Impact of Q-fever fatigue syndrome on patients’ work status, 2020, Reukers et al

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https://academic.oup.com/occmed/advance-article/doi/10.1093/occmed/kqaa166/5929827

Impact of Q-fever fatigue syndrome on patients’ work status

D F M Reukers, J A F van Loenhout, I Roof, T F Senden, S P Keijmel, C P Bleeker-Rovers, C H M van Jaarsveld, J L A Hautvast, K van der Velden

https://doi.org/10.1093/occmed/kqaa166
Published:

19 October 2020

https://doi.org/10.1093/occmed/kqaa166
Published:

19 October 2020

Issue Section:
Original Paper

Abstract
Background
Chronic illnesses can increase the risk of unemployment, but evidence on the specific impact of Q-fever fatigue syndrome (QFS) on work is lacking.

Aims
The aim of this study was to describe and quantify the impact of QFS on work.

Methods
Changes in work status from 1 year prior to 4 years after acute Q-fever infection of QFS patients were retrospectively collected with a self-report questionnaire measuring employment status and hours of paid work per week. In addition, information on work ability, job satisfaction and need for recovery after work was collected in 2016. Data were compared to participants from the general population.

Results
The proportion of employed QFS patients from 1 year prior to 4 years after acute infection decreased from 78 to 41%, while remaining relatively constant in the general population (82 to 78%). Working QFS patients showed a decrease in mean hours of paid work from 35 to 22 h per week, which is significantly steeper compared to the general population (31–28 h per week) (P < 0.001). QFS patients showed a significantly lower work ability (P < 0.001), lower job satisfaction (P = 0.006) and greater need for recovery (P < 0.001) compared to the general population.

Conclusions
The number of QFS patients with paid work decreased over the years, while patients who continue to work experience lower work ability, job satisfaction and increased need for recovery. Occupational physicians should be aware of the occurrence and severity of the impact of QFS on work, even after many years.
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Key learning points

What is already known about this subject:
  • Chronic illnesses can have an impact on work status and increase the risk of unemployment, but evidence on the specific impact of Q-fever fatigue syndrome on work is lacking.
What this study adds:
  • Q-fever fatigue syndrome patients suffer from an impaired work status compared to the general population on different levels, as many become incapacitated or unemployed, decrease their working hours per week or show a significantly lower work ability and higher need for recovery.
What impact this may have on practice or policy:
  • These results show that more research into targeted interventions to improve the work status of Q-fever fatigue syndrome patients may be warranted, as studies have shown that participation in work leads to better health outcomes.
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It is possible that work leads to better health outcomes in the general population. However, that doesn't necessarily mean the same applies in a CFS-like condition like this.
 
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as studies have shown that participation in work leads to better health outcomes.
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I actually had a look at this claim they made. They support it with one study, which is this metanalysis. The metanalysis reports 3 studies that showed that measures of subjective and/or objective physical health are reliably lower in those who are unemployed vs., those that are employed (no surprise there). There was also one study showing that subjective reports of physical health are lower in the long-term unemployed than in short-term unemployed (no surprise there either). The authors acknowledge that correlation does not equal causation.

There were no studies in the metanalysis supporting the specific causal claim the authors make that "participation in work leads to better health outcomes".

I sometimes feel its so hopeless, the sloppiness and stupidity of the people that our society places in the role of "researcher". Honestly, a good proportion of ordinary people would spot the problem here, why do we let these idiots run the place?
 
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Woolie said:
There were no studies in the metanalysis supporting the specific causal claim the authors make that "participation in work leads to better health outcomes".
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Would it be possible for you to write a letter to the journal challenging that false claim, and also questioning the assumption that rehab that leads to return to work is possible.

This is the sort of nonsensical deduction that gives government disability/unemployment funding agencies the excuse not to support people in this situation.
 
Plus what is the difference between QFS and ME/CFS. After years go by being sick there is none and it just serves to silo everyone and generate less research money for ME/CFS.

It’s the same argument I’ve made about post COVID, post SARS, post Giardia, post Ebola, post Lyme, etc. Just because there are unique long-term sequelae specific to each initial infection, many if not most patients in each group all share ME/CFS hallmark symptoms and have ME/CFS.
 
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Medicine has a serious case of the over-Excels. Most of this is just fiddling with a small bit of data. This kind of study is useful in simply asking about work status but there is just too much mathemagics involved here, tweaking knobs the right way to get the pattern they want to emerge. The obsession over "getting people back to work" is seriously unhealthy, all based on assumptions about people who are free of significant illness, usually mixing correlation as some causative thing.

Sick people work less because they are sick. People who can't understand how this causality works out are seriously in the wrong profession if they can't integrate reality to fit with their prejudices.
 
rvallee said:
I thought it was more commonly used but most results are for an anime. Oh well.

Torture your data long enough and it will confess to having killed JFK. Just like that. "Magic".
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A common and similar phrase that’s used in life sciences is p-hacking
 
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leokitten said:
A common and similar phrase that’s used in life sciences is p-hacking
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But in this instance, its none of these more elaborate things, it just plain old logical failure.

Its not just any logical failure. If you pointed these authors to data showing that the risk of death is higher for those admitted to hospital than those in the community, I don't think they'd be stupid enough to conclude that "hospital admission leads to mortality". They'd see the reverse causation problem right away.

The closest thing that has been documented in the thinking and reasoning literature is belief bias, which wikipedia defines as "the tendency to judge the strength of arguments based on the plausibility of their conclusion rather than how strongly they support that conclusion." There are quite a few studies from the 1980s demonstrating this reasoning error. The conventional explanation is that logical reasoning is resource-intensive for humans, so we engage in it only when the conditions warrant it (that is, a conclusion or statement seems dodgy to us).

But one would like to think that researchers and other professional intellectuals are trained to not take those kinds of shortcuts. Surely, they get paid not to take those shortcuts.
 
Trish said:
Would it be possible for you to write a letter to the journal challenging that false claim, and also questioning the assumption that rehab that leads to return to work is possible.

This is the sort of nonsensical deduction that gives government disability/unemployment funding agencies the excuse not to support people in this situation.
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Unfortunately, the journal is Occupational Medicine. It would be like writing a letter to the Journal of Homeopathy pointing out that water doesn't have memory.
 
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