Perceived stress among adolescents as a marker for future mental disorders: A prospective cohort study.

AIM: The mental health problems of adolescents are important in relation to their future health and life course. The aim of this study was to investigate perceived stress in adolescence as a marker for later mental disorders. METHODS: The data consisted of a combination of questionnaire and register data for 11,929 adolescents. Perceived stress was measured using Cohen's Perceived Stress Scale divided into low, moderate and high perceived stress. Mental disorder was identified using the ICD-10 codes for Mental and Behavioural Disorders classified into whether the adolescents were diagnosed or not. Logistic regression was used to examine the prospective association between perceived stress and mental disorders during about 12 months of follow-up, including the adolescents self-rated health, sex and parental education. RESULTS: In total, 247 adolescents (2.1%) were diagnosed with a mental disorder during follow-up. The perceived stress of the adolescents was associated with mental disorders, yielding two-fold higher odds of developing a mental disorder for adolescents reporting moderate perceived stress and six-fold higher odds among adolescents reporting high perceived stress in the adjusted model. CONCLUSIONS: Adolescents with high levels of perceived stress were more likely to develop a mental disorder. Interventions to reduce perceived stress among adolescents could therefore potentially help to identify groups at high risk for later mental disorders.

The timing and duration of depressive symptoms from adolescence to young adulthood and young adults' NEET status: the role of educational attainment.

PURPOSE: Depressive symptoms are negatively associated with labour market outcomes but whether the timing and duration of depressive symptoms or educational attainment (EA) affect NEET (Neither in Employment, Education, nor Training) is unknown. Therefore, this study aims to examine the effects of timing and duration of depressive symptoms in adolescence and the moderating and mediating role of EA on NEET in young adulthood. METHODS: Data were used from 1512 participants in the Vestliv Study, a Danish prospective cohort study. Depressive symptoms were measured at age 14, 18 and 21. EA at age 21 and NEET at age 23 were derived from national registers. Logistic regression analyses and a 4-way decomposition approach were applied. RESULTS: Among boys, depressive symptoms at ages 14 and 21 increased the risk of NEET (OR 1.65, 95% CI 1.00-2.74 and OR 2.20, 95% CI 1.37-3.53). Among girls, this regarded depressive symptoms at ages 18 and 21 (OR 1.76, 95% CI 1.26-2.46 and OR 1.59, 95% CI 1.13-2.22). For the duration of depressive symptoms, among boys any depressive symptoms increased the risk of NEET. Among girls, only persistent depressive symptoms increased the risk of NEET. EA did not mediate or moderate the association between depressive symptoms and NEET. CONCLUSION: The timing and duration of depressive symptoms in adolescence matter for the association with NEET in young adulthood, with a double burden for those with both depressive symptoms and low EA. The results emphasize the importance of support for those who experience depressive symptoms in the school-to-work transition.

The impact of childhood diagnosed ADHD versus controls without ADHD diagnoses on later labour market attachment-a systematic review of longitudinal studies.

Previous studies have suggested that Attention Deficit Hyperactive Disorder (ADHD) affect individuals across their lifespan, especially in relation to employment. The purpose of this review was to synthesize the results from studies examining the prospective association of ADHD diagnosis in childhood and later education, earnings and employment, compared to children without an ADHD diagnosis. A review protocol was prospectively registered with PROSPERO (ID = CRD42019131634). The findings were reported according to the PRISMA guidelines. The systematic review is based on a structured and preplanned analysis of original prospective longitudinal studies. A total of 2505 potential records were identified, two through backward search. Six papers met the inclusion criteria. One paper was assessed as good, four as fair and one as poor quality. The studies indicated that ADHD diagnosis affected the nature of the individual's attachment to the labour market across different labour market attachment outcomes. Adults with persisting symptoms, had significantly more problems at work. Even if ADHD symptoms desist in adulthood, the negative impact of earlier ADHD symptoms can still be seen on occupational outcomes. Significantly fewer probands had a Bachelor's degree compared to controls. Based on one good quality study and four fair quality studies, it is indicated that patients with childhood diagnosed ADHD, generally experience employment of lower quality compared with peers, in relation to income, education and occupational attainment. The overall level of evidence is rated as poor.

The comparative effects of brief or multidisciplinary intervention on return to work at 1 year in employees on sick leave due to low back pain: A randomized controlled trial.

OBJECTIVE: To compare return to work (RTW) rates among patients with low back pain (LBP) and different job relations randomized to brief or multidisciplinary intervention. DESIGN: A randomized controlled trial with 1-year follow-up. SETTING: Silkeborg Regional Hospital, Denmark. SUBJECTS: Four hundred seventy-six participants were divided into two groups concerning job relations: strong (influence on job and no fear of losing it) or weak (no influence on job and/or fear of losing it), and afterwards randomized to brief or multidisciplinary intervention. INTERVENTIONS: Brief intervention included examination and advice by a rheumatologist and a physiotherapist. Multidisciplinary intervention included brief intervention plus coaching by a case manager making a plan for RTW with the patient. MAIN MEASURES: Primary outcome was 1-year RTW rate. Secondary outcomes included pain intensity (LBP rating scale), disability (Roland Morris disability scale), and psychological measures (Common Mental Disorder Questionnaire, Major Depression Inventory, and EQ-5D-3L). RESULTS: Mean (SD) age was 43.1 (9.8) years. Among 272 participants with strong job relations, RTW was achieved for 104/137 (76%) receiving brief intervention compared to 89/135 (66%) receiving multidisciplinary intervention, hazard ratio 0.73 (CI: 0.55-0.96). Corresponding results for 204 participants with weak job relations were 69/102 (68%) in both interventions, hazard ratio 1.07 (CI: 0.77-1.49). For patients with strong job relations, depressive symptoms and quality of life were more improved after brief intervention. CONCLUSION: Brief intervention resulted in higher RTW rates than multidisciplinary intervention for employees with strong job relations. There were no differences in RTW rates between interventions for employees with weak job relations.

Physical activity, return to work self-efficacy, and work status among employees undergoing chemotherapy for cancer - a prospective study with 12 months follow-up.

BACKGROUND: Numerous studies emphasize the positive effects of physical activity on health and well-being in cancer patients. The effects of physical activity on the working lives of cancer patients have received less attention. The aim of the present study was to examine the association between physical activity and work status in employees with cancer, and the mediating role of return to work self-efficacy (RTWSE) in this association. METHODS: Data from questionnaires (physical activity, RTWSE, performance status, sociodemographic), patient records, and Danish national registries (work status, education) were collected for 217 employees initiating chemotherapy for cancer. The associations of physical activity at baseline with work status at baseline and at twelve months follow-up, respectively, were estimated with logistic regression. The mediating role of RTWSE was investigated using the Sobel Goodmann test. RESULTS: Employees with moderate (> 30 min/day) or high (> 150 min/day) levels of current daily activity at baseline had significantly increased odds for working at baseline (OR = 2.83, 95%CI = 0.73-10.96 and OR = 6.13, 95%CI = 1.68-22.40, respectively) and at twelve months (OR = 3.90, 95%CI = 1.19-12.77 and OR = 3.43, 95%CI = 1.12-10.51, respectively), compared to sedentary employees. Likewise, employees, physically active in their leisure time (light or vigorous psychical activity) for 2-4 h/week or > 4 h/week of light activity at baseline, had increased odds for working at twelve months (OR range = 1.20 (95%CI = 0.40-3.61)-5.39(95%CI = 0.78-37.32)), compared to sedentary employees. RTWSE was not found to mediate the observed associations. CONCLUSIONS: Physical activity appears positively associated with work status in employees undergoing treatment for cancer in the twelve months period after initiating chemotherapy.

Validation of the Return To Work Self-Efficacy questionnaire in a population of employees undergoing treatment for cancer.

OBJECTIVE: Several Return To Work Self-Efficacy (RTWSE) questionnaires have been developed and found relevant to understanding the return to work (RTW) process of employees with various health problems, including employees with cancer. The aim of the present study was to examine the reliability and validity of the Danish 19-item RTWSE questionnaire (RTWSE-19DK ) in a sample of employees with cancer. METHODS: Employees undergoing treatment for cancer completed the RTWSE-19DK at baseline (n = 68) and at 1 week (n = 49). Additional questionnaires measured work ability, cancer-related self-efficacy and psychological distress. Internal consistency, test-retest reliability and construct validity were examined. RESULTS: The total and the three subscales of the RTWSE-19DK showed good internal consistencies with Cronbach's alphas between 0.90 and 0.97 and high test-retest reliability with Intraclass Correlation Coefficients between 0.84 and 0.90. Examining construct validity, the RTWSE-19DK showed medium and large correlations with cancer-related self-efficacy (r = 0.54), mental work ability (r = 0.51), and general work ability (r = 0.35), small correlations with physical work ability (r = 0.26) and anxiety (r = -0.10), and no correlations with depression (r = -0.08) and test date (r = 0.03). CONCLUSION: The RTWSE-19DK showed good reliability and adequate validity in employees undergoing cancer treatment. In clinical practice, the RTWSE-19 questionnaire may help practitioners identify areas of concern in the RTW process of cancer patients.

Understanding depression as a workplace issue: Clarifying employers' attitudes to manage employees with depression.

BACKGROUND: Sickness absence due to depression has indirect and direct costs for employers. Whilst employers play a key role in establishing supportive work environments and providing work adjustments, there is a lack of knowledge on employers' attitudes to support employees with depression. OBJECTIVE: To investigate employers' attitudes to manage employees' depression, focusing on the employers' opportunities and challenges to support employees with depression. METHODS: Individual interviews were conducted with five employers. Interview transcripts were analysed using qualitative content analysis. RESULTS: Four categories emerged from the interviews: Attitude to and understanding of depression affect supportive practices; Dilemma between supporting employees with depression and accommodating workplace needs; The employer-employee relationship influences supportive practices; and Work accommodations target the employee's ability to work. CONCLUSION: Employers may need a wider understanding of depression and the importance of the work environment influencing work disability due to depression. Studies should investigate how knowledge of work disability due to depression can be transferred to workplaces.Conflicting agendas of the vocational rehabilitation stakeholders poison opportunities to support, and initiatives may aim to promote employers' understanding of the benefits of collaborating with other stakeholders. The involvement of decision-makers to provide initiatives that support employers in managing employees with depression to promote their work participation is recommended.

The Predictive Value of Return to Work Self-efficacy for Return to Work Among Employees with Cancer Undergoing Chemotherapy.

Purpose The aim of the present study was to examine the predictive value of Return to Work Self-efficacy (RTWSE) on Return to Work (RTW) among employees undergoing chemotherapy for cancer and to examine the relative contribution of RTWSE as predictor variable compared to personal, health-related, illness- and treatment-related and work-related factors. Methods A sample of 114 sickness absent employees with various cancers (age 18-62) included in the study on average 33 days after initiating chemotherapy were followed for 15 months. Data sources included patient questionnaires (RTWSE, depression, fatigue, performance status), sociodemographic factors (age, sex, job type, and perceived support from the workplace), patient records (type of cancer, treatment intention, number of treatment modalities, time since diagnosis and time since initiation of chemotherapy), and Danish national registries (RTW and education). Associations between RTWSE at baseline and weeks until full RTW during 15-months follow-up were analyzed using Cox proportional hazards regression. Results In the univariate analysis, high RTWSE was associated with shorter time to RTW (Hazard Ratio (HR) 1.84, 95% confidence interval (CI) 1.12-3.03). In the multivariate model, RTWSE failed to reach statistical significance (HR 1.12, 95% CI 0.62-2.02), whereas female sex (HR 0.30, 95% CI 0.15-0.60) and receiving palliative treatment (HR 0.15, 95% CI 0.05-0.44) were significantly associated with later RTW. Conclusion Compared to other factors of significance, RTWSE was not the strongest predictor of RTW when examined among employees undergoing chemotherapy for cancer. Before using the RTWSE questionnaire to identify employees with cancer at risk of late RTW, it is important to recognize that the predictive value of RTWSE may be different for employees on sick leave due to cancer than for other sickness absence populations.

Coping strategies in adolescence and labour-market participation in young adulthood: A prospective birth cohort study.

Aims: The aim of this study was to investigate whether coping strategies in adolescence (14-15 years of age) were associated with labour-market participation (LMP) in young adulthood (25-26 years of age) and whether the association differed by sex. Methods: A birth cohort from the former county of Ringkjoebing, Denmark, consisting of 2826 individuals, comprised the study population. In 2004, the study population completed a questionnaire from which information about coping and covariates were gathered. Coping strategies were measured using five sub-scales of the Brief COPE Scale, which were combined into two overall coping strategies: active coping and avoidant coping. Ten years later, the participants were followed for a 52-week period in a register on social benefits. Logistic regression was applied to data, with adjustment for covariates: sex, parents' socio-economic status (education and income) and self-rated health. Results: A total of 2203 (78%) participants were categorised as high LMP at follow-up. No significant associations were found between active coping in adolescence and LMP in 2014/2015. For avoidant coping, in the fully adjusted model, medium-level avoidant coping was associated with higher odds (odds ratio (OR)=1.02 (95% confidence interval (CI) 0.83-1.25) of high LMP. For low avoidant coping, the OR was 1.37 (95% 1.07-1.75). For both coping strategies, sex did not modify the association. Conclusions: Findings showed that avoidant coping was significantly associated with high LMP. Further research is needed to investigate coping in relation to specific problem areas.

Managing employees' depression from the employees', co-workers' and employers' perspectives. An integrative review.

Purpose: To synthesize evidence on factors promoting or hindering work participation (WP) of employees with depression from the employees', co-workers' and employers' perspectives, as well as an additional focus on the influence of the employee's occupation.Methods: An integrative review was conducted. Pre-defined eligibility criteria guided study selection. Articles were critically appraised using tools developed by Joanna Briggs and Mixed Methods Appraisal Tool. Findings were analysed and synthesised using qualitative inductive content analysis.Results: Seventeen studies were included: 12 quantitative studies, three qualitative studies and two mixed methods studies. From these, 144 findings were extracted and combined into six categories from which two syntheses were developed. One synthesis demonstrated that employees, co-workers and employers hold different perspectives on rehabilitation stakeholders' responsibilities hindering WP. The other synthesis revealed that WP is influenced by interactions between individual and occupational factors.Conclusions: Sufficient treatment from health professionals promotes WP. Employees' fear of stigmatization hinders WP. Co-workers and employers find that open communication is important, however, employers are concerned about entering employees' private sphere. When managing employees with depression, employers intervene at the individual level. There is a need for structural interventions to promote WP among employees with depression.Implications for RehabilitationThe responsibilities of rehabilitation stakeholders should be clarified to promote collaboration.Structural workplace interventions should be initiated to supplement individual level interventions.Workplace interventions may focus on more open communication and awareness towards mental illness.Interactions between the occupational factors and individual factors should be carefully considered.

Labour market attachment among parents and self-rated health of their offspring: an intergenerational study.

BACKGROUND: Unemployment influences the individual's health, whether this effect passes through generations is less studied. The aim of this intergenerational study was to investigate whether parents' labour market attachment (LMA) were associated with self-rated health (SRH) among adolescents using preceding labour market events. METHODS: The study was performed using questionnaire data from the Danish Future Occupation of Children and Adolescents cohort (the FOCA cohort) of 13 100 adolescents (mean age 15.8 years) and their accompanying parents identified through registers. Adolescents' SRH was measured using one item from SF-36. Information on parents' LMA was obtained from a national register, analyzed on a weekly basis in a 5-year period before the adolescents completed the questionnaire. An integration indicator was calculated from an initial sequence analysis to determine how well the parents were integrated in the labour market. The association between the adolescents' SRH and parents' LMA was examined by logistic regression and an extended sequence analysis stratified on adolescents' SRH. RESULTS: Totally, 29.1% of the adolescents reported moderate SRH. The adjusted odds ratios (OR) of moderate SRH was higher among adolescents of parents with low labour market integration (OR: 1.5 95% CI: 1.3-1.6 for fathers and OR: 1.4 95% CI: 1.2-1.5 for mothers). Also, adolescents with moderate SRH had parents who were less integrated in the labour market and had more weeks on non-employment benefits compared with the adolescents, who reported high SRH. CONCLUSIONS: Unstable LMA among parents affected SRH among their adolescent children, indicating a negative effect of labour market marginalization across generations.

Prediction of 2-year work participation in sickness absentees with neck or shoulder pain: the contribution of demographic, patient-reported, clinical and imaging information.

BACKGROUND: In cases of neck and shoulder pain, the responsibility for assessing work prognosis is held by clinicians with access to different domains of information. One of these domains is magnetic resonance imaging (MRI), and although MRI is increasingly used, it is unknown which domains of information contribute the most to the prediction of work prognosis. This retrospective cohort study explored the contribution of demographic, patient-reported, clinical, and MRI information to the prediction of work participation in sickness absentees with neck or shoulder pain. METHODS: From a secondary care setting, 168 sickness absentees with neck or shoulder pain were included. Based on registry data, a successful work outcome was defined as ≥50% work participation score (WPS) from Weeks 1 to 104 after enrolment. Prognostic variables were categorized into four domains (demographic, patient-reported, clinical, and MRI) resembling the order of information obtained in a clinical setting. Crude logistic regression analyses were used to identify prognostic variables for each domain (p < 0.2). This was followed by multivariable analyses including the identified variables in a domain-wise order. For each added domain, the probability of successful WPS was dichotomized leaving two possible classifications: ≥ 50% chance of successful WPS or not. In cross-tabulations of chance and the actual WPS outcome, positive and negative predictive values (PPV and NPV), sensitivity, specificity and area under the curve (AUC) were calculated. RESULTS: The combination of demographic and patient-reported variables yielded an NPV of 0.72 and a PPV of 0.67, while specificity was 0.82, sensitivity 0.54 and AUC 0.77. None of these values improved notably by adding clinical and MRI variables as predictors of successful WPS. CONCLUSIONS: These results suggest that - among sickness absentees with neck or shoulder pain - clinical and MRI variables provide no additional information for the prediction of work participation compared with only demographic and patient-reported information.

Reading and writing difficulties and self-rated health among Danish adolescents: cross-sectional study from the FOCA cohort.

BACKGROUND: People struggling with reading and writing difficulties may have poor odds of achieving a good and healthy life. Reading and writing difficulties are independent risk factors for not completing education and unemployment, which are essential in order to obtain a good and healthy life. Therefore, the purpose of this study was to investigate the association between reading and writing difficulties and self-rated health among adolescents, and to investigate how mental health mediates the association. METHODS: A cross-sectional study was performed based on the FOCA cohort, a Danish population-based survey among 9th grade pupils, mainly aged 15- and 16-years old, gathered during the first months of 2017. The study population contained 9748 pupils. The dependent variable was a yes-or-no answer to experiencing limitations in every-day life due to reading and writing difficulties. The independent variable was measured with the SF-36 self-rated health question, dichotomised in high (very good, excellent) and low (good, fair, poor). A logistic regression model was applied. RESULTS: Among the study population 953 (9.8%) pupils reported having reading and writing difficulties. The adjusted OR of having a low self-rated health was significantly higher among adolescents with reading and writing difficulties than without (1.37 (95% CI: 1.14-1.66)). Loneliness and perceived stress, explained a minor part of the association, OR attenuated from 1.77 (95% CI: 1.51-2.09) in the crude model to 1.47 (95% CI: 1.23-1.74) in a more adjusted model. CONCLUSION: Adolescents with reading and writing difficulties are not only struggling with reading and writing difficulties but experiencing also low self-rated health. Mental health only explained a minor part of this association. To clarify whether causal relationship between reading and writing difficulties and self-rated health may exist, longitudinal studies are needed. If support for the hypothesised causality is found early identification of reading and writing difficulties is important, to prevent future health inequality in adolescents with reading and writing difficulties.

Technically measured compositional physical work demands and prospective register-based sickness absence (PODESA): a study protocol.

BACKGROUND: Various physical work demands are shown to be associated with sickness absence. However, these studies have: (a) predominantly used self-reported data on physical work demands that have been shown to be inaccurate compared with technical measurements, (b) principally focused on various physical work demands in 'isolation', i.e. ignoring their co-dependency - compositional nature -, and (c) mainly used register data on long-term sickness absence. The present article describes the protocol of a study with the objective of investigating the association between technically measured compositional data on physical work demands and prospective long- and short-term register-based data on sickness absence. METHODS: 'The technically measured compositional Physical wOrk DEmands and prospective association with register-based Sickness Absence study (PODESA)' comprises data from two Danish cohorts (NOMAD and DPhacto) primarily on blue-collar workers. In the PODESA cohort, data on 1108 workers were collected at baseline (between 2011 and 2014). The cohort data comprise, e.g., self-reported information on descriptives, lifestyle, workday, and health, as well as accelerometer-based measurements of physical work demands (physical activity, movements, and postures). These baseline measurements are linked with prospective register-based data on sickness absence for up to four years after baseline. The prospective association between physical work demands and sickness absence will be analysed using a Compositional Data Analysis approach. DISCUSSION: PODESA provides a unique possibility of unravelling which combinations of physical work demands are associated with prospective sickness absence. PODESA employs technically measured information on physical work demands (taking into account the compositionality of physical work demand data) and prospective sickness absence data. The findings from PODESA can be used to develop strengthened preventive interventions for sickness absence. Results are expected in 2019-2021.

A systematic review of interventions to retain chronically ill occupationally active employees in work: can findings be transferred to cancer survivors?

Background: Interventions supporting occupationally active cancer survivors to retain work and prevent adverse work outcomes, beyond return to work, are scarce. As lessons may be learned from interventions that have been evaluated in working employees with other chronic diseases than cancer, the objective of this review was to summarize the characteristics of these interventions. Material and methods: Studies were identified through computerized PubMed, EMBASE and PsycINFO searches, without any language or year of publication restrictions. Randomized controlled trials were included if they evaluated the effectiveness of interventions to retain chronically ill occupationally active employees in work. Two authors independently extracted data from each study and assessed the risk of bias. Results: The search identified 536 unique studies, of which 18 met the inclusion criteria. All included studies had a low risk of bias. (Psycho-)educational interventions for chronically ill employees to retain work were evaluated in two studies, physical interventions in three studies, vocational/work-related interventions in five studies, and multidisciplinary interventions in eight studies. Vocational/work-related and multidisciplinary interventions, and the involvement of professional trainers, showed the most promising effects in retaining employees. However, small sample sizes may have caused imprecise effect estimates. Conclusion: Based on studies focusing on occupationally active employees with other chronic diseases than cancer, it is advised that working cancer survivors should be offered tailored interventions, by skilled trainers, to sustain their employability. Shared goal setting, with relevant stakeholders, and vocational components should be included, potentially as part of a multidisciplinary intervention.

Cohort profile: the Danish Future Occupation of Children and Adolescents cohort (the FOCA cohort): education, work-life, health and living conditions in a life-course perspective.

PURPOSE: The Future Occupation of Children and Adolescents cohort (the FOCA cohort) is a large population-based cohort study that was established as a resource for research in order to study adolescence factors and future educational and vocational trajectories in a life-course perspective. The cohort covers a broad array of themes within public health, including diseases and health behaviours. Through linkage to register data on the participants' parents, the cohort allows investigation of parental effects over time on adolescents' behaviours and interactions across generations. PARTICIPANTS: The FOCA cohort consists of 13 100 adolescents attending ninth grade in Denmark during the first quarter of 2017, independent of school type. FINDINGS TO DATE: Included were 6685 girls (51.03%) and 6415 boys (48.97%) with an average age of 15.85 years, representing 650 schools (37.23%), covering all options in the Danish school system and widely distributed across the country. The use of the personal identification number allowed for a merge of parents to all adolescents in the cohort, resulting in the identification of 25 911 registered parents. Register data on parents' socio-economic position and labour market history showed representativeness among the adolescents' socio-economic background compared with the general population in Denmark. FUTURE PLANS: The adolescents will be followed by ongoing linkage to administrative registers. Future studies will focus on factors affecting future health, education, work and well-being in a life-course perspective and for specific research projects, it will be possible to apply for permission to link data to further ongoing national registers covering all participants.

Cross-Cultural Adaptation, Reliability and Validity of the Danish Version of the Readiness for Return to Work Instrument.

The objective of the present study was to translate and validate the Canadian Readiness for Return To Work instrument (RRTW-CA) into a Danish version (RRTWDK) by testing its test-retest and internal consistency reliability and its structural and construct validity. Cross-cultural adaptation of the six-staged RRTW-CA instrument was performed in a standardised, systematic five-step-procedure; forward translation, panel synthesis of the translation, back translation, consolidation and revision by researchers, and finally pre-testing. This RRTW-DK beta-version was tested for its psychometric properties by intra-class correlation coefficient and standard error of measurement (n = 114), Cronbach's alpha (n = 471), confirmatory factor analyses (n = 373), and Spearman's rank correlation coefficient (n = 436) in sickness beneficiaries from a municipal employment agency and hospital wards. The original RRTW-CA stage structure could not be confirmed in the RRTWDK. The psychometric properties were thus inconclusive. The RRTW-DK cannot be recommended for use in the current version as the RRTW construct is questionable. The RRTW construct needs further exploration, preferably in a population that is homogeneous with regard to cause of sickness, disability duration and age.

Systematic review of interventions targeting sickness absence among pregnant women in healthcare settings and workplaces.

OBJECTIVES: The high rate of sickness absence from work during pregnancy is recognised as a problem, and may be higher than necessary from a health perspective. The aim was to evaluate the effectiveness of interventions in healthcare settings and workplaces targeting sickness absence among pregnant women. METHODS: Studies were eligible if they included pregnant women participating in any intervention in healthcare settings or workplaces. The outcome was length of sickness absence in days or number of episodes. Study design had to be either randomised controlled trials (RCTs) or quasi-experimental studies.The search for studies was conducted in PubMed, Scopus, CINAHL, PsycINFO, ClinicalTrials.gov and WHO trial registry. Risk of bias was assessed by the Joanna Briggs Institute standardised quality assessment instrument. RESULTS: A total of nine studies were quality assessed and of these, four were excluded due to insufficient methodological quality. Five RCTs conducted in healthcare settings in Sweden and Norway were included. Due to heterogeneity, meta-analysis was not performed.Two RCTs examined complementary and alternative medicine and three RCTs the effect of physical exercise. In general, the frequency of women on sickness absence was lower in the intervention groups than the control groups, however, only among pregnant women who participated in a 12-week exercise programme, the frequency was significantly lower (22% vs 30%, p=0.04). CONCLUSION: The evidence of interventions targeting sickness absence among pregnant women in healthcare settings is sparse, and no studies were conducted at workplaces.Future interventions including physical activity provided in collaboration with healthcare settings and workplaces are requested. Studies should measure sickness absence based on valid methods, measure compliance to the intervention and provide transparency of statistical methods. PROSPERO REGISTRATION NUMBER: CRD42018084802.

Cross-cultural adaptation of the Work Role Functioning Questionnaire 2.0 to Norwegian and Danish.

BACKGROUND: A healthy and productive working life has attracted attention owing to future employment and demographic challenges. OBJECTIVE: The aim was to translate and adapt the Work Role Functioning Questionnaire (WRFQ) 2.0 to Norwegian and Danish. METHODS: The WRFQ is a self-administered tool developed to identify health-related work limitations. Standardised cross-cultural adaptation procedures were followed in both countries' translation processes. Direct translation, synthesis, back translation and consolidation were carried out successfully. RESULTS: A pre-test among 78 employees who had returned to work after sickness absence found idiomatic issues requiring reformulation in the instructions, four items in the Norwegian version, and three items in the Danish version, respectively. In the final versions, seven items were adjusted in each country. Psychometric properties were analysed for the Norwegian sample (n = 40) and preliminary Cronbach's alpha coefficients were satisfactory. A final consensus process was performed to achieve similar titles and introductions. CONCLUSIONS: The WRFQ 2.0 cross-cultural adaptation to Norwegian and Danish was performed and consensus was obtained. Future validation studies will examine validity, reliability, responsiveness and differential item response. The WRFQ can be used to elucidate both individual and work environmental factors leading to a more holistic approach in work rehabilitation.

Return to Work in Employees on Sick Leave due to Neck or Shoulder Pain: A Randomized Clinical Trial Comparing Multidisciplinary and Brief Intervention with One-Year Register-Based Follow-Up.

Purpose The aim of this study was to evaluate the effect of a multidisciplinary intervention (MDI) compared to a brief intervention (BI) with respect to return to work (RTW), pain and disability in workers on sick leave because of neck or shoulder pain. Methods 168 study participants with sickness absence for 4-16 weeks due to neck or shoulder pain were enrolled in a hospital-based clinical study and randomized to either MDI or BI. The primary outcome was RTW obtained by a national registry on public transfer payments. Secondary outcomes were self-reported pain and disability levels. One-year follow-up RTW rates were estimated by Cox proportional hazard regression adjusted for gender, age, sick leave prior to inclusion, part-time sick leave and clinical diagnosis. Secondary outcomes were analysed using logistic and linear regression analysis for pain and disability, respectively. Results In the MDI group, 50 participants (59%) experienced four or more continuous weeks of RTW while 48 (58%) returned to work in the BI group during the 1 year of follow-up. Results showed a statistically non significant tendency towards a lower rate of RTW in the MDI group than in the BI group (adjusted HR = 0.84, 95% CI 0.54, 1.31). There were no statistically significant differences in secondary outcomes between the MDI and BI groups. Conclusion The brief and the multidisciplinary interventions performed equally with respect to both primary and secondary outcomes. The added focus on RTW in the multidisciplinary group did not improve RTW rates in this group.