general well-being, control at work, and working conditions predicted worsened psychological well-being. Applications : Our findings highlight the importance of understanding and addressing the impact of the pandemic on the Social Care and Social Work workforce, thus highlighting that individuals, organizations, and governments need to develop mechanisms to support these employees during and beyond the pandemic.

Patient-reported respiratory outcome measures in the recovery of adults hospitalised with COVID-19: A systematic review and meta-analysis

Background: The morbidity associated with recovery from COVID-19 is huge with apparent persisting respiratory limitation. Aims and objectives: We investigate the persisting respiratory symptomatic and functional recovery of patients initially hospitalised with COVID-19 in a systematic review and meta-analysis using patient-reported outcome measures (PROMs). Method(s): Comprehensive database searches in accordance with the PRISMA statement were carried out up till 31/05/2021 where data exists for patients >8 weeks after hospital discharge, according to PROSPERO (1). Data were narratively synthesized, and meta-analyses were performed using the random-effects inverse variance method. Result(s): Of 49 studies, across 14 countries with 2-12 months follow up, fatigue was the most commonly reported persisting symptom at 2-4 months (36.6%, 95 % CI 27.6 to 46.6, n=14), and at >4 months (32.5%, 95% CI 22.6 to 44.2, n=15). Modified MRC dyspnoea score >=1 was reported in 48% (95% CI 30 to 37, n=5) at 2-4 months and 32% (95% CI 22 to 43, n=7) at >4 months. Persisting sick leave, change in their scope of work and increased healthcare usage was also reported. Conclusion(s): Persisting respiratory symptoms are experienced by survivors of COVID-19 hospital admission with associated impact on work and healthcare usage.

Profile of healthcare workers who contracted COVID-19 after vaccination against SARS-CoV-2

Introduction: Being at high-risk for COVID-19, healthcare workers (HCW) were prioritized in the beginning of vaccination campaigns in Tunisia. The emergence of several variants raises the issue of resistance and postvaccination infection. Aim(s): To study epidemiological and clinical characteristics of COVID-19 infection in HCW who previously had COVID19 vaccine. Method(s): Retrospective descriptive study focusing on Rabta hospital's HCW who presented themselves for a reinstatement visit after post-vaccination COVID-19 infection, from 15 March to 31 December 2021. Result(s): There were 122 HCW with a mean age of 42.8 years, a sex ratio of 0.5, and an average professional seniority of 13.8 years. 32% worked full-time in COVID-19 wards and13.1% had a history of COVID-19 before vaccination. Half had received two doses of vaccine. They were vaccinated mainly with mRNA (66.4%), viral vector (19.9%) or attenuated virus (12.3%). Symptoms appeared, on average, 35 days after the last dose of vaccine and the disease was confirmed by RT-PCR after 3 days of the symptom's onset. The main symptoms described were asthenia (66.4%), cough (66.4%), headache (62.3%), anosmia (64.8%), ageusia (55.7%), fever (52.2%), diarrhea (40.2%) ans dyspnea (21.3%). They were mainly put on symptomatic treatment and home rest for 11 days. However, 15% had an extension of their sick-leave and 2.5% presented a severe form requiring hospitalization. On return to work, 59.8% reported the persistence of symptoms including cough (18.9%), asthenia (11.5%), dyspnea (9.8%), anosmia and ageusia (7.4%). Conclusion(s): Vaccinated HCW presented mainly a mild form of COVID-19. Vaccination is an important and promising means to end this pandemic.

Work-life disrupted: A comparative study of company responses to paid care leave programs in the COVID-19 pandemic

Despite numerous positive outcomes associated with paid care leave (PCL) policies (i.e. maternity leave, family leave) such as wage replacement and job continuity, United States is a notable outlier among its peers as the only advanced nation without a federal paid leave program. Using a policy experiment around the 500-employee cutoff associated with the Families First Coronavirus Response Act (FFCRA), my dissertation examined US employer responses PCL regulations during the COVID-19 pandemic in 2020. To identify how American firms perceive and react to PCL regulations, a unique survey was administered to 306 business managers in the New York and Boston metropolitan areas and analyzed through binary logistic regressions across 19 outcomes. Regressions were performed on the full dataset, subsets associated with the policy experiment, FFCRA users, and six additional subsets corresponding to different employee management structures. Concurrently, a document analysis-based scorecard of Fortune 500 companies' actions during the COVID-19 pandemic established a triangulation device for the statistical analysis. In general, while 54.6 percent of firms reported cost concerns with PCL policies such as FFCRA, my results found that firms reporting PCL cost concerns were more likely to report non-employee focused operational changes such as increases in prices or a change in the number of locations instead of the predicted explicit employee-oriented set of outcomes such as layoffs or wage decreases. Furthermore, many outcomes resulted from firm characteristics-firm size, industry, and location-proving firm responses to government regulation is a dynamic and dependent on the unique circumstances of each company. As such, PCL cost concerns held significant predictive power across certain subsets of participating companies, such as FFCRA users who were more likely to change their employee headcount. Thus, the assumed cost burden of PCL policies is more likely to predict outcomes such as an increase in prices, while the central policy of my dissertation, FFCRA, may have been more disruptive than helpful for small American firms. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The great resignation: Exploring the effect of regular and digital instructional leadership on teachers' intention to leave

Research on the effect of COVID-19 and its aftermath on education is gaining momentum. Nevertheless, this expanding contemporary literature only scarcely addresses principals' digital instructional leadership and has not investigated how principals' regular instructional leadership aligns with it. Moreover, the emerging writing on the aftermath of COVID-19 notes the phenomenon of teacher shortages in schools as a result of a growing tendency of teachers to leave the profession, but the possible connection with various forms of principals' instructional leadership remains unexplored. The purpose of this study was to examine the effect of combinations of different levels of principals' regular instructional leadership and digital instructional leadership on teachers' intention to leave. Cluster analysis of data of 267 school teachers in Israel was conducted. The results indicate an association between differences in teachers' intention to leave the profession and mixtures of regular and digital instructional leadership. The results and their implications are discussed. © 2023 British Educational Leadership, Management & Administration Society (BELMAS).

Rural-Urban Differences in Workers' Access to Paid Sick Leave

Paid sick leave (PSL) is associated with health care access and health outcomes. The COVID-19 pandemic highlighted the importance of PSL as a public health strategy, yet PSL is not guaranteed in the United States. Rural workers may have more limited PSL, but research on rural PSL has been limited. We estimated unadjusted and adjusted PSL prevalence among rural versus urban workers and identified characteristics of rural workers with lower PSL access using the 2014–2017 Medical Expenditure Panel Survey. We found rural workers had lower access to PSL than urban workers, even after adjusting for worker and employment characteristics. Paid sick leave access was lowest among rural workers who were Hispanic, lacked employer-sponsored insurance, and reported poorer health status. Lower rural access to PSL poses a threat to the health and health care access of rural workers and has implications for the COVID-19 public health emergency and beyond.

Detection of COVID-19 in hospitalised patients by exhaled breath analysis

Introduction: SARS-COV-2 is mainly transmitted through respiratory droplets. The standard diagnostic procedure is based on a reverse transcription polymerase chain reaction (RT-PCR). Aim(s): 1) To develop a safe and easy to perform breath test for the detection of COVID-19 in hospitalised patients based on the analysis of volatile organic compounds (VOCs) in exhaled breath. 2) To differentiate in hospitalised patients with respiratory symptoms those with and without COVID-19. Method(s): We performed a monocenter, cross-sectional, case-control study in 38 subjects (63% males, age 62+/-12.7 yrs) admitted at the pulmonology ward. Breath samples were taken using a home-made sampling system. Analysis of breath samples was performed by proton transfer high resolution mass spectrometry (PTR-HRMS). A lassoregression with leave-one-out cross-validation was performed to differentiate the groups and designate the most differentiating VOCs. Result(s): COVID-19 positive (n=22) and control respiratory patients (n=16) were similar with respect to baseline characteristics, except for lower blood neutrophil and lymphocyte counts and higher ferritin level in COVID+ve patients (p<0.05). Lasso-regression revealed 6 VOCs as potential biomarkers that differentiated between both groups with 84% accuracy, 100% specificity and 100% positive predictive value based on PTR-HRMS data. Conclusion(s): Breath analysis could identify a breathprint differentiating between hospitalised COVID-19 and nonCOVID-19 patients with respiratory symptoms with a good accuracy. Therefore, VOCs profiling could be integrated in sensors allowing a fast breathalyzer for COVID-19 for large-scale screening.