Biomedical subjects

G Tellnes

Publications and source records attributed to G Tellnes.

At least 37 records · Page 2Linked to original sources

PubMed1990

[The sick leave notification II system. From the project Evaluation of follow-up of long-term sick leave patients].

In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.

Absenteeism↗

PubMed1990

[Experience of cooperative groups--annual report 1988. From the project Evaluation of follow-up of long-term sick leave patients].

According to the annual reports for 1988, which all local insurance offices were instructed to send to the National Insurance Administration, interprofessional cooperation groups were regarded as a positive initiative. Only a few local offices were sceptical to the cooperation, due to local circumstances, lack of resources, or other reasons. The reports' main tendency was as expected; most of those who had their case treated in a cooperation group belonged to prognosis group B, i.e. when reeducation/rehabilitation is relevant in addition to medical treatment. The majority of the patients had been certified sick for more than 20 weeks and usually it was the local insurance office that submitted the case to the cooperation group. Local circumstances influenced the interprofessional cooperation. The labour market, communications, the location of the offices of the different professions in relation to each other, as well as clients' and group members' personal qualities led to different expressions of the cooperation from municipality to municipality and influenced the results of the work in the interprofessional cooperation groups.

Absenteeism↗

PubMed1990

Occupational factors in sickness certification.

Physical work load was assessed by doctors and patients to have contributed to the health problems leading to sickness certification in 48.4% of 1413 patients certified sick by 118 general practitioners in Buskerud county, Norway (1986). Correspondingly, psychological factors were considered contributory in 32.1%. The potential for prevention of health problems underlying sickness certificates was reported in 37.1%. As expected, the frequency of sickness certification in which physical work load and psychological factors were considered to have contributed varied with the patients' occupation, type of work, and health problem. Physical work load was assessed as contributory particularly in patients with musculoskeletal/connective tissue diseases whose work involved much walking and lifting (93.2%) or was physically strenuous (94.0%). Psychological factors were assessed as contributory in a high percentage of cases whose work was mostly sedentary. The findings indicate that the potentials for prevention as assessed by doctors and patients were highest when the health problems underlying sickness certification were associated with musculoskeletal/connective tissue diseases. The results indicate a potential for prevention and limitation of sickness certification which may be utilized by a better collaboration between community medicine and occupational health services.

Adolescent↗

PubMed1990

Inter-doctor variation in sickness certification.

Do doctor-related factors influence the duration of episodes of sickness certification? This problem was studied in an analysis of 2,999 persons certified sick by 107 general practitioners in Buskerud county, Norway, during a 4-week period in 1985. Doctors' attitudes toward sickness certification were measured by composing an index based on 12 statements (Likert scale), "weighed" by principal component analysis. Doctors' sickness certification practice was measured by duration of each episode of sickness certification. The analysis revealed no association between doctors' attitudes toward sickness certification and the duration of the episodes. Cox regression analysis showed, however, that the duration was significantly longer in patients of the oldest doctors, while it was shorter in patients of specialists in general practice and of GPs working part-time as industrial medical officers.

Adult↗

PubMed1989

[Doctors' sickness certification practice].

Sickness certification is a frequent task for doctors. The economic consequences are important for the community. One problem is that many patients have subjective symptoms that cannot be verified by objective criteria. This paper describes the history of a patient in order to illustrate some of the challenges doctors meet when they have to issue sickness certificates to patients with such illnesses. The problem underlines how important it is for doctors to know in detail the rules laid down by the National Insurance Administration. The more important rules are described in the present paper.

Adult↗

PubMed1989

[Interprofessional cooperation in the municipalities: basic groups. From the project Evaluation of the follow-up of patients with long-term sickness certification].

The Norwegian Government has decided that an interprofessional co-operation group should be established in all municipalities as from 1988. The purpose of the co-operation groups is to improve rehabilitation of patients with long-term sickness certification. The aim of the survey was to describe the establishment and function of the co-operation groups as per 1/7 1988. The local national insurance offices reported that 88% of the municipalities had started a co-operation group and 63% had held meetings. The co-operation groups were most effective in small municipalities. Activity was low in the larger towns.

Chronic Disease↗

PubMed1989

Sickness certification in general practice: a review.

Sickness certification is one of the most common tasks performed in general practice. This review describes and discusses concepts and terms used in earlier studies. 'Sickness certification' is defined, and related to the issues of 'absence from work' and 'sickness absence'. The use of measurements and results reported are emphasized according to patient- and doctor-related variables. Great variations are found, and some of the reasons may be differences in morbidity patterns, diagnostic procedures or sickness benefit acts. However, in studies from general practice, the number of sickness certificates is related to different denominators without describing the real population at risk, that is those of the patients who were employed or entitled to sickness benefits. Further studies are needed on the epidemiology of sickness certification, and the duration of the episodes. Analysis of the basis for the doctors' decisions, the patients' viewpoint, inter-doctor variations and doctors' attitudes should also be emphasized in the future. There is a need to discuss the reliability and validity of the measurements used, and theoretical considerations of the doctor's sickness certification practice are called for.

Absenteeism↗

PubMed1989

Epidemiology of sickness certification--a methodological approach based on a study from Buskerud County in Norway.

This paper is part of a broader study of doctors' "sickness certification" practice, which is correlated with, but not the same as, "sickness absence" or "sickness benefits". In order to obtain a total picture, information on sickness certification must be related to the population at risk, i.e. the epidemiology of sickness certification in a total population defined geographically. There is no routine registration system that provides statistics of sickness certification in Norway. Neither is there current information about those of the population who at any one time are entitled to sickness benefits, i.e. the population at risk. The aim of the present paper is to discuss the problems of estimating annual incidences of sickness certification, and to describe the results according to patients' sex, age, and place of residence. The study is based on all "initial certificates" received at the National Insurance Offices in Buskerud county during a period of four weeks in 1985. The population at risk was estimated at 106,019 employed persons aged 16-69 years, and the annual incidence of sickness certification at 580 per 1,000 employed persons per year (females 596, males 568). The highest incidence was found in the age group 20-29 years (females 739, males 741). In the age groups 30-39 and 40-49 years, incidences were significantly higher in females than males. The standardized incidence ratio was significantly lower than average for both females and males in agricultural municipalities, while it was significantly higher than average for females 30-39 years old in urban municipalities. The basis of epidemiological studies of sickness certification used in health services planning and in community medicine is in need of improvement. This challenge is being addressed by the National Insurance Administration in association with the Central Bureau of Statistics in Norway.

Absenteeism↗

PubMed1989

Incidence of sickness certification. Proposal for use as a health status indicator.

Cause-, sex-, and age-specific incidences of sickness certification in a total population are reported. The population at risk of having a sickness certificate issued was 106,019 employed persons 16-69 years of age. The annual incidence of sickness certification was estimated at 580 per 1,000 employed persons per year (females 596, males 568). The most frequent causes of sickness certification, according to diagnostic groups, were diseases of the respiratory system, musculoskeletal/connective tissue diseases, mental disorders, and injuries. Adjusted for age, injuries were found to be less frequent causes of sickness certification among females than males (p less than 0.001), while the reverse was true for mental disorders (p less than 0.01). Among single diagnoses, "other nonarticular rheumatism" (including myalgia) was more frequent among females than males, while the opposite was true for "backpain without radiating symptoms" (p less than 0.001). Comparisons with morbidity studies indicate that diagnoses stated on initial certificates, issued to employed persons in the total population, give a reflection of a population's health problems. This suggests that sickness certification may provide a basis for a health status indicator which may prove useful in planning and evaluation of occupational health, general practice, and community health.

Adolescent↗

PubMed1989

Duration of episodes of sickness certification.

The duration of episodes of sickness certification are reported according to cause, sex, and age. The study is based on the 5,042 initial certificates issued to residents of Buskerud county in Norway during a period of four weeks in 1985. Forty per cent were still certified sick after two weeks, 14.2% after eight weeks, and 1.3% at the end of one year. The mean duration of the 5,042 episodes of sickness certification was 34 calendar days for both sexes, increasing significantly with age (range 16-57 days). Patients with a high probability of long-term sickness certification were those with circulatory system diseases, musculoskeletal/connective tissue diseases, neoplasms, endocrine/nutritional/metabolic diseases, and mental disorders. The same was true for patients certified sick due to "other complications of pregnancy", syndromes related to the cervical spine, and back pain with radiating symptoms. Information on cause-, sex-, and age-specific duration of episodes of sickness certification, such as provided by the present study, may help general practitioners to select those patients who should be given priority for early rehabilitation. A systematic follow-up of patients with a high probability of long-term sickness certification is an important task in primary health care, and should be carried out in co-operation with other health- and social-workers.

Absenteeism↗

PubMed1989

Days lost by sickness certification.

Number of calendar days lost by sickness certification, according to cause, sex, and age, are reported. The basis of the study was 5,042 episodes of sickness certification among residents of Buskerud county in Norway in 1985. The number of days lost was estimated to be 19.8 per employed person per year (females 20.4, and males 19.2). There was an increase with age, but the number of days lost was almost the same for persons between 20 and 50 years of age. Conditions classifiable to the diagnostic groups musculoskeletal/connective tissue diseases, respiratory system diseases, injuries, and mental disorders were responsible for 70.4% of the total number of days lost. Among "single diagnoses" the most dominating were "back pain without radiating symptoms", "other nonarticular rheumatism", "influenza", "other bursitis, tendinitis & synovitis", and "depressive neurosis", and these accounted for 33.7% of the total number of days lost. Cause-, sex-, and age-specific numbers of days lost reflect the socioeconomic importance of different health problems. Such information may be useful in setting priorities in preventive medicine.

Absenteeism↗

PubMed1989

A dietary fibre supplement and weight maintenance after weight reduction: a randomized, double-blind, placebo-controlled long-term trial.

Ninety-seven mildly obese females (BMI = 27.4 kg/m2) were in a randomized, double-blind, placebo-controlled trial treated for 52 weeks. The treatment consisted of a hypocaloric diet providing 5000 kJ/day (1200 kcal) and a dietary fibre supplement of 7 g/day for 11 weeks, (part I), followed by a diet providing 6720 kJ/day (1600 kcal) and a dietary fibre supplement of 6 g/day for 16 weeks (part II). Finally placebo was withdrawn and all still adhering subjects were given a dietary fibre supplement of 6 g/day and an ad libitum diet for the rest of the period (part III). Initial body weights were comparable, 76.9 +/- 0.8 kg in the fibre group versus 77.7 +/- 1.3 kg in the placebo group. During part I the weight reduction in the fibre group of 4.9 kg was significantly higher compared to that of 3.3 kg in the placebo group (P = 0.05). Accumulated weight reduction during part II was still significantly higher in the fibre group, 3.8 kg, compared to 2.8 kg in the placebo group (P less than 0.05). Total weight loss in the fibre group after 52 weeks was 6.7 kg. Probability of adherence to the treatment regimen was significantly higher in the fibre group from week 13 and onwards (P less than 0.01). Initial blood pressures were comparable. A significant reduction of systolic blood pressure occurred in both groups. A significant reduction of diastolic blood pressure occurred in the fibre group only, from 85.4 +/- 1.2 mmHg to 81.7 +/- 1.1 mmHg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1988