A register has been built for planned epidemiological studies of sick-leave, containing all cases exceeding 6 days in a population of 184,000, over a period of 3 years. The diagnoses were coded from medical certificates. To assess the quality of this information this study reviews the medical certificates of 2,364 cases. In 299 cases the corresponding medical records are reviewed and independent diagnoses made. The coding and entering of data into the register is correct in 98% of cases. The independently-made diagnoses match exactly the ones registered in 50% of cases. When grouping the diagnoses into 39 groups, the match on group level is 72%. Ten percentage points of the mismatch are caused by specified overlaps between groups. The remaining 18% mismatch is caused mainly by different interpretations or unspecific labelling of the disease states, not so much by them being obscure in themselves or by doctor covering up unpleasant diagnoses.
A cross-sectional study was undertaken on 222 patients with rheumatoid arthritis (RA) within a Swedish health-care district. An exploratory analysis of functional status, according to a Swedish version of the Health Assessment Questionnaire (HAQ), was carried out in order to explore the extent and pattern of functional disability in an unselected group of individuals with RA. The mean score of functional disability according to HAQ increased with more clinical manifest disease. There were no significant differences between the mean score in men and women. Most functional disability was related to hand-grip function and the ability to take care of personal hygiene. Increased functional disability was significantly associated with increasing age and disease duration. There was no significant relation between functional status and housing condition and educational level. A strong correlation was found between pain and functional disability. Multiple regression analysis was performed and predictive functional scores were tabulated based upon sex, age at onset and duration of RA disease.
In order to get a better epidemiological base for preventive intervention in the county of Ostergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Ostergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.
The objective of this study was to provide an epidemiologic basis for planning community programmes preventing injuries during leisure physical activity, especially participation in sports. A total population survey of unintentional injuries was carried out in an area with a population of over 41,000. All sports injuries (n = 933) occurring within a 12-month period and requiring medical care were noted, giving a ratio of 22.5 per 1000 inhabitants. The majority of the injuries occurred in soccer (38.9%), followed by injuries in basketball/volleyball/handball (10.9%), and bandy/hockey (9.2%). The results correspond to previous studies in southern Scandinavia. In northern communities, the proportion of injuries in winter sports has been shown to be higher. Identification of these similarities and differences between the studies makes it possible to use the findings together in the design of general community-based sports injury prevention programmes suited to northern European conditions.
OBJECTIVES: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement. DESIGN: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness. SETTING: Out-patient clinic at the department of social medicine in tertiary care hospital. SUBJECTS: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found. MAIN OUTCOME MEASURES: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs. RESULTS: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.3 MSEK (600,000 Pounds). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (2,500,000 Pounds). The net present value of the programme at the 1991 price level was 27.5 MSEK (2,365,000 Pounds). CONCLUSIONS: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.
A cross-sectional study was performed upon a group of patients (N = 222) with rheumatoid arthritis (RA), from a Swedish health care district. The aim was to elucidate expectations and satisfaction with health care workers. The participants indicated that a good reception is more important than professional knowledge followed by the ability to inform about RA and the ability to show empathy. There was a trend towards increasing satisfaction with information about medical problems with severity of RA. This stands in contrast to the lack of such a systematic relation with regard to increasing functional disability as measured by the Stanford Health Assessment Questionnaire. Reasons for this could be that the physicians tend to respond more to clinical signs than to daily living restrictions. A relatively high percentage (around 80%) of the patients were satisfied with the surgical procedures offered to them. Only one third of the individuals felt that they had been involved in planning of treatment and discharge although a majority expressed this as very important. The importance of a continuous dialogue between patient and physician with regard to fulfillment of patient expectations is emphasized.
OBJECTIVES: The objective of this study was to analyze the variation of pregnancy-related sickness absence among employed women according to age, occupation, and degree of male-female domination within occupations. METHODS: Data from a prospective study of all new sick-leave spells exceeding 7 d in 1985 and 1986 in the county of Ostergötland, Sweden, were related to the population at risk, through the Swedish Medical Birth Register. The subjects included in the analysis were all 7000 employed women that gave birth in 1985 and 1986, of which some 3000 were sick-listed at least once with pregnancy-related diagnoses. RESULTS: There was little difference in the pregnancy-related sickness absence between the age groups. The age-standardized rate for sick leaves involving pregnancy-related diagnoses differed substantially between occupations. Women in the metal industry had the highest rates; those employed in administration, banking, and insurance had the lowest. White-collar occupations generally had lower rates and blue-collar occupations higher rates, with some exceptions (eg, in saw mills, farming, and the chemical industry). Gender-integrated occupations had the lowest sick-leave rate, while extremely male-dominated jobs had the highest. The latter association remained after adjustment for occupational area. CONCLUSIONS: There were considerable differences between occupational groups in the rates of sick leaves involving pregnancy-related diagnoses. Some differences were related to physical load of the jobs being done, but not all. It seems important to consider also male-female domination within a job with respect to such sick leaves.
Sickness absence during pregnancy has increased in Sweden as well as in other countries. STUDY OBJECTIVE--The study aimed to describe pregnancy related sickness absence and its increase from 1985-87; to consider if the increase were parallel to an increase in sickness absence for all diagnoses or could be explained by a higher birth rate; and to compare different ways of presenting sickness absence data. DESIGN--The data from a prospective incidence study of all new sick leave spells exceeding seven days in 1985-87 were related to the population at risk through relevant data from different registers. SETTING--The county of Ostergötland, Sweden (about 400,000 inhabitants). PARTICIPANTS--Subjects were approximately 70,000 sick leave-insured women aged 16-44 years, of whom some 15,000 had sickness absences > seven days. Some 4600 women gave birth in 1985, approximately 1300 of whom were listed as having pregnancy related diagnoses. MAIN RESULTS--The number of women with sick leave associated with pregnancy related diagnoses increased by 24% (95% confidence interval (CI) 15, 33%) during the period. This diagnosis group was one of the very few with an increasing number of people listed as sick. The corresponding increase for all diagnoses in women aged 16-44 years was