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PubMed2003

Do junior doctors take sick leave?

Nosocomial infections place a heavy burden on overstretched health services. An audit of junior doctors' sick leave behaviour was undertaken in 1993 and again in 2001. The object was to ascertain the level of common infectious illness and to investigate whether junior doctors were remaining at work inappropriately. The doctors were asked if any factors had influenced their decision to take sick leave or not. Between the two audits several initiatives have been introduced to improve the working conditions of junior doctors, including the New Deal to reduce hours of work. Eighty one junior doctors in a large teaching hospital participated in 1993 and 110 in 2001. The number reporting an infectious illness in the previous six months was similar (61.7% in 1993, 68.2% in 2001). There had been a significant increase in the percentage of infectious illness episodes for which the doctors took sick leave (15.1% in 1993, 36.8% in 2001, p < 0.001). The most common reason for taking less sick leave than was felt necessary was concern about colleagues having to do extra work (72% in 1993, 68% in 2001). Consultant pressure was cited by 26% (1993) and 20% (2001). Use of the staff occupational health unit was minimal, with none of the ill doctors contacting the department in 1993 and only three in 2001. Overall, despite the reduction in the number of infectious doctors not taking sick leave, the majority remained at work. Fundamental changes are needed if potentially infected doctors are not to present a risk of iatrogenic infection.

Attitude of Health Personnel↗
PubMed2001

Sick leave -- Cushion or entitlement? A study of age cohorts' attitudes and practices in two Australian workplaces.

Stereotypes of older people suggest that they may experience more sickness and injury therefore may not be as productive as younger employees. The present paper attempts to test these stereotypes and reports research into patterns of sick leave in different age cohorts and attitudes towards the use of sick leave. The research was carried out at two case study sites. Managers were interviewed and focus groups were held with workers. A complex pattern was found, suggesting structural issues such as sick leave entitlements, workplace organisation, and flexible work patterns interacted with managers' and workers' attitudes, age, gender and family responsibilities. Flexible workplace hours, and part payment for unused sick leave and insecurity of employment appeared as important factors in reducing absenteeism. The most striking finding was that older workers past pensionable age took the least sick leave. Older workers were careful to conserve sick leave as a 'cushion' for serious illness. Workplace pressures especially those resulting from the failure of management to replace absent workers resulted in work pressure on peers and thus reluctance of workers to take leave.

Journal Article↗
PubMed2005

Does hospital discharge policy influence sick-leave patterns in the case of female breast cancer?

The objective was to investigate how differences among hospitals in the shift from in-patient care to day surgery and a reduced hospital length of stay affect the sick-leave period for female patients surgically treated for breast cancer. All women aged 18-64 who were diagnosed with breast cancer in 2000 were selected from the National Cancer Register and combined with data from the sick-leave database of the National Social Insurance Board and the National Hospital Discharge Register (N = 1834). A multi-factorial model was fitted to the data to investigate how differences in hospital care practice affected the length of sick-leave. The main output measure was the number of sick-leave days after discharge during the year following surgery. The confounders used included age, type of primary surgical treatment, whether or not lymph node dissection was performed, labour-market status, county, and readmission. Women treated with breast-conserving surgery had a 54.7-day (-71.9 < or = CI(95%) < or = -37.5) shorter sick-leave period than those with more invasive surgery. The day-surgery cases had 24.3 (-47.5 < or = CI(95%) < or = -1.1) days shorter sick-leave than those who received overnight care. The effect of the hospital median length of stay (LOS) was U-shaped, suggesting that hospitals with a median LOS that is either short or long are associated with longer sick-leave. In the intermediate range, women treated in hospitals with a median LOS of 2 days had 22 days longer sick-leave than those treated in hospitals with a mean LOS of 3 days. This is possibly a sign of sub-optimising.

Adolescent↗
PubMed1996

Sick-leave due to psychiatric disorder: higher incidence among women and longer duration for men.

BACKGROUND: Women take sick-leave more often than men, both in general and because of psychiatric disorders. The aim of the present study was to introduce the new dimension of sick-leave duration in the analysis of gender differences in minor psychiatric disorders. METHOD: A population-based register was used, which included all sick-leave spells exceeding seven consecutive days, 1985-1987, in a Swedish county. RESULTS: Sick-leave duration was longer for men. The greatest gender differences were found in the youngest and oldest age-groups. Women had higher incidence also in the longest spells. An increase in duration over the three years was found among women, leading to decreased gender differences. CONCLUSIONS: Contrary to other studies on minor psychiatric disorders, small gender differences were found. It is suggested that sick-leave duration can be used as a quantitative measure of health-related working capacity.

Adolescent↗
PubMed2003

Downsizing of staff is associated with lowered medically certified sick leave in female employees.

AIM: To determine whether changes in number of staff in work sites are associated with medically certified sick leave among employees with an increased risk of developing cardiovascular disease. METHODS: The 5720 employees (aged 18-65) were from the WOLF study of cardiovascular risk factors in working men and women in greater Stockholm during the years 1992-95. From the medical examination a cardiovascular score was calculated for each participant. The WOLF study base was linked to a Statistics Sweden registry of economic and administrative activities. Sick leave spells lasting for at least 15 days during the calendar year following downsizing/expansion were identified for each subject. RESULTS: In multiple logistic regression an increased likelihood of having no medically certified sick leave (15 days or more) was found in women during the year following both downsizing and expansion. These analyses were adjusted for age and cardiovascular score. A high cardiovascular risk score reduced the likelihood of having no medically certified sick leave. The inclusion of psychosocial work environment variables did not change the results markedly. Separate analyses of women with and without high cardiovascular score showed that downsizing had a more pronounced effect on reduced long term sick leave among those with high than among those without low cardiovascular score. There were no consistent findings in men. CONCLUSIONS: There is evidence of a reduction of long term sick leave in women after downsizing and this is particularly evident among those with high cardiovascular score.

Adolescent↗
PubMed2005

Sick leave in patients with obstructive lung disease is related to psychosocial and work variables rather than to FEV1.

The aim of this exploratory study was to investigate associations between sick leave in workers with asthma or COPD and disease-related variables, psychosocial variables, and work characteristics. Hundred and eighty-nine patients with physician-diagnosed asthma (N=118) or COPD (n=71) who had paid work in the past 12 months completed questionnaires on sick leave, health complaints, functional limitations, work characteristics and psychosocial issues, and underwent a pulmonary function test (FEV1 and FVC before and after bronchodilation). Logistic regression analyses were performed to investigate variables independently associated with high sick leave (i.e. more than twice a year and/or longer than 1 month per episode). Asthma patients, not having an emotionally difficult job, with low job satisfaction, who had changed employers, utilized job control, and who encountered pulmonary aggravating factors at work were found to have a higher incidence of sick leave. COPD patients, who had informed the employer or colleagues about the disease, who did not have difficult tasks at work, who did not hide dyspnea and limitations, and who reported high fatigue were showing higher sick leave. FEV1 and FVC were not associated with sick leave in either group. It was concluded that psychosocial variables, work characteristics, functional limitations, and complaints play a more important role in sick leave in workers with asthma and COPD than FEV1.

Adult↗
PubMed1997

Sick leave and social benefits during pregnancy--a Swedish-Norwegian comparison.

BACKGROUND: To analyze the correlation between sickness absence, working conditions, pregnancy outcomes and pregnancy associated social benefits in two urban pregnant populations in Sweden and Norway with different social benefit systems. METHODS: Relevant information on 1649 delivered women was manually extracted by the authors from the antenatal care and delivery records as well as from the personal social security files kept in the Värnamo and Hamar communities, and then computerized in a depersonalized form. RESULTS: The reproductive histories and the pregnancy outcomes appeared clinically similar in the two samples. Swedish pregnant women were significantly more often employed outside home (84 vs. 69 per cent). The types of occupations held were similar in Värnamo and Hamar. Swedish pregnant women were significantly more sick-listed during pregnancy than Norwegian women (64 vs. 32 per cent) and with a longer average duration of the sick-leave spells (61 days vs. 44 days). The sick-leave rate among Swedish employed pregnant women was 75 per cent as compared to 48 per cent in Norway. The differences appeared most evident in younger pregnant women (<25 years). The Swedish sick-leave rates were higher within all four occupational subgroups studied. During the observation period the pregnancy associated social benefits were significantly more generous in Sweden. CONCLUSIONS: Sickness absence during pregnancy does not seem to covariate in a simple way with ill health, working conditions or the amount of social benefits available. The increased sick-leave rates in Sweden may possibly be accounted for by a changing attitude towards pregnancy and its natural consequences, especially among younger women.

Adult↗
PubMed2001

A cognitive-behavioral return-to-work program: effects on pain patients with a history of long-term versus short-term sick leave.

A cognitive-behavioral return-to-work focused program was evaluated in a randomized controlled design, and the effects were compared between two groups of women with musculoskeletal pain. One group of patients (n=36) had a history of long-term sick leave (>12 months) at the start of the program and the other (n=36) had a history of short-term sick leave (2-6 months). The outpatient treatment program, conducted by a psychologist, included 12 sessions with the primary aim to help the patients return-to-work. The treatment first included teaching of coping strategies such as applied relaxation, stress management, graded activity training and pacing. Thereafter the patients were taught how to manage difficulties at their return-to-work and how to generalize coping strategies to different risk factors at their work places. The control condition received treatment-as-usual. The results showed that the cognitive-behavioral return-to-work program was more effective than the treatment-as-usual control condition in reducing the number of days on sick leave for patients on short-term sick leave, but not for patients on long-term sick leave. The treatment program also helped the patients on short-term sick leave to increase their ability to control and decrease pain and to increase their general activity level compared to the control condition. These results underscore the need for an early return-to-work focused rehabilitation to prevent long-term sick leave and disability.

Absenteeism↗
PubMed1996

Absence of relation between sick leave caused by musculoskeletal disorders and exposure to magnetic fields in an aluminum plant.

This is a study of the relationship between occupational exposure to magnetic fields in pot rooms and occurrence of sick leave caused by musculoskeletal disorders. The average exposure to static magnetic fields was 8 mT in the pot rooms. Ripple fields were recorded as well. A cohort of 342 exposed workers and 222 unexposed workers from the same electrolysis plant was retrospectively followed for 5 years. The reference group had a type of work similar to the exposed group except for the exposure to magnetic fields. The occurrence of sick leave and the diagnoses causing the sick leave were obtained from the Occupational Health Care Unit: these data were stored in their computer files. The data were complete. No relationship between the occurrence of sick leave caused by musculoskeletal disorders and exposure to magnetic fields was found. This was the case for both the annual number of periods of sick leave and the total number of days with sick leave. The results must be interpreted with caution due to limitations in the design and available data. Also, static magnetic fields constituted the major exposure, and the results may be different when related to work in other types of magnetic-field exposure.

Adult↗
PubMed2000

Clinical findings in a population with back pain. Relation to one-year outcome and long-term sick leave.

OBJECTIVE: To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave. DESIGN: One-year prospective study of a single cohort. SETTINGS: Semi-rural Swedish county. POPULATION: A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age. MAIN OUTCOME MEASURES: Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain. RESULTS: For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33; CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67; CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44; CI 1.1-10.5) were predictive. CONCLUSION: There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

Adult↗
PubMed2006

Economic evaluation of a multi-stage return to work program for workers on sick-leave due to low back pain.

OBJECTIVE: To evaluate the cost-effectiveness and cost-utility of a return to work (RTW) program for workers on sick-leave due to low back pain (LBP), comparing a workplace intervention implemented between 2 to 8 weeks of sick-leave with usual care, and a clinical intervention after 8 weeks of sick-leave with usual care. DESIGN: Economic evaluation alongside a randomised controlled trial (RCT). STUDY POPULATION: Workers sick-listed for a period of 2 to 6 weeks due to LBP. INTERVENTIONS: 1. workplace assessment, work modifications and case management). 2. physiotherapy based on operant behavioural principles. 3. usual care: provided by an occupational physician. OUTCOMES: The primary outcome was return to work (RTW). Other outcomes were pain intensity, functional status, quality of life and general health. The economic evaluation was conducted from a societal perspective. Outcomes were assessed at baseline (after 2-6 weeks on sick-leave), and 12 weeks, 26 weeks, and 52 weeks after the first day of sick-leave. RESULTS: The workplace intervention group returned to work 30.0 days (95% CI=[3.1, 51.3]) earlier on average than the usual care group at slightly higher direct costs (ratio of 1 day: 19 euro). Workers in the clinical intervention group that had received usual care in the first 8 weeks returned to work 21.3 days (95% CI= [-74.1, 29.2]) later on average. The group that had received the workplace intervention in the first 8 weeks and the clinical intervention after 8 weeks returned to work 50.9 days (95% CI=[-89.4, -2.7]) later on average. A workplace intervention was more effective than usual care in RTW at slightly higher costs and was equally effective as usual care at equal costs on other outcomes. A clinical intervention was less effective than usual care and associated with higher costs. CONCLUSION: The workplace intervention results in a safe and faster RTW than usual care at reasonable costs for workers on sick-leave for two to six weeks due to LBP.

Adolescent↗
PubMed1998

Sick-leave in women with alcohol dependence or abuse: effects of additional psychiatric disorders.

The study objective was to assess sick-leave among women investigated in a general population survey of alcohol dependence/abuse (ADA). A total of 399 women, selected by stratified random sampling, were interviewed and diagnosed according to DSM-III-R. Data on sick-leave were obtained by linkage with the Social Insurance records. The study found that women with ADA but without other psychiatric disorders had an increased number of annual sick-leave spells--1.82 compared with 1.47 in the reference population-whereas the mean duration was similar. Women with ADA and other psychiatric disorders had 2.38 annual spells, but also considerably longer spells (mean 16.54 days vs 9.70). Socio-economic differences were large, with the less privileged groups having both more and longer spells. Stepwise multiple regression showed that both ADA and other psychiatric disorders contributed to high sick-leave incidence and duration, as, to a lesser extent, did low education and low social group (the last variable only affected duration of the spells). The frequency of disability pension/long sickness spells was higher in women with ADA (odds ratio of 2.95). We concluded that there is a strong association between ADA and sick-leave, which increases considerably in the presence of additional psychiatric disorders.

Adult↗
PubMed2005

Influence of modified work on return to work for employees on sick leave due to musculoskeletal complaints.

OBJECTIVE: To determine which individual and work-related factors are associated with performing modified work and to evaluate the influence of modified work on the duration of sick leave and health-related outcomes among employees with musculoskeletal complaints. STUDY DESIGN: A prospective study with 12 months follow-up. METHODS: In this prospective study a total of 164 employees on sick leave for 2-6 weeks due to musculoskeletal complaints completed 2 questionnaires. At baseline we gathered information about individual characteristics, physical and psychosocial workload, and disease specific and general health. The follow-up questionnaire, sent to respondents who returned to their original job on full duty, collected information about having performed modified work, and disease-specific and general health. RESULTS: Employees were less likely to perform modified work when their regular work was characterized by frequent lifting and their relationship with colleagues was less than good. Employees were more likely to return to modified work when they had a better mental health, had prolonged periods of standing in their regular job and had less skill discretion. Duration of sick leave was influenced by chronicity of complaints and disability, but not by modified work. CONCLUSION: Modified work, as the only advice given by a occupational health physician, did not influence the total duration of sick leave nor the improvement in health during sick leave for employees on sick leave due to musculoskeletal complaints.

Adult↗
PubMed2006

Effectiveness of a Minimal Intervention for Stress-related mental disorders with Sick leave (MISS); study protocol of a cluster randomised controlled trial in general practice [ISRCTN43779641].

BACKGROUND: The main aims of this paper are to describe the setting and design of a Minimal Intervention in general practice for Stress-related mental disorders in patients on Sick leave (MISS), as well as to ascertain the study complies with the requirements for a cluster randomised controlled trial (RCT). The potential adverse consequences of sick leave due to Stress-related Mental Disorders (SMDs) are extensive, but often not recognised. Since most people having SMDs with sick leave consult their general practitioner (GP) at an early stage, a tailored intervention given by GPs is justified. We provide a detailed description of the MISS; that is more accurate assessment, education, advice and monitoring to treat SMDs in patients on sick leave. Our hypothesis is that the MISS will be more effective compared to the usual care, in reducing days of sick leave of these patients. METHODS: The design is a pragmatic RCT. Randomisation is at the level of GPs. They received the MISS-training versus no training, in order to compare the MISS vs. usual care at patient level. Enrollment of patients took place after screening in the source population, that comprised 20-60 year old primary care attendees. Inclusion criteria were: moderately elevated distress levels, having a paid job and sick leave for no longer than three months. There is a one year follow up. The primary outcome measure is lasting full return to work. Reduction of SMD- symptoms is one of the secondary outcome measures. Forty-six GPs and 433 patients agreed to participate. DISCUSSION: In our study design, attention is given to the practical application of the requirements for a pragmatic trial. The results of this cluster RCT will add to the evidence about treatment options in general practice for SMDs in patients on sick leave, and might contribute to a new and appropriate guideline. These results will be available at the end of 2006.

Adult↗
PubMed1999

Sick leave and disability pension before and after treatment for obesity: a report from the Swedish Obese Subjects (SOS) study.

OBJECTIVES: To analyse sick leave and disability pension among surgically and conventionally treated obese patients. DESIGN: A prospective study over five years. Differences in sick leave and disability pension were analysed using multiple and logistic regressions. Possible confounding factors were analysed and controlled for. SETTING: Nine counties in Sweden. SUBJECTS: 369 surgically treated patients and 371 matched obese controls, included in the Swedish Obese Subjects (SOS) study. At baseline, mean body mass index (BMI) was 42 kg/m2 in surgical patients and 41 kg/m2 in controls. After four years of treatment, weight reduction was 20% among surgical patients while the control patients kept their initial weight. INTERVENTION: Gastric bariatric surgery. MEASUREMENTS: Days of sick leave plus disability pension, and days of disability pension. RESULTS: In the year prior to treatment, adjusted average number of days of sickness due to sick leave plus disability pension was similar in surgical patients and controls. Compared with controls, the surgical group had 35% more days of sickness during the first year after initiation of treatment, but 10-14% fewer days during years 2-3. During year four, days of sickness tended to be lower in the surgical group (P = 0.07). In the sub-group, aged above the median, surgical patients had 14-18% fewer days of sickness than controls, during years 2-3 after initiation of treatment This difference did not occur in the group below median age. CONCLUSION: Surgical treatment of obesity results in a reduction of sick leave and disability pension, compared to controls, particularly in subjects aged 47-60 y.

Adult↗
PubMed1992

[The calendar as criterion--duration of sick leave and physicians' work conditions].

This paper addresses physicians' tendency to allot standardized, "rounded off" sick leave. Of the 401 sick leaves reviewed, 64.3% lasted for one or two weeks, one or two months, or to the end of the week or month. The patients' presumed wish for an extended leave, and the practitioners' strained work situation were examined as possible influential factors. A scrutiny of general practitioners' and company practitioners' working conditions, and employees' current inclination to work, does not support these ideas. Dialogue between physician and patient should be improved and we also suggest a change to "vaguer" durations of sick leave.

Humans↗
PubMed1999

[Pregnancy-related and work-related sick leave of pregnant women].

Pregnant women are allowed sick leave (SL) due to obstetrical or occupational risk factors. The aim was to describe reasons for SL during pregnancy. Pregnant women in a Danish county applying for SL were consecutively included in the study during 12 months in 1991-92. Data were obtained by questionnaires mailed to the women and their medical doctors. Of 1483 pregnant women on SL, 994 participated. Approximately 96% were on SL due to obstetrical risk factors. Occupational factors contributed to SL in at least 50% of the cases, mainly when working in a standing or walking position or when lifting. The women were rarely replaced in other jobs before leaving work. On average the women were absent for 83 days before official pregnancy leave started. Although SL during pregnancy is overwhelmingly due to obstetrical risk factors, occupational factors often contribute. Occupational Health and Safety Organizations are rarely involved at the workplace before issuing a sick leave certificate.

Denmark↗
PubMed1990

Smoking in a public health agency: its relationship to sick leave and other life-style behavior.

A survey questionnaire was administered to employees of a public health agency regarding their involvement with smoking and other life-style behavior. Responses were analyzed and combined with sick leave data to determine the use of sick leave among employees who currently smoke, those who never smoked, and those who formerly smoked. Current smokers took significantly more sick leave than those who have never smoked ("nonsmokers") or former smokers. Using an analysis of variance model, only smoking status, education level, and sex, among selected demographic variables, were significantly related to the amount of sick leave taken. Current smokers took excess sick leave (amounting to nearly $40,000) as compared with nonsmokers and ex-smokers combined over a 21-month period. This study also characterizes the relationship between smoking status and selected life-style behavior. Smokers were less active, less likely to use seat belts, less likely to believe that smoking is related to health, and more likely to be heavier and to eat a poor diet than their nonsmoking or former smoking counterparts. We make suggestions regarding the reduction of smoking and other deleterious behavior as a means of controlling costs and reducing employee morbidity.

Absenteeism↗