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Biomedical subjects

G Tellnes

Publications and source records attributed to G Tellnes.

At least 19 recordsLinked to original sources
PubMed2001

Work ability and duration of certified sickness absence.

AIMS: The aim of this study was to examine the association between assessed work ability and the duration of certified sickness absence. METHODS: A total of 549 patients and 52 doctors provided questionnaire data about 549 episodes of absence. The episodes were classified as new, one month, or three months according to their duration at the time of questionnaire completion. Their duration after that was used as outcome. Uni-and multivariate Cox regression analyses were performed. RESULTS: In the multivariate analyses, a "very much reduced" work ability assessed by patients was associated with a longer duration than a "moderately reduced" work ability, in both one- and three-month episodes. Musculoskeletal and psychological disorders were associated with a longer duration, and respiratory disorders with a shorter duration than other disorders in new episodes. Patient age above 50 years was associated with a longer duration than lower age in new and three-month episodes. The doctors' use of referral and tests in the consultations, and the presence of non-medical factors as judged by the patients, were associated with a longer duration than the absence of those factors in new episodes. The patients' degree of job satisfaction, and non-medical factors as judged by doctors. were significantly associated with duration only in univariate Cox regression analyses in new episodes. Work demands were not significantly associated with duration in any of the analyses. CONCLUSIONS: Work ability assessed by patients may be a useful prognostic indicator of duration in prolonged episodes of certified sickness absence. Further studies using other outcomes, such as disability pensioning, would be of interest to enlighten the concepts of work ability.

Adolescent↗
PubMed2000

Sickness absence with psychiatric disorders--an increased risk for marginalisation among men?

BACKGROUND: Sickness absence with psychiatric disorders is a major public health problem with serious consequences for the individual, the employer and society. The aim was to assess the occurrence of psychiatric sickness absence with special focus on sex differences. METHODS: A nationwide sickness insurance register was used. Population at risk was defined as all individuals entitled to sickness benefits in 1994 (N = 1,978,030). Those who were sick-listed for more than 14 consecutive days with a psychiatric diagnosis (n = 28,799) were selected as cases. RESULTS: Of the population under study, 1.46% had at least one psychiatric sickness absence episode. Women had twice the male cumulative incidence of sickness absence for a psychiatric diagnosis. Cumulative incidence was highest among those aged 45-59 years. Men had more sickness absence days. Depression was the most common diagnosis among both women and men. CONCLUSION: Increased efforts are needed to recognise, treat and rehabilitate individuals with a lowered work capacity due to sickness absence. The increased risk of long sick-leave spells among men needs further attention.

Adolescent↗
PubMed2000

Work ability assessed by patients and their GPs in new episodes of sickness certification.

BACKGROUND: Sickness certification legislation demands that work ability is reduced due to disease or injury. Most sickness certificates are issued by GPs. Assessment of work ability might introduce conflict in the doctor-patient relationship. OBJECTIVES: The aim of this study was to compare the level of work ability assessments by patients and their GPs in new episodes of sickness certification, and to explore how medical conditions and work demands are associated with the assessments. METHODS: Forty nine GPs supplied data about 408 patients certified sick <8 days before questionnaires were filled in. A total of 268 (66%) patients completed corresponding questionnaires. Patients and GPs independently answered the following question using a five-point scale: "To what degree is your (the patient's) ability to perform your (his or her) ordinary, remunerative work reduced today?" RESULTS: Work ability was assessed by patients as very much or much reduced in 66%, moderately reduced in 23% and not much or hardly reduced at all in 11% of the cases. Corresponding assessments made by GPs were 71, 27 and 2%. Patients and GPs agreed well on their assessments (+/- 1 answer category) in 81% (216/266) of the cases. The patients assessed work ability as more reduced the more stressful or physically strenuous their jobs were, and the older their GPs were. The GPs assessed work ability as more reduced the more their assessments were based on clinical findings. CONCLUSIONS: The agreement between work ability assessments made by patients and GPs was high, despite patients' assessments being associated with work demands and GPs' with medical conditions.

Adolescent↗
PubMed2000

Relation between health problems and sickness absence: gender and age differences--a comparison of low-back pain, psychiatric disorders, and injuries.

Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).

Female↗
PubMed1998

The gender gap in musculoskeletal-related long-term sickness absence in Norway.

OBJECTIVE: To examine the gender differences in long-term (> 14 days) sickness absence due to musculoskeletal health problems. DESIGN: Analysis of data from the National Sickness Benefit Register, 1994. SETTING: The economically active population in Norway, except civil servants (n = 1,978,030). SUBJECTS: All persons, 16-66 years old, with long-term sickness absence episodes due to musculoskeletal health problems in 1994 (n = 141,839). MAIN OUTCOME MEASURES: Cumulative incidence, episode frequency, and episode duration of sickness absence. RESULTS: Women had higher cumulative incidence of sickness absence than men-80.6 pr 1,000 vs. 64.1 pr 1,000, and longer mean duration of episodes-94 calendar days vs. 86 days counted from the first day of absence. Episode frequency did not differ between the genders. After adjustment for age and income the gender ratio (men/women) in cumulative incidence changed from 0.80 to 1.08, and in mean duration from 0.91 to 0.96. CONCLUSION: Long-term sickness absence due to musculoskeletal health problems was strongly associated with gender, age, income, and diagnosis. Multivariate analysis indicated that the large gender differences in sickness absence might be overstated due to lack of adjustment for income and income-related factors.

Absenteeism↗
PubMed1997

[Occupational injuries and prolonged sick listings during the period 1989-93].

Norway lacks reliable data on the magnitude and development of occupational injuries. Each year about 25,000 occupational injuries and 2,000 occupational diseases are reported to the Labour Inspection. These constitute only one-third of all expected injuries and accidents related to the work environment. The aim of this study was to estimate the magnitude of occupational injuries in Norway causing long-term certification of illness. There was a 35% reduction in the incidence of occupational injuries in Norway from 1990 to 1993. The reduction applies to men and women combined, all age groups and most counties. The distribution of characteristics by age, sex, diagnosis and place of residence corresponds well with previous, limited studies. Injuries, especially fractures, account for approximately 70 per cent of the occupational injuries. Possible explanations for the decrease in incidence could be preventive efforts, a tighter labour market, a change from primary and secondary to tertiary industry, and the overall reduction in long-term certification of illness in Norway from 1990 to 1993.

Accidents, Occupational↗
PubMed1996

ICPC as a standard classification in Norway.

BACKGROUND: The International Classification for Primary Care (ICPC) has been the standard classification for diagnoses on sickness certificates and bills for services to the National Insurance Administration in Norway since 1992. Coding according to ICPC is compulsory for all general practitioners. OBJECTIVE: The objective of the present study was to describe the introduction of ICPC in Norway, to comment on introduction problems, and to examine the compliance and validity of coding. METHODS: The study was based on statistics for episodes of sickness certification in the National Benefit Absence Register. RESULTS: In 1994, the underlying medical diagnosis was coded in 98% of the sickness absence episodes lasting more than 2 weeks. Component 1 codes (symptom codes) were used in 23% of episodes, compared with 26-31% in practice studies. CONCLUSIONS: ICPC-coded data in a large Norwegian register appear promising. Most doctors do accurate and careful work in coding, and data appear to be of acceptable quality for further analysis. It is a matter of concern, however, that as many as 23% of episodes had component 1 codes, since these certificates were issued during follow-up encounters. The introduction of ICPC coding has enabled researchers to use diagnoses in the analyses of sickness absence. The growing use of ICPC in general practice has made multi-practice studies possible. The introduction of criteria is mandatory for the improvement of validity in diagnostic coding.

Classification↗
PubMed1996

Musculoskeletal pain: concepts of disease, illness, and sickness certification in health professionals in Norway.

Concepts of disease, illness (being ill), and criteria for issuing sickness certificate for musculoskeletal pain have been investigated by a postal survey based on case histories. Questionnaires were filled in by 898 individuals; 194 General Practitioners, 76 medical consultants working for the National Insurance Administration, 307 insurance clerks, and a representative sample (N = 321) of the general public. The concepts disease and illness are meaningful and used consistently by medical doctors for infectious disease and somatic problems. Discrepancies between the medical profession representatives and the general public were, in general, attributable to differences in information and knowledge about these somatic conditions. However, for musculoskeletal pain all groups had conceptual problems. In particular, there was a lack of consensus for issuing sickness certificates. For musculoskeletal pain conditions the doctors, as a group, seemed to score at random or 50-50 level for sickness certification. All groups, including medical doctors, were reluctant to accept depression and social problems as diseases, or to accept social problems as reasons for sickness certification. The decision criteria should be identified and systematized in order to establish whether it is possible to reach a consensus for subjective complaints.

Absenteeism↗
PubMed1995

[Malignant pleural mesothelioma in Norway 1960-1992].

The incidence of malignant pleural mesothelioma among men in Norway increased about eightfold from 1960 to 1992. A similar rise in incidence has been observed in many countries with large consumption of asbestos during the last 50 years. The causal relationship between malignant mesothelioma and previous exposure to asbestos is well established. The investigation shows incomplete notification to the Labour Inspection as compared with the number of cases recorded by the Cancer Registry. Patients may therefore lose compensation both from the National Insurance Administration and as authorized by the new Occupational Injury Insurance Act of 1990. Asbestos was prohibited in Norway in 1985. Owing to the long latency time, about 30-40 years, the rise in incidence will probably continue for the next 20 years or more. Strict preventive precautions are important in order to prevent a "third wave" of asbestos-related diseases in the future.

Adult↗
PubMed1995

The use of case histories to explore concepts of disease, illness and sickness certification.

A questionnaire with 12 case histories was constructed to investigate views on sickness certification and concepts of disease and illness among GPs and laymen. It was mailed to random samples of 436 Norwegian GPs and 600 Norwegians, stratified for gender, age and residence. Response rates were low, 44% for doctors, and 54% for laymen, probably indicating that the method was more suitable for smaller surveys. Case histories could be used to compare views of GPs and laymen on the concepts of disease and illness. They were also useful in examining views on sickness certification, but, in that case, they probably only reveal what respondents thought should be done. From this study it was not safe to conclude how often, and for what medical conditions doctors would issue sickness certificates in practice. ICPC was useful for coding diagnostic suggestions, set by GPs, but will be more useful after inclusion of criteria and more extensive synonym lists.

Abstracting and Indexing↗
PubMed1995

Assessment of sickness certification and concepts of musculoskeletal disease and illness in the general population.

OBJECTIVE: To investigate how laymen assess the need for sickness certification and how they use the concepts "disease" and "illness" in relation to musculoskeletal disorders. DESIGN: Mail questionnaire with simulated case histories. SUBJECTS: A stratified, random sample of 600 Norwegians, aged 16-69 years. MAIN OUTCOME MEASURES: Scores that measured the respondents' use of the concept "illness", and their view on need for sickness certification were constructed and analysed. RESULTS: Response rate was 54%. The respondents perceived seven case histories describing musculoskeletal health problems more often as "illness" (61%) than as "disease" (46%). There was a close correlation between the use of "illness" and assessed need for sickness certification. However, sickness certification could be suggested for cases with neck pain, even if the patient was not perceived as ill. Women suggested sickness certification significantly more often than men. Age, length of education, and personal experience with serious musculoskeletal health problems influenced suggestions on certification among men. However, these variables could not explain any difference in use of the concept "illness".

Absenteeism↗
PubMed1994

[Physician's role in certification for sick leave]].

The aim of the study was to analyse general practitioners' decisions when certifying patients as sick. The study was conducted among 38 general practitioners in Bergen, Norway, during two weeks in March 1990. The need for certification of sickness was considered for 328 patients. Among these 91% were certified as sick and 9% were not found to be incapable of work. If the patients took the first initiative for certification, 95% received a certificate, while 84% were certified sick when the doctors took the first initiative (p < 0.001). When no objective signs, symptoms or findings were registered by the general practitioners, the patients took the first initiative for sickness certification in 85% and the doctor in 15% (p = 0.001) of the cases. The study indicates that the patients are a stronger controlling element than the general practitioners in the process of certification of sickness.

Absenteeism↗
PubMed1992

[Who is long-term sick-listed in Norway? From the project Evaluation of the follow-up of long-term sick-listed].

The aim of the study was to analyse the characteristics of persons with long-term sickness certification at the end of 1990 in Norway. The study was based on data registered by the National Insurance Administration: Age, sex, place of residence, diagnoses, and prognosis as registered on Sickness certificate II. At the end of 1990 a total of 57,567 persons had been incapacitated for work for longer than eight weeks and up to 52 weeks. The prevalence was 27.9 per 1,000 employed persons, with a significantly higher prevalence among women than among men. 25% of the women certified as sick were 40-49 years old. The highest prevalence of long-term certification of sickness was found in the counties Finnmark and Troms in Northern Norway, and Hedmark in central Norway. In cases of long-term sickness certification, the most common diagnoses were musculoskeletal/connective tissue diseases and mental disorders, with a prevalence of 9.3 and 3.1 per 1,000 employed persons respectively. The study indicates the possibility of using data from existing administrative population registers to provide information on the epidemiology of long-term sickness certification in Norway. It is necessary to further improve the validity of the data.

Adult↗
PubMed1992

[ICPC in general practice].

The aim of this pilot study was to describe the distribution of diagnoses in general practice using International Classification of Primary Care (ICPC). The study took place in a group practice in Kongsberg, Southern Norway, in May 1991. It was of particular interest to find out how often doctors could use a disease as diagnosis (ICPC component 7) after the meeting with the patient and how often they used a symptom or complaint (ICPC component 1) as diagnosis. Results from 1,189 consultations show that a disease was used as diagnosis in 61% of all cases. A complaint or a symptom was used in 21%. Women were more often given a symptom as diagnosis. The study also shows that disorders of the respiratory and musculoskeletal systems were the most common diagnoses, accounting for 18% and 16% respectively. During one month, 247 diagnoses were used. Inter-observer tests of reliability showed that 81% of all consultations were coded to the same chapter.

Disease↗
PubMed1992

[What symptoms and complaints result in sick-listing? ICPC-coding of patients' own opinion in general practice].

The aim of this study was to describe which complaints patients themselves regard as the cause of sickness certification. During one week in April 1986, 1,379 patients in Buskerud county, Norway, filled in a form after receiving an initial certificate of illness or a continuation certificate from a general practitioner. International Classification of Primary Care (ICPC) no. 1-29 was used to classify the patients' symptoms and complaints. More than half of the patients (53%) considered pain in the musculoskeletal system, particularly back pain (22%), as the reason for their sickness certification. Physical work load was assumed to be a contributory cause to the complaints by 66% of the patients certified sick because of back pain, 58% of those certified sick due to cervical spine and shoulder symptoms, and 72% of those with myalgia, fibrositis (ICPC no. L18, L19). 29% of the patients meant that their health problems could have been prevented, and 15% reported that they could have continued work if their jobs had been adjusted because of their condition.

Family Practice↗
PubMed1992

[Unemployment among long-term sick-listed persons. From the project Evaluation of Follow-up of Long-term Sick-listed Persons].

The aim of the study was to compare two subgroups of patients with long-term sickness certificate, i.e. a group who were unemployed after eight weeks of incapacity for work and a group who still had a paid job at the end of the eight weeks. 712 patients who received a medical certificate II after eight weeks of incapacity for work in 1988 were followed up for another 12-15 months by means of information collected as a routine at the local National Insurance Offices in five municipalities in Norway. Of our total sample of patients, the sub-group of unemployed persons differed in a number of ways from the group who still had a job. Among the unemployed the duration of sickness certificate was longer and there were higher frequencies of mental disorders and diseases of the nervous system/sense organs. Admission to hospital was less frequent, however, among the unemployed group than among the group who still had a job. The rate of return-to-work observed after one year of sickness certificate was lower among the unemployed.

Adolescent↗
PubMed1992

[How is it going with the Sick-listing II patients? From the project Evaluation of Follow-up of Long-term Sick-listed Persons].

The aim of the study was to follow up 712 persons with respect to social insurance and labour market status one year after the start of a period of long-term sickness certificate. The study is based on information from the local National Insurance Offices in five municipalities in Norway. Mean duration of the long-term sickness certificate was 185 calendar days, slightly longer for males than females. 44.9% returned to work during the first year, another 2.9% attended vocational rehabilitation programmes, 11.7% were still receiving medical treatment, 12.2% had qualified for a disability pension, 5.6% were in receipt of an old age pension and 5.6% were unemployed. The remaining 17.1% had either died or had moved from the municipality. The few patients attending vocational rehabilitation programmes, compared with the increasing number of persons granted a disability pension in Norway since 1985 indicate insufficient effort to provide vocational rehabilitation.

Adolescent↗