Return to work is a key rehabilitation goal for people with cardiovascular disease (CVD) because employment matters to individuals and societies. However, people recovering from CVD often struggle ...with returning to work and maintaining employment. To identify people in need of vocational counselling, we examined the probability of feeling under pressure to return to work following CVD.
We conducted a combined survey- and register-based study in a randomly selected, population-based cohort of 10,000 people diagnosed with atrial fibrillation, heart failure, heart valve disease, or ischaemic heart disease in 2018. The questionnaire covered return-to-work items, and we reported the probabilities of feeling under pressure to return to work with 95% confidence intervals (CIs) in categories defined by sex, age, and CVD diagnosis.
The survey response rate was 51.1%. In this study, we included 842 respondents (79.7% men) aged 32-85 years, who had returned to work following a sick leave. Overall, 249 (29.7%) had felt pressure to return to work. The probability of feeling under pressure to return to work ranged from 18.3% (95% CI: 13.1-24.6) among men aged > 55 years with atrial fibrillation to 51.7% (95% CI: 32.5-70.6) among women aged ≤ 55 years with atrial fibrillation. In addition, 66.0% of all respondents had not been offered vocational rehabilitation, and 48.6% of those who reported a need for vocational counselling had unmet needs. Survey responses also indicated that many respondents had returned to work before feeling mentally and physically ready.
A substantial proportion of people with cardiovascular disease feel under pressure to return to work, and this pressure is associated with age, sex, and diagnosis. The results show that vocational rehabilitation must be improved and emphasize the importance of ensuring that cardiac rehabilitation programmes include all core rehabilitation components.
ObjectivesParticipation in population-based surveys and epidemiological studies has been declining over the years in many countries. The aim of this study was to examine the association between job ...type and participation in the work environment and health in Denmark survey with/without taking into account other socio-demographic factors.DesignCross-sectional survey using questionnaire data on working environment and registry data on job type, industry and socio-economic variables.SettingThe work environment and health study.ParticipantsA total of 50 806 employees (15 767 in a stratified workplace sample; 35 039 in a random sample) working at least 35 hours/month and earning at least 3000 Danish Krones.Outcome measuresThe outcome was participation (yes/no) and logistic regression was used to estimate the OR for participation with 95% CI.ResultsIn the random sample, women were more likely to participate than men, and married/non-married couples were more likely to participate than persons living alone or more families living together. Participation increased with higher age, higher annual personal income, higher education and Danish origin, and there were marked differences in participation between job types and geographical regions. For armed forces, craft and related trade workers, and skilled agricultural, forestry and fishery workers, the association between job type and participation was strongly attenuated after adjustment for sex and age. Additional adjustment for annual income, education, cohabitation, country of origin and geographical region generally attenuated the association between job type and participation. Similar results were found in the stratified workplace sample.ConclusionIn this population of Danish employees, participation varied across types of jobs. Some but not all the variation between job types was explained by other socio-demographic factors. Future studies using questionnaires may consider targeting efforts to (sub-)populations, defined by job type and other factors, where response probability is particularly important.
Objectives To evaluate the association between a simple lifestyle index based on the recommendations for five lifestyle factors and the incidence of colorectal cancer, and to estimate the proportion ...of colorectal cancer cases attributable to lack of adherence to the recommendations.Design Prospective cohort study.Setting General population of Copenhagen and Aarhus, Denmark.Participants 55 487 men and women aged 50-64 years at baseline (1993-7), not previously diagnosed with cancer.Main outcome measure Risk of colorectal cancer in relation to points achieved in the lifestyle index (based on physical activity, waist circumference, smoking, alcohol intake, and diet (dietary fibre, energy percentage from fat, red and processed meat, and fruits and vegetables)) modelled through Cox regression.Results During a median follow-up of 9.9 years, 678 men and women had colorectal cancer diagnosed. After adjustment for potential confounders, each additional point achieved on the lifestyle index, corresponding to one additional recommendation that was met, was associated with a lower risk of colorectal cancer (incidence rate ratio 0.89 (95% confidence interval 0.82 to 0.96). In this population an estimated total of 13% (95% CI 4% to 22%) of the colorectal cancer cases were attributable to lack of adherence to merely one additional recommendation among all participants except the healthiest. If all participants had followed the five recommendations 23% (9% to 37%) of the colorectal cancer cases might have been prevented. Results were similar for colon and rectal cancer, but only statistically significant for colon cancer.Conclusions Adherence to the recommendations for physical activity, waist circumference, smoking, alcohol intake, and diet may reduce colorectal cancer risk considerably, and in this population 23% of the cases might be attributable to lack of adherence to the five lifestyle recommendations. The simple structure of the lifestyle index facilitates its use in public health practice.
PURPOSEFor people of working-age diagnosed with heart failure, return to work (RTW) is often a significant rehabilitation goal. To inform vocational rehabilitation strategies, we conducted a ...qualitative study aiming at exploring patient experienced support needs, and barriers and facilitators to RTW. MATERIALS AND METHODSTen men and eight women with heart failure (48-60 years) were interviewed in Denmark during 2022. A thematic analysis was conducted using the Sherbrooke model as framework. RESULTSMultiple factors operating at different levels shaped participants' RTW processes. Personal factors included motivation, mental and physical health, social relations, and financial concerns. Factors in the health care system shaping RTW included access to medical treatment, mental health care, and cardiac rehabilitation. Factors in workplace system shaping RTW included job type, employer support, and social relations. Factors in the legislative and insurance system shaping RTW included authorities' administration of sickness benefits, professional assistance, vocational counselling, and interdisciplinary cooperation. CONCLUSIONFindings illustrate a need to include vocational rehabilitation within comprehensive cardiac rehabilitation programmes, to identify people in need of support, to improve the coordination of care across the health and social care sectors, and to involve employers, health care professionals, and social workers in individualised RTW strategies.IMPLICATIONS FOR REHABILITATIONVocational re-integration is shaped by multiple factors operating at different levels (including personal factors, work-related factors, factors in the health care system, and factors in the legislative and insurance system).To improve return to work following heart failure, there is a need for multi-level initiatives, including policy measures and efforts to enhance continuity and coordination of care.People with heart failure in need of vocational support should be identified early within comprehensive cardiac rehabilitation programmes.Health care professionals should address work-related issues and provide individualised information and clear advice regarding timely and safe return to work.Individualised return-to-work plans should be developed within interdisciplinary teams across health and social care sectors and involve employers to ensure that they are aware of relevant work accommodations.
Studies have indicated that people with disabilities die earlier and may experience a poorer health than the general population. This study investigated 31 factors related to health and well-being, ...health behaviour and social relations among Danish adults with activity limitation (AL).
This study was based on data from the Danish Health and Morbidity Survey (DHMS) 2013 where 25,000 men and women aged 16 years or older were selected randomly from the adult Danish population. A total of 14,265 individuals answered the self-administered questionnaire including 100 questions on health-related quality of life, health behaviour, morbidity, consequences of illness and social relations. Based on an international standard question on AL, 888 individuals (6%) were defined as having profound AL and 4180 (29%) as having some AL. Multiple logistic regression analyses were used to analyse the associations between activity limitation and 31 indicators of health. The results were presented as relative risks 95% confidence intervals.
Twenty-eight of 31 indicators showed consistently poorer health and well-being, health behaviour and social relations among individuals with AL as compared to individuals without AL. The increased relative risks were in a range of 7-661% the risk among individuals without AL. An example is obesity where RR (95% CI) was 2.07 (1.82-2.37). Only contact with internet friends was significantly higher among individuals with AL as compared to individuals with no AL. There was no association between alcohol and AL and no association between fast food and some AL.
Danish adults with AL experience a poorer health and well-being, and have an unhealthier lifestyle and poorer social relations than adults without AL. People with activity limitation should be prioritized in public health and efforts done to secure availability and flexibility of health care services and primary prevention programs. Policies should address accessibility, availability and affordability of health care and health behaviour among people with activity limitation.
Background: Some studies indicate that a large part of the beneficial effect of physical activity on mortality is confined to a threshold effect of participation. Methods: Self-reported physical ...activity was investigated in relation to all-cause mortality in the Danish Diet, Cancer and Health cohort, including 29,129 women and 26,576 men aged 50—64 years at baseline 1993—1997. Using Cox proportional hazards models we investigated the associations between mortality rate and leisure time physical activity by exploring 1) participation (yes/no) in each type of activity; 2) a simple dose—response relationship with hours spent on each activity, supplemented with indicators of participation in each activity; and 3) inflexion or nonmonotonic dose—response relationships using linear splines. Results: A total of 2696 women and 4044 men died through March 2010. We found lower mortality with participation in sports (for women, mortality rate ratio = 0.75, 95% confidence interval = 0.69—0.81; for men, 0.78, 0.73—0.84), cycling (for women, 0.77, 0.71—0.84; for men, 0.90, 0.84—0.96), or gardening (for women, 0.84, 0.78—0.91; for men, 0.73, 0.68—0.79) and in men participating in do-it-yourself activity (0.77, 0.71—0.84). A weak adverse dose response was seen for walking and gardening, but the association was small (1—2% increase in mortality per additional hour). We found no signs of inflexion or nonmonotonic effects of additional hours spent on each activity. Conclusion: Mortality was lower with participation in specific leisure time physical activities, but not with more time spent on those activities. This could suggest that avoiding a sedative lifestyle is more important than a high volume of activity. Nonparticipation in these types of physical activity may be considered as risk factors.
Abstract
Aims
The aim of this study was to evaluate if a combination of World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2), and Major Depression Inventory-2 (MDI-2) can replace the ...Hospital Anxiety and Depression Scale (HADS) as screening tool for anxiety and depression in cardiac patients across diagnoses and whether it is feasible to generate crosswalks (translation tables) for use in clinical practice.
Methods and results
We used data from the Danish ‘Life with a heart disease’ survey, in which 10 000 patients with a hospital contact and discharge diagnosis of ischaemic heart disease, heart failure, heart valve disease, or atrial fibrillation in 2018 were invited. Potential participants received an electronic questionnaire including 51 questions on health, well-being, and evaluation of the health care system. Crosswalks between WHO-5/ASS-2 and HADS anxiety dimension (HADS-A) and between WHO-5/MDI-2 and HADS depression dimension (HADS-D) were generated and tested using item response theory (IRT). A total of 4346 patients responded to HADS, WHO-5, ASS-2, and MDI-2. Model fit of the bi-factor IRT models illustrated appropriateness of a bi-factor structure and thus of essential uni-dimensionality root mean square error of approximation (RMSEA) (P value) range 0.000–0.053 (0.0099–0.7529) for anxiety and 0.033–0.061 (0.0168–0.2233) for depression. A combination of WHO-5 and ASS-2 measured the same trait as HADS-A, and a combination of WHO-5 and MDI-2 measured the same trait as HADS-D. Consequently, crosswalks (translation tables) were generated.
Conclusions
Our study shows that it is feasible to use crosswalks between HADS-A and WHO-5/ASS-2 and HADS-D and WHO-5/MDI-2 for screening cardiac patients across diagnoses for anxiety and depression in clinical practice.
Lay Summary
This large, national survey of cardiac patients study shows that the psychometric scales, World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2), and Major Depression Inventory-2 (MDI-2), can be used instead of the Hospital Anxiety and Depression Scale (HADS) in follow-up care when screening for anxiety and depression in cardiac patients:
The combination of the questionnaires, WHO-5, ASS-2, and MDI-2, can replace the HADS questionnaire.Translation tables (crosswalks) are presented for use in clinical practice.
Graphical Abstract
Graphical Abstract
Abstract Aims In recent decades there has been an increased focus on non-pharmacological treatment of diabetes. The aim of this study was to investigate trends in leisure time physical activity (PA), ...smoking, body mass index (BMI), and alcohol consumption reported in 2000, 2005 and 2010 by Danish subjects with diabetes. Methods Data comprised level of leisure time PA (inactive; moderate active; medium active; high active); smoking; BMI; and alcohol consumption, provided by The Danish Health and Morbidity Surveys. Participants older than 45 years with or without diabetes were included from cross-sectional analyses from 2000, 2005 and 2010. Results In participants with diabetes, leisure time PA levels increased from 2000 to 2010: The percentage of those that were physically active increased from 53.5% to 78.2% ( p < 0.001; women) and from 67.8% to 79.1% ( p = 0.01; men). The prevalence of daily smokers was reduced from 27.2% to 16.4%, p = 0.015, in women with diabetes. In men with diabetes, BMI increased from 27.2 ± 4.0 to 28.6 ± 5.1 kg m−2 , p = 0.003, and men who exceeded the maximum recommendation for alcohol consumption increased from 9.4% to 19.0%, p = 0.007. The leisure time PA level was reduced in participants with diabetes compared to participants without diabetes throughout the study. Conclusions The percentage of physically active Danish participants older than 45 years with diabetes increased from 2000 to 2010, and the most beneficial trends in life style were observed among the women. These trends may have serious implications for cardiovascular risk in Danish patients with diabetes.
ObjectivesThis study aimed to examine whether high emotional demands at work predict long-term sickness absence (LTSA) in the Danish workforce and whether associations differ by perceived and ...content-related emotional demands.MethodsWe included 26 410 individuals from the Work Environment and Health in Denmark Study, a nationwide sample of the Danish workforce. Emotional demands at work were measured with two items: one assessing perceived emotional demands (asking how often respondents were emotionally affected by work) and one assessing content-related emotional demands (frequency of contact with individuals in difficult situations). LTSA was register based and defined as spells of ≥6 weeks. Respondents with LTSA during 2 years before baseline were excluded. Follow-up was 52 weeks. Using Cox regression, we estimated risk of LTSA per one-unit increase in emotional demands rated on a five-point scale.ResultsDuring 22 466 person-years, we identified 1002 LTSA cases. Both perceived (HR 1.20, 95% CI 1.12 to 1.28) and content-related emotional demands (HR 1.07, 95% CI 1.01 to 1.13) predicted risk of LTSA after adjustment for confounders. Further adjustment for baseline depressive symptoms substantially attenuated associations for perceived (HR 1.08, 95% CI 1.01 to 1.16) but not content-related emotional demands (HR 1.05, 95% CI 1.00 to 1.11). Individuals working in occupations with above-average values of both exposures had an increased risk of LTSA (HR 1.32, 95% CI 1.14 to 1.52) compared with individuals in all other job groups.ConclusionsPerceived and content-related emotional demands at work predicted LTSA, also after adjustment for baseline depressive symptoms, supporting the interpretation that high emotional demands may be hazardous to employee’s health.
Abstract
Aims
Return to work and employment maintenance following cardiovascular disease (CVD) are important rehabilitation goals for people of working age. To identify people in particular need of ...vocational rehabilitation, we examined differences in return to work and subsequent detachment from employment among people with atrial fibrillation (AF), heart failure (HF), heart valve disease, and ischaemic heart disease.
Methods and results
We conducted a nationwide cohort study and included all individuals of working age (35–65 years) who were employed when diagnosed with incident CVD in 2018. We estimated sex- and age-standardized probabilities of remaining employed at 3, 6, and 12 months after diagnosis, and of detachment from employment within 6 months after having returned to work. Of 46 912 individuals diagnosed in 2018, 8187 were of working age and employed at diagnosis. The mean age was 54.7 years (SD = 6.7), and 74.0% were men. Within 1 year, 89.8% had returned to work, but within the subsequent 6 months, 23.5% of these experienced detachment from employment. At 3, 6, and 12 months after diagnosis the highest standardized probability of being employed was found among people with AF, whereas the lowest probability was found among people with HF {78.9% 95% confidence interval (CI): 77.3–80.4 vs. 62.2% 95% CI: 59.0–65.4 at 12 months}. Similarly, the highest probability of detachment was found for people with HF 30.3% (95% CI: 26.9–33.7).
Conclusion
People with HF present the highest probability of not returning to work. There is a need for developing and documenting effects of vocational rehabilitation strategies within comprehensive cardiac rehabilitation programmes.
Graphical Abstract
Graphical Abstract
PDF
