Förtidspensionärer i ett tioårsperspektiv : En jämförelse av de nya förtidspensionärerna 1988, 1993 och 1998

The main objective with this study was to compile a picture of the individuals granted disability pension in Sweden in 1988, 1993 and 1998. It presents an overall picture of the social and professional backgrounds of the individuals granted disability pension during these three years and discusses the trends that we observed. The data material used contains information about all individuals who received disability pension 1988 (54,000), 1993 (63,000) and 1998 (34,000). The results showed that fairly substantial changes have occurred over the ten-year period studied. During the period there has been a continuous increase in the proportion of female disability pensioners. The average age has dropped considerably while the proportion of individuals who prior to the pension year were single and/or unmarried has increased. The picture with regard to diagnoses has changed fairly dramatically, and the most marked change is that the proportion of musculoskeletal disorders has decreased, while psychological complaints account for a larger proportion of the diagnoses. Another development during the ten-year period is that fewer and fewer disability pensioners were granted full disability pension and thus, the number with partial benefits have increased. The situation concerning the educational and labour market background have changed substantially. Those who received disability pension in the late 1990s were more highly educated than was the corresponding group 10 years earlier. It is primarily the proportion of individuals with 2-year Swedish upper secondary school that has increased, while those with only compulsory school education declined. These changes in educational background correspond to changes concerning social class and occupation. Although manual labourers still made up the largest proportion of disability pensioners, this proportion steadily decreased, while the proportion of white-collar workers grew. This trend is also reflected in the decreasing numbers that had worked in manufacturing occupations prior to the pension while those previously hired in professional, technical occupations accounted for a growing proportion among the disability pensioners. The comparison between the three years has thus reviled a shift towards mid-level groups in terms of both profession and education and this trend is more pronounced among women. A general conclusion that can be drawn from the comparison presented in this study is that the variation concerning pension types, diagnoses categories, social background and labour market status has increased over time. In this respect, disability pension has been diversified. At the same time, however, the results suggest that the disability pension system is placing greater emphasis on groups clearly marginalized in relation to the labour market. Individuals with clearly definable handicaps and complex social circumstances are being granted disability pension to an increasing extent, regardless of their social class and professional background.Huvudsyftet med denna rapport har varit att beskriva de som blivit förtidspensionärer i Sverige vid tre olika tidpunkter, 1988, 1993 samt 1998. En övergripande bild av de olika pensionsårgångarnas sammansättning med avseende på social och arbetsmarknadsmässig bakgrund, samt en diskusson av de trendmässiga förändringar som inträffat under den studerade perioden, har presenterats. Datamaterialet som analyserats rymmer information om samtliga individer som förtidspensionerats 1988 (54000), 1993 (63000) samt 1998 (34000). Resultaten av jämförelsen mellan de tre åren pekar på att relativt omfattande förändringar avseende de nya förtidspensionärernas bakgrund har inträffat under den studerade tioårsperioden. Andelen kvinnor bland dem som beviljas förtidspension ökar trendmässigt. Medelåldern bland de nya förtidspensionärerna har sjunkit, medan andelen som innan pensioneringen levt som ogifta och/eller frånskilda har ökat. Stora förändringar i förtidspensionärernas diagnoser har inträffat och den tydligaste förändringen är att andelen med psykiska diagnoser ökar medan de som rör muskler och skelett (belastningsbesvär) minskar. Under perioden minskar andelen som ges hel pension/sjukbidrag medan de partiella förmånerna ökar. Också när det gäller utbildnings- och arbetsmarknadsbakgrund har förändringar inträffat. De som erhåller förtidspension i slutet av 1990-talet är mer välutbildade än vad fallet var tio år tidigare. Det är framför allt andelen med 2-årig gymnasieutbildning som ökar medan de som endast har grundskoleutbildning blir färre. Förändringarna i utbildningsbakgrund korresponderar väl med de förändringar som framkommit när det gäller social klass och yrke. Även om arbetarkategorier under hela perioden är den dominerande rekryteringsbasen bland förtidspensionärerna visar jämförelsen mellan åren att andelen med en bakgrund i tjänstemannayrken växer över tid. Detta avspeglas också i det faktum att en bakgrund som anställd i tillverkningsyrken minskar medan de som arbetat inom tekniskt, naturvetenskapliga yrkesområden växer. Vi ser således en förskjutning mot mellanskikten både utbildnings- och yrkesmässigt och bilden är tydligare bland kvinnor. En generell slutsats av jämförelsen är att spridningen mellan förtidspensionärerna när det gäller pensionsformer, diagnosgrupper, social bakgrund och arbetsmarknadspositioner har ökat över tid. Förtidspensioneringen har därigenom diversifierats. Men samtidigt framkommer också att förtidspensionssystemet i högre grad än tidigare fokuseras på individer som är tydligt marginaliserade visavi arbetsmarknaden. Individer som har ett klart diagnostiserbart handikapp och med en komplicerad social situation förtidspensioneras i växande utsträckning oberoende av klass- och yrkesmässig bakgrund

Job satisfaction and abscene

Diss. Umeå : Universitet, 1985digitalisering@um

Work situation and self-perceived economic situation as predictors of change in burnout - a prospective general population-based cohort study

Background: Sick leave rates due to mental and behavioural disorders have increased in Sweden during the last decades. The aim of this prospective study was to investigate changes in the level of burnout in a working subset of the general population and to identify how such changes relate to changes in work situation and self-perceived economic situation. Methods: A cohort of 1000 persons from a subset of the 2004 northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) general population survey was followed over a five-year period (2004-2009). In total, 623 persons (323 women and 300 men) were included in the analysis. Burnout levels were measured at baseline and follow-up using the Shirom Melamed Burnout Questionnaire. Risk factors were assessed at both measuring points. Results: In the whole study cohort, a small (-0.15) but statistically significant reduction in burnout level was found. No differences in change of burnout were found between men and women. Constant strain at work, an increased risk of unemployment, and a perceived worsening of economic situation during the study time period were related to an increased burnout level. An accumulation of these risk factors was associated with increased burnout level. Conclusions: Risk factors in work situation and self-perceived economy are related to changes in burnout level, and special attention should be directed towards persons exposed to multiple risk factors

Work situation and self-perceived economic situation as predictors of change in burnout - a prospective general population-based cohort study

Background: Sick leave rates due to mental and behavioural disorders have increased in Sweden during the last decades. The aim of this prospective study was to investigate changes in the level of burnout in a working subset of the general population and to identify how such changes relate to changes in work situation and self-perceived economic situation. Methods: A cohort of 1000 persons from a subset of the 2004 northern Sweden MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) general population survey was followed over a five-year period (2004-2009). In total, 623 persons (323 women and 300 men) were included in the analysis. Burnout levels were measured at baseline and follow-up using the Shirom Melamed Burnout Questionnaire. Risk factors were assessed at both measuring points. Results: In the whole study cohort, a small (-0.15) but statistically significant reduction in burnout level was found. No differences in change of burnout were found between men and women. Constant strain at work, an increased risk of unemployment, and a perceived worsening of economic situation during the study time period were related to an increased burnout level. An accumulation of these risk factors was associated with increased burnout level. Conclusions: Risk factors in work situation and self-perceived economy are related to changes in burnout level, and special attention should be directed towards persons exposed to multiple risk factors

Active NET formation in Libman–Sacks endocarditis without antiphospholipid antibodies : A dramatic onset of systemic lupus erythematosus

Although neutrophil extracellular traps (NETs) have been highlighted in several systemic inflammatory diseases, their clinical correlates and potential pathological role remain obscure. Herein, we describe a dramatic onset of systemic lupus erythematosus (SLE) with clear-cut pathogenic implications for neutrophils and NET formation in a young woman with cardiac (Libman–Sacks endocarditis) and central nervous system (psychosis and seizures) involvement. Despite extensive search, circulating antiphospholipid autoantibodies, a hallmark of Libman–Sacks endocarditis, could not be detected. Instead, we observed active NET formation in the tissue of the mitral valve, as well as in the circulation. Levels of NET remnants were significantly higher in serially obtained sera from the patient compared with sex-matched blood donors (p =.0011), and showed a non-significant but substantial correlation with blood neutrophil counts (r = 0.65, p =.16). The specific neutrophil elastase activity measured in serum seemed to be modulated by the provided immunosuppressive treatment. In addition, we found anti-Ro60/SSA antibodies in the cerebrospinal fluid of the patient but not NET remnants or increased elastase activity. This case illustrates that different disease mechanisms mediated via autoantibodies can occur simultaneously in SLE. NET formation with release of cytotoxic NET remnants is a candidate player in the pathogenesis of this non-canonical form of Libman–Sacks endocarditis occurring in the absence of traditional antiphospholipid autoantibodies. The case description includes longitudinal results with clinical follow-up data and a discussion of the potential roles of NETs in SLE