improve mental health might reduce the risk of future work incapacity in young adulthood. Education, lifestyle and life course differences in level of work incapacity – genes and environment Karoline Brobakke Seglem K Seglem 1 , F Torvik 1,2,4 , E Røysamb 3,4 , LC Gjerde 1,4 , P Magnus 2 , T Reichborn-Kjennerud 1,5 , P Svedberg 6 , R Ørstavik 7 , M Vollrath 7 1 Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway 2 Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway 3 Department of Child Health, Norwegian Institute of Public Health, Oslo, Norway 4 Department of Psychology, University of Oslo, Oslo, Norway 5 Institute of Clinical Medicine, University of Oslo, Oslo, Norway 6 Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden 7 Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway Contact: karoline.seglem@fhi.no Background: As many countries face an aging workforce, it is becoming ever more relevant to understand the underlying causes of work incapacity across the entire working age. Previous twin studies have demonstrated that work incapacity is influenced by genetic as well as environmental factors. Furthermore, educational attainment and lifestyle behaviors are relatively stable from early adulthood and are associated with work incapacity. This association may be confounded by unobserved factors - both genetic and environmental. In two separate twin studies, we examine 1) the stability and change in genetic and environmental factors influencing work incapacity from age 18 until retirement, and sex differences in these effects, and 2) the associations and likelihood of causality between educational attainment, lifestyle and sickness absence. Methods: study 1: A population-based sample of 28,759 twins were linked to high quality national registry data and followed for up to 23 years. We measured work incapacity as the total proportion of potential workdays lost due to sickness absence, rehabilitation, and disability benefits. study 2: Data from a subsample of 8,806 twins who completed health questionnaires were linked to registry data on sickness absence and educational attainment. Self-reported lifestyle behaviors were smoking, physical activity and BMI (height and weight). Results: study 1: Structural equation modeling indicated moderate genetic influences on work incapacity throughout life in both men and women, with a high degree of genetic stability from young to old adulthood. study 2: Preliminary regression analyses indicated that genetic factors largely confound the associations between educational attainment, lifestyle and sickness absence. Conclusions: Genetic factors seem to be a major issue in understanding causes of work incapacity. Largely the same genetic factors influence individual differences in work incapacity throughout working age. Adverse outcomes of sick leave due to mental disorders: prospective studies of discordant twin pairs Lisa Mather L Mather 1 , J Narusyte 1 , A Ropponen 1 , G Bergstro ¨m 2,3 , V Blom 1,4 , B Helgado ´ ttir 1 , P Svedberg 1 1 Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden 2 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden 3 Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, University of Ga ¨ vle, Ga ¨ vle, Sweden 4 The Swedish School of Sport and Health Sciences, Stockholm, Sweden Contact: lisa.mather@ki.se Background: Sick leave due to mental disorders is common. We investigated if sick leave due to mental disorders increased the risk of reoccurring sick leave, disability pension, unemployment, in- and specialized outpatient care, and mortality, using a co-twin design, taking genetics and shared environment (familial factors) into account. Methods: The register-based open cohort studies contained twin pairs 18-64 years old discordant for sick leave due to a mental disorder. First, 2202 pairs were followed up to 8 years from the end of the sick leave spell for reoccurring sick leave, disability pension and unemployment. Second, 4979 twin pairs were followed up to 9 years from the beginning of the sick leave spell for death, inpatient and specialized outpatient care. Conditional Cox proportional hazard regression, adjusting for familial factors, was used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI). Results: Those with sick leave due to mental disorders had 3.64 (CI: 3.24-4.08) times higher risk of reoccurring sick leave the first two years and the first year, they had 12.24 (CI: 8.11-18.46) times the risk for disability pension. The risk of unemployment was 1.99 (CI: 1.72-2.31). The HR for inpatient care was 1.90 (CI: 1.66-2.17) among men but lower among women. For men the risk of outpatient care was higher the first 2 years (HR: 2.08, CI: 1.87-2.31), and for women the HR was 1.57 (CI: 1.47- 1.68) for the whole study time. There was an increased risk of death among men (HR: 2.91, CI: 1.70-4.99), but not among women. Conclusions: By adjusting for familial factors we could investigate if the same factors that predispose to sick leave due to mental disorders also predispose to morbidity, mortality and unem- ployment and hence explain the associations. But, sick leave due to mental disorders was associated with a higher risk of work related and health outcomes, independent of familial factors. The risks varied over time and differed among women and men. 9.G. Skills building seminar: Capacity-building for implementing integrated care Organised by: Scottish Government, EUPHA (CHR), Chair persons: Iveta Nagyova - EUPHA (CHR), Andrea Pavlickova - UK Contact: andreapavlickova@nhs.net Rationale: The significance of integrated care as a means for improving health outcomes and effectiveness and sustainability of health and care systems is widely acknowledged. Integrated care is a central element in many on-going or planned healthcare system reforms, however, the main challenge remains of how to build relevant capacity and know-how for the successful implementation of integrated care. Capacity-building is both the foundation and aspiration of SCIROCCO Exchange EU Health Programme funded project. The project aims to facilitate access to tailored, evidence-based support and improvement planning by recognising different staring points, or levels of maturity of healthcare systems in Europe. Objectives: This round table aims to explore different levels of local maturity and capacity to implement integrated care in three European regions; Basque Country, Flanders and Poland. The 256 European Journal of Public Health, Vol. 29, Supplement 4, 2019 Downloaded from https://academic.oup.com/eurpub/article/29/Supplement_4/ckz185.700/5624588 by guest on 15 December 2023