Sustaining work ability amongst female professional workers with long COVID.

BACKGROUND: Long COVID (LC) compromises work ability (WA). Female worker WA has been more adversely impacted than WA in men. Exploration of lived experiences could elucidate the WA support required. AIMS: To explore the working conditions and circumstances experienced as affecting sustained WA amongst female workers with LC, to help mitigate worklessness risks. METHODS: Online semi-structured qualitative interviews were conducted with 10 female workers self-reporting or formally diagnosed with LC who had made some attempt to return to work (RTW). Interviews were analysed using template analysis to map themes informing WA enablers and obstacles onto a biopsychosocial model of rehabilitation. RESULTS: All participants were professionals working in an employed or self-employed capacity. Key themes reflecting circumstances that afforded sustained WA included the autonomy over where, when and how to work indicated as facilitated by a professional role, rapid health care access, predominantly sedentary work, competent colleagues able to cover for transient reduced WA, a strong interface between specialist health and management support, and accessible organizational policies that steer health management according to equity rather than equality. Highly flexible, iterative, co-produced RTW planning, tolerant of fluctuating symptom expression appears vital. In return for providing such flexibility, participants felt that employers' workforce diversity and competence would be protected and that workers would need to reciprocate flexibility. CONCLUSIONS: These qualitatively derived findings of workers' lived experiences add to existing guidance on supporting WA for people struggling with LC. Moreover, the same principles seem appropriate for tackling worklessness amongst working-age adults with complex long-term health conditions.

What workers can tell us about post-COVID workability.

BACKGROUND: The apparent functional impact of post-COVID-19 syndrome has workability implications for large segments of the working-age population. AIMS: To understand obstacles and enablers around self-reported workability of workers following COVID-19, to better guide sustainable workplace accommodations. METHODS: An exploratory online survey comprising quantitative and qualitative questions was disseminated via social media and industry networks between December 2020 and February 2021, yielding usable responses from 145 workers. Qualitative data were subjected to content analysis. RESULTS: Over half of the sample (64%) were from the health, social care, and education sectors. Just under 15% had returned to work, and 53% and 50% reported their physical and psychological workability respectively as moderate at best. Leading workability obstacles were multi-level, comprising fatigue, the interaction between symptoms and job, lack of control over job pressures, inappropriate sickness absence management policies, and lack of COVID-aware organizational cultures. Self-management support, modified work, flexible co-developed graded return-to-work planning, and improved line management competency were advocated as key enablers. CONCLUSIONS: Assuming appropriate medical management of any pathophysiological complications of COVID-19, maintaining or regaining post-COVID workability might reasonably follow a typical biopsychosocial framework enhanced to cater to the fluctuating nature of the symptoms. This should entail flexible, regularly reviewed and longer-term return-to-work planning addressing multi-level workability obstacles, co-developed between workers and line managers, with support from human resources, occupational health professionals (OHP's), and a COVID-aware organizational culture.

Motivational and behavioural models of change: A longitudinal analysis of change among men with chronic haemophilia-related joint pain.

BACKGROUND: Motivational and behavioural models of adjustment to chronic pain make different predictions about change processes, which can be tested in longitudinal analyses. METHODS: We examined changes in motivation, coping and acceptance among 78 men with chronic haemophilia-related joint pain. Using cross-lagged regression analyses of changes from baseline to 6 months as predictors of changes from 6 to 12 months, with supplementary structural equation modelling, we tested two models in which motivational changes influence behavioural changes, and one in which behavioural changes influence motivational changes. RESULTS: Changes in motivation to self-manage pain influenced later changes in pain coping, consistent with the motivational model of pain self-management, and also influenced later changes in activity engagement, the behavioural component of pain acceptance. Changes in activity engagement influenced later changes in pain willingness, consistent with the behavioural model of pain acceptance. CONCLUSIONS: Based on the findings, a combined model of changes in pain self-management and acceptance is proposed, which could guide combined interventions based on theories of motivation, coping and acceptance in chronic pain. SIGNIFICANCE: This study adds longitudinal evidence about sequential change processes; a test of the motivational model of pain self-management; and tests of behavioural versus motivational models of pain acceptance.

A review of evidence about behavioural and psychological aspects of chronic joint pain among people with haemophilia.

Joint pain related to haemophilia affects large numbers of people and has a significant impact on their quality of life. This article reviews evidence about behavioural and psychological aspects of joint pain in haemophilia, and considers that evidence in the context of research on other chronic pain conditions. The aim is to inform initiatives to improve pain self-management among people with haemophilia (PWH). Reduced pain intensity predicts better physical quality of life, so better pain management should lead to improved physical quality of life. Increased pain acceptance predicts better mental quality of life, so acceptance-based approaches to self-management could potentially be adapted for PWH. Pain self-management interventions could include elements designed to: improve assessment of pain; increase understanding of the difference between acute and chronic pain; improve adherence to clotting factor treatment; improve knowledge and understanding about the benefits and costs of using pain medications; improve judgements about what is excessive use of pain medication; increase motivation to self-manage pain; reduce negative emotional thinking about pain; and increase pain acceptance. The influence of behavioural and psychological factors related to pain are similar in haemophilia and other chronic pain conditions, so there should be scope for self-management approaches and interventions developed for other chronic pain conditions to be adapted for haemophilia, provided that careful account is taken of the need to respond promptly to acute bleeding pain by administering clotting factor.

Pain coping and acceptance as longitudinal predictors of health-related quality of life among people with haemophilia-related joint pain.

BACKGROUND: Interventions based on coping and acceptance can be adapted for people with different painful conditions. Evidence about baseline characteristics that predict improved outcomes is informative for matching people to interventions, whereas evidence about changes that predict improved outcomes is informative about the processes that interventions should target. METHODS: Participants in a low-intensity programme to promote self-management of haemophilia-related chronic joint pain (n = 101) reported pain intensity, coping, acceptance and quality of life at baseline and 6-month follow-up. Baseline and change measures of pain intensity, coping and acceptance were used to predict follow-up quality of life, taking account of baseline quality of life. RESULTS: Changed (reduced) pain intensity predicted better physical quality of life, independently of age, haemophilia severity, baseline pain intensity and baseline physical quality of life. Lower baseline passive coping and changed (increased) pain acceptance predicted better mental quality of life, independently of age, severity and baseline mental quality of life. Increased activity engagement but not pain willingness predicted better mental quality of life when pain acceptance was decomposed. Changed (reduced) negative thoughts also predicted better mental quality of life when separate acceptance subscales were used. Active pain coping did not predict physical or mental quality of life. CONCLUSIONS: Initially high levels of passive coping may be an obstacle to improving mental quality of life. Acceptance rather than coping may be a more useful behavioural change target, but more research is needed about the meanings and therapeutic implications of different elements of pain acceptance.

A brief haemophilia pain coping questionnaire.

Pain coping strategies are important influences on outcomes among people with painful chronic conditions. The pain coping strategies questionnaire (CSQ) was previously adapted for sickle cell disease and haemophilia, but those versions have 80 items, and a briefer version with similar psychometric properties would facilitate research on pain coping. The full-length haemophilia-adapted CSQ, plus measures of pain frequency and intensity, pain acceptance, pain readiness to change, and health-related quality of life were completed by 190 men with haemophilia. Items were selected for a 27-item short form, which was completed 6 months later by 129 (68%) participants. Factor structure, reliability and concurrent validity were the same in the long and short forms. For the short form, internal reliabilities of the three composite scales were 0.86 for negative thoughts, 0.80 for active coping and 0.76 for passive adherence. Test-retest reliabilities were 0.73 for negative thoughts, 0.70 for active coping and 0.64 for passive adherence. Negative thoughts were associated with less readiness to change, less acceptance of pain and more impaired health-related quality of life, whereas active coping was associated with greater readiness to change and more acceptance of pain. The short form is a convenient brief measure of pain coping with good psychometric properties, and could be used to extend research on pain coping in haemophilia.

Analgesic use and pain coping among patients with haemophilia.

Pain is an important consequence of bleeding episodes in haemophilia. Previous research has included pain frequency and severity among measures of illness-related disability and quality of life in haemophilia, but little systematic evidence exists about analgesic use and pain coping in haemophilia. This paper reports cross-sectional findings from a national survey of patients with severe haemophilia type A and type B. Respondents provided information about pain frequency, pain coping strategies (using the haemophilia-adapted CSQ), use of analgesics and other drugs, and described any concerns they had about their drug use. Participants registered with comprehensive care haemophilia centres did not differ from the rest of the sample on any of the factors recorded. Over one-third of participants expressed concerns about their drug use, the most frequent of which were about dependence on prescribed analgesics. Pain frequency was the most important predictor of analgesic use, but pain coping, and specifically negative thoughts about pain, was associated with concerns about drug use independently of other factors, including analgesic use and pain frequency. Further research will be needed to evaluate possible interventions to promote more effective pain coping in haemophilia, and to examine the possible effects of pain coping on illness outcomes beyond analgesic use, such as well-being and quality of life.

A review of evidence about factors affecting quality of pain management in sickle cell disease.

OBJECTIVE: To assess the evidence for pharmacological, behavioural, and interpersonal influences on quality of pain management in sickle cell disease. DATA SOURCES: English-language reports from the research literature up to 1995, identified using Medline, Psychlit, and the Bath Information Data Service. STUDY SELECTION: Studies are reviewed that (a) reported quantitative clinical outcomes for particular analgesic methods used to treat painful episodes or (b) provide data on patient factors, interpersonal treatment factors, or levels of drug dependence in relation to pain management in sickle cell disease. DATA SYNTHESIS: Findings vary on the effectiveness of longer-acting opiates, patient-controlled or continuously infused analgesia, and behavioural analgesic techniques, with better results for trials where interpersonal aspects of pain management were also addressed. Risks for poorer pain management are greatest for patients in adverse social circumstances, who are more severely affected by painful episodes and who are poorly adjusted and have less effective personal strategies for coping with pain, but the limited evidence on drug dependence indicates very low levels by comparison with risk and exposure factors. CONCLUSIONS: Analgesic methods and approaches should continue to be developed and evaluated, but conflicting perceptions between patients and staff about pain that is reported and analgesia that is required probably contribute most to poor pain management in sickle cell disease. Promising areas for future research include the assessment of patients' everyday pain coping styles and patterns of drug use in relation to their hospital experiences of pain management, and the evaluation of psychological interventions to improve patients' styles and strategies for coping with pain.

A calibration program for Rotorod samplers.

BACKGROUND: Despite widespread use in the United States, the need for calibrating Rotorod Samplers on a regular basis has not been demonstrated. OBJECTIVE: The purpose of this present investigation was to inspect Rotorods that had been operating in the field to determine whether they conformed to the manufacturer's operating specifications. METHODS: Allergists who own Rotorods voluntarily returned their devices to the manufacturer for calibration over the course of two successive winters. The speed of each device's motor was measured with a stroboscopic tachometer. RESULTS: Of the 89 devices examined, ten were found to be operating at the manufacturer's exact speed specification (2400 RPM) and another 31 were within 5%. The remaining devices deviated by more than 5% from the prescribed speed or possessed motors that would not operate. CONCLUSIONS: The authors underscore the importance of calibrating Rotorod Samplers to maintain data quality.

Decision-making style, driving style, and self-reported involvement in road traffic accidents.

In an exploratory postal survey of 711 drivers stratified by age, sex, annual mileage, and accident involvement, decision-making style was measured using a Decision-Making Questionnaire (DMQ) and driving style was assessed using a Driving Style Questionnaire (DSQ). Responses to 21 items of the DMQ formed seven independent and internally coherent dimensions according to a principal components (PC) analysis. These were labelled: control, thoroughness, instinctiveness, social resistance, hesitancy, perfectionism, and idealism. PC analysis also revealed that responses to 15 items of the DSQ formed six independent dimensions of driving style. These were labelled: speed, calmness, social resistance, focus, planning, and deviance. Multiple regression analysis indicated that drivers of 60 years and under who scored lower on thoroughness were at greater risk of a traffic accident and that this relationship was mediated by faster driving. This relationship was independent of age, sex, annual mileage and all other factors measured. In the drivers over 60 years, lower thoroughness, greater hesitancy, and faster driving were independently associated with higher accident rates independent of all other factors measured. The results provide preliminary support for the view that people import aspects of their general decision-making style into the driving situation, and that in so doing they put themselves at differential risk of having a road traffic accident.

Direct observation of driving, self reports of driver behaviour, and accident involvement.

Forty-eight drivers answered a set of written questions about their driving style and drove a pre-defined, mixed urban and motorway route under observation. For 20 drivers there was a second observer in the car to check on inter-observer reliability. Relationships were examined between self-reports of driver behaviour and observers' reports, and between both of these and the number of accidents in which the drivers had been involved in the past three years. The results indicated that there was good inter-observer agreement on a number of important variables including speed, calmness, and attentiveness. Inter-observer reliability for other variables was less good; among these were preferred distance to car in front, use of indicators, and aggressiveness. Observers also showed good agreement on overall ratings of driver skill and safety. Observed speed on the motorway correlated well with drivers' self reports of normal driving speed. Observer ratings of calmness correlated significantly with self-reports of calmness. Also observer ratings of attentiveness and carefulness correlated significantly with self-reports of deviant driving behaviour. Observed speed on the motorway showed a clear positive correlation with self-reported accident involvement. The results indicate that self-reports of certain aspects of driver behaviour can be used as surrogates for observational measures, thus providing a convenient extension to the researcher's methodological armoury. One such aspect is speed which appears to play an important role in accident involvement.

Mild social deviance, Type-A behaviour pattern and decision-making style as predictors of self-reported driving style and traffic accident risk.

A 10-item self-report scale for mild social deviance (the Social Motivation Questionnaire) was developed and used in a study examining the role of social deviance in traffic accident risk. The scale focused on self-serving behaviours which might directly or indirectly harm the interests of others. Data were obtained from 108 drivers taking part in a research programme examining a range of factors underlying traffic accident risk. Apart from social deviance scores, measures were taken of Type-A behaviour pattern, decision-making style, self-reported driving style, age, sex, annual mileage, and accidents over a three-year period. The results indicated that the social deviance scale yielded a good spread of values and had adequate intra-scale reliability. Social deviance was positively correlated with accident rates independently of age, sex and annual mileage. The association between social deviance and accident rates appeared to be partly mediated by faster driving speed. The results indicate that, even within the general population, social deviance can show measurable variation and that this variation is predictive of traffic accident risk.

Behavioral correlates of individual differences in road-traffic crash risk: an examination method and findings.

This article considers methodological issues relevant to the study of differential crash involvement and reviews the findings of research in this area. Aspects of both driving skill and driving style appear to contribute to crash risk. Of the former, hazard-perception latency appears to play an important role, and this may be attributable to generalized abilities to identify visual targets in a complex background and to switch attention rapidly. Of the latter, faster driving speed and willingness to commit driving violations increase crash risk, and these factors may be explicable in terms of personality and antisocial motivation. The article concludes with an examination of the practical implications and of the ways in which research in this area might usefully proceed.