Effort-Reward Imbalance, Workabilty and Utility Estimates in Chronic Kidney Failure

In the US about 300.000 Chronic Kidney Failure (CKF) patients are of the working age. Despite longer survival and improved quality of life (QOL), the employment rate of CKF patients is low. Factors associated to job retention after disease onset are under-investigated. We examined the relationship between Effort-Reward Imbalance (ERI), Workability, and QOL in Hemodialysis (HD). Also, we examined the association of Workability and sick leave rate (SL) in the post-enrollment month. Forty employed HD patients answered a self-administered survey including the ERI, the Work Ability Index (WAI ), and the Kidney Disease QOL 36 items (KDQOL-36) questionnaires. We also computed SF-6D utility index, a tool suitable for cost-benefit analyses. We recorded 4-week SL by computer-assisted telephone interview. We tested the associations of ERI quintiles with WAI , KDQOL-36 and utility estimates with Spearman’s partial correlation adjusted for age, hourly income (HI), and number of comorbidities (NoC). Patients were classified by WAI scores (Group A if WAI ≤27, Group B otherwise). Differences in SL between groups were assessed by Mann-Whitney test. Sample mean age was 46.9 (SD=8.2). Almost 95% of subjects reported at least one concurrent disease and 65% reported 3 or more comorbidities. Sixteen (40%) were hand laborer. Only 3 (7%) reported ERI values indicating disequilibrium between job efforts and rewards. However, WAI (ρ= -0.41, p<0.012), SF-6D (ρ= -0.47, p<0.001) and KDQOL scale (ρ= -0.48, p<0.001) were negatively correlated to ERI after adjusting for age, HI and NoC. The mean SL was 5.9 days/month (SD=10.4 days/month). Subjects with poor WAI reported 11.8 sick days/month compared to 4.0 sick days/month for subjects with moderate or higher WAI (p=0.049). Our data showed that workplace psychosocial environment might have a significant effect on patients’ clinical care, workability, and absenteeism rates. It provides the rational for interventional studies aimed at sustaining HD patients’ job retention. Effect of Exposure in Vivo on Work Functioning: Systematic Review Erik Noordik* Academic Medical Center (Amsterdam, Netherlands) Background: Anxiety disorders are associated with functional disability, sickness absence and decreased productivity. Effective treatments of anxiety disorders result in remission of symptoms; however this does not automatically generate complete functional recovery at work. This study is a systematic review of the effect of exposure in vivo in anxiety treatment on work-related outcomes for workers. PTSD studies were excluded as a category that needs a specific approach. Method: A systematic search was conducted using text words based on bibliographic research. Inclusion and exclusion criteria were defined. After the search, we used the snowball method based on reviews, references, citations and authors of included publications. We assessed the quality of included publications by a checklist. High and low quality studies were incorporated in an evidence synthesis evaluating the level of evidence. Results: The systematic search resulted in two included publications, by snowballing we found another three. Four studies were aimed at Obsessive Compulsive Disorder (OCD), while one study included a mixed group of participants with either OCD or severe phobias. All studies were rated as being of low quality. Using the rules for evidence synthesis, we found conflicting evidence for a positive relationship between exposure in vivo in anxiety treatment and workrelated outcomes. Conclusion: We found five relevant studies. All studies concerned patients with Obsessive Compulsive Disorders (OCD). For these patients, we found conflicting evidence that exposure in vivo is effective on work-related outcomes. There is a lack of high quality intervention studies aimed at anxiety disorders, apart from PTSD, measuring work-related outcomes.