Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study.

AIMS: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. METHODS: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. Persons who survived cancer were aged 30-50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. RESULTS: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. Female persons who survived cancer were in education more often than male persons who survived cancer. CONCLUSIONS: Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and controls.

Subjective health complaints, functional ability, fear avoidance beliefs, and days on sickness benefits after work rehabilitation - a mediation model.

BACKGROUND: Long-term sick leave and withdrawal from working life is a concern in western countries. In Norway, comprehensive inpatient work rehabilitation may be offered to sick listed individuals at risk of long-term absence from work. Knowledge about prognostic factors for work outcomes after long-term sick leave and work rehabilitation is still limited. The aim of this study was to test a mediation model for various hypothesized biopsychosocial predictors of continued sick leave after inpatient work rehabilitation. METHODS: One thousand one hundred fifty-five participants on long-term sick leave from eight different work rehabilitation clinics answered comprehensive questionnaires at arrival to the clinic, and were followed with official register data on sickness benefits for 3 years. Structural equation models were conducted, with days on sickness benefits after work rehabilitation as the outcome. RESULTS: Fear avoidance beliefs for work mediated the relation between both musculoskeletal complaints and education on days on sickness benefits after work rehabilitation. The relation between musculoskeletal complaints and fear avoidance beliefs for work was furthermore fully mediated by poor physical function. Previous sick leave had a strong independent effect on continued sick leave after work rehabilitation. Fear avoidance beliefs for work did not mediate the small effect of pseudoneurological complaints on continued sick leave. Poor coping/interaction ability was neither related to continued sick leave nor fear avoidance beliefs for work. CONCLUSIONS: The mediation model was partly supported by the data, and provides some possible new insight into how fear avoidance beliefs for work and functional ability may intervene with subjective health complaints and days on sickness benefits after work rehabilitation.

Prognostic factors for return to work, sickness benefits, and transitions between these states: a 4-year follow-up after work-related rehabilitation.

PURPOSE: The aim of this study was to examine if age, gender, medical diagnosis, occupation, and previous sick leave predicted different probabilities for being at work and for registered sickness benefits, and differences in the transitions between any of these states, for individuals that had participated in an interdisciplinary work-related rehabilitation program. METHODS: 584 individuals on long-term sickness benefits (mean 9.3 months, SD = 3.4) were followed with official register data over a 4-year period after a rehabilitation program. 66 % were female, and mean age was 44 years (SD = 9.3). The majority had a mental (47 %) or a musculoskeletal (46 %) diagnosis. 7 % had other diagnoses. Proportional hazards regression models were used to analyze prognostic factors for the probability of being on, and the intensity of transitions between, any of the following seven states during follow-up; working, partial sick leave, full sick leave, medical rehabilitation, vocational rehabilitation, partial disability pension (DP), and full DP. RESULTS: In a fully adjusted model; women, those with diagnoses other than mental and musculoskeletal, blue-collar workers, and those with previous long-term sick leave, had a lower probability for being at work and a higher probability for full DP during follow-up. DP was also associated with high age. Mental diagnoses gave higher probability for being on full sick leave, but not for transitions to full sick leave. Regression models based on transition intensities showed that risk factors for entering a given state (work or receiving sickness benefits) were slightly different from risk factors for leaving the same state. CONCLUSIONS: The probabilities for working and for receiving sickness benefits and DP were dependent on gender, diagnoses, type of work and previous history of sick leave, as expected. The use of novel statistical methods to analyze factors predicting transition intensities have improved our understanding of how the processes to and from work, and to and from sickness benefits may differ between groups. Further research is required to understand more about differences in prognosis for return to work after intensive work-related rehabilitation efforts.

Multiple transitions in sick leave, disability benefits, and return to work. - A 4-year follow-up of patients participating in a work-related rehabilitation program.

BACKGROUND: Return to work (RTW) after long-term sick leave can be a long-lasting process where the individual may shift between work and receiving different social security benefits, as well as between part-time and full-time work. This is a challenge in the assessment of RTW outcomes after rehabilitation interventions. The aim of this study was to analyse the probability for RTW, and the probabilities of transitions between different benefits during a 4-year follow-up, after participating in a work-related rehabilitation program. METHODS: The sample consisted of 584 patients (66% females), mean age 44 years (sd = 9.3). Mean duration on various types of sick leave benefits at entry to the rehabilitation program was 9.3 months (sd = 3.4)]. The patients had mental (47%), musculoskeletal (46%), or other diagnoses (7%). Official national register data over a 4-year follow-up period was analysed. Extended statistical tools for multistate models were used to calculate transition probabilities between the following eight states; working, partial sick leave, full-time sick leave, medical rehabilitation, vocational rehabilitation, and disability pension; (partial, permanent and time-limited). RESULTS: During the follow-up there was an increased probability for working, a decreased probability for being on sick leave, and an increased probability for being on disability pension. The probability of RTW was not related to the work and benefit status at departure from the rehabilitation clinic. The patients had an average of 3.7 (range 0-18) transitions between work and the different benefits. CONCLUSIONS: The process of RTW or of receiving disability pension was complex, and may take several years, with multiple transitions between work and different benefits. Access to reliable register data and the use of a multistate RTW model, makes it possible to describe the developmental nature and the different levels of the recovery and disability process.

Comorbid subjective health complaints in patients with sciatica: a prospective study including comparison with the general population.

OBJECTIVE: Chronic nonspecific low back pain is accompanied by high rates of comorbid mental and physical conditions. The aims of this study were to investigate if patients with specific back pain, that is, sciatica caused by lumbar herniation, report higher rates of subjective health complaints (SHCs) than the general population and if there is an association between change in sciatica symptoms and change in SHCs over a 12-month period. METHODS: A multicenter cohort study of 466 sciatica patients was conducted with follow-up at 3 months and 1 year. Comorbid SHCs were measured by 27 items of the SHC inventory. Odds ratios (ORs) for each SHC were calculated with comparison to a general population sample (n=928) by logistic regression. The SHC number was calculated by summing all complaints present. RESULTS: At baseline, the ORs for reporting SHCs for the sciatica patients were significantly elevated in 15 of the 27 items with a mean (S.D.) SHC number of 7.5 (4.4), compared to 5.2 (4.4) in the general population (P<.01). Among those who during the 1-year follow-up period fully recovered from their sciatica, the SHC number was reduced to normal levels. Among those with persisting or worsening sciatica, the number increased to a level almost double that of the general population. CONCLUSION: Compared to the general population, the prevalence of subjective health complaints in sciatica is increased. During follow-up, the number of health complaints increased in patients with persisting or worsening sciatica.

Health-Related Quality of Life, Subjective Health Complaints, Psychological Distress and Coping in Pakistani Immigrant Women With and Without the Metabolic Syndrome : The InnvaDiab-DEPLAN Study on Pakistani Immigrant Women Living in Oslo, Norway.

The increasingly high number of immigrants from South-East Asia with The Metabolic Syndrome (MetS) is an important challenge for the public health sector. Impaired glucose is essential in MetS. The blood glucose concentration is not only governed by diet and physical activity, but also by psychological distress which could contribute to the development of MetS. The aim of this study is to describe health-related quality of life, subjective health complaints (SHC), psychological distress, and coping in Pakistani immigrant women, with and without MetS. As a part of an randomized controlled intervention study in Oslo, Norway, female Pakistani immigrants (n = 198) answered questionnaires regarding health related quality of life, SHC, psychological distress, and coping. Blood variables were determined and a standardized oral glucose tolerance test was performed. The participants had a high score on SHC and psychological distress. About 40% of the participants had MetS, and this group showed significantly lower general health, lower physical function, and more bodily pain, than those without MetS. Those with MetS also had more SHC, depressive symptoms, higher levels of somatisation, and scored significantly lower on the coping strategy of active problem solving. Pakistani immigrant women seem to have a high prevalence of SHC and psychological distress, especially those with MetS.

Change in the number of musculoskeletal pain sites: A 14-year prospective study.

Musculoskeletal pain that affects multiple body sites is typically regarded as comorbidity to single-site pain. Pain present in multiple sites, however, is more severe and disabling compared to single-site pain. This study aimed to prospectively investigate the change in the number of pain sites over 14years, in addition to identifying predictors of multi-site pain. In 1990 and 2004, questionnaires about musculoskeletal pain were mailed to six birth cohorts in Ullensaker, Norway. Data on demographic, lifestyle, and health-related variables were also collected. Participation rate in 1990 was 67.2% and among those 60.4% participated in 2004. A slight increase in the average number of pain sites occurred between 1990 and 2004, but results showed a relatively stable pattern of pain reporting over a period of 14 years. Several demographic, lifestyle, and health-related variables in 1990 predicted the number of pain sites at follow-up in the bivariate analyses. However, only sex, age, sleep quality, and educational level remained significant in the final multivariate model after controlling for the number of pain sites at baseline. The final model explained 35% of the variance, of which nearly 80% was accounted for by the number of pain sites at baseline. As the pattern of reporting the number of pain sites appears relatively stable across adulthood and baseline multi-site pain demonstrated strong predictive utility, studies investigating the occurrence of multi-site pain in children and adolescents are recommended to determine potential causal factors contributing to the early course and development of multi-site musculoskeletal pain.

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study.

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work-related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as "employed", "unemployed", "homemaker", or "student". Among them, 176 persons had received long-term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong "dose-response" relationship between number of pain sites and disability with a 10-fold increase from 0 to 9-10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.

Number of pain sites is associated with demographic, lifestyle, and health-related factors in the general population.

Research on widespread pain often relies upon case definitions bounded by duration limits or "cut-offs." In clinical reality, however, there are no natural cut-off points between localized and widespread pain. Rather, pain is best represented by a continuum of "widespreadness" from localized pain to pain spread across the body. The objective of this paper was to describe the number of pain sites (NPS) reported in a population study and its association with demographic, lifestyle, and health-related factors. Using a cross-sectional design, the Standardized Nordic Questionnaire was used to measure musculoskeletal pain among seven age groups in Ullensaker, Norway (n=2926). Results showed that women reported a higher mean NPS than men. A higher NPS was also found for individuals who were separated or divorced, undergoing rehabilitation, or who had a disability pension. Additionally, greater NPS was reported by smokers, individuals with less physical activity, and a higher BMI. A strong linear relationship was found between NPS and reduction in overall health, sleep quality, and psychological health. Results from a multivariate linear regression analysis showed that overall health, sleep quality, and gender demonstrated the strongest associations with increasing NPS, accounting for 31.4% of the variance. Our study indicates that the straightforward and simple method of counting the NPS could be important in managing the complex problem of musculoskeletal pain.

Localized or widespread musculoskeletal pain: does it matter?

Although epidemiological descriptions indicate that musculoskeletal pain is often widespread, still a lot of musculoskeletal pain is diagnosed and treated as localized pain. This led us to question whether localized pain exists at all and to evaluate its functional impact compared with that of widespread musculoskeletal pain. Therefore, this study aimed to describe the prevalence of localized and widespread musculoskeletal pain and its association to functional ability. In 2004, questionnaires about musculoskeletal pain were mailed to seven age groups in Ullensaker, Norway: 24-26, 34-36, 44-46, 54-56, 64-66, 74-76, and 84-86 years old. In total, 3325 persons participated (participation rate 54.4%). We excluded the oldest age group and persons who did not respond to any questions about pain during the previous week, thus reducing the participants in this study to 3179. Although musculoskeletal pain occurred frequently in the population, localized pain, in the meaning of single site pain, was relatively rare. Most people having musculoskeletal pain reported pain from a number of sites. Furthermore, experiencing single site pain did not have a large impact on physical fitness, feelings, or daily and social activities. Functional problems increased markedly, in an almost linear way with increasing number of pain sites. These findings suggest that musculoskeletal pain usually coexists with pain in other body regions and that the functional consequences are highly dependent on how widespread the pain is. This should have important implications for future research into musculoskeletal pain, and for clinical and social insurance medicine.

Comorbid subjective health complaints in low back pain.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: To compare subjective health complaints in subacute patients with low back pain with reference values from a Norwegian normal population. SUMMARY OF BACKGROUND DATA: Comorbidity is common with nonspecific low back pain. We wanted to investigate if these complaints were specific or part of a more general unspecific condition comparable to subjective health complaints in the normal population. MATERIALS AND METHODS: The study group consisted of 457 patients sick-listed 8 to 12 weeks for low back pain. All subjects filled out questionnaires. The subjective health complaints in the study group were compared with reference values from a Norwegian normal population using logistic regression analysis. RESULTS: Compared with the normal reference population, the patients with low back pain had significantly more low back pain, neck pain, upper back pain, pain in the feet during exercise, headache, migraine, sleep problems, flushes/heat sensations, anxiety, and sadness/depression. The prevalence of pain in arms, pain in shoulders, and tiredness was also high, but not significantly higher than in the reference population. CONCLUSIONS: Our findings indicate that patients with low back pain suffer from what may be referred to as a "syndrome," consisting of muscle pain located to the whole spine as well as to legs and head, and accompanying sleep problems, anxiety, and sadness/depression.