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BackgroundGiven the acceleration of population ageing and policy changes to extend working lives, evidence is needed on the ability of older adults to work for longer. To understand more about the health impacts of work, this study examined the relationship between employment histories before retirement and trajectories of frailty thereafter.MethodsThe sample comprised 2765 women and 1621 men from the English Longitudinal Study of Ageing. We used gendered typologies of life-time employment and a frailty index (FI). Multilevel growth curve models were used to predict frailty trajectories by employment histories.ResultsWomen who had a short break for family care, then did part-time work till 59 years had a lower FI after 60 years than those who undertook full-time work until 59 years. Women who were largely family carers or non-employed throughout adulthood, had higher levels of frailty at 60 years but experienced a slower decline with age. Men who worked full-time but early exited at either 49 or 60 years had a higher FI at 65 years than those who worked full-time up to 65 years. Interaction between employment histories and age indicated that men in full-time work who experienced an early exit at 49 tended to report slower declines.ConclusionsFor women, experiencing distinct periods throughout the lifecourse of either work or family care may be advantageous for lessening frailty risk in later life. For men, leaving paid employment before 65 years seems to be beneficial for decelerating increases in frailty thereafter. Continuous full-time work until retirement age conferred no long-term health benefits.

BackgroundGiven the current policy emphasis in many Western societies on extending working lives, we investigated the health effects of being in paid work beyond state pension age (SPA). Until now, work has largely focused on the health of those who exit the labour force early.MethodsOur data come from waves 2–4 of the English Longitudinal Study of Ageing, including the life history interview at wave 3. Using logistic and linear regression models, we assessed the longitudinal associations between being in paid work beyond SPA and 3 measures of health (depression, a latent measure of somatic health and sleep disturbance) among men aged 65–74 and women aged 60–69. Our analyses controlled for baseline health and socioeconomic characteristics, as well as for work histories and health in adulthood and childhood.ResultsApproximately a quarter of women and 15% of men were in paid work beyond SPA. Descriptive bivariate analyses suggested that men and women in paid work were more likely to report better health at follow-up. However, once baseline socioeconomic characteristics as well as adulthood and baseline health and labour market histories were accounted for, the health benefits of working beyond SPA were no longer significant.ConclusionsPotential health benefits of working beyond SPA need to be considered in the light of the fact that those who report good health and are more socioeconomically advantaged are more likely to be working beyond SPA to begin with.

IMPORTANCE Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims. OBJECTIVE To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis. MAIN OUTCOMES AND MEASURES Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant). RESULTS During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non–general medical malpractice claims (P < .001). CONCLUSIONS AND RELEVANCE In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice allegations in other settings, primary care ambulatory claims appear to be more difficult to defend, with more cases settled or resulting in a verdict for the plaintiff.

Health researchers often use the life-course perspective, exploring how long-range experiences in one life domain may influence, and be influenced by, those in another. We develop a multiple-process latent transition model (MPLTM) to estimate changes in health and poverty dynamics simultaneously, using repeated measures of self-rated health and income for working-aged adults from the British Household Panel Survey. We apply the model to quantify concurrent and longitudinal effects to assess whether changes in these two processes are related or independent. Model extensions add time-invariant (cohort, gender) and time-varying (weeks nonemployed in previous year) covariates. We find both concurrent and bidirectional longitudinal relationships between poverty and health, with nonemployment appearing to mediate longitudinal health-to-poverty effects and confound longitudinal poverty-to-health effects. The MPLTM can provide quantitative estimates of complex interlocking processes that are often difficult to measure and assess.

The welfare state promises to moderate the duration and concentration of poverty. The authors ask how well this promise has been fulfilled in the United States and Britain from 1993 to 2003. They examine two aspects of poverty vulnerability during this period of welfare reform: (1) its persistence and associated risk factors and (2) the efficacy of social transfers. After accounting for measurement error, sociodemographic characteristics, and the impact of redistributive programs, the authors find that poverty is often persistent and risk is concentrated, especially in the United States. Moreover, the British safety net appears to better protect those at risk.

As employers respond to new competitive pressures of global capitalism through layoffs and the casualization of labor, job insecurity affects a growing number of workers. It appears to harm mental health, but less is known about its effects on physical health and health behaviors and the mechanisms through which it may act. The prevailing individual-centered conceptualization of job insecurity as the perception of a threat to job continuity precludes systematic investigation of the social patterning of its health effects. Analysis of data from a 1994 Canadian national probability sample of adults determined that high levels of job insecurity lowered self-rated health and increased distress and the use of medications, but had no impact on heavy drinking. The findings support one possible mechanism of action whereby job insecurity reduces feelings of control over one's environment and opportunities for positive self-evaluation; these psychological experiences, in turn, have deleterious health consequences. There is little evidence of social patterning of this relationship by gender, education, household income, age, marital status, and social support at work.

Although work disability is widespread among women with physical or mental impairment, little is known about its gendered nature. Drawing on the disablement and women's health literatures, it is argued that labor-market resources and participation in normatively structured social roles may be important in shaping women's work disability. Using data from a Canadian probability sample of community dwellers with disabilities, the paper examines the effects of functional limitation, labormarket resources, stage in the life course, and family roles on work disability. It also assesses the extent to which the relationship between social roles and disability depends on women's socioeconomic circumstances. Results indicate that younger individuals, married women, and those with high levels of homemaking responsibilities were less likely to report work disability than their counterparts without these social resources and roles. The impact of the parental role (children in the household) on work disability varied according to education.

The action imperative inherent in amniocentesis, one that emphasizes the detection and selective abortion of disabled fetuses, exerts a powerful influence on women's decisions to undergo prenatal diagnosis. In this paper, the construction of this imperative 1s considered through an examination of medical research that contributed to the development and clinical practice of amniocentesis. It is argued that this research reflects medical judgments about socially "undesirable" human attributes, professional interests, and individual, technical solutions to the "burden" of congenital disability. The necessity to consider the implications of this technology within both a feminist and disability rights framework is discused.