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The aim of the project was to describe the reasons for sick leave during pregnancy. This article presents data on a subgroup of women on sick leave. The purpose of this reanalysis was to examine whether women with short maternity leave had longer sick leave during pregnancy. Pregnant women in a Danish County applying for sick leave in a year were consecutively included in the study. Data were obtained by questionnaires during 1991-1992. Women with rights to a longer maternity leave, obtained through collective bargaining, were mainly employed in occupational groups related to the public sector and were on sick leave significantly longer, than women with short maternity leave, obtained only through legislation. The diagnoses differed among the two groups. Data suggest unequal possibilities for obtaining pregnancy related sick leave, as women with longer predelivery leave and a more secure employment situation had significantly longer sick leave than other women.
Sick leave rates among pregnant women have been found to vary substantially over time. 8,884 woman delivered at Linköping and Värnamo Women's Clinics in 1978, 1986, 1988, 1992, 1995 and 1997 were studied. Sick leave nearly doubled between 1978 and 1986, and dropped back to the 1978 level in 1997. The somewhat paradoxical findings in our surveys indicate that attitudes, especially as observed in the youngest age groups, together with a sensible adaptation to the prevailing terms of the social security system, may well be the most plausible explanation. Studies on sick leave among women of fertile age should preferably also contain information on the proportion of sick-listed pregnant women, as a small proportion of pregnant women may have a profound impact on sick leave statistics among all insured women of fertile age.
An increase in sick leave has been registered by both the National Insurance Administration and by the Confederation of Norwegian Business and Industry. In 1988, expenditure on sick leave was NOK 20.7 billion. The same year the National Insurance Institution found that the average length of each sick leave was 49 days. An arrangement for notification of sick leave was enforced in order to strengthen follow up of persons in receipt of sick pay who had been off work for more than eight weeks. Our survey in Skedsmo shows that this arrangement is not commonly known among the public. In view of the increasing public consciousness about national insurance in general, the doctors who are required to submit notification of sick leave are of the opinion that this arrangement is a useful venture. It is difficult to conclude, however, that this arrangement has been of any benefit to the individual patient. The national insurance office has registered a decrease in expenditure on sick leave, but the work load of officials in the administration has increased.
BACKGROUND: The knowledge of factors accurately predicting the long lasting sick leaves is sparse, but information on medical condition is believed to be necessary to identify persons at risk. Based on the current practice, with identifying sick-listed individuals at risk of long-lasting sick leaves, the objectives of this study were to inquire the diagnostic accuracy of length of sick leaves predicted in the Norwegian National Insurance Offices, and to compare their predictions with the self-predictions of the sick-listed. METHODS: Based on medical certificates, two National Insurance medical consultants and two National Insurance officers predicted, at day 14, the length of sick leave in 993 consecutive cases of sick leave, resulting from musculoskeletal or mental disorders, in this 1-year follow-up study. Two months later they reassessed 322 cases based on extended medical certificates. Self-predictions were obtained in 152 sick-listed subjects when their sick leave passed 14 days. Diagnostic accuracy of the predictions was analysed by ROC area, sensitivity, specificity, likelihood ratio, and positive predictive value was included in the analyses of predictive validity. RESULTS: The sick-listed identified sick leave lasting 12 weeks or longer with an ROC area of 80.9% (95% CI 73.7-86.8), while the corresponding estimates for medical consultants and officers had ROC areas of 55.6% (95% CI 45.6-65.6%) and 56.0% (95% CI 46.6-65.4%), respectively. The predictions of sick-listed males were significantly better than those of female subjects, and older subjects predicted somewhat better than younger subjects. Neither formal medical competence, nor additional medical information, noticeably improved the diagnostic accuracy based on medical certificates. CONCLUSION: This study demonstrates that the accuracy of a prognosis based on medical documentation in sickness absence forms, is lower than that of one based on direct communication with the sick-listed themselves.
BACKGROUND: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. AIMS: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. METHODS: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. RESULTS: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. CONCLUSIONS: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.
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The objective of this study was to compare sick leave data obtained from questionnaires with data from company records. During a period of 12 months, questionnaires were completed monthly for 6 months and then at 9 and 12 months. The sensitivity and specificity of questionnaires for detecting an episode of sick leave were determined, using the company records as a reference standard. In addition, the duration of sick leave episodes reported in the two data sets was compared. In this analysis, company records were not assumed to be superior, and agreement was assessed with intraclass correlation coefficients (ICCs). The sensitivity of questionnaires for detecting an episode of sick leave was 55% (95% CI = 0.50-0.60) and the specificity 83% (95% CI = 0.72-0.94). The ICC for all episodes was 0.58 (95% CI = 0.47-0.67). The only satisfactory ICC (0.87; 95% CI = 0.74-0.93) was found for the questionnaires at 9 and 12 months. No large systematic differences were found between the duration of episodes reported in the two data sets. In conclusion, in our study, the sensitivity of questionnaires for detecting an episode of sick leave was very low. Furthermore, when episodes were recalled, there was little agreement on the duration of the episode between questionnaire data and data in the company records. Based on these results and considering the risk of missing questionnaires, data on sick leave gathered from company records are clearly preferable as an outcome measure in research.
OBJECTIVE: Determinants of sick leave should be investigated before interventions to reduce sick leave can be designed. This cross-sectional study compares employees with asthma and chronic obstructive pulmonary disease (COPD) with and without sick leave. METHODS: One hundred and eighteen participants with asthma and 71 with COPD underwent a lung function test [one-second forced expiratory volume (FEV1), forced vital capacity (FVC)] and completed questionnaires on health complaints, work characteristics, demographic and psychosocial variables, and self-reported sick leave in the past 12 months. Backward multivariate logistic regression analyses, with sick leave (no/any) as dependent variable, were conducted for asthma, COPD, and the total group. RESULTS: Lung function measures were not significantly associated with sick leave in any group (P > 0.05). For asthma, psychosocial variables (spending all energy at work, OR 0.7) and health complaints (frequency of dyspnoea, OR 0.4 and breathing problems such as coughing, wheezing, OR 1.1) were associated with sick leave. In the COPD group, age (OR 0.9) was the only significant variable to be maintained in the model. In the total group, work characteristics (adjustment in work pace, OR 3.3), age (OR 0.9) and spending all energy at work (OR 0.7) were maintained in the final model. CONCLUSION: Severity of the disease, as measured by lung function, is not a determinant of sick leave in asthma and COPD. Different processes play a role in asthma and COPD. Interventions for reducing sick leave should aim more at psychosocial factors than at treating the severity of the disease.
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A study of sick leave from work during pregnancy has been performed from data collected by Social Security's consulting doctors in 1985. The proportion of sick leave of a duration of less than six months during pregnancy may be estimated to be 18.6% of all the reasons for sick leave for all women aged less than fifty years, and so represents the second highest reason for sick leave after mental diseases. A socio-professional inequality exists with regard to sick leave during pregnancy: the estimated frequency of sick leave for pregnancy is thirteen times higher in workers than in managers, and seven times higher in employees.
Parental and sick leave are medical staff benefits that can lead to all kinds of problems. This article offers specific guidance for heading off the most common and difficult problems, focusing particularly on ways to provide fair benefits to employees who need them without inviting unnecessary absences and policy abuse. It reviews typical medical practice sick leave policies as well as four creative strategies for encouraging and rewarding excellent attendance and deterring abuse. In addition, this article suggests ways to structure a parental leave policy that will not only be fair to employees but also help the practice fulfill its legal obligations.
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In 1988 the National Insurance Administration in Norway introduced a compulsory sickness certificate to be issued by the doctor after eight weeks of incapacity of work (sickness certificate II). The form contains 25 specified items to be filled in by the doctor. We registered and analysed the sickness certificates received by the local National Insurance offices in five municipalities during the last three months of 1988 (n = 735). The patients included a slight majority of males. 1/3 of the patients were younger than 30 years old and 2/3 younger than 50. 1/4 of the items had not been filled in by the doctors. The most frequent diagnostic groups were musculo-skeletal/connective tissue diseases (46.4%), mental disorders (11.2%), and complications related to pregnancy and birth (9.6%). Sickness certificate II included a five-level prognosis scheme. 68.3% of the patients were allocated to prognosis A, i.e. full recovery as a result of medical treatment only. Few doctors noted that cooperation with other health and social welfare personnel was desirable. The level of unemployment was reported as being higher in patients who were certified sick for greater than or equal to 8 weeks than in the general population of the countries included in the study. The extra costs of introducing sickness certificate II are estimated to equal one day's sickness allowance for each of the 735 patients.
BACKGROUND: Sickness absence often occurs in patients with emotional distress or minor mental disorders. In several European countries, these patients are over-represented among those receiving illness benefits, and interventions are needed. The aim of this study was to evaluate the cost-effectiveness of an intervention conducted by social workers, designed to reduce sick leave duration in patients absent from work owing to emotional distress or minor mental disorders. METHODS: In this Randomized Controlled Trial, patients were recruited by GPs. The intervention group (N = 98) received an activating, structured treatment by social workers, the control group (N = 96) received routine GP care. Sick leave duration, clinical symptoms, and medical consumption (consumption of medical staffs' time as well as consumption of drugs) were measured at baseline and 3, 6, and 18 months later. RESULTS: Neither for sick leave duration nor for clinical improvement over time were significant differences found between the groups. Also the associated costs were not significantly lower in the intervention group. CONCLUSIONS: Compared with usual GP care, the activating social work intervention was not superior in reducing sick leave duration, improving clinical symptoms, and decreasing medical consumption. It was also not cost-effective compared with GP routine care in the treatment of minor mental disorders. Therefore, further implementation of the intervention is not justified. Potentially, programmes aimed at reducing sick leave duration in patients with minor mental disorders carried out closer to the workplace (e.g. by occupational physicians) are more successful than programmes in primary care.
BACKGROUND: Medical sickness certificates are generally the main source for information when scrutinizing the need for aimed intervention strategies to avoid or reduce the individual and community side effects of sick leave. This study explored the value of medical sickness certificates related to daily work in Norwegian National Insurance Offices to identify sick-listed persons, where modified working conditions might reduce the ongoing sick leave. METHODS: The potential for reducing the ongoing sick leave by modifying working conditions was individually assessed on routine sickness certificates in 999 consecutive sick leave episodes by four Norwegian National Insurance collaborators, two with and two without formal medical competence. The study took place in Northern Norway in 1997 and 1998. Agreement analysed with differences against mean, kappa, and proportional-agreement analysis within and between groups of assessors was used in the judgement. Agreements between the assessors and the self-assessment of sick-listed subjects were additionally analysed in 159 sick-leave episodes. RESULTS: Both sick-listed subjects and National Insurance collaborators anticipated a potential reduction in sick leave in 20-30% of cases, and in another 20% the potential was assessed as possible. The chance corrected agreements, however, were poor (k < 0.20) within and between groups of National Insurance collaborators. The agreement between National Insurance collaborators and the sick-listed subjects was no better than chance. Neither extended medical information nor formal medical competence increased agreement in cases where modified working conditions might have reduced sick leave. CONCLUSION: Information in medical sickness certificates proved ineffective in detecting cases where modified working conditions may reduce sick leave, and focusing on medical certificates may prevent identification of needed interventions. Strategies on how to communicate directly with sick-listed subjects would enable social authorities to exploit more of the sick leave reduction potential by modifying the working conditions than strategies on improving medical information.
The literature indicates a high percentage of sick leave during pregnancy in the past 10 years. In the Nordic countries 30-50 percent of pregnant women on the labour market are on sick leave during pregnancy. There is no indication that the increased frequency is due to decreased health amongst pregnant women, but it may be a consequence of an increase in working women. Pregnancy means additional strain to the double tasks that many working women experience. A few references indicate that sick leave is most common among women working full time and women, who have previously given birth. Sick leave may cover up for increasingly poor working environments or social problems, but may also reflect changes in standards, legislation or role performance. It is advisable to follow pregnant women on sick leave closely in order to avoid expulsion from the labour market. Pregnancy-related sick leave seems to be multifactorial, which should lead to caution concerning conclusions on the relative influence of different factors on sick leave during pregnancy.
BACKGROUND: Sick leave due to neck, shoulder and back disorders (NSBD) is higher among health-care workers, especially nursing aides/assistant nurses, compared with employees in other occupations. More information is needed about predictors of sick leave among health care workers. The aim of the study was to assess whether self-reported factors related to health, work and leisure time could predict: 1) future certified sick leave due to any cause, in nursing aides/assistant nurses (Study group I) and 2) future self-reported sick leave due to NSBD in nursing aides/assistant nurses (Study group II). METHODS: Study group I, comprised 443 female nursing aides/assistant nurses, not on sick leave at baseline when a questionnaire was completed. Data on certified sick leave were collected after 18 months. Study group II comprised 274 of the women, who at baseline reported no sick leave during the preceding year due to NSBD and who participated at the 18 month follow-up. Data on sick leave due to NSBD were collected from the questionnaire at 18 months. The associations between future sick leave and factors related to health, work and leisure time were tested by logistic regression analyses. RESULTS: Health-related factors such as previous low back disorders (OR: 1.89; 95% CI 1.20-2.97) and previous sick leave (OR 6.40; 95%CI 3.97-10.31), were associated with a higher risk of future sick leave due to any cause. Factors related to health, work and leisure time, i.e. previous low back disorders (OR: 4.45; 95% CI 1.27-15.77) previous sick leave, not due to NSBD (OR 3.30; 95%CI 1.33-8.17), high strain work (OR 2.34; 95%CI 1.05-5.23) and high perceived physical exertion in domestic work (OR 2.56; 95%CI 1.12-5.86) were associated with a higher risk of future sick leave due to NSBD. In the final analyses, previous low back disorders and previous sick leave remained significant in both study groups. CONCLUSION: The results suggest a focus on previous low back disorders and previous sick leave for the design of early prevention programmes aiming at reducing future sick leave due to any cause, as well as due to NSBD, among nursing aides/assistant nurses. A multifactorial approach may be of importance in the early prevention of sick leave due to NSBD.