This study explores the stability and change in maternal life satisfaction and psychological distress following the birth of a child with a congenital anomaly using 5 assessments from the Norwegian Mother and Child Cohort Study collected from Pregnancy Week 17 to 36 months postpartum. Participating mothers were divided into those having infants with (a) Down syndrome (DS; n = 114), (b) cleft lip/palate (CLP; n = 179), and (c) no disability (ND; n = 99,122). Responses on the Satisfaction With Life Scale and a short version of the Hopkins Symptom Checklist were analyzed using structural equation modeling, including latent growth curves. Satisfaction and distress levels were highly diverse in the sample, but fairly stable over time (retest correlations: .47-.68). However, the birth of a child with DS was associated with a rapid decrease in maternal life satisfaction and a corresponding increase in psychological distress observed between pregnancy and 6 months postpartum. The unique effects from DS on changes in satisfaction (Cohen's d = -.66) and distress (Cohen's d = .60) remained stable. Higher distress and lower life satisfaction at later assessments appeared to reflect a persistent burden that was already experienced 6 months after birth. CLP had a temporary impact (Cohen's d = .29) on maternal distress at 6 months. However, the overall trajectories did not differ between CLP and ND mothers. In sum, the birth of a child with DS influences maternal psychological distress and life satisfaction throughout the toddler period, whereas a curable condition like CLP has only a minor temporary effect on maternal psychological distress.
This study aimed to quantify how much of the adult social gradient in sick leave can be attributed to the mediating role of physical workload while accounting for the role of childhood and adolescent social position and neuroticism.
Our sample consisted of 2099 women and 1229 men from a Norwegian birth cohort study (born 1967-1976) who participated in the Nord-Trøndelag Health Study (2006-2008) (HUNT3). Data on sick leave (defined as >16 calendar days; 2006-2009) and social position during childhood, adolescence, and adulthood were obtained from national registers. Study outcome was time-to-first sick leave spell. Physical workload and neuroticism were self-reported in HUNT3. Mediating effects through physical workload were estimated using a method based on the additive hazards survival model.
A hypothetical change from highest to lowest group in adult social position was, for women, associated with 51.6 [95% confidence interval (95% CI) 24.7-78.5] additional spells per 100,000 person-days at risk, in a model adjusted for childhood and adolescent social position and neuroticism. The corresponding rate increase for men was 41.1 (95% CI 21.4-60.8). Of these additional spells, the proportion mediated through physical workload was 24% (95% CI 10-49) and 30% (95% CI 10-63) for women and men, respectively.
The effect of adult social position on sick leave was partly mediated through physical workload, even while accounting for earlier life course factors. Our findings provide support that interventions aimed at reducing physical workload among those with lower adult social position could reduce sick leave risk.
BACKGROUND: Consequences of chronic diseases in childhood with respect to health, educational achievement and participation in the labour force in young adult age are evaluated. MATERIAL AND METHODS :A total of 14,364 children (2.3%) of the 626,928 born in Norway 1967-76 received basic and /or supplemental benefits for at least one year of the age span 0-16 years. The more common diagnoses included Endocrine diseases (diabetes), disease classified under Mental diagnoses, Neurological diseases and Congenital malformations. All the children were followed up to the age of 27 with respect to mortality and disability pensioning and to the age of 25 with regard to education, participation in the labour force and income, and in addition national service for the men. The study was made possible through the linking of data from several national registers, performed by Statistics Norway. Before the file was released for analyses, all personal identification was removed. RESULTS: Basic and supplementary benefits in childhood predict adverse outcomes in young adult age: mortality, disability, low education, lack of gainful employment and low pensionable income. The diagnosis registered with the benefit strongly influenced the outcomes. Conscripts who had received benefits were judged to have a mean score for general ability of 4.5 compared to 5.2. Adjusted for score for general ability the proportion of those having received benefits achieving higher education was 84% of that of those that had not received benefits. After adjustment for educational attainment, the percentage gainfully employed was 11-12% less among subjects having received benefits in childhood. This negative association between having received a benefit in childhood and gainful employment in adulthood was restricted to the low educational group. INTERPRETATION: Persons with health problems in childhood did not achieve the education, employment and income they should have been capable of judged by their general ability and the education they had actually achieved.
BACKGROUND: In a number of studies, birthweight has been associated with cognition and educational attainment into adult age. However, the association is not clear between birthweight and work participation in adulthood. We investigated this association assessing to which extent it was influenced by circumstances concerning family background or disease in early life. METHODS: Through linkage between several national registers containing personal information from birth into adult age we established a longitudinal, population-based cohort study. Study participants were all 308 829 singletons born in Norway in 1967-1971 as registered by the Medical Birth Registry of Norway who were national residents at age 29. The study outcome was unemployment defined as a lack of personal income among people who were not under education in the calendar year of their 29th birthday as registered by the National Insurance Administration and Statistics Norway. RESULTS: Birthweight below the standardized mean was associated with unemployment. The risk of unemployment increased by decreasing birthweight for both women and men and also after adjustment for potential confounding factors. The association was evident both in people with or without social disadvantage, as well as people with or without childhood disease. Still, birthweight below the standardized mean explained much less of the unemployment risk than did social disadvantage (attributable fractions 8.0% versus 28.3% for women and 10.0% versus 40.2% for men). CONCLUSION: Birthweight below the standardized mean was independently associated with unemployment at age 29, also in the normal birthweight range.
Comment In: Int J Epidemiol. 2004 Aug;33(4):856-715166198
Emigration causes loss to follow-up. The study aim was to assess the influence of the choice of handling migration in population-based cohort studies on estimated mortality and cancer incidence in the population of origin. All persons born in Norway between 1967 and 1976 and who were not registered dead before 1992 (N = 614,176) were followed up in national registries regarding migration movements, death, and incident cancer between 1992 and 2004. A total of 40,366 (6.6%) of the study population had between 1 and 13 migration movements and 5,354 deaths and 4,447 first cancer cases were recorded during follow-up. Four different follow-up scenarios concerning migration were analysed: considering only person-time before emigration; considering person-time as national residents both before emigration and after repatriation; disregarding whether emigration took place or not; and excluding all who emigrated during follow-up. Mortality and cancer incidence rates were compared in Poisson regression models. Mortality and cancer incidence were only marginally influenced by choice of follow-up scenario. Mortality was higher after repatriation, in particular during the first year of follow-up (rate ratio 2.03; 95% confidence interval 1.02-4.03). This excess had little influence on total population rates. Cancer incidence was not affected by repatriation status. Mortality rates after repatriation were probably elevated because persons who expected to die shortly were more prone to return to their native country ("salmon bias"). The analytical choice concerning follow-up has little influence on outcome occurrences in populations with rather low migration rates. However, the best solution is apparently to censor out persons at the date of emigration in order to avoid salmon bias.
To examine the effect of sex and socioeconomic position (SEP) on individuals' perceptions of pain and its work-relatedness.
We compared self-reported pain in neck-shoulder or arm with clinical diagnoses and workers' judgments of work-relatedness with physicians' assessments based on specific criteria, between sexes and high- and low-SEP participants in the Oslo Health Study (n = 217).
Clinical diagnoses were more frequent in low-SEP subjects than high-SEP subjects with pain and generally higher in women than in men. Pain attributed to work was more frequently assessed as work-related by the physicians in low-SEP subjects than high-SEP subjects and in men than in women of low SEP.
The threshold for reporting pain seemed higher in low-SEP subjects and among women. Physicians were more likely to agree with low-SEP workers about work-relatedness.
Children born at term with low birth weight (LBW) are regarded growth restricted and are at particular risk of adverse health outcomes requiring a high degree of parental participation in the day-to-day care. This study examined whether their increased risk of special health care needs compared to other children may influence mothers' opportunities for participation in the labor market at different times after delivery. Data from 32,938 participants in the population-based Norwegian Mother and Child Cohort Study with singleton children born at term in 2004-2006 were linked to national registers in order to investigate the mothers' employment status when their children were 1-3 years in 2007 and 4-6 years in 2010. Children weighing less than two standard deviations below the gender-specific mean were defined as LBW children. Although not significantly different from mothers of children in the normal weight range, mothers of LBW children had the overall highest level of non-employment when the children were 1-3 years. At child age 4-6 years on the other hand, LBW was associated with an increased risk of non-employment (RR 1.39: 95 % CI 1.11-1.75) also after adjustment for factors associated with employment in general. In accordance with employment trends in the general population, our findings show that while mothers of normal birth weight children re-enter the labor market as their children grow older, mothers of LBW children born at term participate to a lesser extent in paid employment and remain at levels similar to those of mothers with younger children.
BACKGROUND: Our aim was to analyse long-term employment trends among disadvantaged groups on the assumption that they may be more exposed to unemployment during recessions or be at increasingly higher risk of unemployment because of stricter requirements in the workplace. MATERIAL AND METHODS: We established a cohort through links between data on individuals in national registers for all 321,975 men born 1967 through 1976. Disadvantaged groups under study were those receiving supplementary benefits in childhood because of chronic disease, and those with few educational attainments. Using Poisson regression we estimated associations with unemployment or disability over the course of the 1991-2001 period. RESULTS: Disadvantaged groups had higher risk of unemployment or disability. Associations between chronic disease in childhood and subsequent unemployment followed the business cycle; they were highest during the 1993 recession and lowest during the boom years around 1999. Over the long term, the gap in unemployment widened between those with low educational attainment and the better-educated. We found similar but less clear trends for disability. INTERPRETATION: The observed negative effect of chronic childhood disease on employment status paralleled the business cycle: it was weakest in boom years and strongest in recession years. Low educational attainment was associated with a gradual decline in the level of employment.
Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality.
All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates.
The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths.
Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.
Women have shown consistently higher levels of sickness absence from work in comparison to men, but explanations for this gender gap have not been completely understood. Life-course studies suggest that health and health-related social benefits in adult age are influenced by early life experiences. We aimed to estimate intergenerational associations with a 15-year time gap between parents' and offspring sickness absences, pursuing the hypothesis that this parental influence would have a stronger impact for women than for men.
All persons born alive between 1974 and 1976 in Norway were followed up in several national registries. Employed persons considered to be at risk of sickness absence and also with parents at risk of sickness absence (n?=?78,878) were followed in the calendar year of their 33(rd) birthday with respect to spells lasting >16 days. The probability of one or more spells during this year constituted the one-year risk under study. Additive risk differences in association with an exposure (parental sickness absence 15 years earlier) were estimated in a binomial regression analysis. The estimates were adjusted for parental socioeconomic factors.
The 1-year sickness absence risk was higher for women (30.4%) than for men (12.3%). The crude risk differences between those exposed and those unexposed to parental sickness absence were similar in percentage points (PP) for women (3.8; 95% confidence interval (CI) 2.6 to 4.9) and men (3.8; 95% CI 2.9 to 4.6). The risk differences were moderately attenuated after adjustment for parental education and father's income to 3.4 PP (2.2 to 4.5) for women and 2.8 PP (2.0 to 3.7) for men. Male absence was more strongly associated with the father's than with the mother's sickness absence, while associations for women were stronger for the same diagnostic groups as their parents.
Parental sickness absence was moderately associated with sickness absence in the next generation. Bias from unmeasured confounders cannot be entirely dismissed. Contrary to our hypothesis, associations were not stronger for women than for men. If parental sickness absence has a long-term causal effect, preventive measures could have an impact over generations.
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