Room
Paternot salle n° 30 ( à côté de l'auditoire PATERNOT )
Theme
Work - Health and work conditions
Chair
Karin Nordström
Title
Management of occupational burnout in Switzerland: prognostic believes and treatment
Name
Irina Guseva Canu
Affiliation
Unisanté, University of Lausanne
Abstract
We aimed at investigating the characteristics and current practices of Swiss health professionals, namely the general practitioners (GP), psychiatrist-psychotherapists (PP), occupational physicians (OP) and psychologists in the management of burned-out patients (BOP).A 48-item e-questionnaire in RedCAP was distributed via the national professional associations between April and July 2021. Data were analyzed using logistic and multinomial regression models.
Among 3216 respondents, 2951 reported having BOP, and 1130 (713 physicians and 410 psychologists) treat them. Most (n=894, 79%) work in private practice and have 16.9-year experience in average.
We found no influence of age, sex, number of consultations and experience on the treatment of BOP, which was determined by profession, specialty and practice place. Psychologists treat BOP more often than physicians [OR=1.97, p<0.001], especially psychotherapists [OR=6.35, p<0.001]. Psychiatrists treat burnout more frequently than GP [OR=12.6, p<0.001] while OP treat them less [OR=0.18, p=0.02]. Professionals in German-speaking cantons have less optimistic believes on burnout prognosis. The latter is also associated with 60+ age in physicians [OR=2.2, p=0.011] and female sex in psychologists [OR 2.15, p=0.024]. This believe affects the treatment practices. The less optimistic physicians tend to contact the employer and/or insurance doctor besides the medication, sick leave or psychotherapy prescription more often [RRR 1.77, p=0.004]. Psychologists have a similar trend [RRR=1.80, p=0.026]. The treatment practices also depend on burnout severity. Psychiatrists [OR=3.8, p<0.001] and physicians with double specialty [OR=5.9, P=0.006] have more severely BOP than GP and are more prone to contact the BOP’s employer and/or insurance doctor. Psychologists who have mostly severely BOP also collaborate with other health professionals [OR=2.35, p=0.022]. We found no relationships between treatment practices or burnout severity on the proportion of relapsed patients. Yet, the latter is associated with professionals’ age, sex, and specialty. Physicians with waiting time >3 months have a higher proportion of relapsed patients [OR=2.5, p=0.045].
The prognostic believes and current practices of Swiss professionals in BOP management present important variations. These findings suggest a need for a better harmonization of practices, for instance through the specific professional recommendations and continuous education.
Title
Breast cancer and occupation: non-parametric and parametric net survival analyses among Swiss women (1990–2014)
Name
Irina Guseva Canu
Affiliation
Unisanté, University of Lausanne
Abstract
Occupation and socio-economic status may both contribute to differences in risk and stage at diagnosis of breast cancer. We aimed at determining whether occupation, skill level required for the occupation and the socio-professional category affect the breast cancer survival (BCS) up to 10 years after diagnosis.We used cancer registry records to identify women diagnosed with primary invasive breast cancer between 1990 and 2014 in western Switzerland and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods.
Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors/low level management and skilled laborers, compared to unskilled employees.
These results suggest that work-related factors may affect BCS. As this study was conducted using a relatively small sample and limited set of covariates, further larger studies are required for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.
Title
Migration health and primary care: lessons from China’s migrant workers
Name
Kailing Marcus
Affiliation
Institute of Global Health, Global Studies Institute, University of Geneva
Abstract
Migrant health is a critical component for public health concerns. Yet, migrant workers are often marginalised by their socioeconomic disadvantages and vulnerabilities. Further, even those in countries with universal health coverage, those who are underprivileged are often excluded from obtaining health coverage and receiving primary care when it is needed.Therefore, international migrant workers are often described as one of the most disproportionately vulnerable groups of the society, but this scenario is not limited to those who cross national borders. In certain countries, internal migrant workers who relocate within of their own country can also face similar healthcare access challenges, due to their national legislations. Such is the case of China’s internal migrant workers, whose health needs are exacerbated by primary care access inequities, since lack of access to care is significantly associated with higher risk of long hospitalization stays, poorer health indicators, lower quality of life and other adverse health outcomes.
In this interdisciplinary study, we aimed to investigate the risk factors of healthcare access barriers for migrant workers and the associated health consequences. First, we conducted an analysis of China’s legal framework on healthcare access, including laws and regulations that are closely linked with health coverage: labour and labour contract laws, social protection laws, household registry regulations and migration-related regulation reforms. Then, we examined the associations of healthcare access determinants and outcomes among Chinese migrant workers, using the China migrants Dynamic Survey (CMDS), a annually repeated cross-sectional study conducted by the China National Health Commission since 2009. We included 840,215 participants (aged >16 years), using six cross-sectional years (2009, 2011, 2012, 2013, 2015, 2018). For indicators, we examined participants’ knowledge on right to health coverage, formal employment status, self-rated health, out-of-pocket health expenditures, hospitalization and health-seeking behaviour.
To our knowledge, this is the first study to investigate in-depth China’s legal framework on healthcare access and applying the legal knowledge to strengthen the interpretation of a quantitative analysis on migrant health. This study can shed light on closing the socioeconomic gap on primary care delivery and improve crisis preparedness.
Title
Health and work conditions of Swiss bus drivers: repeated cross-sectional surveys in 2010, 2018, and 2022
Name
Viviane Remy
Affiliation
Unisanté, University of Lausanne
Abstract
For the past decades, bus drivers (BDs) have been considered as one of the most exposed and diseased occupational groups worldwide. Furthermore, the Covid-19 pandemic had an impact on their working conditions and health since 2020.The present repeated cross-sectional study was conducted among BDs affiliated to a union active in the public transport sector in Switzerland. It was based on previously used self-administered questionnaire divided into two parts. The first part addressed the prevalence of driving accidents, musculoskeletal, digestive, and mental disorders at three-time points: 2010, 2018 and 2022. In the second part, we measured the tediousness score of twelve factors reflecting BDs’ working conditions.
For health problems and accidents, which increased between 2010 and 2022, we performed logistic regression models adjusted for socio-professional, demographic, working condition difficulties factors, health problems, and Covid-19 crisis impacts.
The study sample included 734 participants in 2010, 367 in 2018 and 870 in 2022.
The most prevalent health problems, reported by 50% or more of BDs, were shoulder or neck muscle pain, abnormal fatigue, and back pain. The most difficult working condition was working days over 10 hours. Shoulder and neck pain, sleep disorders, sick leaves, and driving accidents all increased between 2010 and 2022, due to various health issues, working condition tediousness, and consequences of the pandemic on health working conditions.
The female proportion of bus drivers’ workforce increased fourfold between 2010 and 2022. Furthermore, most working conditions have worsened, partly responsible for BDs’ declining health. The understanding of working conditions is essential to prevent occupational diseases in BDs.
Title
Peri-pandemic acceptance of influenza and Covid-19 vaccination by Swiss healthcare workers in primary care 2020/21: a cross-sectional study
Name
Phung Lang
Affiliation
Interdisciplinary Emergency Centre Lucerne Cantonal Hospital, Lucerne, MD, Switzerland, 2 QualiCCare,, Baden, 3 Epidemiology, Biostatistics and Prevention Institute at the University of Zurich
Abstract
ObjectivesTo assess and compare influenza and Covid-19 vaccination uptake of Swiss healthcare workers (HCWs) in primary care 2020/21 and compare it to pre-pandemic influenza vaccination rates 2015/16.
Methods
Influenza and Covid-19 vaccination uptake and recommendation behaviours of HCWs in the primary care sector were assessed using an online semi-structured questionnaire. Associations between vaccination rates and age, language, gender, profession, vaccination training and recommendation behaviours were evaluated using descriptive and multivariable logistic regression analyses.
Results
Of the 1331 questionnaires evaluated, 61.3% of the participating HCW were vaccinated against the influenza in 2020/21 compared to 40.2% in 2015/16 and 91.8% vaccinated against Covid-19. Physicians and pharmacists presented the highest vaccination rates (influenza 87.3% and 73.7%; Covid-19: 95.7% and 94.8%, respectively). Influenza vaccination rates for nurses and medical practice assistants increased significantly compared to 2015/16 (2020/21: 48.3% and 51.4%, respectively) while that for Covid-19 was at 87.0% and 88.8%, respectively. Influenza and Covid-19 vaccination rates were significantly associated with age, profession, vaccination training and recommendation behaviours. In addition to the reasons given for getting an influenza vaccination such as protecting oneself, the patients and the family, reasons for getting a Covid-19 vaccination also included solidarity, herd immunity and Covid-19 certification.
Conclusion
Acceptance for influenza vaccination has increased during the pandemic but is lower than that for Covid-19 among the HCWs. Demographics, vaccination status and vaccination training impact the vaccination behaviour among HCWs and should be considered in future campaigns to increase vaccination uptake.