Sickness presence,sick leave and adjustment latitude

Objectives

Previous research on the association between adjustment latitude (defined as the opportunity to adjust work efforts in case of illness) and sickness absence and sickness presence has produced inconsistent results. In particular, low adjustment latitude has been identified as both a risk factor and a deterrent of sick leave. The present study uses an alternative analytical strategy with the aim of joining these results together.

Material and Methods

Using a cross-sectional design, a random sample of employees covered by the Upper Austrian Sickness Fund (N = 930) was analyzed. Logistic and ordinary least square (OLS) regression models were used to examine the association between adjustment latitude and days of sickness absence, sickness presence, and an estimator for the individual sickness absence and sickness presence propensity.

Results

A high level of adjustment latitude was found to be associated with a reduced number of days of sickness absence and sickness presence, but an elevated propensity for sickness absence.

Conclusions

Employees with high adjustment latitude experience fewer days of health complaints associated with lower rates of sick leave and sickness presence compared to those with low adjustment latitude. In case of illness, however, high adjustment latitude is associated with a higher probability of taking sick leave rather than sickness presence.     

Predictors of attendance at a relocatable mammography service for rural women

Abstract: This study aimed to identify factors that predicted attendance at a relocatable screening mammography service in a rural centre in Victoria. A cohort design was used whereby 180 women from the target population were interviewed by telephone two weeks before the service moved to the area for a 10–week period of operation. Attendance data were ascertained from service records. Fifty per cent of the sample attended the service. Significant predictors of attendance were: mammographic history, with women who reported previous screening mammography being less likely to attend than women who had not had a previous mammogram (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17 to 0.83); perception of personal risk for breast cancer, with women who perceived at least some risk being more likely to attend than women who perceived no risk (OR 2.73, CI 1.07 to 6.99); stated intention of attending (OR 2.01, CI 1.49 to 2.71); knowing the correct location of the service (OR 3.08, CI 1.37 to 6.89); and education, with higher education being associated with a lower likelihood of attending (OR 0.65, CI 0.44 to 0.96). Our study raised some issues, including the high prevalence of rural women who reported a previous screening mammogram, although BreastScreen services had not previously been available in their area; factors underlying perceptions of personal risk for breast cancer; and the generalisability of our finding of an inverse relationship between higher education and attendance for screening.     

Salvadoran fathers' attendance at prenatal care, delivery, and postpartum care.

OBJECTIVE: To provide a baseline perspective on the prevalence of Salvadoran men's attendance at prenatal care, delivery, and postpartum well-baby care and on sociodemographic factors associated with their attendance, with the goal of informing efforts to help men play more positive roles in maternal-child health. METHODS: The data came from the 2003 Salvadoran National Male Health Survey. The data focused on fathers (n = 418) and their most recent live-born child in the preceding five years. Factors associated with the fathers' participation in prenatal care visits, attendance at delivery, and participation in postnatal well-baby visits were explored using logistic and multinomial regression models. RESULTS: Ninety percent of the recent Salvadoran fathers who were surveyed participated in a prenatal care visit, attended the delivery, or participated in a postpartum well-baby care visit; 34% participated in all three of the activities. Attendance at delivery was most common, reported by 81% of fathers; the most common reason that subjects cited for not attending was that they had had to work. CONCLUSIONS: A large majority of the Salvadoran fathers participated in at least one prenatal care visit, delivery, or a postpartum well-baby care visit. While attendance alone does not necessarily indicate that men are supporting their partners, the results suggest that norms are in place for men to play positive roles in maternal-child health matters. Furthermore, the participation of fathers in these maternal and child health care activities may provide new opportunities to educate and further support men in both their own health and their family's health.     

Prediction of intern attendance at a seminar-based training programme: a behavioural intention model

CONTEXT: The factors determining intern attendance at 'resident rounds' training programmes are not known. AIMS: This study aimed to use a behavioural model (the Triandis theory of social behaviour) to predict intern attendance at the resident round programme at a metropolitan teaching hospital. SUBJECTS: These included 109 interns in a large metropolitan teaching hospital, in the 1996 and 1997 cohorts. METHODS: Tabulated responses from a structured interview administered to 10 randomly selected interns were used to develop survey items related to the Triandis variables. Attendance was monitored using a sessional logbook and by self-report. Item analysis was conducted for each variable scale. Stepwise multiple regression models were constructed to predict attendance and intention. RESULTS: The average proportion of resident rounds attended was 43% (95% confidence intervals (CI) 40-47%) from logbook attendance, and 63% (95% CI 61-65%) by self-report. Cronbach's alpha for the subscales ranged from 0.62 to 0.91. Intern attendance was predicted by the habit of attendance and negatively predicted by facilitating conditions (AdjR2=0.26, P<0.0001). The intention to attend was only independently predicted by perceived consequences (AdjR2= 0.19, P < 0.0001). CONCLUSIONS: The establishment of resident education programmes within teaching hospitals requires attention to and modification of facilitating conditions that may allow improvements in attendance and in quality of the programme.     

The attendance allowance

SUMMARY The National Insurance (old persons'and widows' pensions and attendance allowance) Act 1970 provides for an attendance allowance to be paid to disabled persons who require a lot of attention or supervision both at night and by day. With the passing of the National Insurance Act 1972 this became known as the higher rate and a new lower rate was introduced in 1973 for those who require a lot of attention or supervision either by day or at night. The current rates of attendance allowance are at the higher rate £8.00 a week and at the lower rate £5·35 a week. To qualify for the attendance allowance the conditions must have been satisfied for at least 6 months. The allowance can be paid from the age of 2 years, which means that the conditions must have been satisfied from the age of 18 months; one of the conditions for children is that they need substantially more attention or supervision than a non-disabled child of the same age. Whether a person satisfies the medical conditions and if so for how long they are likely to remain satisfied is decided by the Attendance Allowance Board.     

Functional limitations and religious service attendance among African American and white older adults

Church attendance is associated with improved health and well-being among older adults, but older adults with functional limitations may have difficulty attending church services. This article examines differences in the association between functional limitations and church attendance in a sample of 987 elderly African American and white individuals. African American and white elderly people without limitations attended church at virtually the same rate (69 percent). Despite their higher scores on religiousness measures, elderly African Americans with one or more limitations were significantly less likely to attend church regularly than were white counterparts. Health status measures did not help explain older African Americans' lower attendance rates. Differences in attendance were associated primarily with educational attainment and cognitive functioning. The article recommends social work intervention to reduce barriers to church attendance for older adults who want to attend services.     

Health problems and psychosocial work environment as predictors of long term sickness absence in employees who visited the occupational physician and/or general practitioner in relation to work: a prospective study

Aims: To determine whether psychosocial work environment and indicators of health problems are prospectively related to incident long term sickness absence in employees who visited the occupational physician (OP) and/or general practitioner (GP) in relation to work.

Methods: The baseline measurement (May 1998) of the Maastricht Cohort Study, a prospective cohort study among 45 companies and organisations, was used to select employees at work who indicated having visited the OP and/or GP in relation to work. Self report questionnaires were used to measure indicators of health problems (presence of at least one long term disease, likeliness of having a mental illness, fatigue) and psychosocial work environment (job demands, decision latitude, social support, job satisfaction) as predictors of subsequent sickness absence. Sickness absence data regarding total numbers of sickness absence days were obtained from the companies and occupational health services during an 18 month period (between 1 July 1998 and 31 December 1999). Complete data were available from 1271 employees.

Results: After adjustment for demographics and the other predictors, presence of at least one long term disease (OR 2.36; 95% CI 1.29 to 4.29) and lower level of decision latitude (OR 1.69; 95% CI 1.22 to 2.38) were the strongest predictors for sickness absence of at least one month. A higher likelihood of having a mental illness, a higher level of fatigue, a lower level of social support at work, and low job satisfaction were also significant predictors for long term sickness absence, but their effect was less strong.

Conclusion: In detecting employees at work but at risk for long term sickness absence, OPs and GPs should take into account not only influence of the psychosocial work environment in general and level of decision latitude in particular, but also influence of indicators of health problems, especially in the form of long term diseases.

     

Relationship of stages of change to attendance in a diabetes prevention program

PURPOSE: To determine whether preintervention stage-of-change measures are indicative of subsequent attendance at diabetes prevention intervention sessions. DESIGN: Cross-sectional. SETTING: Local community. SUBJECTS: Seventy-five adult American Indian women participated. MEASURES: Attendance, stage-of-change questions for seven diabetes prevention behaviors, and mean stage-of-change score to reflect the combined stages of change for all behaviors. ANALYSIS: Univariate analyses for stage-of-change distribution and Fisher's exact test and prevalence ratios for the association between attendance and stage of change. RESULTS: Participants' readiness for change at baseline was distributed across all stages of change. The most common stage was preparation. There was a significant relationship between the mean stage-of-change scores and attendance. Participants with lower mean stage-of-change scores (mean +/- SE, 3.03 +/- 0.13) were less likely to attend all 5 sessions than those with higher mean stage-of-change scores (mean +/- SE, 3.38 +/- 0.10) (p = .04). Participants in the action category (preparation, action, and maintenance stages) before the intervention were 6.7 (95% confidence interval, 1.0-44.1; p < .01) times more likely to be high attenders than those in the preaction category (precontemplation and contemplation stages) before the intervention. CONCLUSIONS: Findings from this study suggest that stage of change may be a good predictor of attendance at diabetes prevention intervention sessions and have implications for intervention design and assessment. The mean stage-of-change score may be a more stable estimate of stage of change.     

Influence of change in psychosocial work characteristics on sickness absence: The Whitehall II Study

OBJECTIVES: To study the influence of change in self perceived psychosocial work characteristics on subsequent rates of sickness absence. METHODS: Prospective cohort study of British civil service employees. Job control, job demands, and work social supports were measured in 1985/88 and in 1991/93. Analyses included 3817 British civil servants with sickness absence records at baseline (1985-89) and for two follow up periods, early (1994-95) and later follow up (1996-98). RESULTS: Change in work characteristics predicted subsequent incidence of long spells of sickness absence (>7 days) in the early follow up period after adjustment for covariates including baseline work characteristics, health status, and sickness absence. Adjusted rate ratios were 1.23 (95% CI 1.03 to 1.46) for decreased compared with stable decision latitude; 1.17 (95% CI 1.01 to 1.36) for increased compared with stable job demands and 0.79 (95% CI 0.67 to 0.93) for increased compared with stable work social support. These associations were also seen in a sub-sample who did not change employment grade. In the later follow up period, associations between work change and long spells of sickness absence were similar for decision latitude, less pronounced for job demands, and no longer apparent for social supports. Changes in work characteristics were not associated with subsequent short spells of sickness absence (相似文献   

The association between community physician's attendance at a medical center's CME courses and their patient referrals to the medical center

This study attempts to quantify an overall association between CME course attendance and referrals. Attendance at formal CME courses given by the University of Michigan Medical School and referrals to the University Hospitals were examined over a two-year period. Attendance and referrals were linked to physicians in Michigan identified through the Michigan Department of Licensing and Regulation and through the American Medical Association. For physicians who are office-based and likely to be in active practice (age less than 70), those who attended at least one of the University's CME courses referred more patients than those who did not attend one (means of 1.9 referrals per physician and 1.3 referrals per physician, p less than .001). The causal direction of the relationship is not clear, but probably operates in both directions. It is reasonable for medical center marketers to consider CME as an indirect method for marketing clinical services. It is also reasonable for CME directors to identify referring physicians as high-priority groups for marketing CME. Both marketing efforts may be significantly enhanced by linking data bases for referrals and for CME attendance. CME directors must also ensure that marketing efforts do not compromise the objectivity and integrity of the content of the institution's CME program.     

Sickness absence in the Whitehall II study, London: the role of social support and material problems.

STUDY OBJECTIVE--To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence. DESIGN--A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively. SETTING--Twenty London based non-industrial departments of the British civil service. PARTICIPANTS--Participants were civil servants (n = 10,308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4.3% of participants did not complete all necessary questions and were excluded. MEASUREMENTS AND MAIN RESULTS--High levels of confiding/emotional support from the "closest person" predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness. Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables. CONCLUSIONS--Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardize health and hence increase sickness absence.     

Return to work and adjustment latitude among employees on long-term sickness absence

Introduction: The aim was to study whether return to work (RTW) after long-term sickness absence is affected by adjustment latitude i.e. opportunities to adjust one's work to one's state of health by e.g. choosing among work tasks and deciding about work pace and working hours. We also studied whether the effect of adjustment latitude differed between those returning full-time and those returning part-time. Methods: Differences between men and women were also studied. A questionnaire was sent to 5,590 salaried employees who had been on sick leave for at least 90 days in 2000. The year after, 2001, they received a questionnaire which included questions about work status, working conditions, adjustment latitude and health. Results: The questionnaire was returned from 3056 persons. Among women 32% were fully back to work, 34% were partly back and 34% were still on sick leave. Comparable figures for men were 33%, 32% and 36%. Conclusion: For both men and women the likelihood to RTW increased with increasing number of opportunities to adjust. Adjustment latitude increased returning to part-time as well as full-time work. The study indicates that work organisation is important for RTW.     

Workplace air-conditioning and health services attendance among French middle-aged women: a prospective cohort study

OBJECTIVES: To assess the relationship between type of ventilation in the workplace, health services attendance, and sickness absence among middle-aged women. METHODS: In a national sample of 920 professionally active women aged 49-65 yr from the SU.VI.MAX cohort, recruited from the general population in France, health services attendance and sickness absence were assessed prospectively during 1999. RESULTS: Being exposed to heating, ventilation, and air-conditioning (HVAC) systems in the workplace proved to be a risk factor for attendance at global and several specialist medical services. The adjusted odds ratio for otorhinolaryngologist attendance was 2.33 (95% CI = 1.35-4.04) in the HVAC group compared with the natural ventilation group, and 1.70 (1.13-2.58) for sickness absence. Dermatologist and global medical services attendance rates may also be higher in this group (P = 0.06 in both cases). CONCLUSIONS: Exposure to HVAC systems was a strong and significant risk factor for otorhinolaryngologist attendance and sickness absence. HVAC systems are prevalent in recent office buildings and have been shown to be associated with several adverse health effects in terms of morbidity and mortality. From a public-health perspective, our results outline the need for a quantitative assessment of the health impact of ventilation systems, taking into account the possible loss of production that exists in addition to the direct costs of medical services use.     

Recruiting patients from a sexually transmitted disease clinic to sexual risk reduction workshops: are monetary incentives necessary?

Most patients attending urban STD clinics can benefit from workshops designed to promote sexual health and reduce sexual risk behaviors. However, many patients do not attend such workshops when invited. The purpose of this study was to evaluate the effects of providing a financial incentive on attendance at a sexual risk reduction workshop tailored to patients at an urban STD clinic. A quasi-experimental design with two conditions (incentive vs no incentive) was implemented sequentially with 107 STD clinic patients (58 men, 49 women; 69% African American; mean age = 27 years) reporting risky sexual behavior. Attendance at a subsequent sexual risk reduction workshop served as the key outcome. Results indicated that participants who were provided with a $30 cash incentive were more likely to attend the risk reduction workshop (38%) than participants who were not offered an incentive (9%), chi (1, N = 107) = 12.88, p < .001. Additional analyses confirmed that incentive (AOR = 7.59, p < .001) predicted attendance even after controlling for other significant predictors, namely, employment status (AOR = 3.04, p < .05) and age (AOR = 1.07, p < .05). We conclude that financial incentives are an effective way to increase attendance at sexual risk reduction workshops for at-risk urban populations.     

Psychosocial factors at work and sickness absence in the Gazel cohort: a prospective study

OBJECTIVE: To test whether psychosocial factors at work are predictors of rates of sickness absence. METHODS: The study population consisted of middle aged men and women employed by the French national electricity and gas company (EDF-GDF) in various occupations and followed up since 1989 by annual self administered questionnaires and independent data obtained from the medical and personnel departments of EDF-GDF. The 1995 questionnaire provided information about three psychosocial work factors: psychological demands, decision latitude, and social support at work. Sick-ness absence data were provided by the company's social security department. The occurrence of spells and days of absence in the 12 months after completion of the 1995 questionnaire was studied. Potential confounding variables were age, smoking, alcohol, and marital status, assessed in the 1995 questionnaire, and educational level and occupation, assessed from data provided by the personnel department. This study was restricted to the 12,555 subjects of the initial cohort who were still working and answered the self administered questionnaire in 1995. RESULTS: Low levels of decision latitude were associated with more frequent and longer sickness absences among men and women. Low levels of social support at work increased the numbers of spells and days of absence among men only. These associations weakened after adjustment for potential confounding factors, but remained significant. CONCLUSION: The study indicates that psychosocial factors at work, especially decision latitude, are predictive of sickness absence.

 

     

Work and family characteristics as socioeconomic determinants in long sickness absence: the Japanese civil servants study

Long sickness absence is more common among low socioeconomic status (SES) groups than high SES groups. This study aimed to evaluate whether work and family characteristics contribute to SES and sex differences in long sickness absence (7 days or more). The participants were 3080 civil servants working for a local Japanese government. In both sexes, low-grade employees were likely to take long sickness absence, with a statistically significant association for men (age-adjusted OR of lowest-grade employees for long sickness absence: 2.30 (95% Confidence Interval (CI): 1.32–4.02)). After adjusting for all variables, SES differences in long sickness absence in men decreased to OR 1.98 (CI 1.10–3.55) but remained significant; in men, being without a spouse was significantly associated with long sickness absence. Employees working long hours had lower OR for long sickness absence after adjusting for all variables in both sexes. Conversely, poor sleep quality and longstanding illness significantly increased OR for long sickness absence. In conclusion, SES differences in sickness absence were explained partly by work and family characteristics, longstanding illness, and poor sleep quality; however, other factors that were not evaluated in this study may also be associated with SES differences.     

Job decision latitude, organizational justice and health: multilevel covariance structure analysis

A total of 2969 hospital employees from 162 wards participated in a 2-year follow-up study that examined the relationship between job decision latitude, organizational justice and employee health in Finland. We used medically certified sickness absence records as indicators of health problems. Multilevel covariance structure analysis was applied to take into account the hierarchical nature of the data. Responses from individuals within work units seem not always to be independent, and any models that ignore this lack of independence may incorrectly estimate the between individual relationships. Our results suggest that both job decision latitude and organizational justice varied considerably between work units in addition to individual level variation. Furthermore job decision latitude was associated with organizational justice both at individual and work unit level. Justice evaluations predicted sickness absence only at the individual level.     

Using performance indicators to monitor attendance at the Broken Hill blood lead screening clinic

Although the average blood lead level of 1-4-year-old children in Broken Hill has halved since 1991, about 1 in 5 still have blood lead levels higher than the national target (<10 μg/dL). The estimated proportion of children attending the Lead Clinic has declined, to approximately 42% in 2006, raising concern that some children with elevated blood lead levels may not be presenting, thus missing out on appropriate treatment and advice. The aim of this study was to describe patterns of attendance at the clinic as a first step to understanding what factors contribute to clinic attendance and non-attendance. Routinely collected data from the Lead Clinic database were used to describe the impact of factors such as child age, the lead-risk area in which they live, seasonal influences and specific promotional activities on clinic attendance rates from 1999 to June 2007. Estimates of the number of children living in each of the five lead-risk areas were derived from 2001 and 2006 census data and estimates of the number of children born to mothers resident in Broken Hill were derived from the Midwives Data Collection. Attendance rates declined by approximately one-third during the study period. Younger children, and those living closer to the central mining area, were more likely to attend for blood lead screening. Cohort analysis indicated cumulative attendance has declined, with children born in 2005 having a cumulative incidence at 18 months of age 5-10% lower than that for previous birth cohorts. The majority (54%) of children who developed a notifiable blood lead level (15 μg/dL) were first detected at 2 years of age or older, a number of whom (40%) had no recorded tests before the age of 2 years. The analysis has demonstrated the benefits of using an expanded set of performance indicators to monitor the blood lead screening programme. It provides valuable additional information about the reach of the programme. Next steps include seeking additional feedback from carers and the broader community, developing a strategy to increase screening and monitoring the effectiveness of efforts to reinvigorate the lead management programme.     

Child health clinic attendance during the first two years of life

Attendance at child health clinics in three contrasting urban areas is described. Sociodemographic analysis of clinic attenders in the inner city area showed that families in poor socio-economic circumstance attended child health clinics more frequently than their more fortunate contemporaries during the first six months of life. Health visitor home visiting was a major determinant in clinic attendance rates.