Rolf Wahlström

Chapter 7. Sickness absence and psychiatric disorders

There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).

Influencing Prescribing for Urinary Tract Infection and Asthma in Primary Care in Sweden: A Randomized Controlled Trial of an Interactive Educational Intervention

Our aim was to evaluate effects on prescribing for urinary tract infection (UTI) and asthma, of an education with messages based on national guidelines, aimed at improving prescribing in primary care in Sweden. The study is part of the European Drug Education Project. A randomized controlled trial, with groups of general practitioners (GPs) allocated to education on UTI (18 groups, 104 GPs) or asthma (18 groups, 100 GPs), the two parallel intervention arms being controls for each other. Feedback was provided on the GPs judgments of simulated cases and prescribing. Prescribing indicators were developed and measured before and after the intervention. Analysis was performed by multi-level technique. Prescribing of first choice UTI drugs increased in the intervention arm from 52% to 70% and remained constant in the control arm (P < 0.001). The proportion of patients receiving an inhaled corticosteroid increased insignificantly in both study arms. The educational model can be used to improve prescribing. Further studies are needed to define when the model is effective.

Sickness absence and self-reported health a population-based study of 43,600 individuals in central Sweden

BackgroundSickness absence is very high in Sweden. The reasons for this phenomenon are not well known. The aim of this study was to investigate the association between degree of self-reported sickness absence and health. The hypothesis was that individuals with long-term sickness absence would report more symptoms and lower self-rated health. Another hypothesis was that women are more likely to self-rate psychiatric diagnoses compared to men, who are more likely to self-rate musculoskeletal diagnoses.MethodsThe data was obtained with a postal survey questionnaire answered by 43,589 individuals, a Swedish random population sample of men and women aged 18–84 years. The response rate was 65%. This study included 19,826 individuals aged 18–64 years old and still at work. They were divided into four groups, based on the number of reported days of sickness absence during the past year.ResultsApproximately 40% of the individuals at work mentioned that they had been absent due to illness sometime during the past year. Of those who had been absent 90 days or more, two thirds were women. There was a significant difference between the groups in self-rated health (p < 0.05). Every fifth woman (19.4%) and every fourth man (25.9%) in the group with a sickness absence of more than 89 days rated their health as poor or very poor, but a large proportion, 43.5% of the women and 31.6% of the men, rated their health as good. Long-term illnesses and complaints differed between the groups. The correlations between the groups and illness were mostly significant (p < 0.01). Two thirds of the subjects had both psychiatric and musculoskeletal symptoms. There was a significant difference among them, as men more often had musculoskeletal diagnoses. One third had only psychiatric or musculoskeletal symptoms and in those groups there were no significant diagnosis differences between the sexes.ConclusionIndividuals with long-term sickness absence reported more symptoms and lower self-rated health than did those who had not been absent at all, and than those who had been ill 1–28 days. Men and women sick-listed 29 days or more generally reported more illness and complaints. No sex differences among psychiatric and musculoskeletal diagnoses were found, but when reported both psychiatric and musculoskeletal symptoms the musculoskeletal diagnoses were significant among men.

Effectiveness of feedback for improving case management of malaria, diarrhoea and pneumonia--a randomized controlled trial at provincial hospitals in Lao PDR.

Background Standard Treatment Guidelines were introduced to all prescribers at provincial hospitals in Lao PDR and treatment indicators were developed within the National Drug Policy programme to monitor compliance.

Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option?

Abstract This paper explores HIV patients’ adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: “Patients’ competing costs and systems’ resource constraints” and “Patients’ trust in ART and quality of the patient–provider encounters.” The first theme refers to how patients’ adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients’ capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.

Antimicrobial self medication for reproductive tract infections in two provinces in Lao People’s Democratic Republic

Objectives: To describe antimicrobial self medication for reproductive tract infections (RTI) including sexually transmitted infections (STI), and to explore the understanding and use of health information among the adult population self medicating with antimicrobials for RTI/STI in two provinces of Laos. This could contribute to quality improvement of RTI/STI management. Methods: Cross sectional community based study. Structured interviews (household survey) were conducted among 500 subjects aged 18 or more, who had used antimicrobials as self medication for RTI/STI during the past year. They were recruited among 3056 family members in Vientiane capital and Champasak province, divided equally between the two study sites, and between urban and rural areas. Results: Among the 500 respondents reporting self medication for RTI/STI, 91% had bought the antimicrobials from local private pharmacies without a physician’s prescription. 58% of those were advised to buy the drugs from drug sellers. Ampicillin (not recommended as syndromic treatment for RTI/STI) was used in 83% of all cases, in 28% combined with tetracycline. 79% of respondents used antimicrobials for a non-recommended duration of time. Most respondents had access to health messages for RTI/STI, largely from radio/television and drug sellers. However, only 17% of all respondents reported that they had ever used a condom. Conclusions: More than three quarters of respondents, self medicating for RTI/STI with antimicrobials, used inappropriate drugs bought from private pharmacies. There is a need to improve RTI/STI management, including health promotion, through interventions at community level, and to health providers, including private drug sellers.

The quality of public and private pharmacy practices

Abstract. Aim: The aim was to study the practices of public and private pharmacies in the Savannakhet province, Lao PDR, in relation to defined aspects of good pharmacy practice (GPP) and rational use of drugs (RUD). Study design: The study design was cross-sectional using structured interviews and observations. A total of 105 drug sellers (31% and 4% had pharmacy education at public and private pharmacies, respectively) were interviewed, and the pharmacies were inspected. In addition, 576 customers were interviewed immediately after the drug transaction and all their drug purchases were recorded. Facility, patient-care and prescribing indicators covering aspects of GPP and RUD were used to measure and compare the quality of services of the pharmacies. Results: The results showed that public pharmacies differed significantly from private pharmacies, with lower mean scores for availability of essential drugs (5.1 vs 6.4), 95% confidence interval (CI –2.23, –0.34) and essential materials (5.6 vs 6.9, 95% CI –2.40, –0.20), and with a higher percentage of antibiotics dispensed (34% vs 24%, P<0.02), as well as more injections (31% vs 7%, P<0.001) and drugs per customer (2.4 vs 1.4, 95% CI 0.84, 1.16). More drug purchases were decided by health workers at public pharmacies than at private pharmacies (92% vs 16%). At public pharmacies, significantly more drugs were prescribed from the National Essential Drug List (76% vs 56%, P=0.004), and more drugs had an international non-proprietary name (67% vs 35%, P<0.001). There was no significant difference regarding order in the pharmacy, oral information and drugs adequately labelled at the public pharmacies compared with the private pharmacies. Conclusion: In spite of the differences shown, both public and private pharmacies performed suboptimally in relation to several aspects of GPP and RUD. The lack of essential drugs, essential materials, information on drug use and adequate drug labelling all contribute to irrational use of drugs. Interventions are needed to improve practice and drug use.

Safety, feasibility, and acceptability of visual inspection with acetic acid and immediate treatment with cryotherapy in rural Laos

To assess the safety, acceptability, and feasibility of visual inspection with acetic acid (VIA) followed by immediate treatment with cryotherapy as a single‐visit approach for the prevention of cervical cancer among women in rural Laos.

Practice-knowledge-attitudes-practice: An explorative study of information in primary care

Contemporary information programmes for health staff fail to give thorough consideration to the influence of situational factors on information transfer within health institutions. To study information transfer in Swedish primary care health centres, we have therefore used the participant observation method, to explore the influences of practice on knowledge and attitude formation, in turn giving rise to new practice. Management of hyperlipidaemia was used as an example. Our study suggests that the practice generates new information, which is added to or counteracts the acquisition and use of already existing information and is subsequently used in practice. Ongoing discussions between staff members give an opportunity to share practice experiences. Profession, professional hierarchy and gender are some of the factors influencing the use of information in this context. To improve the effectiveness of information programmes these factors and the professional roles of the health staff should be taken into consideration.

Women's perception of cervical cancer and its prevention in rural Laos.

Background: Cervical cancer is the second most common cancer of women in the world, and it becomes a major cause of cancer mortality in low-income countries. Currently, little is known regarding cervical cancer incidence in Laos, although it is anticipated to be high like in neighboring countries. To be able to develop a screening program in the country, it is essential to explore womens perception of the disease. The purpose of this study was therefore to describe knowledge, awareness, and attitudes regarding cervical cancer among rural women of Laos. Methods: In a descriptive cross-sectional study, women were interviewed using a structured questionnaire covering sociodemographic factors, knowledge of the disease and its risk factors, awareness, and attitudes toward cervical cancer and its prevention. Results: Eight hundred women were included in the study, and 58% claimed to know about cervical cancer. Approximately one third (38%) considered themselves to be at risk, but less than 5% had ever had a Papanicolau test. Sixty-two percent believed it was possible to prevent cervical cancer and that vaccination may be a suitable method, but only 14% know about risk factors. Another method for prevention was frequent vaginal douching, which was suggested by 70% of the women. Symptoms like bleeding and discharge were correctly identified as possible indicators of cervical cancer, but only 57 women (7%) knew that an early stage of the disease could be symptom-free. Lack of subjective symptoms was the main reason for women to refrain from gynecological examinations. Conclusions: This study indicates that rural women in Laos have limited knowledge about cervical cancer and even less about screening and prevention. There is a need to educate the general community about the disease and its prevention.