Psychosocial working conditions and the subjective prognosis of gainful employment among employees with asthma: a cross-sectional study.

PURPOSE: The present study set out to examine whether low job decision latitude (JDL, i.e., limited work autonomy) and low social support at work are related to a poor subjective prognosis of gainful employment (SPE) among working rehabilitants with asthma. METHODS: JDL and support were assessed by the Copenhagen Psychosocial Questionnaire. The SPE was measured by a validated three-item scale. Separate logistic regression analyses were conducted for all variables to calculate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Among the 221 participants (response rate = 29.3%), those reporting low JDL or low support had more than doubled odds of being unsure that they would be working until retirement age (OR = 2.28; 95% CI = 1.19-4.37; OR = 2.78; 95% CI = 1.43-5.40, respectively) and of considering their work ability permanently at risk due to ill-health (OR = 3.89; 95% CI = 2.03-7.46; OR = 2.05; 95% CI = 1.08-3.90, respectively) compared to those with good working conditions. The associations of JDL or support were weaker with one's consideration to apply for premature pension (OR = 1.54; 95% CI = 0.60-3.98; OR = 2.18; 95% CI = 0.83-5.77, respectively). Additional analyses identified job satisfaction as a possible explanatory factor for the observed relationships. CONCLUSIONS: Adverse psychosocial working conditions are related to a poor SPE, and low job satisfaction may explain those relationships. Future prospective research is needed to confirm our findings.Implications for rehabilitationEarlier research suggested that asthma increases the risk of disability retirement and thus causes high direct and indirect costs.Prior findings showed that adverse psychosocial working conditions are related to poorer asthma self-management and increased asthma morbidity among rehabilitants with asthma.Consistent with earlier work the present study found that job decision latitude and social support at work are associated with the subjective prognosis of gainful employment among working rehabilitants with asthma.If the reported findings are confirmed by prospective studies, interventions could be developed to improve the working conditions for rehabilitants with asthma and to thereby reduce their risk of disability retirement.

[Environmental factors and the promotion of participation. The Perspective of medical rehabilitation]. / Umweltfaktoren und Teilhabeförderung. Die Perspektive der medizinischen Rehabilitation.

BACKGROUND: The International Classification of Functioning, Disability and Health (ICF), as well as the main goal of enabling participation, are of fundamental importance for medical rehabilitation. According to the logic of the ICF and its underlying multidimensional model of functioning and disability, the participation of a person can be influenced by modelling environmental factors. OBJECTIVES: This article presents environmental factors as defined by the ICF in the context of medical rehabilitation and aims to answer to what extent environmental factors are already involved in medical rehabilitation and if there are further environmental factors with the potential of being involved in interventions for improvement of participation. MATERIALS AND METHODS: An analysis of documents with relevance to medical rehabilitation was done. Text passages that referred to environmental factors were linked to the environmental factor codes of the ICF. RESULTS AND CONCLUSIONS: The ICF and its underlying model of functioning and disability provide a conceptual framework both for making the current usage of environmental factors apparent and for deriving and developing new intervention approaches with the involvement of environmental factors. The analysis of documents showed that environmental factor codes vary in how well they are represented in these documents. There are environmental factor codes that are barely or not at all represented, but do have potential to contribute to the improvement of participation.