Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence

Purpose There is growing research evidence that workplace factors influence disability outcomes, but these variables reflect a variety of stakeholder perspectives, measurement tools, and methodologies. The goal of this article is to summarize existing research of workplace factors in relation to disability, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, “Improving Research of Employer Practices to Prevent Disability, held October 14–16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Predominant factors in the scientific literature were categorized as physical or psychosocial job demands, work organization and support, and workplace beliefs and attitudes. Employees experiencing musculoskeletal disorders in large organizations were the most frequently studied population. Research varied with respect to the basic unit of assessment (e.g., worker, supervisor, policy level) and whether assessments should be based on worker perceptions, written policies, or observable practices. The grey literature suggested that employers focus primarily on defining roles and responsibilities, standardizing management tools and procedures, being prompt and proactive, and attending to the individualized needs of workers. Industry publications reflected a high reliance of employers on a strict biomedical model in contrast to the more psychosocial framework that appears to guide research designs. Conclusion Assessing workplace factors at multiple levels, within small and medium-sized organizations, and at a more granular level may help to clarify generalizable concepts of organizational support that can be translated to specific employer strategies involving personnel, tools, and practices.     

Recurrence of Medically Certified Sickness Absence According to Diagnosis: A Sickness Absence Register Study

Introduction Sickness absence is a major public health problem. Research on sickness absence focuses on interventions aimed at expediting return to work. However, we need to know more about sustaining employees at work after return to work. Therefore, this study investigated the recurrence of sickness absence according to diagnosis. Methods We analyzed the registered sickness absence data of 137,172 employees working for the Dutch Post and Telecom. Episodes of sickness absence were medically certified, according to the ICD-10 classification of diseases, by an occupational physician. The incidence density (ID) and recurrence density (RD) of medically certified absences were calculated per 1,000 person-years in each ICD-10 category. Results Sickness absence due to musculoskeletal disorders had the highest recurrence (RD = 118.7 per 1,000 person-years), followed by recurrence of sickness absence due to mental disorders (RD = 80.4 per 1,000 person-years). The median time to recurrent sickness absence due to musculoskeletal disorders was 409 days after the index episode. Recurrences of sickness absence due to musculoskeletal disorders accounted for 37% of the total number of recurrent sickness absence days. For recurrences of sickness absence due to mental disorders this was 328 days and 21%, respectively. Unskilled employees with a short duration (<5 years) of employment had a higher risk of recurrent sickness absence. Conclusions Interventions to expedite return to work of employees sick-listed due to musculoskeletal or mental disorders should also aim at reducing recurrence of sickness absence in order to sustain employees at work.     

External Validation and Update of a Prediction Rule for the Duration of Sickness Absence Due to Common Mental Disorders

Purpose The objective of the present study was to validate an existing prediction rule (including age, education, depressive/anxiety symptoms, and recovery expectations) for predictions of the duration of sickness absence due to common mental disorders (CMDs) and investigate the added value of work-related factors. Methods A prospective cohort study including 596 employees who reported sick with CMDs in the period from September 2013 to April 2014. Work-related factors were measured at baseline with the Questionnaire on the Experience and Evaluation of Work. During 1-year follow-up, sickness absence data were retrieved from an occupational health register. The outcome variables of the study were sickness absence (no = 0, yes = 1) at 3 and 6 months after reporting sick with CMDs. Discrimination between workers with and without sickness absence was investigated at 3 and 6 months with the area under the receiver operating characteristic curve (AUC). Results A total of 220 (37 %) employees agreed to participate and 211 (35 %) had complete data for analysis. Discrimination was poor with AUC = 0.69 and AUC = 0.55 at 3 and 6 months, respectively. When ‘variety in work’ was added as predictor variable, discrimination between employees with and without CMD sickness absence improved to AUC = 0.74 (at 3 months) and AUC = 0.62 (at 6 months). Conclusions The original prediction rule poorly predicted CMD sickness absence duration. After adding ‘variety in work’, the prediction rule discriminated between employees with and without CMD sickness absence 3 months after reporting sick. This new prediction rule remains to be validated in other populations.     

The Effect of Medical Marijuana on Sickness Absence

Utilizing the Current Population Survey, the study identifies that absences due to sickness decline following the legalization of medical marijuana. The effect is stronger in states with ‘lax’ medical marijuana regulations, for full‐time workers, and for middle‐aged males, which is the group most likely to hold medical marijuana cards. Copyright © 2016 John Wiley & Sons, Ltd.     

Sickness Absence,Moral Hazard,and the Business Cycle

The procyclical nature of sickness absence has been documented by many scholars in literature. So far, explanations have been based on labor force composition and reduced moral hazard caused by fear of job loss during recessions. In this paper, we propose and test a third mechanism caused by reduced moral hazard during booms and infections. We suggest that the workload is higher during economic booms and thus employees have to go to work despite being sick. In a theoretical model focusing on infectious diseases, we show that this will provoke infections of coworkers leading to overall higher sickness absence during economic upturns. Using state‐level aggregated data from 112 German public health insurance funds (out of 145 in total), we find that sickness absence due to infectious diseases shows the largest procyclical pattern, as predicted by our theoretical model. Copyright © 2014 John Wiley & Sons, Ltd.     

The Association Between Self-Assessed Future Work Ability and Long-Term Sickness Absence,Disability Pension and Unemployment in a General Working Population: A 7-Year Follow-Up Study

Purpose Work ability is commonly measured with self-assessments, in the form of indices or single items. The validity of these assessments lies in their predictive ability. Prospective studies have reported associations between work ability and sickness absence and disability pension, but few examined why these associations exist. Several correlates of work ability have been reported, but their mechanistic role is largely unknown. This study aims to investigate to what extent individual’s own prognosis of work ability predicts labor market participation and whether this was due to individual characteristics and/or working conditions. Methods Self-assessed prognosis of work ability, 2 years from “now,” in the Stockholm Public Health Questionnaire (2002–2003) was linked to national registers on sickness absence, disability pension and unemployment up to year 2010. Effects were studied with Cox regression models. Results Of a total of 12,064 individuals 1466 reported poor work ability. There were 299 cases of disability pension, 1466 long-term sickness absence cases and 765 long-term unemployed during follow-up. Poor work ability increased the risk of long-term sickness absence (HR 2.25, CI 95 % 1.97–2.56), disability pension (HR 5.19, CI 95 % 4.07–6.62), and long-term unemployment (HR 2.18, CI 95 % 1.83–2.60). These associations were partially explained by baseline health conditions, physical and (less strongly) psychosocial aspects of working conditions. Conclusions Self-assessed poor ability predicted future long-term sickness absence, disability pension and long-term unemployment. Self-assessed poor work ability seems to be an indicator of future labor market exclusion of different kinds, and can be used in public health monitoring.     

Sickness Absence in Drivers of London Taxis and Buses

Sickness absence data for periods of 1 week or more among 2385London taxi drivers were analysed over a period of 1 year. Thereasons, in order of decreasing prevalence, were accidents,disorders of bone and movement, circulatory disorders, and respiratorydisorders. In order to place the absence rates of taxi driversin perspective, a comparison over the same year was made withsimilar sickness absence data for the total work force (12 639)of bus drivers for London Transport. It was found that the busdrivers incurred about 3 times as many days of sickness absence(22.1 days per person compared with 65 days for taxi drivers)and 4 times as many spells of absence (0.73 spells per personcompared with 0.16 spells for taxi drivers) as compared withtaxi drivers. The main reason for these differences was consideredto be due to the terms of employment including sick pay arrangementsof the two groups. Accepted        1 August 1981 Requests for reprints should be addressed to: Dr A. R. Erlam, Medical Centre, 201 Hamilton Road, Felixstowe, Suffolk, IP2 7DT.     

Shift and Day Work: A Comparison of Sickness Absence, Lateness, and other Absence Behaviour at an Oil Refinery from 1962 to 1965

Despite the increasing use of continuous process shift work in modern industry, few studies on the medical aspects of shift work can be found in recent literature of occupational health. Physiologists have shown that the ability of the body to adjust its circadian rhythms to alteration in hours of work or sleep can take up to a month. The usual type of shift work in industry involves weekly changes of hours, and thus on theoretical grounds at least this may not be the most suitable frequency for shift changes.

Sickness absence of male refinery workers has been studied over a four-year period. The figures show that continuous three-cycle shift workers have consistently and significantly lower rates of sickness than day workers in similar occupations. The annual inception rate (spells) standardized for age was 108% for shift workers and 182% for day workers, and the average annual duration per man was 11 days for shift workers and 18 days for day workers, although the average length of spell was slightly longer among shift workers. As far as is known, such a difference has not been described before in detail.

Age-related lateness and absenteeism have been measured and show similar wide differences between the two groups.

Although both types of worker are largely self-selected, the difference is not due to medical selection or to an excess of any one type of disease in day workers. Over three-quarters of 150 shift workers interviewed stated that they preferred shift work hours and that sleeping difficulties were not common.

It is suggested that the main reasons for the difference between shift and day workers' sickness absence lie in the degree of personal involvement in the work and in the social structure of the working group.

     

Sickness Absence Among Forestry Workers in the North of Scotland, 1958

The sickness absence records of 1,115 forest workers in the highlands of Scotland during 1958 were examined. Only absences of four days or more were considered. Two hundred and seventy of the workers were established and were therefore entitled to retirement pensions. There was a high proportion of older men among the established workers; but the sickness record of these men was generally better than that of the unestablished workers except in respect of cardiovascular disease, rheumatism, and arthritis.

Among forest workers as a whole, accidents off duty accounted for more sickness absence than accidents on duty, a reversal of the finding in the male working population at large. The second most important cause of sickness absence was back troubles of all kinds. Among the male working population at large the second most important cause of absence was bronchitis, a disease which among forest workers comes 13th on the list.

A comparison was made between the sickness absence record of the highland forest workers and a group of telephone construction gang hands performing broadly comparable work (as regards health hazards) in the same area but whose members were drawn from more urban homes. In general fewer forest workers than telephone gang hands went sick in 1958 for all common ailments except cardiovascular disease, a finding perhaps related to the greater average age of forest workers. When this difference in age was allowed for it was found that the greatest difference between the two groups of sickness records was in bronchitis, cardiovascular disease, and peptic ulcer and gastritis, in that order, and was to the advantage of the forest workers. Next came the upper respiratory tract infections. The least difference was in accidents, septic conditions, and rheumatism and arthritis.

     

Accuracy of Symptom Perception in Asthma and Illness Severity

The inaccurate perception of airway obstruction is a risk factor in fatal asthma and a common problem in asthma management. Perceptual inaccuracy often has been attributed to airway pathophysiology. Accuracy is defined in terms of airway obstruction, reflected in lung function. The accuracy of symptom perception was investigated during induced airway obstruction. In Experiment 1, 30 children and adolescents with asthma underwent a histamine provocation test. In Experiment 2, 64 children and adolescents with asthma and 30 without asthma performed a physical exercise task. Ages ranged from 7 to 18 years. Lung function and self-reported dyspnea were measured in parallel. The results showed that dyspnea reporting was independent of lung function (Forced Expiratory Volume in 1 sec), asthma severity, and airway hyperresponsiveness. Participants with asthma but without airway obstruction reported significantly more dyspnea than controls. It was suggested that dyspnea is a highly subjective experience with its magnitude determined by psychological and situational factors rather than airway pathophysiology.     

The Health of Welders in Naval Dockyards: the Work Situation and Sickness Absence Patterns

Welding processes used in Her Majesty's Dockyards are describedin terms of materials, worksites and expected patterns of exposure.Absence attributed to sickness by welders and men in two controlgroups during a 5-year period has been studied in terms of frequencyand severity. Differences between welders and controls withrespect to age and smoking habits have been considered. Dataon manpower turnover, selected employment, medical dischargesand deaths during employment are presented. It is concludedthat there is no evidence of an excess of absence among welderswhich can be attributed to respiratory or other disease causedby welding pollutants, but that these pollutants may promptwelders with respiratory disorders to be absent more readilythan controls. Requests for reprints should be addressed to: Surg. Lt Cdr G. H. G. McMillan, Dockyard Medical Centre, HM Naval Base, Gibraltar.     

Sickness Absence and Control of Insulin-treated Diabetes as Assessed by Glycosylated Haemoglobin

The sickness absence records for 1986 were obtained for 63 employedinsulin-treated diabetic patients who had glycosylated haemoglobin(HbA1) measurements during that year. One subject whose absencewas associated with attempts to improve control because of pregnancywas excluded from the analysis. Fifteen had good control (HbA18.5 per cent or less) and 47 had poor control (HbA1>8.5%).The groups were similar for age, sex, duration of diabetes andoccupation. The distribution of sickness absence showed greaterfrequency of absence (p<0.05), greater number of workingdays lost (p<0.02), and greater average duration of absence(p<0.04) among those diabetic workers with poor control comparedto those with good control. Because some individuals with poorcontrol had no absence, HbA1 measurement cannot be recommendedon its own to identify those workers who will be absent fromwork. Its use may lie in indicating a level below which sicknessabsence is minimized. Requests for reprints should be addressed to: E. R. Waclawski, Institute of Occupational Medicine Ltd, 8 Roxburgh Place, Edinburgh EH8 9SU, UK     

Benefit Duration and Return to Work Outcomes in Short Term Disability Insurance Programs: Evidence from Temporary Disability Insurance Program

Purpose The Workforce Innovation and Opportunity Act strengthens the vocational rehabilitation program’s focus on providing early intervention services to keep workers with disabilities in the workforce. At the same time, some have suggested that short-term disability insurance (STDI) programs may hold promise as an early intervention service, helping people with disabilities stay in the labor force and avoid needing longer-term benefits. Rhode Island is one of five states with a mandatory STDI program. We examine the extent to which Rhode Island STDI claimant characteristics are correlated with partial return-to-work (PRTW) benefit receipt and certain STDI benefit receipt duration measures.Methods Our study used administrative data from 2011 to 2014 to explore Rhode Island’s STDI program—called the Temporary Disability Insurance program—and regression analysis to estimate the correlations of interest. Results Regression adjusted estimates revealed that claimants opting to receive PRTW benefits earned more and received benefits for fewer weeks than claimants opting to not receive PRTW benefits. We also observed significant correlations between duration of benefit receipt and claimant characteristics such as diagnosis and treating healthcare provider specialty. Conclusions Findings suggest that STDI claimants with certain characteristics are more likely to receive benefits for a long duration or not receive PRTW benefits, signaling that they might benefit from early Vocational Rehabilitation supports and services that would allow them to remain productive members of the workforce and avoid long term benefit receipt.     

Body Composition in Multiple Sclerosis Patients and Its Relationship to the Disability Level,Disease Duration and Glucocorticoid Therapy

Background: Patients with multiple sclerosis (MS) have many potential factors (spasticity, immobilization, glucocorticoids use) for the deterioration of body composition. Aim: To assess the nutritional status (by classical anthropometry and by bioelectrical impedance analysis (BIA)) in MS patients and to correlate it with clinical state, MS duration time and the presence of glucocorticoid therapy in anamnesis (ever used). Methods: Anthropometrical (BMI and waist and hip circumferences, waist-to-height ratio (W/HtR), and waist-to-hip ratio (WHR)) and body composition (BIA) data were evaluated in 176 patients with MS. Fat mass (FM), and fat-free mass (FFM) were expressed as kilograms (kg), percentage (%) and indexes (FMI: fat mass index, FFMI: fat-free mass index) expressed in kg/m². The median Expanded Disability Status Scale score was 4.5. Patients were then divided according to EDSS score as mild (EDSS 1.0–4.0) or moderate (EDSS 4.5–6.5) disability subgroup. Results: Waist c., WHtR, WHR, and FM% were significantly higher in the moderate MS group (p < 0.01; p < 0.001; p < 0.001; and p < 0.05, respectively). Whilst, FFM% was significantly lower (p < 0.05). BMI did not correlate significantly with any disability status score and MS time. Significant correlations were observed between EDSS, ΔEDSS and MS time and Waist c., WHtR, WHR, FM% and FFM%. WHtR had the strongest significance (p < 0.0001 vs. EDSS; p < 0.0001 vs. ΔEDSS; and p < 0.01 vs. MS time, respectively). After the adjustment to the MS time, only FM% was no longer significantly related to both EDSS and ΔEDSS. MS duration time, EDSS, ΔEDSS, WHtR, FM(kg), FM%, and FMI were significantly higher in the patients with a positive history of glucocorticoid therapy (all p < 0.05). Whilst, FFM% was significantly lower in MS patients treated with glucocorticoids (p < 0.01). Conclusions: Greater disability in MS patients is strongly related to lower fat-free mass and higher fat mass, especially with the abdominal distribution, irrespective of the duration time of the disease. Oral glucocorticoid therapy seems to have a negative impact on the body composition of MS patients. However, further prospective multifactorial studies in this field have to be done. For the proper assessment of nutritional status in MS patients, Waist c., WHtR, WHR, or body composition parameters seem to be of greater use than BMI.     

Health and Sickness Absence in Denmark: A Study of Elderly-Care Immigrant Workers

The objective of this study is to investigate patterns of sickness absence in light of health status among immigrants. Cross-sectional data from 2005 was used and the study population consisted of 3,121 healthcare assistants and healthcare helpers working in the elderly-care sector in Denmark. A multinomial logistic regression was employed to investigate the relationship between health indicator, sickness absence and being an immigrant. Our findings show that, on one hand, immigrants have worse health status, but on the other, they have significantly lower sickness absence than their Danish counterparts, even after factors such as age and gender are controlled for. The results show that the relationship between being an immigrant and sickness absence differs according to health status. Our findings are in line with Steer and Rhode’s theoretical framework, according to which attendance to work is a function of ability and motivation to be at work.     

环境高温对晕动病发病机制的影响

目的探讨常温与高温环境下晕动病生病的差异。方法261名18～20岁男性军校学员作为受试对象。经体检和“军人体能标准”测试均合格者,分别在20℃常温与38℃高温环境下以科里奥利（Coriolis）转椅诱发晕动病,以格瑞比尔（Graybiel）法评定晕动病程度。结果常温和高温环境下受试者格瑞比尔评分分别为6．53&#177;7．36和7．55&#177;6．75（z=2756．5,P=0．0025）,常温和高温环境下受试者格瑞比尔等级人数,从无症状（N）到极度重症（IV）分别为。46人、37人、47人、62人、39人、30人和47人、37人、30人、32人、51人、64人（z=2410．50,P=0．000．7）。结论高温与常温环境相比．更容易发生晕动病。而且晕动病等级更高。