{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T21:03:47Z","timestamp":1765832627068,"version":"3.48.0"},"reference-count":45,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T00:00:00Z","timestamp":1609200000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,11,20]]},"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To explore sequences of annual states of activity and sickness absence (SA) or disability pension (DP) (SA\/DP) among working-aged people with multiple sclerosis (PwMS) as well as characteristics associated with the identified types of working-life sequences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nationwide Swedish register-based cohort study from 1 year prior to 5 years after the year of multiple sclerosis (MS) diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>PwMS diagnosed in 2008\u20132011 when aged 20\u201355 (n=2652, 69.9% women).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Individual-level sequences spanning 7 years were constructed with annual states regarding activity (income from paid work, student allowances, parental leave or unemployment compensation) and\/or SA\/DP. Types of working-life sequences were identified among the individuals\u2019 sequences using hierarchical cluster analysis with optimal matching dissimilarity measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six types of working-life sequences were identified. The largest cluster, Stable High Activity, represented 48.4% of the cohort. Other types were: Stable High SA\/DP (14.5%); Other (4.5%); and three types with mixed activity and varying SA\/DP regarding the number of days\/year and timing (32.6%). Characteristics of the different identified types of sequences were subsequently investigated. All types of sequences had lower odds for university education (OR range: 0.18\u20130.72) compared with Stable High Activity. Increasingly higher odds of having anxiety\/depression compared with Stable High Activity were observed across the types of sequences, by increasing proportions of SA\/DP. Stable High SA\/DP sequences were less likely than Stable High Activity to be prescribed MS drugs in the MS diagnosis year (OR 0.61; 95% CI 0.47 to 0.78). All types of sequences had higher disposable income in the final study year than the first, except for Stable High SA\/DP sequences (Swedish Krona 4669, 95% CI \u22121892 to 11 230).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Diversity in working life was influenced by sociodemographic and clinical characteristics resulting in different activity and SA\/DP patterns across the six identified types of working-life sequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-039228","type":"journal-article","created":{"date-parts":[[2020,12,29]],"date-time":"2020-12-29T12:11:50Z","timestamp":1609243910000},"page":"e039228","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Types of working-life sequences among people recently diagnosed with multiple sclerosis in Sweden: a nationwide register-based cohort study"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4150-4275","authenticated-orcid":false,"given":"Chantelle","family":"Murley","sequence":"first","affiliation":[{"name":"Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petter","family":"Tingh\u00f6g","sequence":"additional","affiliation":[{"name":"Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden"},{"name":"Department of Health Sciences, Swedish Red Cross University College, 141-21 Huddinge, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Korinna","family":"Karampampa","sequence":"additional","affiliation":[{"name":"Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Hillert","sequence":"additional","affiliation":[{"name":"Division of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, 171-77 Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Alexanderson","sequence":"additional","affiliation":[{"name":"Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilie","family":"Friberg","sequence":"additional","affiliation":[{"name":"Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 171-77 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,12,29]]},"reference":[{"key":"2025121513010391000_10.12.e039228.1","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/1352458517708682","article-title":"New insights into the burden and costs of multiple sclerosis in Europe: results for Sweden","volume":"23","author":"Brundin","year":"2017","journal-title":"Mult Scler"},{"key":"2025121513010391000_10.12.e039228.2","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/j.msard.2016.07.003","article-title":"Brain health: time matters in multiple sclerosis","volume":"9 Suppl 1","author":"Giovannoni","year":"2016","journal-title":"Mult Scler Relat Disord"},{"key":"2025121513010391000_10.12.e039228.3","doi-asserted-by":"publisher","DOI":"10.1177\/1352458509352196"},{"key":"2025121513010391000_10.12.e039228.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012731"},{"key":"2025121513010391000_10.12.e039228.5","doi-asserted-by":"publisher","DOI":"10.1177\/1352458515570767"},{"key":"2025121513010391000_10.12.e039228.6","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1007\/s00415-018-8764-4","article-title":"The long-term impact of early treatment of multiple sclerosis on the risk of disability pension","volume":"265","author":"Landfeldt","year":"2018","journal-title":"J Neurol"},{"key":"2025121513010391000_10.12.e039228.7","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1080\/14034950410021808","article-title":"Swedish Council on technology assessment in health care (SBU). 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