Prevalence of and factors associated with long-term sick leave in working-age adults with osteoarthritis: a retrospective cohort study conducted in Germany.

PURPOSE: Little is known about the impact of osteoarthritis on the long-term work participation of working-age adults. Therefore, the goal of this study was to investigate the prevalence of and the factors associated with long-term sick leave in people newly diagnosed with osteoarthritis from Germany. METHODS: This retrospective cohort study included patients aged 18-65 years diagnosed with osteoarthritis for the first time (index date) in 1 of 1198 general practices in Germany between 2016 and 2019 (Disease Analyzer database, IQVIA). Patients were considered to be on long-term sick leave if they were absent from work for medical reasons for more than 42 days in the year following the index date. Independent variables included sociodemographic characteristics, type of osteoarthritis, and frequent comorbidities. The association between these variables and long-term sick leave (dependent variable) was studied using an adjusted logistic regression model. RESULTS: This study included 51,034 patients with osteoarthritis [mean (standard deviation) age 50.8 (9.2) years; 50.9% women]. The prevalence of long-term sick leave was 36.2%. Younger age and male sex were positively and significantly associated with long-term sick leave compared with older age and female sex, respectively. There was also a strong relationship between several comorbidities (e.g., reaction to severe stress, and adjustment disorders, gastritis and duodenitis, and depression) with long-term sick leave. CONCLUSIONS: The prevalence of long-term sick leave was high in this sample of patients newly diagnosed with osteoarthritis from Germany. In this context, interventions should be implemented to increase the long-term working participation of people with osteoarthritis.

Exposure to discrimination and subsequent changes in self-rated health: prospective evidence from the UK's Life Opportunities Survey.

OBJECTIVES: We sought to estimate risk of poor self-rated health (SRH) following exposure to disability-related and other forms of overt discrimination in a cohort of working age adults. STUDY DESIGN: The study design is a population-based cohort survey. METHODS: Secondary analysis of data collected in Waves 1 and 2 of the UK's Life Opportunities Survey which at Wave 2 involved the participation of 12,789 working age adults. Adjusted prevalence rate ratios were used to estimate the impact of exposure to disability and non-disability discrimination on two measures of SRH at Wave 2, controlling for SRH status at Wave 1. RESULTS: Exposure to disability discrimination in the previous year was reported by 3.9% of working age British adults. Other forms of discrimination were reported less frequently (age: 3.7%, ethnicity: 2.5%, gender: 1.6%, religion: 0.8%, sexual orientation: 0.4%). In all analyses, there were stronger associations between exposure to disability discrimination and poor SRH at Wave 2 when compared with exposure to other forms of discrimination. CONCLUSIONS: Disability discrimination represents a violation of human rights. It is also likely to be a major contributor to the health inequities experienced by working age adults with disability.

Narratives of patient participation in haemodialysis.

AIM AND OBJECTIVE: To explore how working-age adults experience patient participation in hospital haemodialysis. BACKGROUND: End-stage kidney disease is a progressive, chronic condition imposing patients with high treatment burdens and low health-related quality of life. Patients face multiple medical decisions related to living with kidney failure. Given their frequent interaction with health services, patient participation may be of special value. DESIGN: Qualitative design with a narrative approach. METHODS: In 2018, eleven patients aged 35-64 years undergoing hospital haemodialysis participated in individual interviews. All interviews were analysed using a narrative approach. Reporting followed the Consolidated criteria for Reporting Qualitative Research guidelines. FINDINGS: The patients' narratives of participation comprised three themes following their healthcare trajectory: Informed, but not involved in treatment choices; Duality of care and control; and Frail trust reflecting collaborative deficiencies. The patients received good information about dialysis, but were not involved in choice of treatment modality. Professional work, as well as the nature of treatment, contributed to restricted patient autonomy. Patients' trust suffered from collaborative deficiency generating delays in their treatment trajectories, and patients extended their responsibility into the coordination of transitions as a way of coping with these issues. CONCLUSIONS: The study identified challenges related to patient involvement and interdisciplinary collaboration. Involving patients through dialogue and acknowledging their experiences, preferences and lifestyles may strengthen the mutual patient-professional understanding of treatment. Despite increased focus on seamless trajectories, patients face obstacles regarding interdisciplinary collaboration and coordination of health services. RELEVANCE TO CLINICAL PRACTICE: The findings indicate a want of individually customised care for people requiring dialysis. Patients need to be involved in the choice of treatment modality as well as decisions related to the current treatment. Information must include potential consequences of the different treatment modalities. Health services need to strengthen collaboration in order to secure treatment continuity and patient involvement.

Changes in consumption of food away from home and intakes of energy and other nutrients among US working-age adults, 2005-2014.

OBJECTIVE: To document changes in consumption of food away from home (FAFH) and intakes of selected nutrients by working-age adults between 2005-06 and 2013-14, covering the most recent recessionary period and recovery. DESIGN: Means were compared across survey rounds relative to 2005-06. Multivariate regression was used to account for changes in demographic characteristics over time. SETTING: National Health and Nutrition Examination Survey (NHANES), 2005-2014. SUBJECTS: Working-age adults born in 1951-80 (n 12 129) and adolescents and young adults born in 1981-90 (n 5197) who reported day 1 dietary intake data. RESULTS: Approximately 34 % of energy consumed by working-age adults came from FAFH (14 % from fast foods) in 2005-06. Levels of FAFH consumption were lowest in 2009-10, at 28 and 11 % of energy from FAFH and fast foods, respectively. Percentage of energy from fast foods was 1·9 percentage points higher in 2013-14. Percentage of energy from saturated fat and total mg of cholesterol consumed were lower in 2009-14, while intake of fibre was higher in 2011-14. At-home foods had less saturated fat and more fibre in 2009-14. The greater the percentage of energy from FAFH in the day, the greater the intakes of fat and cholesterol. Percentage of energy from FAFH was highest among those born in 1981-90 and lowest among those born in 1951-60. CONCLUSIONS: FAFH is a significant source of energy, fat and cholesterol among working-age adults. Menu labelling may lower FAFH's energy content and make it easier for consumers to choose more healthful items.

Kidney Supportive Care for Working-Age Adults with Chronic Kidney Disease: A Profile of Characteristics and Symptom Burden.

INTRODUCTION: Chronic kidney disease (CKD) affects people across their lifespan. Kidney supportive care (KSC) is typically offered for older people for symptom management, education, and/or advance care planning (ACP). However, younger people may also benefit from KSC. This study sought to explore characteristics of working-age adults with CKD accessing KSC. METHODS: Using a cross-sectional design, working-age adults (18-64 years) with CKD referred to a KSC service from February 2016 to July 2021 were included. Demographic and clinical data were extracted from patients' hospital records. Self-reported symptoms (Integrated Palliative Care Outcome Scale renal [IPOS-renal]) and health-related quality of life (European quality of life [EQ-5D-5L]) were assessed. Reasons for referral to KSC, kidney replacement therapy (KRT) pathway at referral, and comorbidity calculated using the Charlson Comorbidity Index were also assessed. RESULTS: One Hundred Fifty-six working-age adults attended the KSC service. Median age was 57 years, with more than half receiving KRT. Weakness (92.2%), poor mobility (83.3%), and pain (82.5%) were the most prevalent and severe symptoms. The majority were referred for symptom management (n = 83, 53.2%) and 27% for ACP (n = 42). The ACP completion rate was low (28.9%). Those on dialysis had significantly higher symptom scores than those not receiving dialysis (p < 0.05). CONCLUSION: Working-age adults with CKD experience a significant and debilitating symptom burden and need to consider options for treatment. This study provides new understanding about working-age adults with CKD that may help provide the specific support needed to meet their end-of-life care needs.

Social Infrastructure Availability and Suicide Rates among Working-Age Adults in the United States.

Social infrastructure (SI) may buffer against suicide risk by improving social cohesion, social support, and information and resource sharing. This study uses an ecological approach to examine the relationship between county-level SI availability and suicide rates among working-age adults (ages 25-64) in the United States, a population for whom suicide rates are high, rising, and geographically unequal. Mortality data are from the National Vital Statistics System for 2016-2019. SI data are from the National Neighborhood Data Archive for 2013-2015 and capture the availability of typically free SI (e.g. libraries, community centers) and commercial SI (e.g. coffee shops, diners, entertainment venues). Results from negative binomial models show that suicide rates are significantly lower in counties with more SI availability, net of county demographic, socioeconomic, and health care factors. This relationship held for both typically free and commercial SI. Policymakers should consider strengthening existing and developing new social infrastructure, particularly in counties with less educated populations, as part of a broader strategy to reduce suicide rates in the United States.

The differences of metabolic profiles, socioeconomic status and diabetic retinopathy in U.S. working-age and elderly adults with diabetes: results from NHANES 1999-2018.

AIMS: Controlled metabolic factors and socioeconomic status (SES) was crucial for prevention of diabetic retinopathy (DR). The study aims to assess the metabolic factors control and SES among working-age adults (18-64 years) with diabetes compared to older adults (65 years and older). METHODS: Totals of 6738 participants with self-reported diagnosed diabetes from National Health and Nutrition Examination Survey were included, of whom 3482 were working-age and 3256 were elderly. The prevalence of DR, metabolic factors control, and the impact of SES and diabetic duration on DR was estimated. Subgroup analysis among working-age adults was employed across different diabetic duration and SES level. RESULTS: The prevalence of DR was 20.8% among working-age adults and 20.6% in elderly adults. Further, working-age adults possessed suboptimal control on glycemia (median HbA1c: 7.0% vs. 6.8%, p < 0.001) and lipids (Low-density lipoprotein < 100 mg/dL: 46.4% vs. 63.5%, p < 0.001), but better blood pressure control (< 130/80 mmHg: 53.5% vs. 37.5%, p < 0.001) compared to the elderly, judging based on age-specific control targets. Prolonged diabetic duration didn't improve glycemic and composite factors control. SES like education and income impacted metabolic factors control and adults with higher SES were more likely to control well. Diabetic duration was a significant risk factor (OR = 4.006, 95%CI= (2.752,5.832), p < 0.001) while higher income (OR = 0.590, 95%CI= (0.421,0.826), p = 0.002) and educational level (OR = 0.637, 95%CI= (0.457,0.889), p = 0.008) were protective against DR. CONCLUSIONS: Working-age adults with diabetes demonstrate suboptimal metabolic profile control, especially glycemia and lipids. Additional efforts are needed to improve metabolic factor control and reduce DR risk, particularly for those with longer diabetes duration, less education, and lower incomes.

Cannabis use, social support and social engagement among working-age adults in rural America.

Objective: Cannabis use has been linked to physical, psychological, and behavioral changes. Although research indicates separately that informal social support and formal social engagement - which are correlated measures - serve as protective factors in cannabis use, much of this research focuses on youth and more urban samples, limiting our understanding of if these findings are true for rural populations where social support and social engagement are particularly important for health and health behaviors. To fill the research gap, this study examines the effects of informal social support (tangible support and emotional support) and formal social engagement on cannabis use among rural working-age adults. Methods: This research analyzed 1,122 observations from a cross-sectional online survey conducted in 2022 of working-age adults (18-64) from rural America. Multilevel logistic regression models were used to predict cannabis use in the past 12 months using informal social support (tangible support and emotional support) and formal social engagement and other sociodemographic covariates and state legalization status. Results: Multilevel logistic modeling indicates that low emotional support and low formal social engagement are associated with a higher odds of reporting cannabis use in the past 12 months among rural working-age adults, net of other sociodemographic variables and state legalization status. Conclusions: The study suggests that emotional support and social engagement may contribute to cannabis use prevention among rural working-age adults. These findings should inform future research as well as the development of tailored health interventions targeting rural working-age adults.

Watchful, skeptics, and system distrusters: Characteristics associated with different types of COVID-19 vaccine hesitancy among U.S. working-age adults.

COVID-19 vaccine hesitancy is complex, with adults identifying various reasons for not getting vaccinated. Using data from the 2022 National Wellbeing Survey on 7612 U.S. adults aged 18-64, we identified how age, race/ethnicity, sex, marital status, education, income, employment status, partisanship, and metropolitan status are associated with COVID-19 vaccination status and three non-mutually exclusive types of vaccine hesitancy: 1) watchful, concerned about vaccine side effects and efficacy; 2) skeptics, distrust the vaccine, and 3) system distrusters, distrust government. A third of respondents overall (N = 2643) had not received at least one dose at the time of the survey. Among respondents who were not vaccinated, 67 % are classified as watchful, 53 % are skeptics, and 32 % are system distrusters. Results from logistic regression show that concerns about side effects and safety (watchfulness) appear to be major drivers for not getting vaccinated among females and among non-Hispanic Black and unmarried adults, whereas skepticism and distrust appear to be more important barriers among ages 25-44. All three types of hesitancy appear to be important contributors to lower vaccination uptake among low-income, low-education, and unemployed adults, and among individuals who voted for Donald Trump in the 2020 election (with skepticism and distrust being most endorsed by this group). Findings suggest that universal messaging and intervention strategies are unlikely to be effective in reducing vaccine hesitancy. Different messages, messengers, and tactics must be used with different groups.

Trends of Low Back Pain Research in Older and Working-Age Adults from 1993 to 2023: A Bibliometric Analysis.

Although the number of publications focusing on low back pain in older adults (LBP-O) and working-age adults (LBP-W) has been growing for decades, comparative research trends in these two populations, which may help to guide future investigation, have not been rigorously explored. This analysis aimed to describe publication patterns and trends of research targeting LBP-O and LBP-W over the last three decades. Peer-reviewed LBP-O and LBP-W articles published between 1993 and 2023 were retrieved from the Web of Science, which provided the details of annual publication volume, and prominent journals/countries/institutions. The relationship between the annual publication volumes and years was analyzed by Spearman correlation analysis. The hot topics and emerging trends were analyzed by VOSviewer and CiteSpace, respectively. A total of 4217 LBP-O-related and 50,559 LBP-W-related documents were included. The annual publication volumes of LBP-O and LBP-W articles increased over the years (r=0.995 to 0.998, p<0.001). The United States had the highest number of prominent institutions publishing relevant articles. The most prolific journal for LBP-O (5.4%) and LBP-W-related (6.1%) papers is the journal "Spine". Cognitive behavioral therapy, intervertebral disc (IVD) degeneration, physiotherapy, physical activity, and walking were the recent hot topics and physical activity was an emerging trend in LBP-O, while surgery and IVD degeneration (also a hot topic) were emerging trends in LBP-W. This study highlights the paucity of LBP-O-related research in the past. The United States and the journal Spine stand out in LBP research. The research trend of physical activity in LBP-O is consistent with the recognized importance of physical activity for older adults in general, and for managing LBP-O in particular. Conversely, the emerging trends of surgery and intervertebral disc degeneration in LBP-W research highlight a focus on the biomedical model of LBP despite LBP being a biopsychosocial condition.

U.S. States' COVID-19 physical distancing policies and working-age adult mental health outcomes.

In the early months of the COVID-19 pandemic, states enacted multiple policies to reduce in-person interactions. Scholars have speculated that these policies may have contributed to adverse mental health outcomes. This study examines potential associations between states' COVID-19 physical distancing policies and working-age (18-64) adults' self-reported mental health. Mental health outcomes (depression, anxiety, worsened mental health, and sought treatment for anxiety or depression) are from the National Wellbeing Survey collected from working-age adults in the United States (U.S.) February 1 to March 18, 2021 (N = 3,804). Data on 12 state policies are from the COVID-19 U.S. State Policy Database. Analyses included logistic regression and Bayesian group index modeling, which identified sets, or "bundles," of policies that were associated with each mental health outcome. Multiple policies (both separately and in bundles) were associated with adverse mental health outcomes, with certain policies (closures and curfews on retail and other businesses) being particularly important. A one-month increase in exposure to respective model-derived physical distancing policy bundles was associated with a 36% increase in the odds of reporting that COVID-19 worsened one's mental health (odds ratio [OR] = 1·36; 95% credible interval [CRI] = 1·01 to 1·80), a 6% increase in the odds of meeting the clinical threshold for anxiety (OR = 1·06; CRI = 0·99 to 1·16), and a 15% increase in the odds of seeking treatment for anxiety or depression (OR = 1·15; CRI = 1·02 to 1·49). To accurately understand the role of states' COVID-19 policies on mental health during the pandemic, researchers must consider how collections of policies might influence outcomes.

Relationship between Nutrient Intake and Hearing Loss According to the Income Level of Working-Aged Adults: A Korean National Health and Nutrition Survey.

The relationship between hearing impairment and nutrition has been extensively investigated; however, few studies have focused on this topic in working-age adults by income level. Herein, we aimed to determine the differences in hearing impairment among working-age adults by income level and identify the nutritional factors that affect hearing loss in various socioeconomic groups. Seven-hundred-and-twenty participants had hearing impairment, while 10,130 had normal hearing. After adjustment for propensity score matching, income and smoking status were identified as significant variables. By assessing the relationship between hearing impairment and nutrient intake by income level using multiple regression analyses, significant nutrients differed for each income category. Carbohydrate and vitamin C levels were significant in the low-income group; protein, fat, and vitamin B1 levels were significant in the middle-income group; and carbohydrates were significant in the high-income group. Income was significantly associated with hearing impairment in working-age adults. The proportion of individuals with hearing impairment increased as income decreased. The association between hearing impairment and nutritional intake also differed by income level. Our findings may enable the establishment of health policies for preventing hearing impairment in working-age adults by income level.

Post-COVID-19 Status and Its Physical, Nutritional, Psychological, and Social Effects in Working-Age Adults-A Prospective Questionnaire Study.

BACKGROUND: The main objective of this study was to evaluate the evolution of physical and daily routine, dietary habits, and mental and social health in individuals with recent COVID-19 infection. METHODS: A qualitative prospective cross-sectional study was conducted from 01 October 2021 to 01 March 2022, which included 80 working-age adults from the territory of Central Serbia who had PCR-confirmed SARS-CoV-2 infection in the previous six months. Two structured pre-coded closed-ended questionnaires were submitted to the participants: a questionnaire about post-COVID-19 status (pCOVq) and a shortened version of the World Health Organization's Quality of Life Scale (WHOQOL-BREF). RESULTS: The presence of the COVID-19 disease in the previous period of 6 months among the working-age participants significantly affected the duration of aerobic, anaerobic, and high-intensity physical activities, but also the possibility of performing certain activities such as walking, which represents basic aerobic activity and a measure of general health among middle-aged participants. In the majority of cases (78%), in the post-COVID-19 period, participants indicated a decline in educational and productive activities. CONCLUSION: Post-COVID status in working-aged participants consists of reduced physical activity, lower quality of life, and similar nutritional habits. Health policies should be more focused on these findings.

Perspectives of working-age adults with aphasia regarding social participation.

BACKGROUND: Working-age adults with aphasia experience difficulties in social participation, specifically fulfilling social roles and reintegrating into communities. Literature regarding social participation of people with aphasia (PWA) is predominantly based on studies conducted in high-income countries (HIC), limiting generalisability of findings. Perspectives of social participation are influenced by person, place and cultural background warranting investigation in heterogeneous low- and middle-income countries (LMICs), like South Africa. OBJECTIVES: Describe perspectives of working-age adults with aphasia regarding social participation within the first 2 years post-incident. METHOD: Semi-structured interviews gained perspectives of 10 working-age adults (with mild to moderate aphasia) using principles of supported conversation for adults with aphasia. Data were thematically analysed to describe participants' perspectives of social participation. RESULTS: Seven themes were identified pertaining to participants' perspectives of social participation. Participants considered rehabilitation services, faith-related activities and returning to work as valued areas of social participation. Previous interests, presence of support and characteristics of communication partners determined their preference and willingness to participate with others. Finally, personal attitudes and feelings continued to influence their perspectives of social participation, as well as their motivation to participate. CONCLUSION: Successful social participation was dependent on the PWA's perceived value of social activities and presence of support from significant others. Speech-language therapists are in the ideal position to facilitate PWA's communication abilities and their experience of successful participation through the implementation of person-centered care and community-led intervention. This study provided a preliminary investigation of social participation in South Africa and further investigation is warranted.

Preventing Suicide Among Working-Age Adults: The Correlates of Help-Seeking Behavior.

We aimed to identify the correlates with not seeking help among working-age adults with suicidal ideation. By adapting the integrated model of suicide help-seeking, we examined help-seeking behavior in the following 3 stages: problem recognition, decision to seek help, and sources of help. We used a sample of working-age adults between 26 and 64 years old, who reported suicidal ideation in the past year (N = 1414). Data were drawn from the 2011 and 2012 National Survey on Drug Use and Health, and multinomial logistic regression analyses were applied. Findings suggested that being male, being nonwhite, being employed full-time, having lower levels of general mental health needs, and not having health insurance were associated with not seeking help. Results also indicated how each factor was related in the help-seeking pathway. Strategies to help problem recognition can be effective in enhancing help-seeking behavior among men, racial/ethnic minorities, and those without serious clinical conditions. Help-seeking interventions for working-age adults with suicidal ideation should also consider that race/ethnic minorities and those with lower levels of functional impairment might rely on alternative sources of help, such as family, friends, and religious advisors.

Perspectives of adults with disabilities on access to health care after the ACA: Qualitative findings.

BACKGROUND: Although health insurance gains are documented, little is known about personal experiences of adults with disabilities in accessing health care after coverage expansions of the Affordable Care Act (ACA) in 2014. OBJECTIVE/HYPOTHESIS: We interviewed 22 adults across the U.S. with a variety of disabilities and health insurance types to document remaining barriers to health care after ACA coverage expansions. METHODS: Telephone interviews were conducted from May to August 2017. Participants were recruited via disability-related organizations and were demographically and geographically diverse. Content analysis of interview transcripts was used to identify major themes related to accessing health care. RESULTS: Five major themes emerged: 1) information and understanding of coverage; 2) out-of-pocket costs; 3) prescription medications; 4) provider networks; and 5) transportation. Barriers in these areas led participants to delay or forgo health care and interfered with their ability to participate in paid employment. CONCLUSIONS: The ACA was intended to expand access to insurance coverage, not necessarily meet all health care related needs for people with disabilities. Many barriers remain to accessing needed care for this population, regardless of insurance status. Limited prescription coverage, limited provider networks and steep out-of-pocket costs may be addressed by policy makers at the state or national level. Similarly, having timely and accurate plan information is important in facilitating access to care and insurers should be aware that outdated information can result in missed care. Finally, transportation to appointments can be especially challenging for people with disabilities and insurers should consider options to address this issue.

Validation of Thai version of the Health Literacy in Dentistry scale: Validation among Thai adults with physical disabilities.

AIM: To validate the Thai version of the Health Literacy in Dentistry scale (HeLD-Th) among Thai adults with physical disabilities. METHODS: The original Health Literacy in Dentistry (HeLD) was translated into Thai (HeLD-Th). The final version of the HeLD-Th was evaluated through a cross-sectional study of 160 participants in Thailand. Interview questionnaires and oral examination were performed. The reliability and validity of the HeLD-Th were determined. RESULTS: The internal consistency was acceptable, with an overall Cronbach's alpha of 0.76. The face and content validity were confirmed. Sufficient construct validity was revealed by exploratory factor analysis. The convergent validity (P ≤ .013) and discriminant validity (P = .017) were estimated. The concurrent validity and predictive validity were confirmed by significantly higher HeLD-Th scores (P < .001). Multiple linear regression analyses indicated that approximately 60% of the variation in the HeLD-Th scores was explained by the final model. CONCLUSION: The HeLD-Th has sufficient psychometric properties to assess the oral health literacy of Thai adults with mild to moderate disabilities. There are some limitations of the study due to the small sample size, and the results are specific to Thai adults with disabilities. Future studies using the HeLD-Th scale are recommended.