Individual Placement and Support and Participatory Workplace Intervention on the Work Participation of People with Disabilities: A Randomised Controlled Trial.

PURPOSE: This study assessed the effectiveness of Individual Placement and Support (IPS), Participatory Workplace Intervention (PWI), and IPS + PWI on work participation and health of people with work disabilities. METHODS: A randomised controlled 2 × 2 factorial trial with 120 clients and an 18-month follow-up was performed. Differences between IPS and no-IPS and between PWI and no-PWI were assessed using log-rank tests and Cox proportional hazards models. RESULTS: In the IPS group, restricted mean survival time (RMST) for sustainable paid employment was 352 days, compared to 394 in the no-IPS group (HR = 1.47, 95% CI = 0.81-2.63). In the PWI group the RMST was 378 days, compared to 367 in the no-PWI group (HR = 0.89, 95% CI = 0.48-1.64). For the secondary outcome 'starting any paid employment, a trial placement, or education' RMST was significantly lower for the IPS group (222 days) than for the no-IPS group (335 days; HR = 1.85, 95% CI = 1.01-3.42). Mental health was significantly lower (worse) in the PWI group (difference -4.07, 95% CI = -7.93 to -0.22) than in the no-PWI group. For all other secondary outcomes, no statistically significant differences were found. CONCLUSION: No statistically significant differences were observed in the duration until starting sustainable employment between IPS and no-IPS, and between PWI and no-PWI. The duration until starting any paid employment, a trial placement, or education was shorter in the IPS group than in the no-IPS group, but further research should explore whether this also increases sustainable employment in the longer term.

Sustainable labour market participation among working young adults with diagnosed attention deficit/hyperactivity disorder (ADHD).

Background: The aims were to study the sustainability of labour-market participation five years after an incident diagnosis of attention-deficit/hyperactivity disorder (ADHD) among young adults with gainful employment, and to examine the impact of sociodemographic-, work- and health-related factors on these findings. Methods: Swedish registers identified 2517 individuals, 19-29 years old, with an incident diagnosis of ADHD and gainful employment during 2006-2011. Labour-market participation was measured by the core-peripheral model, a model that measures the connection to the labour market from a weak connection (peripheral) to a strong connection (core). Sequence analysis analysed clusters of labour-market participation, from one year before and up to five years after diagnosis. Odds ratios (OR) with 95% confidence intervals (CI) between sociodemographic factors, comorbid disorders, and the identified clusters were analysed by multinomial logistic regression. Results: Five clusters of labour-market participation were identified: 60% of individuals belonged to a cluster that maintained labour-market participation throughout the study period (core, close to core); 20% belonged to a cluster with a transition to a weak connection to the labour market (close to peripheral, peripheral); and 20% belonged to a cluster with "middle" labour-market participation, characterised by having long periods of sick leave and unemployment. Individuals with elementary school as highest attained education (OR:4.03;CI:2.35-6.93), comorbid mental disorders (OR:2.77;CI:2.10-3.66), or living in villages/small cities (OR:1.77;CI:1.25-2.51) were most likely to belong to a cluster transitioning towards a "peripheral" labour-market participation. Men were less likely to have peripheral labour-market participation than women (OR:0.55;CI:0.40-0.75). Conclusions: Over half of working individuals with ADHD maintain a strong attachment to the labour market several years after their first diagnosis of ADHD. Therefore, it is important to target those who have problems maintaining a position in the labour market, including women, those with low educational levels, and those living outside large cities.

Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: study protocol for a cohort randomised controlled trial with embedded economic and process evaluations.

BACKGROUND: Around one-third of workdays lost in Norway are due to musculoskeletal conditions, with persistent (chronic) pain being the most frequent cause of sick leave and work disability. Increasing work participation for people with persistent pain improves their health, quality of life, and well-being and reduces poverty; however, it is not clear how to best help unemployed people who have persistent pain to return to work. The aim of this study is to examine if a matched work placement intervention featuring case manager support and work-focused healthcare improves return to work rates and quality of life for unemployed people in Norway with persistent pain who want to work. METHODS: We will use a cohort randomised controlled approach to test the effectiveness and cost-effectiveness of a matched work placement intervention featuring case manager support and work-focused healthcare compared to those receiving usual care in the cohort alone. We will recruit people aged 18-64, who have been out of work for at least 1 month, had pain for more than 3 months, and want to work. Initially, all (n = 228) will be recruited to an observational cohort study on the impact of being unemployed with persistent pain. We will then randomly select one in three to be offered the intervention. The primary outcome of sustained return to work will be measured using registry and self-reported data, while secondary outcomes include self-reported levels of health-related quality of life and physical and mental health. Outcomes will be measured at baseline and 3, 6, and 12 months post-randomisation. We will run a process evaluation parallel to the intervention exploring implementation, continuity of the intervention, reasons for participating, declining participation, and mechanisms behind cases of sustained return to work. An economic evaluation of the trial process will also be conducted. DISCUSSION: The ReISE intervention is designed to increase work participation for people with persistent pain. The intervention has the potential to improve work ability by collaboratively navigating obstacles to working. If successful, the intervention may be a viable option for helping people in this population. TRIAL REGISTRATION: ISRCTN Registry 85,437,524 Registered on 30 March 2022.

Caregivers' Experiences with School-Work Transitions for Their Children with Disorders of Intellectual Development.

During the period of school-work transition, caregivers of young adults with disorders of intellectual development (ID) often play an extended and leading role in supporting their children. This article explores caregivers' overall experiences with their children's school-work transition. Ten qualitative in-depth interviews were carried out with eleven parents/guardians of ten young adults with disorders of ID. Through reflexive thematic analysis, the following themes emerged: (i) varying degrees of preparation for employment during school years; (ii) the experience of transition collapse; (iii) struggling to navigate the system; (iv) caregivers' ambitions and high expectations; and (v) positive meetings with professionals. All caregivers in our study had clear ambitions about employment for their children, and they supported them by advocating for their rights and by collaborating as best as possible with the support system. However, their experiences bring to light how the transition process often appears random and without an overarching implementation strategy. The overall picture of the transition process is a time of concern and stress for caregivers, with room for improvement in most areas.

Perceived stress in adolescence and labour market participation in young adulthood - a prospective cohort study.

BACKGROUND: Adolescence is a key-developmental stage for physical, neurological, psychological, and social changes. In this developmental stage, a large number of people struggle with mental health problems like stress, anxiety, or depression. Psychological vulnerability in adolescence has previously been found to be negatively related to future low labour market participation. However, studies are lacking that investigate the impact of stress during adolescence on labour market participation in early adulthood using register data. The aim of this prospective study was therefore to examine the association between perceived stress during adolescence and labour market participation in young men and women in early adulthood. METHODS: A Danish cohort of 3038 participants born in 1989 was followed with use of questionnaires from age 15 to age 28. The exposure, self-reported perceived stress, was collected by questionnaires at ages 15, 18, and 21. The outcome, labour market participation, was based on register information on social benefits, such as unemployment benefits, sickness benefits, and disability benefits, collected on a weekly basis during a 4-year period. Information about the socioeconomic confounders was also gleaned from registers. RESULTS: The study found consistent associations between perceived stress from age 15 to age 21 and low labour market participation from age 25 to age 29 in both women and men after adjusting for mental health and socioeconomic confounders. The strongest associations between perceived stress and low labour market participation were seen among men who reported stress several times during adolescence. CONCLUSIONS: The results indicate that although, women in general, reported being more stressed than men during adolescence and had lower labour market participation in early adulthood, there was a small group of men who had experienced stress during adolescence who were at particularly high risk of being marginalised in the labour market.

Smoking and labour market participation: a 5-year prospective cohort study of transitions between work, unemployment and sickness absence.

AIM: To examine whether smokers are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared to never smokers. METHODS: The study sample in this prospective register-based cohort study consisted of 87,830 men and women between 18 and 60 years of age from the Danish National Health Survey 2010. Assessment of smoking status was obtained at baseline and the participants were followed in the Danish register-based evaluation of marginalisation database from 2010 to 2015. Data were analysed by Cox proportional hazards. RESULTS: The median age was 44.5 years and 47.3% were men. At baseline, 88.8% were categorised as working, 7.7% as unemployed and 3.5% as being on sickness absence. At the 5-year follow-up, hazard ratios for transitions from work to unemployment were 1.31 (95% confidence interval (CI) 1.22-1.40; P<0.001) for current smokers (<15/day) and 1.52 (95% CI 1.43-1.62; P<0.001) for current heavy smokers (⩾15/day), compared to never smokers. Hazard ratios for transitions from work to sickness absence were 1.31 (95% CI 1.24-1.38; P<0.001) for current smokers (<15/day) and 1.64 (95% CI 1.56-1.71; P<0.001) for current heavy smokers (⩾15/day). Current heavy smokers (⩾15/day) also had a lower chance of becoming re-employed with a hazard ratio of 0.81 (95% CI 0.75-0.88; P<0.001) compared to never smokers.Smoking was associated with a higher risk of unemployment and sickness absence, and a lower chance of becoming employed. More focus on smoking prevention and smoking cessation could therefore be implemented in relation to job seeking and sickness absence.

'Investing' in care for old age? An examination of long-term care expenditure dynamics and its spillovers.

We study the dynamic drivers of expenditure on long-term care (LTC) programmes, and more specifically, the effects of labour market participation of traditional unpaid caregivers (women aged 40 and older) on LTC spending, alongside the spillover effects of a rise in LTC expenditure on health care expenditures (HCE) and the economy (per capita GDP). Our estimates draw from a panel of more than a decade worth of expenditure data from a sample of OECD countries. We use a panel vector auto-regressive (panel-VAR) system that considers the dynamics between the dependent variables. We find that LTC expenditure increases with the rise of the labour market participation of the traditional unpaid caregiver (women over 40 years of age), and that such expenditures rise exerts large spillover effects on health spending and the economy. We find that a 1% increase in female labour participation gives rise to a 1.48% increase in LTC expenditure and a 0.88% reduction in HCE. The effect of LTC spending over HCE is mainly driven by a reduction in inpatient and medicine expenditures, exhibiting large country heterogeneity. Finally, we document significant spillover effects of LTC expenditures on per capita GDP. Supplementary Information: The online version contains supplementary material available at 10.1007/s00181-022-02246-0.

Work environment and labour market participation in early adulthood.

BACKGROUND: Investigating whether a poor physical or psychosocial work environment is associated with low labour market participation in early adulthood is important to avoid negative health-related consequences and to improve job prospects. AIMS: To investigate associations between the physical or psychosocial work environment and labour market participation in early adulthood. METHODS: The study was based on data from the West Jutland Cohort, an ongoing study of individuals born in 1989 who lived in the western part of Jutland, Denmark, in 2004. Participants were employed individuals who had questionnaire data on their work environment at age 28 and register information on labour market participation at ages 28-29 (n = 1312). The outcome was categorized into low (>4 weeks) versus high (≤4 weeks) labour market participation based on the total number of weeks receiving any unemployment or health-related benefits during a 52-week period. Logistic regression analyses were performed to examine associations between work environment factors and labour market participation, taking confounders into account. RESULTS: Low influence, low quality of leadership, high job insecurity and temporary employment were associated with low labour market participation. High job insecurity (OR: 2.2; 95% CI 1.5-3.1) and temporary employment (OR: 3.1; 95% CI 2.1-4.5) were strongly associated with low labour market participation. An association was seen between hard physical work and low labour market participation. CONCLUSIONS: Several physical and psychosocial work environment factors, especially high job insecurity and temporary employment, have a negative impact on labour market participation in early adulthood.

Influence of gender on people with disabilities' work relationships: prospects for ergonomics interventions.

Norms and values embedded in what is referred to as 'institutionalised gender,' defined by the distribution of power between genders in the political, educational, religious, medical, cultural or social institutions of a society, exist even today. The above mentioned influential institutions shape societal norms that define, reproduce and justify differing expectations and opportunities for women, men, girls and boys. Using qualitative methods, 41 semi-structured interviews among employed people with deafness/hard of hearing (DHH), blindness/low vision, motor disabilities, or chronic pain from three administrative regions of Québec (Montréal, Outaouais, and Montérégie) were analysed. The results show that while gender is omnipresent in participants' remarks, it is not necessarily associated with exclusion from employment, but most certainly with perpetuating some forms of inequity in work situations. Solutions to raise awareness among ergonomists working with people with disabilities are suggested.Practitioner summary: Based on 41 semi-structured interviews among employed people with disabilities, a relationship between the gender of the participants and factors facilitating or inhibiting their integration into employment were established. Solutions to raise awareness among ergonomists working with a doubly marginalised population-women with disabilities-are suggested.Abbreviations: DEPPI: disability, employment, and public policies initiative; DHH: deaf or hard of hearing; LSQ: québec sign language; M: men; P: participant; s/g: sex and gender; W: women.

Parental substance use disorder and offspring not in education, employment or training: a national cohort study of young adults in Sweden.

AIMS: To test the hypothesis that exposure to parental substance use disorder is associated with an increased risk of being not in education, employment or training (NEET) in male and female offspring during young adulthood. DESIGN, SETTING AND PARTICIPANTS: A register-based, national cohort study of 797 376 individuals born between 1984 and 1990, residing in Sweden at age 17 years. Participants were followed from age 17 years to maximum age 32 years and assessed annually for being NEET. MEASUREMENTS: The exposure variable was binary, defined as any diagnosis of substance use disorder (alcohol and/or drug use disorder) in one or both parents, measured between offspring's birth and age 17 years. Cox regression analysis was used to obtain hazard ratios (HRs) for being NEET, assessed annually as a binary variable using income and employment data. FINDINGS: We found that 4.4% of individuals were exposed to parental substance use disorder. When adjusted for birth year, domicile, origin, psychiatric diagnosis, household income and parental psychiatric diagnosis, HRs for being NEET were HR = 1.13 (95% CI 1.09-1.16) for males, and HR = 1.15 (95% CI 1.12-1.19) for females. When stratified by age, adjusted HRs for experiencing the first episode of NEET peaked at age 17-19 years, HR = 1.37 (95% CI 1.25-1.50) for males, and HR = 1.31 (95% CI 1.18-1.44) for females. CONCLUSIONS: In Sweden, exposure to parental substance use disorder before age 17 years is associated with increased risk of being not in education, employment or training during early adulthood. The risks were highest at age 17-19 years for both males and females, decreasing with greater age.

The sociocultural mechanism of obesity: The influence of gender role attitudes on obesity and the gender gap.

Worldwide, women are more likely to be obese than men, but research on the mechanism of the gender gap in obesity is relatively lacking. This article uses five rounds of Chinese General Social Survey (CGSS) data from 2010 to 2017 to empirically test the impact of gender role attitudes on obesity and the gender gap and to explore the mechanism. The main results show that the traditional gender role attitude will improve the probability of obesity in women, but it will not positively impact obesity in men. Using the proportion of "March 8th red flag bearer" at the provincial level as an instrumental variable to alleviate the possible estimation errors caused by omitted variables, the results show that the lower the proportion of red flag bearers, the higher the probability of obesity of women, and still will not improve the probability of obesity of men. The robustness test based on the generalized propensity score method (GPSM) supports the above results. The mechanism analysis shows that economic status and market participation are two essential mechanisms of gender role attitudes and female obesity. Traditional gender role attitudes increase the risk of women's obesity by reducing their economic status and labour market participation.

Working conditions as risk factors for early exit from work-in a cohort of 2351 employees in Germany.

OBJECTIVES: We would assess the possible impact of a range of physical and psychosocial working conditions on early exit from paid employment (i.e., before retirement age) in a representative employee population in Germany. METHODS: We analysed a cohort from the German Study on Mental Health at Work (S-MGA) with a baseline of 2351 employees in 2011/12, sampled randomly from the register of integrated employment biographies (IEB) at the Institute for Employment Research (IAB). Follow-up ended mid-2015. Early Exit comprised episodes of either pensioning, long-term sickness absence or unemployment ≥ 18 months. Total follow-up years were 8.422. Working conditions were partly assessed by the Copenhagen Psychosocial Questionnaire (COPSOQ). Through Cox regressions, associations of baseline working conditions with time to event of exit were estimated-adjusting for baseline age, gender, poverty, fixed-term contract and socioeconomic position. RESULTS: In multiple regressions, awkward body postures (HR = 1.24; 95% CI = 1.07-1.44), heavy lifting (1.17; 1.00-1.37) and high work pace (1.41; 1.16-1.72) were associated with exit. The estimated attributable fraction of exit for being exposed to less than optimal work environment was 25%. Regarding specific exit routes, repetitive movements (1.25; 1.03-1.53) increased the risk for the long-term sickness absence; work pace (1.86; 1.22-2.86) and role clarity (0.55; 0.31-1.00) were associated to unemployment; and control over working time (0.72; 0.56-0.95) decreased the risk of the early retirement. CONCLUSIONS: Work environment seems to be important for subsequent early exit from work. Physical and psychosocial demands seem to be associated to exit to a stronger extent than resources at work.

Association between alcohol, socioeconomic position and labour market participation: A prospective cohort study of transitions between work and unemployment.

Aims: This study aimed to test the hypothesis that heavy alcohol consumption and problem drinking is associated with a higher risk of becoming unemployed and a lower chance of entering the job market across socioeconomic positions. Methods: A sample of 84,474 men and women aged 18-60 years from the Danish National Health Survey 2010 participated in the study. Information on alcohol consumption and problem drinking was obtained by questionnaire. The primary outcomes were becoming unemployed and entering the job market. The follow-up period was five years. Information on labour market transitions and socioeconomic position (educational level) was obtained through nationwide registers. Multiplicative analyses were performed. Results: Heavy alcohol consumption and problem drinking were associated with a higher risk of unemployment among low-educated (hazard ratio (HR)=1.5; 95% confidence interval (CI) 1.3-1.9) and medium-educated (HR=1.3; 95% CI 1.1-1.5) individuals in comparison to individuals with a similar educational level drinking one to seven drinks per week. Excessive alcohol consumption and problem drinking were associated with a lower chance of entering the job market for individuals with a medium or high level of education: medium-educated individuals drinking >28 drinks per week had a HR of 0.82 (95% CI 0.69-0.98) when compared to medium-educated individuals drinking one to seven drinks per week. The corresponding HR among high-educated individuals was 0.71 (95% CI 0.49-1.0). Conclusions: Heavy alcohol consumption and problem drinking are associated with a higher risk of unemployment in some social strata, whereas excessive alcohol consumption and problem drinking are associated with a lower chance of entering the job market in other social strata.

Constraints that discourage participation in the labour market by female carers of older relatives in Santiago, Chile.

Providing care for older people who have support needs is mainly a familial and female responsibility in Chile. Despite Chile's development level, the participation of females in the workforce lags behind (at around 50%), and 72% of female carers of an older relative are not in the labour force. This paper explores the reasons why in Latin America adult children remain out of the labour force while caring for an older parent or parent-in-law who has support needs. It draws on 30 in-depth interviews of family carers from low- to high-income households. The interviews were carried out in Chile in 2017, and were analysed using an inductive thematic analysis to identify core themes related to the subjects' reasons for remaining out of the labour force. Four factors hinder the combination of paid work and caring for a parent or parent-in-law with support needs: (a) externalised care was too expensive; (b) finding non-precarious, flexible work was difficult; (c) their perception of femininity or womanhood conflicted with the idea of combining care and paid work; and (d) they experienced a lack of public and/or social support.

Psychological resources in adolescence and the association with labour market participation in early adulthood: a prospective cohort study.

BACKGROUND: Young adults at the age of 25-29 in Denmark have the highest unemployment rate and are at higher risk of labour market marginalization. Exclusion from the labour market may have negative individual consequences on mental and physical health and can lead to increasing societal expenditures due to social benefits. It is important to understand what factors determine or protect against early labour market marginalization. The aim of the present study was to investigate the association between psychological resources in adolescence and labour market participation in early adulthood, and whether the associations differed by gender. METHODS: This prospective cohort study used questionnaire data collected through the West Jutland Cohort study in 2004 and 2007. The study population (N = 2982) consisted of people born in 1989 and living in the county of Ringkjoebing at baseline in 2004. Outcome was dichotomized as +/- 12 months of passive labour market participation during the age of 25-29. Psychological resources were measured as self-esteem, sense of coherence and mastery. Logistic regression analyses were performed to investigate the associations between psychological resources and labour market participation. RESULTS: Results indicated associations between high levels of mastery or sense of coherence in adolescence and high labour market participation in early adulthood. The strongest associations were observed for females with a medium (OR: 1.9, 95% CI: 1.3-2.8) or high level (OR: 1.6, 95% CI: 1.0-2.4) of mastery or a high level of sense of coherence (OR: 1.6 95% CI: 1.0-2.4) at age 15 and for males with a medium (OR: 2.7, 95% CI: 1.5-3.8) or high (OR: 1.9, 95% CI: 1.1-3.5) level of mastery or a high level of sense of coherence (OR: 1.7, 95% CI: 0.9-3.1) at age 18. CONCLUSION: The results of the present study indicate associations between a high level of sense of coherence or mastery in adolescence and high labour market participation in early adulthood in a Danish context. Psychological resources seemed to play a bigger role for females in early adolescence compared to males, for whom a larger impact was seen in late adolescence.

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

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

Somatic Complaints in Adolescence and Labour Market Participation in Young Adulthood.

AIMS: The primary aim was to investigate the association between somatic symptoms at ages 15 or 18 and reduced labour market participation at age 23, when socioeconomic, social, and mental health risk factors were taken into account. METHODS: The study included 3223 participants from the West Jutland Cohort Study with questionnaire information on somatic symptoms at ages 15 or 18 and with register information on labour market participation at age 23, gathered from a national register on all public transfer benefits for a 52-week period. The analyses included additional information about socioeconomic background, number of negative life events, social climate in the family, social relations with friends, and depressive symptoms. Logistic regression analyses yielded odds ratios with 95% confidence intervals. RESULTS: Among the males, associations between reporting somatic symptoms at age 18 and low labour market participation was seen in both crude and adjusted analyses (odds ratio: 1.66; 95% confidence intervals: 1.01-2.75), whereas the association among the females disappeared after adjustments (odds ratio: 0.97; 95% confidence intervals: 0.63-1.52). CONCLUSIONS: The males that reported somatic symptoms in late adolescence appeared to be the most vulnerable to future reduced labour market participation.

Employment pathways of individuals with spinal cord injury living in Switzerland: A qualitative study.

BACKGROUND: Labour market participation (LMP) represents a key goal of rehabilitation for individuals with spinal cord injury (SCI). To achieve this goal, Swiss SCI rehabilitation centres seek, together with their clients, viable follow-up solutions for returning to work after initial rehabilitation. However, the long-term outcomes of such vocational follow-up solutions have not been investigated so far, and there is a paucity of knowledge regarding the various types of employment pathways that persons with SCI living in Switzerland may experience. OBJECTIVE: To examine long-term employment pathways as experienced by individuals with SCI living in Switzerland. METHODS: A qualitative descriptive study design involving narrative interviews with individuals who completed vocational rehabilitation (VR) during their initial rehabilitation. Interviews were transcribed verbatim, and data analysed using an inductive thematic analysis approach. RESULTS: The analysis of the 15 interviews revealed four employment pathways: the pathway of no paid work, the pathway of retraining, the pathway of job adaptation and the pathway of continuing work. CONCLUSIONS: Apart from three pathways leading towards paid employment, our results revealed one pathway that was characterized by permanent unemployment. Individuals facing a pathway of no paid work may benefit from more custom-made vocational follow-up solutions and prolonged job coaching after initial VR.

Caring too much? Lack of public services to older people reduces attendance at work among their children.

The need to provide care for older people can put a strain on their adult children, potentially interfering with their work attendance. We tested the hypothesis that public care for older people (nursing homes or home care services) would moderate the association between having an older parent in need of care and reduced work attendance among the adult children. The analysis used data from a survey of Norwegian employees aged 45-65 (N = 529). Institutional care for older people in need of care (i.e. nursing homes) was associated with improved work attendance among their children-their daughters in particular. Data also indicated a moderating effect: the link between the parents' reduced health and reduced work attendance among the children was weaker if the parent lived in a nursing home. However, the results were very different for home-based care: data indicated no positive effects on adult children's work attendance when parents received non-institutionalised care of this kind. Overall, the results suggest that extending public care service to older people can improve their children's ability to combine work with care for parents. However, this effect seems to require the high level of care commonly provided by nursing homes. Thus, the current trend towards de-institutionalising care in Europe (and Norway in particular) might hamper work attendance among care-giving adult children, women in particular. Home care services to older people probably need to be extended if they are intended as a real alternative to institutional care.

Alcohol consumption and risk of unemployment, sickness absence and disability pension in Denmark: a prospective cohort study.

AIMS: We investigated the association between weekly alcohol consumption and binge drinking and the risk of unemployment, sickness absence and disability pension. DESIGN: Prospective register-based cohort study. SETTING: Denmark. PARTICIPANTS: A sample of 17 690 men and women, aged 18-60 years from the Danish Health and Morbidity Survey in 2000, 2005 and 2010 participated in the study. Participants worked the entire year prior to baseline. MEASUREMENTS: Administrative registers were used to obtain information on unemployment, sickness absence and disability pension during a 5-year follow-up period. Data were analysed by multivariate Cox regression model with random effect (frailty) adjusted for cohabitation status, educational level, Charlson comorbidity index, smoking habits, calendar year and geographic region. FINDINGS: Among males, adjusted hazards ratios (HR) of unemployment were 1.24 (95% CI 1.05-1.46, P = 0.01), 1.28 (95% CI 1.04-1.59, P =0.02) and 1.48 (95% CI 1.21-1.81, P = 0.00) respectively, for abstainers and those with alcohol consumption of 21-27 and ≥ 28 drinks per week when compared with individuals who had 1-13 drinks per week. Corresponding HRs for sickness absence were 1.16 (95% CI 1.02-1.33, P = 0.03), 1.02 (95% CI 0.85-1.23, P = 0.84), and 1.23 (95 % CI 1.04-1.46, P = 0.02). Male abstainers had increased HR for subsequently receiving disability pension. Female abstainers had increased HR of unemployment, sickness absence and disability pension compared to women with moderate alcohol consumption. Binge drinking was associated with higher HR of unemployment compared to non-binge drinking in women: HR of 1.21 (95 % CI 1.03-1.41, P = 0.02). CONCLUSIONS: In Danish men aged 18-60, alcohol abstinence and heavy consumption is associated with increased subsequent risk of unemployment and sickness absence compared with low consumption. In Danish women abstainers have increased risk of unemployment, sickness absence and disability pension, while binge drinkers are more likely to become unemployed subsequently.