The changing nature of work - Job strain, job support and sickness absence among care workers and in other occupations in Sweden 1991-2013.

This study examined exposure changes in three psychosocial dimensions - job demands, job control, and social support - and the associations between these dimensions and sickness absence throughout the period 1991-2013. The analyses covered periods of economic ups and downs in Sweden and periods involving major fluctuations in sickness absence. Data on care workers (n = 16,179) and a comparison group of employees in other occupations (n = 82,070) were derived from the biennial Swedish Work Environment Survey and linked to register data on sickness absence. Eight exposure profiles, based on combinations of demands, control, and support, were formed. The proportion of individuals with work profiles involving high demands doubled among care workers (14%-29%) while increasing modestly in the comparison group (17%-21%) 1991-2013. The work profile that isolated high-strain (iso-strain), i.e., high demands, low control, and low social support, was more prevalent among care workers, from 4% in 1991 to 11% in 2013. Individuals with work profiles involving high-demand jobs had the highest number of days on sickness absence during the study period and those with the iso-strain work profile had the highest increase in sickness absence, from 15 days per year during 1993-1994, to 42 days during 2000-2002. Employees with a passive work profile (low job demands and low job control) had the lowest rate and the lowest increase in sickness absence. Individuals with active work profiles, where high demands are supposed to be balanced by high job control, had a rather high increase in sickness days around 2000. A conclusion is that there is a long-term trend towards jobs with high demands. This trend is stronger among care workers than among other occupations. These levels of job demands seem to be at such a level that it is difficult to compensate for with higher job control and social support.

Favorable Working Conditions Related to Health Behavior Among Nurses and Care Assistants in Sweden-A Population-Based Cohort Study.

Objective: To analyze the associations between favorable physical and psychosocial work factors and health behavior among healthcare employees (nurses and care assistants) with health complaints. Methods: The study was based on seven iterations (2001-2013) of a biennial Swedish work environment survey linked with data from public registers. In all, 7,180 healthcare employees, aged 16-64 years, who had reported health complaints, were included. Health behavior was operationalized through four combinations of sickness absence (SA) and sickness presence (SP): 'good health behavior' (Low SP/Low SA), 'recovery behavior' (Low SP/High SA), 'risk behavior' (High SP/Low SA), and 'poor health behavior' (High SP/High SA). Odds ratios (OR) were calculated by multinomial logistic regression with 95% confidence intervals (CI). Results: After adjusting for socio-demographic factors, those who rarely worked in strenuous postures had an increased probability of having 'good health behavior' (OR range: nurses 1.72-2.02; care assistants 1.46-1.75). Those who rarely experienced high job demands had increased odds for having 'good health behavior' (OR: nurses 1.81; OR range: care assistants 1.67-2.13), while having good job control was found to be related to 'good health behavior' only among care assistants (OR range 1.30-1.68). In the full model, after also considering differences in health, none of the work environment indicators affected 'good health behavior' among nursing professionals. Among care assistants, rarely having heavy physical work and having low psychosocial demands remained significantly associated with 'good health behavior' (OR range: 1.24-1.58) and 'recovery behavior' (OR range: 1.33-1.70). No associations were found between favorable work environment factors and 'risk behavior' among the two groups of employees. However, positive assessments of the work situation were associated with 'good health behavior,' even after controlling for all confounders for both groups (OR range: 1.43-2.69). Conclusions: 'Good health behavior' and 'recovery behavior' among care assistants were associated with favorable physical and psychosocial working conditions even when health was considered. This implies that reduced sickness presence and sickness absence among care assistants can be achieved through improved physical and psychosocial working conditions.

Reasons for presenteeism in different occupational branches in Sweden: a population based cross-sectional study.

OBJECTIVE: To compare the prevalence and reasons for presenteeism in occupations in three branches defined as employees handling people, handling things or handling symbols. METHOD: A cross-sectional population-based cohort study was conducted. The study group was drawn from a representative sample (n = 6230) aged 16-64, who had been interviewed in 2015 or in 2017 for the Swedish Work Environment Surveys (SWES). The odds ratios (ORs) stratified by occupational category for reasons of presenteeism, with 95% confidence intervals (CI), were estimated using binomial multiple logistic regression analysis. RESULTS: The study showed that presenteeism was more common among employees handling people (74%), when compared to employees handling things (65%) or handling symbols (70%). The most common reason for presenteeism among employees handling people was "I do not want to burden my colleagues", while "Because nobody else can carry out my responsibilities" was most common in the other two categories. After control for socio-demography, work environments and health, the differences in reasons mostly remained significant between the three occupational categories. CONCLUSION: The differences between occupational categories are important for prevalence and reasons for presenteeism. As presenteeism affects the future health of employees and the productivity of the work unit, attempts to reduce presenteeism may be important. Because the reasons vary between occupations, customized preventive measures should be applied in different occupational settings. Among employees handling people, covering up for absence in work team is relevant, while among employees handling symbols and handling things the corresponding focus could be on shared responsibilities for specific tasks.

Sickness Absence and Sickness Presence Among Health and Care Employees in Sweden-Health Complaints, Health Behavior, and Future Long-Term Sickness Absence.

OBJECTIVE: To describe if health complaints relate to health behavior in terms of sickness absence (SA) and sickness presence (SP) and to examine how complaints and health behavior predicts the risk for future long-term sickness absence (LTSA). METHODS: Data originates from work environment surveys 2001 to 2013 and SA registers 2002 to 2016 of 1838 nurses, 7430 care assistants, and 40,515 individuals in all other occupations. Descriptive and regression analyses were conducted. RESULTS: Physical complaints and high SA in combination with high SP increased the risk of LTSA among nurses and care assistants. Nurses' high SP and care assistants' high SA elevated the LTSA risk. CONCLUSIONS: Strategies to reduce the reasons behind physical health complaints among health care workers are warranted. SP among nurses and SA among care assistants should be considered in the organization of their job demands.

Interaction Effects of Physical and Psychosocial Working Conditions on Risk for Sickness Absence: A Prospective Study of Nurses and Care Assistants in Sweden.

Employees in health and social care are often simultaneously exposed to both physical and psychosocial challenges that may increase their risk for sickness absence. The study examines interaction effects of physical and psychosocial work conditions on the future risk for sickness absence among nurses and care assistants in Sweden. The study was based on 14,372 participants in any of the Swedish Work Environment Surveys conducted during the years 1993-2013 with linked register information on background factors and compensated sickness absence. Adjusted hazard ratio (HR), stratified by occupation, and measures of additive interaction effects were estimated. The combinations of high psychosocial job demands and heavy physical work and strenuous postures, respectively, significantly increased the risks for sickness absence among nurses (HR 1.43; CI 1.09-1.88 and HR 1.42; CI 1.16-1.74, respectively), as well as among care assistants (HR 1.51; CI 1.36-1.67 and HR 1.49; CI 1.36-1.63, respectively). The combinations of low job control and both heavy physical work (HR 1.44; CI 1.30-1.60) and strenuous postures (HR 1.42; CI 1.30-1.56) were also associated with excess risk for sickness absence among care assistants. We also found interaction effects among care assistants but not among nurses. The results indicate that the high sickness absence rate among care workers in Sweden can be reduced if the simultaneous exposures of high psychosocial and high physical challenges are avoided. Management policies for reduced time pressure, improved lifting aids, and measures to avoid awkward work postures are recommended. For care assistants, increased influence over work arrangements is likely to lower their sickness absence risk.

Work environment risk factors for the duration of all cause and diagnose-specific sickness absence among healthcare workers in Sweden: a prospective study.

OBJECTIVES: Increasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on musculoskeletal and psychiatric diagnoses among healthcare workers. METHODS: The study sample consisted of healthcare workers (n=12 452) drawn from representative samples of workers aged 16 to 64, who participated in the Swedish Work Environment Surveys (SWES) between 1993 and 2013. The outcomes were either short-term (≤28 days) or long-term (>104 days) SA between 1994 and 2016. HRs and 95% CIs were calculated for the impact of physical and psychosocial working conditions on risk of subsequent short-term or long-term SA for 3 years after participation in SWES. RESULTS: Heavy physical work and strenuous work postures showed elevated HRs for short-term and long-term SA compared with those without these work exposures. Similarly, high job demands and low job control each increased the risk for both short-term and long-term SA compared with employees with low job demands and high job control. Low job support increased the risk for short-term SA compared with those with high job support. Working conditions were strongly related to short-term SA due to musculoskeletal diagnoses but not to short-term SA due to psychiatric diagnoses. None of the work characteristics, except strenuous postures, elevated the risk for long-term SA due to psychiatric diagnosis compared with employees without these characteristics. CONCLUSIONS: Ergonomic improvements and stress reduction among healthcare workers are likely to reduce the prevalence of SA foremost due to musculoskeletal diagnoses.

A Resourceful Work Environment Moderates the Relationship between Presenteeism and Health. A Study Using Repeated Measures in the Swedish Working Population.

The objective of this study was to investigate if the psychosocial work environment moderates the proposed negative impact of presenteeism on future general health. We expect that the negative impact of presenteeism on general health is weaker if the psychosocial work environment is resourceful, and more pronounced if the environment is stressful. Data were derived from the 2008-2018 biennial waves of the Swedish Longitudinal Occupational Survey of Health (SLOSH). The final analytic sample consisted of n = 15,779 individuals. We applied repeated measures regression analyses through generalized estimating equations (GEE). Results from the autoregressive GEE models showed statistically significant interaction terms between presenteeism and all four investigated moderators, i.e., job demands, job control, job support and job strain. The results indicate that the psychosocial work environment moderates the negative association between presenteeism and general health and illustrates a buffering effect of the psychosocial work environment. A possible explanation for these results may be that psychosocially resourceful work environments give room for adjustments in the work situation and facilitate recovery. The results also indicate that by investing the psychosocial work environment employers may be able to promote worker health as well as prevent reduced job performance due to presenteeism.

Presenteeism, Psychosocial Working Conditions and Work Ability among Care Workers-A Cross-Sectional Swedish Population-Based Study.

Presenteeism, attending work while ill, has been examined in different contexts in the last few decades. The aim was to examine whether poor psychosocial working conditions and perceived work ability are associated with increased odds ratios for presenteeism, focusing on nursing professionals and care assistants. A cross-sectional population-based study was conducted. The selected individuals were extracted from representative samples of employees, aged 16-64, who participated in the Swedish Work Environment Surveys between 2001 and 2013 (n = 45,098). Three dimensions of psychosocial working conditions were measured: job demands, job control, and job support. Presenteeism and perceived work ability was measured. Using multiple logistic regression analyses, odds ratios for presenteeism with 95% confidence intervals (CI) were estimated. While nurses (n = 1716) showed the same presenteeism level as all the other occupation groups (n = 37,125), it was more common among care assistants (n = 6257). The odds ratio for presenteeism among those with high job demands (OR = 2.37, 95% CI 2.21-2.53), were higher among women than among men. For nursing professionals and care assistants, the odds ratios for presenteeism were highest among those with the lowest work ability level. The problems of presenteeism and low work ability among many health and care workers may be lessened by a reduction in psychosocial demands.

What is Number of Days in Number of Times? Associations Between, and Responsiveness of, Two Sickness Presenteeism Measures.

OBJECTIVE: To examine the associations between sickness presenteeism (SP) reported as number of days with SP reported as number of times and to evaluate their responsiveness. METHODS: The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health, and registered sick leave. Both SP constructs were measured several times to examine responsiveness. RESULTS: The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seems to be more sensitive than number of days in detecting changes after rehabilitation. CONCLUSIONS: Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seems to be more responsive.

Interaction effects of physical and psychosocial working conditions on the risk of disability pension among nursing professionals and care assistants in Sweden: A prospective study.

BACKGROUND: Nursing professionals and care assistants are often subject to a combination of negative physical and psychosocial work environment factors, but most disability pension studies on such occupations have focused on one or the other of these factors. As they often coexist, there are reasons to assume that simultaneously being exposed to both types of exposures will increase the risk of disability more than being exposed to either. OBJECTIVES: The study examined combinations of physical and psychosocial work conditions as predictors of future disability pension among nursing professionals and care assistants in Sweden. PARTICIPANTS: The study was based on a random and representative sample of 79,004 participants in any of the Swedish Work Environment Surveys from 1993 to 2013. A total of 2576 nursing professionals, 10,175 care assistants, and 66,253 workers in other occupations were included. METHODS: Information on background factors and disability pension was obtained from population registers. Cox proportional hazard regressions with 95% confidence intervals (CI) were performed to study if pairs of combinations of physical and psychosocial factors were related to an increased risk of disability pension. Additionally, measures of synergistic effects were estimated. The analyses were stratified on occupation group, with adjustment for selected confounders. RESULTS: The results indicated increased hazard ratios (HR) for disability pension for most combinations of physical and psychosocial working conditions. The hazard ratios for joint exposure to high demands and heavy physical work were high among both nursing professionals (HR 1.91; CI 1.06-3.44) and care assistants (HR 2.09; CI 1.63-2.69). Also, the combination of high demands and strenuous postures resulted in significantly elevated risks of disability pension among nursing professionals (HR 1.95; CI 1.20-3.16) and care assistants (HR 2.18; CI 1.71-2.77). The HRs for joint exposure to low control and both heavy physical work and strenuous postures were significant among all other occupations (HR 2.30; CI 2.05-2.58 and HR 2.24; CI 2.01-2.51), and among care assistants (HR 1.52; CI 1.26-1.85 and HR 1.61; CI 1.34-1.93), but not significant among nursing professionals. The synergistic effects on disability pension from combined exposures were generally positive among all three occupational groups. CONCLUSION: Nursing professionals and care assistants exposed to both negative physical and psychosocial conditions had an increased risk of disability pension. A synergistic effect with respect to disability pension was found among care assistants who reported low control and strenuous postures at work.

Working conditions and compensated sickness absence among nurses and care assistants in Sweden during two decades: a cross-sectional biennial survey study.

OBJECTIVES: The aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to compare SA among exposed and non-exposed nurses and care assistants. DESIGN: A cross-sectional survey on work environment factors based on the biennial Swedish Work Environment Surveys 1991-2013, linked to longitudinal register data on SA 1993-2014. PARTICIPANTS: The study included 98 249 individuals, stratified into nurses and care assistants (n=16 179) and a reference population including all other occupations (n=82 070). OUTCOME MEASURE: Annual days of compensated SA (>14 days) 3 years after exposure years. RESULTS: Nurses and care assistants had higher SA in 1993-2014 compared with all other occupations, and differences in background factors only partly explained this relationship. For both groups, exposure to physical work factors remained steady, but the number of exposed were 10%-30% higher among nurses and care assistants. Those exposed to heavy physical work and strenuous working postures had in most years significantly higher SA when compared with non-exposed (rate ratio range: 1.4-1.9). Exposure to high job demands increased 10%-25% in 1991-1999 among nurses and care assistants but became more stable in 2001-2013 and high proportions of high job demands coincided with the increase in SA in 1995-1999. Nurses and care assistants exposed to high job demands had for most years significantly higher SA than non-exposed (rate ratio range: 1.5-2.1). Low job control and low support from supervisors elevated SA significantly only for a few years. CONCLUSIONS: Exposure to negative work factors among nurses and care assistants was weakly associated with variations in SA, but may be related to their higher level of SA when compared with other occupations. Improved physical and psychosocial working conditions may reduce the elevated SA level in these occupations.

Physical work environment factors affecting risk for disability pension due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and other occupations: a prospective, population-based cohort study.

OBJECTIVE: To study the influence of physical work factors on the risks of future disability pension (DP) due to mental or musculoskeletal diagnoses among nursing professionals, care assistants and all other occupations in the general working population in Sweden. METHODS: The prospective population study was based on representative samples of working individuals (n=79 004) aged 16-64, interviewed in the Swedish Work Environment Survey between 1993 and 2013. Information on diagnosed DP in 1994-2014 was gathered from the Social Insurance Agency's database. The focus was on nursing professionals (registered nurses and midwives) and care assistants, for example, assistant nurses and hospital ward assistants. The outcome was DP, classified into two diagnostic groups. Associations between physical work factors and risk of DP were calculated using Cox regression with HR and 95% CI. RESULTS: Physical work factors were associated with future DP after adjusting for sociodemographic conditions and psychosocial work factors among care assistants (n=10 175) and among all other occupations (n=66 253), but not among nursing professionals (n=2576). The increased risk among care assistants (n=197) exposed to heavy physical work was 66% (HR 1.66, 95% CI 1.39 to 1.97), and for those exposed to strenuous work postures (n=420) it was 56% (HR 1.56, 95% CI 1.35 to 1.80). Physical work indicators were mainly associated with musculoskeletal DP diagnoses among care assistants, but two indicators were significant also for mental diagnoses. An increased risk of DP was found among nursing professionals (n=102) exposed to detergents or disinfectants (HR 1.48, 95% CI 1.06 to 2.05), but not among care assistants. CONCLUSIONS: Heavy physical work and strenuous postures are predictors of future DP, particularly among care assistants and in the general working population. In order to reduce early exit from the workforce, efforts should be made to improve physical and ergonomic working conditions.

Exhaustion and Impaired Work Performance in the Workplace: Associations With Presenteeism and Absenteeism.

OBJECTIVE: The aim of this study was to investigate the association between presenteeism and absenteeism during the previous year and the current levels of exhaustion and impaired work performance in a Swedish university setting. METHODS: In a study of 3525 employees, an ordinal logistic regression and general linear model was used to examine the association between presenteeism and absenteeism during the previous year and the current exhaustion and impaired work performance, respectively. RESULTS: Presenteeism, but not absenteeism, during the previous year independently increased the risk of having moderate or severe exhaustion. Presenteeism, absenteeism, and exhaustion remained positively associated with impaired work performance when health status and other confounders had been adjusted for. CONCLUSIONS: Presenteeism, but not absenteeism, was associated with exhaustion. Both presenteeism and absenteeism were the salient correlates of impaired work performance.

Presenteeism as a predictor of disability pension: A prospective study among nursing professionals and care assistants in Sweden.

OBJECTIVES: The aim of the present study was to examine how presenteeism affects the risk of future disability pension among nursing professionals and care assistants (assistant nurses, hospital ward assistants, home-based personal care workers, and child care assistants). A specific objective was to compare health and social care employees with all other occupations. METHODS: The study was based on a representative sample of working women and men (n = 43 682) aged 16-64 years, who had been interviewed between 2001 and 2013 for the Swedish Work Environment Survey conducted every second year since 1989. Information on disability pension was obtained from the Social Insurance Agency's database (2002-2014). The studied predictors were related to disability pension using Cox's proportional hazard regression with hazard ratios (HR) and 95% confidence interval (CI) and selected confounders were controlled for. The follow-up period was 6.7 years (SD 4.2). RESULTS: Health and social care employees with frequent presenteeism showed a particularly elevated risk of future disability pension after adjusting for sex, sociodemographic variables, physical and psychosocial working conditions, and self-rated health symptoms. In the amalgamated occupational group of nursing professionals and care assistants, the impact on disability pension of having engaged in presenteeism four times or more during the prior year remained significant (HR = 3.72, 95% CI = 2.43-5.68). CONCLUSIONS: The study suggests that frequent presenteeism contributes to an increased risk of disability pension among nursing professionals and care assistants as well as among all other occupations.

Work-related psychosocial risk factors and risk of disability pension among employees in health and personal care: A prospective cohort study.

BACKGROUND: Researchers have suggested that psychological factors at work contribute to early retirement due to disability pension in the general working population. Disability pension is a problem that shortens working careers among nursing professionals and personal care or related workers, but few researchers have focused on these occupational groups. Also, a need for studies based on measurements of specific work exposure instead of combined measures has been identified. OBJECTIVES: The aim was to study the potential influence of work-related psychosocial risk factors on the future risk of disability pension among nursing professionals and care assistants in Sweden. Those occupational groups are compared to all other occupations in Sweden. A specific aim was to describe differences in associations to cause-specific disability, and how the results were modified by occupation categories. PARTICIPANTS: A representative sample of 79,004 women and men in Sweden comprising 2,576 nursing professionals, 10,175 care assistants and 66,253 workers in other occupations. METHODS: Factors of the psychosocial work environment were obtained from questionnaire data of the Swedish Work Environment Surveys (SWES) 1993-2013. Information on cause-specific disability pension during follow-up was added from the Social Insurance Agency's database (1994-2014). We calculated Cox's proportional hazards with 95% confidence intervals. RESULTS: During a mean follow-up time of 11.1 years, 6.6% of nursing professionals and 9.4% of care assistants, as compared to 6.1% among all other occupations, received disability pension. Among nursing professionals and care assistants, high quantitative job demands and low social support, but not job control, were associated with future disability pension also after controlling for age, year of interview, socio demographic conditions, and physical work factors. An increase in risk was also noticeable among nursing professionals and care assistants who reported an active job in combination with low social support. An increased risk for disability pension due to mental diagnosis was found among care assistants who reported high job demands. In all other occupations, low social support was associated with an increased risk for disability pension under any condition of job strain (high strain, low strain, active, and passive jobs). CONCLUSION: Based on the results we conclude that high quantitative job demands and poor social support are predictors of future disability pension.

Sick leave before and after the age of 65 years among those in paid work in Sweden in 2000 or 2005: a register-based cohort study.

Objective With pressure for older people to remain in work, research is needed on how people aged over 65 years fare in the labour market. However, few studies have focused on sick leave among older workers, especially those over the standard retirement age. This study investigated changes in sick-leave patterns among people aged over 65 years still in work. Methods All individuals in Sweden who turned 65 years old in 2000 or 2005 were followed from 1995 to 2010. The mean number of sick-leave days per year was measured for those who remained in paid work past the age of 65 years. Results Those over 65 years still working had fewer sick-leave days before the age of 65 years than those who retired. They also had fewer sick-leave days after 65 years than before. There were fewer socioeconomic differences after 65 years than before, but these differences were greater for workers over 65 years in the 2005 cohort. Conclusions Although there were more people over 65 years in paid work in 2005, sick-leave days and socioeconomic differences in sick leave were lower in this age group. Sick-leave days and socioeconomic differences in sick leave were greater in the 2005 cohort.

Transitions Between Compensated Work Disability, Joblessness, and Self-Sufficiency: A Cohort Study 1997-2010 of Those Jobless in 1995.

Associations between unemployment, work, and disability have been researched in many studies. The findings are often based on cross-sectional data and single outcomes. The present study analysed multiple outcomes over a period of 15 years among long-term unemployed individuals. Based on all individuals aged 20-40 living in Sweden in 1995, prospective cohort analyses were conducted. Individual annual labour market proximity 1995-2010 was estimated and categorised into three mutually exclusive categories: "Jobless", "Self-sufficient" (i.e. main income from work), or "Disabled". Individuals in the category "Jobless" (n = 638,622) in 1995 constituted the study population. Using autoregressive multinomial logistic regression, transitions between the three states during 1997-2010 were analysed. Socio-economic factors, previous inpatient care, and national unemployment rates in different time periods were included in the regression models. Among those "Jobless" in 1995, 17 % were also "Jobless" in 2010, while 10 % were "Disabled" and 61 % "Self-sufficient". The transitions were stable over time periods for transitions into "Self-sufficient" and "Disabled" but less so for "Jobless". Previous state was the best predictor of subsequent state. "Jobless" individuals with previous morbidity had a higher transition probability into "Disabled" and a lower transition probability into "Self-sufficient". The transition rates into "Self-sufficient" were higher in periods with lower unemployment levels. The study supports the interpretation that return to work was affected both by the individuals' previous health status and by the national unemployment level. Transition from being "Jobless" into "Disability" may be influenced by previous ill health and by negative health effects of being "Jobless".

Association between adjustment latitude and sickness presence - A panel study of Swedish employees.

OBJECTIVES: This study is analyzing the unexpected reversed or lacking association between high adjustment latitude and sickness presence by examining whether it is due to confounding. MATERIAL AND METHODS: Questionnaires were sent in 2004 and 2005 to a cohort of individuals aged 25-50 years, selected from the Statistics Sweden's register of the Swedish population. Information from 2397 individuals who answered both questionnaires was analyzed by the use of logistic regression analysis. RESULTS: The odds ratio for sickness presence among the individuals with a low adjustment latitude compared to those with high adjustment latitude was 1.7 (range: 1.4-2.2). This increased likelihood was almost entirely unaffected in the analysis of potential confounders. CONCLUSIONS: If the reversed association between adjustment latitude and sickness presence does not reflect confounding, it may be due to reporting bias, which may cause problems in research on sickness presence. We argue that more detailed studies are needed to explore the different sources of possible reporting problems.

Interaction Effects of Social Isolation and Peripheral Work Position on Risk of Disability Pension: A Prospective Study of Swedish Women and Men.

PURPOSE: The study examines various combinations of levels of social isolation in private life and peripheral work position as predictors of disability pension (DP). A second aim was to test the potential interaction effects (above additivity) of social isolation and peripheral work position on the future risk of DP, and to provide results for men and women by age. METHOD: The study was based on a sample of 45567 women and men from the Swedish population who had been interviewed between 1992 and 2007. Further information on DP and diagnoses was obtained from the Swedish Social Insurance Agency's database (1993-2011). The studied predictors were related to DP using Cox's proportional hazard regression. The analyses were stratified on sex and age (20-39 years, 40-64 years), with control for selected confounders. RESULTS: Increased risks of DP were found for most combinations of social isolation and peripheral work position in all strata. The hazard ratios (HRs) for joint exposure to high degree of social isolation and a peripheral work position were particularly strong among men aged 20-39 (HR 5.70; CI 95% 3.74-8.69) and women aged 20-39 (HR 4.07; CI 2.99-5.56). An interaction effect from combined exposure was found for women in both age groups as well as a tendency in the same direction among young men. However, after confounder control the effects did not reach significance. CONCLUSIONS: Individuals who were socially isolated and in a peripheral work position had an increased risk of future DP. The fact that an interaction effect was found among women indicates that a combination of social isolation and peripheral work position may reinforce adverse health effects. There was no evidence that a peripheral work position can be compensated by a high degree of social intergration in private life.

The actions of the social insurance agency regarding long-term sickness absentees before and after a medical assessment--a study of 384 case files.

PURPOSE: The purpose of this article is to investigate actions taken by the Social Insurance Agency (SIA) for long-term sickness absentees and possible associations of this with future sick leave or disability pension. METHOD: For 384 long-term sickness absentees who had had a multidisciplinary medical assessment (MMA) during 2001-2006, three types of data were obtained: (1) case file information about SIA actions, (2) suggested rehabilitation measures from the MMA and (3) sickness absence and disability pension data. RESULTS: Most individuals had been subject to a range of actions by the SIA. Sixty percent had been invited to a coordination meeting, and half of those who assessed by the MMA for vocational rehabilitation were approved to get it by the SIA. Few SIA actions were associated with full or partial return to work. CONCLUSIONS: Although the studied individuals had been on sick leave for a long time, the number of SIA actions related to vocational rehabilitation was limited and came late in the sick-leave spell. The information from the MMA was often not used as a basis for further SIA action and seldom resulted in return to work. The positive MMA views on the potential of vocational rehabilitation were not met by SIA actions. IMPLICATIONS FOR REHABILITATION: Suggestions on vocational rehabilitation from a medical assessment was in many cases not used by the social insurance agency in relationship to long-term sickness absentees. Active rehabilitation measures by the social insurance agency were few and came late in the sickness absence process. Few of the activities taken by the social insurance agency enhanced return to work.