Prior Health Problems Research Articles

Does sickness absence history affect work participation after vocational labour market training?

Abstract Background Active labour market programmes, such as vocational training, have become widely adopted measures to increase job seekers’ employment opportunities, but evidence of their effectiveness in later employment is mixed. Individuals who enter training differ greatly in their socioeconomic background, health, and labour market history, which can affect the effectiveness of these programmes. There is still uncertainty, for example, on how vocational labour market training works for individuals with prior health problems. Methods We use nationally representative Finnish register data on 88,283 individuals aged 25-59 who participated in vocational labour market training in 2008-2013, 23,715 of whom had sickness absence lasting at least 10 weekdays (including Saturday) three years prior to the training and 64,568 of whom did not. To adjust for the differences in sociodemographic and work-related factors between these groups, we will conduct propensity score matching. We will analyze work participation three years before and after the training among those with sickness absence and those without using a difference-in-difference analysis. Results Our preliminary results show that before training the work participation rate was similar in those with sickness absence history (58.5 %) and those without (58.1 %). After training, those with a sickness absence history had slightly lower work participation than those without (54.6% versus 59.6 %). The differences in work participation between these groups increased slightly over time after training. Conclusions Vocational labour market training does not necessarily work equally well for everyone in terms of enhancing employment, and job seekers with work disability history should be offered either extra support or another type of unemployment service. However, these are our pre-matching results, and they cannot be causally interpreted. Next, we will conduct the propensity score matching and difference-in-difference analysis. Key messages • Having a sickness absence history prior to vocational labour market training is associated with lower work participation after training compared to participants without a sickness absence history. • The main advantage of the study is the use of a quasi-experimental study design to test the effectiveness of vocational training, using rich nationally representative register data with long follow-up.

Preinjury Health Status of Adults With Traumatic Brain Injury: A Preliminary Matched Case-Control Study.

To discern whether there is evidence that individuals who sustained a traumatic brain injury (TBI) had the greater odds of preexisting health conditions and/or poorer health behaviors than matched controls without TBI. Brain Injury Inpatient Rehabilitation Unit at Mount Sinai Hospital. Midlife in the United States (MIDUS) control data were collected via random-digit-dialing phone survey. TBI cases were enrolled in the TBI Health Study and met at least 1 of the following 4 injury severity criteria: abnormal computed tomography scan; Glasgow Coma Scale score between 3 and 12; loss of consciousness greater than 30 minutes; or post-TBI amnesia longer than 24 hours. Sixty-two TBI cases and 171 matched MIDUS controls were included in the analyses; controls were excluded if they reported having a history of head injury. Matched case-control study. Self-reported measures of depression symptoms, chronic pain, health status, alcohol use, smoking status, abuse of controlled substances, physical activity, physical health composite score, and behavioral health composite score. Pre-index injury depression was nearly 4 times higher in TBI cases than in matched controls (OR= 3.98, 95% CI, 1.71-9.27; P = .001). We found no significant differences in the odds of self-reporting 3 or more medical health conditions in year prior to index injury (OR = 1.52; 95% CI, 0.82-2.81; P = .183) or reporting more risky health behaviors (OR = 1.48; 95% CI; 0.75-2.91; P = .254]) in individuals with TBI than in controls. These preliminary findings suggest that the odds of depression in the year prior to index injury far exceed those reported in matched controls. Further study in larger samples is required to better understand the relative odds of prior health problems in those who sustain a TBI, with a goal of elucidating the implications of preinjury health on post-TBI disease burden.

Examining Criteria for Defining Persistent Post-concussion Symptoms in Children and Adolescents.

Researchers operationalize persistent post-concussion symptoms in children and adolescents using varied definitions. Many pre-existing conditions, personal characteristics, and current health issues can affect symptom endorsement rates in the absence of, or in combination with, a recent concussion, and the use of varied definitions can lead to differences in conclusions about persistent symptoms and recovery across studies. This study examined how endorsement rates varied by 14 different operational definitions of persistent post-concussion symptoms for uninjured boys and girls with and without pre-existing or current health problems. This cross-sectional study included a large sample (age range: 11–18) of girls (n = 21,923) and boys (n = 26,556) without a recent concussion who completed the Post-Concussion Symptom Scale at preseason baseline. Endorsements rates varied substantially by definition, health history, and current health issues. The most lenient definition (i.e., a single mild symptom) was endorsed by most participants (54.5% of boys/65.3% of girls). A large portion of participants with pre-existing mental health problems (42.7% of boys/51.5% of girls), current moderate psychological distress (70.9% of boys/72.4% of girls), and insufficient sleep prior to testing (33.4% of boys/47.6% of girls) endorsed symptoms consistent with mild ICD-10 postconcussional syndrome; whereas participants with no current or prior health problems rarely met this definition (1.6% of boys/1.6% of girls). The results illustrate the tremendous variability in the case definitions of persistent symptoms and the importance of harmonizing definitions across future studies.

ECG of the month

In this issue's ECG of the month, Martin Regan presents a case of a 29-year-old woman with no prior health problems who was admitted to the emergency department with breathlessness and chest pain.

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Does Australia's Health Policy Environment Create Unintended Outcomes for Birthing Women?

Running With the Pack

This study assessed qualities of adolescent peer relationships as long-term predictors of physical health quality in adulthood. In an intensive multimethod, multireporter study of a community sample of 171 individuals assessed repeatedly from the ages of 13 to 27 years, physical health quality in adulthood was robustly predicted by independent reports of early-adolescent close-friendship quality and by a pattern of acquiescence to social norms in adolescent peer relationships. Predictions remained after accounting for numerous potential confounds, including prior health problems, concurrent body mass index, anxious and depressive symptoms, personality characteristics, adolescent-era financial adversity, and adolescent-era physical attractiveness. These findings have important implications for understanding the unique intensity of peer relationships in adolescence.

Educational mismatch and mortality among native-born workers in Sweden. A 19-year longitudinal study of 2.5 million over-educated, matched and under-educated individuals, 1990-2008.

This study tests the hypothesis that a disjuncture between an individual's attained level of education and that held by average workers in the individual's occupation leads to higher mortality among those with a prolonged mismatched status. Swedish register data are used in a 19-year longitudinal mortality follow-up study of all causes and specific causes of mortality. Participants were all men and women born between 1926 and 1985 who were alive on 1 September 1990, who had concurrent information on their attained level of education and the specific occupation or industry they were employed in during this period for at least a consecutive year. An objective measure of educational and occupational mismatch was constructed from these data. Those with a stable, over-educated matched, or under-educated employment status are included in the final analysis (N = 2,482,696). Independent of social, family, employers' characteristics and prior health problems, the findings from a multivariate, stratified Cox regression analysis suggest there is excessive mortality among the over-educated, and a protective effect of under-education among native-born Swedish men and women.

Short communication: Use of single nucleotide polymorphism genotypes and health history to predict future phenotypes for milk production, dry matter intake, body weight, and residual feed intake in dairy cattle

As feed prices have increased, the efficiency of feed utilization in dairy cattle has attracted increasing attention. In this study, we used residual feed intake (RFI) as a measurement of feed efficiency along with its component traits, adjusted milk energy (aMilkE), adjusted dry matter intake (aDMI), and adjusted metabolic body weight (aMBW), where the adjustment was for environmental factors. These traits may also be affected by prior health problems. Therefore, the carryover effects of 3 health traits from the rearing period and 10 health traits from the lactating period (in the same lactation before phenotype measurements) on RFI, aMilkE, aDMI, and aMBW were evaluated. Cows with heavier birth weight and greater body weight at calving of this lactation had significant increases in aMilkE, aDMI, and aMBW. The only trait associated with RFI was the incidence of diarrhea early in the lactation. Mastitis and reproductive problems had negative carryover effects on aMilkE. The aMBW of cows with metabolic disorders early in the lactation was lower than that of unaffected cows. The incidence of respiratory disease during lactating period was associated with greater aMBW and higher aDMI. To examine the contribution of health traits to the accuracy of predicted phenotype, genomic predictions were computed with or without information regarding 13 health trait phenotypes using random forests (RF) and support vector machine algorithms. Adding health trait phenotypes increased prediction accuracies slightly, except for prediction of RFI using RF. In general, the accuracies were greater for support vector machine than RF, especially for RFI. The methods described herein can be used to predict future phenotypes for dairy replacement heifers, thereby facilitating culling decisions that can lead to decreased feed costs during the rearing period. For these decisions, prediction of the animal’s own phenotype is of greater importance than prediction of the genetic superiority or inferiority that will transmit to its offspring.

Identidad y riesgos para la salud mental de jóvenes gays en México: recreando la experiencia homosexual

In Mexico, mental disorders have displayed a sharp upward trend. Suicidal conduct is one of the most important mental health problems in the young population, with sexual orientation as a risk factor, since homosexuals show higher probability of suicide as compared to heterosexuals. Suicidal conduct is associated with prior health problems such as depression, anxiety, and low self-esteem, related to predisposing factors like formative experiences with personality. The current study takes a qualitative approach to explore the risk of mental health disorders in homosexuals, associated with suicidal conduct, based on their experience with homophobia in primary and secondary socialization settings. Discourse analysis revealed the relationship interviewees assigned to social rejection of their sexuality and key symptoms of depression (sadness), anxiety (fear), and suicidal conduct (intent and ideation).

Subclinical course of adult visceral Niemann–Pick type C1 disease. A rare or underdiagnosed disorder?

We present the third case of Niemann-Pick disease type C without neurological symptoms. The patient was a 53-year-old woman without significant prior health problems who died of acute pulmonary embolism. Autopsy findings of hepatosplenomegaly, lymphadenopathy and ceroid-rich foam cells raised the suspicion of the visceral form of acid sphingomyelinase deficiency (Niemann-Pick disease type B; NPB) or a much rarer disorder, variant adult visceral form of Niemann-Pick disease type C (NPC). To verify the histopathological findings, SMPD1, NPC1 and NPC2 genes were analysed. Two novel sequence variants, c.1997G>A (S666N) and c.2882A>G (N961S) were detected in the NPC1 gene. No pathogenic sequence variants were found either in the SMPD1 gene mutated in NPB or in NPC2 gene. The pathogenicity of both NPC1 variants was supported by their location in regions important for the protein function. Both variations were not found in more than 300 control alleles. Identified sequence variations confirm the diagnosis of the extremely rare adult visceral form of Niemann-Pick disease type C, which is otherwise dominated by neurovisceral symptoms. Although only three patients have been reported, this (most probably underdiagnosed) form of NPC should be considered in differential diagnosis of isolated hepatosplenomegaly with foam cells in adulthood.