Primary Healthcare Professionals’ Experiences of the Sick Leave Process: A Focus Group Study in Sweden

Purpose The aim of this study was to explore primary healthcare (PHC) professionals’ experiences of the sick leave process. Methods This is an explorative study using data from four semi-structured focus group discussions with a purposeful sample of PHC professionals in Östergötland County, Sweden. Content analysis with an inductive approach was used in the analysis. Results Four key themes emerged from the analysis; priority to the sick leave process, handling sickness certifications, collaboration within PHC and with other stakeholders, and work ability assessments. Patients’ need for sick leave was handled from each professional group’s perspective. Collaboration was considered important, but difficult to achieve and all the competencies available at the PHC centre were not used for work ability assessments. There was insufficient knowledge of patients’ work demands and contact with an employer was rare, and the strained relationship with the social insurance officers affected the collaboration. Conclusions This study highlights the challenges physicians and other PHC professionals face when handling the need for sick leave, especially when encountering patients with symptom-based diagnoses, and the influence of non-medical factors. Hindrances to good practice were increased demands, collaboration, and role responsibility. The challenges in the sick leave process concerned both content and consequences related to poor collaboration within PHC and with representatives from various organizations, primarily employers and social insurance officers. Further research on how to develop a professional approach for handling the sick leave process is needed.     

Multiple Social Roles,Health, and Sickness Absence—A Five-Year Follow-Up Study of Professional Women in Sweden

The aim of this study was to analyze associations between changes in social roles and physical health, mental well-being, psychiatric disorder, and long-term sickness absence over a five-year period. The study was part of a general population-based multipurpose project. Professional women from six birth cohorts born in 1935, 1945, 1955, 1965, 1970, or 1975 (N = 532) were interviewed twice. Self-rated information on physical health, mental well-being, long-term sickness absence, and changes in social roles was used. Information on psychiatric disorders was based on Diagnostic and Statistical Manual of Mental Disorders-III-R and Diagnostic and Statistical Manual of Mental Disorders-IV diagnoses. Multivariate logistic regressions were adjusted for age, socio-economic position, alcohol dependence and abuse, and health at baseline. An increase in number of social roles was associated with lower odds for poor mental well-being, odds ratio (OR) 0.4 (confidence interval [CI] 0.2 to 0.8), while a decrease was associated with higher odds for poor mental well-being, OR 4.5 (CI 1.8 to 11.0), psychiatric disorder, OR 2.6 (1.0 to 6.8), and sickness absence, OR 4.4 (1.6 to 11.7). The results indicated that an increase in number of social roles might be protective against poor mental well-being, while a decrease in number of roles might be related to increased psychiatric disorders and long-term sickness absence. More studies on long-term health implications of gender-specific experiences are needed.     

Suicide in married couples in Sweden: Is the risk greater in same-sex couples?

European Journal of Epidemiology - Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on...     

A cost-effectiveness analysis of lowering residential radon levels in Sweden—Results from a modelling study

PurposeResidential exposure to radon is considered as the second leading cause of lung cancer after smoking. The purpose of this study was to conduct a cost-effectiveness analysis of reducing the indoor radon levels in Sweden from the current reference level of 200 Bq/m³ to the WHO suggested reference level of maximum 100 Bq/m³.MethodsWe constructed a decision-analytic cost-effectiveness model using input data from published literature and administrative records. The model compared the increase in economic costs to the health benefits of lower indoor radon-levels in a Swedish policy context. We estimated the cost per life-year and quality adjusted life year (QALY) gained and assessed the robustness of the results using both deterministic and probabilistic sensitivity analysis.ResultsIncluding (excluding) costs of added life years the cost per QALY for existing homes was €130,000 (€99,000). For new homes the cost per QALY including (excluding) costs of added life years was €39,000 (€25,000).ConclusionsThe results indicate that it is not cost-effective to reduce indoor radon levels from 200 Bq/m³ to a maximum of 100 Bq/m³ in existing homes, whereas it is cost-effective for new homes.     

Foreign-Born Women's Experiences of Community-Based Doulas in Sweden—A Qualitative Study

We conducted 32 in-depth interviews with 20 rural, low-income, women residing in the United States who were pregnant (n = 12) or 3 months postpartum (n = 8) and had experienced intimate partner violence (IPV). Using purposive sampling and the grounded theory method, we generated a conceptual model of coping. The urge to protect the unborn baby was the primary influence for participants’ decisions about separating from or permanently leaving an abusive relationship. Implications include universal screening for IPV in child-bearing women, inquiry into maternal identity development during pregnancy, and improved resource access for rural, low-income women.     

Esophageal abnormalities and the risk for gastroesophageal cancers—a histopathology-register-based study in Sweden

European Journal of Epidemiology - The poor survival of patients with gastroesophageal cancers may improve if additional esophageal precursor lesions to Barrett’s esophagus and squamous...     

Suicide: a disturbing factor in the ‘development model’ of Kerala,India

Aim  

To report the prevalence and causes of suicide in Kerala, which is a well-developed Indian state in terms of better demographic and health indicators.     

Do Smoke Alarms Still Function a Year After Installation? A Follow-Up of the Get-Alarmed Campaign

The Get-Alarmed Campaign Follow-up Study was the second phase of an initiative to assure that homes of families at high risk of fire-related injury and death had functioning smoke alarms. Smoke alarms and/or batteries were installed in over 94 percent of 454 participating households in Schley and Henry Counties, Georgia, in 2000. Before the study began, 60.6 percent of these homes had smoke alarms, but only 36.6 percent had functioning smoke alarms. The follow-up study was designed to determine the experiences of participants with smoke alarms and whether participating households had functioning smoke alarms a year after baseline. Participants were phoned or visited and asked about their experiences with smoke alarms since the baseline study. During the interview, they were asked to test a smoke alarm, the results of which could frequently be heard. Respondents included 237 from Schley County and 113 from Henry County, for an overall 77.1 percent response rate. While 80.3 percent of respondents had a smoke alarm that was heard by the interviewer when it was tested, 6.6 percent reported that their smoke alarm had been disabled or had a dead battery. Over 75 percent of respondents had smoke alarm sound offs in the prior year, predominately due to cooking smoke, but only about 5 percent reported removing the battery or otherwise disabling it to prevent sound offs. However, the measures taken may render a household unprotected at a critical time. Efforts to increase protection with smoke alarms should be augmented with programs to insure adequate and timely testing and maintenance of existing smoke alarms.     

Intra-urban differences in breast cancer mortality: a study from the city of Malmö in Sweden

STUDY OBJECTIVE—To assess whether in an urban population stage at breast cancer diagnosis is related to area of living and to what extent intra-urban differences in breast cancer mortality are related to incidence respectively stage at diagnosis.DESIGN—National registries were used to identify cases. Mortality in 17 residential areas was studied in relation to incidence and stage distribution using linear regression analysis. Areas with high and low breast cancer mortality, incidence and proportion of stage II+ tumours at diagnosis were also compared in terms of their sociodemographic profile.SETTING—City of Malmö in southern Sweden.PATIENTS—The 1675 incident breast cancer cases and 448 deaths that occurred in women above 45 years of age in Malmö 1986-96.MAIN RESULTS—Average annual age standardised breast cancer mortality ranged between residential areas, from 35/10⁵ to 107/10⁵, p=0.04. Mortality of breast cancer was not correlated to incidence, r= 0.22, p=0.39. The ratio of stage II+/0-I cancer incidence varied between areas from 0.45 to 1.99 and was significantly correlated to breast cancer mortality, r= 0.53, p=0.03. Areas with high proportion of stage II+ cancers and high mortality/incidence ratio were characterised by a high proportion of residentials receiving income support, being foreigners and current smokers.CONCLUSIONS—Within this urban population there were marked differences in breast cancer mortality between residential areas. Stage at diagnosis, but not incidence, contributed to the pattern of mortality. Areas with high proportion of stage II+ tumours differed unfavourably in several sociodemographic aspects from the city average.     

Is the decline of the increasing incidence of non-Hodgkin lymphoma in Sweden and other countries a result of cancer preventive measures?

Is the decline of the increasing incidence of non-Hodgkin lymphoma (NHL) in Sweden and other countries a result of cancer preventive measures? The yearly age-standardized incidence of NHL increased significantly in Sweden during 1971-1990, for men an average of 3.2% and for women 3.1%. The corresponding figures for 1991-2000 were -0.8% and -0.2%, respectively. A decline of the increasing incidence has also been seen in other countries, such as the United States, Finland, and Denmark. Immunosuppression is one established risk factor for NHL, possibly with interaction with Epstein-Barr virus. Phenoxyacetic acids and chlorophenols, both pesticides, have been associated with NHL. Use of these chemicals was banned in Sweden in 1977 and 1978, respectively. Also, persistent organic pollutants such as polychlorinated biphenyls, hexachlorobenzene, chlordanes, and dioxins have been shown to increase the risk. Exposure of the whole population occurs predominantly through the food chain. Exposure to such chemicals was highest in the 1960s and 1970s. Because of regulation in the 1970s, exposure has declined substantially in the population. The change in incidence of NHL in Sweden and other countries may serve as a good example of how prohibition and limitation of exposure may be reflected in cancer statistics some decades later.     

Social capital and sense of insecurity in the neighbourhood: a population-based multilevel analysis in Malmö, Sweden

The aim of this study was to investigate the influence of social capital on self-reported sense of insecurity in the neighbourhood. The public health survey in Malm?, Sweden in 1994 was a cross-sectional study. A total of 5600 individuals aged 20-80 years were asked to answer a postal questionnaire. The participation rate was 71%. A multilevel logistic regression model, with individuals at the first level and neighbourhoods at the second, was performed. We analysed the effect (intra-area correlation, cross-level modification and odds ratios) of individual (social participation) and neighbourhood social capital (electoral participation in the 1994 municipal election) on sense of insecurity after adjustment for compositional factors. Neighbourhood factors accounted for 7.2% of the total variance in individual insecurity. This effect was marginally reduced when the individual factors were included in the model. In contrast, it was reduced by 70% by the introduction of the contextual variable. This study suggests that social capital, measured as electoral participation, may partly explain the individual's sense of insecurity in the neighbourhood.     

Breast Cancer Survivorship—Intersecting Gendered Discourses in a 5-Year Follow-Up Study

In this article the authors present a follow-up study of women's interview narratives about life 5 to 7 years after a breast cancer operation. The women had taken part in a study during the 6-month postoperation period. Art therapy contributed to well-being, including strengthening personal boundaries. In the new study, interview analysis informed by critical discursive psychology indicated three problematic discourses that the women still struggled with several years after the operation: the female survivor, the “good woman,” and individual responsibility. We concluded that many women with a history of breast cancer need support several years after their medical treatment is finished.     

Cost of unintended pregnancy in Sweden — a possibility to lower costs by increasing LARC usage

Objectives

The objective of this study was to determine the cost of unintended pregnancy (UP) in Sweden and savings generated by a switch of 5% of women from short-acting reversible contraception (SARC) and other methods to long-acting reversible contraceptives (LARCs).

Increased incidence of malignancies in Sweden after the Chernobyl accident—a promoting effect?

BACKGROUND: After the Chernobyl accident in 1986, as much as 5% of the released caesium-137 was deposited in Sweden due to a heavy rainfall 2 days after the event. A study of increased incidence of malignancies was initiated after the accident. METHODS: The cohort included 1,137,106 inhabitants who were 0-60 years old in 1986 and lived in 8 counties of Sweden with the highest fallout of caesium-137. With the dwelling coordinate, GIS-technique and a digital map on caesium-137, each individual was matched for the exposure. Adjustments were made for several potential confounding factors. During the follow-up 33,851 malignancies was recorded 1988-1999. RESULTS: Exposure categories were: 0-8 (reference), 9-23, 24-43, 44-66, 67-84, and > or =85 nGy/hr. The corresponding adjusted Mantel-Haenszel incidence rate ratios for total malignancies during follow-up amounted to 1.000, 0.997, 1.072, 1.114, 1.068, 1.125, respectively. The excess relative risk per 100 nGy/hr with the same adjustments and time period was 0.042 95% confidence limit 0.001;0.084. An excess for thyroid cancer or leukemia could not be ruled out. CONCLUSION: Increased incidence of total malignancies possibly related to the fallout from the Chernobyl accident is seen.     

Addendum to “Four-Year Follow-Up of a Randomized Controlled Trial of Triple P Group for Parent and Child Outcomes”

A previous article published in Prevention Science 3 years ago (Heinrichs et al. 2014) presented the results of a randomized controlled trial of the Triple P group program 4 years (FU4) after administration as a universal prevention approach in preschools. The present addendum resolves inconsistencies in outcome reporting (e.g., total scores of scales versus subscale scores) and provides information on measures that were additionally available to analyze further potential effects of the intervention. Effects in secondary outcome domains not reported in Heinrichs et al. (2014) are furthermore analyzed and reported. The original data analyses were varied using a different statistical model in this addendum. Re-analyses supported the original results, including changes in self-reported maternal and paternal positive parenting, in maternal dysfunctional parenting behavior as well as in maternal reports of child behavior. In addition, when analyzing the externalizing and internalizing dimensions, analysis revealed a statistically significant change in externalizing but not internalizing child symptoms. No significant intervention effects were found for secondary outcome domains. Considering important limitations in the study design [such as baseline differences at pre-assessment with mothers from intervention preschools reporting more child behavioral problems prior to introducing the intervention and predominantly non-significant effects from (a) fathers perspective, (b) teacher ratings at 1-year follow up (FU1), and (c) behavioral observations at FU1], we believe that this trial alone cannot be taken as sufficient evidence for a significant and meaningful change in child behavioral problems, which is the ultimate goal of child prevention programs. Therefore, future studies need to replicate and extend upon these results by including larger sample sizes and overcome the discussed limitations.     

Migration and mortality trajectories: a study of individuals born in the rural community of Överkalix, Sweden

Migration may result in exposure to factors that are both beneficial and harmful for good health. How the act of migration is associated with mortality, or whether the socio-economic condition of migrants prior to migration influences their mortality trajectory, is not well understood. In the present study, a cohort of 413 randomly selected individuals born in the rural community of Överkalix, Sweden, between 1890 and 1935 were followed from birth to either death or old age. Around 50% of the study-population moved away from Överkalix at one time or another. To adjust for a potential bias resulting from self-selection among the migrants, the father’s occupational status was used together with parents’ and grandparents’ longevity. Overall, migration could not be shown to predict mortality when the backgrounds of the migrants were taken into account. Nonetheless, socio-economic background conditions appeared to moderate the association, decreasing the mortality rates for migrants with relatively good pre-migratory socio-economic conditions, while increasing it for migrants with poorer pre-migratory conditions. However, further scrutiny revealed that this effect modification mainly affected the female migrants’ mortality. In conclusion, the study suggests that there is no general association between migration and mortality, but that migrants with better socio-economic resources are more likely to improve their mortality trajectories than migrants with poorer resources. Better pre-migratory conditions hence appear to be important for avoiding health-adverse circumstances and gaining access to health beneficial living conditions when moving to foreign environments – especially for women.