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Salonen L, Hartikainen E, Solovieva S, Viikari-Juntura E, Leinonen T. Contribution of compositional changes in the workforce to sickness absence trends in Finland. SSM Popul Health 2023; 24:101525. [PMID: 37808232 PMCID: PMC10550613 DOI: 10.1016/j.ssmph.2023.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023] Open
Abstract
In this study, we assessed whether the long-term decrease in sickness absences in Finland is explained by observed and unobserved compositional changes in the workforce. Utilizing register-based panel data on Finnish wage earners aged 30-62, we examined the annual onset of compensated sickness absence (granted after 10 weekdays) in the period 2005-2016. We applied random effects models adjusting for changes in the observed sociodemographic and occupational characteristics of the study population. We also applied fixed effects models, with corrections of the estimates for cohort ageing, to additionally account for the unobserved time-invariant characteristics of the study population over the years. Of the observed characteristics, increasing educational level partly explained the decreasing trend in sickness absences, and the further contribution of the occupational class was weak. Additionally, accounting for unobserved individual characteristics further explained the decreasing trend in sickness absences among those aged 30-47 years and led to a reverse increasing trend among those aged 48-62 years irrespective of sex and employment sector. Particularly for those over 47 years old, the decrease in sickness absences appeared to be more strongly influenced by compositional changes in characteristics that are established before fully entering the labour market - such as educational level as well as unmeasured individual characteristics that remain unchanged after childhood and early adulthood - than in the work environment or other factors contributing at working age. Sickness absence trends fluctuated during economic cycles, which did not appear to be explained by immediate changes in the observed or unobserved characteristics. Different mechanisms are likely to explain long-term sickness absence trends and trends around economic cycles. Attempts to improve work ability and labour market inclusion in long-term should rely more on increasing educational levels among the workforce and on interventions carried out early during the life course.
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Affiliation(s)
- Laura Salonen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
| | - Elli Hartikainen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
| | | | | | - Taina Leinonen
- Finnish Institute of Occupational Health, 00032, Helsinki, Finland
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2
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Björkenstam E, Helgesson M, Mittendorfer-Rutz E. Childhood adversity and risk of later labor market marginalization in young employees in Sweden. Eur J Public Health 2023; 33:264-271. [PMID: 36825449 PMCID: PMC10066470 DOI: 10.1093/eurpub/ckad019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The present study examined the independent and combined effects of childhood adversity (CA) and occupational class on the risk of future labor market marginalization (LMM) in young employees in Sweden. Occupational class (non-manual/manual workers) was also explored as a potential mediator. METHODS This population-based longitudinal cohort study included 556 793 employees, 19-29 years, residing in Sweden in 2009. CAs included parental death, parental mental and somatic disorders, parental separation, household public assistance, single-parent household and residential instability. Measures of LMM included long-term unemployment (LTU), long-term sickness absence (LTSA) and disability pension. Estimates of risk of each LMM measure, between 2010 and 2016 were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using a Cox regression analysis. RESULTS Those exposed to CA had an elevated risk for all measures of LMM. Manual workers with a history of household public assistance had the highest risk estimates compared to non-manual workers with no CAs [adjusted HR spanning from 1.59 (LTSA) to 2.50 (LTU)]. Regardless of occupational class, the risk of LMM grew higher with increasing number of CAs (e.g. adjusted HR of LMM in manual workers with 3+ CAs: 1.87, 95% CI: 1.81-1.94). These patterns persisted after adjustments for a range of confounders, including psychiatric and somatic morbidity. Last, we found a small but significant mediating effect of occupational class in the association between CA and LMM. CONCLUSIONS Information on CAs are important determinants of LMM in young adults, and especially in manual workers.
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Affiliation(s)
- Emma Björkenstam
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
| | - Magnus Helgesson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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3
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Malmborg P, Everhov ÅH, Söderling J, Ludvigsson JF, Bruze G, Olén O. Earnings during adulthood in patients with childhood-onset inflammatory bowel disease: a nationwide population-based cohort study. Aliment Pharmacol Ther 2022; 56:1007-1017. [PMID: 35916469 PMCID: PMC9544615 DOI: 10.1111/apt.17148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND IBD with onset during childhood seems to represent a severe disease phenotype with increased morbidity. We have previously demonstrated that children with IBD have significantly lower final grades in compulsory school compared to healthy peers. AIM To evaluate the association of childhood-onset IBD with a later professional career and subsequent earnings METHODS: We identified 5404 individuals diagnosed with childhood-onset (<18 years) IBD between 1990 and 2014 (2818 with ulcerative colitis and 2328 with Crohn's disease) in the Swedish National Patient Register. Patients were matched with 10 general population reference individuals by sex, birth year, and place of residence (n = 51,295). Data on earnings during 1992-2017 were obtained through the longitudinal integration database for health insurance and labour market studies. Earnings were converted into Euros (inflation-adjusted to 2019). The differences in earnings between patients and general population reference individuals were calculated through quantile regression. RESULTS Patients with childhood-onset IBD had significantly lower annual taxable earnings from ages 20 to 30 (adjusted median annual income difference (AMAID) at age 30: -5.4% [95% CI -9.1% to -1.8%]). In particular, annual taxable earnings through early adult age were lower in patients who, during childhood, had had surgery or long-term inpatient treatment for IBD (AMAID at age 30: -16.3% [95% CI -24.7% to -7.9%]). CONCLUSIONS Overall, the negative influence of disease on earnings in early adult age was modest for patients with childhood-onset IBD. The markedly larger negative income gap from ages 20 to 30 in patients with more severe IBD during childhood should be recognised.
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Affiliation(s)
- Petter Malmborg
- Sachs' Children and Youth HospitalStockholmSweden,Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Åsa H. Everhov
- Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Jonas Söderling
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden,Department of PaediatricsÖrebro University HospitalÖrebroSweden,Division of Epidemiology and Public HealthSchool of Medicine, University of NottinghamNottinghamUK,Columbia universityNew York CityNew YorkUSA
| | - Gustaf Bruze
- Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
| | - Ola Olén
- Sachs' Children and Youth HospitalStockholmSweden,Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden,Division of Clinical Epidemiology, Department of Medicine SolnaKarolinska InstitutetStockholmSweden
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4
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Sickness absence due to common mental disorders in young employees in Sweden: are there differences in occupational class and employment sector? Soc Psychiatry Psychiatr Epidemiol 2022; 57:1097-1106. [PMID: 34386867 PMCID: PMC9042979 DOI: 10.1007/s00127-021-02152-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 07/30/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND A large proportion of sickness absence (SA) in young adults is due to common mental disorders (CMDs). Still studies on CMD-related SA in young workers are lacking, especially studies for those employed in the private sector. The current study investigated the associations between sector of employment, occupational class and SA due to CMDs. In addition, associations between type of employment branch and SA due CMDs within each sector were examined. METHODS This population-based longitudinal cohort study included 663,583 employees, 19-29 years, residing in Sweden in 2009. Employment sector (i.e., private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of SA due to CMDs, between 2010 and 2016, were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using Cox regression analysis. RESULTS Sector of employment was associated with SA due to CMDs, such that public sector workers had an elevated risk when compared with private sector employees (adjusted HR: 1.31 (95% CI 1.29-1.33). Moreover, manual workers had a slightly elevated risk for SA due to CMDs compared to non-manual workers. Within the private sector, in both manual and non-manual workers, those employed in education and health and social services evidenced the highest rates and risks of SA due to CMDs. CONCLUSION Sector of employment and occupational class play a role in SA due to CMDs in young employees. These findings should be considered when identifying high-risk groups for SA in the young working population.
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Dantas GDSV, Cardoso JP. Factors associated with presenteeism due to work-related musculoskeletal disorders. Rev Bras Med Trab 2020; 18:133-141. [PMID: 33324454 PMCID: PMC7732051 DOI: 10.47626/1679-4435-2020-508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Presenteeism associated to work-related musculoskeletal disorders is an important aspect of occupational health that can reveal important information regarding productivity and quality of life at work. Objective To quantify and evaluate the factors associated to presenteeism due to work-related musculoskeletal disorders. Methods This is a crosssectional study that used data from the Brazilian National Survey of Health of 2013, involving 847 workers diagnosed with workrelated musculoskeletal disorders. Results A multivariate analysis observed an association between presenteeism due to workrelated musculoskeletal disorders and income of a minimum wage or less (prevalence ratio 1.27, 95% confidence interval 1.02-1.60), intense physical activity at work (prevalence ratio 1.22, 95% confidence interval 1.08-1.37), and chronic diseases (prevalence ratio 1.23, 95% confidence interval 1.09-1.38). Conclusions Our observations indicated a high incidence of presenteeism, which was associated to sociodemographic and occupational aspects, as well as to the workers’ lifestyle and health conditions.
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Affiliation(s)
| | - Jefferson Paixão Cardoso
- Núcleo de Estudos em Saúde da População (NESP), Departamento de Saúde II, UESB - Jequié (BA), Brazil
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Lock M, Post D, Dollman J, Parfitt G. Feasibility and Process Evaluation of a Need-Supportive Physical Activity Program in Aged Care Workers: The Activity for Well-Being Project. Front Psychol 2020; 11:518413. [PMID: 33101113 PMCID: PMC7554301 DOI: 10.3389/fpsyg.2020.518413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
The need to undertake pilot testing and evaluation of novel health promotion programs has become increasingly apparent for the purpose of understanding the true effects of complex interventions and for testing and refining behavioral theories that these interventions are informed by. A mixed-methods process evaluation and feasibility study was undertaken for a need-supportive physical activity program that was piloted in a single-group pre–post study. The piloted program was designed to support participant needs of autonomy, competence, and relatedness through evidence-based and theory-informed behavior change strategies including a motivational interviewing style appointment, education on self-management tools (i.e., pedometers, goal setting, action and coping planning, a customized website for goal setting and self-monitoring), and self-determined methods of regulating physical activity intensity [affect, rating of perceived exertion (RPE), and self-pacing]. The program aimed to positively impact physical activity behavior, psychological well-being, and associated motivational processes. Reach, adoption, fidelity, context, change and performance objectives, and feasibility of the program were evaluated using information from survey respondents from the target population (n = 118) and implementing staff (n = 6); questionnaires from pilot study participants (n = 21); and individual semi-structured interviews with a combination of pilot study participants, non-participants, and implementing staff (n = 19). Process evaluation of the Activity for Well-Being program found that the reach of the program was moderate but adoption was low. The use of self-management tools and self-determined methods of regulating physical activity intensity appeared to be feasible. The website had mixed responses and low engagement. The element of having a support person elicited a strong positive response in the program participant interviews. Involving local implementing staff more directly into the delivery of the intervention could have potentially improved reach, adoption, and feasibility of the program.
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Affiliation(s)
- Merilyn Lock
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Dannielle Post
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - James Dollman
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Gaynor Parfitt
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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Brolin Låftman S, Ramberg J, Modin B. School Ethos and Recurring Sickness Absence: A Multilevel Study of Ninth-Grade Students in Stockholm. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E745. [PMID: 31979392 PMCID: PMC7038162 DOI: 10.3390/ijerph17030745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 11/16/2022]
Abstract
School absence has been identified as a severe problem in Sweden, both at the individual level and for society as a whole. Despite the multitude and complexity of reasons behind school absence, health-related problems are likely to be one important determinant. This indicates that knowledge about factors that may contribute to preventing health-related absence among students is relevant. The aim was to investigate whether a higher level of teacher-reported school ethos was associated with less recurring sickness absence among students. Data from four cross-sectional surveys performed in 2014 and 2016 were combined. The Stockholm School Survey was carried out among 9482 ninth-grade students (ages 15-16 years) in 150 school units, and the Stockholm Teacher Survey was performed among 2090 teachers in the same units. School ethos was operationalised by an index of 12 teacher-reported items that was aggregated to the school-level. Recurring student sickness absence was captured by self-reports and defined as absence on >10 occasions during the current school year. Two-level logistic regressions were performed. The results show that about 9.5% of the students reported recurring sickness absence. Students attending schools with higher levels of teacher-rated school ethos were less likely to reporting recurring sickness absence than those attending schools with lower levels of ethos, even when adjusting for potential confounders (OR 0.79, 95% CI 0.65-0.97). In conclusion, recurring sickness absence was less common among students attending schools with higher levels of teacher-rated ethos. The findings suggest that schools may contribute to promoting student health.
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Affiliation(s)
- Sara Brolin Låftman
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University, SE-10691 Stockholm, Sweden;
| | - Joacim Ramberg
- Department of Special Education, Stockholm University, SE-10691 Stockholm, Sweden;
| | - Bitte Modin
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University, SE-10691 Stockholm, Sweden;
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8
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Malmborg P, Mouratidou N, Sachs MC, Hammar U, Khalili H, Neovius M, Hjern A, Smedby KE, Ekbom A, Askling J, Ludvigsson JF, Olén O. Effects of Childhood-onset Inflammatory Bowel Disease on School Performance: A Nationwide Population-based Cohort Study Using Swedish Health and Educational Registers. Inflamm Bowel Dis 2019; 25:1663-1673. [PMID: 30916332 DOI: 10.1093/ibd/izz040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood-onset inflammatory bowel disease (IBD) might negatively impact academic school performance. We conducted a nationwide study to examine the association between childhood-onset IBD and school results. METHODS Our study population was selected from Swedish health registers. In the National Patient Register (1990 to 2013), we identified 2827 children with IBD: Crohn's disease (CD), n = 1207, and ulcerative colitis (UC), n = 1370. Patients were matched with 10 reference individuals by age, sex, birth year, and place of residence (n = 28,235). Final compulsory school grades (0 to 320 grade points) and qualification for high school (yes or no) were obtained through the National School Register. Regression models controlling for socioeconomic factors were used to analyze the association of IBD with school performance. RESULTS Children with IBD had a lower final grade point average (adjusted mean grade difference [AMGD] -4.9, 95% confidence interval [CI] -7.1 to -2.6) but not a significantly higher risk to not qualify for high school (odds ratio [OR] 1.14, CI 0.99-1.31). The results were similar in children with UC (AMGD -5.5, CI -8.7 to -2.3) and CD (AMGD -4.7, CI -8.2 to -1.2). Underperformance was more common in subsets of IBD children characterized by markers associated with long-standing active disease (eg, >30 inpatient days [AMGD-18.1, CI -25.8 to -10.4]). CONCLUSION Most children with IBD achieve comparable results in the final year of compulsory school as their healthy peers. Care should be improved for the subgroup of children for which IBD has a stronger negative impact on school performance.
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Affiliation(s)
- Petter Malmborg
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Mouratidou
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Michael C Sachs
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ulf Hammar
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hamed Khalili
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Division of Gastroenterology, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - Martin Neovius
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hjern
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ekbom
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Askling
- Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
| | - Ola Olén
- Sachs' Children and Youth Hospital, South General Hospital, Stockholm, Sweden.,Clinical Epidemiology Unit, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Haeffner R, Kalinke LP, Felli VEA, Mantovani MDF, Consonni D, Sarquis LMM. Absenteeism due to musculoskeletal disorders in Brazilian workers: thousands days missed at work. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180003. [PMID: 30088591 DOI: 10.1590/1980-549720180003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/03/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe and analyze the absenteeism of Brazilian workers notified with musculoskeletal disorders, from 2007 to 2012. METHODS This is a quantitative, cross-sectional and descriptive study, including retrospective and secondary data. The records came from the Information System of Notifiable Diseases, which notifies workers on a social security system, as well as informal workers. The study lasted for six years. We analyzed sociodemographic, work organization and injury variables. RESULTS There were approximately 5 million working days lost for 18,611 workers who were notified and removed from the position. The groups that stood out in the analysis were the illiterate people, in the age group of 50 to 59 years, with daily working hours higher than 6 hours, from the great occupational group 4, the ICD-10 M50 and M51, and workers with mental disorders. CONCLUSIONS High absenteeism among workers with musculoskeletal disorders, illiterate, aged from 50 to 59 years, administrative service workers, ICD-10 M51 and workers with mental disorders. It is necessary to outline public policies that contemplate the absenteeism caused by the disease, in order to reduce morbidity, as well as the socioeconomic losses.
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Affiliation(s)
- Rafael Haeffner
- Programa de Pós-Graduação em Epidemiologia, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Vanda Elisa Andres Felli
- Programa de Pós-Graduação em Gerenciamento de Enfermagem, Escola de Enfermagem, Universidade de São Paulo, São Paulo, SP, Brazil
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Landstedt E, Hammarström A, Fairweather-Schmidt AK, Wade T. Associations between adolescent risk for restrictive disordered eating and long-term outcomes related to somatic symptoms, body mass index, and poor well-being. Br J Health Psychol 2018; 23:496-518. [DOI: 10.1111/bjhp.12301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 01/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anne Hammarström
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
| | | | - Tracey Wade
- School of Psychology; Flinders University; Adelaide South Australia Australia
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Frilander H, Lallukka T, Viikari-Juntura E, Heliövaara M, Solovieva S. Health Problems during Compulsory Military Service Predict Disability Retirement: A Register-Based Study on Secular Trends during 40 Years of Follow-Up. PLoS One 2016; 11:e0159786. [PMID: 27533052 PMCID: PMC4988709 DOI: 10.1371/journal.pone.0159786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 07/08/2016] [Indexed: 11/19/2022] Open
Abstract
Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967–1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26–1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967–1976. In conclusion, health problems—in particular mental problems—during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.
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Affiliation(s)
- Heikki Frilander
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
- * E-mail:
| | - Tea Lallukka
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Eira Viikari-Juntura
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
| | - Markku Heliövaara
- Department of Health, National Institute for Health and Welfare, Helsinki, Finland
| | - Svetlana Solovieva
- Centre of Expertise for Health and Work Ability, Finnish Institute of Occupational Health, Helsinki, Finland
- Disability Prevention Research Centre, Finnish Institute of Occupational Health, Helsinki, Finland
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12
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Niederkrotenthaler T, Tinghög P, Goldman-Mellor S, Wilcox HC, Gould M, Mittendorfer-Rutz E. Medical and Social Determinants of Subsequent Labour Market Marginalization in Young Hospitalized Suicide Attempters. PLoS One 2016; 11:e0146130. [PMID: 26784886 PMCID: PMC4718648 DOI: 10.1371/journal.pone.0146130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022] Open
Abstract
Background Individuals with a history of suicide attempt have a high risk for subsequent labour market marginalization. This study aimed at assessing the effect of individual and parental factors on different measures of marginalization. Methods Prospective cohort study based on register linkage of 5 649 individuals who in 1994 were 16–30 years old, lived in Sweden and were treated in inpatient care for suicide attempt during 1992–1994. Hazard ratios (HRs) for labour market marginalization defined as long-term unemployment (>180 days), sickness absence (>90 days), or disability pension in 1995–2010 were calculated with Cox regression. Results Medical risk factors, particularly any earlier diagnosed specific mental disorders (e.g., schizophrenia: HR 5.4 (95% CI: 4.2, 7.0), personality disorders: HR 3.9, 95% CI: 3.1, 4.9), repetitive suicide attempts (HR 1.6, 95% CI: 1.4, 1.9) were associated with a higher relative risk of disability pension. Individual medical factors were of smaller importance for long-term sickness absence, and of only marginal relevance to long-term unemployment. Country of birth outside Europe had an opposite effect on disability pension (HR 0.6, 95% CI: 0.4, 0.8) and long-term unemployment (HR 1.5, 95% CI: 1.3, 1.8). Female sex was positively correlated with long-term sickness absence (HR 1.6, 95% CI: 1.4, 1.7), and negatively associated with long-term unemployment (HR: 0.8, 95% CI: 0.7, 0.9). Conclusions As compared to disability pension, long-term sickness absence and unemployment was more strongly related to socio-economic variables. Marginalization pathways seemed to vary with migration status and sex. These findings may contribute to the development of intervention strategies which take the individual risk for marginalization into account.
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Affiliation(s)
- Thomas Niederkrotenthaler
- Medical University Vienna, Center for Public Health, Institute of Social Medicine, Suicide Research Unit, Vienna, A-1090 Vienna, Austria
- * E-mail:
| | - Petter Tinghög
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden
- The Swedish Red Cross University College, Stockholm, Sweden
| | | | - Holly C. Wilcox
- Johns Hopkins School of Medicine, Baltimore, MD 21205, United States of America
| | - Madelyn Gould
- Columbia University, NYS Psychiatric Institute, New York, NY 10032, United States of America
| | - Ellenor Mittendorfer-Rutz
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Insurance Medicine, 17 177 Stockholm, Sweden
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de Ridder K, Pape K, Krokstad S, Bjørngaard JH. Health in adolescence and subsequent receipt of social insurance benefits – The HUNT Study. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2015; 135:942-8. [PMID: 26037755 DOI: 10.4045/tidsskr.14.0261] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Long-term illness and work incapacity in young adulthood has consequences for both the individual and for society. The purpose of the study was to investigate the association between adolescent health and receipt of long-term sickness and disability benefits for young adults in their twenties. MATERIAL AND METHOD An adolescent population of 8949 school students (aged 13-21 years) assessed their own health in the Young-HUNT1 Study (1995-1997). Health was measured by means of a questionnaire enquiring about chronic somatic illnesses, somatic symptoms, symptoms of anxiety and depression, sleep disturbance, poor concentration, self-reported health and smoking, and by measuring height and weight. Information about receipt of long-term benefits was retrieved from the FD-Trygd registry for the period 1998-2008 and defined as receipt of sickness benefit (>180 days/year), medical/vocational rehabilitation benefit and disability pension in the age group 20-29 years. We investigated the relationship between adolescent health and long-term social insurance benefits with logistic regression, adjusted for sex, age, follow-up time, mother's education and family composition. Siblings with different exposure and outcome were investigated to adjust for all familial factors shared by siblings. RESULTS Each of the health measures was associated with an increased risk of long-term benefit. For example, adolescents who reported one or more somatic illnesses or poor concentration had a 5.4 and 3.4 percentage point higher risk, respectively, of receiving long-term benefits at the age of 20-29 years than adolescents who did not report somatic illness or poor concentration. Moreover the risk increased with an increase in the number of health problems. Sibling analyses supported these associations. INTERPRETATION Health in adolescence is an indicator of increased vulnerability in the transition to the labour market. Preventing health selection during this transition should be a priority for welfare policy.
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Affiliation(s)
- Karin de Ridder
- Institutt for samfunnsmedisin Norges teknisk-naturvitenskapelige universitet og Folkehelseinstitutt, operasjonell administrasjon, folkehelse og overvåking (WIV-ISP) Brussel
| | - Kristine Pape
- Institutt for samfunnsmedisin Norges teknisk-naturvitenskapelige universitet
| | - Steinar Krokstad
- HUNT forskningssenter Institutt for samfunnsmedisin Norges teknisk-naturvitenskapelige universitet og Psykiatrisk poliklinikk Sykehuset Levanger
| | - Johan Håkon Bjørngaard
- Institutt for samfunnsmedisin Norges teknisk-naturvitenskapelige universitet og Avdeling Brøset - kompetansesenter for sikkerhets-, fengsels- og rettspsykiatri St. Olavs hospital
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