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PubMed1998

Changes in sick leave rates and the use of pregnancy-associated social benefits among pregnant Swedish women: an outcomes study.

We attempted to determine if an amended social security system has lessened the rate of sickness absence during pregnancy in Sweden over the period 1978-1989. We studied the records of 3998 women who gave birth in 1978, 1986, 1988, and 1989 at the University Hospital in Linköping and the Värnamo County Hospital. Retrospective collection of all data concerning the rates and durations of sickness absence during pregnancy, drawing of parental benefit, and use of granted pregnancy benefit was performed from Sweden's standardized social security files. Obstetric variables concerning the course and outcome of pregnancy and delivery, as well as the health status of the newborns, were obtained from standardized and antenatal care and delivery files. Between 1978 and 1989, the rate of sickness absenteeism during pregnancy increased by almost 100% for periods of absence not supported by a doctor's certificate and by about 50% for those with a doctor's certificate. During the same time, the average number of days of sick leave per pregnant woman more than doubled. The changes were most apparent among younger pregnant women. During the decade studied, no significant differences were found with regard to antenatal care, modes of delivery, or the health status of the newborns. In spite of the introduction within the Swedish social security system of more generous rules for pregnant women, the changes in the rates of registered sick leave during pregnancy observed over time were most unfavorable. The present study indicates that the rate of sick leave during pregnancy reflects a complex social phenomenon and cannot be explained solely by an increase in the rate of actual illness or sickness. Such a rate is also likely to depend on general attitudes and expectations among pregnant women, which may vary over time. When amendments in social benefits for pregnant women are considered to improve the health status of the pregnant population, society ought to clearly define the precise aim pursued and the consequences expected to escape unintended socioeconomic results.

Absenteeism↗
PubMed2000

Subject-domain approach to the study of air pollution effects on schoolchildren's illness absence.

In this paper, the authors propose a new statistical modeling technique, the subject-domain approach, which is theoretically proven to be equivalent to the time-domain approach in detecting an association between exposure and response with time trends. The authors use an empirical data set from a school absence monitoring study conducted during the 1994-1995 school year in Taiwan to demonstrate this subject-domain approach's application to environmental epidemiologic studies. Because the subject-domain models can control the influential personal confounding factors in the models, they show greater statistical power than the traditional time-domain approaches in determining the relation between air pollution and illness absences. The authors' models found that the schoolchildren's risks of illness absence were significantly related to acute exposures to nitrogen dioxide and nitrogen oxides with a 1-day lag (p < 0.01) at levels below the World Health Organization's guidelines. By contrast, the authors could not detect significant associations between air pollution and schoolchildren's absenteeism using time-domain approaches. Such findings imply that the models built on subject domain may be a general solution to the problem of the ecologic fallacy, which is commonly encountered in environmental and social epidemiologic studies.

Absenteeism↗
PubMed1991

Morbidity due to Schistosoma mansoni among sugar-cane cutters in Zimbabwe.

Quantitative determination of Schistosoma mansoni infection was carried out on 1995 cane cutters of the Hippo Valley and Triangle Sugar Estates. A total of 315 cutters were chosen for the study on the basis of S. mansoni infection and lack of anti-schistosomal chemotherapy during the previous three years. Stool consistency and blood and mucus in stool were determined for all the infected cutters. Overt and occult blood in stool was detected in a significantly high number of infected people compared to the control subjects (chi 2 p less than 0.001). However, the blood loss was found to have no anaemia-producing effect as determined by haemoglobin and red blood cell counts. Watery stool was prevalent among people with egg output exceeding 500 eggs per gram of stool. Mucus in stool was found to be more prevalent among infected people compared to the control subjects but the difference was not significant (p greater than 0.05). Symmer's periportal fibrosis (PPF) of various degrees of severity was detected in 47% of the infected people and grade one liver fibrosis was found in 7.5% of the control subjects (p less than 0.0001). Some 54.5% of those infected complained of abdominal pains compared to 35% of uninfected controls (p less than 0.01). There was a significant difference in the rate of absenteeism from work due to abdominal pains and diarrhoea among the infected and uninfected cane cutters (p less than 0.02).

Absenteeism↗
PubMed1978

Excess mortality and influenza surveillance in Taiwan.

Excess mortality has proven to be a useful epidemiologic tool for influenza surveillance in the temperate zone. A retrospective analysis of the epidemiology of influenza in Taiwan was undertaken to explore the usefulness of this technique in the tropical--subtropical zone. Excess mortality similar to that observed during influenza epidemics in the temperate zone was noted during periods of previously recognized influenza epidemics in Taiwan. For the very young and the elderly excess mortality was observed to be even higher than in the temperate zone. Virus isolations, increased school absenteeism, and high clinical attack rates were also noted during influenza epidemics. Use of these epidemiologic techniques in Taiwan proved to be a useful approach to describe the impact of influenza.

Absenteeism↗
PubMed2004

Anxiety or depressive disorders and risk of ischaemic heart disease among French power company employees.

BACKGROUND: The aim of this study was to determine whether depression and anxiety are predictive factors for ischaemic heart disease among adults <60 years. Method A case-control study among active employees of the French nationwide power company (Electricité de France-Gaz de France) analysed men aged 31-55 years who presented an initial clinical form of ischaemic heart disease from 1993 through 1997, collected from the company registry. These 660 men were each matched by age to 10 controls per case. Adjusted odds ratios (OR) were calculated by logistic regression. RESULTS: There was a significant association between ischaemic heart disease and sick-leave for any medical reason in the 3 years before its onset (OR = 1.79; 95% CI: 1.50, 2.14). This association was strengthened when only absences for depression and anxiety were considered (OR = 3.10; 95% CI: 2.29, 4.19) and remained important and significant when adjusted for socioeconomic status: OR = 2.66 (95% CI: 1.95, 3.63). A previous sick-leave for depression or anxiety in the 10 years before the heart disease strengthened the association (OR = 3.61; 95% CI: 2.39, 4.45), which was further reinforced by an elevated number (> or =4) of such sick-leaves (OR = 5.11; 95 % CI: 3.11, 8.40). CONCLUSION: Depressive and anxiety disorders that lead to absenteeism seem to be associated with an increased risk of ischaemic heart disease in the 3 years thereafter, especially when depression and anxiety were severe and chronic; this association is independent of socioeconomic status.

Absenteeism↗
PubMed1995

Occupational health care and work incapacity: recent developments in The Netherlands.

Due to political priorities and benefit arrangements, prevention of work incapacity has played a minor role in employers' policies in the Netherlands. However, the comparatively high sickness absence rates and large numbers of disability benefit recipients in the Netherlands have fostered preventive policies and measures regarding unfavourable working conditions. Corresponding to recent changes in legislation, the role of occupational health and safety services will substantially increase in the coming years. Part of the new orientation will be a multi-disciplinary staff structure and more attention to tailor-made services and effectiveness. There is much debate about the precise role for occupational physicians in the control of sickness absenteeism in companies. This paper presents several instruments which are now being applied or which are still in a developmental stage. The issues of prevention of sickness absence and monitoring of long-term sick employees will remain a substantial part of the responsibilities of occupational health and safety services.

Absenteeism↗
PubMed2004

Characteristics of an external employee assistance programme in Japan.

BACKGROUND: Mental health care is now a major occupational health issue in Japan. Although realizing effective use of external employee assistance programmes (EAPs) has been identified as crucial for mental health care, few scientific papers describe or analyse the characteristics of EAPs in Japan. AIMS: This study sought to clarify the characteristics of an external EAP in Japan. METHODS: The characteristics of an external EAP were clarified in terms of programme description and utilization. A total of 10,260 counselling sessions from 1996 to 2000 were used for utilization analysis. RESULTS: The EAP studied had contracts with 133 organizations, half of which were health insurance societies. The EAP provided employees and family members with free, confidential counselling. Annual mean utilization rate per 1000 individuals increased from 1.3 in 1996 to 2.7 in 2000. Less than one-third of counselling sessions were for work-related mental health issues, and male users (30%) consulted significantly more often than female users (14%) for such problems. Among men, career development issues were most common, while job dissatisfaction was highest among women. Absenteeism, depression and fatigue were the most frequently observed problems in both sexes. CONCLUSIONS: EAP use in Japan is rising. The majority of its use is for non-work-related health issues. Male users were more likely to consult for work-related mental health problems.

Absenteeism↗
PubMed2005

Systematic review of studies of productivity loss due to rheumatoid arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic, debilitating disease with a significant impact on workplace productivity. AIM: To perform a systematic review of studies of the relationship between RA and reduced workplace productivity. METHODS: Screening of 307 titles identified in bibliographic database searches resulted in 38 articles subject to systematic review. Productivity loss was expressed by three different measures: work disability, work loss (synonymous with absenteeism or short-term sick leave) and work limitation (reduction in productivity while present at work). RESULTS: A median of 66% (range 36-84%) of employed RA subjects experienced work loss due to RA in the previous 12 months, for a median duration of 39 days (range 7-84 days). The times from RA diagnosis until a 50% probability of being work disabled varied from 4.5 to 22 years. In inception cohort studies, the baseline variables consistently predictive of subsequent work disability were a physically demanding work type, more severe RA and older age. CONCLUSIONS: RA-related work-disability rates were similar in the USA and European countries. An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically demanding work rather than to epidemiologic changes in RA. The majority of the literature addresses permanent disability and temporary work loss; none of the studies reviewed reported the effect of RA on presenteeism, i.e. work limitation from the employer perspective, and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss.

Absenteeism↗
PubMed2006

An assessment of occupational health care in the Netherlands (1996-2005).

BACKGROUND: The extensive Dutch occupational health care system of the past decade has not led to the desired outcomes, namely, a decrease of work absenteeism and the associated costs. AIM: To assess the differences between in-house and external occupational health care services in the process quality of occupational health care provided. METHODS: In total, 26 interviews were conducted with chief executive officers of occupational health services (OHS). The responses and other relevant policy documents were analysed and described. A key component of this process was to compare differences between in-house and external services. RESULTS: Notable differences in quality were found to exist between in-house and external occupational health care systems, with the in-house occupational health care services offering the highest process quality. CONCLUSION: Our findings suggest that the effectiveness of OHS is mainly dependent on their structure (in-house versus external) and on economic factors (profit driven versus not for profit).

Absenteeism↗
PubMed1999

Role of schools in the transmission of measles in rural Senegal: implications for measles control in developing countries.

Patterns of measles transmission at school and at home were studied in 1995 in a rural area of Senegal with a high level of vaccination coverage. Among 209 case children with a median age of 8 years, there were no deaths, although the case fatality ratio has previously been 6-7% in this area. Forty percent of the case children had been vaccinated against measles; the proportion of vaccinated children was higher among secondary cases (47%) than among index cases (33%) (prevalence ratio = 1.36, 95% confidence interval (CI) 1.04-1.76). Vaccinated index cases may have been less infectious than unvaccinated index cases, since they produced fewer clinical cases among exposed children (relative risk = 0.55, 95% CI 0.29-1.04). The secondary attack rate was lower in the schools than in the homes (relative risk = 0.31, 95% CI 0.20-0.49). The school outbreaks were protracted, with 4-5 generations of cases being seen in the two larger schools. Vaccine efficacy was found to be 57% (95% CI -23 to 85) in the schools and 74% (95% CI 62-82) in the residential compounds. Measles infection resulted in a mean of 3.8 days of absenteeism per case, though this did not appear to have an impact on the children's grades. Among the index cases, 56% of children were probably infected by neighbors in the community, and 7% were probably infected at health centers, 13% outside the community, and 24% in one of the three schools which had outbreaks during the epidemic. However, most of the school-related cases occurred at the beginning and therefore contributed to the general propagation of the epidemic. To prevent school outbreaks, it may be necessary to require vaccination prior to school entry and to revaccinate children in individual schools upon detection of cases of measles. Multidose measles vaccination schedules will be necessary to control measles in developing countries.

Absenteeism↗
PubMed1980

Epidemiologic observations of influenza B virus infections in Houston, Texas, 1976-1977.

Influenza B virus infections were documented in Houston, Texas, in 726 patients with febrile respiratory illnesses who presented to representative primary care facilities during the 1976-1977 respiratory disease season. This epidemic followed a "herald wave" of illness associated with influenza B during the preceding spring. Over one-half the virus isolates were from children aged 5-19 years, and school absenteeism rates indicated that about 40 per cent of the students in the Houston area were ill enough to miss school during the epidemic. The rapid rise in the number of cases among students after the school holiday recess demonstrated the importance of school attendance for the rapid dissemination of influenza viruses. During the later phase of the epidemic, most of the cases were preschool children and adults. In addition to disease of the respiratory tract, the epidemic was accompanied by cases of Reye's syndrome at a rate expected for an urban area.

Absenteeism↗
PubMed2001

A cohort study of stress and the common cold.

The common cold is one of the major causes of work absenteeism. Former studies, based on artificial inoculation of rhinovirus, implicated psychological stress in the occurrence of this syndrome, either by increasing susceptibility to the virus or by causing the subject to overrate the perception of the symptoms. Nevertheless, few studies on the effect of stress on the naturally acquired common cold have been conducted. We carried out a 1-year prospective cohort study among the faculty and staff of a Spanish university (N = 1,149). By means of standardized questionnaires, validated in a random sample of the population, we assessed the relation between the occurrence of common cold episodes and exposure to four dimensions of stress: stressful life events, negative affect, positive affect, and perceived stress. All four aspects of stress were related to the occurrence of the common cold. Subjects with a high (fourth quartile) index of negative affect showed an incidence rate ratio of 3.7 (95% confidence interval = 2.2-6.2). The incidence rate ratios for the fourth quartile were 2.5 (95% confidence interval = 1.5-4.1) and 1.9 (95% confidence interval = 1.1-3.2) for perceived stress and stressful events, respectively. A high index of positive affect was associated with an incidence rate ratio of 0.6 (95% confidence interval = 0.3-1.0). These findings suggest that psychological stress is a risk factor for the common cold.

Absenteeism↗
PubMed1983

The epidemiology of minor illnesses among medical students.

A cohort of 126 third-year medical students was followed for a year by means of self-administered questionnaires at the end of major clinical clerkships to ascertain the frequency and duration of the symptoms of their minor illnesses. Students reported an average of 4.36 illnesses per person per year, more than 80 percent of which were upper respiratory episodes. The absenteeism rate was 2.1 days per student per year. A highly significant association between the illness rate and the pediatric clerkship was documented; a less significant seasonal trend of more upper respiratory illnesses in winter than in other seasons was also observed.

Absenteeism↗
PubMed2003

Didactic teaching conferences for IM residents: who attends, and is attendance related to medical certifying examination scores?

PURPOSE: Didactic teaching conferences are a cornerstone of residents' training in internal medicine, yet these programs have received little formal evaluation. This study determines the factors associated with residents' attendance at didactic teaching conferences and the relationship of attendance to residents' scores on medical certification examinations. METHOD: The attendance of 81 residents was recorded at 199 conferences at one university hospital's internal medicine residency program during the 1996-97 academic year. Characteristics of the conferences were recorded, including the date, whether lunch was provided, the daily census on the medicine general wards, daily ambient temperature, and conference type. Residents' scores on the United States Medical Licensing Examination (USMLE) Step 2 and American Board of Internal Medicine (ABIM) certification examination were collected. RESULTS: Residents' attendance at conferences was 34% overall or 54% excluding excused absences. Adjusting for the conferences' and residents' characteristics, attendance declined by one third as the year progressed. Providing lunch at noon conferences enhanced residents' attendance (odds ratio [OR] 1.26 overall and OR 1.64 for residents on inpatient rotations). Higher attendance was not associated with improvement in standardized medical knowledge test scores. CONCLUSIONS: Absenteeism and waning attendance through the year have important implications for structuring didactic internal medicine teaching. Providing lunch improves attendance, but this incentive should be weighed against the potential burdens of the pharmaceutical industry's funding of these lunches. The lack of relationship between attendance and residents' adjusted board scores calls for a better understanding of the value of this high-intensity medical education intervention.

Absenteeism↗
PubMed1992

An 18-month follow-up of a secondary prevention program for back pain: help and hindrance factors related to outcome maintenance.

Thirty-six subjects participated in an 18-month follow-up of a secondary prevention program for back pain of recent onset. The follow-up assessment included most of the same instruments used in the original study. In addition, interviews were conducted to ascertain help and hindrance factors for maintaining improvements during the follow-up period. Results showed that subjects had significantly less pain, used fewer medications, and were more active at 18-month follow-up than at baseline. All subjects had returned to work, and one third had no pain-related work absences during the follow-up. A cost-benefit analysis indicated substantial economic savings when follow-up sick-listing data were compared with estimates based on an increasing trend for pain-related absenteeism found during the baseline period. Hindrance factors reported by subjects were related to personal time-management and workplace factors, especially psychosocial aspects of the work environment. It was concluded that the secondary prevention program was effective and that future maintenance programs should focus more on personal time-management and workplace factors.

Absenteeism↗
PubMed1990

Changes in peptic ulcer and gastritis/duodenitis in Great Britain, 1970-1985.

The signal event of the 1970s in peptic ulcer disease was the introduction of H2 blockers. We examined changing direct and indirect effects of peptic ulcer and gastritis/duodenitis on the British population from 1970 to 1985. Death rates from gastric ulcer declined irregularly for all except women 65 years of age and older, in whom it increased, while for duodenal ulcer mortality declined only for men less than 65 years old and increased sharply for women 65 years and above. Mortality due to gastritis/duodenitis rose irregularly to 1980 and then fell inconsistently through 1985, and was but 1.0 to 1.5% that of peptic ulcer. Elderly women were disproportionately affected, much as with peptic ulcer. There was no significant change in essentially stable time trends for peptic ulcer perforation deaths. Hospitalizations for gastric and duodenal ulcer continued to fall through 1985 except for those age 65 years and above. Hospitalizations for peptic ulcer hemorrhage did not change overall, but the distribution favoring the elderly in the early 1970s reversed. Elderly men and women are now the most likely to bleed for both gastric and duodenal ulcer. Hospitalizations for gastritis/duodenitis increased for all populations. Peptic ulcer operations declined markedly for all groups, most for men and women less than 65 years old. Peptic ulcer as a cause of work loss declined sharply over time for men but was stable for women, while work loss due to gastritis/duodenitis plunged for both sexes beginning in 1979. Mean days off work per spell of absenteeism remained relatively constant: 35-45 days for peptic ulcer and 10-12 days for gastritis/duodenitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1980

Children's health care and the changing role of women.

The pivotal role of women as wife, mother or adult daughter in performing health-related activities for family members has received little attention from health researchers or policymakers. Yet the majority of health problems do not reach the medical care system, but are dealt with informally or through other social systems. This article discusses the impact of family health care responsibilities on women's market and nonmarket roles in two areas: home nursing care for children's illnesses and escorting children to sources of formal medical care. National data on the incidence of children's illnesses provide the basis for an analysis of the contribution to absenteeism among employed women represented by care of an ill child. Similarly, data from the National Ambulatory Care Survey form the basis for estimates of the economic value of escort time involved in children's medical care. The analysis suggests that policies directed to assuring adequate health care for children take account of the informal, nonmarket health services in which women now play the major role. It must also be recognized that women's changing labor market roles are affecting the availability of these services and increasing their costs to the women who provide them.

Absenteeism↗