The labor market costs of work-related stress: A longitudinal study of 52 763 Danish employees using multi-state modeling

OBJECTIVE

Work-related stress is an important public health concern in all industrialized countries and is linked to reduced labor market affiliation and an increased disease burden. We aimed to quantify the labor market costs of work-related stress for a large sample of Danish employees.

METHODS

We linked four consecutive survey waves on occupational health and five national longitudinal registers with date-based information on wage and social benefits payments. From 2012 to 2020, we followed survey participants for two year-periods, yielding 110 559 person-years. We identified work stress by combining three dichotomous stress indicators: (i) self-perceived work stress, (ii) Cohen 4-level perceived stress scale, and (iii) job strain. Using the multi-state expected labor market affiliation (ELMA) method, we estimated the labor market expenses associated with work-related stress.

RESULTS

Of the employees, 26-37% had at least one work-stress indicator. Men aged 35-64 years and women aged 18-64 years with work-related stress had up to 81.6 fewer workdays and up to 50.7 more days of sickness absence during follow-up than similarly aged men without work stress. The average annual work absenteeism loss per employee linked to work-related stress was €1903 for men and €3909 for women, corresponding to 3.3% of men's average annual wages and 9.0% of women's average annual wages, respectively. The total annual expenses were €305.2 million for men and €868.5 million for women.

CONCLUSION

Work-related stress was associated with significant labor market costs due to increased sickness absence and unemployment. The prevention of work-related stress is an important occupational health concern, and the development of effective interventions should be given high priority.

Auger-Meitner and X-ray Absorption Spectra of Ethylene Cation: Insight into Conical Intersection Dynamics

We present a theoretical investigation of the near-edge X-ray absorption fine structure and the Auger-Meitner decay spectra of ethylene and its cation. Herein, we demonstrate that our method, coupled with the nuclear ensemble approach, successfully reproduces the natural bandwidth structure of the experimental resonant Auger-Meitner decay spectra of ethylene, which is not very well reproduced within the Franck-Condon approximation. Furthermore, we analyze the Auger-Meitner decay spectra of the ethylene cation in light of minimum energy conical intersection structures involving the two lowest cationic states (D1 and D0), providing valuable insights into the ultrafast D1/D0 relaxation dynamics. Our results suggest that Auger-Meitner electron spectroscopy can help elucidate the mechanism behind the initial 20 fs of the relaxation dynamics.

Solvent-Induced Symmetry Breaking of the Photoinduced Charge Transfer Dynamics in the Bridged Perylene Dimer

The charge transfer dynamics of the bridged perylene dimer were investigated with the recently developed solvent coupling Redfield time propagation model. The results are compared with previous experimental findings to showcase the significance and applicability of the model. The charge transfer dynamics in vacuum showed that no breaking of the charge transfer direction symmetry occurred upon optical excitation, in perfect agreement with the experiment. Meanwhile, attractive solute-solvent interactions facilitated by the dipole moments of the polar solvents were observed to break the charge transfer direction symmetry. The conformational isomerism effect on the transfer dynamics manifested itself by promoting different transport channels upon solvation. Consequently, the solvent coupling Redfield time propagation model was indeed found to be able to quantitatively describe the charge transfer dynamics including exotic phenomena such as symmetry breaking of charge transfer direction.

Description of the KLL Auger-Meitner decay spectra of argon following primary and satellite core-ionized states

The K-edge photoelectron and KLL Auger-Meitner decay spectra of Argon have been investigated computationally at the restricted active space perturbation theory to the second order level using biorthonormally transformed orbital sets. Binding energies were computed for the Ar 1s primary ionization, as well as for satellite states originated from shake-up and shake-off processes. Based on our calculations, the contributions of shake-up and shake-off states to the KLL Auger-Meitner spectra of Argon have been completely elucidated. Our results are compared with recent state-of-the-art experimental measurements on Argon.

Emotional demands and all-cause and diagnosis-specific long-term sickness absence: a prospective cohort study in Sweden

BACKGROUND

High emotional demands at work require sustained emotional effort and are associated with adverse health outcomes. We tested whether individuals in occupations with high emotional demands, compared with low demands, had a higher future risk of all-cause long-term sickness absence (LTSA). We further explored whether the risk of LTSA associated with high emotional demands differed by LTSA diagnoses.

METHODS

We conducted a prospective, nationwide cohort study on the association between emotional demands and LTSA (>30 days) in the workforce in Sweden (n = 3 905 685) during a 7-year follow-up. Using Cox regression, we analyzed sex-stratified risks of all-cause and diagnosis-specific LTSA due to common mental disorders (CMD), musculoskeletal disorders (MSD) and all other diagnoses. Multivariable adjusted models included age, birth country, education, living area, family situation and physical work demands.

RESULTS

Working in emotionally demanding occupations was associated with a higher risk of all-cause LTSA in women [hazard ratio (HR) = 1.92, 95% confidence interval (CI): 1.88-1.96] and men (HR = 1.23, 95% CI: 1.21-1.25). In women, the higher risk was similar for LTSA due to CMD, MSD and all other diagnoses (HR of 1.82, 1.92 and 1.93, respectively). In men, risk of LTSA due to CMD was pronounced (HR = 2.01, 95% CI: 1.92-2.11), whereas risk of LTSA due to MSD and all other diagnoses was only slightly elevated (HR of 1.13, both outcomes).

CONCLUSIONS

Workers in occupations with high emotional demands had a higher risk of all-cause LTSA. In women, risk of all-cause and diagnosis-specific LTSA were similar. In men, the risk was more pronounced for LTSA due to CMD.

Trajectories of marginal part-time work and risk of depression. Does job or income insecurity mediate the relation?

OBJECTIVES

Working few hours a week, known as marginal part-time work, may increase both job and income insecurity, which have been linked to the risk of depression. This study examines the association between marginal part-time work and depression and the mediating role of job and income insecurity.

METHODS

We included 30 523 respondents of the Danish Labor Force Survey (DLFS) between 2010 and 2017 and linked them to register-based information on weekly working hours, which was used to identify full-time workers and model group-based trajectories of marginal part-time. These data were linked with survey information on job and income insecurity, and register-based information on hospital-diagnosed depression or redeemed anti-depressant drugs in the following two years. We estimated hazard ratios (HR) by Cox proportional hazards models and conducted mediation analyses to estimate the natural direct and indirect effects using job and income insecurity as mediators.

RESULTS

We identified three distinct trajectories of marginal part-time work: constant marginal part-time work, mobile towards marginal part-time work, and fluctuating in and out of marginal part-time work. Compared with full-time workers, the constant [HR 2.42, 95% confidence interval (CI) 1.83-3.20], mobile (HR 2.84, 95% CI 2.16-3.75), and fluctuating (HR 3.51, 95% CI 2.07-5.97) trajectories all had higher risks of depression. There was no evidence of mediation by either job (HR 1.02, 95% CI 0.92-1.12) or income (HR 0.98, 95% CI 0.89-1.08) insecurity.

CONCLUSIONS

We found a higher risk of depression following marginal part-time work. The higher risk was not mediated by job or income insecurity.

Psychosocial working conditions and sickness absence among younger employees in Denmark: a register-based cohort study using job exposure matrices

OBJECTIVE

Previous literature has established associations between psychosocial working conditions and sickness absence (SA), but only few studies have examined associations among younger employees. This study aimed to investigate associations between psychosocial working conditions and SA among employees, aged 15-30 years, who entered the labor market in Denmark between 2010 and 2018.

METHOD

We followed 301 185 younger employees in registers for on average 2.6 years. Using job exposure matrices, we assessed job insecurity, quantitative demands, decision authority, job strain, emotional demands, and work-related physical violence. Adjusted rate ratios of SA spells of any length were estimated for women and men separately with Poisson models.

RESULTS

Among women, employment in occupations with high quantitative demands, low decision authority, high job strain, high emotional demands, or high work-related physical violence was associated with higher rates of SA. Being employed in occupations with high versus low emotional demands showed the strongest association with SA, with a rate ratio of 1.44 [95% confidence interval (CI) 1.41-1.47]. Among men, being employed in occupations with low decision authority showed the strongest association with SA (1.34, 95% CI 1.31-1.37), whereas occupations with high quantitative demands, high job strain, and high emotional demands were associated with lower rates of SA.

CONCLUSION

We found that several psychosocial working conditions were associated with SA spells of any length. Associations with SA spells of any length resemble associations with long-term SA, suggesting that results from previous studies on long-term SA may be generalizable to all lengths of SA among younger employees.

A Benchmark Study of Aromaticity Indexes for Benzene, Pyridine, and the Diazines - II. Excited State Aromaticity

In this work, one geometrical aromaticity index and four electron sharing indexes are benchmarked for their application in excited state aromaticity calculations. Two computationally feasible and reliable procedures are identified, namely, CAM-B3LYP/cc-pVTZ and ωB97X-D/cc-pVTZ. Topological effects on the first excited singlet and triplet electronic manifold were investigated, and the latter was in general found to display more aromatic character compared to the S₁ surface. Besides, geometrical relaxation on each of the manifolds was observed to hamper the aromaticity, thereby resulting in more antiaromatic character. The relative order of excited state aromaticity within the studied molecules was noted to resemble the reversed version of the relative order of ground state aromaticity. Thereby, the following generalization was postulated: The more aromatic a molecule is in its ground state, the more antiaromatic it will be in its electronic first excited manifolds.

The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees

OBJECTIVE

Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees.

METHODS

We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age.

RESULTS

Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders.

CONCLUSIONS

The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Redfield Propagation of Photoinduced Electron Transfer Reactions in Vacuum and Solution

Dynamical simulations of ultrafast electron transfer reactions are of utmost interest. To allow for energy dissipation directly into an external surrounding environment, a solvent coupling model has been deduced, implemented, and utilized to describe the photoinduced electron transfer dynamics within a model triad system herein. The model is based on Redfield theory, and the environment is represented by harmonic oscillators filled with bosonic quanta. To imitate real solvents, the oscillators have been equipped with frequencies and polarization lifetimes characteristic of the corresponding solvent. The population was found to transfer through the energetically lowest electron transfer route regardless of the medium. The condensed population transfer dynamics were observed to be highly dependent on the solvent parameters. In particular, an increase in the solvent coupling entailed a detainment in the population transfer from the initially prepared diabatic state and a promotion in the population transfer through the other electron transfer route. Two explanations based on the diagonal and off-diagonal matrix elements of the Kohn-Sham Fock matrix, respectively, have been provided. The lifetime of the populated partially charge-separated state was prolonged with increasing solvent polarity, and it was explained in terms of attractive interactions between the solvent's dipole moments and the fragments' charges. The high-frequency vibrational fine-structure in the correlation function was demonstrated to be important for the transfer dynamics, and the importance of dephasing effects in polar solvents was verified and precised to concern the optical polarization of the solvents.

Utilizing a Nordic Crosswalk for Occupational Coding in an Analysis on Occupation-Specific Prolonged Sickness Absence among 7 Million Employees in Denmark, Finland, Norway and Sweden

We identified occupations with a high incidence of prolonged sickness absence (SA) in Nordic employees and explored similarities and differences between the countries. Utilizing data from national registers on 25-59-year-old wage-earners from Denmark, Finland, Norway and Sweden, we estimated the gender- and occupation-specific age-adjusted cumulative incidence of SA due to any cause, musculoskeletal diseases and mental disorders. To increase the comparability of occupations between the countries, we developed a Nordic crosswalk for occupational codes. We ranked occupational groups with the incidence of SA being statistically significantly higher than the population average of the country in question and calculated excess fractions with the employee population being the reference group. We observed considerable occupational differences in SA within and between the countries. Few occupational groups had a high incidence in all countries, particularly for mental disorders among men. In each country, manual occupations typically had a high incidence of SA due to any cause and musculoskeletal diseases, while service occupations had a high incidence due to mental disorders. Preventive measures targeted at specific occupational groups have a high potential to reduce work disability, especially due to musculoskeletal diseases. Particularly groups with excess SA in all Nordic countries could be at focus.

Physical work demands and expected labor market affiliation (ELMA): Prospective cohort with register-follow-up among 46 169 employees

OBJECTIVE

This study aimed to estimate the impact of high physical work demands on expected labor market affiliation (ELMA) among men and women of different ages in the general working population.

METHODS

After participating in the Danish Work Environment and Health study (2012, 2014, and/or 2016), 46 169 employees were followed for two years in national registers. Using multi-state modeling, taking all day-to-day transition probabilities of labor market affiliation into account (work, unemployment, sickness absence, temporary out, and permanently out), and performing multilevel adjustment, we estimated the prospective association between physical work demands (ergonomic index including 7 factors) and ELMA.

RESULTS

During 104 896 person-years of follow-up, we identified of 439 045 transitions. Using low physical work demands as reference, higher physical work demands were associated with fewer days of active work (2-35 days) during 730 days of follow-up, and more days of sickness absence (4-26 days) and unemployment (ranging 1-9 days) among men and women of aged 40-49 and 50-64 years. Among men and women aged 18-39 years, high physical work demands only had minor and inconsistent impact on ELMA.

CONCLUSIONS

Analyzing multiple and highly detailed patterns of transition probabilities concerning labor market affiliation we showed that reducing physical work demands is likely to increase the active working time and prevent high societal cost of sickness absence and unemployment, especially among middle-aged and older workers.

Combined psychosocial work factors and risk of long-term sickness absence in the general working population: Prospective cohort with register follow-up among 69 371 workers

OBJECTIVE

This study aimed to investigate the importance of combined psychosocial work factors for the risk of long-term sickness absence (LTSA).

METHODS

We followed 69 371 employees in the general working population (Work Environment and Health in Denmark study 2012-2018), without LTSA during the preceding year, for up to two years in the Danish Register for Evaluation of Marginalization. Using k-means cluster analyses and weighted Cox-regression controlling for age, gender, survey year, education, health-behaviors, and physical work demands, we determined the prospective association of 11 identified clusters - based on the combination of nine psychosocial work factors (recognition, quantitative demands, work pace, emotional demands, influence, justice, role clarity, role conflicts, and support from colleagues) - with the risk of LTSA.

RESULTS

During 124 045 person-years of follow-up, 6197 employees developed LTSA (weighted 8.5%). Using the cluster with the most favorable psychosocial scores as reference, clusters scoring poorly on several combined psychosocial factors had increased risk of LTSA. The cluster scoring poor on all nine psychosocial factors exhibited the highest risk [hazard ratio (HR) 1.68, 95% confidence interval (CI) 1.45-1.94]. Scoring poorly on one or two psychosocial factors did not increase the risk of LTSA when combined with favorable scores on the other psychosocial factors. Interaction analyses showed that gender, but not age and education, modified the association between cluster and LTSA.

CONCLUSION

Scoring poorly on several combined psychosocial work factors plays an important role in the risk of LTSA. Scoring favorably on several psychosocial factors outweighed the potentially adverse effects of scoring poorly on one or two factors.

Work stress and loss of years lived without chronic disease: an 18-year follow-up of 1.5 million employees in Denmark

We aimed to examine the association between exposure to work stress and chronic disease incidence and loss of chronic disease-free life years in the Danish workforce. The study population included 1,592,491 employees, aged 30-59 in 2000 and without prevalent chronic diseases. We assessed work stress as the combination of job strain and effort-reward imbalance using job exposure matrices. We used Cox regressions to estimate risk of incident hospital-diagnoses or death of chronic diseases (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and calculated corresponding chronic disease-free life expectancy from age 30 to age 75. Individuals working in occupations with high prevalence of work stress had a higher risk of incident chronic disease compared to those in occupations with low prevalence of work stress (women: HR 1.04 (95% CI 1.02-1.05), men: HR 1.12 (95% CI 1.11-1.14)). The corresponding loss in chronic disease-free life expectancy was 0.25 (95% CI - 0.10 to 0.60) and 0.84 (95% CI 0.56-1.11) years in women and men, respectively. Additional adjustment for health behaviours attenuated these associations among men. We conclude that men working in high-stress occupations have a small loss of years lived without chronic disease compared to men working in low-stress occupations. This finding appeared to be partially attributable to harmful health behaviours. In women, high work stress indicated a very small and statistically non-significant loss of years lived without chronic disease.

A benchmark study of aromaticity indexes for benzene, pyridine and the diazines - I. Ground state aromaticity

Five different aromaticity indexes are benchmarked for benzene, pyridine and the diazines in their ground states. A basis set study was performed using the Pople style, Karlsruhe and Dunning's correlation consistent basis sets. Ten different DFT functionals, including LSDA, PBE, PBE0, B3LYP, CAM-B3LYP, wB97XD, M06-2X, SOGGA11X, M11 and MN15 were benchmarked by comparison with CCSD, CASSCF and MP2. Large out-of-plane imaginary frequencies were observed for some of the optimized structures at the correlated wavefunction level of theory. It was found that the DFT functionals in general predict the para-delocalization index, multicenter index and aromatic fluctuation index to be approximately 70%, 50% and 45% larger, respectively, compared to the CCSD method. Comparisons of the DFT functionals showed that the wB97XD, CAM-B3LYP and M06-2X functionals performed the best. Furthermore, the basis set dependence of the DFT functionals was found to be large for the electron sharing indexes. Based on these findings, it is recommended to perform ground state calculations of aromaticity indexes at the wB97XD, CAM-B3LYP or M06-2X level of theory utilizing a simple basis set of triple-ζ quality.

Five different aromaticity indexes are benchmarked for benzene, pyridine and the diazines in their ground states.

Mediating role of multimorbidity in inequality in mortality: a register study on the Danish population

BACKGROUND

The social inequality in mortality is due to differential incidence of several disorders and injury types, as well as differential survival. The resulting clustering and possible interaction in disadvantaged groups of several disorders make multimorbidity a potentially important component in the health divide. This study decomposes the effect of education on mortality into a direct effect, a pure indirect effect mediated by multimorbidity and a mediated interaction between education and multimorbidity.

METHODS

The study uses the Danish population registers on the total Danish population aged 45-69 years. A multimorbidity index based on all somatic and psychiatric hospital contacts as well as prescribed medicines includes 22 diagnostic groups weighted together by their 5 years mortality risk as weight. The Aalen additive hazard model is used to estimate and decompose the 5 years risk difference in absolute numbers of deaths according to educational status.

RESULTS

Most (69%-79%) of the effect is direct not involving multimorbidity, and the mediated effect is for low educated women 155 per 100 000 of which 87 is an effect of mediated interaction. For low educated men, the mediated effect is 250 per 100 000 of which 93 is mediated interaction.

CONCLUSION

Multimorbidity plays an important role in the social inequality in mortality among middle aged in Denmark and mediated interaction represents 5%-17%. As multimorbidity is a growing challenge in specialised health systems, the mediated interaction might be a relevant indicator of inequities in care of multimorbid patients.

Rhinopharynx irrigations and mouthwash with dissolved mupirocin in treatment of MRSA throat colonization - proof-of-concept study

BACKGROUND

To prevent transmission of, and infection with, meticillin-resistant Staphylococcus aureus (MRSA), eradication treatment of colonized individuals is recommended. Throat colonization is a well-known risk factor for eradication failure. Staphylococcus aureus throat colonization is associated with colonization of the rhinopharynx, but in the currently recommended Danish MRSA eradication strategies, rhinopharynx colonization is not directly targeted. Rhinopharynx colonization could therefore be an important risk factor for prolonged MRSA throat carriage.

AIM

To determine whether irrigation and wash of the rhinopharynx and mouth with dissolved mupirocin is a feasible and potentially efficacious supplementary strategy against treatment-resistant MRSA throat carriage.

METHODS

The patient study was an open, non-blinded, trial including 20 treatment-resistant MRSA throat carriers. In the study, the patients received a supplementary treatment besides the standard treatment according to the Danish MRSA eradication strategy. The supplementary treatment consisted of rhinopharyngeal irrigation and mouth-gurgling twice a day for 14 days with a mupirocin ointment (22 g 2% ointment per litre of isotonic sterile saline solution) in a 37°C solution.

FINDINGS

Eighteen patients (90%) complied with the treatment protocol and none ex-perienced any major adverse events. Out of the 18 patients who finished the study per protocol, 15 (83%) and seven (39%) patients had negative MRSA sampling results one and six months after end of treatment, respectively.

CONCLUSION

This study demonstrates the feasibility and clinical potential of also targeting the rhinopharynx and oropharynx in non-systemic throat MRSA eradication strategies.

Emotional demands at work and risk of long-term sickness absence in 1·5 million employees in Denmark: a prospective cohort study on effect modifiers

BACKGROUND

High emotional demands at work can affect employees' health and there is a need to understand whether such an association might be modified by other working conditions. We aimed to examine emotional demands at work as a risk factor for long-term sickness absence and analyse whether influence, possibilities for development, role conflicts, and physical demands at work might modify this risk.

METHODS

We did a nationwide, population-based, prospective cohort study in Denmark and included employed individuals who were residing in Denmark in 2000, aged 30-59 years, who had complete data on age, sex, and migration background, with information on emotional demands and possible effect modifiers from job exposure matrices, and covariates and outcome (sickness absence) from population registers. Individuals with long-term sickness absence (≥6 weeks of consecutive sickness absence) between Jan 1, 1998, and Dec 31, 2000, and self-employed individuals were excluded. We assessed long-term sickness absence during a 10-year period from Jan 1, 2001, to Dec 31, 2010. Using Cox regression, we estimated hazard ratios (HRs) and 95% CIs and tested interaction as departure from additivity, estimating relative excess risk due to interaction (RERI). Multivariable adjusted models included sex, age, cohabitation, migration background, and income.

FINDINGS

1 521 352 employed individuals were included and contributed data between Jan 1, 2000, and Dec 31, 2010. During 11 919 021 person-years (mean follow-up 7·8 years), we identified 480 685 new cases of long-term sickness absence. High emotional demands were associated with increased risk of long-term sickness absence compared with low emotional demands, after adjusting for age, sex, cohabitation, migration background, income, and the four possible effect modifiers (adjusted HR 1·55 [95% CI 1·53-1·56]). The association between high emotional demands and risk of long-term sickness absence was stronger in a synergistic way when individuals were also exposed to low possibilities for development (RERI 0·35 [95% CI 0·22-0·47]; 28·9 additional cases per 1000 person-years) and high role conflicts (0·13 [0·11-0·15]; 22·0 additional cases per 1000 person-years). No synergy was observed for influence and physical demands at work.

INTERPRETATION

People in occupations with high emotional demands were at increased risk of long-term sickness absence. Our findings on synergistic interactions suggest that, in emotionally demanding occupations, increasing possibilities for development and reducing work-related role conflicts might reduce long-term sickness absence. Further interventional studies are needed to confirm or refute this hypothesis.

FUNDING

Danish Work Environment Research Fund, NordForsk.

1175Work stress and loss of years lived without chronic disease; an 18-year prospective cohort study

Background

Aim: To examine the association of work stress with future chronic disease incidence and loss of chronic disease-free life years in the Danish workforce.

Method

A population-based prospective register-based cohort study of all employees aged 30-59 in 2000 in Denmark, without chronic diseases at baseline (n = 1,592,491). Using job exposure matrices, we assessed exposure to work stress by a combined measure of job strain and effort-reward imbalance. We estimated the risk of incident hospital-diagnosed chronic disease or death (i.e., type 2 diabetes, coronary heart disease, stroke, cancer, asthma, chronic obstructive pulmonary disease, heart failure, and dementia) during 18 years of follow-up and corresponding chronic disease-free life expectancy.

Results

Individuals working in occupations with high risk of both job strain and effort-reward imbalance had a slightly higher risk of future incident chronic disease compared to those in occupations with low risk of both stressors. The hazard ratio was 1.04 (95% CI 1.02 to 1.05) in women and 1.12 (95% CI 1.11 to 1.14) in men. The corresponding loss in chronic disease-free life expectancy was 0.25 years in women and 0.84 years in men.

Conclusion

Working in occupations with a high risk of work stress was associated with a small loss of years lived without chronic disease compared to working in occupations with low risk of work stress.

Key messages

According to our findings, employees in occupations with high risk of work stress live slightly shorter lives free of chronic diseases compared to employees in occupations with low risk of work stress.

Working life expectancies among individuals with type 1 and type 2 diabetes over a 30-year period

Objectives

This study aimed to (i) estimate working life expectancies (WLE) and the number of working years lost (WYL) among individuals with type 1 and type 2 diabetes over a 30-year period and (ii) identify educational differences in WLE and WYL.

Methods

Individuals aged 18–65 years diagnosed with type 1 (N=33 188) or type 2 diabetes (N=81 930) in 2000–2016 and age- and gender-matched controls without diabetes (N=663 656) were identified in Danish national registers. WLE in years were estimated as time in employment from age 35–65 years. We used a life-table approach with multi-state (eg, disability pension, sickness absence, unemployment) Cox proportional hazard modeling. Analyses were performed separately for sex, cohabitation status, educational duration, and type of diabetes. Inverse probability weights accounted for differences between populations.

Results

People with diabetes had significantly shorter WLE and greater WYL compared to people without diabetes over the 30-year span. At age 35, cohabitant women with lower education and diabetes lost up to 8.0 years [95% confidence interval (CI) 5.0–11.0] and men 7.0 years (95% CI 4.0–8.7). WYL among women with higher education was 4.4 (95% CI 6.6–2.3) and 3.7 years among men (95% CI 1.5–4.5). Compared to people with type 2 diabetes, those with type 1 spend significantly more years in disability pension, but there were no significant differences in the other WYL estimates.

Conclusions

The WYL among people with diabetes is substantial and characterized by social disparities. The WYL help identify intervention targets at different ages, types of diabetes, sex, educational and cohabitant status.

High physical work demands have worse consequences for older workers: prospective study of long-term sickness absence among 69 117 employees

Objective

This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA).

Methods

We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012–2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA.

Results

During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (p<0.01). In the fully adjusted model, very high physical work demands were associated with LTSA with HRs of 1.18 (95% CI 0.93 to 1.50), 1.57 (95% CI 1.41 to 1.75) and 2.09 (95% CI 1.81 to 2.41) for 20, 40 and 60 years old (point estimates), respectively. Results remained robust in subgroup analyses including only skilled and unskilled workers and stratified for gender.

Conclusion

The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.

A comparison of work environment, job insecurity, and health between marginal part-time workers and full-time workers in Denmark using pooled register data

OBJECTIVES

This study aimed to evaluate characteristics of the work environment, job insecurity, and health of marginal part-time workers (8.0-14.9 hours/week) compared with full-time workers (32.0-40.0 hours/week).

METHODS

The study population included employees in the survey Work Environment and Health in Denmark (WEHD) in 2012, 2014, or 2016 (n = 34 960). Survey information from WEHD on work environment and health was linked with register-based information of exposure based on working hours 3 months prior to the survey, obtained from the register Labour Market Account. Associations between marginal part-time work and work environment and health were assessed using logistic regression models.

RESULTS

Marginal part-time workers reported less quantitative job demands, lower levels of influence at work, poorer support from colleagues and leaders, less job satisfaction and poorer safety, as well as more job insecurity. Results on negative social relations in the workplace and physical workload were more ambiguous. Marginal part-time workers were more likely to report poorer self-rated health, treatment-requiring illness, and depressive symptoms compared with full-time workers. Adjusting for characteristics of the work environment showed an indication of altered odds ratios for self-rated health and depressive symptoms, whereas job insecurity did not.

CONCLUSIONS

This study finds that marginal part-time workers experience a poorer psychosocial work environment and safety, higher job insecurity, and poorer health than full-time workers. Work environment characteristics may confound or mediate the association between marginal part-time work and health. However, prospective studies are needed to determine the causal direction of the revealed associations.

Deployment experiences and mental health problems as predictors of post-deployment unemployment length: a prospective, register-based study among Danish soldiers

OBJECTIVES

To test responses of formerly deployed soldiers (FDS) to a questionnaire on deployment experiences in combination with screening levels of post-traumatic stress disorder (PTSD) and depression approximately 6 months after homecoming as predictors of the subsequent probability of gaining employment when unemployed within 5 years post-deployment.

DESIGN, SETTING AND PARTICIPANTS

Danish FDS responders (n=3935) and non-responders (n=3046) to a 6-month post-deployment screening questionnaire after returning from a first-ever deployment to Kosovo, Iraq or Afghanistan (2002 to 2012) were included in the study and followed in public registers from 6 months to 5 years post-deployment.

PRIMARY AND SECONDARY OUTCOME MEASURES

We tested Cox regression models including deployment experiences (1a), screening levels of PTSD and depressive symptoms (1b), and their combination (2) for FDS responders. For all FDS, a secondary model included a measure on whether they responded to the questionnaire (3).

RESULTS

Neither the deployment experiences (1a) of exposure to danger and combat (HR=1.00, 95% CI=0.97 to 1.03) and witnessing consequences of war (HR=1.01, 95% CI=0.96 to 1.06), or the screening levels (1b) of PTSD (HR=1.06, 95% CI=0.84 to 1.33) and depressive symptoms (HR=0.82, 95% CI=0.64 to 1.06) were significant predictors of transitioning from unemployment to employment. Similar results were found for the combined model (2). A tendency among non-respondents (3) to have a lower probability of transitioning from unemployment to employment was found (HR=0.90, 95% CI=0.81 to 1.00).

CONCLUSION

Deployment experiences, PTSD and depressive symptoms, as measured at 6-month screening questionnaire, did not predict differences in the probability of gaining employment when unemployed within 5 years post-deployment. However, the findings suggest that those with the least probability of transitioning from unemployment to employment can be found among the non-responders to the post-deployment screening questionnaire.

Effects of a participatory organisational, core work task focused workplace intervention on employees' primary healthcare consultations: secondary analysis of a cluster RCT

OBJECTIVES

We aimed to examine whether a participatory organisational workplace intervention focusing on core tasks at work resulted in lower primary healthcare utilisation of employees.

METHODS

The cluster randomised controlled trial included 78 preschools, 44 allocated to the intervention group (1745 employees) and 34 allocated to the control group (1267 employees). The intervention aimed to involve employees in improving the psychosocial work environment while focusing on core tasks at work. Using Poisson regression, we tested the rate ratios (RRs) of consultations in the intervention compared with the control group in terms of all consultations in primary healthcare and general practitioner (GP) consultations, respectively, per person-year during 31 months of follow-up. The fully adjusted model included adjustment for sex, age, job group, workplace type and size, and previous primary healthcare utilisation.

RESULTS

During the follow-up, intervention group employees had 11.0 consultations/person-year, while control group employees had 11.6 consultations/person-year (RR 0.97, 95% CI 0.92 to 1.01). Employees in the intervention group had 7.5 GP consultations/person-year, while control group employees had 8.2 GP consultations/person-year (RR 0.95, 95% CI 0.90 to 0.99). Post hoc analyses indicated that the effect of the intervention was particularly strong in employees in preschools with a moderate or high level of implementation.

CONCLUSIONS

The participatory organisational workplace intervention focusing on core tasks at work among preschool employees had a small, statistically non-significant effect on overall primary healthcare utilisation and a small, statistically significant effect on GP consultations. These results suggest a beneficial effect of the participatory organisational intervention on employees' health.

TRIAL REGISTRATION NUMBER

ISRCTN16271504.

Activation pattern during his pacing: how close are we to normal physiology?

Background

His bundle pacing aims to mimic the activation pattern of normal conduction to maintain ventricular synchrony. However, selective His capture can be challenging, and the activation sequence during His pacing may not replicate normal conduction.

Purpose

Compare the right ventricular (RV) and left ventricular (LV) activation pattern in sinus rhythm and His bundle pacing.

Methods

Baseline LV and RV map was created in sinus rhythm using Rhythmia mapping system (Boston Scientific Corporation) in canine animal model. Medtronic 3830 lead was placed near the bundle of His under fluoroscopic, intracardiac echocardiogram, and electroanatomic guidance. Conduction system capture was confirmed by observing a QRS duration &lt;120ms and an isoelectric segment between pacing artifact and QRS on surface ECG. Repeat LV and RV activation map was obtained during His pacing. Average QRS, HV and pacing to V intervals were calculated with standard deviation.

Results

Mapping was performed successfully in four animals. At baseline, the average QRS duration was 44±2.6ms and HV interval was 32±4.2ms. Earliest site of myocardial activation was in the mid-septal LV region. The earliest RV myocardial activation was also at the septum closer to the apex, but later than the LV (Figure1A). With His pacing, the average QRS duration was 70±17.0ms and the average stim to V interval was 31±8.7ms. During His pacing, the earliest site of activation was in the RV septum, with an activation pattern from base to apex in both the RV and LV.

Conclusion

Unlike normal physiology, the activation pattern during conduction system pacing is from base to apex with earliest site in the RV.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Mayo Clinic

A cool modality to restore sinus rhythm

Background

Slowing electrical conduction by cooling the myocardium can be used for defibrillation. We previously demonstrated the efficacy of a small cold device placed in oblique sinus (OS) in terminating atrial fibrillation (AF). However, the parameters needed to achieve effective atrial defibrillation are unknown.

Purpose

Assess effect of the size of cooled myocardium on frequency of AF termination in acute canine animal models.

Methods

Sternotomy was performed under general anesthesia in 10 acute canine experiments. AF was induced using rapid atrial pacing and intra-myocardial epinephrine and acetylcholine injections. Once AF sustained for at least 30s, either a cool (7–9°C) or placebo (body temperature) device was placed in the OS. Four device sizes were tested; ½X½, ¾X¾, and 1X1 inch devices and two ¾X¾ inch devices placed side by side simultaneously. Time to AF termination was recorded. Chi-squared or Fisher's exact test were used to compare the frequency of arrhythmia termination with cooling versus placebo.

Results

A total of 166 applications were performed (89 cool vs 77 placebo) in 10 animal experiments. Overall, AF terminated in 82% of the cooling applications vs. 67.5% of placebo (P=0.03, Figure 1). For the ½X½ inch device 88% of cold applications restored sinus rhythm vs. 63.6% for placebo (P=0.05). The frequency of sinus restoration for cold ¾X¾, 1X1 and two ¾X¾ side by side devices was 86.7%, 83.3% and 70% respectively. Time to sinus restoration when achieved was within three minutes was also not significantly changed.

Conclusion

Placing a cool device in the oblique sinus can terminate AF and efficacy is not affected by the size of device.

Funding Acknowledgement

Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MediCool Technologies

Increased risk of long-term sickness absence, lower rate of return to work and higher risk of disability pension among people with type 1 and type 2 diabetes mellitus: a Danish retrospective cohort study with up to 17 years' follow-up

AIM

To evaluate labour market outcomes in type 1 or type 2 diabetes.

METHODS

Individuals with type 1 (n = 431) and type 2 diabetes (n = 4047) were identified in Danish national registers from 1994 to 2011 and compared with individuals without diabetes (n = 101 295). Multi-state Cox proportional hazards analyses estimated hazard ratios (HR) with 95% confidence intervals (CI) for transitions between work, sickness absence, unemployment and disability pension.

RESULTS

We observed significantly higher HR of sickness absence in type 1 diabetes (women: 1.34, 95% CI 1.12-1.62; men: 1.43, 1.01-2.03) and type 2 diabetes (women: 1.46, 95% CI 1.35-1.58; men: 1.64, 1.46-1.85) compared with people without diabetes. HR of unemployment was higher for men with type 1 diabetes (1.25, 95% CI 1.01-1.53) and women with type 2 diabetes (1.09, 95% CI 1.03-1.16) and men with type 2 diabetes (1.17, 95% CI 1.08-1.27). HR of disability pension was higher in type 1 diabetes (women: 1.90, 95% CI 1.46-2.46; men: 2.09, 1.38-3.18) and type 2 diabetes (women: 1.78, 95% CI 1.62-1.96; men: 2.11, 1.86-2.40). Only women with type 2 diabetes were less likely to return to work from sickness absence (HR 0.91, 95% CI 0.86-0.98) or unemployment (0.89, 95% CI 0.85-0.94). We found no significant difference between the two types of diabetes. Hazard ratios for diabetes regarding unemployment, sickness absence while unemployed and disability pension were significantly higher for men than for women.

CONCLUSIONS

Both type 1 and type 2 diabetes affect labour market outcomes, but future studies should also consider comorbidity and social gradient.

Associations between physical and psychosocial work environment factors and sickness absence incidence depend on the lengths of the sickness absence episodes: a prospective study of 27 678 Danish employees

Objectives

This study examined if the association between work environment factors and sickness absence (SA) depended on the inclusion or exclusion of short-term SA episodes.

Methods

We linked the ‘Work Environment and Health in Denmark’ survey with the ‘Danish Register of Work Absences’ (n=27 678). Using covariate adjusted Cox regression, we examined the associations between work environment factors and SA by changing the cut-off points for the length of the SA episodes, for example, episodes ≥1 day, ≥6 days and ≥21 days. We examined three physical work environment factors: ‘Back bend or twisted’, ‘Lifting or carrying’, ‘Wet hands’ and three psychosocial work environment factors: ‘Poor influence’, ‘Role conflicts’ and ‘Bullying’.

Results

‘Back bend or twisted’ and ‘Lifting or carrying’ had small significant HRs for SA episodes ≥1 day and large and highly significant HRs for SA episodes ≥6 days and ≥21 days. ‘Wet hands’ had small significant HRs for SA episodes ≥1 day for both sexes and large and highly significant HR for ≥6 days for women. HRs of all three psychosocial factors were highly significant for SA episodes ≥1 day and ≥6 days for both sexes, and ‘Poor influence’ and ‘Role conflicts’ were significant for SA episodes ≥21 days for women.

Conclusions

The physical work factors had higher associations with SA when SA episodes of 1–5 days were excluded and focus was on SA episodes ≥6 days. The psychosocial work factors were strongly associated with SA both with and without SA episodes of 1–5 days included in the analyses.

The number of years lost in 30-year work life spans of people with type 1 and type 2 diabetes

Background

Although diabetes is among the most common causes of lifelong disability, no studies have yet outlined work disability from a life course perspective. This study estimated the number of years people with type 1 and type 2 diabetes lost in a work life span compared to people without diabetes

Methods

Individuals aged 18-65 years, diagnosed with type 1 (n = 33,188) or type 2 diabetes (n = 81,930) were identified from national registers from the entire Danish population and age and gender matched with controls without diabetes (n = 663,656), for period 2000-2017. WLE in years were estimated as time in employment from age 35 to 65. We used a life table approach with multi-state Cox proportional hazard modelling (95% Confidence Intervals: CI). Age was the underlying time-axis. Inverse probability weights accounted for differences between populations. Analyses were performed separately for sex, educational status, and types of diabetes in 5-year age intervals.

Results

Individuals with type 1 diabetes and type 2 diabetes had significantly shorter WLE compared to people without diabetes in the 30-year span. Type 1 diabetes: WLE ranged from 8 years shorter among women with short education [-8.0; CI:-11/-5.0] to 4 years shorter [-4.4; CI:-6.6/-2.3] with high education; WLE in men ranged from -6.4 [CI:-8.7/-4.0] with short education to -3.0 [CI:-4.5/-1.5] with high education. Type 2 diabetes: WLE ranged from -6.5 [CI: -8.9/-4.0] in women with short education to -2.9 [CI: -4.5/-1.3] with high education. WLE in men ranged from -7.0 [CI: -9.4/-4.5] with short education to -3.7 [CI: -5.4/-2.0] with high education.

Conclusions

The substantial number of years lost in a work life span for individuals with type 1 or type 2 diabetes, highlight need for new strategies that prevent work disability, particularly for individuals with short education.

Key messages

Individuals with type 1 diabetes and type 2 diabetes had between 9 and 3 years shorter work life expectancies compared to people without diabetes in a 30-year span. The work life spans are substantial shorter for individuals with type 1 or type 2 diabetes with short educations.

Beta Decay of Molecular Tritium

The beta decay of tritium in the form of molecular T_{2} is the basis of sensitive experiments to measure neutrino mass. The final-state electronic, vibrational, and rotational excitations modify the beta spectrum significantly and are obtained from theory. We report measurements of the branching ratios to specific ionization states for the isotopolog HT. Two earlier, concordant measurements gave branching ratios of HT to the bound HHe^{+} ion of 89.5% and 93.2%, in sharp disagreement with the theoretical prediction of 55%-57%, raising concerns about the theory's reliability in neutrino mass experiments. Our result, 56.5(6)%, is compatible with the theoretical expectation and disagrees strongly with the previous measurements.

High physical work demands and working life expectancy in Denmark

Objective

In most European countries, political reforms gradually increase the statutory retirement age to counter the economic costs of a growing elderly population. However, working to a high age may be difficult for people with hard physical labour. We aim to study the impact of high physical work demands on working life expectancy (WLE).

Methods

We combined physical work demands assessed by job exposure matrix (JEM) and longitudinal high-quality national registers (outcome) in 1.6 million Danish workers to estimate WLE and years of sickness absence, unemployment and disability pension. The JEM value for physical work demand is a summarised score of eight ergonomic exposures for 317 occupations groups, sex and age. The WLE was estimated using a multistate proportional hazards model in a 4-year follow-up period.

Results

Individuals with high physical work demands had a significantly lower WLE, than those with low physical work demands, with largest differences seen among women. At age 30 years, women with high physical work demands can expect 3.1 years less working, 11 months more of sickness absence and 16 months more of unemployment than low-exposed women. For 30-year-old men, the corresponding results were 2.0 years, 12 months and 8 months, respectively.

Conclusion

Our findings show that high physical work demands are a marked risk factor for a shortened working life and increased years of sickness absence and unemployment. The results are important when selecting high-risk occupations, and expand the knowledge base for informed political decision making concerning statutory retirement age.

Perceived and content-related emotional demands at work and risk of long-term sickness absence in the Danish workforce: a cohort study of 26 410 Danish employees

Objectives

This study aimed to examine whether high emotional demands at work predict long-term sickness absence (LTSA) in the Danish workforce and whether associations differ by perceived and content-related emotional demands.

Methods

We included 26 410 individuals from the Work Environment and Health in Denmark Study, a nationwide sample of the Danish workforce. Emotional demands at work were measured with two items: one assessing perceived emotional demands (asking how often respondents were emotionally affected by work) and one assessing content-related emotional demands (frequency of contact with individuals in difficult situations). LTSA was register based and defined as spells of ≥6 weeks. Respondents with LTSA during 2 years before baseline were excluded. Follow-up was 52 weeks. Using Cox regression, we estimated risk of LTSA per one-unit increase in emotional demands rated on a five-point scale.

Results

During 22 466 person-years, we identified 1002 LTSA cases. Both perceived (HR 1.20, 95% CI 1.12 to 1.28) and content-related emotional demands (HR 1.07, 95% CI 1.01 to 1.13) predicted risk of LTSA after adjustment for confounders. Further adjustment for baseline depressive symptoms substantially attenuated associations for perceived (HR 1.08, 95% CI 1.01 to 1.16) but not content-related emotional demands (HR 1.05, 95% CI 1.00 to 1.11). Individuals working in occupations with above-average values of both exposures had an increased risk of LTSA (HR 1.32, 95% CI 1.14 to 1.52) compared with individuals in all other job groups.

Conclusions

Perceived and content-related emotional demands at work predicted LTSA, also after adjustment for baseline depressive symptoms, supporting the interpretation that high emotional demands may be hazardous to employee’s health.

Impact of depressive symptoms on worklife expectancy: a longitudinal study on Danish employees

Objective

Depressive symptoms are associated with sickness absence, work disability and unemployment, but little is known about worklife expectancy (WLE). This study investigates the impact of depressive symptoms on the WLE of a large sample of Danish employees.

Methods

We used occupational health survey data of 11 967 Danish employees from 2010 and linked them with register data on salary and transfer payments from 2010 to 2015. Depressive symptoms were self-reported using the Major Depression Inventory. We used multistate data and a life table approach with Cox proportional hazard modelling to estimate the WLE of employees, expressed by time in work, unemployment and sickness absence. Separate analyses were conducted for sex and employees with a voluntary early retirement pension scheme. Using age as time axis, we used inverse probability weights to account for differences in educational level, sector, body mass index, smoking habits and loss of employment during sickness absence.

Results

The WLE of employees reporting depressive symptoms was shorter compared with those not reporting depressive symptoms; that is, the expected time in unemployment and sickness absence was longer, while the expected time in work was shorter. The shorter WLE was most pronounced in women; for example, a 40-year-old woman with depressive symptoms can expect 3.3 years less in work, 0.8 years more in unemployment and 0.7 years more in sickness absence. Employees with a voluntary early retirement pension scheme showed an even lower WLE.

Conclusions

Our study showed a meaningful impact of depressive symptoms on the WLE of Danish employees using a multistate framework.

Effect of a participatory organizational workplace intervention on workplace social capital: post-hoc results from a cluster randomized controlled trial

BACKGROUND

A high level of workplace social capital (WSC) may contribute to the protection of employees' health. We hypothesized that a participatory workplace intervention would increase the level of WSC defined as vertical WSC (i.e. WSC linking together employees and their leaders) and horizontal WSC (i.e. WSC bonding employees together).

METHODS

We conducted a secondary data analysis of a cluster randomized controlled trial that was implemented among all employees in 78 municipal Danish pre-schools (44 intervention and 34 control group schools). The study sample consisted of 606 employees, 386 in the intervention and 220 in the control group. The intervention aimed to improve the psychosocial working environment by using a participatory approach and focusing on core job tasks. Vertical and horizontal WSC was measured by five and four items, respectively, at baseline and at 24-months follow-up. We estimated intervention effect by calculating the interaction of change over time by group assignment (intervention versus control group) and included workplace identification number in a repeated statement to take into account that employees were nested within workplaces. We conducted post-hoc analyses to examine whether intervention effect differed by implementation degree.

RESULTS

WSC decreased in both groups. In the main analyses, there was no statistically significant difference between intervention and control group, neither for vertical nor horizontal WSC. However, when we excluded intervention workplaces with a low degree of implementation, we found a statistically significant difference between the intervention and the control group (estimate: 0.25, 95% CI: 0.00 to 0.50, p = 0.049), indicating that vertical WSC decreased in the control group and remained stable in the intervention group.

CONCLUSIONS

There was not a statistically significant difference between intervention and control group in the main analysis. Post-hoc analyses, however, suggest that the intervention may have prevented a decrease in vertical WSC among employees in workplaces with a high or a medium degree of implementation. A conference abstract with the key results of this study has been previously presented and published, European Journal of Public Health, Volume 28, Issue suppl_4, November 2018, cky260, https://academic.oup.com/eurpub/article/28/suppl_4/cky260/5187184 .

TRIAL REGISTRATION

ISRCTN16271504 , retrospectively registered on November 15, 2016.

Labor market affiliation after deployment: Danish soldiers fare well, but face increased risk of long-term sickness absence when returning from Afghanistan

Objectives Little is known about the employment prospects of formerly deployed soldiers (FDS) after returning from military deployment. The few studies that exist reported mixed results, and even fewer undertook comparisons with a civilian control population. This study compared labor market transitions of FDS within five years of returning from their first international deployment with those of a closely matched general-population control group. Methods Danish FDS (N=6653) returning from their first ever peacekeeping in Kosovo or Iraq, or more intense combat in Afghanistan (period 2002-2012), were matched with non-deployed controls from the general population (N=62 281). We modelled time-to-event using Cox models, for transitioning from employed to unemployed and back, and from work to long-term sickness absence and back. Each analysis adjusted for age and level of education and was stratified for the region of residence and the underlying period. Results Independent of deployment country, FDS had a lower risk of becoming unemployed [hazard ratio (HR) 0.55-0.73] and a higher chance of obtaining employment (HR 1.19-1.31) than matched controls. FDS returning from Afghanistan had a higher risk of long-term sickness absence (HR 1.66), while those returning from Kosovo had a higher chance of returning to work (HR 1.24). Conclusion Independent of deployment country, FDS fared better in the labor market within five years of returning home compared to non-deployed controls. However, deployment to Afghanistan was related to a higher risk of long-term sickness absence, suggesting that some soldiers have worse outcomes than the general population.

Alcohol consumption and labour market participation: a prospective cohort study of transitions between work, unemployment, sickness absence, and social benefits

The aim of this study was to investigate the association of alcohol consumption and problem drinking on transitions between work, unemployment, sickness absence and social benefits. Participants were 86,417 men and women aged 18-60 years who participated in the Danish National Health Survey in 2010. Information on alcohol consumption (units per week) and problem drinking (CAGE-C score of 4-6) was obtained by questionnaire. The primary outcome was labour market attachment. Information on labour market attachment was obtained from the national administrative registers during a 5-year follow-up period. Using Cox proportional hazards models, we estimated hazard ratios (HR) for transitions between work, unemployment, sickness absence and social benefits. Analyses were adjusted for potential confounders associated with demography, health, and socio-economy. High alcohol consumption and problem drinking was associated with higher probability of unemployment, sickness absence and social benefits among participants employed at baseline compared with participants who consumed 1-6 drinks/week. High alcohol consumption and problem drinking was associated with lower probability of returning to work among participants receiving sickness absence at baseline compared with participants who consumed 1-6 drinks/week and with non-problem drinkers: HRs were 0.75 (0.58-0.98) for 35+ drinks per week and 0.81 (0.65-1.00) for problem drinking (CAGE-C score of 4-6). Similar trends for weekly alcohol consumption and problem drinking were observed among participants who were unemployed at baseline. In summary, problem drinking has adverse consequences for labour market participation and is associated with higher probability of losing a job and a lower chance of becoming employed again.

Comorbid symptoms of depression and musculoskeletal pain and risk of long term sickness absence

Background

Symptoms of depression and musculoskeletal pain have both been found to be associated with increased risk of long term sickness absence (LTSA). The comorbidity between depression and pain i.e. simultaneous presence of both symptoms, is well established in the literature. The aim for the current investigation was to investigate whether the presence of comorbid pain influences the associations between depressive symptoms and LTSA or if the presence of comorbid depressive symptoms influences associations between musculoskeletal pain and LTSA.

Methods

A sample of 6572 Danish female health care workers responding to a questionnaire about health and working conditions were followed up in a national register of social transfer payments (DREAM) for 550 days. We estimated the risk for LTSA of four weeks or more, associated with depressive symptoms and number of musculoskeletal pain locations using a Cox proportional hazards model allowing multiple observations per individual. We conducted a test for multiplicative interaction between musculoskeletal pain locations and depressive symptoms, and presented stratified regression models to facilitate the interpretation of the results.

Results

The severity of depressive symptoms was correlated with the number of pain locations reported (Spearman’s rho = .24, p < 0.001). We found a significant multiplicative interaction between depressive symptoms and musculoskeletal pain in predicting the risk of LTSA. Depressive symptoms and number of musculoskeletal pain locations were associated with increased risk of LTSA for individuals who did not have comorbid symptoms. However, we found no significant associations between the two predictors and LTSA among participants who reported comorbid symptoms.

Conclusions

The risk of LTSA associated with depressive symptoms and musculoskeletal pain appears to be moderated by the presence of comorbid symptoms. The modified risk for LTSA among workers with comorbid symptoms requires further investigation.

Long-term sickness absence of 32 chronic conditions: a Danish register-based longitudinal study with up to 17 years of follow-up

OBJECTIVES

Sickness absence has been used as a central indicator of work disability, but has mainly been examined in single diseases, with limited follow-up time. This study identified the risk of long-term sickness absence (LTSA) of 32 chronic disease groups in the first year after diagnosis and the subsequent years.

SETTING

We identified chronic disease groups prevalent in the work force (26 physical and 6 mental conditions) requiring all levels of care (primary, secondary, tertiary), by national registers of diagnoses from all hospital visits and prescribed medicine in Denmark from 1994 to 2011.

PARTICIPANTS

A general population sample within the working age range (18-59 years) was drawn by Statistics Denmark. Participants not working before and during the follow-up period were excluded. A total of 102 746 participants were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

HRs of transitions from work to LTSA of each of the chronic conditions were estimated in Cox proportional hazards models for repeated events-distinguishing between risk within the first (<1 year) and subsequent years of diagnosis (≥1 year) and an HR ratio (HRR): HR ≥1 year divided by HR <1 year.

RESULTS

Almost all the conditions were associated with significantly increased risks of LTSA over time. The risks were generally more increased in men than in women. Three main patterns of LTSA were identified across diseases: strong decreases of LTSA from the first to subsequent years (eg, stroke in men <1 year: HR=7.55, 95% CI 6.45 to 8.85; ≥1 year HR=1.43, 95% CI 1.20 to 1.74; HRR=0.23). Moderate or small decreases in LTSA (HRR between 0.46 and 0.76). No changes (HRR between 0.92 and 0.95) or increases in elevated risks of LTSA over time (HRR between 1.02 and 1.16).

CONCLUSIONS

The 32 chronic diseases were associated with three different risk patterns of LTSA over time. These patterns implicate different strategies for managing work disability over time.