The causal effect of mental health on labor market outcomes: The case of stress-related mental disorders following a human-made disaster.

As disasters increase due to climate change, population density, epidemics, and technology, information is needed about postdisaster consequences for people's mental health and how stress-related mental disorders affect multiple spheres of life, including labor-market attachment. We tested the causal hypothesis that individuals who developed stress-related mental disorders as a consequence of their disaster exposure experienced subsequent weak labor-market attachment and poor work-related outcomes. We leveraged a natural experiment in an instrumental variables model, studying a 2004 fireworks factory explosion disaster that precipitated the onset of stress-related disorders (posttraumatic stress disorder, anxiety, and depression) among individuals in the local community (N = 86,726). We measured labor-market outcomes using longitudinal population-level administrative data: sick leave, unemployment benefits, early retirement pension, and income from wages from 2007 to 2010. We found that individuals who developed a stress-related disorder after the disaster were likely to go on sickness benefit, both in the short- and long-term, were likely to use unemployment benefits and to lose wage income in the long term. Stress-related disorders did not increase the likelihood of early retirement. The natural experiment design minimized the possibility that omitted confounders biased these effects of mental health on work outcomes. Addressing the mental health and employment needs of survivors after a traumatic experience may improve their labor-market outcomes and their nations' economic outputs.

Health-promoting physical activities for refugees from Syria - physiotherapists' clinical reasoning.

BACKGROUND: Refugees from Syria face health challenges with psychosocial dimensions due to disrupted networks, uncertain life situations, and language barriers. Additionally, a sedentary lifestyle increases the risk of noncommunicable diseases, so health-promoting initiatives involving physical activities are essential. PURPOSE: To explore physiotherapists' clinical reasoning and collaboration with refugee families in developing group-based health-promoting physical exercising to increase participants' wellbeing, sense of togetherness, and self-efficacy. METHODS: The design was participating action research with 24 resettled refugees from Syria. Data consisted of field notes and three focus group interviews. Data gathering followed a phenomenological approach, and the four-step analysis was inspired by Giorgi. RESULTS: Based on clinical reasoning and collaboration with the participants and their wishes, the physiotherapists organized a physical exercise intervention integrating language learning. The physiotherapists based the intervention on social cognitive theory, focusing on the group's and the individual's capacity and working with the participants on exercise and organizational adaptations to the group and individual. The participants appreciated the joyful physical activities, body awareness, and a sense of togetherness. To accommodate that many suffered from musculoskeletal pain, the physiotherapists developed an intervention for therapeutic exercising that included individual assessment and pain management. CONCLUSION: The physiotherapists' clinical reasoning in working with refugees included the cultural, linguistic, and social context rooted in a salutogenic perspective. The participants' wellbeing and self-efficacy in adhering to exercise increased. They experienced pain relief and increased confidence in using the body.

Longitudinal Change in Serum Neurofilament Light Chain in Type 2 Diabetes and Early Diabetic Polyneuropathy: ADDITION-Denmark.

OBJECTIVE: To investigate the longitudinal development of neurofilament light chain (NfL) levels in type 2 diabetes with and without diabetic polyneuropathy (+/-DPN) and to explore the predictive potential of NfL as a biomarker for DPN. RESEARCH DESIGN AND METHODS: We performed retrospective longitudinal case-control analysis of data from 178 participants of the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care-Denmark (ADDITION-Denmark) cohort of people with screen-detected type 2 diabetes. Biobank samples acquired at the ADDITION-Denmark 5- and 10-year follow-ups were analyzed for serum NfL (s-NfL) using single-molecule array, and the results were compared with established reference material to obtain NfL z-scores. DPN was diagnosed according to Toronto criteria for confirmed DPN at the 10-year follow-up. RESULTS: s-NfL increased over time in +DPN (N = 39) and -DPN participants (N = 139) at levels above normal age-induced s-NfL increase. Longitudinal s-NfL change was greater in +DPN than in -DPN participants (17.4% [95% CI 4.3; 32.2] or 0.31 SD [95% CI 0.03; 0.60] higher s-NfL or NfL z-score increase in +DPN compared with -DPN). s-NfL at the 5-year follow-up was positively associated with nerve conduction studies at the 10-year follow-up (P = 0.02 to <0.001), but not with DPN risk. Areas under the curve (AUCs) for s-NfL were not inferior to AUCs for the Michigan Neuropathy Screening Instrument questionnaire score or vibration detection thresholds. Higher yearly s-NfL increase was associated with higher DPN risk (odds ratio 1.36 [95% CI 1.08; 1.71] per 1 ng/L/year). CONCLUSIONS: Our findings suggest that preceding s-NfL trajectories differ slightly between those with and without DPN and imply a possible biomarker value of s-NfL trajectories in DPN.

Suicides, drug poisonings, and alcohol-related deaths cluster with health and social disadvantage in 4.1 million citizens from two nations.

BACKGROUND: Deaths from suicides, drug poisonings, and alcohol-related diseases ('deaths of despair') are well-documented among working-age Americans, and have been hypothesized to be largely specific to the U.S. However, support for this assertion-and associated policies to reduce premature mortality-requires tests concerning these deaths in other industrialized countries, with different institutional contexts. We tested whether the concentration and accumulation of health and social disadvantage forecasts deaths of despair, in New Zealand and Denmark. METHODS: We used nationwide administrative data. Our observation period was 10 years (NZ = July 2006-June 2016, Denmark = January 2007-December 2016). We identified all NZ-born and Danish-born individuals aged 25-64 in the last observation year (NZ = 1 555 902, Denmark = 2 541 758). We ascertained measures of disadvantage (public-hospital stays for physical- and mental-health difficulties, social-welfare benefit-use, and criminal convictions) across the first nine years. We ascertained deaths from suicide, drugs, alcohol, and all other causes in the last year. RESULTS: Deaths of despair clustered within a population segment that disproportionately experienced multiple disadvantages. In both countries, individuals in the top 5% of the population in multiple health- and social-service sectors were at elevated risk for deaths from suicide, drugs, and alcohol, and deaths from other causes. Associations were evident across sex and age. CONCLUSIONS: Deaths of despair are a marker of inequalities in countries beyond the U.S. with robust social-safety nets, nationwide healthcare, and strong pharmaceutical regulations. These deaths cluster within a highly disadvantaged population segment identifiable within health- and social-service systems.

Hospitalisation at Home of Patients with COVID-19: A Qualitative Study of User Experiences.

Hospitalisation at Home (HaH) is a new model providing hospital-level care at home as a substitute for traditional care. Biometric monitoring and digital communication are crucial, but little is known about user perspectives. We aim to explore how in-patients with severe COVID-19 infection and clinicians engage with and experience communication and self-monitoring activities following the HaH model. A qualitative study based on semi-structured interviews of patients and clinicians participating in the early development phase of HaH were conducted. We interviewed eight clinicians and six patients. Five themes emerged from clinicians: (1) staff fear and concerns, (2) workflow, (3) virtual closeness, (4) patient relatives, and (5) future HaH models; four themes emerged from patients: (1) transition to home, (2) joint responsibility, (3) acceptability of technologies, and (4) relatives. Despite technical problems, both patients and clinicians were enthusiastic about the conceptual HaH idea. If appropriately introduced, treatment based on self-monitoring and remote communication was perceived acceptable for the patients; however, obtaining vitals at night was an overwhelming challenge. HaH is generally acceptable, perceived patient-centred, influencing routine clinical workflow, role and job satisfaction. Therefore, it calls for educational programs including more perspective than issues related to technical devices.

Correlation between CD4/CD8 ratio and neurocognitive performance during early HIV infection.

INTRODUCTION: CD4/CD8 ratio is a marker of immune activation in HIV infection and has been associated with neurocognitive performance during chronic infection, but little is known about the early phases. The aim of this study was to examine the relationship between blood CD4/CD8 ratio and central nervous system endpoints in primary HIV infection (PHI) before and after antiretroviral treatment (ART). METHODS: This was a retrospective analysis of the Primary Infection Stage CNS Events Study (PISCES) cohort. We longitudinally assessed blood and cerebrospinal fluid (CSF) markers of inflammation, immune activation and neuronal injury, and neuropsychological testing performance (NPZ4, an average of three motor and one processing speed tests, and a summarized total score, NPZ11, including also executive function, learning and memory) in ART-naïve participants enrolled during PHI. Spearman correlation and linear mixed models assessed the relationships between the trajectory of CD4/CD8 ratio over time and neurocognitive performance, blood and CSF markers of immune activation and neuronal injury. RESULTS: In all, 109 PHI participants were enrolled. The mean CD4/CD8 ratio decreased with longer time from infection to starting treatment (p < 0.001). Every unit increase in NPZ4 score was independently associated with a 0.15 increase in CD4/CD8 ratio (95% CI: 0.002-0.29; p = 0.047), whereas no correlation was found between CD4/CD8 ratio and NPZ11. Among the cognitive domains, only a change in processing speed was correlated with CD4/CD8 ratio over time (p = 0.03). The trajectory of the CD4/CD8 ratio was negatively correlated with change in CSF neurofilament light chain (p = 0.04). CONCLUSIONS: The trajectory of CD4/CD8 ratio was independently associated with motor/psychomotor speed performance, suggesting that immune activation is involved in brain injury during the early stages of the infection.

Serum neurofilament light chain - A potential biomarker for polyneuropathy in type 2 diabetes?

AIMS: To investigate the relationship between neurofilament light chain (NfL) and the presence and severity of diabetic polyneuropathy (DPN). METHODS: We performed cross-sectional analysis of data from 178 participants of the ADDITION-Denmark cohort of people with screen-detected type 2 diabetes and 32 healthy controls. Biobank serum samples were analyzed for NfL using single-molecule array. DPN was defined by Toronto criteria for confirmed DPN. Original and axonal nerve conduction study (NCS) sum z-scores were used as indicators of the severity of DPN and peripheral nerve damage. RESULTS: 39 (21.9%) participants had DPN. Serum NfL (s-NfL) was significantly higher in participants with DPN (18.8 ng/L [IQR 14.4; 27.9]) than in participants without DPN (15.4 ng/L [IQR 11.7; 20.1]). There were no unadjusted s-NfL differences between controls (17.6 ng/L [IQR 12.7; 19.8]) and participants with or without DPN. Higher original and axonal NCS sum z-scores were associated with 10% higher s-NfL (10.2 and 12.1% [95% CI's 4.0; 16.8 and 6.6; 17.9] per 1 SD). The AUC of s-NfL for DPN was 0.63 (95% CI 0.52; 0.73). CONCLUSIONS: S-NfL is unlikely to be a reliable biomarker for the presence of DPN. S-NfL is however associated tothe severity of the nerve damage underlying DPN.

Long-term effects of intensive multifactorial treatment on aortic stiffness and central hemodynamics after 13 years with screen-detected type 2 diabetes: the ADDITION-Denmark trial.

BACKGROUND: Peripheral and central hemodynamic indices are modifiable by lifestyle and medical intervention. We aimed to determine the long-term effect of intensive multifactorial treatment on peripheral and central hemodynamic indices among people with screen-detected diabetes. METHODS: Between 2001 and 2006, people with screen-detected type 2 diabetes were included in the Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION) trial (NCT00237549, ClinicalTrials.gov). In the Danish arm, participants were invited to a clinical examination in 2015-2016, 13 years after inclusion and 8 years after trial-end. Out of 586 eligible participants who attended the clinical examination, 411 had a valid examination of central and peripheral hemodynamic indices (242 received intensive treatment and 169 received routine care). Carotid-femoral pulse wave velocity (cfPWV), central blood pressure and augmentation index were assessed by applanation tonometry. We used mixed-effect models to examine the intervention effect adjusting for cluster randomization and heart rate. RESULTS: Randomization to intensive treatment during the trial-period was associated with a 0.58 m/s lower cfPWV (95% CI - 1.09 to - 0.06) at follow-up. Adjustment for blood pressure attenuated the association. Differences between intervention groups for central augmentation index were - 1.25% (95% CI: - 3.28 to 0.78), central pulse pressure - 1.74 mmHg (95% CI - 4.79 to 1.31), central systolic blood pressure - 3.06 mmHg (- 7.08 to 0.96), and central diastolic blood pressure - 1.70 mmHg (- 3.74 to 0.34). CONCLUSIONS: Intensive multifactorial treatment of screen-detected type 2 diabetes has a sustained positive effect on aortic stiffness measured by cfPWV. Although all estimates pointed in favor of intensive treatment, we observed no clear beneficial effect on other hemodynamic indices.

Individual differences in timing of susceptibility to adverse effects of family dysfunction.

Do adolescents vary in the timing of their susceptibility to family-related adversity? Does early exposure to family dysfunction affect later adolescent plasticity? To address these two questions an influence statistic, DFBETAS, was used to capture degree to which 605,344 Danish children (294,479 females, 5.21% immigrants; race/ethnicity information not available in Danish registry) appeared susceptible to the adverse effects of household dysfunction measured annually at ages 0-5 and 13-18 on problematic development at age 18-19. Degree of susceptibility to family-adversity effects proved generally consistent across periods (γ = 0.5195), though for a not insubstantial number of adolescents this was decidedly not the case, as they were highly dissimilar (N = 80,408, 13.28%). Also, greater early-adversity susceptibility did not forecast reduced adolescent susceptibility, as has been hypothesized, but just the opposite. Future research can address the generalizability of these findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Use of Population-Level Administrative Data in Developmental Science.

Population-level administrative data-data on individuals' interactions with administrative systems (e.g., health, criminal justice, and education)-have substantially advanced our understanding of life-course development. In this review, we focus on five areas where research using these data has made significant contributions to developmental science: (a) understanding small or difficult-to-study populations, (b) evaluating intergenerational and family influences, (c) enabling estimation of causal effects through natural experiments and regional comparisons, (d) identifying individuals at risk for negative developmental outcomes, and (e) assessing neighborhood and environmental influences. Further advances will be made by linking prospective surveys to administrative data to expand the range of developmental questions that can be tested; supporting efforts to establish new linked administrative data resources, including in developing countries; and conducting cross-national comparisons to test findings' generalizability. New administrative data initiatives should involve consultation with population subgroups including vulnerable groups, efforts to obtain social license, and strong ethical oversight and governance arrangements.

Beyond early years versus adolescence: The interactive effect of adversity in both periods on life-course development.

Developmental scholars, parents, and policymakers alike have long heralded the opening years of life as disproportionately influential. Recent work on adolescence has revealed, however, greater influence of these later years-but without considering how experience during these two periods interact. We address this issue by studying adverse experiences (e.g., parental divorce, incarceration) measured at ages 0-5 years and 13-18 years on problematic development at 18-19 years (e.g., criminal behavior, disconnection from school and work) on 363,444 Danish siblings. Given multiple possible interaction patterns, no predictions were advanced. The extent to which adverse experiences in early childhood impact future problematic development depends on level of adversity experienced in adolescence: Only when exposure to adversity in adolescence was limited did greater early life adversity predict poorer future outcomes. Otherwise, adolescent adversity swamped effects of early life adversity. Results are discussed in terms of the design and context of the research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Nationwide evidence that education disrupts the intergenerational transmission of disadvantage.

Despite overall improvements in health and living standards in the Western world, health and social disadvantages persist across generations. Using nationwide administrative databases linked for 2.1 million Danish citizens, we leveraged a three-generation approach to test whether multiple, different health and social disadvantages-poor physical health, poor mental health, social welfare dependency, criminal offending, and Child Protective Services involvement-were transmitted within families and whether education disrupted these statistical associations. Health and social disadvantages concentrated, aggregated, and accumulated within a small, high-need segment of families: Adults who relied disproportionately on multiple, different health and social services tended to have parents who relied disproportionately on multiple, different health and social services and tended to have children who evidenced risk for disadvantage at an early age, through appearance in protective services records. Intra- and intergenerational comparisons were consistent with the possibility that education disrupted this transmission. Within families, siblings who obtained more education were at a reduced risk for later-life disadvantage compared with their cosiblings who obtained less education, despite shared family background. Supporting the education potential of the most vulnerable citizens might mitigate the multigenerational transmission of multiple disadvantages and reduce health and social disparities.

Plasma lipid metabolites associate with diabetic polyneuropathy in a cohort with type 2 diabetes.

OBJECTIVE: The global rise in type 2 diabetes is associated with a concomitant increase in diabetic complications. Diabetic polyneuropathy is the most frequent type 2 diabetes complication and is associated with poor outcomes. The metabolic syndrome has emerged as a major risk factor for diabetic polyneuropathy; however, the metabolites associated with the metabolic syndrome that correlate with diabetic polyneuropathy are unknown. METHODS: We conducted a global metabolomics analysis on plasma samples from a subcohort of participants from the Danish arm of Anglo-Danish-Dutch study of Intensive Treatment of Diabetes in Primary Care (ADDITION-Denmark) with and without diabetic polyneuropathy versus lean control participants. RESULTS: Compared to lean controls, type 2 diabetes participants had significantly higher HbA1c (p = 0.0028), BMI (p = 0.0004), and waist circumference (p = 0.0001), but lower total cholesterol (p = 0.0001). Out of 991 total metabolites, we identified 15 plasma metabolites that differed in type 2 diabetes participants by diabetic polyneuropathy status, including metabolites belonging to energy, lipid, and xenobiotic pathways, among others. Additionally, these metabolites correlated with alterations in plasma lipid metabolites in type 2 diabetes participants based on neuropathy status. Further evaluating all plasma lipid metabolites identified a shift in abundance, chain length, and saturation of free fatty acids in type 2 diabetes participants. Importantly, the presence of diabetic polyneuropathy impacted the abundance of plasma complex lipids, including acylcarnitines and sphingolipids. INTERPRETATION: Our explorative study suggests that diabetic polyneuropathy in type 2 diabetes is associated with novel alterations in plasma metabolites related to lipid metabolism.

Diabetic Polyneuropathy Early in Type 2 Diabetes Is Associated With Higher Incidence Rate of Cardiovascular Disease: Results From Two Danish Cohort Studies.

OBJECTIVE: Symptoms indicative of diabetic polyneuropathy (DPN) early in type 2 diabetes may act as a marker for cardiovascular disease (CVD) and death. RESEARCH DESIGN AND METHODS: We linked data from two Danish type 2 diabetes cohorts, the Anglo-Danish-Dutch Study of Intensive Treatment in People With Screen-Detected Diabetes in Primary Care (ADDITION-Denmark) and the Danish Centre for Strategic Research in Type 2 Diabetes (DD2), to national health care registers. The Michigan Neuropathy Screening Instrument questionnaire (MNSIq) was completed at diabetes diagnosis in ADDITION-Denmark and at a median of 4.6 years after diagnosis of diabetes in DD2. An MNSIq score ≥4 was considered as indicative of DPN. Using Poisson regressions, we computed incidence rate ratios (IRRs) of CVD and all-cause mortality comparing MNSIq scores ≥4 with scores <4. Analyses were adjusted for a range of established CVD risk factors. RESULTS: In total, 1,445 (ADDITION-Denmark) and 5,028 (DD2) individuals were included in the study. Compared with MNSIq scores <4, MNSIq scores ≥4 were associated with higher incidence rate of CVD, with IRRs of 1.79 (95% CI 1.38-2.31) in ADDITION-Denmark, 1.57 (CI 1.27-1.94) in the DD2, and a combined IRR of 1.65 (CI 1.41-1.95) in a fixed-effect meta-analysis. MNSIq scores ≥4 did not associate with mortality; combined mortality rate ratio was 1.11 (CI 0.83-1.48). CONCLUSIONS: The MNSIq may be a tool to identify a subgroup within individuals with newly diagnosed type 2 diabetes with a high incidence rate of subsequent CVD. MNSIq scores ≥4, indicating DPN, were associated with a markedly higher incidence rate of CVD, beyond that conferred by established CVD risk factors.

Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management.

Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in 30-40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycaemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc., which lead to the best therapeutic outcomes.

Association of Youth Age at Exposure to Household Dysfunction With Outcomes in Early Adulthood.

Importance: The current focus on the association of negative experiences in early childhood with adverse outcomes later in life is based on limited empirical evidence. Objective: To evaluate whether age at exposure to negative experiences in childhood and adolescence is associated with outcomes in early adulthood. Design, Setting, and Participants: This cohort study used population data from administrative sources for all Danish individuals born between 1987 and 1995 who were living in Denmark at 19 years of age. Data were analyzed in July 2020. Exposures: Exposure to 6 household dysfunction items (HDIs) from birth to 17 years of age by age group. Age groups were as follows: 0 to 2 years (early childhood), 3 to 5 years (preschool), 6 to 12 years (mid-childhood), and 13 to 17 years (early adolescence). The 6 items were parents' unemployment, incarceration, mental disorders, death, and divorce and the child's foster care experiences. Main Outcomes and Measures: Mental disorders, low educational attainment, disconnection from education and the labor market, and criminal charges. A fixed-effects model was used to estimate the dose-response and age-specific associations between HDI exposure and the collated outcome measure. Results: The study sample included 605 344 individuals observed from birth to 19 years of age (mean [SD] birth year, 1991 [2.56] years; range, 1987-1995; 335 725 [55%] male). Overall, 278 115 individuals (45.94%) were exposed to 1 or more of the 6 HDIs from birth to 17 years of age. Exposure was most prevalent at 1 year of age (exposure rate, 11.3%), and parental unemployment was the most common HDI (15.5% observed in mid-childhood). The risk of experiencing the 4 outcomes was monotonically associated with the number of HDIs. For example, experiencing 1 HDI between birth and 17 years of age was associated with an increased risk of experiencing an adverse outcome by approximately 1.0 percentage point (ß = 0.011; 95% CI, 0.010-0.012; P < .001). Similarly, the risk of experiencing adverse outcomes varied significantly in association with age at exposure. Exposure during early adolescence was more strongly associated with adverse outcomes than was exposure during early childhood (increased risk of 5.8 percentage points [ß = 0.058; 95% CI, 0.052-0.063; P < .001] vs 1.0 [ß = 0.010; 95% CI, 0.004-0.015; P = .001]). Conclusions and Relevance: In this cohort study, exposure to negative experiences in early adolescence was more strongly associated with later adverse outcomes than was exposure at other points in childhood. Knowledge of age-specific associations is important information for policy makers who need to prioritize resources targeting disadvantaged children and youths.

The effects of unemployment on fertility.

We analyse the effects of unemployment on the likelihood of having a first and second birth in Denmark. The existing studies on this topic have generated contradictory results, and have made a weak case for the exogeneity of unemployment to fertility. We suggest that firm closures constitute an exogenous source of unemployment, and adopt firm closures as an instrument for estimating individuals' fertility responses. Using a life-course approach, we exploit unique administrative data from Denmark that include all Danish residents born in 1966 and followed between 1982 and 2006. The data contain monthly information about each individual's employment status, type of employer, relationship status and partner's characteristics; as well as very detailed fertility information, including on stillbirths and registered miscarriages. We find that unemployment has a positive effect on motherhood transitions and a negative effect on fatherhood transitions, although the latter is not robust to the inclusion of controls. We find no significant effect of unemployment on second births.

Information and communication technology-based assistive technology to compensate for impaired cognition in everyday life: a systematic review.

Purpose: A systematic review was performed evaluating the effectiveness of Information and Communication Technology-based Assistive Technology (ICT-based-AT) to compensate for impaired cognition in everyday life activities.Materials and methods: The study was registered in PROSPERO, registration number CRD42018114913. Six databases were searched (years 2008-2019).Inclusion criteria: Randomized controlled trials (RCTs) or cohort studies; people with impaired cognition due to non-degenerative diseases; and evaluation of ICT-based-ATs' effectiveness regarding activity and participation, including prospective memory, execution of tasks and satisfaction with task execution. Each study's level of evidence and quality were assessed using "JBI Levels of Evidence" and the "JBI Meta-Analysis of Statistics Assessment and Review Instrument", respectively.Results: About 3,153 publications were located, of which 12 were included. The levels of evidence were: 1.c (RCT) (n = 7), 1.d (pseudo-RCT) (n = 1) and 3.e (observational study without control group) (n = 4). Three studies had high quality (2 RCT/1 cohort), eight acceptable (5 RCT/3 cohort) and one low (RCT) quality.Conclusions: Smartphones, personal digital assistants (PDAs), etc. with e.g. calendars and reminder alarms can improve prospective memory, especially for people with ABI. Furthermore, PDAs and similar products with prompts can improve execution of tasks for people with cognitive impairment due to different diagnoses. Products should be tailored to the users' needs and the users trained in product use. Further studies concerning children, older people and people with intellectual and developmental disability are required; as well as studies on cost-effectiveness and the effectiveness of related services.Implications for rehabilitationIn order to support activity and participation in everyday life for people with prospective memory problems, especially people with acquired brain injury, they should be offered information and communication technology-based products, such smart phones, mobile phones, personal digital assistants or similar mainstream products equipped with reminding software.People with cognitive impairment having difficulties executing tasks independently should be offered PDAs and mobile telephones and similar products with prompting software, e.g. audio-verbal, picture and video-based task-sequencing prompts.The ICT-based products should be individually tailored, and the person should be trained in using the selected product.

Clustering of health, crime and social-welfare inequality in 4 million citizens from two nations.

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.

Traveling health-promoting infrastructures: A meta-ethnographic analysis.

In recent years, it has become increasingly important to understand the global circulation of healthcare innovations in nations' attempts to solve contemporary health challenges. This article is a systematic review and meta-ethnography-inspired analysis that explores the global circulation of health-related standards, protocols, procedures, and regulations, or what we term health-promoting infrastructures (HPIs). The notion of HPIs is defined as built networks that allow for the circulation of health expertise with the intention of promoting solutions that address global health problems. We conducted systematic searches in six relevant electronic databases and ended up with a set of 13 studies. The review shows that it takes arduous work to prepare and facilitate the travel of HPIs and to mold them into meaningful local forms. In conclusion, we argue that HPIs can helpfully be thought of as scripted forms, which are globally available in always sited efforts to address specific problems.