The joint contribution of pain and insomnia to sickness absence and disability retirement: a register-linkage study among Norwegian and Finnish employees.

BACKGROUND: Pain and insomnia are both independently associated with work disability. Although pain and insomnia often co-occur, their joint associations with subsequent sickness absence and disability retirement have not been studied. We aimed to examine these associations in two prospective occupational cohorts while considering key covariates. METHODS: Norwegian Hordaland Health Study (n = 6892, 59% women) and Finnish Helsinki Health Study (n = 6060, 78% women) data were used. Those with only pain, only insomnia or both conditions at baseline were compared with those with no pain and no insomnia. Work disability outcomes were derived from national and employers' register data. Medically certified sickness absence spells lasting 2 weeks or more and all-cause disability retirement were examined. Register-based follow-up was 4 years for sickness absence and 5 years for disability retirement. Covariates were sex, age, marital status, education, smoking, alcohol use, body mass index and blood pressure. Poisson and Cox regression models were fitted. RESULTS: Both pain and insomnia were associated with subsequent sickness absence and disability retirement, but the associations were stronger for those reporting co-morbid pain and insomnia with support for a synergistic interaction effect, particularly regarding disability retirement. The associations were largely similar in both cohorts and remained after full adjustments. CONCLUSIONS: This study is the first to report the separate and combined effects of pain and insomnia on objective health outcomes. Common patterns observed in two separate cohorts suggest that the combination of pain and insomnia might be particularly relevant for subsequent disability retirement.

Common mental disorders and long-term sickness absence in a general working population. The Hordaland Health Study.

OBJECTIVE: To examine and compare the prospective effect of the common mental disorders (CMD) anxiety and depression on duration and recurrence of sickness absence (SA), and to investigate whether the effect of CMD on SA is detectable over time. METHOD: Information from a large epidemiological health study (N = 13 436) was linked with official records of SA episodes lasting ≥16 days up to 6 years after participation. Common mental disorders were assessed with the Hospital Anxiety and Depression Scale (HADS). Associations were analysed with Cox regression and multinomial logistic regression models controlling for potential covariates. RESULTS: Comorbid anxiety and depression, and anxiety only were significant risk factors for SA after adjusting for covariates, whilst depression only was not. Anxiety and depression were stronger predictors for longer duration of SA episodes compared with shorter duration and associated with more frequent recurrence of SA. There was a general trend toward the effect of CMD on SA becoming weaker over time; however, the effect of anxiety only on SA remained stable throughout the follow-up. CONCLUSION: Common mental disorders are long-lasting predictors of onset, duration and recurrence of SA. Anxiety appears to be a more important contributor to long-term SA than previously described in the literature.

Widespread pain and medically certified disability pension in the Hordaland Health Study.

Widespread pain (WSP) is common in the general population and is associated with poor outcomes. The aim of this study was to quantify the risk for medically certified disability pension from WSP. We further studied how other common physical symptoms, common mental disorders and functional limitations influenced this risk. A prospective cohort design was established by linking the large population based Hordaland Health Study (n > 18000 individuals aged 40-46) with an administrative registry on disability pension awards. We modelled hazard ratios for later all-cause and diagnosis specific disability pensioning from WSP, adjusted for potential confounders and examined the impact of other co-occurring health problems and functional limitations. WSP was common (12.4%) and associated with a range of mental health, and non-specific and non-musculoskeletal symptoms. As expected, WSP was a strong predictor for disability pension award. Hazard ratios (HR) adjusted for socio-economic status, health behaviours and comorbid medical diagnoses indicated WSP was strongest in predicting pensioning for musculoskeletal diagnoses (HR = 5.91, 95% CI 4.64-7.54), but also predicted pensioning for mental disorder (HR = 3.13, 95% CI 2.20-4.46) and other diagnoses (HR = 1.81, 95% CI 1.30-2.51). Further adjustments for other common symptoms, including mental illness, reduced, but did not abolish these risks. WSP is a major risk factor for disability pensions, and not only pensions for musculoskeletal disorders. The global impact of WSP, and its close association to other symptoms, suggests prevention of the severe occupational outcomes for this group must have a broad focus and move beyond symptom directed approaches.

Work and common psychiatric disorders.

Psychiatric disorders are now the most common reason for long-term sickness absence. The associated loss in productivity and the payment of disability benefits places a substantial burden on the economies of many developed countries. The occupational dysfunction associated with psychiatric disorders can also lead to poverty and social isolation. As a result the area of work and psychiatric disorders is a high priority for policymakers. There are two main agendas: for many researchers and clinicians the focus is on the need to overcome stigma and ensure people with severe psychiatric disorders have meaningful work; however the public health agenda predominantly relates to the more common disorders such as depression and anxiety, which contribute a greater burden of disability benefits and pensions. In this review we attempt to address this second agenda. The relatively sparse evidence available reveals a complex field with significant interplay between medical, psychological social and cultural factors. Sick leave can be a 'process' as well as an 'event'. In this review we propose a staged model where different risk and protective factors contribute to the onset of psychiatric disorders in the working population, the onset of short-term sickness absence, and the transition from short- to long-term absence. We also examine strategies to manage psychiatric disorder in the workforce with a view towards returning the employee to work. Our aim in this review is to highlight the complexity of the area, to stimulate debate and to identify important gaps in knowledge where further research might benefit both patients and wider society.

Somatization: the under-recognized factor in nonspecific eczema. The Hordaland Health Study (HUSK).

BACKGROUND: Psychodermatology has focused primarily on depression and anxiety in eczema. Skin symptoms are listed among many others for the ICD-10 diagnosis of somatization disorder. Somatization (unexplained somatic symptoms) is highly prevalent in the general population, but its association with eczema is yet to be empirically investigated. OBJECTIVES: We therefore explored the association between somatization and eczema by examining the extent of somatization in eczema compared with allergic rhinitis, and by examining if eczema was more strongly associated with somatization than with anxiety and depression. Finally, we aimed to examine the relationship between the site of eczema and somatization for individual somatic symptoms and for somatic symptoms as a whole. METHODS: For this population-based cross-sectional study we employed data from the Hordaland Health Study (HUSK) with 15,225 participants aged 41-48 years. Information on nonspecific eczema, allergic rhinitis, somatization, anxiety, depression and other covariates was obtained by self-report. RESULTS: The association between nonspecific eczema and somatization was strong and followed a dose-response pattern, as did all somatic symptoms in our index of somatization when analysed separately. The association between nonspecific eczema and somatization was stronger than that between rhinitis and somatization, and also the association between nonspecific eczema and anxiety and depression. In multivariate models, somatization accounted for most of the association between nonspecific eczema and anxiety/depression. In contrast, the association between nonspecific eczema and somatization was robust for adjustment for anxiety/depression. CONCLUSIONS: Somatization was strongly associated with nonspecific eczema. This applies to a whole range of somatic symptoms constituting the construct of somatization. There is hardly any mention of somatization in leading dermatological journals, in contrast to anxiety and depression which are frequently reported in eczema. We speculate that this under-recognition of somatization in the dermatological literature may correspond to under-recognition of this factor also in clinical practice.

Relative harm of snus and cigarettes: what do Norwegian adolescents say?

BACKGROUND: The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and little is known about what present and potential users of these products actually think about their relative harmfulness. METHODS: In a nationally representative survey of 2415 Norwegian adolescents aged 16-20 years, participants were asked to rate the harmfulness of various available tobacco products and their own use of snus and cigarettes. A study was undertaken to examine how adolescents rate the relative harm of tobacco products in general, and snus and cigarettes in particular, and how this varies with age, gender and their own use of snus and smoking. RESULTS: Cigarettes were generally rated as more harmful than snus, but 41% still rated snus as equally or more harmful than cigarettes. Male participants reported lower harm from all products than females. Being a snus user was associated with lower ratings of harm for snus, but being a smoker was not associated with reporting of harm for cigarettes. CONCLUSIONS: Compared with the current scientific consensus, the participants overrated the harmfulness of snus and, as such, our results suggest a potential for changing peoples' perceptions of the relative health risks of various tobacco products. To the extent that health information affects consumption, accurate information on relative risks may lead more people to choose snus over cigarettes.

Health status before, during and after disability pension award: the Hordaland Health Study (HUSK).

OBJECTIVES: Up to one in eight of the working age population receives permanent disability benefits. As little is known about the consequences of this major event, analysis aimed to compare health status before and after disability pension award. METHODS: Data from the population based Hordaland Health Study (HUSK) in Norway 1997-99 (n = 18 581) were linked to official disability benefits registries. The study identified 1087 participants who were awarded a disability pension before, during and after the health survey. These were grouped into different strata defined by temporal proximity between disability pension award and health survey participation. The study then compared health status across these strata covering the 7 years before to the 7 years after the award. RESULTS: The study found an inverse U-shaped trend with an increase in reported symptoms (anxiety, depression, pain distribution, sleep problems and somatic symptoms) approaching the award, and a reversing of this trajectory afterwards (p<0.05 for the non-linear trend for all symptoms). We found no similar trend for the more objective health measures blood pressure, physical diagnoses and prescribed medication. For most measures, similar levels of health problems were found 3-7 years before compared to 3-7 years after the award. CONCLUSION: When comparing the strata defined by time to the event of disability pension award, there was an increase in symptoms around the time of the disability pension award, with a subsequent return towards pre-award levels. The design precludes any firm conclusions as to what causes the observed results, but possible explanations include temporary adverse health effects from the process itself, the beneficial effects of being removed from harmful work conditions, and recovery after increasing health problems leading up to disability pension award.

The effect of OSAS on sick leave and work disability.

The objective of the present study was to examine the independent contribution of symptoms of obstructive sleep apnoea syndrome (OSAS) to long-term sick leave and permanent work disability. Using a historical cohort design with 4 yrs of follow-up, information on sick leave and disability benefit recipiency were merged with health information from the Hordaland Health Study, carried out in western Norway during 1997-1999. Persons aged 40-45 yrs (n = 7,028) were assessed for self-reported symptoms of OSAS (snoring, breathing cessations and daytime sleepiness), body mass index, somatic conditions and other potential confounders. The outcomes, cumulative sick leave of > or =8 weeks and permanent work disability, were identified in records from the National Insurance Administration. After excluding participants with work disability at baseline, symptoms of OSAS were found to be a significant predictor of both subsequent long-term sick leave and permanent work disability. These effects remained significant after adjustment for a range of possible confounding factors. Daytime sleepiness showed the greatest explanatory power, followed by breathing cessations and snoring. It is concluded that self-reported symptoms of obstructive sleep apnoea syndrome are an independent risk factor for subsequent long-term sick leave and permanent work disability. These findings need to be replicated using objective measures of obstructive sleep apnoea syndrome.

Reduced training frequency effects on aerobic power and muscle adaptations in rats.

Female rats were exercised by swimming up to 4 h/day either 2, 4, or 6 days/wk. After 7 wk they continued to train at these frequencies or had their training reduced from 6 to 4, 2, or 0 days/wk for an additional 9 wk. Ventricular weights and maximum O2 uptake (VO2max) were increased by 5-10% after training 2 days/wk, 15-17% after 4 days/wk, and 25-30% after 6 days/wk. Following reduced training, VO2max was similar when the 4- or 2-day/wk reduced training groups are compared with their 4- or 2-day/wk continued training counterparts. In contrast, VO2max was greater in the 0-day reduced than in the sedentary control group. No differences in mitochondrial markers or myoglobin content in red or mixed skeletal muscles were found between training 2 or 4 days/wk vs. reduced training at comparable frequencies. O2 uptake capacity of plantaris muscles and myoglobin concentration in fast-twitch red vastus lateralis muscles were greater in the 0-day reduced group than in the sedentary controls. These data show that VO2max and certain markers of aerobic metabolism in skeletal muscles of rats are lost at a slower rate than their rate of increase from the untrained state. However, a reduction of swimming frequency from 6 to 4 or 2 days/wk is not a sufficient stimulus to maintain VO2max, cardiac enlargement, or the increased aerobic potential of skeletal muscle at the 6-day/wk levels.(ABSTRACT TRUNCATED AT 250 WORDS)