Returning to work after maternity leave: a systematic literature review.

PURPOSE: Working women often experience difficulties associated with balancing family and career, particularly if they choose to have children. This systematic literature review aimed at investigating women's experience in returning to work after maternity leave. METHODS: The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search led to the identification of 52 articles, which underwent data extraction and qualitative analysis. RESULTS: Results were organized in 5 categories: (1) Work-life balance; (2) Women's mental and physical health; (3) Job-related wellbeing and working experience; (4) Breastfeeding. Women's both mental and physical health seem connected to a longer maternity leave and a greater coworkers' and supervisors' support. Returning to work seems to constitute one of the most important barriers for exclusive breastfeeding or breastfeeding continuation. A shorter duration of maternity leave, a higher workload and the lack of occupational policies supporting breastfeeding seem to be hindering factors. Partner and family support, and the opportunity for fathers to work under a flextime system after childbirth seem to increase both breastfeeding initiation and duration. Women who continue breastfeeding after returning to work seem to experience more family-to-work conflict and overload. CONCLUSIONS: This paper show that there are still many understudied aspects in exploring women's experience of returning to work after maternity leave. This represents an important gap in the literature, since returning to work represents a particularly critical time in women's personal and occupational life, in which challenges and barriers may arise, potentially affecting their experience in the immediate future and years to come.

Quality of working life and adaptability of returning to work in nurse cancer survivors: a cross-sectional study.

OBJECTIVE: To explore the relationship between quality of working life (QWL) and adaptability of returning to work (RTW) among nurse cancer survivors (NCSs). METHOD: We conducted a cross-sectional study on nurses previously diagnosed with cancer. QWL was quantified using the Quality of Working Life Scale (QWL7-32), and the level of RTW adaptability was assessed using the Adaptability of Returning to Work for Cancer Survivors (ARTW-CS) scale. Multiple linear regression analysis was used to control for confounding factors, and a simple effect analysis was performed on the interaction term. RESULTS: After controlling for sociodemographic, work-related, and health-related factors, the findings indicated a significant correlation between "adaptation and planning" and QWL score (p < 0.05). Further analysis revealed that "RTW gradualness" and "support seeking" had an interaction effect (p = 0.021). The simple effect analysis demonstrated that when the "RTW gradualness" score was ≥ 16 points, nurses with a high "support seeking" score (≥ 7 points) exhibited a significantly better QWL than those with a low "support seeking" score (< 7 points) (p < 0.001). CONCLUSION: The interaction between "RTW gradualness" and "support seeking" in the ARTW-CS scale significantly impacted the QWL of the NCSs, underscoring the importance of implementing a gradual career plan and seeking support to enhance QWL.

Opting In and Out: A Qualitative Study Exploring Career Break Experiences of Registered Dietitian Nutritionists.

BACKGROUND: Since 2002, an average of 17.5% of registered dietitian nutritionists (RDNs) have reported being out of the paid dietetics workforce, and approximately half of those report intention to return. With the Academy of Nutrition and Dietetics' focus on expanding workforce demand and capacity, understanding why and how dietitians opt in and out of the dietetics workforce may provide insights into how to potentially reduce the number of career breaks or expedite and enhance the reentry process. OBJECTIVE: To explore the lived experiences and perspectives of dietitians who were taking (with intention to return) or had taken a career break and returned to the paid dietetics' workforce. DESIGN: A qualitative study with semistructured interviews was conducted. PARTICIPANTS/SETTING: Participants (n = 22) were recruited through purposive sampling over social media. They were required to be credentialed as RDNs, reside in the United States, and have either previously or currently (with intent to return) taken a break from the dietetics workforce. Interviews were conducted using Zoom videoconferencing technology during September 2021. DATA ANALYSIS: Data were analyzed using a Coding Reliability Thematic Analysis approach. RESULTS: The data are summarized in four themes: (1) motivations to leave and return, (2) staying connected with dietetics, (3) preparing to return and returning to the dietetics workforce, and (4) desired resources for career breaks and reentry. CONCLUSIONS: Understanding the experiences of dietitians who take career breaks may help inform career reentry and help the profession meet the current and future workforce demand.

Public policy on breastfeeding among working mothers in Taiwan: comparison between two national surveys.

BACKGROUND: Creating a supportive breastfeeding environment after childbirth and enabling women to work with reassurance are essential in maternal care services. The study aimed to explore the effectiveness of the utilization rate of public and workplace lactation rooms in relation to the breastfeeding rate among postpartum women returning to work in Taiwan. METHODS: The study involved a secondary data analysis on 6,992 and 7,350 postpartum women surveyed in 2011 and 2016, respectively. Interviews were conducted with women six months postpartum. Logistic regression analysis was employed to calculate the odds ratio and investigate the differences in the utilization rates of public lactation rooms (PLR) and workplace lactation rooms (WLR) among working mothers over a five-year period, to confirm the effectiveness of public strategies. RESULTS: Comparing the years 2011 and 2016, significant differences in the rates of exclusive breastfeeding (EBF) and any breastfeeding (ABF) among working mothers returning to work after an 8-week maternity leave, depending on whether they used PLR or WLR. The rates were higher in 2016 than in 2011. For mothers who used PLR, the breastfeeding rates for EBF at the second, fourth, and sixth months (2011 vs. 2016: 67.6% vs. 81.1%, 75.0% vs. 86.4%, 77.5% vs. 86.2%) and ABF at the second, fourth, and sixth months (2011 vs. 2016: 60.3% vs. 73.9%, 68.8% vs. 81.3%, 73.7% vs. 85.6%). For mothers who used WLR, the breastfeeding rates for EBF at the second, fourth, and sixth months (2011 vs. 2016: 51.3% vs. 58.7%, 54.7% vs. 61.4%, 57.5% vs. 59.3%) and ABF at the second, fourth, and sixth months (2011 vs. 2016: 48.4% vs. 57.0%, 52.3% vs. 60.5%, 54.1% vs. 62.4%). When comparing 2011 to 2016 from the second to the sixth month postpartum, adjusted odds ratios for EBF (PLR: 4.17-5.23 vs. 4.06-6.22, WLR: 1.71-1.83 vs. 1.30-1.61) and ABF (PLR: 6.44-7.02 vs. 9.27-9.90, WLR: 1.91-1.98 vs. 1.97-1.99) showed differences. CONCLUSION: Lactation support rooms play a vital role in motivating working mothers to sustain breastfeeding upon their return to work. Incentivizing businesses to build additional lactation rooms and offering breastfeeding resources is essential in striving to enhance the global breastfeeding rate.

Supporting factors and structural barriers in the continuity of breastfeeding in the hospital workplace.

BACKGROUND: The World Health Organization recommends that babies should receive exclusive breastfeeding (EBF) for six months, and mothers should be encouraged to breastfeed until their infant is aged two years or older. The breastfeeding rate in Thailand is currently much lower than the target. One critical factor is lactating mothers returning to work, especially in a hospital workplace with high job stress. In this study, we aimed to identify supporting factors and obstacles to sustaining breastfeeding in hospital-type workplaces. METHODS: We conducted a mixed methods study between February 2021 and August 2021 at Chulabhorn Hospital, Thailand. Quantitative data were collected using questionnaires, and qualitative data were gathered in a focus group discussion among purposefully chosen participants, including mothers with both successful and unsuccessful continuation of breastfeeding after returning to work. We conducted multivariate analysis and thematic analysis in quantitative and qualitative data analysis, respectively. RESULTS: Questionnaires were completed by 65 permanent employees of the hospital, and seven of these participated in focus group discussion. The rate of exclusive breastfeeding from birth to six months was sixty six percent, and was measured by the responses from questionnaires, which defined as a practice whereby the infants receive only breastmilk without mixing it with other food. Seventy-seven percent of participants were continuing to breastfeed when they returned to work, with 24% (12/50) having to stop after three months. Factors associated with exclusive breastfeeding was caesarean delivery (OR 7.9; 95% CI 2.00, 31.08). Additionally, childcare at the workplace and the attitude of colleagues were found to be supporting factors for sustaining breastfeeding. Barriers included inadequate private facilities (location and equipment), lack of a breastfeeding break, workload, and inconvenient uniform. CONCLUSIONS: Effort is needed to sustain breastfeeding after maternal return to work. Our findings are crucial in determining how best to support nursing mothers in breastfeeding after returning to work, particularly during the ongoing COVID-19 pandemic. A breastfeeding-friendly policy with clear operating guidelines in the workplace is critical to sustaining breastfeeding. Learning from others who have had a positive experience will ensure that all breastfeeding women are better supported in the workplace in future.

The use of Kumpfer's resilience framework in understanding the breastfeeding experience of employed mothers after returning to work: a qualitative study in China.

BACKGROUND: The increasing numbers of women in the workforce is an inevitable trend in China. More and more employed women stop breastfeeding because of working stressors. Many mothers, however, overcome the challenges and insist on breastfeeding after returning to work. Their individual experience of breastfeeding may provide a new insight to promote and support breastfeeding on employed mothers. This study sought to understand mothers' experience with insisting on breastfeeding after returning to work based on Kumpfer's Resilience Framework in Chinese context. METHODS: This qualitative study was designed with semi-structured interviews. Purposive sampling and snowball sampling were employed to recruit 13 full-time working mothers with a stable job in the public sector who continued to breastfeed for 1 month or longer after returning to work in Haikou, Hainan Province, China. Interviews were conducted from January to March 2020 to capture participants' experiences of breastfeed after returning to work. Grounded theory and Kumpfer's Resilience Framework were used to analyze data via a systematic and iterative process. RESULTS: Employed mothers built resilience while continuing to breastfeed after returning to work. The core concept was "dynamic interaction". Other categories were the background and explanation of this phenomenon. For working mothers who continued to breastfeed, resilience involved "dynamic interaction", which started from "experiencing stressors" and "obtaining support", two environmental factors interacted with the individual to "build resilience qualities", which interact with environment led to "behavioral resilience". And then the ongoing dynamic interaction between behavioral resilience and environment ultimately led to three different "weaning processes", including natural weaning, active weaning, and forced weaning. CONCLUSIONS: This study identified the framework of resilience in mothers who were in the adversity of breastfeeding after returning to work based on Kumpfer's Resilience Framework. It provided a new insight into the resilience of employed mothers around the world to continue breastfeeding and showed the different culture of breastfeeding on employed mothers.

Returning to Work and Breastfeeding Duration at 12 Months, WIC Infant and Toddler Feeding Practices Study-2.

Background: Returning to work can impact breastfeeding duration; limited data exist on how this may impact a lower income population. Methods: Data from U.S. Department of Agriculture's longitudinal study WIC Infant and Toddler Feeding Practices Study-2 were used to assess breastfeeding duration (<12 versus ≥12 months) by age of the baby when women first returned to work and work status (full time and part time). Multivariable logistic regression was used to determine the association of the timing of return to work, work status, and the combination (timing and work status) with breastfeeding duration. Results: Among women who had worked prenatally and initiated breastfeeding, 20.2% breastfed for ≥12 months. Compared to women who did not return to work, fewer women breastfed for ≥12 months if they returned full time or part time (34.1%, 12.0%, and 20.0%, respectively, p < 0.0001). Work status negatively impacted breastfeeding for ≥12 months (full-time adjusted odds ratio [aOR]: 0.24; 95% confidence interval [CI]: 0.13, 0.44 and part-time aOR: 0.51; 95% CI: 0.31, 0.83). Compared to women who did not return, those who returned full time within 3 months or returned part time >1 to 3 months after birth had lower odds of breastfeeding ≥12 months. Conclusions: Returning to work within 3 months after birth had a negative impact on breastfeeding for ≥12 months, particularly for those who returned full time. Efforts to support maternity leave and flexible work schedules could prolong breastfeeding durations among a low-income population. This study was a registered study at clinicaltrials.gov (NCT02031978).

The assessment of returning to work following treatment and the associated personal, disease, and treatment factors among breast cancer survivors in central China.

PURPOSE: To assess the status of returning to work (RTW) following breast cancer treatment and to explore its associated factors among female patients. METHODS: Four-hundred-forty-two eligible patients admitted in a tertiary hospital since 2012 were followed up in 2018. Information about working status after treatment, date of RTW or reason for not RTW was obtained during a 30-min interview. Patients' sociodemographic, disease, and treatment characteristics were retrieved from the hospital record. Overall prevalence rate and probability of RTW during the follow-up were estimated using Kaplan-Meier method. Factors associated with RTW were identified using regression analyses. RESULTS: Three-hundred-ninety-six patients (89.6%) completed the follow-up. The median follow-up was 31 months. Among them, 141 patents (35.6%) RTW of whom 68.1% (n = 96) were back within 12 months after cancer treatment. The reported reasons for not RTW included: prolonged fatigue, low self-esteem, lack of support from family and working unit, or voluntarily quitting. Patients aged under 50 years, being single, having higher level of education, not having extensive axillary node procedure, or without any comorbidities were more likely to RTW. CONCLUSION: The rate of RTW after cancer treatment in this cohort was lower than those reported in others. Both personal and treatment factors were associated with RTW.

The Complexity of Decreased Work Ability: Individuals' Perceptions of Factors That Affect Returning to Work after Sickness Absence.

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.

Returning to work in lung cancer survivors-a multi-center cross-sectional study in Germany.

PURPOSE: To investigate the work situation of lung cancer survivors and to identify the factors associated with their returning to work. METHODS: Descriptive analysis and logistic regression were used to evaluate study population characteristics and independent factors of subsequently returning to work. To analyze time to return to work, Cox regression was used. RESULTS: The study sample included 232 lung cancer survivors of working age from 717 enrolled participants in the multi-center cross-sectional LARIS (Quality of Life and Psychosocial Rehabilitation in Lung Cancer Survivors) study. About 67% of the survivors were not employed during the survey. More than 51% of the survivors who were employed before their illness did not return to their work. The survivors who had returned to their careers were younger, associated with higher household income, lower fatigue score, and stable relationship and vocational training. Patients who received social service counseling showed a higher chance of regaining their career. CONCLUSIONS: Lung cancer survivors were found to be associated with a high risk of unemployment and very low professional reintegration after interruption due to illness. More comprehensive studies are needed to support lung cancer survivors and targeting of patients in need of special attention in rehabilitation that would benefit from the findings in the present study.

Workplace-Related Interpersonal Group Psychotherapy to Improve Life at Work in Individuals With Major Depressive Disorders: A Randomized Interventional Pilot Study.

OBJECTIVES: Individuals suffering from major depressive disorder (MDD) often report workplace-related stress as the major cause of their disorder. Accordingly, workplace-related stress was established as a fifth psychosocial problem area of Interpersonal Psychotherapy (workplace-related Interpersonal Psychotherapy, W-IPT). The aim of the study was to investigate the influence of W-IPT on depressive symptoms and on workplace-related issues in individuals with MDD compared to a treatment-as-usual (TAU) condition. METHODS: A total of 27 individuals with MDD (mean age = 43 years, 48% males) were randomly assigned either to eight weekly group sessions of W-IPT or to the TAU condition. At baseline, 8 weeks later at the end of the intervention, and 20 weeks later at follow-up, the Hamilton Rating Scale for Depression was conducted. In addition, the participants completed the Beck Depression Inventory, the Work Ability Index (WAI), the Return to Work Attitude (RTW-SE), and the Insomnia Severity Index (ISI). RESULTS: Symptoms of depression in experts' ratings as well as in self-rated ratings decreased over time, but more so in the W-IPT condition compared to the TAU condition [experts rating: large effect size (d = 1.25) and self-assessment: large effect sizes (d = 0.94)]. The subjective ability to work (WAI) [medium effect size (d = 0.68)], self-efficacy to returning to work RTW-SE [medium effect size (d = 0.57)], and subjective symptoms of insomnia (ISI) [large effect size (d = 1.15)] increased over time, but again more so in the W-IPT condition compared to the TAU condition. The effects of the intervention remained stable from the end of the intervention to follow-up. CONCLUSIONS: The pattern of results of this pilot study suggests that a newly established fifth IPT focus on workplace-related stress appeared to be particularly efficient in individuals with MDD due to work-related stress in reducing depressive symptoms and reducing sleep complaints as well as in improving occupational outcomes.

Does Spinal Cord Stimulation Due to Failed Back Surgery Syndrome Lead to Permanent Occupational Disability?

OBJECTIVE: Spinal cord stimulation (SCS) is a recommended treatment method for patients afflicted by failed back surgery syndrome (FBSS). Although SCS is shown to be clinically effective, not many patients return to work (RTW). The aim of this study is to assess the RTW rate of these patients. MATERIALS AND METHODS: We prospectively evaluated 102 patients with FBSS, managed by low frequency SCS at a single institution in Poland. RTW rate was the main endpoint in the study. Additionally, we browsed the first 300 records in Google and extracted the suggested RTW time post-SCS implantation. RESULTS: Mean follow-up was 8.5 years. 79.4% of patients were actively working at the baseline. Fifteen patients were sick leave benefit claimants (15/81; 18.5%) and six were permanently disabled (6/81; 7.4%). In the follow-up, 40 did not change their work status. Only 2 of 21 patients resumed work and the total RTW rate was 9.5%. On the other hand, 38 of 81 patients (46.9%), who actively worked before SCS, gained disability status. Out of entire group, 20.6% (21 of 102) were not working at the baseline and 55.9% (57 of 102) were not working in the follow-up. Neither factor influenced RTW rate. In the second stage of the study, internet data search yielded a mean RTW time of 6.1 weeks. CONCLUSIONS: Unlike the well-analyzed effectiveness of SCS, RTW remains an underutilized outcome measure. The RTW rate in our series was the second lowest in the reviewed literature. We demonstrated that half of the patients with an implanted SCS either did not resume their work or left their job.

Retorno às atividades laborais entre amputados: qualidade de vida no trabalho, depressão e ansiedade / Returning to workplace activities among amputees: quality of life at work, depression, and anxiety / Retorno de amputados a las actividades laborales: calidad de vida en el trabajo, depresión ansiedad

Investigou-se, entre sujeitos afastados do trabalho devido à amputação, possíveis relações entre a satisfação com as condições de trabalho anteriores à amputação e os sintomas de ansiedade e depressão, e suas associações com o desejo de retorno ao trabalho. A amostra foi composta por 56 pessoas com amputação de membros inferiores e/ou superiores, nas quais foram aplicados questionário sociodemográfico, Inventário de Qualidade de Vida no Trabalho (QVT), Inventário de Depressão de Beck (BDI) e Inventário de Ansiedade de Beck (BAI), além de entrevistas semiestruturadas. Para a análise de dados, foram utilizadas técnicas quantitativas e qualitativas. Constatou-se que para os amputados o "desejo de voltar a trabalhar" associa-se com a satisfação que pode advir do trabalho - no que se refere ao uso e à possibilidade de desenvolvimento de suas capacidades - e com os sintomas de depressão. A categoria "ocupação/utilidade" apareceu como principal motivo para o desejo de retornar ao trabalho.

The study investigated, among people away from work due to amputation, possible relations between satisfaction with working conditions before amputation and symptoms of anxiety and depression, and their associations with the desire to return to work. The sample consisted of 56 people with lower and/or upper limb amputation who responded to a sociodemographic questionnaire, the Quality of Life at Work (QWL) Inventory, the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI), as well as semi-structured interviews. For the data analysis, quantitative and qualitative techniques were used. It was found that, for the amputees, the 'desire to return to work' is associated with the satisfaction from work regarding the use and possible development of their capacities, and with the symptoms of depression. The category "occupation/utility" appeared as the main reason for the desire to return to work.

Se investigó, en sujetos alejados del trabajo debido a amputación, posibles relaciones entre la satisfacción de las condiciones de trabajo anteriores a la amputación y los síntomas de ansiedad y depresión, y sus asociaciones con el deseo de retorno al trabajo. La muestra fue compuesta por 56 personas que amputaron miembros inferiores y/o superiores, alas cuales se aplicaron cuestionario sociodemográfico, Inventario de Calidad de Vida en el Trabajo (CVL), Inventario de Depresión de Beck (BDI) e Inventario de Ansiedad de Beck (BAI), además de entrevistas semiestructuradas. Para el análisis de datos, se utilizaron técnicas cuantitativas y cualitativas. Se constató que para los amputados el 'deseo de volver a trabajar' se asocia con la satisfacción que puede venir del trabajo en lo que se refiere al uso y posibilidad de desarrollo de sus capacidades y a los síntomas de depresión. La categoría "ocupación / utilidad" apareció como principal motivo para el deseo de regresar al trabajo.

Risk of psychological ill health and methods of organisational downsizing: a cross-sectional survey in four European countries.

BACKGROUND: The manner in which organizational downsizing is implemented can make a substantial difference as to whether the exposed workers will suffer from psychological ill health. Surprisingly, little research has directly investigated this issue. We examined the likelihood of psychological ill health associated with strategic and reactive downsizing. METHODS: A cross-sectional survey included 1456 respondents from France, Sweden, Hungary and the United Kingdom: 681 employees in stable workplaces (reference group) and 775 workers from downsized companies. Reactive downsizing was exemplified by the exposures to compulsory redundancies of medium to large scale resulting in job loss or surviving a layoff while staying employed in downsized organizations. The workforce exposed to strategic downsizing was represented by surplus employees who were internally redeployed and supported through their career change process within a policy context of "no compulsory redundancy". Symptoms of anxiety, depression and emotional exhaustion were assessed in telephone interviews with brief subscales from Hospital Anxiety Scale (HADS-A), Hopkins Symptom Checklist (SCL-CD6) and Maslach Burnout Inventory (MBI-GS). Data were analyzed using logistic regression. RESULTS: We observed no increased risk of psychological ill health in the case of strategic downsizing. The number of significant associations with psychological ill health was the largest for the large-scale reactive downsizing: surviving a layoff was consistently associated with all three outcome measures; returning to work after the job loss experience was related to anxiety and depression, while persons still unemployed at interview had elevated odds of anxiety. After reactive medium-scale downsizing, unemployment at interview was the only exposure associated with anxiety and depression. CONCLUSIONS: The manner in which organizational downsizing is implemented can be important for the psychological wellbeing of workers. If downsizing is unavoidable, it should be achieved strategically. Greater attention is needed to employment and health policies supporting the workers after reactive downsizing.

Do expectancies of return to work and Job satisfaction predict actual return to work in workers with long lasting LBP?

BACKGROUND: Musculoskeletal disorders including low back pain have major individual and socioeconomic consequences as it often leads to disability and long-term sick leave and exclusion from working life. Predictors of disability and return to work often differ, and the dominant knowledge is on predictors for prolonged sick leave and disability. Therefore it is also important to identify key predictors for return to work. The aim of the study was to assess if overall job satisfaction and expectancies of return to work predicts actual return to work after 12 months, among employees with long lasting low back pain, and to assess if there were gender differences in the predictors. METHODS: Data from the Cognitive interventions and nutritional supplements trial (CINS Trial) was used. Predictors for return to work were examined in 574 employees that had been on sick leave 2-10 months for low back pain, before entering the trial. Data were analysed with multiple logistic regression models stratified by gender, and adjusted for potential confounders. RESULTS: Regardless of gender high expectancies were a strong and significant predictor of return to work at 12 months, while high levels of job satisfaction were not a significant predictor. There were no differences in the levels of expectancies or overall job satisfaction between men and women. However, men had in general higher odds of returning to work compared with women. CONCLUSIONS: Among individuals with long lasting low back pain high expectancies of returning to work were strongly associated with successful return to work. We do not know what factors influence individual expectancies of return to work. Screening expectancies and giving individuals with low expectancies interventions with a goal to change expectancies of return to work, such as CBT or self-management interventions, may contribute to increase actual return to work. TRIAL REGISTRATION: http://www.clinicaltrials.gov/ , with registration number NCT00463970 . The trial was registered at the 18th of April 2007.

A qualitative study investigating the barriers to returning to work for breastfeeding mothers in Ireland.

BACKGROUND: The World Health Organization (WHO) recommends that mothers exclusively breastfeed for the first 6 months of an infant's life. In Ireland, currently paid maternity leave is 26 weeks and the expectant mother is required by law to finish work 2 weeks before her expected delivery date. Mothers wishing to exclusively breastfeed for 6 months or longer find themselves having to take holiday leave or unpaid leave from work in order to meet the WHO's guidelines. The aim of this study is to explore women's experiences of breastfeeding after their return to work in Ireland. METHODS: This study was carried out utilizing a qualitative design. Initially 25 women who returned to the workforce while continuing to breastfeed were contacted, 16 women returned consent forms and were subsequently contacted to take part in an interview. Interviews were recorded and transcribed verbatim and thematic analysis was employed to establish recurring patterns and themes throughout the interviews. RESULTS: Women noted that cultural attitudes in Ireland coupled with inadequate or inconsistent advice from health professionals posed the biggest challenge they had to overcome in order to achieve to 6 months exclusive breastfeeding. The findings of this study illustrate that mothers with the desire to continue to breastfeed after their return to work did so with some difficulty. Many did not disclose to their employers that they were breastfeeding and did not make enquiries about being facilitated to continue to breastfeed after their return to the workplace. The perceived lack of support from their employers as well as embarrassment about their breastfeeding status meant many women concealed that they were breastfeeding after their return to the workplace. CONCLUSION: While it has been suggested that WHO guidelines for exclusive breastfeeding for 6 months may be unattainable for many women due to work commitments, a different problem exists in Ireland. Mothers struggle to overcome cultural and societal obstacles coupled with inadequate support from health professionals. Encouraging and facilitating women to continue to breastfeed after they return to work will help to normalise breastfeeding within Irish culture and promote continued breastfeeding as a viable option for working mothers.

Factors influencing return to work after illness in France.

BACKGROUND: Few studies have been published about the factors influencing return to work after sickness absence. AIMS: To identify medical and occupational factors influencing the type of fitness certificate given by occupational physicians before employees return to work after sickness absence. METHODS: A cross-sectional study was undertaken over 3 months in several health services in France. Workers undergoing a medical examination before returning to work after a period of sickness absence of at least 3 weeks were included. Medical and occupational factors were collected using a questionnaire. The relationship between different factors and certification of fitness was assessed by univariate and multivariate analyses. RESULTS: Among the 402 workers included, 64% were considered fit to return to work. Being older, strenuous work, prolonged sick leave and fear of returning to work appeared to be negative factors influencing the return to a previous job. In contrast, having an education level higher than secondary school, being satisfied at work, perception of very good health and benefitting from satisfactory professional relationships appeared to favour return to work. We developed a predictive score of not being fit to return to work after illness. CONCLUSIONS: Our study highlighted the relationship between medical and occupational factors with problems returning to work. The predictive score may be used by occupational physicians as a screening tool to identify those who are likely to have difficulties returning to work after illness, so that their working conditions can be modified to take this into consideration.