Cancer survivors at work : Work-related problems and factors associated with their employment, work ability and social support from the work community

Due to the improved prognosis of many forms of cancer, an increasing number of cancer survivors are willing to return to work after their treatment. It is generally believed, however, that people with cancer are either unemployed, stay at home, or retire more often than people without cancer. This study investigated the problems that cancer survivors experience on the labour market, as well as the disease-related, sociodemographic and psychosocial factors at work that are associated with the employment and work ability of cancer survivors. The impact of cancer on employment was studied combining the data of Finnish Cancer Registry and census data of the years 1985, 1990, 1995 or 1997 of Statistics Finland. There were two data sets containing 46 312 and 12 542 people with cancer. The results showed that cancer survivors were slightly less often employed than their referents. Two to three years after the diagnosis the employment rate of the cancer survivors was 9% lower than that of their referents (64% vs. 73%), whereas the employment rate was the same before the diagnosis (78%). The employment rate varied greatly according to the cancer type and education. The probability of being employed was greater in the lower than in the higher educational groups. People with cancer were less often employed than people without cancer mainly because of their higher retirement rate (34% vs. 27%). As well as employment, retirement varied by cancer type. The risk of retirement was twofold for people having cancer of the nervous system or people with leukaemia compared to their referents, whereas people with skin cancer, for example, did not have an increased risk of retirement. The aim of the questionnaire study was to investigate whether the work ability of cancer survivors differs from that of people without cancer and whether cancer had impaired their work ability. There were 591 cancer survivors and 757 referents in the data. Even though current work ability of cancer survivors did not differ between the survivors and their referents, 26% of cancer survivors reported that their physical work ability, and 19% that their mental work ability had deteriorated due to cancer. The survivors who had other diseases or had had chemotherapy, most often reported impaired work ability, whereas survivors with a strong commitment to their work organization, or a good social climate at work, reported impairment less frequently. The aim of the other questionnaire study containing 640 people with the history of cancer was to examine extent of social support that cancer survivors needed, and had received from their work community. The cancer survivors had received most support from their co-workers, and they hoped for more support especially from the occupational health care personnel (39% of women and 29% of men). More support was especially needed by men who had lymphoma, had received chemotherapy or had a low education level. The results of this study show that the majority of the survivors are able to return to work. There is, however, a group of cancer survivors who leave work life early, have impaired work ability due to their illness, and suffer from lack of support from their work place and the occupational health services. Treatment-related, as well as sociodemographic factors play an important role in survivors' work-related problems, and presumably their possibilities to continue working.

Preoperative visual acuity of cataract patients. Repeatability of visual acuity and refractive error measurements in clinical settings

Visual acuities at the time of referral and on the day before surgery were compared in 124 patients operated on for cataract in Vaasa Central Hospital, Finland. Preoperative visual acuity and the occurrence of ocular and general disease were compared in samples of consecutive cataract extractions performed in 1982, 1985, 1990, 1995 and 2000 in two hospitals in the Vaasa region in Finland. The repeatability and standard deviation of random measurement error in visual acuity and refractive error determination in a clinical environment in cataractous, pseudophakic and healthy eyes were estimated by re-examining visual acuity and refractive error of patients referred to cataract surgery or consultation by ophthalmic professionals. Altogether 99 eyes of 99 persons (41 cataractous, 36 pseudophakic and 22 healthy eyes) with a visual acuity range of Snellen 0.3 to 1.3 (0.52 to -0.11 logMAR) were examined. During an average waiting time of 13 months, visual acuity in the study eye decreased from 0.68 logMAR to 0.96 logMAR (from 0.2 to 0.1 in Snellen decimal values). The average decrease in vision was 0.27 logMAR per year. In the fastest quartile, visual acuity change per year was 0.75 logMAR, and in the second fastest 0.29 logMAR, the third and fourth quartiles were virtually unaffected. From 1982 to 2000, the incidence of cataract surgery increased from 1.0 to 7.2 operations per 1000 inhabitants per year in the Vaasa region. The average preoperative visual acuity in the operated eye increased by 0.85 logMAR (in decimal values from 0.03to 0.2) and in the better eye 0.27 logMAR (in decimal values from 0.23 to 0.43) over this period. The proportion of patients profoundly visually handicapped (VA in the better eye <0.1) before the operation fell from 15% to 4%, and that of patients less profoundly visually handicapped (VA in the better eye 0.1 to <0.3) from 47% to 15%. The repeatability visual acuity measurement estimated as a coefficient of repeatability for all 99 eyes was ±0.18 logMAR, and the standard deviation of measurement error was 0.06 logMAR. Eyes with the lowest visual acuity (0.3-0.45) had the largest variability, the coefficient of repeatability values being ±0.24 logMAR and eyes with a visual acuity of 0.7 or better had the smallest, ±0.12 logMAR. The repeatability of refractive error measurement was studied in the same patient material as the repeatability of visual acuity. Differences between measurements 1 and 2 were calculated as three-dimensional vector values and spherical equivalents and expressed by coefficients of repeatability. Coefficients of repeatability for all eyes for vertical, torsional and horisontal vectors were ±0.74D, ±0.34D and ±0.93D, respectively, and for spherical equivalent for all eyes ±0.74D. Eyes with lower visual acuity (0.3-0.45) had larger variability in vector and spherical equivalent values (±1.14), but the difference between visual acuity groups was not statistically significant. The difference in the mean defocus equivalent between measurements 1 and 2 was, however, significantly greater in the lower visual acuity group. If a change of ±0.5D (measured in defocus equivalents) is accepted as a basis for change of spectacles for eyes with good vision, the basis for eyes in the visual acuity range of 0.3 - 0.65 would be ±1D. Differences in repeated visual acuity measurements are partly explained by errors in refractive error measurements.

Eräiden kansalaisjärjestöjen verkkosivut ja osallistamisen muutos 1990-luvulta 2010-luvulle

Tutkimus analysoi kansalaisten ja kansalaisjärjestöjen välistä vuorovaikutusta verkkomedian mahdollisuuksien kautta. Taustalla on ensinnäkin politiikan teorian kautta muodostettu käsitys kansalaisjärjestöjen positiivisista vaikutuksista niin demokratiaan kuin kansalaisten omiin taitoihin. Toiseksi aiemman aihetta käsittelevän empiirisen tutkimuksen, erityisesti Steinin (2009) ja Brudinin (2008) analyysien perusteella kansalaisjärjestöjen verkkosivut on luotu ennen kaikkea yksisuuntaiseen tiedotukseen, eivätkä ne sisällä kaksisuuntaisen vuorovaikutuksen elementtejä. Viimeisenä perusteena tutkimuksen mielekkyydelle toimii esimerkiksi Winnerin (1985) huomio, että teknologialla ja sen käyttöönotolla on aina poliittinen ulottuvuus, minkä voidaan ajatella pätevän myös kansalaisjärjestöjen tilanteessa. Tässä tutkimuksessa olennainen lisä aiempaan tutkimukseen verrattuna on historiallinen tarkastelutapa. Tutkimuksessa tarkastellaan kymmenen kansalaisjärjestön verkkosivujen ja muun verkkopresenssin kehittymistä vuodesta 1996 vuoteen 2011. Tätä kautta on mahdollista tutkia tarkemmin kahta tutkimuskysymystä: 1. Kansalaisjärjestöjen organisaatiollinen kehityksen, erityisesti institutionalisoitumisen ja professionalisoistumisen vaikutukset, vähentävät kansalaisjärjestöjen osallistuvuutta (Kriesi 1996, Tarrow 1998, Blumer 1951). Havaitaanko näitä muutoksia myös verkkopresenssin kautta? 2. Verkkomedia on kokenut voimakkaita muutoksia, erityisesti 2000-luvun alusta lähtien. Eräs näiden muutoksien keskeinen elementti on ollut kaksisuuntaisten viestintämahdollisuuksien kehittyminen ja parantuminen (Majava 2006, Erkkola 2008). Miten kansalaisjärjestöjen verkkoviestinnässä on otettu näitä uusia verkkomedian mahdollisuuksia käyttöön? Kysymyksiä lähestytään laadullisen analyysin kautta tutkimalla verkkosivujen osallistamista, eli sitä onko kaksisuuntainen vuorovaikutus mahdollista vai ei. Osallistumisen mahdollisuuksien kuvaukseen käytetään Chadwickin ja Mayn (2003) viitekehystä, jonka mukaan verkko-osallistuminen voi olla tiedottavaa, konsultoivaa tai keskustelevaa. Tiedottavalle verkko-osallistumiselle ominaispiirteistä on sen yksisuuntainen luonne, kun taas konsultoiva ja keskusteleva osallistuminen ovat kaksisuuntaista viestintää. Konsultoivaan osallistumiseen verrattuna keskustelevalle osallistumiselle ominaista on jaetumpi tietokäsitys ja kansalaisten mukaanotto agendan muotoilussa. Keskeisenä tuloksena voidaan esittää, ettei ensimmäiseen tutkimuskysymykseen tämän kymmenen tapauksen tapaustutkimuksella voida antaa luotettavaa vastausta. Ensinnäkin, eri ikäisten kansalaisjärjestöjen verkkosivujen osallistumisen mahdollisuuksien välillä ei ole selkeitä eroja. Toiseksi, nuorempien kansalaisjärjestöjen kohdalla osallistumisen mahdollisuuksissa ei havaittu merkittävää muutosta tarkastellulla aikavälillä. Toiseen tutkimuskysymykseen taas voidaan vastata, että osallistumisen mahdollisuudet ovat kasvaneet verkkomedian muutosten ansiosta. Käytännössä siirtymä osallistumista paremmin mahdollistaviin mekaniikkoihin, kuten kommentoinnin mahdollistamiseen, tapahtui 2000-luvun lopussa. Siirtymä on kuitenkin kohdistunut suurimmilta osin vain konsultoiviin mekaniikkoihin, eli näennäisestä vuorovaikutteisuudesta huolimatta aloitteen tekemisen monopoli on säilynyt kansalaisjärjestöillä itsellään. Lisäksi on syytä huomioida, etteivät osallistumisen mahdollisuudet sellaisenaan johda vielä aitoon osallistumiseen, eli kansalaisjärjestöjen ja kansalaisten väliseen vuorovaikutukseen.