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PubMed2005

Relation between diagnoses on severity, sick leave and loss of job among patients with occupational hand eczema.

BACKGROUND: Epidemiological studies indicate that occupational hand eczema (OHE) often is associated with persistent dermatitis and prolonged sick leave, which may lead to unemployment. Previous studies suggest that OHE caused by allergic contact dermatitis and atopic dermatitis (AD) carries the worst prognosis. OBJECTIVES: To evaluate and compare the severity and consequences of recognized OHE in different diagnostic and subdiagnostic groups. METHODS: Between October 2001 and November 2002, all new cases of recognized OHE were identified from the Danish National Board of Industrial Injuries Registry (758 cases). Severity was graded from 0 to 2 depending on the intensity of skin response and the frequency of relapse. To supplement the information from the Registry, we surveyed the study population using a postal questionnaire which included questions about disease duration, sick leave, current occupation and loss of job. RESULTS: The overall response rate to the questionnaire was 82%. We observed substantially greater severity among those with occupational irritant contact dermatitis (ICD) and AD than for any other diagnoses. Age above 50 years was also associated with increased severity of OHE. Prolonged sick leave due to OHE was reported by 19.9% and was associated with AD and severe OHE. We found a higher proportion of prolonged sick leave among those in food-related occupations (27.2%) compared with those in wet occupations (20.1%) and other occupations (16.5%). Twenty-three per cent reported that they had lost their job at least once during the past 12 months due to OHE. The only strong association with loss of job was food-related occupations. CONCLUSIONS: Occupational ICD and AD appear to be strongly associated with severity of OHE. AD and severity of OHE were independently associated with prolonged sick leave. Having a food-related occupation appears to be associated with increased risk of loss of job.

Adolescent↗
PubMed1987

Sick-leave in patients with functional disturbances of the masticatory system.

The number of days and periods of sick-leave in 350 consecutive patients were obtained from the National Health Insurance Service for the year of referral to a TMJ clinic and the following 4 years. As sick-leave varied greatly in the whole group, a subgroup of 157 patients with full sickness benefit was studied more closely. The mean number of days of sick-leave was correlated to the degree of mandibular dysfunction and decreased during the year after referral and the start of stomatognathic treatment. The reduction was greater in those with severer clinical dysfunction of the masticatory system at the first examination. The results indicate that there is an association between functional disturbances of the masticatory system and sick-leave. Stomatognathic treatment may therefore be of greater relative importance in the general health care system than is usually assumed.

Absenteeism↗
PubMed1992

Certified sick leave as a non-specific morbidity indicator: a case-referent study among nurses.

A case-referent study assessed the association between medically certified sick leave from work and some occupational characteristics--namely, two work load indices (nurse patient ratio and patients' average duration of stay) and hospital and care unit. Study participants were nurses from seven general hospitals in Québec City who had been employed for at least six months at the time of study. Cases (n = 184) experienced at least one episode of medically certified sick leave for a diagnosis "most likely to be related to work load" between 1 January 1984 and 31 May 1987. Referents (n = 1165) were chosen from subjects who had no such leave, whatever the medical reason, and were matched to cases by the incidence density sampling method. Occupational data were collected from employment records and administrative files. Analysis was by multiple logistic regression. Significant associations were found between sick leave and nurse-patient ratio among head nurses, patient's duration of stay, and one hospital. Sick leave was more frequent among full time permanent nurses and among those on night and evening schedules. These associations were independent of age, duration of service in this hospital or in the actual job assignment, and care unit. This study supports the relevance of using sick leave as a non-specific indicator of health out-comes.

Absenteeism↗
PubMed1994

Factors affecting long-term sick leave in an industrial population.

Factors affecting long-term absenteeism for non-accident-related sickness leave in a large, remotely located factory (Dead Sea Industry, Israel) were evaluated. About 10% (89 persons) of the workers were found to be on sick leave for more than 20 days/year. This group was designated as high absence workers (HAW). Most of the sickness absence were for repeated short-term leaves due to intercurrent diseases, rather than for continuous periods related to a major or single illness. Average cumulative duration of sick leave in this group was 54 days/year. The average number of spells was 11 per year (4.9 days/spell). There were significantly more HAW among skilled (relative risk, R.R. = 1.6) workers or shift workers (R.R. = 1.3), compared to white collar workers. There were significantly fewer HAW among workers 35-49 years of age (7.6%) than among younger (12.5%) or older workers (13.8%). Except for possible hearing loss in one worker, no occupationally related illness was identified. Sixty-six percent of the HAW took many sick leaves, over 20 days during the year following the study year, and 52% of this group took over 20 days in the preceding year (usually for minor diseases or complaints). This pattern of long-term sickness absence indicates that various socio-economic factors determine HAW to a greater extent than immediate occupational risks or health problems.

Adult↗
PubMed2002

Active sick leave for patients with back pain: all the players onside, but still no action.

STUDY DESIGN: Semistructured interviews, group discussions, and a mailed survey. OBJECTIVE: To identify barriers to the use of active sick leave (ASL) and to design an intervention to improve the use of ASL by patients with low back pain. SUMMARY OF BACKGROUND DATA: ASL was introduced in Norway in 1993 to encourage people on sick leave to return to modified work. With ASL the National Insurance Administration (NIA) pays 100% of wages, thereby allowing the employer to engage a substitute worker at no extra cost, in addition to the worker on ASL. Arranging ASL requires cooperation between the general practitioner (GP), employer, local NIA staff, and the patient, which may explain why ASL was used in less than 1% of the eligible sick leave cases in 1995, despite strong support from all players. METHODS: The authors conducted five in-depth interviews at a workplace where ASL was successfully implemented. Questionnaires were sent to 89 GPs, 102 workplace representatives, and 22 local NIA officers in three counties. Five patients with back pain who had used ASL were interviewed in a focus group, and 10 patients with back pain who had not used ASL were interviewed using a structured guide. Five workplaces participated in a dialogue conference. Data collection and analysis were iterative, and new data were constantly compared with the previously analyzed materials. RESULTS: About 80% of the GPs, employers, and NIA officers believed ASL is effective in reducing long-term sick leave. Among the barriers identified were lack of information, lack of time, and work flow barriers such as poor communication and coordination of activities between the players required to carry out ASL. Two strategies were designed to improve the workflow between them. A passive implementation strategy was designed to require a minimum amount of economic and administrative support. It included targeted information, clinical guidelines for low back pain, a reminder to GPs in the sick leave form, and a standardized agreement. A proactive strategy included the same four elements plus a kick-off continuing education seminar for GPs and a trained resource person to facilitate the use of ASL. CONCLUSIONS: Having all the players onside may be essential, but it is not sufficient to bring about action in workplace strategies for patients with low back pain. If early return to modified work is effective, implementing it may require interventions targeted at identified barriers.

Communication↗
PubMed2005

Effects on sick leave of an inpatient rehabilitation programme for asthmatics in a randomized trial.

AIM: Among adult asthmatics a major proportion of the cost of illness is attributed to productivity losses and societal costs in connection with sick leave compensation. The aim of the study was to evaluate an extensive structured four-week inpatient rehabilitation programme for asthmatics. METHODS: A diagnosis of asthma was made in a structured way among people on sick leave due to a respiratory disorder. In total, 197 persons were randomized to either a rehabilitation programme, or to usual care. The main components of the rehabilitation programme were education, pharmacological optimization, physical training, and coping skill acquisition. RESULTS: At the three-year follow-up, the median number of sick leave days in the rehabilitation group was 104, and in the usual care group 167 (p = 0.12). An analysis of a subgroup consisting of persons not currently smoking with a previous diagnosis of asthma by a physician (n = 57) showed a significant effect on sick leave at three years (median number of days 63 in the rehabilitation group vs 361 in the control group, p = 0.02). All analyses were based on intention to treat. CONCLUSIONS: The long-term effects on sick leave of an extensive inpatient asthma rehabilitation programme are most evident for non-smokers and ex-smokers with a previous asthma diagnosis. It is therefore recommended that persons with asthma who are current smokers should be offered participation in smoking cessation programmes instead of asthma rehabilitation programmes.

Adult↗
PubMed2003

Cost effectiveness of a multi-stage return to work program for workers on sick leave due to low back pain, design of a population based controlled trial [ISRCTN60233560].

BACKGROUND: To describe the design of a population based randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing participative ergonomics interventions between 2-8 weeks of sick leave and Graded Activity after 8 weeks of sick leave with usual care, in occupational back pain management. METHODS DESIGN: An RCT and cost-effectiveness evaluation in employees sick-listed for a period of 2 to 6 weeks due to low back pain. Interventions used are 1. Communication between general practitioner and occupational physician plus Participative Ergonomics protocol performed by an ergonomist. 2. Graded Activity based on cognitive behavioural principles by a physiotherapist. 3. Usual care, provided by an occupational physician according to the Dutch guidelines for the occupational health management of workers with low back pain. The primary outcome measure is return to work. Secondary outcome measures are pain intensity, functional status and general improvement. Intermediate variables are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs due to low back pain. The outcome measures are assessed before randomization (after 2-6 weeks on sick leave) and 12 weeks, 26 weeks and 52 weeks after first day of sick leave. DISCUSSION: The combination of these interventions has been subject of earlier research in Canada. The results of the current RCT will: 1. crossvalidate the Canadian findings in an different sociocultural environment; 2. add to the cost-effectiveness on treatment options for workers in the sub acute phase of low back pain. Results might lead to alterations of existing (inter)national guidelines.

Cost-Benefit Analysis↗
PubMed2002

Effectiveness of a worksite exercise program with respect to perceived work ability and sick leaves among women with physical work.

OBJECTIVES: This multicentered randomized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves. METHODS: Women (N = 260, mean age 40 years) engaged in physically demanding laundry work were individually randomized into an intervention (N = 133) or control (N = 127) group. Perceived work ability was assessed with questionnaires at 3, 8, 12, and 15 months. Sick leave information was obtained from the personnel administration. Follow-up attendance was 100% at 3 months but declined gradually to 90% by 15 months. Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling. The intervention subjects also participated in worksite exercise training guided by a physiotherapist. Sixty-minute sessions (N = 26) were held once a week for 8 months. About 50% of the intervention group participated in at least two-thirds of the sessions. RESULTS: According to a dichotomized work ability index, at 12 months, workers with "good" or "excellent" work ability increased more in the intervention group than in the control group (11.0%, 95% CI 0.2-21.9), as did the health-related prognosis of work ability at 8 months (8.1%, 95% CI 0.5-16.3). There were no statistically significant differences between the two groups as regards job satisfaction, work ability index (including series of questions on 7 items), or sick leaves. CONCLUSIONS: Physical activity once a week at worksites improves the perceived work ability of women with physically demanding work only slightly. Perceived work ability and sick leaves cannot be affected very positively using single-component exercise intervention. Work ability promotion may need a more multiprofessional approach.

Adaptation, Psychological↗
PubMed1994

[Follow-up of persons on long-term sick-leave. A cohort study in the city of Moss].

Follow-up of people on long-term sickness leave has been a priority for central and local authorities for a number of years. In this study we have followed a cohort of such people from the city of Moss. We wanted to find out how many returned to work, and who these were. The cohort consisted of 1,975 persons. Median age was 45 years (25-75 percentile: 35-54 years). 55% were women. Median follow-up time was two years and four months. Incidence of long-term sickness leave (more than eight weeks off sick) was 4.2 per month per 1,000 persons between 16 and 66 years of age. Less than half (47%) of those who had been off sick for more than eight weeks were working at follow-up. Few people were recruited to active rehabilitation programmes; for instance new education and on-the-job training. Age, especially from 45 years and upwards, many earlier sickness leaves and diagnosis (persons with psychiatric and other diagnoses did worst) influenced the result towards inactivity. When tested by multivariate analysis these variables explained little of the total variation in re-entry to the job market. A separate study of a random sample who were offered more time and indepth counselling showed no effect on job status at follow-up. Most probably, the success or lack of success are dominated by two factors which we could not measure directly; the seriousness of the medical condition and the climate on the labour market.

Adult↗
PubMed1995

Short-term and long-term sick-leave in Sweden: relationships with social circumstances, working conditions and gender.

The primary aim of the study was to analyse similarities and differences between repeated spells of short-term sick-leave (more than 3 spells of less than 7 days' duration in a 12-month period) and long-term absence through sickness (at least 1 spell of more than 59 days' duration in a 12-month period) in relation to variables representing certain social circumstances and aspects of the work situation. Particular attention was paid to gender differences. The study, which had a cross-sectional design, employed data from the surveys of living conditions (ULF) conducted by Statistics Sweden over the period 1986-89. The study group comprised 13,828 employed persons between the ages of 16 and 65. The results suggested the existence of a common mechanism by which a variety of factors are related to the taking of both repeated short spells and long-term sick-leave; gender differences with regard to the effect of working conditions on the taking of sick-leave may be incorrectly estimated if factors related to occupational structure are not taken into consideration; a less than additive effect of physical job demands and repeated short spells of sick-leave on subjective health was found.

Absenteeism↗
PubMed1998

Increase in sick leave rates caused by back pain among pregnant Swedish women after amelioration of social benefits. A paradox.

STUDY DESIGN: A retrospective population study. OBJECTIVES: To explore whether the increase in social benefits for pregnant women introduced in Sweden between 1978 and in 1986 was associated with a decrease in the use of sick leave caused by back pain during the same period. SUMMARY OF BACKGROUND DATA: Back pain is a common condition among Swedish pregnant women. It may be regarded as a normal discomfort of pregnancy, because at least 50% of pregnant women experience back pain to some extent during pregnancy. METHODS: Participants were women consecutively delivered in 1978 (n = 1524) and in 1986 (n = 1688). Between these two time points, the number of offered days of parental benefit increased and a new benefit, the pregnancy benefit, was introduced. Data were collected from the antenatal care and delivery records and from pregnant women's social insurance files. RESULTS: From 1978 to 1986 the use of sick leave because of back pain during pregnancy increased. The number of pregnant women granted sick leave employed pregnant women because of back pain increased from 11% in 1978 to 29% in 1986 (P < 0.001). The sick leave rate increased in most occupations and especially among young women. CONCLUSIONS: The Swedish society has provided ample social benefits to allow the pregnant woman to take leave from work, without having to be labeled as "ill," because of normal conditions such as back pain during pregnancy. Instead of an expected decrease in sick leave because of back pain during pregnancy, an increase was observed.

Absenteeism↗
PubMed1995

Sick-leave due to minor psychiatric morbidity: role of sex integration.

During the years 1985-1987 all sick-leave spells exceeding 7 days, together with a number of demographic variables, were registered in a Swedish county. Using this register, the 3,100 employed persons with at least one sick-leave per year due to minor psychiatric morbidity were analysed with regard to age, occupation and sex. The annual cumulative incidence was 1.7% of the employed population. In 1985 the female incidence was 2.1% and the male incidence was 1.3%. Incidence was highest in the middle-aged. The mean number of absence days per sick-listed person was 73 in 1985. For women, the corresponding figure was 63 and for men, 82. Industrial occupations had the highest incidence and with few exceptions, women had a higher incidence than men in each occupation. Occupations were categorized into five groups according to the number of women and men employed. Women in extremely male-dominated occupations had the highest incidence of all groups, 4.6%. Men in extremely female-dominated occupations had the highest incidence of all men, 2.9%. Occupations with an equal sex distribution had the lowest sick-leave incidence, 1.2%. Further studies on the influence of sex integration on sickness absence need to be done.

Adjustment Disorders↗
PubMed1998

A population-based study of spinal pain among 35-45-year-old individuals. Prevalence, sick leave, and health care use.

STUDY DESIGN: A questionnaire was mailed to 3000 randomly selected 35-45-year-old individuals in three communities in central Sweden. OBJECTIVES: To study the 1-year prevalence of spinal pain and its ramifications in the form of pain, function, sick leave, and health care use. SUMMARY OF BACKGROUND DATA: Previous researchers have used a variety of definitions and populations, but primarily have investigated the occurrence of pain. Comprehensive data are needed concerning health care use, the degree of the pain problem, functional disturbances, and sick leave. METHOD: Participants in the study completed a questionnaire regarding spinal pain during the past year including the degree of their experienced pain, functional impairment, lost work days, and health care use. RESULTS: A total of 2305 people (78.5%) responded to the questionnaire. Nonrespondents had similar characteristics but a slightly lower 1-year prevalence rate than did respondents. For respondents, the prevalence of spinal pain during the past year was 66.3%, with women having a slightly higher prevalence than men. Approximately 25% of the respondents indicated that they had a substantial problem based on ratings of pain, functional impairment, and sick leave. Work absenteeism reported to the Public Social Insurance Office involved 19% of those with pain, but an additional 15% indicated unreported absenteeism. On average, those with pain visited health care providers three times during the past year, but a small number of those who experienced pain consumed large amounts of health care and illness benefits. An important gender difference was shown, such that when pain was at its worst, men took sick leave, whereas women sought health care. CONCLUSIONS: Taken together, these data indicate that spinal pain is common among 35-45-year-old men and-women, and that it is related to marked problems for approximately one fourth of those who experience pain. Gender differences exist in the pattern of sick leave and health care use, and a small proportion of those with pain consume very large amounts of the resources. Consequently, there is a need for early, effective, preventive treatments.

Adult↗
PubMed1998

[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↗
PubMed2005

Employer, insurance, and health system response to long-term sick leave in the public sector: policy implications.

This study has been conducted to describe the situation of long-term sick-listed persons employed in the public sector regarding the medical reasons of their sick leave, the duration of their problems, the duration of the actual sick leave, rehabilitation support, rehabilitation measures, and the persons expectations of the future. Response rate of a postal questionnaire, where 484 women and 51 men on long-term sick leave answered, was 69%. The study-group consisted of 90% women with a median age of 50 years. The most common reasons for sick listing were long-lasting musculoskeletal problems, especially neck/shoulder pain, low back pain and osteoarthritis or other joint problems and mental problems, especially depression and burn-out syndromes. Forty-seven procent of the men and 57% of the women had been on the sick list for more than a year. Only half of them had been subjected to the legally required rehabilitation investigation of the employer This half got access to rehabilitation programs and/or vocational rehabilitation to a greater extent than those who not had been subjected to rehabilitation investigation. Less than half had been in contact with the workplace-connected rehabilitation actors, the Occupational Health Service or the Trade Union. In spite of this the sick-listed persons had a positive view of their future return to work. For long-term sick-listed persons in the public sector, there is a great potential for improvements of the rehabilitation at the workplace arena, in the involvement and cooperation between the already existing rehabilitation actors, in order to promote return to work.

Absenteeism↗
PubMed1998

Vocational rehabilitation and future sick-leave.

The aim of the present pretest-posttest study was to examine and compare the impact of vocational rehabilitation on future sick-leave for employed and unemployed people, respectively, on long-term sick-leave. The study is based on 416 registered long-term sick-leave cases that were initiated during 1992-94 in the city of Stockholm, and that became objects for vocational rehabilitation. The hypotheses were (1) that the number of sick-days and levels of benefit for both employed and unemployed would be less after rehabilitation than before and (2) that rehabilitation would affect employed people more than unemployed people. The hypotheses are supported in that both employed and unemployed have less sick-days and lower levels of benefits after vocational rehabilitation than before and that unemployed people have more sick-days and higher levels of benefits than employed people after rehabilitation. However, since unemployed people also have more sick-days before rehabilitation, the proportional decrease is about the same. Another finding was that men, especially among the unemployed improved more than women.

Adult↗
PubMed2006

Effects of co-financed interdisciplinary teamwork on sick leave for people with musculoskeletal disorders.

AIMS: The aim of the study was to assess if health care centres with a co-financing model for collaborative rehabilitation between primary health care, sickness insurance offices and social welfare offices reduced sick leave among persons with musculoskeletal disorders compared to health centres with conventional rehabilitation structures. METHOD: A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed. In addition, we collected register data about patients' allowances for sick leave days for totally 18 months. RESULTS: The intervention group had an average of 94 days and the controls 87 days on sick leave during the 12-months period after inclusion in the study. At 12 months the proportion of patients sick listed was 31% in the intervention group and 32% in the control group. CONCLUSION: The study could not show that the co-financing model reduced the numbers of sick leave days among patients with musculoskeletal disorders. A possible explanation for the lack of positive impact on patients' health or work ability might be that the working procedure has in fact not really been changed and the tool mix lack solid evidence. The study identifies some methodological problems addressed in future research trying to link organisational changes with patient outcomes.

Adolescent↗
PubMed1999

Attitudes towards pain and return to work in young immigrants on long- term sick leave.

OBJECTIVE: To explore attitudes towards pain and returning to work in young immigrants on long-term sick leave because of chronic pain. DESIGN: As a part of a randomised-controlled rehabilitation programme for immigrants 16-45 years of age on sick leave > 6 weeks, the participants in the experimental group were interviewed about their attitudes towards their pain. SETTING: A primary health care centre in an immigrant district in Stockholm, Sweden. SUBJECTS: Twenty-six first generation immigrants with long-standing musculoskeletal or imprecise pain. MEASURES: Semi-structured interviews of explanatory models of pain. The content of the interviews was abstracted and categorised, with the focus on factors that might influence the rehabilitation process and especially cause pain anxiety. RESULTS: The majority of the interviewees were Turks and Southern Europeans with a median age of 38.5 years and a median sick leave of 12.0 months. Nearly all assessed themselves as having no capacity to work and two-thirds reported pain anxiety. The shared characteristics of the attitude to pain were that rest is the best treatment and that occupational work is the main etiological factor for the pain. A difference was found regarding the meaning of the pain, with one cluster of interviewees focusing on a disorder (Type I attitudes) and the other cluster focusing on the pain sensation itself (Type II attitudes). These clusters were equally large and there were no significant differences regarding ethnicity, religion, or other data between them. However, persons in the Type II cluster were generally more fatalistic about their future health and significantly more were working, at least part-time, at the 3 (p < 0.05) and 8 month (p < 0.01) follow-ups. CONCLUSION: Differences in attitudes towards pain and in qualities of pain anxiety, either focusing on the meaning of pain and its consequences or on the immediate experience of pain, might influence rehabilitation.

Adolescent↗