Malin Josephson

Sickness presenteeism today, sickness absenteeism tomorrow? : A prospective study on sickness presenteeism and future sickness absenteeism

Objective: To prospectively investigate whether sickness presenteeism (SP), ie, going to work despite illness, has an impact on future sickness absenteeism. Methods: Two study populations were used, one female dominated from the public sector that included 3757 employees, and one male dominated from the private sector comprising 2485 employees. Results: SP on more than five occasions during the baseline year (2000) was a statistically significant risk factor for future sick leave (2002 and 2003) of more than 30 days among both populations even after adjusting for previous sick leave, health status, demographics, lifestyle, and work-related variables (2002, public sector, relative risk = 1.40; private sector, relative risk = 1.51). Conclusions: SP may be an important phenomenon to consider when evaluating measures aimed at decreasing sickness absenteeism because more SP may lead to future sickness absence.

Comparisons of self-reported and register data on sickness absence among public employees in Sweden

Aim: Self-reported assessments of sickness absence are often performed in epidemiological studies. The objective of this study was to compare the number of sick-leave days according to self-reported data over 12 months with data from the employer’s register for the same period. An additional aim was to ascertain whether the self-reported information and the recorded data would show equivalent associations with self-reported general health. Methods: The study was based on a cohort of 4869 municipal employees in Sweden, about 80% women, who answered a questionnaire in 2001–2. The responses provided by the employees included information on number of sick-leave days and self-rated health. Data on sick-leave days, occupation and age were derived from the employers’ computerised registers. The questionnaire information on sick-leave days was compared with the corresponding information retrieved from the employer register by means of calculating sensitivity and specificity, using the employers’ data as the “gold standard”. Results: The annual number of sick-leave days was lower according to the self-reported information than to the register data. For women the agreement between the two sickness absence measures for no sick-leave days, 1–7 days and ≥28 days were 74%, 72% and 67%, respectively. The sensitivity of questionnaire versus register information regarding any self-reported sick-leave day was 91% and the specificity was 74%. Sensitivity and specificity for sickness absence ⩾28 days were 67% and 98%, respectively. The results for men were similar to those for women. Self-reported and recorded sickness absence were both associated with self-rated health. The odds ratios were 7.27 and 8.25, for subjects with ≥28 recorded and self-reported number of sick-leave days respectively, compared to subjects with no sickness absence. Conclusions: Good agreement was found between self-reported and register information on sickness absence. Self-reported data on sickness absence may be useful in common epidemiological applications.

Long-term sick-listing among women in the public sector and its associations with age, social situation, lifestyle, and work factors: A three-year follow-up study

Background: Since 1997 the number of long-term sick-listed people in Sweden has increased dramatically, especially among women employed in the public sector. Aims: The aim of this study was to investigate associations between age, social situation, lifestyle, work factors, and long-term sick-listing (≥28 days), regardless of diagnosis, during a period of three years among women employed in the public sector. Methods: Exposure information at baseline was recorded by a questionnaire. All new spells of sick-listing ≥28 days were consecutively reported from the employer for three years from baseline. In total 6,246 women from the public sector in Sweden answered the questionnaire (85% response rate); 5,224 were classified as having good or rather good health for working and were included. Of these, 918 persons had spells of sick-listing ≥28 days during follow-up. Results: Univariate and multivariate analyses for calculating relative risks (RR) were carried out. In the Cox regression model age (RR 1.4), strained financial situation (RR 1.3), obesity (RR 1.3), bullying (RR 1.5), physical demands at work higher than own capacity (RR 1.5), and mental demands at work higher than own capacity (1.2) remained risk indicators for long-term sick-listing. Conclusion: This study suggests prevention of some work and lifestyle factors as general measures to reduce long-term sick-listing among women in the public sector.

Work environment and neck and shoulder pain: the influence of exposure time. Results from a population based case-control study

Objectives: To study associations between long term and short term exposure to different work environmental conditions and the incidence of neck or shoulder pain. The results were obtained as part of the MUSIC-Norrtälje study, which is a population based case-control study conducted in Sweden in 1993–7. Methods: The cases were people from the study base who sought medical care or treatment for neck or shoulder pain. Information on physical and psychosocial conditions in the work environment, currently and 5 years ago, and lifestyle factors, was obtained by self administered questionnaires from 310 cases and 1277 randomly selected referents. Results: Associations between both physical and psychosocial exposures in the work environment and seeking care for neck or shoulder pain were found. The risk patterns differed for the sexes, and risk ratios exceeding 1.5 were more often found among women than among men. Generally, subjects who had experienced a recent increase of exposure were more likely (relative risk (RR) 2.1–3.7) to seek care than those who had been exposed long term (RR 1.5–1.8). Among women, an increased amount of visual display terminal (VDT) work, work above shoulder level, and reduced opportunities to acquire new knowledge, and among men, an increased amount of seated work were associated with neck or shoulder pain. This might indicate short induction periods for neck or shoulder pain for these exposures. However, for repetitive work with the hands and hindrance at work among women, and possibly also local vibrations among men, the induction periods seem to be longer. Interactive effects between factors, both at work and in the family, were found, but only among women. Conclusions: Associations between some exposures in the work environment and seeking care for neck or shoulder pain were found. The high RRs for short term exposure might indicate that for many factors the induction period for neck or shoulder pain is short.

Return to work expectation predicts work in chronic musculoskeletal and behavioral health disorders: Prospective study with clinical implications

Study Design: Prospective cohort study with 18-month follow-up. Objective: To investigate if long-term sick listed persons’ own predictions of their future return to work (RTW) have an impact on their RTW when controlling for other established factors. Method: Postal questionnaires at baseline were sent to persons who had been on sick leave for more than 90 days, and were employed in five municipalities and four county councils in Sweden. A follow-up regarding their RTW was performed 18 months later. Results: After 18 months 135 out of 508 persons (27%) had returned to work, full or part-time. In a multivariate logistic regression, the sick listed persons’ own prediction of their RTW proved to be highly significant (OR=8.28, 95% CI: 3.31–20.69). Only six out of 132 persons with a negative view of their RTW did return to wok. Other predictive factors that were found for RTW were: being on sick leave for a period of less than 1 year (OR=2.09, 95% CI: 1.19–3.67), having less pain than persons in the quartile with most pain (OR=2.65, 95% CI: 1.21–5.81), perceiving that one was welcome back to work (OR=1.98, 95% CI: 1.10–3.58), and being under 55 years of age (OR=2.37, 95% CI: 1.07–5.23 for age between 45 and 54 years and the same trend for age below 45 years OR=1.85, 95% CI: 0.82–4.20). Conclusion: Persons with a positive prediction should get help to realise their potential for RTW. Offering traditional rehabilitation measures to a person with a negative prediction of his/her RTW, could be a waste of resources if done ahead of improving self-confidence and view of what is possible. The problems in this group might decrease or be easier to handle if decisions about the future are taken within a year.

The same factors influence job turnover and long spells of sick leave—a 3-year follow-up of Swedish nurses

BACKGROUND In many countries, a general shortage of nurses is a public health problem, and retention of nurses in active work is a challenge. The aim of this study was to ascertain whether the same individual factors, working conditions and health problems had led to increased probability of both leaving jobs and prolonged sickness absence in a cohort of Swedish nurses over a period of 3 years. METHODS A baseline questionnaire was answered by 2293 nurses, representing a response rate of 86%. Exposed and unexposed nurses were compared with regard to two outcomes. During the 3-year follow-up, exposed and unexposed nurses were compared with regard to two outcomes: resigning and having at least one sick leave spell that lasted 28 days or longer. RESULTS We found that 18% of the nurses left their employment, and 16% had sick leave spells > or =28 days. Work in geriatric care, being socially excluded by superiors and/or workmates, negative effects of organizational changes and poor self-rated general health were factors that increased the likelihood of both leaving jobs and long-term sick leave. CONCLUSIONS The present results underline the importance of improving working conditions and supporting sustainable health in order to prevent high turnover and prolonged sick leave among nurses. Resigning and moving to another institution can be interpreted as a way to actively cope with an unhealthy work environment.

Promoting excellent work ability and preventing poor work ability: the same determinants? Results from the Swedish HAKuL study.

Aim: Health has been described as a continuum between the two poles of excellent health and ill health. Research has so far focused on the negative pole, leaving knowledge about the positive pole vague. With a main focus on working life, the authors aim was to identify determinants promoting excellent work ability and determinants preventing poor work ability. Methods: 5638 (73% answering rate) employees in the public sector in Sweden answered a questionnaire both at baseline and at follow up 18 months later. The employees were divided into three groups based on sick leave at follow up: excellent work ability (13%), poor work ability (15%), and a middle group (72%). Self reported sociodemographic data, lifestyle data, and working life exposures at baseline were fitted into logistic regression models to determine which factors, if any, promoted excellent work ability or protected against poor work ability. Results: Some determinants were mutual, but more than half of the determinants in the final model were associated solely with promoting excellent work ability or preventing poor work ability, thus creating different patterns of associations. Promotion of excellent work ability seemed more dependent on physical factors, clear work tasks, and positive feedback, while prevention of poor work ability seemed more dependent on job security and psychosocial factors. Conclusions: This explorative longitudinal study showed slightly different patterns of determinants promoting excellent work ability and preventing poor work ability. As most of the identified determinants are amenable to influence, our results open up the possibility of interventions for promoting excellent work ability and preventing poor work ability.

Predictors of leaving nursing care: a longitudinal study among Swedish nursing personnel.

Objectives: Despite extensive research on turnover among nursing personnel very little is known about the impact of physical workload and health on leaving. The aim of this study was to find predictors for leaving nursing care with special reference to physical working conditions and musculoskeletal problems. Methods: This study is based on longitudinal data from a survey of nursing personnel who were employed at various county hospitals in Sweden from 1992–95. A self administrated follow up questionnaire was used to identify their present position in the labour market. The response rate was 73% (n = 1095). Results: The results showed that nursing personnel reporting musculoskeletal problems of the neck/shoulder or knees and those who had limited use of transfer devices were more likely to leave nursing care. Conclusions: The study highlights the importance of taking musculoskeletal problems and use of transfer devices into consideration in order to retain nursing personnel.

Seeking care for neck/shoulder pain: a prospective study of work-related risk factors in a healthy population.

This study estimated the 5-year cumulative incidence of neck/shoulder pain and identified work-related risk factors leading subjects to seek care for this problem. Four to six years after the case-referent MUSIC-Norrtälje Study, a postal questionnaire was sent to the referents of this study, and 81% responded. At baseline, 516 men and 697 women were assessed as to their work-related exposures. The 4- to 6-year cumulative incidence for seeking care for neck/shoulder pain was 29% for women and 18% for men. For men, moderately increased risks were found for manual handling, night work/shift work, hindrances at work, and solitary work. For men, the risk increased with an increasing number of risk indicators. No work-related risk factors were found for women, highlighting the difficulty of identifying risk factors in a general population.

Differences in the Association Between Psychosocial Work Conditions and Physical Work Load in Female- and Male-Dominated Occupations

This study investigated whether there is a relationship between high physical work load and adverse psychosocial work factors, and whether this relationship is different for women and men. Separate analyses for female registered nurses and assistant nurses were made because these are common occupations involving high physical and psychological demands. This study was part of the MUSIC-Norrtälje study, a population study with the overall aim of identifying risk factors for musculoskeletal disorders. The respondents, 1423 gainfully employed men and women, were randomly selected from the study population. The exposure assessments referred to a typical workday during the previous 12 months. Physical exposure was investigated by interview, psychosocial work factors by interview and questionnaire. For the women, but not the men, mainly routine work and a job strain situation, according to the model of Karasek and Theorell, increased the probability of having a high physical work load, assessed as a time-weighted average of energy expenditure in multiples of the resting metabolic rate. Results indicated that in female-dominated occupations, high physical work load might also imply adverse psychosocial conditions. A higher frequency of high physical work load and job strain was observed among assistant nurses compared with registered nurses. Covariance between physical and psychosocial demands makes it difficult to determine the relative influence of each in health problems. Results of the present study imply that this is a larger problem in studies of women than men.