Subjective cognitive complaints and permanent work disability: a prospective cohort study.

PURPOSE: Work disability (WD) is a medico-legal concept that refers to disability benefits (DB) granted due to diseases. We assessed whether subjective cognitive complaints (SCC)-presenting as self-rated difficulties of concentration, memory, clear thinking, and decision making-predict permanent WD in knowledge-intensive occupations. METHODS: In this prospective cohort study with up to 7-year follow-up, we combined the SCC questionnaire results with reliable registry data on the DBs of 7161 professional/managerial employees (46% females). We excluded employees who were on long-term sickness absence (SA) or had received a DB at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome variable was a granted DB. The cumulative incidence function illustrates the difference between SCC categories, and the Fine-Gray model estimates the predictors of WD during the 8-year follow-up. RESULTS: The annual incidence of DB was 0.15% in the entire cohort: 0.18% among the females, and 0.12% among the males (p = 0.795). The most common primary reasons for permanent WD were mental (36%) and musculoskeletal (20%) disorders. SCC predicted DB in both genders when controlling for age and prior SA. Hazard ratios were 2.9 with a 95% confidence interval 1.4-6.0 for the females and 3.7 (1.8-7.9) for the males. CONCLUSION: Subjective cognitive complaints predict permanent WD in knowledge-intensive occupations. This finding has implications for supporting work ability and preventing work disability among employees with cognitively demanding tasks.

Subjective cognitive complaints and sickness absence: A prospective cohort study of 7059 employees in primarily knowledge-intensive occupations.

Knowledge-intensive work requires capabilities like monitoring multiple sources of information, prioritizing between competing tasks, switching between tasks, and resisting distraction from the primary task(s). We assessed whether subjective cognitive complaints (SCC), presenting as self-rated problems with difficulties of concentration, memory, clear thinking and decision making predict sickness absence (SA) in knowledge-intensive occupations. We combined SCC questionnaire results with reliable registry data on SA of 7743 professional/managerial employees (47% female). We excluded employees who were not active in working life, on long-term SA, and those on a work disability benefit at baseline. The exposure variable was the presence of SCC. Age and SA before the questionnaire as a proxy measure of general health were treated as confounders and the analyses were conducted by gender. The outcome measure was the accumulated SA days during a 12-month follow-up. We used a hurdle model to analyse the SA data. SCC predicted the number of SA days during the 12-month follow-up. The ratio of the means of SA days was higher than 2.8 as compared to the reference group, irrespective of gender, with the lowest limit of 95% confidence interval 2.2. In the Hurdle model, SCC, SA days prior to the questionnaire, and age were additive predictors of the likelihood of SA and accumulated SA days, if any. Subjective cognitive complaints predict sickness absence in knowledge-intensive occupations, irrespective of gender, age, or general health. This finding has implications for supporting work ability (productivity) among employees with cognitively demanding tasks.

Self-reported health problems in a health risk appraisal predict permanent work disability: a prospective cohort study of 22,023 employees from different sectors in Finland with up to 6-year follow-up.

PURPOSE: Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk-a health risk appraisal (HRA)-also predicts permanent WD. METHODS: HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine-Gray model estimates the predictors of WD during 6-year follow-up. RESULTS: The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as "WD risk factors", predicted DB when controlling for age and prior SA. Hazard ratios were 10.9 or over with the lower limit of the 95% confidence interval 3.3 or over among those with two simultaneous WD risk factors. 14% of the females and 17% of the males with three or more simultaneous WD risk factors had received a DB, whereas the respective figures among those without findings were 1.9% and 0.3%. CONCLUSIONS: Self-reported health problems in the HRA, especially multiple simultaneous WD risk factors, predict permanent WD among both genders across occupational groups. Screening WD risk with a self-administered questionnaire is a potential means for identifying high-risk employees for targeting occupational healthcare actions.

Self-reported health problems and obesity predict sickness absence during a 12-month follow-up: a prospective cohort study in 21 608 employees from different industries.

OBJECTIVES: To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. METHODS: The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as 'work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. RESULTS: The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with 'WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, 'WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. CONCLUSION: Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD.

Sick leaves in four factories--do characteristics of employees and work conditions explain differences in sickness absence between workplaces?

OBJECTIVES: The study explored whether differences in sickness absence between four factories of a food industry company were explained by common determinants of sickness absence, such as employee health, sociodemographic characteristics, and physical and psychosocial work conditions. METHODS: Survey responses of 582 employees were linked to the records of short-term (1-3 days) and long-term (>3 days) absence, as well as to records of absences due to musculoskeletal diagnoses. Multilevel models were applied in assessing the between-factory absence differences. RESULTS: Compared with the levels in the factory with the lowest sickness absence, in one factory the levels of short-term [rate ratio (RR) 1.72], long-term (RR 1.96), and musculoskeletal (rate ratio 2.93) absence were significantly higher. Another factory also had higher levels of long-term and musculoskeletal absence (RR 2.17 and 2.52, respectively). Adjustment for the background factors explained 35% of the difference in short-term absence, 3-9% of the differences in long-term absence, and 18-12% of the differences in musculoskeletal absence, but the between-factory differences were still highly significant. CONCLUSIONS: This study showed large differences in sickness absence between factories that were only partly explained by common determinants. Moreover, economic factors and formal control were unlikely explanatory factors, as the study was conducted within a single company. These results justify further research on local absence practices and cultures, including those of health service organizations and professionals.

Long-term associations of stress and chronic diseases in ageing and retired employees.

Long-term associations of prolonged stress symptoms and work-related stressors with chronic diseases were assessed in a sample of ageing and retired food industry workers (N = 100, mean age 62 years) using independent samples t-test, chi-squared test and binary logistic regression analyses. Data was gathered at health checkups and using self-report questionnaires in 1989 and 2000. Prolonged stress symptoms were associated with overall morbidity. Higher scores of stress symptoms predicted musculoskeletal disorders, diseases of the nervous system, eye and ear, endocrine and metabolic diseases, and mental disorders. Of work-related stressors, only job dissatisfaction had a long-term association with endocrine and metabolic diseases. Importantly, prolonged stress symptoms could not be explained by job strain and demands. Identification of prolonged stress symptoms along with traditional and potential risk factors, and combining this knowledge with stress reduction and management is essential for disease prevention and in postponing subsequent onset of disease.

Effectiveness of physiotherapy for lateral epicondylitis: a systematic review.

AIM: To evaluate the available evidence of the effectiveness of physiotherapy for lateral epicondylitis of the elbow. METHOD: Randomised controlled trials (RCTs) identified by a highly sensitive search strategy in six databases in combination with reference checking. Two independent reviewers selected RCTs that included a physiotherapy intervention, patients with lateral epicondylitis, and at least one clinically relevant outcome measure. No language restrictions were made. Methodological quality was independently assessed by two blinded reviewers. A best evidence synthesis, including a quantitative and qualitative analysis, was conducted, weighting the studies with respect to their internal validity, statistical significance, clinical relevance, and statistical power. RESULTS: 23 RCTs were included in the review, evaluating the effects of lasertherapy, ultrasound treatment, electrotherapy, and exercises and mobilisation techniques. Fourteen studies satisfied at least 50% of the internal validity criteria. Except for ultrasound, pooling of data from RCTs was not possible because of insufficient data, or clinical or statistical heterogeneity. The pooled estimate of the treatment effects of two studies on ultrasound compared to placebo ultrasound, showed statistically significant and clinically relevant differences in favour of ultrasound. There is insufficient evidence either to demonstrate benefit or lack of effect of lasertherapy, electrotherapy, exercises and mobilisation techniques for lateral epicondylitis. CONCLUSIONS: Despite the large number of studies, there is still insufficient evidence for most physiotherapy interventions for lateral epicondylitis due to contradicting results, insufficient power, and the low number of studies per intervention. Only for ultrasound, weak evidence for efficacy was found. More better designed, conducted and reported RCTs are needed.