[Supporting belts--prevention gone astray?].
Explore the source record for details and available documents.
Back Pain↗
Biomedical subjects
S Brage
Publications and source records attributed to S Brage.
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↗
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↗
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↗
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↗
[Work ability and gender--physicians' assessment of sick-listed patients].
Medical assessments might be influenced by the patient's gender and work situation. This article explorers the relationship between physicians' assessments of work ability in sick-listed patients, and gender of the sick-listed and the physicians. We conducted a questionnaire survey among 52 primary care physicians and 442 of their sick-listed full-time employed patients in Aust-Agder county. The relationship between physician assessment of the patients' work ability and gender were analysed by full/part-time sick-leave, new/extended sick-leave, patient's workload, and the physician's gender. Multivariate analyses were done in two-level logistic regression models. 60% of sick-listed women were assessed as having "very much" or "much" reduced work ability, against 71% of sick-listed men (p < 0.01). Women received part-time sickness certification more often than men, 27% vs. 11% (p < 0.001). These relationships were only found for extended sick-leaves, and were significant also after adjustment for physician's gender and patient work-load. Male physicians assessed work ability as more reduced among sick-listed men than among sick-listed women. Primary care physicians assessed work ability as less reduced among women than men. Women more often received part-time sickness certification. Possibly, the physicians' gender influenced their assessment of work ability, but this should be confirmed by more studies.
Adolescent↗
[Spinal disorders in Norway--an epidemiological report].
Low back disorders are prevalent and induce large costs to the health services, the national insurance system and employers. This paper describes the prevalence of low back pain and low back work disability in the Norwegian population, and the incidence and duration of low back work disability in Aust-Agder county. Data from the Norwegian Health Survey 1995 and the registers of the National Insurance Administration are presented. 45% of women and 38% of men reported low back pain within a 14 day period. The prevalence of low back work disability was 1.9%. Low back disorders caused 13-17% of sickness absence, rehabilitation allowance and disability pensions in 1995. In Aust-Agder, the incidence of sickness absence caused by low back disorders was higher among men. In 16% of persons sick-listed due to low back pain without radiating symptoms, the sickness absence episode lasted for more than seven weeks. When radiating symptoms were present, the corresponding figure was 35%. The number of persons with low back disorders with radiating symptoms seems to have increased the most. Further research, preventive measures and guidelines for clinical work should focus on the group of persons who develop chronic low back work disability.
Adolescent↗
[Life situation as a reason for sick leave].
The variation in general morbidity can not explain the observed variation in the incidence of sickness certification. 91% of patients who ask for a medical certificate for sick leave are granted the request, and it has been claimed that doctors often issue medical certificates because of the patients' social problems rather than their illness. We used a questionnaire to perform a survey of 1,401 consecutive adult patients who visited 89 general practitioners. 218 patients stated that they were given a medical certificate for sick leave. In 48 (22%) of these patients the doctors assessed that social and occupational factors influenced their decision to issue a medical certificate. In 34 patients occupational problems were stated as the reason, in five patients non-occupational problems, and in nine a combination of the two. According to the doctors, social problems were rarely the only reason for their issuing medical certificates for sick leave.
Adult↗
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↗
Occupation-specific morbidity of musculoskeletal disease in Norway.
The aim of this study was to investigate the occupation-specific prevalence of musculoskeletal disease in Norway. A cross-sectional interview survey of a representative sample of households in Norway in 1985, including 6,681 persons, 16 to 66 years old was carried out. Age-standardised, occupation-specific prevalence ratios for musculoskeletal disease were calculated. Musculoskeletal diseases were more frequent in women (20.6%) than men (17.3%), and increased markedly with age. In men, the prevalence was highest for construction carpenters; in women, for manufacturing/construction workers. In both male and female occupations, the highest prevalence of musculoskeletal diseases was approximately two-fold that of the lowest. Health-related exits from the labour force, and mobility between occupations influenced the results. It is suggested that the high disability pensioning and sickness absence rates observed in some occupations are related to occupation-specific consequences of disease in addition to higher morbidity.
Adolescent↗
Does smoking aggravate musculoskeletal pain?
The present study was based on data from the Norwegian Health Survey 1985, a nationwide interview survey with members of a representative sample of households. Our sample comprised all adult respondents who had reported musculoskeletal pain (n = 4490). Smokers experienced more intense pain than nonsmokers. The association between smoking and considerable/intense pain was, however, only seen in persons younger than 67 years. In this age group, smoking was related to intense pain in a logistic regression analysis (OR = 1.58; 95% CI: 1.24-2.00; p < 0.001), adjusting for age, gender, socioeconomic status, civil status, having children under 16, physical exercise, the presence of a musculoskeletal disease, and mental distress. The association remained significant after adjusting for workplace factors, social network factors, alcohol consumption, and intake of cod liver oil as dietary supplement.
Adolescent↗
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↗
Musculoskeletal pain and smoking in Norway.
OBJECTIVE: To examine the association between musculoskeletal pain and smoking. DESIGN: Cross sectional, national interview survey. SETTING: All individuals in a representative sample of households in Norway in 1985. SUBJECTS: A total of 6681 persons aged 16 to 66 years old. people in institutions were not included. OUTCOME MEASURES: Gender specific and age specific prevalence rates for pain in the cervical region/upper limbs, back, and lower limbs. RESULTS: Current smoking was independently associated with musculoskeletal pain (odds ratio (OR) 1.69; 95% confidence interval (95% CI) 1.45, 1.97) after adjustment for gender, age, comorbidity, mental distress, lifestyle factors, and occupation related factors. The association was of similar strength regarding cervical/upper limb pain (OR 1.87; CI 1.56, 2.25) and back pain (OR 1.84; CI 1.50, 2.25) but weaker in respect of lower limb pain (OR 1.37; CI 1.10, 1.71). Musculoskeletal pain was often present in more than one site. CONCLUSION: Smoking was significantly associated with musculoskeletal pain after adjustment for other relevant factors.
Adolescent↗
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↗
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↗
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↗
[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↗
[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↗