Comparison of seven measures of sickness absence based on data from three counties in Sweden

The objective was to compare the applicability of and results provided by the two measures of sickness absence used most often within the Swedish social insurance administration (that is, unadjusted sick-leave rate and adjusted sick-leave rate) and five measures suggested by epidemiological researchers. Data consisted of four cross-sectional data sets of registry sick-leave data covering four separate years (1997-2000) in three counties. In total 454,000 persons qualified for sickness insurance and aged 20-64 years were included. The two measures used within the social insurance administration and three of the five measures suggested by epidemiological researchers revealed sex-related dissimilarities in absence patterns that indicated that women had more sickness absence than men. However, in marked contrast to those results, two of the epidemiologically based measures (i.e., length of sickness absence and duration of sickness absence) instead showed highly comparable rates of sick leave for men and women, and such information is seldom obtained, albeit definitely of importance, when trying to make a correct assessment of sickness absence. The measure of sickness absence that is used influences the findings and should therefore be chosen with care. Complementing the measures used in the social insurance administration by five measures suggested by epidemiological researchers provided a more informative and comprehensive picture of sickness absence in a population. Further investigations into the effect of using different measures is needed, as well as international consensus on what to call different measures.     

A comparison of perceived health, attitudes to work, leisure time, and social welfare systems among people in a rural area in the north of Sweden and among people in the city of Stockholm

A problem attracting considerable attention in Sweden today is the substantial regional differences in sickness absence. The aim of the study was to investigate and compare how people, from a random sample of the population in both a rural area in the north of Sweden and the Swedish capital Stockholm, perceive their health, and what their attitudes are to work, leisure time and social welfare systems. Results showed that a larger proportion of those answering in Stockholm considered their health status to be "very good", compared with those in the rural area (p<0.0001). A majority in the rural area compared to the city of Stockholm reported a high or very high level of aches/pain (p<0.0001) and that work causes them physical problems p<0.0001). The population in both Stockholm and the rural area is of the opinion that the increase in sickness absence is mainly due to deterioration in the work environment. Almost half of the individuals in both the rural area and in Stockholm are of the opinion that many of those sick-listed are not actually ill. It may be that in the rural area in north Sweden people are more inclined to put their opinions to practice than those in Stockholm are.     

A new model for vocational rehabilitation at an organizational level -- a pilot study with promising results

Sick leave has negative economic consequences for companies. The aim of this study was to implement the model Organizational Rehabilitation in two departments at an industrial company in the county of J?mtland, Sweden, to see if it was possible to reduce the costs due to sick leave. The rehabilitation model consisted of three steps and combined economy and productivity with a good psychosocial work environment, measuring the result in costs. Step 1 consisted of a problem inventory among all co-workers, step 2 semi structured interviews with all co-workers regarding how they experience their work environment and step 3 individual agreements regarding rehabilitation interventions, i.e. interventions where the individual's specific needs and wishes outlined the foundation for rehabilitation measures with the objective of increasing work capacity. The costs were measured at the start and end of the project. The study showed that it is indeed possible to reduce both sick leave and costs. During the study, the organization reduced current sick leave from 12% (2003) to 3% (Nov. 2004) and the costs per employee from euro1 860 per month (2003) to euro440 per month (Nov. 2004). This will make an estimated saving for 2005 of euro470 000. It should be noted that the study is small and should not be generalized, but may be seen as a positive indication regarding the model organizational rehabilitation. Further research is needed.     

Internal locus of control and vocational rehabilitation

In previous studies, internal locus of control (ILC) has been pointed out as a key factor for return to work after vocational rehabilitation. The aim of the current study was to gain a deeper understanding of the concept of ILC in a Swedish vocational rehabilitation context. The study was based on data from 347 long-term sick-listed clients collected at the onset of vocational rehabilitation. A first bi-variate analysis showed that ILC was positively associated with physical functioning and general health, and negatively associated with bodily pain. The analysis also showed that women, more than men, reported high internal locus of control. After a second multivariate analysis, only bodily pain remained associated. It is concluded that there exist a strong and negative association between bodily pain and internal locus of control. Clients with severe pain often also suffer from low internal locus of control. This should be kept in mind when providing vocational rehabilitation.