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Purpose Previous reviews about employment for people with intellectual disability (ID) have left questions about employment sustainability unanswered. Therefore, the aim of this systematic review was to identify and analyse research regarding employment sustainability for people with ID. The research questions were: What research about employment sustainability for people with ID has been published internationally between 2010 and 2020? In the identified studies, how is employment sustainability defined and measured and what are the main findings regarding employment sustainability? Methods A systematic review was conducted using eight databases from various disciplines including medical, health, and social sciences. After a selection process, 10 articles remained, and a framework matrix was created to analyse them. An employment sustainability definition was used as an analytical tool. Results Ten articles were identified as being about employment sustainability for people with ID. Five of them used qualitative designs and five used quantitative designs. Only four out of ten contained a definition of employment sustainability, and there was an inconsistency in measurement methods. The reported findings in the studied articles were categorised into three types: proportions of long-term employed individuals within the studied population, facilitators and barriers to long-term employment. Conclusions There is only a limited amount of research about employment sustainability for people with ID. Nevertheless, a few facilitators and barriers could be identified. There is no consensus about how to define or measure employment sustainability, making comparisons difficult.

Objective: To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers' work- and knowledge-related characteristics and attitude to CMDs. Methods: Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics. Results: Few managers found out about CMDs themselves; another source was more common, for example, employees' self-disclosure. Managers' overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established. Conclusion: Managers' awareness about employees' CMDs mainly came about through employees' self-disclosure. Managers' attitudes and work conditions were related to the way of finding out.

Studien analyserar sambanden mellan sysselsättning för unga vuxna med intellektuell funktionsnedsättning som gått i gymnasiesärskolan och deras sociala bakgrund, mätt som föräldrarnas utbildningsnivå och geografiska härkomst. Den här registerstudien baseras på Halmstad university register on pupils with intellectual disabilities (HURPID), Longitudinell integrationsdatabas för arbetsmarknads- och sjukförsäkringsstudier (LISA) samt LSS-registret. Studien omfattar 12 269 unga med intellektuell funktionsnedsättning som gick ut gymnasiesärskolan mellan 2001 och 2011. De samband som studeras analyseras genom multipla logistiska regressioner. Resultaten visar att föräldrars utbildningsnivå har viss betydelse för före detta gymnasiesärskoleelevers sysselsättning. Barn till högutbildade föräldrar har med större sannolikhet en sysselsättning inom daglig verksamhet och barn till lågutbildade föräldrar har med större sannolikhet ett förvärvsarbete. Sannolikheten för att ha någon av sysselsättningskategorierna daglig verksamhet eller förvärvsarbete är lägst bland barn till föräldrar som är födda i länder utanför Norden. Högutbildade föräldrar antas ha en högre grad av den ”välfärdskompetens” som krävs för att hantera dagens välfärdssystem och härigenom kunna påverka de ungas möjligheter att få insatser likt daglig verksamhet. Lågutbildade föräldrar antas ha egna erfarenheter av, och kontakter med, arbetsplatser där det finns arbetsuppgifter utan (eller med låga) formella kompetenskrav. Samhällets kunskaper och medvetenhet om den sociala bakgrundens betydelse för efter(sär)gymnasial sysselsättning bland unga med intellektuell funktionsnedsättning behöver öka. Detta i syfte att bättre möta varierande individuella förutsättningar och främja etablering i arbetslivet för fler unga vuxna med intellektuell funktionsnedsättning vid övergången från skoltid till arbetsliv.

Background: Abdominal adiposity is an important risk factor in the metabolic syndrome. Since BMI does not reveal fat distribution, waist-to-height ratio (WHtR) has been suggested as a better measure of abdominal adiposity in children, but only a few studies cover the preschool population. The aim of the present study was to examine BMI and WHtR growth patterns and their association regarding their ability to identify children with an elevated WHtR at 5 years of age. Methods: A population-based longitudinal birth cohort study of 1540 children, followed from 0 to 5 years with nine measurement points. The children were classified as having WHtR standard deviation scores (WHtRSDS)

There is growing concern about alcohol problems in low- and middle-income countries. More research is required, particularly among the younger generation. The aim of this study was to investigate the prevalence of alcohol disorders and associated socioeconomic characteristics among young men and women living in the Eastern Cape Province, South Africa. This was a cross-sectional population-based study of 977 participants (52% male and 48% female) aged 18-40, the majority of whom lived in low-income areas. Data collection was carried out in 2012 by trained fieldworkers. The Mini International Neuropsychiatric Interview (DSM-IV) was used to investigate the prevalence of alcohol dependence (increased tolerance to alcohol, failed attempt to cut down, risk of physical and mental effects) and alcohol abuse (harmful use, consistent intoxication, risk behaviour, physically hazardous, social problems). A high 12-month prevalence of alcohol dependence was found (26.5% in total; 39.0% among men and 19.1% among women) as well as of alcohol abuse (9% in total; 19.0% among men and 6.0% among women). Few socioeconomic differences emerged among the men, except older men (OR 1.94, CI 1.11-3.42) and those supported by social grants (OR 2.28, CI 1.06-4.93), who presented higher odd ratios for alcohol dependence than the reference groups. Among the women, more differences emerged: women who were widowed/single (OR 2.35, CI 1.20-4.62), had no education (OR 3.41, CI 1.04-11.21), had a low income (OR 3.26, CI 1.55-6.80) and had no social support from friends when ill presented higher odd ratios (OR 1.73, CI 1.07-2.80). In the adjusted model, marital status and low income remained statistically significant. With regard to alcohol abuse, fewer socioeconomic differences emerged. Interventions need to address the early onset of alcohol misuse in order to meet both current needs and long-standing mental and physical illness.

Background Gender difference in health is an important public health issue. Although biological factors contribute, social processes and living conditions create, maintain and exacerbate health differences between women and men. The aim of this study was to examine if lack of equality in domestic work contributes to the explanation of gender differences in self-reported mental well-being, common symptoms and persistent illness. Methods Population based questionnaire data on co-habiting women and men in Sweden, aged 19-64 years (n = 2666), was used. Division of planning and performing domestic work, satisfaction with division of domestic work and equality in partner relationship, were analysed in relation to health outcomes using binary logistic regression analysis with adjustments for age, income, country of birth, occupational class, weekly hours in paid work and number of children. Results Women, compared to men, showed higher odds (OR) for having low mental well-being, OR 1.35 (1.07-1.70), > 7 common symptoms, OR 1.98 (CI 1.59-2.46) and ≥ 1 persistent illness, OR 1.25 (CI 1.06-1.47). When equal partner relationship and planning and performing domestic work were included in the regression, the ORs for mental well-being and persistent illness slightly weakened and decreased to non-significance when satisfaction with division of domestic work were analysed, OR 1.14 (0.99-1.44) and OR 1.18 (0.99-1.39) respectively. Corresponding ORs for common symptoms were almost unchanged throughout the analysis. Conclusions Satisfaction with division of domestic work contributed to explanation of gender differences in persistent illness and notably to differences in mental well-being. Key messages Inequality in domestic work could contribute to explanation of gender difference in health. Satisfaction in division of domestic work is of specific relevance in gender difference in mental health.

I länder med starkt decentraliserat ansvar för välfärdstjänster kan skillnader mellan kommuner och regioner förväntas. I artikeln studeras om, och iså fall hur, efter(sär)gymnasial sysselsättning bland personer med intellektuell funktionsnedsättning varierar beroende på i vilken kommungrupp eller geografisk region de bor. Analyserna baseras på data från ett unikt register som inkluderar 12 269 avgångselever från gymnasiesärskolan i Sverige från åren 2001–2011. Resultaten visar att kommungrupp och region har en viss oberoende effekt på typ av efter(sär)gymnasial sysselsättning samt att andelen flyttningar överkommungränser som företas i studiepopulationen är få. Slutsatsen är att boendegeografiska variationer, som identifierats i andra delar av det svenska välfärdssystemet, också i viss utsträckning gäller efter(sär)gymnasial sysselsättning. In countries with highly decentralized welfare services, disparities between municipalities and regions can be expected. The article analyzes whether, and in that case, how, the type of post-school occupation among graduates from Swedish upper secondary school for pupils with intellectual disability (USSID) varies depending on the municipality or geographic region the former pupils live in. The analyses are based on data from a unique national database that includes 12,269 pupils who graduated from USSID between 2001 and 2011. Results show that municipality of residence has an independent effect on the type of post-USSID occupation. Moreover, the total percentages of relocations in the studied population are low. The authors conclude that the geographical variations identified in other parts of the Swedish welfare system also apply partly to post-USSID occupations. The article discusses whether municipal and regional affiliation is of particular significance for pupils from USSID, because of their low propensity to relocate.

Knowledge about people with intellectual disability (ID) and their connections to the labor market is scarce. The aim of this study was to describe and analyze the entry into and representation in ...

Background Research has shown inconsistencies in results and difficulties in conceptualization of assessment of socioeconomic status (SES) among adolescents. The aim of this study was thus to test the validity of self-reported information on SES in two age-groups (11–13 and 14–16 years old) in an adolescent population and to evaluate its relationship to self-reported health related quality of life (HRQOL). Different measures of SES commonly used in research in relation to HRQOL were tested in this study; parent’s occupations status, family material affluence status (FAS) and perceived SES. Method A cross-sectional study, with a sample of 948 respondents (n = 467, 11–13 years old and n = 481, 14–16 years old) completed questionnaires about SES and HRQOL. The adolescents’ completion rates were used, with chi2-test, to investigate differences between gender and age-group. Correlation was used for convergent validity and ANOVA for concurrent validity. Results We found a low completion rate for both fathers’ (41.7 %) and mothers' (37.5 %) occupation status, and a difference in completion rate between gender and age-groups. FAS had the highest completion rate (100 %) compared to parent's occupations status and perceived SES. The convergent validity between the SES-indicators was weak (Spearman correlation coefficient below 0.3), suggesting that the indicators measured different dimensions of SES. Both FAS and perceived SES showed a gradient in mean HRQOL between low and high SES in relation to HRQOL, this was significant only for perceived SES (p Funding: municipality of Halmstad, Länsförsäkringar Halland, Ljungbergska foundation and Region Halland

Given the prevalence of mental illness worldwide, it is important to better understand the dynamics of mental health help-seeking behavior to improve access to care. The aim of this study was to investigate if general self-efficacy (GSE) was associated with self-reported mental illness and help-seeking behavior and barriers to care in a randomized population. This study utilized a mailed questionnaire completed by 3,981 persons aged 19-64 years who resided in Western Sweden. GSE was measured and logistic regression models calculated, controlling for various sociodemographic variables. Results showed that 25% of men and 43% of women reported a lifetime prevalence of mental illness that they felt could have benefitted from treatment. Of those, 37% of the men and 27% of the women reported barriers to care. Men and women with low GSE were more likely to suffer from mental illness compared with persons high in GSE, but GSE did not enhance help-seeking behavior or perceived barriers to care. The most prevalent barriers to care for both sexes were beliefs that the illness will pass by itself, doubt whether treatment works, lack of knowledge of where to go and feelings of shame. Overall, GSE scores did not differ among those who experienced various barriers to care with the exception of two barriers only among women.

Background: Greater interest is being shown in participatory approaches, especially in research on interventions that concern children and young people'shealth and well-being. Although participatory approaches have user involvement in common, they differ in terms of the explicit guidance on how to actually involve and engage children and young people in health research. The aim of this scoping review was to systematically map recent research involving children and young people in the development of interventions targeting issues of health and well-being. Methods: An interpretative scoping literature review based on: a scientific literature search in (health and social science) databases, reference lists, a manual search in key journals and contact with existing networks was conducted. A total of 4458 references were identified through the literature search, of which 41 studies published between 2000 and 2017 were included in the review. The target population was children and young people under 25 years old. Level of participation was categorized according to Shier's Pathways to Participation Model. Results: The review showed that participatory approaches were most often used in the development of interventions in school settings and in community and healthcare settings and on issues concerning support in lifestyle or in managing illness or disease. The level of participation varied from children and young people taking part just as active informants, through stages of greater participation both in quantitative and qualitative terms, to children and youngpeople becoming an active agent involved as a co-researcher where the research process was shaped by views of a higher level of mutuality. Most of the studies were categorised at a medium level and only three studies were judged to involve the children and young people at the highest level. Conclusions: This scoping review showed that work remains in enabling children and young people to influence the development of interventions targeting health and well-being. In relation to level of sustainability in the interventions, it is relevant that goals, strategies and processes are formulated by those who can gain from the interventions. Participatory approaches aiming for a higher level of participation where children and young people work together with the researchers in partnerships are thus warranted. © 2018 The Author(s). Funding Agency: Centre of Welfare, Health and Sports at Halmstad University

(Published: 9 May 2016) Citation: Int J Qualitative Stud Health Well-being 2016, 11: 31468 - http://dx.doi.org/10.3402/qhw.v11.31468

Läkares erfarenheter av otillräcklighet vid sjukskrivning är ett uttryck för två problem: Formatet för det försäkringsmedicinska beslutsstödet begränsar vilka aspekter av sin expertkunskap läkare kan förmedla till Försäkringskassan, och man tvingas hantera ett kunskapsobjekt utanför sin etablerade expertis. Nuvarande strategier behandlar symtomen på ett kunskapsteoretiskt glapp, snarare än att höja expertisen kring arbetsförmåga.

Changes in the welfare systems including the sickness insurance scheme are ongoing in several countries, and better knowledge on the extent of health problems in sickness absence seems needed. The ...

Indicators of gender equality in domestic work and sickness absence – Findings among cohabiting women and men in Sweden

Objective: The aim of this study was to analyze the association between frequent headache and self-reported mental and physical work ability in a general population sample in Sweden. Methods: The study was conducted in western Sweden in 2008. Frequent headache was analyzed in relation to mental and physical work ability. Covariates included demographics and socioeconomic variables, work-related variables, and a symptom index. Self-reported and register-based sickness absence data were also analyzed. Results: Sixteen per cent of those who answered the question about headache (n = 2590) had frequent headache (at least once a week). Regression analyses showed that frequent headache sufferers were twice more likely to have poor mental and physical work ability than those having infrequent headache. Conclusions: Frequent headache was associated with poor mental and physical work ability but not with sickness absence. Copyright © 2014 by American College of Occupational and Environmental.

BACKGROUND: Previous studies have found insomnia and long sleep duration to be independently associated with subsequent disability pension (DP). However, the issue of a possible gender-based pattern in this context has received little attention. PURPOSE: This study aims to assess the impact of insomnia symptoms and sleep duration on the DP rates among Swedish women and men during a 12-year follow-up period. METHOD: The participants, from the general population of Malmö, Sweden, were enrolled from 1992 to 1994 (n = 4,319; participation rate 41 %), aged 45-64, healthy, and employed ≥30 h per week. Baseline inquiry data concerning psychosocial circumstances and self-reported sleep habits were compared with official register-based DP rates. RESULTS: Five hundred and nine persons were granted a DP. Insomnia symptoms, affirmed by 33 % of the men and 41 % of the women, were associated with receiving a DP; the hazard ratios in the fully adjusted model were 1.4 for both men [95 % confidence interval (CI) 1.1, 1.9] and women (95 % CI 1.1, 1.7). The fully adjusted hazard ratio for women sleeping ≥9 h was 7.8 (95 % CI 3.7, 16.6) for DP due to a mental disorder. In the age-adjusted analyses, the sub-domain "difficulties falling asleep" was related to DP due to mental disorders in men and DP due to cardiovascular diseases in women. CONCLUSION: The findings suggest that preventing and treating insomnia symptoms could reduce DP and that disease mechanisms linking sleep disturbances to DP may differ by gender.

OBJECTIVES: The aim of this study was to investigate whether job strain, psychological demands, and decision latitude are independent determinants of disability pension rates over a 12-year follow-up period. METHODS: We studied 3,181 men and 3,359 women, all middle-aged and working at least 30 h per week, recruited from the general population of Malmö, Sweden, in 1992. The participation rate was 41 %. Baseline data include sociodemographics, the Job Content Questionnaire, lifestyle, and health-related variables. Disability pension information was obtained through record linkage from the National Health Insurance Register. RESULTS: Nearly 20 % of the women and 15 % of the men were granted a disability pension during the follow-up period. The highest quartile of psychological job demands and the lowest quartile of decision latitude were associated with disability pensions when controlling for age, socioeconomic position, and health risk behaviours. In the final model, with adjustment also for health indicators and stress from outside the workplace, the hazard ratios for high strain jobs (i.e. high psychological demands in combination with low decision latitude) were 1.5 in men (95 % CI, 1.04-2.0) and 1.7 in women (95 % CI, 1.3-2.2). Stratifying for health at baseline showed that high strain tended to affect healthy but not unhealthy men, while this pattern was reversed in women. CONCLUSIONS: High psychological demands, low decision latitude, and job strain were all confirmed as independent risk factors for subsequent disability pensions. In order to increase chances of individuals remaining in the work force, interventions against these adverse psychosocial factors appear worthwhile.

The aim of this study was to analyze associations between changes in social roles and physical health, mental well-being, psychiatric disorder, and long-term sickness absence over a five-year period. The study was part of a general population-based multipurpose project. Professional women from six birth cohorts born in 1935, 1945, 1955, 1965, 1970, or 1975 (N = 532) were interviewed twice. Self-rated information on physical health, mental well-being, long-term sickness absence, and changes in social roles was used. Information on psychiatric disorders was based on Diagnostic and Statistical Manual of Mental Disorders-III-R and Diagnostic and Statistical Manual of Mental Disorders-IV diagnoses. Multivariate logistic regressions were adjusted for age, socio-economic position, alcohol dependence and abuse, and health at baseline. An increase in number of social roles was associated with lower odds for poor mental well-being, odds ratio (OR) 0.4 (confidence interval [CI] 0.2 to 0.8), while a decrease was associated with higher odds for poor mental well-being, OR 4.5 (CI 1.8 to 11.0), psychiatric disorder, OR 2.6 (1.0 to 6.8), and sickness absence, OR 4.4 (1.6 to 11.7). The results indicated that an increase in number of social roles might be protective against poor mental well-being, while a decrease in number of roles might be related to increased psychiatric disorders and long-term sickness absence. More studies on long-term health implications of gender-specific experiences are needed.

Aim: The aim of this study was to analyse the association between strain in domestic work and self-rated health among employed women in Sweden, using two different methods of measuring strain in domestic work. Methods: Questionnaire data were collected on health and living conditions in paid and unpaid work for employed women (n=1,417), aged 17—64 years. ``Domestic job strain'' was an application of the demand—control model developed by Karasek and Theorell, and ``Domestic work equity and marital satisfaction'' was measured by questions on the division of and responsibility for domestic work and relationship with spouse/cohabiter. Self-rated health was measured using the SF-36 Health Survey. Associations were analysed by bivariate and multivariate linear regression analyses, and reported as standardized regression coefficients. Results: Higher strain in domestic work was associated with lower self-rated health, also after controlling for potential confounders and according to both strain measures. ``Domestic work equity and marital satisfaction'' showed for example negative associations with mental health β -0.211 (p

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.