United and flexible: a collaborative approach to early vocational rehabilitation on a spinal unit. A realist study.

STUDY DESIGN: Qualitative study using realist review. OBJECTIVES: To conceptualise how Early Intervention Vocational Rehabilitation (EIVR) functions within inpatient multidisciplinary contexts during spinal cord injury (SCI) rehabilitation. SETTING: New Zealand Spinal Unit. METHODS: People with newly acquired SCI and members of their rehabilitation team were observed in a range of rehabilitation sessions, team meetings and therapeutic interactions. Participants were also interviewed to explore how EIVR functioned alongside the multidisciplinary team (MDT). Interviews and observations were transcribed, coded and analysed using realist methods. RESULTS: We identified three primary contexts which influenced how EIVR was delivered within the MDT: (1) a united approach, (2) a flexible approach, and (3) a hesitant approach. These contexts generated four work-related outcomes for people with SCI; enhanced work self-efficacy, strengthened hope for work, maintained work identity, and the less desirable outcome of increased uncertainty about work. CONCLUSIONS: To optimise work outcomes for people after SCI, it is important to consider how EIVR is delivered and integrated within the wider MDT. Such an understanding can also inform the establishment of new EIVR services in different settings. Results suggest that unity, flexibility and clarity between EIVR services and the wider MDT are essential foundations for supporting people with SCI on their journey to employment. SPONSORSHIP: This research was funded by Health Research Council NZ grant in partnership with Canterbury District Health Board.

How does informal employment affect health and health equity? Emerging gaps in research from a scoping review and modified e-Delphi survey.

INTRODUCTION: This article reports on the results from a scoping review and a modified e-Delphi survey with experts which aimed to synthesize existing knowledge and identify research gaps on the health and health equity implications of informal employment in both low- and middle-income countries (LMICs) and high-income countries (HICs). METHODS: The scoping review included peer-reviewed articles published online between January 2015 and December 2019 in English. Additionally, a modified e-Delphi survey with experts was conducted to validate our findings from the scoping review and receive feedback on additional research and policy gaps. We drew on micro- and macro-level frameworks on employment relations and health inequities developed by the Employment Conditions Knowledge Network to synthesize and analyze existing literature. RESULTS: A total of 540 articles were screened, and 57 met the eligibility criteria for this scoping review study, including 36 on micro-level research, 19 on macro-level research, and 13 on policy intervention research. Most of the included studies were conducted in LMICs while the research interest in informal work and health has increased globally. Findings from existing literature on the health and health equity implications of informal employment are mixed: informal employment does not necessarily lead to poorer health outcomes than formal employment. Although all informal workers share some fundamental vulnerabilities, including harmful working conditions and limited access to health and social protections, the related health implications vary according to the sub-groups of workers (e.g., gender) and the country context (e.g., types of welfare state or labour market). In the modified e-Delphi survey, participants showed a high level of agreement on a lack of consensus on the definition of informal employment, the usefulness of the concept of informal employment, the need for more comparative policy research, qualitative health research, and research on the intersection between gender and informal employment. CONCLUSIONS: Our results clearly identify the need for more research to further understand the various mechanisms through which informal employment affects health in different countries and for different groups of informal workers.

Stakeholder views on young adults with intellectual disabilities as a workforce: A qualitative study on students' performance in upper secondary education and their employment potential.

People with intellectual disabilities are the most disadvantaged group among all disability types when it comes to employment. In Sweden, special needs upper secondary schools prepare students with intellectual disabilities for the labour market using practice periods at workplaces. This study targets stakeholder involved in their school-to-work transition (i.e. teachers, employers, employment agency officials). The aim is to identify how they view: (1) the working capabilities of students during practice periods and (2) their employment potential. We base the analysis on interview data with the stakeholders using Grounded Theory. Our results identify three student types whose preparedness for the labour market differs considerably. One student type performs well during the practice period and represents a high potential to enter the workforce. The other two student types have the lower working capability and employment potential. Our study highlights stakeholders as resources to improve the labour market preparations of students with intellectual disabilities.

Vocational Rehabilitation Service Utilization and Employment Outcomes Among Secondary Students on the Autism Spectrum.

U.S. policy interventions encourage earlier provision of Vocational Rehabilitation (VR) services to support students and youth with disabilities such as autism spectrum disorder (ASD) during the transition from school to work. We analyzed Rehabilitation Services Administration (RSA-911) data using multivariable logistic regression to determine the association of VR services receipt with employment outcomes for students ages 16-21, same-age non-student youth and young adults with ASD. Students with autism received job-related services (job search, job placement, and on-the-job supports) at rates significantly below comparison groups, even though odds of successful employment at VR exit were significantly higher if they received these services. Findings suggest that rates of employment among students with autism might be improved with intentional delivery of job-related services.

Conscientious Objection and Physician-Employees.

This article attempts to motivate a reorientation of ethical analysis of conscientious objection (CO) by physicians. First, it presents an illustrative case from a hospital emergency department for context. Then, it criticizes the standard pro- and anti-CO arguments. It proposes that the fault in standard approaches is to focus on the ethics of the physician's behavior, and a better way forward on this issue is to ask how the party against whom the physician exercises the CO ought to respond. It connects this question with recent trends in physician employment models, which suggest that CO may become a potential source of conflict in the future. The article then develops a relational account of CO that extends James Childress' insights about the nature of CO in "Appeals to Conscience" (1979). This relational account characterizes CO as a two-place relation between conscientious objector and expectant party, in which the conscientious objector makes a request of the expectant party, which has implications that will be welcome and unwelcome for both the pro- and anti-CO camps. Finally, the paper applies this relational account of CO to the case when the physician is an employee. This application demonstrates that it is highly context dependent whether or not an employer should accede to the CO requests of physician-employees.

The Country That Never Retires: The Gendered Pathways to Retirement in South Korea.

OBJECTIVES: Among all Organization for Economic Cooperation and Development countries, South Korean older adults work until the latest age. We investigate the extent to which work experiences over the life course and family circumstances can be associated with older workers' incentives to remain in the labor force beyond the statutory pension age. We explore gender-specific patterns of labor force exit and labor force re-entry in later life. METHODS: Using panel data of South Korean older workers and retirees from 2006 to 2016, we estimate multilevel discrete-time models with random effects to predict their labor force transition process that unfolds over time. RESULTS: Results show that skilled manual workers are less likely to exit employment and more likely to re-enter the labor force. A longer history of self-employment is related to later retirement. The relationship between career characteristics and the risk of retirement is only significant for men. Late-aged employment transition among women appears to be more related to family conditions. Women who receive financial support from adult offspring are more likely to remain out of the labor force but this relationship is not pronounced among men. DISCUSSION: Policies aimed at extending working lives need to provide various types of social support to older job seekers, especially those who had low-class jobs and those without family networks.

Identifying School-Based Factors that Predict Employment Outcomes for Transition-Age Youth with Autism Spectrum Disorder.

There is a growing need to provide appropriate services to help students with autism spectrum disorder (ASD) transition to employment. Limited research has investigated what aspects of support should be prioritized when preparing youth with ASD for employment. By conducting structural equation modeling using a nationally-representative dataset on high school students receiving special education services (NLTS-2), this study examined the malleable predictors of employment during the transition and developed a model to examine the relationships between predictors and employment outcomes. The findings suggested two pathways for youth with ASD. For youth with higher daily functioning skills (DFS), academic performance mediated the relationship between parent participation and employment. For youth with lower DFS, school-based transition supports was the key mediator.

An evaluation of the Veterans Health Administration National Nursing Education Initiative.

BACKGROUND: Since 1999, the Veterans Health Administration's (VHA) National Nursing Education Initiative (NNEI) has provided 16,294 scholarships for registered nurses to attain baccalaureate and advanced nursing degrees. PURPOSE: The goal of this evaluation was to determine factors that enhanced or hindered a scholarship recipient in the completion of their degree and service obligation. METHODS: A regression analysis was performed to identify predictors of degree completion for 10,043 participants in 162 VHA facilities. FINDINGS: Significant predictor variables for degree completion were intended occupation, entry degree, gender, age, and year entering the program. Eighty-six percent (86.7%) of participants completed the degree requirement. Of those who completed their degree, 97% completed the service obligation. DISCUSSION: As recruitment and retention initiative, NNEI scholarships are poised to address the VHA nursing staffing shortages as well as build a highly qualified nursing workforce capable of providing the best care to our Nation's Veterans.

The interprofessional Veterans Affairs Quality Scholars program pre- and postdoctoral nurse fellow outcomes.

BACKGROUND: The Department of Veterans Affairs (VA) Quality Scholars (VAQS) program, an interprofessional fellowship that includes pre- and postdoctoral nurses, aims to inspire practice change leaders. Fellows participate in a national curriculum, lead improvement/research teams, and establish professional development plans with expert mentor guidance. PURPOSE: To describe the distinctive elements of the VAQS program, nurse fellow outcomes, and accomplishments of nurse alumni as leaders, researchers, and educators. METHODS: Data were reviewed and aggregated from past and current fellow surveys. FINDINGS: Nurse fellows completed research and improvement projects that benefitted both the VA and the local health systems. Scholarly outcomes include publications, conference presentations, grant submissions, teaching/leading quality improvement, and research initiatives. Graduates transition to positions as nurse scientists, academic faculty, and operational leaders. DISCUSSION: Fellows contribute to the strategic priorities of local and national VA and external health care organizations providing a pipeline of health system expert leaders, educators, and researchers. CONCLUSION: Doctoral nursing fellowship experiences build human capital for enhancing the science of improvement and implementation, interprofessional collaboration, and leadership.

Workplace Social Challenges Experienced by Employees on the Autism Spectrum: An International Exploratory Study Examining Employee and Supervisor Perspectives.

Social challenges represent a significantly under-researched area when it comes to the poor employment outcomes in autism. In this exploratory study employees on the autism spectrum (N = 29) and supervisors (N = 15), representing seven continents, provided 128 written examples of workplace-based social challenges, their interpretation, consequences and resolution. Content analysis revealed that types of social challenges were individually oriented or associated with the work-environment. Social challenges were frequently attributed to internal or personal factors with direct consequences for the employee. Resolutions were more frequently targeted toward the individual than the workplace, and hindered employees' experience of work. This international study represents a first look at the types of social challenges that impact equitable work participation of autistic people.

Employability and intention to apply for rehabilitation in people with back pain: A cross-sectional cohort study.

OBJECTIVES: To analyse the association between self-reported prognosis of employability and health-related measures, and to clarify which determinants influence the intention to apply for medical rehabil-itation. DESIGN: Cross-sectional study of a random sample of German employees. PARTICIPANTS: A total of 6,654 participants (58% female) aged 45-59 years with back pain during the last 3 months. RESULTS: Out of a total of 6,654 persons, 4,838 had a positive self-reported prognosis of employability. Persons with positive and negative prognoses clearly differ with regard to health-related measures. Of 1,816 persons who reported a negative prognosis, 26% stated an intention to apply for rehabilitation. Intention was determined mainly by perceived social support from family and friends (odds ratio (OR) 1.87; 95% confidence interval (95% CI) 1.66-2.10), as well as physicians and therapists (OR 1.64; 95% CI 1.41-1.90). CONCLUSION: A negative self-reported prognosis of employability is associated with self-reported health restrictions that may determine the need for rehabilitation interventions. A considerable proportion of persons with self-reported health restrictions do not plan to use medical rehabilitation. Perceived social support is an important facilitator of intention to apply for rehabilitation. However, this study needs to be replicated in other populations combining self-reported and administrative data.

Maternal Employment and Infant BMI z Score in a US Birth Cohort.

OBJECTIVE: The purpose of this study was to investigate the association between maternal employment and infant BMI z score. METHODS: Longitudinal data from 520 mother-infant dyads participating in the Nurture Study, an observational cohort in the southeastern United States, were leveraged. Women were categorized as employed or nonemployed at 3, 6, 9, and 12 months, and measured anthropometrics were used to calculate infants' BMI z scores at the corresponding time points. BMI z score was defined using the World Health Organization standard. Household income was an effect modifier. Therefore, income-stratified (≤$40,000/y vs. >$40,000/y) linear regression models, with individual fixed effects, were used to examine associations between change in maternal employment status and BMI z scores among infants aged 3 to 12 months. Fixed effects controlled for time-invariant confounders (race/ethnicity, infant gender). This study also controlled for marital status and infant age. RESULTS: More women from higher-income (68.4%) versus lower-income households (52.6%) were employed. Among lower-income households, change from nonemployment to employment was associated with higher infant BMI z scores (ß = 0.12; 95% CI: -0.01 to 0.25, P = 0.07). Among higher-income households, change in maternal employment status was associated with lower infant BMI z scores (ß = -0.72; 95% CI: -1.17 to -0.27, P = 0.02). CONCLUSIONS: Maternal employment was related to infant adiposity. The direction of the association varied by household-level income.

Psychosocial risks and the health of health workers: reflections on Brazilian labor reform.

OBJECTIVE: to reflect on the psychosocial risks and their impacts on the health of health workers in light of the Brazilian economic context and Labor Reform. METHOD: reflective study on the Brazilian Labor Reform and its impacts on health of health workers. RESULTS: although the changes observed in the labor sphere have contributed to improvements in health and safety policies for, these changes have also contributed to the emergence of new risks arising from work activities, including psychosocial risks, which affect all occupational categories. Final considerations: we understand that the Brazilian Labor Reform carried out in 2017 leads to the weakening of labor relations, increases workers' exposure to risks in the workplace, increases the risk of illness, and opposes the global movement of international organizations aimed at the prevention of aggravation in workers' health and also at preserving their health.

Initial changes in neuropsychologists clinical practice during the COVID-19 pandemic: A survey study.

Objective: In light of the COVID-19 pandemic, a majority of clinicians have had to quickly and dramatically alter their clinical practices. Two surveys were administered on 3/26/2020 and 3/30/2020, respectively, to document immediate changes and challenges in clinical practice.Method: Two surveys were administered between 3/26/2020 and 3/30/2020, via SurveyMonkey and Google Forms, asking clinicians questions pertaining to practice issues during the early stages of the COVID-19 pandemic. Quantitative responses from the second survey were stratified by clinical setting (Medical Hospital vs. Private Practice) prior to analysis. Qualitative, free-response items were coded by the authors to better understand immediate changes in practice and other concerns.Results: 266 neuropsychologists completed Survey 1 and 230 completed Survey 2. Results suggest that practices immediately moved towards remote service provision. A meaningful proportion of clinicians and their staff were immediately affected economically by the pandemic, with clinicians in private practice differentially affected. Furthermore, a small but significant minority of respondents faced ethical dilemmas related to service provision and expressed concerns with initial communication from their employment organizations. Respondents requested clear best-practice guidelines from neuropsychological practice organizations.Conclusions: It is clear that field of neuropsychology has drastically shifted clinical practices in response to COVID-19 and is likely to continue to evolve. While these responses were collected in the early stages of stay-at-home orders, policy changes continue to occur and it is paramount that practice organizations consider the initial challenges expressed by clinicians when formulating practice recommendations and evaluating the clinical utility of telehealth services.

Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa.

BACKGROUND: Worldwide, over 740 million women make their living in the informal economy and therefore lack formal employment benefits, such as maternity leave, that can improve infant feeding practices. Returning to work is one of the biggest challenges women face to maintaining breastfeeding. This study aimed to explore attitudes and perceptions towards breastfeeding in the informal work environment among male and female informal workers. METHODS: The study used a qualitative research design. Purposive and snowball sampling was employed. Focus group discussions (FGDs) were conducted among men and women working in different types of informal jobs, in India and South Africa. Data was analysed using a thematic approach and the framework method. RESULTS: Between March and July 2017, 14 FGDs were conducted in South Africa and nine in India. Most women were knowledgeable about the benefits of breastfeeding and reported initiating breastfeeding. However, pressures of family responsibilities and household financial obligations frequently forced mothers to return to work soon after childbirth. Upon return to work many mothers changed their infant feeding practices, adding breastmilk substitutes like formula milk, buffalo milk, and non-nutritive fluids like Rooibos tea. Some mothers expressed breastmilk to feed the infant while working but many mothers raised concerns about expressed breastmilk becoming 'spoilt'. Breastfeeding in the workplace was challenging as the work environment was described as unsafe and unhygienic for breastfeeding. Mothers also described being unable to complete work tasks while caring for an infant. In contrast, the flexibility of informal work allowed some mothers to successfully balance competing priorities of childcare and work. Sociocultural challenges influenced breastfeeding practices. For example, men in both countries expressed mixed views about breastfeeding. Breastfeeding was perceived as beneficial for both mother and child, however it was culturally unacceptable for women to breastfeed in public. This affected working mothers' ability to breastfeed outside the home and contributed to a lack of respect for women who chose to breastfeed in the workplace. CONCLUSION: Mothers working in the informal sector face multiple challenges to maintaining breastfeeding. Interventions are required to support feeding and childcare if global nutrition and development goals are to be met.

A conceptual framework to promote career development for vocational rehabilitation consumers with traumatic brain injuries.

The purpose of this article is to describe the Illinois Work and Well-being Model (ILW2M), a multi-domain framework for conceptualizing the employment development of people with traumatic brain injuries (TBIs). The model emphasizes the interaction of contextual and career development domains to improve participation in the areas of work, society, community, and home. A brief discussion of potential implications regarding vocational rehabilitation research and service is offered with the overall goal of reinforcing employment development as the foundation of vocational rehabilitation services for adults with TBIs.

Contract Negotiation for Neurosurgeons: A Practical Guide.

Contract negotiation is a reality in the career of any neurosurgeon. However, little formal training exists for physicians - including neurosurgeons - on potential techniques and strategies for conducting meaningful contract negotiation. Increasing numbers of neurosurgeons seek hospital employment for which an employment contract will be provided. During contract negotiation, it is likely that a young neurosurgeon will be in discussion with an experienced negotiator acting on behalf of a hospital, practice, or department. Understanding and adapting to this imbalance in experience and using basic negotiating techniques as a means of approaching and resolving key contract issues is critical for the neurosurgeon to maximize his or her value in the course of contract negotiation. Even without formal training in negotiation in residency, negotiation skills can be taught, practiced, and improved. In affiliation with the Medical Director's Ad-Hoc Representational Section of Council of State Neurosurgical Societies (CSNS) this article is intended to serve as a practical guide for contract negotiation. Contract basics, negotiation terms, strategies, unique neurosurgical issues, and value creation are explored.

Brief Report: A Job-Based Social Skills Program (JOBSS) for Adults with Autism Spectrum Disorder: A Pilot Randomized Controlled Trial.

Adults with autism spectrum disorder (ASD) have low employment rates; even those who are employed have low wages and limited hours. This study evaluated the effectiveness of the Job-Based Social Skills (JOBSS) curriculum, a manualized, 15-week, group-delivered intervention for adults with ASD. The intervention aimed to increase social-pragmatic skills necessary to obtain and maintain employment. Twenty-two adults were randomly assigned to either JOBSS intervention or wait-list control groups. Results showed significant improvement in social cognition, as reported by caregivers, among JOBSS group participants compared to wait-list control participants. Forty-five percent of intervention participants gained employment in the six months following participation. This curriculum has potential to improve social skills of adults with ASD, thereby increasing successful employment.

Informal workplaces and their comparative effects on the health of street vendors and home-based garment workers in Yangon, Myanmar: a qualitative study.

BACKGROUND: Globally, two billion workers are employed informally but there is limited research on the relationship between informal work and health. Existing studies have focused on informality as an employment condition, with little emphasis on the diversity of physical and social contexts in which informal work takes place. The study considers the diversity of informal workplaces and explores the ways in which this diversity might influence health and well-being of two informal occupational groups in Yangon, the former capital of Myanmar. METHODS: We conducted 21 field observations and 47 semi-structured interviews with street vendors and home-based garment workers based in Yangon, Myanmar. A constant comparative method was used to identify and compare how the physical characteristics of their informal workplaces affect their health for these two informal subgroups. RESULTS: Although both street vendors and home-based garment workers work informally, their exposure to occupational health and income risks are specific to the physical features of their informal workplaces. Street vendors, who work in public spaces with minimal coverage, are more likely to experience the direct effects of outdoor pollution, inclement weather and ergonomic risks from lifting, carrying and transporting heavy merchandise while home-based garment workers, many of whom live and work in unsanitary housing and deprived neighborhoods, are more likely to experience pollution in or near their homes, and ergonomic risks from poor posture. Similarly, although both groups face safety challenges, street vendors face urban violence and abuse during their commute and at vending points whereas home-based garment workers felt unsafe in their home-based workplaces due to the presence of crime and violence in their neighborhoods. CONCLUSION: While informal employment is universally characterized by lack of social protection, exposure to occupational health and income risks for subpopulations of informal workers is determined by the specific physical and social environments of their workplaces. Efforts to improve the health of informal workers should consider the contexts in which informal work takes place to develop tailored interventions for subpopulations of informal workers.