Sickness certification in general practice: a review

Sickness certification is one of the most common tasks performed in general practice. This review describes and discusses concepts and terms used in earlier studies. 'Sickness certification' is defined, and related to the issues of 'absence from work' and 'sickness absence'. The use of measurements and results reported are emphasized according to patient- and doctor-related variables. Great variations are found, and some of the reasons may be differences in morbidity patterns, diagnostic procedures or sickness benefit acts. However, in studies from general practice, the number of sickness certificates is related to different denominators without describing the real population at risk, that is those of the patients who were employed or entitled to sickness benefits. Further studies are needed on the epidemiology of sickness certification, and the duration of the episodes. Analysis of the basis for the doctors' decisions, the patients' viewpoint, inter-doctor variations and doctors' attitudes should also be emphasized in the future. There is a need to discuss the reliability and validity of the measurements used, and theoretical considerations of the doctor's sickness certification practice are called for.     

Sickness absence with psychiatric disorders – an increased risk for marginalisation among men?

  Background: Sickness absence with psychiatric disorders is a major public health problem with serious consequences for the individual, the employer and society. The aim was to assess the occurrence of psychiatric sickness absence with special focus on sex differences. Methods: A nationwide sickness insurance register was used. Population at risk was defined as all individuals entitled to sickness benefits in 1994 (N = 1,978,030). Those who were sick-listed for more than 14 consecutive days with a psychiatric diagnosis (n = 28,799) were selected as cases. Results: Of the population under study, 1.46% had at least one psychiatric sickness absence episode. Women had twice the male cumulative incidence of sickness absence for a psychiatric diagnosis. Cumulative incidence was highest among those aged 45–59 years. Men had more sickness absence days. Depression was the most common diagnosis among both women and men. Conclusion: Increased efforts are needed to recognise, treat and rehabilitate individuals with a lowered work capacity due to sickness absence. The increased risk of long sick-leave spells among men needs further attention. Accepted: 22 March 2000     

Social factors of sickness absences and ways of coping: a qualitative study of men and women with mental and musculoskeletal diagnoses,Norway

The rate of sickness absence is a serious problem in Norway and Scandinavia as a whole. Musculoskeletal problems are a heterogeneous category, covering a spectrum from a broken back and diffuse muscle pains. Mental diagnoses constitute generally about 25–30% of the total number of the long-term sickness absences. It is thus important to document scientifically how and why participation in nature–culture–health (NaCuHeal) activities may prove beneficial for individuals with long-term illnesses. The purpose of our project is to focus on and to discuss how social factors influence sickness absence. There were two aims of this study: (a) to explore and reveal the absentees' own experiences and perceptions of sickness absence in daily life and (b) to explore and reveal the absentees' own perceptions and experiences of various coping strategies while being on sickness absence. Qualitative method through a pragmatic synthesis of elements of ethnography and grounded theory were used. The sample from the county of Oppland, Norway (n = 30), had a mental or a musculoskeletal diagnosis in accordance with the ICPC-2 medical classification system. In this study, men and women understand and interpret their health situation differently; most men in this sample have become ill due to work-related factors, and for women it seems to be the combined impact of domestic responsibilities and job strain, the so-called double exposure. Health-promoting nature and culture activities refuel their energy levels, which in turn help them to sustain their social network. A combination of various social activities seemed also to be beneficial as long as these activities could be personally chosen within their own time and space. This notion highlights the importance of a lay perspective on the illness experience and its connections to coping strategies. Combined with discussion of sickness absence as a phenomenon, we believe that our findings can contribute to a wider understanding of sickness absence, the complexity behind the outbreak of long-term illnesses and ways of coping in everyday life. This research may add important knowledge and insight, hence increase awareness and understanding of NaCuHeal benefits among health personnel and rehabilitation.     

Relation between health problems and sickness absence: gender and age differences--a comparison of low-back pain, psychiatric disorders, and injuries

Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).     

A dietary fibre supplement and weight maintenance after weight reduction: a randomized, double-blind, placebo-controlled long-term trial

Ninety-seven mildly obese females (BMI = 27.4 kg/m2) were in a randomized, double-blind, placebo-controlled trial treated for 52 weeks. The treatment consisted of a hypocaloric diet providing 5000 kJ/day (1200 kcal) and a dietary fibre supplement of 7 g/day for 11 weeks, (part I), followed by a diet providing 6720 kJ/day (1600 kcal) and a dietary fibre supplement of 6 g/day for 16 weeks (part II). Finally placebo was withdrawn and all still adhering subjects were given a dietary fibre supplement of 6 g/day and an ad libitum diet for the rest of the period (part III). Initial body weights were comparable, 76.9 +/- 0.8 kg in the fibre group versus 77.7 +/- 1.3 kg in the placebo group. During part I the weight reduction in the fibre group of 4.9 kg was significantly higher compared to that of 3.3 kg in the placebo group (P = 0.05). Accumulated weight reduction during part II was still significantly higher in the fibre group, 3.8 kg, compared to 2.8 kg in the placebo group (P less than 0.05). Total weight loss in the fibre group after 52 weeks was 6.7 kg. Probability of adherence to the treatment regimen was significantly higher in the fibre group from week 13 and onwards (P less than 0.01). Initial blood pressures were comparable. A significant reduction of systolic blood pressure occurred in both groups. A significant reduction of diastolic blood pressure occurred in the fibre group only, from 85.4 +/- 1.2 mmHg to 81.7 +/- 1.1 mmHg (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

Nature-culture-health activities as a method of rehabilitation: an evaluation of participants' health, quality of life and function

The dramatic increase in sickness absence and disability pensions in recent years are negative side-effects of our welfare society. Among others, people certified as long-term sick are offered participation in a programme of health-promoting activities (salutogenesis) in Asker, Norway. The aim of this study was to evaluate health, quality of life and function among participants included in a programme of community-based nature-culture-health activities. A qualitative evaluation study in 2003 included 30 men and 16 women aged 30-79 years old participating in 12 different health-promoting activities at the Nature-Culture-Health (NaCuHeal) Centre. The group activities were hiking, physical activities, gardening, music, singing, painting, dancing, dialogue groups for men or women, ethics, painting and local history. Around two-thirds of the participants reported to have improved their health status, quality of life and function, particularly when given the opportunity to utilize their own abilities and creativity. Belonging to a themed group seems to play a significant role in increasing self-efficacy and self-esteem. The majority of participants reported improved health, quality of life and functionality when considering returning to work due to their experiences in the NaCuHeal groups. Increasing the population's participation in health-promoting outdoor and cultural activities seem to be a useful method for enhance complete rehabilitation.     

The use of case histories to explore concepts of disease, illness and sickness certification

A questionnaire with 12 case histories was constructed to investigateviews on sickness certification and concepts of disease andillness among GPs and laymen. It was mailed to random samplesof 436 Norwegian GPs and 600 Norwegians, stratified for gender,age and residence. Response rates were low, 44% for doctors,and 54% for laymen, probably indicating that the method wasmore suitable for smaller surveys. Case histories could be usedto compare views of GPs and laymen on the concepts of diseaseand illness. They were also useful in examining views on sicknesscertification, but, in that case, they probably only revealwhat respondents thought should be done. From this study itwas not safe to conclude how often, and for what medical conditionsdoctors would issue sickness certificates in practice. ICPCwas useful for coding diagnostic suggestions, set by GPs, butwill be more useful after inclusion of criteria and more extensivesynonym lists.