Health complaints and sickness absence in Norway, 1996-2003

BACKGROUND: From 1996 to 2003, the total number of sickness absence days increased by 65% in Norway. AIM: To investigate if this could be explained by a corresponding increase in the prevalence of self-reported health complaints in the same period. METHODS: Representative samples of the Norwegian working population in 1996 (n = 838) and 2003 (n = 637) answered the subjective health complaints (SHC) questionnaire. The single items of the SHC questionnaire were matched with the corresponding sickness absence statistics from the National Insurance Administration in 1996 and 2003. RESULTS: The main finding was a poor concordance between the change in prevalence of health complaints and the change in the prevalence of sickness absence for diagnoses corresponding to these complaints. The prevalence of health complaints in Norway was high and relatively stable from 1996 to 2003. The only complaints that increased in prevalence during the period were allergy and severe asthma. Sickness absence for health complaints, however, showed a general increase. The diagnoses with the largest percentage increase in sickness absence were sleep problems, tiredness, anxiety and palpitation, although the absolute number of individuals with sickness absence for these complaints was small. CONCLUSIONS: The increased sickness absence in Norway from 1996 to 2003 cannot be explained by an increase in health complaints in the general population in the same period. The increase in sickness absence is most likely to be explained by multifactorial causes, such as changes in working life and health expectations.     

Second-tier reviews of complaints in health and social care

There has been a flurry of recent government initiatives concerning how citizens should be able to take up grievances against the state. In the fields of health and social care, people have been expected to use internal complaints procedures to resolve grievances. Research in this area suggests that there have been problems with the existing complaints procedures and there has been particular criticism of the 'second-tier' review stage in both health and social care. This has led to the introduction of more independent means of review. Different models of review have been developed in England, Wales and Scotland. Based on a review of recent policy documents and legislative instruments, this article looks at recent changes and proposals and considers the relative merits of the different models in the three administrations.     

Work-related musculoskeletal health and social support

BACKGROUND: This review concerns the relationship between inequalities experienced at work with respect to social support (e.g. poor communication channels, unsatisfactory work relationships, unsupportive organizational culture) and work-related musculoskeletal ill-health. METHODS: Cross-sectional, case control and prospective studies, published between 1985 and 2003, that investigated this association were selected and reviewed. RESULTS: Studies varied greatly in the breadth of definitions of social support used and many measures were employed for the collection of data. There is good evidence for an association between poor social support and an increased risk in musculoskeletal morbidity. There is also limited evidence that poor social support is associated with musculoskeletal sickness absence, restricted activity and not returning to work after a musculoskeletal problem. A small number of studies have shown the effects of good social support and its importance in protecting against musculoskeletal ill-health and helping workers cope with problems. CONCLUSIONS: The overall findings of this review have implications for the design of proactive broad-based prevention programmes and organizational policies for the management of musculoskeletal ill-health and its potential outcomes, i.e. sickness absence and early retirement. Further research, using stronger study designs and more concise definitions of social support, to investigate the importance of social support in the amelioration of musculoskeletal ill-health is identified, e.g. the contribution of social support received away from the workplace.     

Importance of psychosocial work factors on general health outcomes in the national French SUMER survey

AIM: To examine the associations between psychosocial work factors and general health outcomes, taking into account other occupational risk factors, within the national French working population. METHODS: The study was based on a large national sample of 24 486 women and men of the French working population who filled in a self-administered questionnaire in 2003 (response rate: 96.5%). Psychosocial work exposures included psychological demands, decision latitude, social support, workplace bullying and violence from the public. The three health indicators studied were self-reported health, long sickness absence (>8 days of absence) and work injury. Adjustment was made for covariates: age, occupation, work status, working hours, time schedules, physical, ergonomic, biological and chemical exposures. Men and women were studied separately. RESULTS: Low levels of decision latitude, and of social support, and high psychological demands were found to be risk factors for poor self-reported health and long sickness absence. High demands were also found to be associated with work injury. Workplace bullying and/or violence from the public also increased the risk of poor health, long sickness absence and work injury. CONCLUSION: Psychosocial work factors were found to be strong risk factors for health outcomes; the results were unchanged after adjustment for other occupational risk factors. Preventive efforts should be intensified towards reducing these psychosocial work exposures.     

Cigarette smoking status and recurrent subjective health complaints among US school‐aged adolescents

Background Subjective health complaints are common among adolescents. There is evidence that girls are more likely to register complaints than boys. This study examines gender differences in the relationship between daily smoking and recurrent subjective health complaints in school‐aged adolescents in the USA. Methods A cross‐sectional design with a multistage probability sample was used to survey 13 339 middle and high school students (grades 6 through 10) with the US 2001–2002 Health Behavior in School‐Aged Children Survey. Results Recurrent subjective health complaints were higher for adolescents who smoke daily and experiment with cigarettes than for those who never smoke. In logistic regression analyses, the odds of daily smoking increased twofold for both boys and girls who report recurrent irritability/bad temper. For girls, the odds of daily smoking were higher among those who reported recurrent headache, stomachache and backache compared with never smokers. For boys only recurrent backache and feeling dizzy were associated with increased odds of daily smoking. Conclusions The relationship between recurrent subjective health complaints and daily smoking provides new insights into both conditions for school‐aged adolescents. Findings from this study suggest different patterns of association between daily smoking and recurrent subjective health complaints occur for girls and boys. Further studies are needed to explore causes and treatment of daily smoking and recurrent health complaints among school‐aged children.     

Interdisciplinary diagnostics in environmental medicine--findings and follow-up in patients with chronic medically unexplained health complaints

PROBLEM: In patients attributing their chronic, medically unexplained complaints to environmental factors the greatest challenge is to overcome their disabling belief in toxicogenic explanations. METHOD: Patients presenting with health complaints that they attributed to environmental causes in an environmental outpatient department (EOPD) within a university medical center in Germany were studied. An interdisciplinary review of previously diagnosed medical conditions, current clinical consultations, personal risk communication and therapeutic advice is presented. Additionally, patient contentedness, complaint development, and belief in environmental attribution in a follow-up interview are given. RESULTS: The open, prospective study comprises 51 patients reporting more than one complaint. Symptoms had lasted for more than 3 years in 63% of the cases. Seventy percent attributed their complaints to more than one environmental cause. The clinical diagnostic procedure reduced the number of prediagnosed clinical conditions by 50%. Numerous foregoing environmental laboratory analyses had overestimated toxicologically relevant findings. These were not confirmed in 80% (8/10) of the cases. In 8% (n = 4) of the patients a relevant environmental or occupational medical condition was found. A mental or behavioral condition was not considered to have first priority in explaining all complaints in 43% (22/51) of the patients. Among these, mostly respiratory or skin-related diseases were found. All patients contacted participated in a follow-up study after a minimum of 21 months. Sixty-seven percent reported having felt that they were taken seriously, 38% felt better after the beginning of the study, and 45% were no longer certain about the importance of the environmental attribution. Since 83% of the patients with a preceding residential diagnosis of MCS or SBS still believed in environmental causes of their complaints in the follow-up study, we conclude that these prediagnoses appear to be a risk for persisting attribution of the environmental factor. About one third (37%) of these patients with complaints that had not been medically explained by an organic condition during interdisciplinary diagnostics had meanwhile consulted a psychotherapist. CONCLUSIONS: Interdisciplinary diagnostics and scientifically based risk assessment in a specialized clinical center were effective and mostly well accepted by the patients and resulted in reduced attribution of complaints to environmental conditions. No indication was found that patients with complaints not medically explained by organic conditions were managed less successfully by this approach. Considering the high costs that these patients have previously caused, it appears valuable to apply an interdisciplinary diagnostic strategy.     

Low back pain and occupation among Irish health service workers

BACKGROUND: The health services sector has been identified as a high-risk work sector for low back pain (LBP) and related absenteeism. AIMS: To establish levels and predictors of LBP prevalence and associated sick leave among health service workers. To identify if levels of LBP or related absenteeism differ between occupational groups. METHODS: A postal survey using a standardized questionnaire and disproportionate random sampling of occupational groups was conducted at a single Dublin hospital. Overall hospital LBP prevalence and sickness absence were calculated using weighted analysis methods. Univariate analysis included the use of Chi-square, Fisher's exact and Mann-Whitney tests. Multivariate logistic regression techniques were used to explore for independent predictors of lifetime LBP prevalence and LBP-related sickness absence. RESULTS: An overall response rate of 62% (n = 246) was achieved. Lifetime, annual and point prevalence rates for the hospital employees were calculated at 46, 30 and 15.5%, respectively. No significant difference in prevalence was found between occupational groups but sick leave did differ with the highest level among general support and nursing staff. Multivariate analysis confirmed that occupation was an independent predictor for LBP-related sick leave (P < 0.05). CONCLUSIONS: LBP prevalence rates did not differ significantly between occupational groups but occupation was found to be an independent predictor of LBP-related sick leave. Involvement in manual handling did not predict either LBP or related sick leave.     

Occupational health in the European Union

Despite extensive legislation in the European Union, employees remain exposed to occupational risks and there is still a significant burden of work-related ill-health. The trend for more people to work in service industries rather than manufacturing has resulted in a change in the nature of risk and pattern of occupational illness. Worker access to occupational health services ranges from 15 to 96% and depends on the country in which employees live and the type of operation in which they work. The increasing number of small enterprises provides a particular challenge when trying to provide occupational health support to the European Union's 158.4 million workers. European law alone is not sufficient to improve the health of those at work and further action is needed at state, employer and professional level. New initiatives seek to improve the health of the Union's workforce, including a drive for better compliance with new law by every member state. Governments are working with key stakeholders through partnering strategies to develop innovative approaches for better access to quality occupational health services. Furthermore, targets for reduction in occupational ill-health have been identified. Where country laws do not mandate the provision of occupational health services, employers need to see the benefit of providing occupational health support. Finally, the medical profession is making procedures for self-regulation more rigorous and professional bodies are actively engaged in issuing professional standards and guidelines. Ultimately, the individual practitioner is responsible for ensuring that he or she develops and maintains the necessary knowledge and skills to provide competent services.     

Occupational health services in the UK--challenges and opportunities

BACKGROUND: A small minority of the UK workforce currently has access to an occupational physician. Reduction in the size of enterprises, the emergence of atypical work patterns and problems recruiting and training occupational health specialists risk making this minority even smaller. AIM: This paper considers the challenges currently facing occupational medicine and how we can improve access to occupational health services (OHS). It aims to highlight some of the diverse internal and external factors that restrict the UK's ability to provide all workers access to OHS. METHOD: A literature review was carried out and combined with awareness of current trends in business and new legislation together with provision of occupational medicine in other countries. RESULTS: Potentially controversial solutions that might help to make OHS more widely accessible were identified and are discussed. It is hoped that these will provoke further debate. CONCLUSION: Individually and organizationally, we must examine and improve capabilities if we are to improve worker access to OHS and deliver targets to reduce occupational ill-health. It is suggested that this requires a strategic shift to apply resources differently. There is need to explore delegation of tasks traditionally performed by doctors to nurses and other staff together with the outsourcing of non-core work. The increased use of telemedicine and the enhanced use of information technology for training, risk assessments, wellness programmes and questionnaire-based health assessments are other developments that should be explored.     

Occupational health provision and health surveillance in the semiconductor industry

AIMS: To identify the nature of occupational health provision in UK semiconductor-manufacturing plants. To identify the level of industry compliance with legal health surveillance requirements. METHOD: A national inspection programme was carried out by Health & Safety Executive inspectors using a developed protocol. RESULTS: A wide range of occupational health provision was identified from none to use of an accredited specialist. The majority of work was of a reactive nature even where there was specialist occupational health input. Seven companies were identified as not meeting legal compliance and one as having unacceptable compliance for health surveillance. CONCLUSIONS: The spectrum of occupational health provision was very wide. Where health surveillance was provided, it was poorly targeted with limited interpretation and feedback to management.     

Occupational health provision in UK universities

BACKGROUND: Very few studies have been done of occupational health provision across an entire employment sector and universities are particularly understudied. The British government published updated guidance on university occupational health in 2006. AIM: To describe the occupational health services to all the universities in the UK. METHODS: All 117 universities in the UK were included. Detailed surveys were carried out in 2002, 2003 and 2004 requesting self-completed information from each university occupational health service. This paper presents information on general characteristics of the service, staffing, services provided and outcome reporting. RESULTS: There was variation in the type of occupational health provision; half the universities had an in-house occupational health service, 32% used a contractor, 9% relied on the campus primary care or student health service and 9% had ad hoc or no arrangements. In all, 93 of the 117 (79%) universities responded to the detailed questionnaire, the response rate being higher from in-house services and from larger universities. There was a wide variation in staffing levels but the average service was small, staffed by one full-time nurse with one half-day of doctor time per week and a part-time clerical or administrative member of staff. A range of services was provided but, again, there was wide variation between universities. CONCLUSIONS: It is unclear if the occupational health provision to universities is proportional to their needs. The wide variation suggests that some universities may have less adequate services than others.     

Relations between Internet use, socio-economic status (SES), social support and subjective health

This study aimed to explore relations between Internet use, socio-economic status (SES), social support and subjective health. Participants were from representative samples between 15 and 80 years of age from seven different European countries. Two different survey datasets were used: (i) eHealth trends (eHT; N = 7934) and (ii) the European social survey (ESS2; N = 11248). Internet users who had used the Internet for health purposes were compared with Internet users who had not used it for health purposes. Structural equation modelling was used to assess the relationships between SES, Internet use, social support and subjective health. Use of other media was compared to Internet use in relation to social support and subjective health. Internet use was found to be more closely related to social support and subjective health than use of other media. Internet use was also found to be a plausible mediator between SES and subjective health, especially through interacting with social support.     

Occupational health in the Andalusian Fisheries Sector

BACKGROUND: The conditions of work in the fisheries sector are arduous with high rates of occupational accidents. Numerous factors are known that can directly influence the health of the sailor or fisherman both in fishing and merchant fleets. AIM: To evaluate the health status, safety and working conditions in the Andalusian fishing sector. METHODS: Cross-sectional questionnaire study with proportional sampling of the health and lifestyles of fishery workers in 19 of the 23 Andalusian ports. RESULTS: A total of 247 workers employed on 202 craft fishing boats responded. In all 87% of workers reported a current medical condition. The main problems reported were musculoskeletal disorders, respiratory diseases, diseases of the digestive system, eye problems and skin problems. A total of 72% reported taking some self-prescribed medication, and 60% of fishery workers smoked. Nine per cent of fishery workers admitted taking illicit drugs and 3% reported using illicit drugs on board. Diets on board were poorly balanced. While on board, 62% of crews reported a subjective significant worsening of previous health. The lifetime prevalence of accidents was 76%. CONCLUSIONS: Fishery workers had a high prevalence of self-reported medical problems, a high prevalence of self-medication, poor diets and frequently smoked. Self-medication and some medical conditions (diabetes, angina and depression) may reflect a potential failing of health checks and pre-employment checks. National health services and insurance companies dealing with occupational health should focus more on appropriate health checks, illness prevention and health promotion activities for this population.     

Relationship between self-reported low productivity and overtime working

OBJECTIVE: To investigate the relationship between overtime working and self-reported low productivity due to poor health over the course of 1 year. METHODS: The subjects were 94 random-sampled workers at a Japanese manufacturing company. The data on sickness absence and low productivity due to poor health were collected by self-report questionnaires every month from October 1999 to September 2000. Seventy-four workers returned complete answers. The complete data on overtime hours of forty-nine of these employees were obtained from company records. RESULTS: In those reporting low productivity, cold-like symptoms and sleep loss were given as the causes. Low productivity was closely linked to overtime worked, whereas sick leave tended to increase during periods of change in overtime working. CONCLUSION: Our results suggest the possibility of a relationship between overtime working and self-reported low productivity.     

Job demands, health perception and sickness absence

BACKGROUND: Investigation of the relations between job demands, health and sickness absence is required to design a strategy for the prevention of absence and disability. AIM: To study the relationships between (physical and psychological) job demands, health perception and sickness absence. METHODS: Prospective study of 414 male employees working in two organizations with low company absence levels. Job demands and health were examined using the Basic Occupational Health Questionnaire. Sickness absence was followed for 1 year thereafter. The number of days and episodes of absence were counted. RESULTS: The questionnaires of 247 workers (60%) were suitable for statistical analysis. Physical job demands (r = 0.41; P <0.01) and, to a lesser extent, psychological job demands (r = 0.16; P = 0.01) were related to the number of health complaints. Short (1-7 days) duration absence was neither related to job demands nor to the number of health complaints. Longer (>7 days) duration absence was positively related to psychological job demands and to the number of health complaints. CONCLUSIONS: Job demands, particularly physical demands, correlated with perceived health. Poor health predicted long-term sickness absence. Early recognition of poor health should be the basis of a strategy that prevents long-term sickness absence.     

Self-reported work-related health problems from the Oslo Health Study

BACKGROUND: Lack of knowledge about the occurrence of work-related health problems in the general population makes it difficult to estimate the potential for their prevention in the workplace. AIMS: To examine the prevalence of self-reported work-related health problems among adult citizens of Oslo, Norway. METHODS: The study was part of the Oslo Health Study 2000-2001, in which all individuals in certain age cohorts were invited to a comprehensive health screening. All 30-, 40- and 45-year old subjects who attended the screening were asked if they had experienced any of 11 common health problems in the past month, and whether they considered these to be work-related. Of the 26,074 invitees in these age cohorts, 8,594 (33%) answered the questionnaire. RESULTS: Nearly 60% of subjects reported one or more work-related health problems, most commonly reported were pain in the neck/shoulders (38%) and low back pain (23%). Neck/shoulder pain was most frequently attributed to working conditions, by 74% of subjects with this problem; followed by arm pain (72%), fatigue (51%) and low back pain (50%). Work-related fractions for eczema and asthma symptoms were 23 and 18%, respectively. There were marked gender differences, but small age differences. CONCLUSIONS: A substantial proportion of common health problems in the Oslo population were attributed to working conditions. This implies a large preventive potential and call for increased preventive efforts targeted at known risk factors in the workplace.     

Careful expressions of social aspects: How local professionals in high school settings,municipal services,and general practice communicate care to youth presenting persistent bodily complaints

Persistent health complaints pose communicative dilemmas in care encounters, adversely affecting patient experiences and pathways. Little is known about the impact and role of professionals in encounters with young people with incipient, debilitating, and persistent symptoms. This study aims to explore communicative dilemmas and the role of language in care provided by local professionals in high school settings, municipal services, and general practice to young people presenting persistent bodily complaints. The study is based on in‐depth individual interviews conducted from April to July 2016 with 12 professionals identified and selected during anthropological multi‐sited fieldwork in a Norwegian community. We identify two modalities of what we have chosen to call ‘careful expression’, used as strategies across professions to overcome communicative dilemmas. Professionals reflexively and pragmatically negotiated with the powers of language to influence illness experience and to enact empowered young subjects. These insights may prove relevant for future studies of care encounters while also indicating a critical attitude to institutional logics that affect care responses.     

The implementation of occupational health guidelines principles for reducing sickness absence due to musculoskeletal disorders

BACKGROUND: Occupational health guidelines recommend a biopsychosocial approach to manage sickness absence due to musculoskeletal disorders (MSDs), with a primary focus on early intervention through provision of a supportive network. AIMS: To investigate the implementation of a guidelines-based intervention (early contact of absentees; addressing psychosocial obstacles; offering temporary modified work; communicating among the players), and to determine whether this is effective for reducing return-to-work times and duration of future absence. METHODS: A non-randomized controlled trial was conducted within a UK company. Occupational health nurses at two experimental sites (1,435 workers) were trained to deliver the intervention to workers taking absence due to MSDs (low back and upper limb disorders), while usual care was delivered at three control sites (1,483 workers). Company-recorded absence data were collected over a 12-month follow-up period. RESULTS: The implementation of the experimental intervention was impeded by unforeseen organizational obstacles at one site (policies, procedures and individual approaches) which had a detrimental effect on uptake and delivery. At the site where the intervention was delivered per protocol, absence was significantly less compared with controls; 6.5 and 10.8 days, respectively. However, the duration of future absence was not significantly different (13.0 and 25.1 days, respectively). CONCLUSIONS: An early intervention addressing psychosocial obstacles to recovery can be effective for reducing absence due to MSDs. Successful implementation, where the key players are onside and organizational obstacles are overcome, is difficult to achieve.     

Occupational health in the USA in the 21st century

Comparable to the confusion encountered in the birth of the machine age is the perplexing reconfiguration of the United States' health care system. Paralleling the advances in medicine have been the divesting mergers and downsizing of industry, coupled with globalization, which have released millions of long-time workers. The labour contingent is changing, with the addition of great numbers of women and immigrant workers, and the manufacturing economy has become one of service and information. Serving the occupational health (OH) needs of such a force have been the professional societies of physicians, nurses, and industrial hygienists, with their members providing care in a broad variety of facilities. It is possible that a national organization, including all these disciplines, would have a greater voice in the protection of workers' health. Immediate leadership of an occupational health service (OHS) can be rotated among the disciplines, so that competition for primacy among the professionals would end. The new workforce demands culture sensitivity among OH personnel and polylingual capabilities may be demanded in the future. Management skills will be required of all in OH, and greater participation of employees in OH policy will characterize the decades ahead. Nearly neglected up to now, occupational mental health programming will be required to meet the real needs of workers, and to counter the move to outsource OH services, where little patient contact results. Behavioural safety, total quality management, and application of the rapidly developing technologies in health care will define the 21st century efforts in OH. Remaining issues, such as violence, telecommuting injuries, the inclusion of alternative medicine, and women's health, among others, will see carry-over for resolution into the year 2000.