Exchange Rates and the International Adjustments Process

macroeconomics, exchange rates

Use of pain medication before and after inpatient musculoskeletal rehabilitation: longitudinal analysis of a nationwide cohort

The objective of this study was to identify subgroups among the participants in inpatient multidisciplinary musculoskeletal rehabilitation based on the differences in the shapes of trajectories of pain medication consumption during the 9 years around the time of intervention. A register-based study among 4578 public sector employees was conducted. Group-based trajectory analysis was done on the purchase of prescribed pain medications during the 9 years around the time of rehabilitation. The participants were on an average 50.7 (SD=6.6) years of age, and 2955 (86%) were women. Average yearly purchase of pain medications increased during the follow-up period from 73.4 (SD=193.0) to 163.3 (SD=295.7) defined daily doses. The analysis suggested six-cluster model. The shapes of the trajectories of three clusters did not show any steep slopes, one trajectory demonstrated nonstop rising through the entire follow-up, and one trajectory was closed to the trajectory average of medication use. One trajectory (11% of the sample) demonstrated a steep growth before the intervention and steep drop after it. When comparing this cluster with all other clusters combined, odds ratios were 0.40 [95% confidence interval (CI): 0.19-0.85] for age group (older vs. younger), 0.78 (95% CI: 0.61-1.01) for sex (women vs. men), and 1.44 (95% CI: 1.09-1.90) for occupational status (lower vs. higher). In other words, the participants belonged to this cluster were younger employees with a lower occupational grade. It seems that younger employees in manual jobs benefitted of the studied multidisciplinary musculoskeletal rehabilitation the most, especially when the timing of intervention is bounded to the substantial rise of pain severity

Physical activity and peripheral artery disease: Two prospective cohort studies and a systematic review

Background and aims Physical activity is a modifiable risk factor for cardiovascular disease and an important therapy in individuals with intermittent claudication. However, its role in the development of peripheral artery disease (PAD) is unclear. We have examined the evidence of the association between physical activity and development of PAD. Methods We searched PubMed, EMBASE and CINAHL Plus in August 2018 for original studies of physical activity and PAD. Studies reporting prevalence or incidence of PAD by categories of physical activity (an amount of activity per unit of time) were included. In addition, we analysed unpublished individual-level data from two register-linked cohort studies, Finnish Public Sector Study (n = 63,924) and Whitehall II (n = 10,200). Due to heterogeneity in the assessment of physical activity and PAD, we provide a qualitative synthesis of the findings. Results Evidence from 18 studies (15 cross-sectional/case-control and 7 prospective studies) of the association between physical activity and PAD in total of 152,188 participants, including 3971 PAD patients, suggests that individuals with a diagnosis or clinical findings of PAD were less physically active, regardless of whether activity was self-reported or measured using accelerometers. The findings from the longitudinal studies point to more intense physical activity being associated with lower odds of developing PAD; however, the study-specific findings lacked power to precisely estimate this relationship. Conclusions Individuals with PAD were less physically active than those without PAD. The longitudinal findings suggest that physical activity decreases the risk of PAD, although better powered studies are needed to confirm this

Depression-related work disability: socioeconomic inequalities in onset, duration and recurrence

Objective: Depression is a major cause of disability in working populations and the reduction of socioeconomic inequalities in disability is an important public health challenge. We examined work disability due to depression with four indicators of socioeconomic status. Methods: A prospective cohort study of 125 355 Finnish public sector employees was linked to national register data on work disability (>9 days) due to depressive disorders (International Classification of Diseases, codes F32–F34) from January 2005 to December 2011. Primary outcomes were the onset of work disability due to depressive disorders and, among those with such disability, return to work after and recurrent episodes of work disability due to depression. Results: We found a consistent inverse socioeconomic gradient in work disability due to depression. Lower occupational position, lower educational level, smaller residence size, and rented (vs. owner-occupied) residence were all associated with an increased risk of work disability. Return to work was slower for employees with basic education (cumulative odds ratio = 1.21, 95% CI: 1.05–1.39) compared to those with higher education. Recurrent work disability episodes due to depression were less common among upper-grade non-manual workers (the highest occupational group) than among lower-grade non-manual (hazard ratio = 1.16, 95% CI: 1.07–1.25) and manual (hazard ratio = 1.14, 95% CI: 1.02–1.26) workers. Conclusions: These data from Finnish public sector employees show persistent socioeconomic inequalities in work disability due to depression from 2005 to 2011 in terms of onset, recovery and recurrence

Trajectories of work ability from mid-life to pensionable age and their association with retirement timing

BACKGROUND: This study aimed to identify the trajectories of work ability over 16 years preceding the individual pensionable age and to examine the association with retirement timing. METHODS: The study population consisted of 2612 public sector employees from the Finnish Retirement and Aging study and the Finnish Public Sector study. Participants were grouped into 'no-extension' (retired at the individual pensionable date or worked no longer than 6 months after that date) and 'extension' (worked more than 6 months after individual pensionable age). Trajectories of self-reported work ability score (0-10) in maximum of eight measurement points over 16 years preceding retirement were examined using the group-based latent trajectory analysis. Log-binomial regression was used to analyse the association between trajectory groups and extended employment. RESULTS: Four stable ('Stable excellent', 7%; 'Stable high', 62%; 'Stable medium', 24%; 'Low', 4%) and one decreasing ('Declining', 3%) work ability trajectories were identified. After taking into account gender, age, occupational status, marital status and self-rated health, 'Stable excellent' trajectory was associated with a higher likelihood of extended employment compared with the 'Low' (risk ratio (RR) 2.38, 95% CI 1.21 to 4.68) and to the 'Declining' (RR 2.82, 95% CI 1.32 to 6.01) trajectories. There was no difference in retirement timing between 'Declining', 'Low' and 'Stable medium' trajectories. CONCLUSION: Work ability remained relatively stable among majority of the participants over 16 years of follow-up. Stable excellent work ability from mid-life to late career was associated with higher likelihood of extending employment beyond individual pensionable age than those with low or declining work ability

Trends in work disability with mental diagnoses among social workers in Finland and Sweden in 2005-2012

AIMS: Social workers report high levels of stress and have an increased risk for hospitalisation with mental diagnoses. However, it is not known whether the risk of work disability with mental diagnoses is higher among social workers compared with other human service professionals. We analysed trends in work disability (sickness absence and disability pension) with mental diagnoses and return to work (RTW) in 2005-2012 among social workers in Finland and Sweden, comparing with such trends in preschool teachers, special education teachers and psychologists. METHODS: Records of work disability (>14 days) with mental diagnoses (ICD-10 codes F00-F99) from nationwide health registers were linked to two prospective cohort projects: the Finnish Public Sector study, years 2005-2011 and the Insurance Medicine All Sweden database, years 2005-2012. The Finnish sample comprised 4849 employees and the Swedish 119 219 employees covering four occupations: social workers (Finland 1155/Sweden 23 704), preschool teachers (2419/74 785), special education teachers (832/14 004) and psychologists (443/6726). The reference occupations were comparable regarding educational level. Risk of work disability was analysed with negative binomial regression and RTW with Cox proportional hazards. RESULTS: Social workers in Finland and Sweden had a higher risk of work disability with mental diagnoses compared with preschool teachers and special education teachers (rate ratios (RR) 1.43-1.91), after adjustment for age and sex. In Sweden, but not in Finland, social workers also had higher work disability risk than psychologists (RR 1.52; 95% confidence interval 1.28-1.81). In Sweden, in the final model special education teachers had a 9% higher probability RTW than social workers. In Sweden, in the final model the risks for work disability with depression diagnoses and stress-related disorder diagnoses were similar to the risk with all mental diagnoses (RR 1.40-1.77), and the probability of RTW was 6% higher in preschool teachers after work disability with depression diagnoses and 9% higher in special education teachers after work disability with stress-related disorder diagnoses compared with social workers. CONCLUSION: Social workers appear to be at a greater risk of work disability with mental diagnoses compared with other human service professionals in Finland and Sweden. It remains to be studied whether the higher risk is due to selection of vulnerable employees to social work or the effect of work-related stress in social work. Further studies should focus on these mechanisms and the risk of work disability with mental diagnoses among human service professionals

Do predictors of return to work and recurrence of work disability due to mental disorders vary by age? A cohort study

BACKGROUND: The extent to which predictors of return to work (RTW) and recurrence of work disability episodes vary by age group is not well understood. METHODS: We examined the associations of sociodemographic and clinical factors with RTW and recurrence after mental-disorder-related work disability episodes in a cohort of 10,496 Finnish public sector employees. Disability records were derived from national disability registers between 2005 and 2011. Effect modification by age was examined in age groups of 21-34, 35-50 and >50 years. RESULTS: A total of 16,551 disability episodes from mental disorders were recorded. The likelihood of RTW was elevated in age group 21-34 (hazard ratio (HR) = 1.36, 95% confidence interval (CI) = 1.28-1.46) and 35-50 years (HR = 1.22, 95% CI = 1.18-1.26) compared to age group >50 years. The risk of a recurrent episode of work disability was higher in age groups >50 (HR = 1.29, 95% CI = 1.09-1.52) and 35-50 years (HR = 1.20, 95% CI = 1.03-1.41) compared to the youngest age group. Employees with depressive disorders were less likely to RTW than employees with neurotic, stress-related and somatoform disorders, and this difference increased with age. Low education was associated with increased risk of recurrent work disability episode in age groups of 50 years or younger, while no such association was observed in age group >50 years. CONCLUSIONS: The importance of depressive symptoms over neurotic, stress-related and somatoform disorders as predictors of delayed RTW increases with age, whereas educational differences in the recurrence of an episode diminish by age