Prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in the South Gondar zone primary hospitals, North-West Ethiopia: an institution-based cross-sectional study.

OBJECTIVE: To assess the prevalence and associated factors of neurocognitive disorder among people living with HIV/AIDS in South Gondar primary hospitals, North-West Ethiopia, 2023. DESIGN: Institution-based cross-sectional study design. SETTING: South Gondar primary hospitals, North-West Ethiopia. PARTICIPANTS: 608 participants were recruited using the systematic random sampling technique. MEASUREMENT: Data were collected using an interviewer-administered questionnaire and medical chart reviews. The International HIV Dementia Scale was used to screen for neurocognitive disorder. The data were entered through EPI-DATA V.4.6 and exported to SPSS V.21 statistical software for analysis. In the bivariable logistic regression analyses, variables with a value of p<0.25 were entered into a multivariable logistic regression analysis to identify factors independently associated with neurocognitive disorder. Statistical significance was declared at a value of p<0.05. RESULTS: The prevalence of neurocognitive disorder among HIV-positive participants was 39.1%. In multivariable logistic regression, lower level of education (adjusted OR (AOR)=2.94; 95% CI 1.29 to 6.82), unemployment (AOR=2.74; 95% CI 1.29 to 6.84) and comorbid medical illness (AOR=1.80; 95% CI 1.03 to 3.14) were significantly associated with neurocognitive disorder. CONCLUSION: HIV-associated neurocognitive problems affected over a third of the participants. According to the current study, comorbid medical conditions, unemployment and low educational attainment are associated with an increased risk of neurocognitive disorder. Therefore, early detection and treatment are essential.

How do labour market conditions explain the development of mental health over the life-course? a conceptual integration of the ecological model with life-course epidemiology in an integrative review of results from the Northern Swedish Cohort.

BACKGROUND: The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner's ecological model with mainly earlier theoretical work on life-course theory. METHODS: An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner's ecological framework combined with life-course theories. RESULTS: The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals' mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals' exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model CONCLUSION: Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.

Predictors of MOUD referral among persons with involvement in the criminal legal system.

INTRODUCTION: Opioid use disorder (OUD) is a significant cause of opioid-related fatality, and while medications to treat OUD (MOUD) are effective, disparities remain in the access and uptake of such medications. This study investigated factors that may influence referral to and initiation of MOUD treatment. METHODS: Data from electronic medical records of 677 patients with a history of criminal legal system involvement in a recovery program were used to examine the flow of MOUD referral. RESULTS: Among patients identified as potentially eligible for MOUD treatment, about 38.0 percent were referred and 18.8 percent were confirmed to initiate MOUD treatment. Logistic regression analyses highlighted female gender and unemployment due to incarceration as positive and negative predictors of referral, respectively. The Chi-square test revealed that women and uninsured patients were more likely to initiate referred MOUD treatment. CONCLUSIONS: Data highlight the need for greater connection between referral agencies and MOUD treatment providers, considering factors that may influence referral.

Overindebtedness, unemployment, and poor mental health - and the role of sense of control: a population-based Swiss study.

Background: Both overindebtedness and unemployment are critical life events that can result in or lead to poor mental health. What is less known is that the two partly interrelated events frequently go along with a feeling of loss or lack of control in life, which could be the main reason why they are associated with poor mental health. This has not been examined in previous research, particularly not in this combination. Methods: This study used and merged two cross-sectional data sets. Data collected in 2019 on 219 overindebted clients of the four official debt advisory centers in the Canton of Zurich were linked with a comparable subsample of 1,997 respondents from the Swiss Health Survey of 2017. The entire study population covered 2,216 adult individuals living in the Canton of Zurich. Results: The prevalence of no or low sense of control, medium to high psychological distress, and moderate to major depression was much higher among the 44 solely unemployed (36/30/12%), the 189 solely overindebted (73/83/53%), and particularly among the 30 unemployed and overindebted (93/97/60%) than among all 1,953 other survey participants (21/13/7%). Unemployment, overindebtedness, and a (resulting) lack or loss of control were all found to be strong risk factors for the two mental health outcomes under study. Associations, or rather negative health effects, were partly but not fully mediated by the sense of control. Overindebtedness much more strongly predicted psychological distress (ß = -0.37) and depression (ß = 0.17) than unemployment (ß = -0.05/0.01). The sense of control turned out to be an independent explanatory factor for poor mental health and even the strongest of all (ß = 0.49/-0.59). Conclusion: Improving a person's control beliefs could be a promising measure for preventing mental health disorders in general and in people who are unemployed and/or overindebted in particular.

Efficacy of the iJobs Web-Based Psychoeducational Intervention to Improve Job Search Behavior and Promote Mental Health Among Unemployed People: Protocol for a Waitlist Randomized Controlled Trial.

BACKGROUND: Unemployment affects millions of people worldwide and, beyond its economic impact, has severe implications for people's well-being and mental health. Different programs have been developed in response to this phenomenon, but to date, job-search interventions have proved to be most effective, especially the JOBS II program. The JOBS II program proved not only to be effective for re-employment but also has a positive impact on beneficiaries' mental health (ie, reduces anxiety or depression). However, by now, this evidence-based program has been delivered only on site in the various countries where it was implemented. In the digital era, web-based alternatives to such programs are highly needed because they have the advantages of scalability and cost-effectiveness. OBJECTIVE: In this context, we aim to investigate the efficacy of iJobs, the web-based adaptation of the JOBS II program, on job-search intensity and effort, the quality of job-search behaviors, and job-search self-efficacy. Further, 1 month after the intervention, we will also assess the employment status and the satisfaction with the job (if applicable). This study will also investigate the effect of iJobs on well-being and mental health (ie, anxiety and depression). METHODS: This study is a 2-arm randomized controlled trial. The 2 independent groups (intervention vs waiting list control group) will be crossed with 3 measurement times (ie, baseline, the postintervention time point, and 1-month follow-up). The design will be a 2 (intervention vs control) × 3 (baseline, the postintervention time point, and 1-month follow-up) factorial design. iJobs is a 2-week intervention consisting of 6 modules: an introductive module and 5 modules adapted from the original JOBS II program to the web-based setting and Romanian population. The web-based intervention also has a human component, as beneficiaries receive personalized written feedback after each module on the platform from a team of psychologists involved in the project. RESULTS: The enrollment of study participants started in June 2023 and is expected to end in May 2024. The data collection is expected to be completed by July 2024. The results are expected to be submitted for publication in the summer of 2024. CONCLUSIONS: This study is the first large-scale randomized controlled trial aiming to test the efficacy of a web-based adaptation of the JOBS II program. If our results support the efficacy of iJobs, they will offer the premise for it to become an evidence-based, accessible alternative for unemployed people in Romania and might be implemented in other countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT05962554; https://clinicaltrials.gov/study/NCT05962554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/55374.

Psychological implications of unemployment among higher educated migrant youth in Kolkata City, India.

Mental health issues are intricately linked to socioeconomic background, employment and migration status. However, there remains a gap in understanding the mental health challenges faced by graduate youth in India, particularly in Kolkata City. This study aims to assess the prevalence and associated risk factors of depression, anxiety, and stress among higher-educated migrant youth. A survey was conducted on four hundred migrant graduate youths aged 21-35 residing in Kolkata. Measures included socio-demographics and the Depression Anxiety Stress Scale (DASS-21). Chi-square tests and binary logistic regression were employed to identify factors associated with mental health issues. The overall prevalence rates were 54.4% for depression, 61.8% for anxiety, and 47.9% for stress. Unemployed youths exhibited significantly more symptoms of depression and anxiety than their employed counter parts. The logistic regression model showed that unemployed youth, female sex, never married, and second- and third-time migrant youths were risk factors for high scores on the DASS-21. This study showed that mental health issues were alarming in the higher educated migrant youth. The study suggests the implementation of skill-based, job-oriented, and professional courses at the graduation level to prevent graduates from being rendered unproductive and jobless. Beside these, regular psychological support should be provided to the higher educated youth by the local governments.

Precarious employment in young adulthood and later alcohol-related morbidity: a register-based cohort study.

OBJECTIVES: The prevalence of precarious employment is increasing, particularly among young adults where less is known about the long-term health consequences. The present study aims to test if being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life. METHODS: A register-based cohort study was conducted in Sweden. The Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was used to identify individuals who were aged 27 years between 2000 and 2003 (n=339 403). Information on labour market position (precarious employment, long-term unemployment, substandard employment and standard employment relations) was collected for young people 3 years after graduation from school using nationwide registers. Details about alcohol-related morbidity during a 28-year follow-up period were collected from the National Hospital Discharge Register. Data on sex, age, country of birth, education and previous poor health were also obtained from the registers. RESULTS: Young adults in precarious employment had an increased risk of alcohol-related morbidity compared with individuals of the same age in standard employment (HR 1.43, 95% CI 1.32 to 1.55), after adjusting for several important covariates. A stronger association was found among young men who were precariously employed compared with young women. CONCLUSION: This nationwide register-based study conducted in Sweden with a long-term follow-up suggests that being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.

Modelling for disability: How does artificial intelligence affect unemployment among people with disability? An empirical analysis of linear and nonlinear effects.

There is a growing debate among scholars regarding the impact of artificial intelligence (AI) on the employment opportunities and professional development of people with disability. Although there has been an increasing body of empirical research on the topic, it has generally yielded conflicting findings. This study contributes to the ongoing debate by examining the linear and nonlinear effects of AI on the unemployment of people with disability in 40 countries between 2007 and 2021. Using the system Generalized Methods of Moments and panel smooth transition regression, the main conclusions are as follows. First, AI reduces the unemployment of people with disability in the full sample. Second, upon disaggregating the sample based on income level (high income/non-high income) and gender (men/women), the linear model only detects an inverse correlation between AI and unemployment among people with disability in high-income countries and among men, whereas it does not influence unemployment in non-high-income countries and women. Third, the panel smooth transition regression model suggests that the effects of AI on the unemployment of people with disability and among women are only observed once artificial intelligence interest search exceeds a specific threshold level. The effects of AI in non-high-income economies and among women are not significant in the lower regime, which confirms the nonlinear association between AI and the unemployment rate of people with disability. These findings have important policy implications for facilitating the integration of people with disability into the labor market.

Diversity patterns in non-standard employment and their relationship with self-rated health in urban China from 2010 to 2021.

In recent decades, the rise of non-standard employment in China is thought to profoundly influence workers' health. Using data from the China General Social Survey 2010-2021, this study compares the self-rated health of workers engaged in various non-standard employment types with those in unemployment or standard employment in urban China. The research also investigates how these patterns have evolved over time among urban residents with different hukou types amid the expansion of China's welfare system and labor market shifts. We find that while unemployment is significantly related to worse self-rated health, the effects vary across different types of non-standard employment. Precarious employment has a more substantial adverse effect on health than part-time and self-employment, although the effect is less severe than that of unemployment. Between 2010 and 2018, the health impact of precarious employment declined, aligning with China's enhanced welfare system. However, its negative effect re-emerged in 2021. These patterns are particularly pronounced for urban residents holding agricultural hukou, highlighting the intersection of non-standard employment with the household registration system in shaping health outcomes within evolving labor markets.

Changes in family situation and concurrent changes in working life: a 15-year longitudinal analysis.

OBJECTIVE: Currently, little is known regarding changes in family situation with concurrent changes in working life. This study aimed to examine whether changes in family situation (based on living with children and/or marrying/divorcing) were associated with changes in working life and whether the associations were influenced by sex, genetics and early life environment. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Data from Swedish national registers of 16 410 twins were used. Fixed-effects logistic regression models assessing ORs with 95% CIs were applied to examine associations between changes in family situation and working life controlling for time-invariant effects and adjusted for covariates, and conditional models to account for confounding of genetics and early life environment. RESULTS: Changes in individuals life situation from being single and living without children to married and living with children were associated with transitioning from unsustainable (ie, having unemployment or sickness absence/disability pension) to sustainable working life (men: OR 2.40, 95% CI 2.26 to 2.56; women: OR 1.68, 95% CI 1.59 to 1.78). Changes from being married to single, in contrast, attenuated the likelihood of transitioning to a sustainable working life. Moreover, changes in men's working life seem to be more dependent on changes in family situation compared with women. Genetic factors and early life environment play a role in the associations. CONCLUSIONS: Family formation increases the likelihood of a more stable working life whereas divorce is a risk factor for work interruptions. Our study emphasises that family formation improves the work life situation and to a higher degree for men.

Impacts of Working Hours, Wages, and Regular Employment Opportunity on Suicide Mortalities of Employed and Unemployed Individuals before and during the COVID-19 Pandemic in Japan.

Standardized suicide mortality rates per 100,000 population (SMRs) in Japan consistently decreased from 2009-2019, but these decreasing trends were reversed to increase in 2020. To clarify the mechanisms of recent increasing suicide in Japan, temporal fluctuations of SMRs disaggregated by sex and employment status (employed and unemployed individuals) and labor indices such as working hours, wages, and regular employment opportunity index (REO) from January 2012 to June 2023 were analyzed using interrupted time-series analysis. Additionally, temporal causalities from labor indices to SMRs were analyzed using vector autoregressive and non-linear auto-regressive distributed lag analyses. Decreasing trends among employed SMRs of both sexes were attenuated after the enactment of the "Work Style Reform Program" in 2018, but male SMRs were unaffected by the COVID-19 pandemic. However, female employed SMRs sharply increased, synchronized with the "Work Style Reform Act" and the COVID-19 pandemic outbreak (the COVID-19 impact was greater than the "Work Style Reform Act"). Additionally, unemployed SMRs of both sexes sharply increased with the revision and scale-down of countermeasures against economic deterioration caused by COVID-19 ("revision of economic supportive countermeasures against economic deterioration caused by COVID-19"). Unexpectedly, after enacting the "Work Style Reform Act", wages decreased due to possibly decreasing working hours. Increasing REO, which consistently increased, was a protective factor for male suicides, but unemployed SMRs were not affected by any labor indices. It has been established that controlling a heavy workload plays an important role in suppressing the deterioration of physical and mental conditions, including suicide; however, this study suggested that, at least within appropriate ranges of working hours, decreasing working hours due to excessive management probably contributes to increasing suicides of some vulnerable individuals via de-creasing their wages. Although governmental welfare and economic support measures had to be revised according to rapidly changing situations during the COVID-19 pandemic, this study also suggested that temporal gaps among a part of revisions of several welfare and economic support measures were unexpectedly involved in drastically/sharply increasing suicides of unemployed individuals in 2022.

Long-term benzodiazepine use and risk of labor market marginalization in Finland: A cohort study with 5-year follow-up.

BACKGROUND: Benzodiazepines and related drugs (BZDRs) are widely used in the treatment of anxiety and sleep disorders, but cognitive adverse effects have been reported in long-term use, and these may increase the risk of labor market marginalization (LMM). The aim of this study was to investigate whether the risk of LMM is associated with new long-term BZDR use compared to short-term use. METHODS: This register-based nationwide cohort study from Finland included 37,703 incident BZDR users aged 18-60 years who initiated BZDR use in 2006. During the first year of use, BZDR users were categorized as long-term users (≥180 days) versus short-term users based on PRE2DUP method. The main outcome was LMM, defined as receipt of disability pension, long-term sickness absence (>90 days), or long-term unemployment (>180 days). The risk of outcomes was analyzed with Cox regression models, adjusted with sociodemographic background, somatic and psychiatric morbidity, other types of medication and previous sickness absence. RESULTS: During 5 years of follow-up, long-term use (34.4%, N = 12,962) was associated with 27% (adjusted Hazard Ratio, aHR 1.27, 95% CI 1.23-1.31) increased risk of LMM compared with short-term use. Long-term use was associated with 42% (aHR 1.42, 95% CI 1.34-1.50) increased risk of disability pension and 26% increased risk of both long-term unemployment and long-term sickness absence. CONCLUSIONS: These results indicate that long-term use of BZDRs is associated with increased risk of dropping out from labor market. This may be partly explained by cognitive adverse effects of prolonged BZDR use, which should be taken into account when prescribing BZDRs.

The relationship between money supply and inflation in Pakistan.

This paper investigates the long-run and short-run relationship between money supply and inflation in Pakistan, utilizing annual data spanning from 1981 to 2021. The key objective is to assess the impact of monetary policy, specifically money supply, on inflation dynamics in the country. To achieve this, the Autoregressive Distributed Lag (ARDL) bounds testing approach is employed, which is suitable for analyzing cointegration among variables with mixed integration orders. The results reveal both short and long-run cointegration between inflation, money supply, unemployment, and interest rates. Notably, unemployment demonstrates a negative correlation with inflation, while money supply and interest rates exhibit a positive relationship. These findings underscore the importance of dedicated policy measures to manage inflation effectively. The paper concludes by recommending the establishment of a policy implementation body and collaboration between the government and the central bank to ensure financial stability and control inflation through well-calibrated monetary and fiscal policies.

Association between maternal employment status and presence of children with major congenital anomalies in Denmark.

IMPORTANCE: The burden of caring for children with complex medical problems such as major congenital anomalies falls principally on mothers, who in turn suffer a variety of potentially severe economic consequences. As well, health consequences of caregiving often further impact the social and economic prospects of mothers of children with major congenital anomalies (MCMCAs). Evaluating the long-term economic consequences of extensive in-home caregiving among MCMCAs can inform strategies to mitigate these effects. OBJECTIVE: To assess whether MCMCAs face reduced employment and increased need for disability benefits over a 20-year period. DESIGN: A population-based matched cohort study. SETTING: Denmark. PARTICIPANTS: All women who gave birth to a singleton child with a major congenital anomaly in Denmark between January 1, 1997 and December 31, 2017 (n = 23,637) and a comparison cohort of mothers matched by maternal age, parity, and infant's year of birth (n = 234,586). EXPOSURES: Liveborn infant with a major congenital anomaly. MAIN OUTCOMES AND MEASURES: The primary outcome was mothers' employment status, stratified by their child's age. Employment status was categorized as employed, outside the workforce (on temporary leave, holding a flexible job, or pursuing education), or unemployed; the number of weeks in each category was measured over time. The secondary outcome was time to receipt of a disability pension, which in Denmark implies permanent exit from the labor market. We used a negative binomial regression model to estimate the number of weeks in each employment category, stratified by the child's age (i.e., 0-1 year, > 1-6 years, 7-13 years, 14-18 years). A Cox proportional hazards regression model was used to compute hazard ratios as a measure of the relative risk of receiving a disability pension. Rate ratios and hazard ratios were adjusted for maternal demographics, pregnancy history, health, and infant's year of birth. RESULTS: During 1-6 years after delivery, MCMCAs were outside the workforce for a median of 50 weeks (IQR, 6-107 weeks), while members of the comparison cohort were outside the workforce for a median of 48 weeks (IQR, 4-98 weeks), corresponding to an adjusted rate ratio [ARR] of 1.05 (95% confidence interval [CI], 1.04-1.07). During the first year after delivery, MCMCAs were more likely to be employed than mothers in the comparison cohort (ARR, 1.08; 95% CI, 1.06-1.10). At all timepoints thereafter, MCMCAs had a lower rate of workforce participation. The rate of being outside the workforce was 5% higher than mothers in the comparison cohort during 1-6 years after delivery (ARR, 1.05; 95% CI, 1.04-1.07), 9% higher during 7-13 years after delivery (ARR, 1.09; 95% CI, 1.06-1.12), and 12% higher during 14-18 years after delivery (ARR, 1.12; 95% CI, 1.07-1.18). Overall, MCMCAs had a 20% increased risk of receiving a disability pension during follow-up than mothers in the matched comparison cohort [incidence rates 3.10 per 1000 person-years (95% CI, 2.89-3.32) vs. 2.34 per 1000 person-years (95% CI, 2.29-2.40), adjusted hazard ratio, 1.20; 95% CI, 1.11-1.29]. CONCLUSION AND RELEVANCE: MCMCAs were less likely to participate in the Danish workforce, less likely to be employed, and more likely to receive disability pensions than mothers of unaffected children. The rate of leaving the workforce intensified as their affected children grew older. The high demands of caregiving among MCMCAs may have long-term employment consequences even in nations with comprehensive and heavily tax-supported childcare systems, such as Denmark.

Does country of resettlement influence the risk of labor market marginalization among refugees? A cohort study in Sweden and Norway.

OBJECTIVES: This study aimed to compare the risk of labor market marginalization among refugees across different host countries of resettlement and examine the moderating role of birth country and length of stay on these associations. METHODS: Cohorts of refugees and native-born individuals aged 19-60 in Sweden (N=3 605 949, 3.5% refugees) and Norway (N=1 784 861, 1.7% refugees) were followed during 2010-2016. Rates (per 1000 person-years) of long-term unemployment, long-term sickness absence, and disability pension were estimated for refugees and the host populations. Cox regression models estimated crude and adjusted (for sex, age, educational level, and civil status) hazard ratio (HRadj) for refugees compared to their respective host population, with 95% confidence intervals (CI). Analyses were also stratified by birth country and length of stay. RESULTS: Refugees in Norway and Sweden had a higher incidence of labor market marginalization compared to their host population. Refugees in Sweden had a comparatively lower relative risk of long-term unemployment but higher risk of disability pension (HRadj 3.44, 95% CI, 3.38-3.50 and HRadj 2.45, 2.35-2.56, respectively) than refugees in Norway (HRadj 3.70, 3.58-3.82 and HRadj 1.57, 1.49-1.66, respectively). These relative risks varied when stratifying by birth country. A shorter length of stay was associated with a higher risk of long-term unemployment and a lower risk of disability pension, with a stronger gradient in Sweden than in Norway. CONCLUSIONS: The relative risk of labor market marginalization varied by the refugees' birth country but followed similar trends in Sweden and Norway. Although speculative, these findings may hint at non-structural factors related to the refugee experience playing a more important role than host country structural factors for the risk of labor market marginalization among refugees. Future research, including host countries with more variability in structural factors, is required to further investigate these associations. The higher risk of long-term unemployment among refugees with shorter length of stay indicates a need for more efficient labor market integration policies for newly-arrived refugees.

Individual Placement and Support for persons with alcohol and drug addiction in a Swedish context (IPS-ADAS): study protocol for a randomised controlled trial.

BACKGROUND: Employment is a vital source for experiencing well-being and lowering the risk of long-term social marginalisation and poverty. For persons with alcohol and drug addiction, it may also improve sobriety. However, the unemployment situation for this group reflects the knowledge gap in effective interventions to support employment. While Individual Placement and Support (IPS) is recognised as evidence-based supported employment for those with serious mental health problems, no scientific evidence for the target group of addiction exists to date. The aim of the present IPS for Alcohol and Drug Addiction in Sweden (IPS-ADAS) trial is to study whether IPS has an effect on gaining employment for this group. METHODS: The IPS-ADAS trial is a multisite, pragmatic, parallel, and single-blinded, superiority randomised controlled trial (RCT). Participants (N = 330) will be randomly assigned (1:1) and participate in IPS plus treatment as usual within Addiction Services (IPS + TAU) or Traditional Vocational Rehabilitation (TVR) available plus TAU (TVR + TAU) for 12 months. The principle of intention-to-treat (ITT) will be applied. The hypothesis is that a significantly larger proportion of IPS + TAU participants will be employed for > 1 day (primary outcome), reach employment sooner, work more hours and longer periods of time, and have a higher income as compared to TVR + TAU participants at 18-month follow-up. We further anticipate that those who benefit from IPS + TAU will use less alcohol and drugs, experience better health, and use less care and support, including support from the justice system, in comparison to TVR + TAU participants, at 6, 12, and 18 months. A supplementary process evaluation, using the IPS Fidelity Scale (25 items) and adhered interviews will address delivery and receipt of the IPS as well as contextual hinders and barriers for coproduction and implementation. Working age (18-65), willingness to work, unemployment, participation in an information meeting about the RCT, treatment for addiction diagnosis, and being financially supported by welfare, constitute eligible criteria. DISCUSSION: A primary study on the effectiveness of IPS on employment for the new target group of addictions will add to the international IPS knowledge base and inform national policy to include the underrepresented group in working life. TRIAL REGISTRATION: WHO International Clinical Trials Registry Platform ISRCTN10492363. Registered on 14 August 2023.

Worker and workplace determinants of employment exit: a register study.

BACKGROUND: Workers with chronic illness are in higher risk of unemployment. This article investigated the worker and workplace characteristics associated with labour market inclusion for workers with a diagnosed chronic illness. METHODS: Linked employer-employee register data covering all Norwegian employers and employees each month from February 2015 to December 2019 were merged with patient data from specialist healthcare (136 196 observations (job spells); 70 923 individual workers). Survival analysis was used to estimate the risk of employment exit, with age, gender, chronic illness, full-time/part-time employment, skill level, marital status, children in household, branch, share of chronically ill workers, firm size and unemployment rate as covariates. RESULTS: 85% of the study population was employed in December 2019; 58% remain employed throughout the follow-up period. Mental illness, male gender, young age, part-time employment and lower skill levels were the worker-level predictors of labour market exit. Employments in secondary industries, in firms with high shares of chronically ill workers and, to some extent, in larger firms were the significant workplace-level determinants. CONCLUSION: Only a minority of our sample of workers with chronic illness experienced labour market exclusion. Targeted measures should be considered towards workers with poor mental health and/or low formal skills. Chronically ill workers within public administration have the best labour market prospects, while workplaces within the education branch have an unfulfilled potential.

Socioeconomic differences in working life expectancy: a scoping review.

BACKGROUND: In the last decade, interest in working life expectancy (WLE) and socioeconomic differences in WLE has grown considerably. However, a comprehensive overview of the socioeconomic differences in WLE is lacking. The aim of this review is to systematically map the research literature to improve the insight on differences in WLE and healthy WLE (HWLE) by education, occupational class and income while using different ways of measuring and estimating WLE and to define future research needs. METHODS: A systematic search was carried out in Web of Science, PubMed and EMBASE and complemented by relevant publications derived through screening of reference lists of the identified publications and expert knowledge. Reports on differences in WLE or HWLE by education, occupational class or income, published until November 2022, were included. Information on socioeconomic differences in WLE and HWLE was synthesized in absolute and relative terms. RESULTS: A total of 26 reports from 21 studies on educational and occupational class differences in WLE or HWLE were included. No reports on income differences were found. On average, WLE in persons with low education is 30% (men) and 27% (women) shorter than in those with high education. The corresponding numbers for occupational class difference were 21% (men) and 27% (women). Low-educated persons were expected to lose more working years due to unemployment and disability retirement than high-educated persons. CONCLUSIONS: The identified socioeconomic inequalities are highly relevant for policy makers and pose serious challenges for equitable pension policies. Many policy interventions aimed at increasing the length of working life follow a one-size-fits-all approach which does not take these inequalities into account. More research is needed on socioeconomic differences in HWLE and potential influences of income on working life duration.