Employment Status Research Articles

Should We Use Clinician Self-Report to Tailor Implementation Strategies? Predicting Use of Youth CBT with Clinician Self-Report Versus Direct Observation.

Developing tailored implementation strategies to increase the use of evidence-based practice (EBP) requires accurate identification of predictors of their use. However, known difficulties with measuring EBP use complicates interpretation of the extant literature. In this proof-of-concept study, we examined whether the same predictors of use of cognitive behavioral therapy (CBT) are identified when CBT use is measured with clinician self-report compared to direct observation. We examined four candidate predictors of CBT use - clinician participation in an EBP training initiative, years of experience, caseload, and employment status - in a sample of 36 clinicians (64% female; 72% White and 28% Black) from 19 community mental health agencies treating youth in greater Philadelphia. CBT use was captured for 100 unique client sessions (M = 2.8 recorded sessions per clinician) through both clinician self-report and direct observation, using parallel measures. We used three-level (client, clinician, and agency) regression models with random intercepts to estimate the relationship between each predictor variable and CBT use in both measures and compared the magnitude and direction of each model across self-report and direct observation using z-tests. There was no alignment for any of the four candidate predictors between predictive relationships identified by self-report compared to those identified by direct observation. The findings in this study extend literature documenting limitations of using clinician self-report to capture clinician behavior and suggest that even the characteristics that predict higher self-reported CBT use do not align with (and often are discordant with) those that predict directly observed CBT use. This raises questions about the utility of relying on self-reported use to inform implementation strategy design.

Factors associated with zero vegetable and fruit consumption among Tanzanian children

BackgroundProper nutrition during early childhood is essential for healthy growth and development, yet many children, particularly in low and middle-income countries, fail to meet recommended intake levels of fruits and vegetables. This study aims to assess the factors associated with zero vegetable and fruit (ZVF) consumption among children aged 6–23 months in Tanzania, using data from the 2022 Tanzania Demographic and Health Survey (DHS).MethodsA weighted sample of 4582 children aged between 6 and 23 months were included in the study. Data cleaning, coding, and analysis were performed using STATA version 17 software. To address the hierarchical nature of the DHS data and the binary outcome variable, a multilevel mixed-effect binary logistic regression model was used. The deviance value served as a guide for determining the best-fitting model. In the subsequent multivariable multilevel binary logistic regression analysis, adjusted odds ratios were computed alongside their respective 95% confidence intervals to evaluate the strength of association, with statistical significance set at a p-value below 0.05.ResultThe overall proportion of ZVF consumption among children aged 6–23 months in Tanzania was 48.34% (95% CI: 46.87, 49.81). Current breastfeeding status, maternal educational status, household wealth index, sex of the household head, and community poverty level were associated with higher odds of ZVF consumption. Meanwhile, child age, maternal employment status, father’s educational status, and media exposure were associated with lower odds of ZVF consumption.ConclusionChild age, current breastfeeding status, maternal educational status, maternal employment status, father’s educational status, household wealth index, sex of household, media exposure, and community poverty level were significantly associated with ZVF consumption. Efforts should focus on educating mothers about the early introduction of fruits and vegetables in children’s diets, alongside supporting breastfeeding. Tailored economic empowerment initiatives are needed in impoverished communities to improve access to nutritious foods.

Association of socioeconomic status with unintended pregnancy and induced abortion in married couples: An analysis of the 2021 national survey data in Japan

BackgroundAn association of the major indicators of socioeconomic status with unintended pregnancy and induced abortion in married couples has not been investigated in Japan, and we investigated it using recent nationwide survey data in Japan. MethodsData from the National Fertility Survey in 2021 in Japan, which evaluated the outcomes and intentions of previous pregnancies in married couples, were used. Number of unintended pregnancies, induced abortions, and unintended pregnancies ending in induced abortion were used as outcomes, and the number of unintended pregnancies ending in induced abortion was analyzed among couples who experienced an unintended pregnancy. Associations with current educational attainment, employment status, and household income were investigated using Poisson regression analysis. A complete-case analysis was conducted for dealing with missing data, as well as an analysis using multiple imputation. ResultsAverage number of unintended pregnancy and induced abortion per pregnancy of junior high school graduates was the highest among educational attainments of wives and husbands. The adjusted regression analysis showed that junior high school graduate in husbands was significantly associated with higher number of unintended pregnancies and induced abortions, regardless of the missing data analysis methods. In addition, high school or training school graduate in husbands was significantly associated with higher number of induced abortions. A significant association between socioeconomic status and the unintended pregnancy ending in induced abortion was not observed. ConclusionThis study showed that a lower educational attainment in husband was associated with higher number of unintended pregnancies and induced abortions in Japan.

Long-term course and factors influencing work ability and return to work in post-COVID patients 12 months after inpatient rehabilitation

BackgroundRehabilitation plays a crucial role in restoring work ability and facilitating the reintegration of post-COVID patients into the workforce. The impact of rehabilitation on work ability and return to work (RTW) of post-COVID patients remains poorly understood. This study was conducted to assess the work ability and RTW of post-COVID patients before rehabilitation and 12 months after rehabilitation and to identify physical and neuropsychological health factors influencing RTW 12 months after rehabilitation.MethodsThis longitudinal observational study included 114 post-COVID patients with work-related SARS-CoV-2 infection who underwent inpatient post-COVID rehabilitation with indicative focus on pulmonology and/or psychotraumatology (interval between date of SARS-CoV-2 infection and start of rehabilitation: M = 412.90 days). Employment status, work ability, and the subjective prognosis of employment (SPE) scale were assessed before rehabilitation (T1) and 12 months after rehabilitation (T4). The predictors analysed at T4 were functional exercise capacity, physical activity, subjective physical and mental health status, fatigue, depression, and cognitive function. Longitudinal analyses were performed via the Wilcoxon signed-rank test. Logistic and linear regression analyses identified predictors of work ability and return to work (RTW), whereas mediation analyses examined the relationships between these predictors and work ability.ResultsAt T4, the median of WAI total score indicated poor work ability, which significantly worsened over time (p < 0.001; r = 0.484). The SPE scale significantly increased from T1 to T4 (p = 0.022, r = -0.216). A total of 48.6% of patients had returned to work 12 months after rehabilitation. Fatigue was identified as the main predictor of reduced work ability and RTW, with each unit increase in fatigue severity decreasing the odds of RTW by 3.1%. In addition, physical capacity and subjective health status were significant predictors of perceived work ability.ConclusionsThe findings highlight the significant challenges that post-COVID patients face in regaining work ability and achieving successful RTW 12 months after rehabilitation. Fatigue appears to be an important predictor of work ability and RTW. To optimize recovery and enhance both biopsychosocial health and work ability, it is crucial to develop and implement personalised interventions that address fatigue, improve physical capacity, and support mental health.Trial registrationThis study is registered in the German Clinical Trials Register under DRKS00022928.

Correlation between employment status and income level of mothers with exclusive breastfeeding

Introduction: Ideally, breastfeeding should begin within one hour of birth and continue for the first six months of life. The percentage of female workers in Indonesia increases year after year, and the country already has an exclusive breastfeeding policy. However, exclusive breastfeeding coverage remains relatively low. The mother's role in exclusive breastfeeding can be influenced by a number of factors. The study aims to determine the correlation between exclusive breastfeeding with employment status and the income level of mothers in Tambak Wedi Public Health Centre in Surabaya. Methods: Observational analysis with cross-sectional approach. The research population is in the area of Tambak Wedi Public Health Centre Surabaya. It Covers 114 mothers with babies aged 6-12 months old obtain from a non-probability sampling technique. Variables included exclusive breastfeeding status, employment status, and income level. The research instrument was a questionnaire and was analyzed using chi-square with a significant degree of &lt; a 0,05. Results: Of 114 mothers, 84 mothers provide exclusive breastfeeding, and 30 mothers not exclusively breastfeeding their babies. The analysis showed there is a correlation between employment status (p-value= 0,00) and income level (p-value= 0,00) of mothers with exclusive breastfeeding. Conclusion: The mother’s employment status and income level positively affect exclusive breastfeeding practice in Tambak Wedi Public Health Centre Surabaya.

Regional and social disparities in cessation behavior and motivation to quit among U.S. adult current smokers, Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey 2014–15 and 2018–19

IntroductionVariation in smoking cessation behaviors and motivators across the United States may contribute to health disparities. This study investigates regional differences over time in two key cessation motivators (quit interest and doctor's advice to quit) and two cessation behaviors (past-year quit attempts and recent successful cessation) across diverse demographic factors.MethodsData were analyzed from two releases of the Tobacco Use Supplement to the U.S. Census Bureau's Current Population Survey (TUS-CPS) for the years 2014–15 and 2018–19. The analysis included sex, age, race and ethnicity, education, marital status, employment status, and household income.ResultsFindings from 2018 to 2019 TUS-CPS revealed that quit interest was highest in the Northeast and lowest in the Midwest, while doctor's advice to quit was most prevalent in the Northeast and least in the West. Past-year quit attempts were most common in the Northeast and least in the South. Recent successful cessation (defined as quitting for 6 to 12 months) was highest in the Northeast and Midwest, with the South showing the lowest rates. Compared to the 2014–15 survey, 14 demographic groups (7 in the Midwest, 6 in the South, and 1 in the West) showed decreases in both quit interest and actions to quit. Notably, the Asian non-Hispanic group in the Northeast experienced a significant decrease in quit interest (–17.9%) but an increase in recent successful cessation (+369.2%).DiscussionOverall, the study indicates that while quit interest was highest in the West, the South exhibited the lowest rates of quit attempts and successful cessation. Significant differences were also noted between age groups. These findings highlight the need for further research into cessation behaviors at more granular levels to inform policies aimed at reducing smoking-related health disparities among populations facing the greatest challenges in cessation.

Exploring profiles of engagement in reading, numeracy, writing, and computer skills-use of U.S. adults with low literacy skills

AbstractThis study uses Program for the International Assessment of Adult Competencies (PIAAC) data to examine latent profiles of engagement in reading, numeracy, writing, and computer skills-use for U.S. adults with low literacy skills. Additionally, we examine how these profiles relate to overall literacy performance and demographic heterogeneity. Results indicate five engagement profiles: High (8%), Average-High (44%), Average-Low (40%), and two generally Low profiles that are most differentiated on numeracy skills-use engagement (5.5%, 2%). High and Average-High engagement profiles had higher probabilities of adults scoring at a higher literacy level than the Average-Low profile and to a greater degree than the lowest engagement profile. Covariates of learning disability status, English speaker status, race, ethnicity, age, and educational attainment were also related to differences in literacy performance and skills-use engagement. Employment status was unrelated to differences in literacy performance and skills-use engagement. Generally, native English speakers, non-learning disabled adults, younger adults, those identifying as non-Hispanic and White, and adults with higher educational attainment (high school/some college and college degree or higher) had higher probabilities of higher literacy performance, particularly in the High and Average-High engagement profiles. Findings have implications for increasing skills-use engagement in daily life to increase literacy performance and suggest differences by demographic characteristics that may be of interest to adult foundational education programs.

Multidimensional employment trajectories and dynamic links with mental health: Evidence from the UK Household Longitudinal Study.

Low-quality and precarious employment have been associated with adverse mental health and wellbeing. More evidence is needed on how the quality of employment trajectories - including transitions in and out of unemployment, inactivity, and employment of varying quality - are associated with individuals' mental health over time. This paper aimed to derive a typology of multidimensional employment trajectories and assess associations with mental health in the UK. Data from waves 1-9 of the UK Household Longitudinal Study were used (2009-2019). Individuals aged 30-40 at baseline were included (N=1603). Using multichannel sequence and clustering analyses, we derived a typology of employment trajectories across employment statuses and four employment quality indicators. We assessed associations with subsequent psychological distress, accounting for baseline mental health. Changes in average General Health Questionnaire scores are described. A typology of five trajectory clusters highlighted stable and secure and precarious/low-quality trajectories for both men and women. Women who reported being economically inactive at most waves had higher odds of experiencing psychological distress than did women in 'standard' trajectories, regardless of baseline mental health. Women's scores of psychological distress in the 'precarious' group on average increased along their trajectories characterized by instability and transitions in/out of unemployment, before a move into employment. Men who likely moved in and out of unemployment and economic inactivity, with low probability of paid employment, reported increased psychological distress at the end of follow-up. This may partly be due to pre-existing mental ill-health. This paper shows the importance of high-quality employment for individuals' mental health over time. Researchers need to consider dynamic associations between employment quality and mental health across the life-course.

Quality of life of patients with neurofibromatosis 1—Physical disability does not necessarily result in poor mental health

IntroductionNeurofibromatosis 1 (NF1) is a chronic neurocutaneous disease known to profoundly affect quality of life (QoL). We have performed an analysis of disease severity, mental and physical QoL and compare the different subclasses among patients with neurofibromatosis 1 (NF1).Patients and methodsWe conducted a prospective analysis of 89 NF1 patients between January 2016 and March 2018. Data sourced from local records including demographic information, employment status, education level, and marital status. All patients completed 36-Item Short Form Health Survey (SF-36) and additionally the numerical pain rating scale (NPS). Patients were stratified based on severity of NF1, visibility and disease severity.ResultsAmong 89 patients, severity was classified as grade 4 was identified in 42 (47.2%), moderate in 17 (19.1%), mild in 23 (25.8%) and minimal in 7 (7.9%) cases. According to visibility scale, severe grade 3 was found in 28 (31.5%), moderate grade 2 in 26 (29.2%) and mild grade in 35 (39.3%) cases. SF-36 data, except for pain, showed significantly lower values, if compared to the standard German population (P &amp;lt; 0.001, physical component summary P = 0.045). Sex, marital status and education level did not significantly influence results. Employment was significantly associated with better mental and physical status (P = 0.028 and P = 0.01 respectively) and age &amp;gt;40 was linked to lower physical (P = 0.027) but not mental component scores (P = 0.362). The numerical pain rating scale indicated pain levels of 7–10 in 9 cases (10,1%), 5–6 in 10 patients (11.2%), 1–4 in 26 patients (29.2%) and no pain in 44 cases (49.4%). Physical component scores significantly differed across different NPS grades (P &amp;lt; 0.001) but not in mental component scores (P = 0.06). Finally, no significant differences were found in mental component scores across severity or visibility grades.ConclusionSeverity and visibility grades of patients with NF1 may not necessarily result in poor mental health. Symptomatic treatment should be considered even for severely disabled patients as they may have comparable QoL to less severely affected patients with NF1. Employment was linked to better quality of life outcomes in our findings.

Physical and psychological aspects of multiple sclerosis: Revisiting the Multiple Sclerosis Impact Scale (MSIS-29).

The MSIS-29 measures the physical and psychological impact of MS. The associations between MSIS-29 domains and demographic/clinical aspects were examined and trajectories analysed over time. Data were collected in the Trajectories of Outcome in Neurological Conditions study for a diverse population of people with MS, with follow-up for up to 5 years. Following Rasch analysis, minimal important change (MIC) was computed for ensuing total, physical and psychological domains. Fit to the Rasch model using data from 5921 participants validated physical, psychological and total domains, and the conversion table transforms raw scores to interval-level metric equivalents. These domains showed significant differences across demographic (age, gender, employment, education, and marital status) and clinical (subtype, treatment, and duration) factors with large effect sizes. The MIC scores were physical: 9.1, total: 14.1, which were both above measurement error, and psychological: 5.5 which was not, so 1.6% of participants reported psychological change which was clinically important but not statistically significant. Trajectory analysis showed three groups, one stable and two with significant slopes, improving and deteriorating. The MSIS-29 has shown adequate fit to the Rasch model after accommodating problems with local item dependency, through a bi-factor solution. The domains showed good discrimination across key factors.

Patient Demographics and Factors Influencing Access to General Practitioner Services for Musculoskeletal Pain in the United Kingdom.

Access to general practitioner (GP) services is essential for managing musculoskeletal pain. This study investigates the relationship between patient demographics, co-morbidities, health behaviours and difficulty in accessing GP services in the United Kingdom. Significant associations were explored between age, co-morbidities and ease of securing GP appointments. This analysis provides insights into the barriers patients face and suggests targeted interventions for improving access to primary care. A cross-sectional study was conducted using survey data from participants of various ages, ethnicities and socioeconomic statuses with either localised or generalised musculoskeletal pain. Relationships between key variables, such as age, co-morbidities and difficulty in accessing GP services, were examined using chi-square tests (for nominal variables) and Kruskal-Wallis tests (for nominal and ordinal variables). A total of 503 respondents participated in the online questionnaire. In all, 66% of the respondents were female. The majority of participants were Caucasian (69%), followed by South Asians (19%), with the remainder identifying as Black or of mixed ethnicity. Most respondents (62%) reported experiencing musculoskeletal pain for over 2years. Significant associations were found between the age of the participants and difficulty in accessing GP services (χ2(20)=39, p=0.006), co-morbidities and the impact of delayed GP reviews on patients' musculoskeletal pain (χ2(10)=31, p=0.001), employment status and alternative care choices (χ2(4)=10.99, p=0.027). These results highlight the multifaceted nature of healthcare access for patients of various ages with musculoskeletal pain. Age, co-morbidities and employment status significantly influence access to GP services. Future studies should explore additional systemic healthcare barriers and develop personalised interventions to improve access for high-risk populations.

Suicidal transition rates and their predictors in the adult general population: a repeated survey over 21years in France.

The "suicidal transition" from ideation to an act has become a specific topic of research. However, rates in the general population, variations across time and risk factors are unclear. Data were collected from the phone survey Baromètre Santé among 18-75-year-olds in France. Seven independent samples interviewed between 2000 and 2021 (total N=133,827 people; 51.3% females) were questioned about suicidal ideation and attempts over the previous 12months. Transition was calculated as the weighted ratio of attempt on ideation 12-month rates. Mean 12-month rates of suicidal ideation, attempts and transition were 4.7% (95% Confidence Interval (CI) (4.6-4.8)), 0.5% (95% CI (0.4-0.5)) and 7.7% (95% CI (6.8-8.6)), respectively. Transition rates varied between 4.5 and 11.9% across surveys. In multivariable analyses, higher transitions rates were associated with a previous suicide attempt (adjusted Odds Ratio (aOR)=11.1 95% CI (7.9-15.6)); 18-25 vs 26-55-year-olds (1.8 95% CI (1.2-2.8)); lower vs higher income (1.7 95% CI (1.0-2.7); and lower vs higher professional categories (aOR around 1.9). No significant association was found with gender, education level, employment status, living alone, urbanicity, current major depression, daily smoking, weekly heavy drinking, cannabis use, and body mass index. Most people with suicidal ideation do not attempt suicide. These findings emphasize the need to avoid generic terms such as "suicidality", and to increase research on suicidal transition to improve prevention and prediction. They may also inform the organization of suicide prevention in the general population.

Quality of Life Among Patients with Impaired Vision

Introduction: Individuals with impaired vision often experience stress that can lead to psychological, physical, and psychosocial effects. It has a significant impact on quality of life (QOL). The objective of the study was to assess QOL among patients with impaired vision, visiting the Department of Ophthalmology, of Tertiary Care Hospital, Vellore. Methods: A quantitative descriptive study design was utilized; consecutive sampling technique was used. After written informed consent was taken, 200 subjects were recruited for the study. Data was collected using Visual Functioning Questionnaire-25 (VFQ-25). Descriptive and inferential statistics were used to analyse the data. Result: The findings revealed more than half of them had poor QOL. There was a significant association between educational level (p = 0.004), employment status (p = 0.013), monthly income (p = 0.002), and availing government benefits (p = 0.017) with QOL of Visually impaired. The study demonstrated that people with impaired vision faced challenges in maintaining the quality of life. Education, Counselling, and Rehabilitation can address the needs and bring a better outcome in their lives. Keywords: Visual impairment, Quality of life.

Updated Results from the Retrospective CREST Study on the Safety and Effectiveness of 8-Week Glecaprevir/Pibrentasvir in HCV-Infected Treatment-Naïve Patients with Compensated Cirrhosis.

This brief report presents updated findings from the previously published CREST study evaluating the safety and effectiveness of 8-week glecaprevir/pibrentasvir (GLE/PIB) in treatment-naïve patients with chronic hepatitisC virus (HCV) infection and compensated cirrhosis. The current study includes an additional 51 patients, presents effectiveness data stratified by additional comorbidities and comedications, and offers insights into healthcare resource utilization. Analysis of treatment-naïve patients with HCV infection and compensated cirrhosis enrolled in the CREST study, a real-world, observational multicenter study. All enrolled patients were included in the full analysis set (FAS); the modified analysis set (MAS) excluded patients with missing SVR12 data, or who discontinued GLE/PIB for nonvirologic failure. The primary endpoint was sustained virologic response at posttreatment week12 (SVR12) in the MAS. Safety and healthcare resource utilization were also assessed. The FAS included 437 patients, and the MAS 375. Overall, the results were consistent with the previously published study, with 98.9% of patients in the MAS achieving SVR12. Patients with comorbidities such as alcoholism, diabetes, and hyperlipidemia achieved SVR12 rates > 94%. High SVR12 rates were also achieved by patients receiving comedications such as anxiolytics, antidepressants, and opioid agonists. Of the 26.8% of patients with an adverse event, 1.1% had a serious adverse event, none of which were deemed related to GLE/PIB. Healthcare resource utilization varied by employment status and history of drug use. Active drug users had more physician and nurse visits than specialist visits compared with former drug users. This study provides further evidence on the safety and effectiveness of 8-week GLE/PIB, supporting the use of shorter treatment in treatment-naïve patients with Child-PughA cirrhosis including subgroups of interest, regardless of comorbidities and comedications observed in this population. The variable healthcare resource utilization in different patient types can help plan and resource linkage to care better, thus supporting HCV elimination efforts.

An Eye on the Future: Student Plans for Higher Education in Qatar

Education is identified as very critical to the achievement of the goals that were specified as strategic to Qatar’s socio-economic progress and development. At the core of the country’s policy plans is the need to develop human capacity as is highlighted in the Qatar National Vision (QNV) 2030. Not surprisingly, education has been identified as a strategic key to achieving the goals outlined in the QNV 2030. The present exploratory study employed a quantitative research design in order to investigate the factors that are likely to influence the educational aspirations of Qatari students. Drawing on Social Cognitive Theory (SCT) and Attribution Theory (AT), this study sought to examine students’ aspirations for post-secondary education in Qatar. Data for this study were collected using the Qatar Education Study (QES) survey, which is a nationally representative survey involving K-12 students in the State of Qatar. The analysis of this study’s data revealed that personal and household characteristics play an important role in shaping post-secondary educational aspirations of student participants, including age, nationality, education and employment status, as well as parental influence. Based on the study’s results, statistically significant associations were observed between personal and household variables and students’ aspirations for higher education. This study concludes with relevant recommendations and proposes future studies to explore the potential impact of individual aptitude and contextual factors on student future academic plans.

Employment Problems of Graduates of Chinese-foreign Cooperative Education Programs and Policy Suggestions

The purpose of this study is to analyze the causes of the employment status of graduates of Chinese-foreign cooperative universities and give countermeasure suggestions. With the acceleration of the internationalization of higher education, the development of Sino-foreign cooperative education is deepening in China, and it has also won the favor of many middle-class families because of its unique system of schooling that integrates the advantages of domestic and foreign bilateral education and enhances the employment competitiveness of graduates. However, in 2020, the international challenges of anti-globalization, the impact of major emergency health incidents and the slowdown of the domestic economic development and the structural adjustment of the industry have seriously disrupted the pace of employment of graduates of Chinese-foreign cooperative education and increased the difficulty of employment of graduates of Chinese-foreign cooperative education, which has aroused widespread concern and discussion. This study adopts the method of literature review to explore the specific impact of the education policy of Sino-foreign cooperative education on the career choice and employment pace of college students, which helps to deeply understand the role of the policy of Sino-foreign cooperative education in the career development of college students as well as the attitude of college students towards the phenomenon of slow employment and provides policy makers with suggestions on optimizing the policy of Sino-foreign cooperative education to promote the employment of college students, and at the same time provides important references to the higher education managers to cope with the problem of slow employment of graduates of Sino-foreign cooperative education.

Interaction between alcohol intake and employment status changes on mortality among young workers

Abstract Background To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption. Methods We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status. Results Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men. Conclusions The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers. Key messages • Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men. • This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.

The relationship between mental health and employment: a systematic review of cohort studies

Abstract Background Knowledge on the bi-directional association between employment status and mental health is important, as it affects multiple dimensions of our daily lives, both at the individual and societal level. Given that the mental health status and employment situation of individuals are likely to change over time, there is an important need for longitudinal data to better understand causality patterns in this association and the underlying mechanisms. Methods A systematic review was carried out based on the PRISMA guidelines in 3 electronic databases: PubMed, Embase, and PsycInfo. Studies eligible for inclusion were cohort studies, involving the general population, and assessing the relationship between employment status and mental health longitudinally. Results In total, 3,733 studies were identified and 36 met the inclusion criteria. The eleven studies focusing on the social causation hypothesis highlighted the negative long-term impact of unemployment and unstable employment on mental health. Four studies observed mental health improvements upon re-entering employment, although limited and in more specific contexts. The fourteen studies focusing on the health selection hypothesis found a lower probability for individuals with mental health problems in finding and maintaining employment. Finally, the eleven studies assessing the two hypothesis simultaneously found that mental health problems were both a consequence of and risk factor for poor employment status, although some important moderating factors, such as gender differences, influence the direction and strength of the association. Conclusions This review underscores the bi-directional association between the employment status and mental health of individuals, highlighting the need to develop targeted prevention (e.g. mental health support in the workplace) and interventions strategies (e.g. supported employment programs) in both the mental health and labor market systems. Key messages • The bidirectional link between employment and mental health highlights the need for concurrent responses to break the vicious cycle between poor mental health and social exclusion. • To reduce the clinical and social burden of mental health problems, gender differences must be taken into account in mental health and employment support practices and policies.

Alcohol intake and patterns of multi-site musculoskeletal pain in the British Whitehall II study

Abstract Background Patterns of multi-site musculoskeletal (MSK) pain and its relationship with alcohol drinking among white-collar employees and retirees remain unclear compared to blue-collar workers. This study aimed to examine the relationship between alcohol drinking and MSK pain through latent class analysis (LCA) in current and retired white-collar employees. Methods We used the data from the 7th phase (2000-2002, n = 6,967, response rate 71.6%) of the British Whitehall II study, chosen for its availability of MSK items and approximately 1:1 ratio of employees to retirees, allowing for an evaluation of the relationship between alcohol drinking and MSK pain by employment status. LCA was used to distinguish patterns of multi-site MSK pain. A multinomial logistic regression model was used to examine the association between alcohol drinking and the identified pain patterns, with analyses conducted separately for employees and retirees. Results We identified five latent classes for pain (back/cervical: 7.1%, cervical: 28.9%, upper limb: 29.4%, combined LBP/upper limb/cervical: 13.2%, and LBP alone: 21.5%). Increased alcohol intake might be associated with elevated odds of upper limb pain in current drinkers, but this could not be statistically confirmed (OR: 1.04, 95% CI: 0.99-1.09). Employment status may modify the association with a significant interaction found between alcohol intake and retirement (p-value: 0.043). Every 7-unit increase in alcohol intake is associated with 18% and 12% higher odds of pain in LBP/UBP/cervical and upper limbs, respectively (95% CI: 1.02-1.37; 1.02-1.23). Conclusions Increased alcohol intake was associated with pain patterns only among retired white-collar employees but not the current ones. Interventions on alcohol consumption could help confirm if, reducing alcohol intake or avoiding hazardous drinking, for white-collar retirees prevents not only upper limb pain but also more complex pain patterns. Key messages • Musculoskeletal pain in white-collar employees and retirees contributes to the cervical and upper extremities, differing from low back/neck pain studies among general or blue-collar workers. • The association between alcohol drinking and pain patterns may differ across employment status. Reducing alcohol intake might be advised to retired drinkers for preventing multi-site pain.

Parental leave benefit levels and postpartum maternal mental health: a Swedish cohort study

Abstract Background While generous parental leave benefits are protective for postpartum maternal mental health, not all mothers qualify for these benefits due to strong work requirements. Sweden offers paid parental leave to all residents, but the benefit level depends on their salary and labour market attachment. Objectives To evaluate the association between parental leave benefit levels and maternal mental health in the postpartum period. Methods Using total population register data, we studied 210 800 first-time mothers, aged 18-52 years, who gave birth to a live singleton offspring in Sweden between January 1, 2007 and December 31, 2011. We performed multivariable logistic regression to compare odds of mental health outcomes from different levels of severity (prescribed anti-depressants or anxiolytics, specialist outpatient care and hospitalisation) between mothers receiving higher-level benefits (i.e., qualified for earnings-related benefits) and those with basic benefits (i.e., a low flat-rate level). We also performed decomposition analyses using the Karlson-Holm-Breen method, and subgroup analyses by region of birth. Results Mothers receiving basic benefits had increased odds of prescribed antidepressants or anxiolytics (OR 1.44 95% CI 1.37-1.51), specialist outpatient care (OR 2.27 95% CI 2.13-2.44), and hospitalisations (OR 2.47 95% CI 2.97) compared with mothers receiving higher-level benefits. Increased odds remained after adjustment for pre-existing mental health. After further adjustment for income and employment status, the odds remained elevated for specialist outpatient care (OR 1.13, 95%CI 1.02-1.24) and hospitalisation (OR 1.34, 95%CI 1.03-1.76). Conclusions Mothers with basic benefits are more likely to experience moderate-to-severe mental disorders compared to mothers with higher-level benefits, independent of pre-existing mental health, income and employment status. Key messages • Labour market attachment prior to childbirth affects parental leave benefit levels and plays an important role in determining mental health outcomes in the postpartum period. • The work requirements for more generous parental leave benefits may prevent mothers from benefiting from the protective mental health advantages of parental leave.