The effects of a national, voluntary agreement for a more inclusive working life on work participation following long-term sickness absence:a Norwegian cohort study

OBJECTIVES: This study aimed to estimate the average individual effect of the company-level Norwegian Agreement on a More Inclusive Working Life (IA Agreement) on individuals' (i) sustained return to work after a sickness absence (SA) episode, and (ii) recurrent SA. METHODS: Using register data, 79 253 men and 94 914 women born in Norway 1967-1976 were followed for one year between 2005 and 2010 after returning to work from an SA episode (&gt;16 days). Weighted Cox proportional hazard models analysed time to first exit from work by companies' IA status (IA/non-IA). Weighted cumulative incidence differences between IA and non-IA groups with 95% bootstrapped confidence intervals (CI) were calculated for the competing events of full SA, graded (&lt;100%) SA, unemployment/economic inactivity, education, disability pension, and death/emigration. Stabilised inverse probability of treatment weights balanced IA/non-IA groups according to nine covariates. Analyses were stratified by gender, and separately for two initial SA diagnoses (musculoskeletal and psychological). RESULTS: Both men [adjusted hazard ratio (HR) 0.96, 95% CI 0.93-0.99] and women (adjusted HR 0.97, 95% CI 0.94-0.99) in IA companies were less likely to exit work in the year following SA. Similar findings were seen among individuals with musculoskeletal diagnoses and women with psychological diagnoses. Men with psychological diagnoses were more likely to exit work. Recurrent full and graded SA were more likely, and unemployment/economic inactivity less likely, in IA companies. However, the estimated effects were small and the CI often included the null. CONCLUSIONS: Individuals working in IA companies were more likely to remain in work. This was mainly due to reduced unemployment/economic inactivity, suggesting the IA Agreement may have influenced work participation through other means than reduced SA.</p

Individual accumulation of heterogeneous risks explains perinatal inequalities within deprived neighbourhoods

Dutch' figures on perinatal mortality and morbidity are poor compared to EU-standards. Considerable within-country differences have been reported too, with decreased perinatal health in deprived urban areas. We investigated associations between perinatal risk factors and adverse perinatal outcomes in 7,359 pregnant women participating in population-based prospective cohort study, to establish the independent role, if any, for living within a deprived urban neighbourhood. Main outcome measures included perinatal death, intrauterine growth restriction (IUGR), prematurity, congenital malformations, Apgar at 5 min < 7, and pre-eclampsia. Information regarding individual risk factors was obtained from questionnaires, physical examinations, ultrasounds, biological samples, and medical records. The dichotomous Dutch deprivation indicator was additionally used to test for unexplained deprived urban area effects. Pregnancies from a deprived neighbourhood had an increased risk for perinatal death (RR 1.8, 95% CI [1.1; 3.1]). IUGR, prematurity, Apgar at 5 min < 7, and pre-eclampsia also showed higher prevalences (P < 0.05). Residing within a deprived neighbourhood was associated with increased prevalence of all measured risk factors. Regression analysis showed that the observed neighbourhood related differences in perinatal outcomes could be attributed to the increased risk factor prevalence only, without a separated role for living within a deprived neighbourhood. Women from a deprived neighbourhood had significantly more 'possibly avoidable' risk factors. To conclude, women from a socioeconomically deprived neighbourhood are at an increased risk for adverse pregnancy outcomes. Differences regarding possibly avoidable risk factors imply that preventive strategies may prove effective

Qualidade de Vida: comparação entre diálise peritoneal automatizada e hemodiálise Calidad de vida: comparación entre diálisis peritoneal automatizada y hemodiálisis Quality of Life: comparison between patients on automated peritoneal dialysis and patients on hemodialysis

OBJETIVO: Avaliar a Qualidade de Vida relacionada à saúde em pacientes submetidos à Diálise Peritoneal Automatizada (DPA) e Hemodiálise em um centro de diálise satélite no Município de São Paulo. MÉTODOS: Este estudo observacional transversal, incluiu 101 pacientes com idade entre 18-75 anos, em terapia há mais de 90 dias e que compreenderam o questionário. RESULTADOS: O grupo em Hemodiálise (n=79) estava em terapia há mais tempo (p=0.001) e tinha albumina sérica maior (p<0.001) comparado ao grupo em DPA (n=22). Os escores do SF-36 foram semelhantes em várias dimensões, exceto pelo escore de Aspectos Físicos que foi maior nos pacientes em Hemodiálise (p=0.03). Não houveram interações significativas entre SF-36 e as demais variáveis que explicassem esta diferença. CONCLUSÃO: A Qualidade de Vida foi semelhante entre as modalidades, porém o escore de Aspectos Físicos foi menor para pacientes em Diálise Peritoneal Automatizada.<br>OBJETIVO: Evaluar la Calidad de Vida relacionada a la salud de pacientes sometidos a Diálisis Peritoneal Automatizada (DPA) y Hemodiálisis en un centro de diálisis del Municipio de Sao Paulo. MÉTODOS: Este estudio observacional transversal, incluyó a 101 pacientes con edades comprendidas entre los 18 y 75 años, que se encontraban en terapia hace más de 90 días y que comprendieran el cuestionario. RESULTADOS: El grupo en Hemodiálisis (n=79) estaba en terapia hace más de un tiempo (p=0.001) y tenía albúmina sérica mayor (p<0.001) comparado al grupo en DPA (n=22). Los escores del SF-36 fueron semejantes en varias dimensiones, excepto para el escore de Aspectos Físicos que fue mayor en los pacientes en Hemodiálisis (p=0.03). No hubo interacciones significativas entre SF-36 y las demás variables que explicaran esta diferencia. CONCLUSIÓN: La calidad de Vida fue semejante entre las modalidades, no obstante el escore de Aspectos Físicos fue menor para pacientes en Diálisis Peritoneal Automatizada.<br>OBJECTIVE: To evaluate the health-related quality of life in patients from a satellite dialysis center in São Paulo city undergoing Automated Peritoneal Dialysis (APD) or Hemodialysis. METHODS: This cross-sectional descriptive study included 101 patients with ages ranging from 18 to 75 years-old, who were in dialysis treatment over 90 days and able to understand the items of the SF-36 questionnaire in Portuguese. RESULTS: The Hemodialysis group (n=79) had been in dialysis treatment longer (p=0.001) and had higher serum albumin level (p<0.001) than the APD group (n=22). The SF-36 scores of the two groups were similar in all dimensions, except for the physical functioning dimension, on which the hemodialysis group had higher scores than the APD group (p=0.03). There were no statistically significant interactions between the SF-36 score and the other variables of the study. CONCLUSION: There were no differences in quality of life between patients on APD and patients on hemodialysis, except for the physical functioning dimension