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1.  Sickness Absence in the Three Principal Ethnic Divisions of Singapore 
Records of sickness for all industrial employees of H. M. Dockyard, Singapore were analysed over a calendar year, 1955-56, with a view to producing a standard rate for sickness absence in the three main ethnic divisions of this area, with particular reference to age.
Other factors, such as form of grade of employment and residence, were considered in order to test their effect, if any, upon sickness absence. The principal diagnostic groups were separated to give a general picture of the trends of sickness.
The reactions of Chinese, Indians, and Malays to disease or to any of the associated factors were found to be totally dissimilar, and the possibility of this being due to chance is so slight as to be negligible.
Comparisons are subsequently made with the one rather scanty record of another organization in South East Asia, and with detailed modern analyses of sickness absence in England. Again it is found that absence rates for inceptions per 1,000 workers and days lost per worker differ entirely both as regards the total and individual disease groups and also in the effect of age. It is evident that the ethnic grouping of the population concerned must be taken into consideration in studies of sickness absence.
PMCID: PMC1038168  PMID: 13880579
2.  Individual Variations in Sickness Absence 
Records of personal sickness absence, including all spells of one day's duration or more, have been kept at this refinery for more than 20 years. The distributions of sickness spells and also calendar days of absence have been analysed for single years and also for periods of up to 20 years' continuous service for the 1,350 hourly paid male employees. It is shown that both these measures of sickness absence are distributed among the men in an unequal fashion (negative binomial) rather than at random (Poisson) and thus resemble the distribution of industrial accidents first described almost 50 years ago. This pattern of distribution is not related to occupation or to length of service. Analysis of the distribution of lateness and absenteeism for reasons other than sickness or holidays shows that these also follow this pattern. It is postulated that this could be a principle applicable to all forms of industrial absenteeism as well as to accidents.
The personal records of 187 men with continuous service from 1946 to 1965 have been studied to investigate the trends in their sickness absence over this 20-year period. In contrast to the well-recognized pattern that in any one period of time young men have more spells of absence than their older fellows, this secular study shows that sickness spells have not decreased with age. This apparent paradox is explicable by the rising national trend in sickness absence and by a high labour turnover in young men with frequent sickness spells.
PMCID: PMC1008578  PMID: 6028712
3.  Short-term absence from industry: II Temporal variation and inter-association with other recorded factors 
Froggatt, P. (1970).Brit. J. industr. Med.,27, 211-224. Short-term absence from industry. II. Temporal variation and inter-association with other recorded factors. This paper (a) extends the previous analysis (Froggatt, 1970b) of short-term absence from work among groups of male and female industrial personnel and clerks in government service, and (b) studies other recorded variables, particularly lateness, long-term sickness absence, and passes from work both `medical' and `works'.
Multiple regression shows one-day absences to be generally associated with two-day absences, lateness, and medical passes but independent of works passes and long-term sickness absence; and two-day absences to be generally associated with one-day absences and long-term sickness absence but not with lateness or passes from work. Higher order correlations show lateness and works passes, medical passes and works passes, and lateness and age to be (weakly) associated, the last negatively.
Irrespective of season, one-day absences were consistently most prevalent on Monday and least so on Friday, with a subsidiary peak for the male groups on Wednesday; two-day absences - as measured by the day each absence starts - were consistently most prevalent on Monday and least so on Thursday (Friday was omitted) and during the summer months. Medical passes were generally independent of the day of the week and the period of the year; lateness was greatest on Friday and during the winter, though the increase was slight; but works passes were relatively prevalent on Friday.
Correlation and regression show the association between numbers of one-day absences taken in two periods of time (each one year) to be marked (r = 0·5 to 0·7), unaffected by transforming to normal functions, and explicable on a linear hypothesis, but the value of r to increase as the periods of time increase and to decrease as the interval between the periods of time lengthens. Similar analyses for two-day absences show r = 0·25 to 0·55, acceptance of a linear hypothesis, and a suggestion that the value of r may increase as the periods of time increase and as the interval between them shortens. More limited examination shows corresponding values of r (for contiguous years) to be of the order 0·25 for medical passes, 0·60 for works passes, but > 0·80 for lateness.
Values of r between each of these factors in turn for all possible pairs of days of the week are reasonably consistent and show r of the order 0·35 for one-day absences, 0·25 for medical passes, 0·40 for works passes, and 0·80 for lateness (values for two-day absences are irregular and in the range 0 to 0·4). The consistency of lateness experience over days and years is very marked, the correlations being among the highest recorded for any event involving human behaviour.
The importance and application of the findings are briefly discussed; detailed consideration is reserved for the third and last paper.
PMCID: PMC1009136  PMID: 5448119
4.  Sickness absence and early retirement on health grounds in the construction industry in Ireland 
OBJECTIVE—To establish a detailed pattern of the nature and extent of illnesses and injuries among construction workers in Ireland which cause temporary absence from work, and to identify diseases and disabilities which lead to premature retirement from the industry on health grounds.
METHODS—The population base for the study consisted of construction workers who were members of the Construction Federation operatives pension and sick pay scheme. Records of sickness absence since 1981, stored on computer disks, and records of early retirement on health grounds since 1972, stored on microfiche film, were examined. Pertinent data were extracted and transferred to a database; after cleaning and the exclusion of unvalidated data, records of 28 792 absences and 3098 records of early retirement were available for analysis. Data were analysed with Access 97 and Epi Info.
RESULTS—Over the period of the study the mean annual absences were 7.8/100 workers. Three quarters of absences were among younger workers; however, the rate of absence increased with age, as did the mean duration of absence. Injury was the most frequent reason for absence, followed by infectious disease, then musculoskeletal disorders. The mean annual rate of early retirement on health grounds was 5.3/1000 workers. The median age at retirement was 58 years. Cardiovascular disease and musculoskeletal disorders each accounted for nearly one third of the conditions leading to permanent disability on the grounds of which early retirement was granted. During the period of the study, over 677 000 working days were lost due to sickness absence, and over 24 000 potential years of working lives were lost due to early retirement on health grounds.
CONCLUSIONS—The study has shown patterns of sickness absence and early retirement on health grounds in the Irish construction industry which will contribute to the further development of health promotion strategies for construction workers.


Keywords: construction industry; sickness absence; early retirement
doi:10.1136/oem.57.9.615
PMCID: PMC1740016  PMID: 10935942
5.  Validation of sick leave measures: self-reported sick leave and sickness benefit data from a Danish national register compared to multiple workplace-registered sick leave spells in a Danish municipality 
BMC Public Health  2012;12:661.
Background
Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave.
Methods
Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used.
Results
The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).
The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 – 95.5) % and 58.5 (95% CI: 51.1 – 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 – 88.6) % and 98.9 (95% CI: 98.3 – 99.3) %.
Conclusions
The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy-related sick leave should be excluded in studies planning to use DREAM data on sickness benefit. Self-reported sick leave became more imprecise when number of absence days increased, but the sensitivity and specificity were acceptable for lengths not exceeding one week.
doi:10.1186/1471-2458-12-661
PMCID: PMC3511193  PMID: 22894644
Agreement; Eldercare sector; Public transfer payment; Register data; Self-report; Sensitivity; Sick leave; Specificity; Validation; Workplace record
6.  Studies on influenza vaccine in industry 
Postgraduate Medical Journal  1973;49(569):169-174.
Large scale studies of influenza vaccination in industry have recently been started. The studies are of two types:
(a) Vaccination was offered to a factory and a record maintained of sickness absence of all employees, both the vaccinated volunteers and the non-volunteers. In five different factories, the average acceptance rate was 42%.
An analysis of the volunteers in one factory indicated that acceptance of vaccination was highest in middle-aged married women and low in younger and older men.
(b) In the Post Office telecommunications branch vaccination was offered to 26,317 employees in eighty-eight units in different parts of the country; 42% of these accepted vaccination. Ninety-eight other units, employing 25,202 employees, are acting as unvaccinated controls. Sickness absence is being recorded in both groups of units.
In both these groups of studies it is aimed to compare the absence experience of the immunized and non-immunized groups for a prolonged period, both when influenza is and is not occurring.
Preliminary findings are presented of the absence figures for January and February 1972, during which time a mild outbreak of influenza occurred, with only a small effect on sickness absence. Vaccinated persons in factories had lower absence rates than the non-vaccinated persons, and telecommunications units in which vaccination was offered experienced lower absence rates with less respiratory absence.
The significance of these findings is discussed.
PMCID: PMC2495387  PMID: 4802598
7.  ANALYSIS OF ABSENTEEISM IN INDUSTRY 
California Medicine  1959;91(6):348-354.
There are many nonmedical factors that contribute to employee absenteeism in industry. An employee's total life situation or total environment may be a causative factor in excessive “sick absenteeism.” In many instances the cure for “abnormal” sickness absenteeism is within the province of supervisory personnel, who should look upon abuse of sick leave benefits among employees as morale problems and as evidence of possible maladjustment to the demands of the job or the industry. There are, however, many problems in mental and physical health affecting absence rates in which preventive psychiatry and medicine can make greater contributions. Even truancy and malingering may sometimes be conditions requiring professional medical care.
The role of a private physician in determining and certifying the true state of a patient's health is a most important one economically to industry and the community. The total problem of absenteeism for sickness, as it exists in industry today, points up the need for the most effective cooperation and communication possible between industrial and private physicians. Since no more than 25 per cent of the total work force is employed in industries having in-plant medical programs, the burden of responsibility for the control of absenteeism for sickness rests mainly with private practitioners.
PMCID: PMC1577980  PMID: 14418976
8.  Personal Factors Associated with Sickness Absence: A Study of 194 Men with Contrasting Sickness Absence Experience in a Refinery Population1 
Men with different patterns of sickness absence behaviour have been identified from a refinery population by simple epidemiological techniques. A detailed clinical study is described of four groups: 56 men with five or more sickness spells in 1964 and a matched control of 56 men; 35 men who had 60 or more days of sickness absence in 1964; and finally 47 men who had not had one day off sick for at least eight years.
Whereas the men who were frequently sick tended to be younger and mostly on day work, those with long periods of sickness were reasonably representative of the whole population, and the men without any sickness absence were older and mostly on shift work. An analysis of records both before and since 1964 showed that the groups had maintained a consistent pattern of sickness absence, but when individuals were considered their behaviour was less consistent. Nevertheless there appeared to be states of sickness absence `liability' and also `resistance' which persisted for a variable length of time from a year or two up to many years.
The pre-employment medical examination proved in retrospect to have been of little predictive value. Absenteeism, lateness, and also occupational injuries were all strongly associated with sickness spells, although the level of overtime was not. Previous episodes of neurotic illness, peptic ulceration, and loss of work due to back pain were also associated with frequent sickness spells, so also were frequent colds and troublesome constipation. An unexpected finding from the physical examination was that over one quarter of those who were never sick had some organic disease.
Although neither the social nor economic circumstances differed between the groups, the attitude of the men towards themselves and their work proved to be of major importance. A memory of an unhappy childhood was more common in both groups with a lot of sickness absence, whilst dislike of the job or frustrated ambition was common in men with frequent spells. Those who were never sick denied all such problems as they denied illness. Personality testing revealed that extroversion was more marked in the frequently sick group, neuroticism in the long sick, and introversion in the never sick.
The validity and significance of the results are discussed and suggestions are made for further investigation.
PMCID: PMC1008718  PMID: 4231051
9.  Perceived Working Conditions and Sickness Absence - A Four-year Follow-up in the Food Industry 
Safety and Health at Work  2011;2(4):313-320.
Objectives
To analyze the association between changes in perceived physical and psychosocial working conditions and change of sickness absence days in younger and older (< 50 and ≥ 50 years) food industry employees.
Methods
This was a follow up study of 679 employees, who completed working conditions survey questionnaires in 2005 and 2009 and for whom the requisite sickness absence data were available for the years 2004 and 2008.
Results
Sickness absence increased and working conditions improved during follow-up. However, the change of increased sickness absence days were associated with the change of increased poor working postures and the change of deteriorated team spirit and reactivity (especially among < 50 years). No other changes in working conditions were associated with the changes in sickness absence.
Conclusion
Sickness absence is affected by many factors other than working conditions. Nevertheless, according to this study improving team spirit and reactivity and preventing poor working postures are important in decreasing sickness absence.
doi:10.5491/SHAW.2011.2.4.313
PMCID: PMC3430917  PMID: 22953215
Occupational exposure; Social environment; Sick leave; Food industry; Follow-up studies
10.  Identification of UK sickness certification rates, standardised for age and sex 
Background
There is growing interest in tackling the perceived ‘sick note’ culture in the UK.
Aim
The aim of this paper was to report the rates of sickness certification in a UK population, using sick certification rates as a precursor to addressing fitness for work.
Method
Electronic records from all 14 practices included in the Keele GP Research Network were reviewed; all sickness certification records from 2005 were retrieved and corresponding consultation records were examined. Participants were 148 176 patients registered during 2005, including 6398 patients who received at least one sickness certificate during the same year.
Results
The rate of sickness certification was 101.67 certificates per 1000 person years (95% confidence interval [CI] = 100.13 to 103.21). This rate was significantly higher in women, at 109.76 certificates per 1000 person years (95% CI = 107.550 to 112.02), compared to men who had a rate of 93.68 certificates per 1000 person years (95% CI = 91.59 to 95.78; P<0.001). The rate of sickness certification was greatest for mental health conditions, followed closely by musculoskeletal conditions.
Conclusion
On average, one in 10 patients will receive a sickness certificate each year, with the highest rates occurring around 50 years of age, in women. Mental health and musculoskeletal conditions were associated with the highest rates of certification. These results provide important information to underpin the national ‘Fit for Work’ scheme, by providing targets for intervention and a benchmark against which the impact of public health initiatives to reduce certified sickness absence due to health conditions can be evaluated and monitored.
doi:10.3399/bjgp09X453431
PMCID: PMC2702016  PMID: 19566999
epidemiology; general practice; primary care; sickness certification
11.  Patterns of Sickness Absence in a Railway Population 
This investigation was carried out in order to obtain morbidity statistics in a large industrial population with special reference to the effects of ageing.
The population chosen, the “railway research population,” consisted of a sample of Scottish railwaymen, drawn from five of the eight areas in the Scottish Region of British Railways. Only certain occupational grades were studied.
Information was obtained over a period of one year by means of a detailed monthly return of (a) sickness absence data and (b) job changes. Indices of sickness absence were defined. The sickness absence experience of the railway research population was compared with that of other populations. It is a healthier group than the total insured population but differs in some respects from that of London Transport.
The nature of sickness absence within the railway research population was then studied. It was shown in all but one measure used that sickness tends to increase with age, the most important factor being the increase of long episodes. Examination of the frequency distribution of the duration of sickness episodes revealed that sickness absence tends to be taken in terms of weeks off rather than days off.
Analysis of the daily variation in sickness absence showed that the total absence rate increased from Monday to Friday. There was a well defined tendency for sickness to start on Mondays, and in longer episodes an additional tendency to start on Fridays. This was interpreted in terms of morale, both positive and negative.
Marked differences of the same order of magnitude as those due to age were noted in the sickness experience of the various grades, related to both conditions of work and responsibility.
The reasons for job changes were analysed and the grades to which men were transferred were identified. The choice of suitable grades for older workers was discussed.
It was concluded that working conditions might be important factors in the type of sickness absence experienced and that comparisons with other populations might be helpful in this context. More detailed work was also called for on the psychological as well as physical aspects of the work situation for both the individual and the grade.
PMCID: PMC1037951  PMID: 13851172
12.  Self-reported treatment, workplace-oriented rehabilitation, change of occupation and subsequent sickness absence and disability pension among employees long-term sick-listed for psychiatric disorders: a prospective cohort study 
BMJ Open  2012;2(6):e001704.
Aim
To examine whether self-reported treatments, workplace-oriented rehabilitation and change of occupation were associated with subsequent sickness absence and disability pension among long-term sick-listed for psychiatric disorders.
Design
A prospective cohort study.
Setting and participants
5200 employees (80% from the Swedish municipalities and county councils and 20% manual workers from the Swedish industry) were randomly selected who in 1999 in the register of AFA Insurance had a new spell of long-term sickness absence due to a psychiatric disorder. Of these, 99 were excluded (duplicates and deaths, persons living abroad, with protected personal information), and 5101 received a questionnaire in 2001. 3053 individuals responded (60%). After the exclusion of employees with no sick leave in 1999 according to the Swedish social insurance agency, aged 62 years and older, with disability pension 1999–2001, no self-reported treatment, and with missing information on the covariates, our final study group was 2324 individuals. Logistic regression analyses were performed.
Outcome measures
Sickness absence (>90 days) and disability pension (>0 day).
Results
45% had sickness absence and 18% a new disability pension in 2002. Drug treatment and physiotherapy, respectively, were associated with increased odds of sickness absence (OR 1.56, 95% CI 1.28 to 1.90; OR 1.43, 95% CI 1.21 to 1.69), and disability pension (OR 1.79, 95% CI 1.34 to 2.41; OR 1.75, 95% CI 1.40 to 2.18). Workplace-oriented rehabilitation and change of occupation, respectively, reduced the odds of sickness absence (OR 0.70, 95% CI 0.59 to 0.83; OR 0.35, 95% CI 0.27 to 0.45).
Conclusions
We found a pattern of poorer outcome of drug treatment and physiotherapy compared with other treatments (psychotherapy, workplace-oriented rehabilitation and complementary or alternative medicine) in terms of increased odds of sickness absence and disability pension. Workplace-oriented rehabilitation and/or change of occupation were associated with reduced odds of sick leave. Studies with a randomised controlled trial design are needed to examine the effect on sick leave of a workplace-oriented intervention.
doi:10.1136/bmjopen-2012-001704
PMCID: PMC3533007  PMID: 23117569
Rehabilitation Medicine; Public Health
13.  Low back pain and widespread pain predict sickness absence among industrial workers 
Background
The prevalence of musculoskeletal disorders (MSD) in the aluminium industry is high, and there is a considerable work-related fraction. More knowledge about the predictors of sickness absence from MSD in this industry will be valuable in determining strategies for prevention. The aim of this study was to analyse the relative impact of body parts, psychosocial and individual factors as predictors for short- and long-term sickness absence from MSD among industrial workers.
Methods
A follow-up study was conducted among all the workers at eight aluminium plants in Norway. A questionnaire was completed by 5654 workers at baseline in 1998. A total of 3320 of these participated in the follow-up study in 2000. Cox regression analysis was applied to investigate the relative impact of MSD in various parts of the body and of psychosocial and individual factors reported in 1998 on short-term and long-term sickness absence from MSD reported in 2000.
Results
MSD accounted for 45% of all working days lost the year prior to follow-up in 2000. Blue-collar workers had significantly higher risk than white-collar workers for both short- and long-term sickness absence from MSD (long-term sickness absence: RR = 3.04, 95% CI 2.08–4.45). Widespread and low back pain in 1998 significantly predicted both short- and long-term sickness absence in 2000. In addition, shoulder pain predicted long-term sickness absence. Low social support predicted short-term sickness absence (RR = 1.28, 95% CI 1.11–1.49).
Conclusions
Reducing sickness absence from MSD among industrial workers requires focusing on the working conditions of blue-collar workers and risk factors for low back pain and widespread pain. Increasing social support in the work environment may have effects in reducing short-term sickness absence from MSD.
doi:10.1186/1471-2474-4-21
PMCID: PMC200978  PMID: 12956891
sickness absence; musculoskeletal disorders; low back pain; widespread pain; blue-collar workers; social support
14.  Sickness Absenteeism, Morbidity and Workplace Injuries among Iron and Steel workers - A Cross Sectional Study from Karnataka, Southern India 
The Australasian Medical Journal  2011;4(3):144-147.
Background
The study of illnesses causing absence of workers from work in industries is a practical method to study the health status of industrial workers and to identify occupational health hazards. The iron and steel industries are particularly hazardous places of work. Published data from India on health status of iron and steel workers is limited, therefore this study was undertaken to investigate the sickness absenteeism, morbidity and workplace injuries among this population.
Method
Workers were selected using stratified random sampling. A structured pre-tested interview schedule was used to collect the data. A p value of < 0.05 was considered for statistical significance.
Results
From a total of 2525 workers, 353 (mean age 55.1 yrs, male 69.4%) participated in the study. The overall proportion of sickness absenteeism was 66.9% (95% CI: 0.62 – 0.71). Overall 16.4 days were lost per worker per year (male = 16.5 & female = 16.2) due to sickness absence. A blue collar worker lost 21.5 days compared to 11.9 days by a white collar worker (p > 0.01). Among workers, health ailments related to the musculoskeletal system (31.4%), gastrointestinal system (25.8%), hypertension (24.4%), respiratory system (18.1%) and other minor ailments (19.3%) were found to be high.
Conclusion
Sickness absenteeism is significantly higher among iron and steel workers when compared to other occupations in India. Blue collar workers and shift workers loose higher number of days due to sickness absence, and they face problems related to musculoskeletal system, gastrointestinal system and hypertension in higher proportions compared to their counterparts. Women experienced hypertension as the common health problem and higher proportions of injuries outside the work environment.
doi:10.4066/AMJ.2011.576
PMCID: PMC3562962  PMID: 23390463
Sickness absence; industrial workers; Karnataka; morbidity
15.  Analysis of sickness absence among employees of four NHS trusts 
OBJECTIVES: To determine the value of using routinely collected sickness absence data as part of a health needs assessment of healthcare workers. METHOD: Sickness absence records of almost 12900 NHS staff for one calendar year were analysed. Three measures of absence, the absence rate, the absence frequency rate, and the mean duration of absence, were assessed for the population and comparisons made between men and women, full and part time and different occupational groups of staff. Also, the main causes of sickness absence were found. RESULTS: Almost 60% of the study population had no spells of sickness absence in the year of study and almost 20% had only one spell of sickness absence. Female staff were more likely to have experienced sickness absence than male staff. Although absence due to conditions related to pregnancy were included in the analysis, the incidence of these was not sufficient to account for the higher rates of absence among female staff. In general, full time staff had greater rates of sickness absence than part time staff. 71% of all absences were of < 1 week duration. The main known causes of sickness absence were respiratory disorders, digestive disorders, and musculoskeletal disorders. CONCLUSIONS: The transition from units managed directly from the health board to trusts with individual responsibility for personnel issues at the time of data collection resulted in variations in the quality of data available for analysis. This together with the use of "dump" codes has influenced the quality of the analysis. However, such data should be available for analysis to tailor occupational health care to the needs of the population.
 
PMCID: PMC1757661  PMID: 10658551
16.  Sickness absence in hospital physicians: 2 year follow up study on determinants 
OBJECTIVES—To identify determinants of sickness absence in hospital physicians.
METHODS—The Poisson regression analyses of short (1-3 days) and long (>3 days) recorded spells of sickness absence relating to potential determinants of sickness absence were based on a 2 year follow up period and cohorts of 447 (251 male and 196 female) physicians and 466 controls (female head nurses and ward sisters).
RESULTS—There were no differences in health outcomes, self rated health status, prevalence of chronic illness, and being a case on the general health questionnaire (GHQ), between the groups but physicians took one third to a half the sick leave of controls. All the health outcomes were strongly associated with sickness absence in both groups. Of work related factors, teamwork had the greatest effect on sickness absence in physicians but not in the controls. Physicians working in poorly functioning teams were at 1.8 (95% confidence interval (95% CI) 1.3 to 3.0) times greater risk of taking long spells than physicians working in well functioning teams. Risks related to overload, heavy on call responsibility, poor job control, social circumstances outside the workplace, and health behaviours were smaller.
CONCLUSION—This is the first study of hospital physicians to show the association between recorded sickness absence and factors across various areas of life. In this occupational group, sickness absence is strongly associated with health problems, and the threshold for taking sick leave is high. Poor teamwork seems to contribute to the sickness absenteeism of hospital physicians even more than traditional psychosocial risks—such as overload and low job control. These findings may have implications for training and health promotion in hospitals.


Keywords: health care personnel; occupational health; psychosocial factors
doi:10.1136/oem.58.6.361
PMCID: PMC1740149  PMID: 11351050
17.  Reliability of a questionnaire on sickness absence with specific attention to absence due to back pain and respiratory complaints. 
OBJECTIVE--To evaluate the performance of a questionnaire on sickness absence due to back pain and respiratory disorders with the view of using sickness absence as a measure of morbidity. METHODS--A cross sectional survey was conducted among 511 male workers aged 20-65, drawn from the personnel register of an animal feed mill. The response was 404 (79%) participants. Data on sickness absence in the six months before the survey were collected by a self administered questionnaire and by sickness absence records. Correlation between both methods was examined for prevalence, duration, and frequency of overall sickness absence, back pain absence, and absence due to respiratory complaints. RESULTS--The questions about the prevalence of sickness absence from all causes, back pain, and respiratory complaints showed a high specificity of 91%, 97%, and 98%, respectively. The sensitivities of these questions were 79%, 88%, and 13%, respectively. The survey found a moderate agreement between the questionnaire and the medical register for duration and frequency of overall sickness absence with kappa values of 0.54 and 0.50. A good agreement was found for back pain absence with kappa values of 0.65 and 0.61. Respiratory absence showed a poor agreement of 0.16 and 0.13. CONCLUSION--In epidemiological studies questionnaires might be considered a valuable source of information on overall sickness absence or absence due to back pain which lasted for at least two weeks in the past six months. Whether a questionnaire survey is a reliable source of data on sickness absence due to respiratory complaints remains to be seen.
PMCID: PMC1128405  PMID: 8563859
18.  A screening questionnaire to predict no return to work within 3 months for low back pain claimants 
European Spine Journal  2008;17(3):380-385.
The objective of the present study was to develop a short prediction questionnaire for estimating the risk of no return to work (RTW) within 3 months of sick leave to facilitate triage and management of a patient population of subacute low-back pain (LBP) sufferers. We conducted a prospective study with a 3-month follow-up on 186 patients with LBP introducing a claim for sickness benefits to the largest sickness fund in Belgium. Patients completed a screening questionnaire within 2 weeks after claim submission. All patients were invited for clinical assessment, at 6–8 weeks of sick leave, by the medical adviser. Patients’ work status was recorded by the sickness fund. About 20% of the patients did not resume work at 3 months’ sick leave. They were more likely to experience pain below the knee, to have an own previous prediction of a 100% no RTW and to have a severe interference of pain on daily activities. The screening tool based on these three items correctly classified 73.7% of the non-resumers and 78.4% of the resumers at a cut-off score of 0.22. The findings of this study provide evidence of the utility of a short screening questionnaire for future use in intervention studies in a social security setting.
doi:10.1007/s00586-007-0567-8
PMCID: PMC2270393  PMID: 18172698
Low back pain; Return to work; Screening; Predictors; Outcomes
19.  Socioeconomic status and duration and pattern of sickness absence. A 1-year follow-up study of 2331 hospital employees 
BMC Public Health  2010;10:643.
Background
Sickness absence increases with lower socioeconomic status. However, it is not well known how this relation depends on specific aspects of sickness absence or the degree to which socioeconomic differences in sickness absence may be explained by other factors.
The purpose of the study was to examine differences in sickness absence among occupational groups in a large general hospital; how they depend on combinations of frequency and duration of sickness absence spells; and if they could be explained by self-reported general health, personal factors and work factors.
Methods
The design is a 1-year prospective cohort study of 2331 hospital employees. Baseline information include job title, work unit, perceived general health, work factors and personal factors recorded from hospital administrative files or by questionnaire (response rate 84%). Sickness absence during follow-up was divided into short (1-3 days), medium (4-14 days) and long (>14 days) spells, and into no absence, "normal" absence (1-3 absences of certain durations) and "abnormal" absence (any other absence than "normal"). Socioeconomic status was assessed by job titles grouped in six occupational groups by level of education (from doctors to cleaners/porters). Effects of occupational group on sickness absence were adjusted for significant effects of age, gender, general health, personal factors and work factors. We used Poisson or logistic regression analysis to estimate the effects of model covariates (rate ratios (RR) or odds ratios (OR)) and their 95% confidence intervals (CI).
Results
With a few exceptions sickness absence increased with decreasing socioeconomic status. However, the social gradient was quite different for different types of sickness absence. The gradient was strong for medium spells and "abnormal" absence, and weak for all spells, short spells, long spells and "normal" absence. For cleaners compared to doctors the adjusted risk estimates increased 4.2 (95% CI 2.8-6.2) and 7.4 (95% CI 3.3-16) times for medium spells and "abnormal" absence, respectively, while the similar changes varied from 0.79 to 2.8 for the other absence outcomes. General health explained some of the social gradient. Work factors and personal factors did not.
Conclusions
The social gradient in sickness absence was different for absences of different duration and patterns. It was strongest for absences of medium length and "abnormal" absence. The social gradient was not explained by other factors.
doi:10.1186/1471-2458-10-643
PMCID: PMC3091566  PMID: 20973979
20.  Are environmental characteristics in the municipal eldercare, more closely associated with frequent short sick leave spells among employees than with total sick leave: a cross-sectional study 
BMC Public Health  2013;13:578.
Background
It has been suggested that frequent-, short-term sick leave is associated with work environment factors, whereas long-term sick leave is associated mainly with health factors. However, studies of the hypothesis of an association between a poor working environment and frequent short spells of sick leave are few and results are inconsistent. Therefore, we aimed to explore associations between self-reported psychosocial work factors and workplace-registered frequency and length of sick leave in the eldercare sector.
Methods
Employees from the municipal eldercare in Aarhus (N = 2,534) were included. In 2005, they responded to a work environment questionnaire. Sick leave records from 2005 were dichotomised into total sick leave days (0–14 and above 14 days) and into spell patterns (0–2 short, 3–9 short, and mixed spells and 1–3 long spells). Logistic regression models were used to analyse associations; adjusted for age, gender, occupation, and number of spells or sick leave length.
Results
The response rate was 76%; 96% of the respondents were women. Unfavourable mean scores in work pace, demands for hiding emotions, poor quality of leadership and bullying were best indicated by more than 14 sick leave days compared with 0–14 sick leave days. For work pace, the best indicator was a long-term sick leave pattern compared with a non-frequent short-term pattern. A frequent short-term sick leave pattern was a better indicator of emotional demands (1.62; 95% CI: 1.1-2.5) and role conflict (1.50; 95% CI: 1.2-1.9) than a short-term non-frequent pattern.
Age (= < 40 / >40 years) statistically significantly modified the association between the 1–3 long-term sick leave spell pattern and commitment to the workplace compared with the 3–9 frequent short-term pattern.
Conclusions
Total sick leave length and a long-term sick leave spell pattern were just as good or even better indicators of unfavourable work factor scores than a frequent short-term sick leave pattern. Scores in commitment to the workplace and quality of leadership varied with sick leave pattern and age. Thus, different sick leave measures seem to be associated with different work environment factors. Further studies on these associations may inform interventions to improve occupational health care.
doi:10.1186/1471-2458-13-578
PMCID: PMC3701566  PMID: 23764253
Cross-sectional; Home care services; Psychology, Social; Sick leave; Working environment
21.  Bronchitis—Sickness Absence in London Transport 
This study is based on the records of sickness absence of four days or longer attributed to bronchitis among nearly 60,000 London Transport employees during the years 1952 to 1956. The figures support previous observations that there is a close association between the incidence of bronchitis and the occurrence of fog in any year. The bronchitis experience of employees living and working in the north-eastern sector of London is shown to be worse than in other areas of London. The experience of employees in the country belt round London, particularly in the southern sector, is better than in London itself. With the possible exception of conductors, the figures do not suggest that there are occupational factors in the transport industry causing bronchitis.
PMCID: PMC1038013  PMID: 13695613
22.  A study of neurosis and occupation 
Ferguson, D. (1973).British Journal of Industrial Medicine,30, 187-198. A study of neurosis and occupation. Claims that male telegraphists in an Australian communications undertaking were unduly subject to neurosis and certain psychosomatic disorders as a result of the stress of their work were investigated by sickness absence and environmental and prevalence studies. The absence records of all telegraphists in the mainland capital city offices of the undertaking were compared with those of random samples of clerks and mechanics and, because of excess absence among sydney telegraphists, with those of mail sorters in that city. Subsequently, 516 telegraphists, 93% of those available in Sydney, Melbourne, and Brisbane, and 155 Sydney mail sorters (79% of a sample) were examined medically.
Absence attributed to neurosis was much commoner in telegraphists than in the other occupations in each capital, and in Sydney telegraphists than in those of other capitals. Employees having such absence were more likely than others also to have uncertified and repeated absences, and absence attributed to bronchial and dyspeptic disorder and to injury. One-third (33%) of the 516 telegraphists examined were considered to have or to have had disabling neurosis, the prevalence being much greater in Sydney (44%) than in Melbourne (19%) or Brisbane (26%). The onset, course, associations, and other characteristics of neurosis are described.
There was some evidence that the neurotic employee had increased liability to some other disorders but also that he was more likely to report ill health than others. Interpretation of increased other ill health in neurosis is confounded by the effects of an excess indulgence in habits. An increase in indices of mental stress was noted but some disorders commonly attributed to stress were not unduly prevalent in neurotics. Loss of craft status, monotony, dissatisfaction with job, fear of displacement by machine, group size, and supervisory practices were all thought to predispose to the high prevalence of neurosis in Sydney telegraphists. However, personal and social maladjustment was particularly evident in telegraphists in that city, and the population from which telegraphists were drawn may have been less well adjusted in Sydney than in Melbourne or Brisbane.
Though it was possible in general to characterize the employee liable to neurosis, the predictive power of the characterization would be poor. The disorder followed no one pattern. Rather it appeared to be a collection of clinical syndromes which present as a result of the complex interaction of the personality with multiple factors at work and elsewhere over most of a lifetime. In individual subjects the relationship of stress at work to symptoms was usually ill defined, even in cases in which the identified probable factors were mainly or solely occupational. Nevertheless, there seems much to be gained from the establishment of mental health programmes in industry.
PMCID: PMC1009503  PMID: 4703090
23.  Pattern of accident distribution in the telecommunications industry. 
Examination of the accident records from the telecommunication industry covering some 100 000 engineers over a 12-month period showed that 25% of accidents resulting in more than three days' sick leave gave rise to back injuries. Handling accidents and falls accounted for 65% of three-day-plus accidents; handling accidents alone gave rise to 65% of back injuries. The absolute numbers of accidents have been compared with the total population of engineers to estimate the effects of age or occupation on levels of hazard; certain occupations constituting 33% of the engineers' population suffered 70% of all three-day-plus accidents. Accidents occurred most frequently in the group aged from 31 to 48 years. Other significant factors affecting the occurrence of accidents were time of year and duty experience of the workers.
PMCID: PMC1008686  PMID: 7426467
24.  Risk factors for sickness absence due to low back pain and prognostic factors for return to work in a cohort of shipyard workers 
European Spine Journal  2008;17(9):1185-1192.
The purpose of this study was to determine risk factors for the occurrence of sickness absence due to low back pain (LBP) and to evaluate prognostic factors for return to work. A longitudinal study with 1-year follow-up was conducted among 853 shipyard workers. The cohort was drawn around January 2004 among employees in the shipyard industry. Baseline information was obtained by questionnaire on physical and psychosocial work load, need for recovery, perceived general health, musculoskeletal complaints, sickness absence, and health care use during the past year. During the 1-year follow-up for each subject medical certifications were retrieved for information on the frequency and duration of spells of sickness absence and associated diagnoses. Cox regression analyses were conducted on occurrence and on duration of sickness absence with hazard ratios (HR) with 95% confidence interval (95% CI) as measure of association. During the 1-year follow-up period, 14% of the population was on sick leave at least once with LBP while recurrence reached 41%. The main risk factors for sickness absence were previous absence due to a health problem other than LBP (HR 3.07; 95%CI 1.66–5.68) or previous sickness absence due to LBP (HR 6.52; 95%CI 3.16–13.46). Care seeking for LBP and lower educational level also hold significant influences (HR 2.41; 95%CI 1.45–4.01 and HR 2.46; 95%CI 1.19–5.07, respectively). Living with others, night shift and supervising duties were associated with less absenteeism due to LBP. Workers with a history of herniated disc had a significantly decreased rate of returning to work, whereas those who suffered from hand-wrist complaints and LBP returned to work faster. Prior sick leave due to LBP partly captured the effects of work-related physical and psychosocial factors on occurrence of sick leave. Our study showed that individual and job characteristics (living alone, night shift, lower education, sick leave, or care seeking during the last 12 months) influenced the decision to take sick leave due to LBP. An increased awareness of those frequently on sick leave and additional management after return to work may have a beneficial effect on the sickness absence pattern.
doi:10.1007/s00586-008-0711-0
PMCID: PMC2527417  PMID: 18649089
Low back pain; Sick leave; Prognosis; Recurrence; Return to work
25.  Sickness absence in the Whitehall II study, London: the role of social support and material problems. 
STUDY OBJECTIVE--To investigate the role of social supports, social networks, and chronic stressors: (i) as predictors of sickness absence; and (ii) as potential explanations for the socioeconomic gradient in sickness absence. DESIGN--A prospective cohort study (Whitehall II study) with sociodemographic factors, health and social support measured at baseline, and spells of sickness absence measured prospectively. SETTING--Twenty London based non-industrial departments of the British civil service. PARTICIPANTS--Participants were civil servants (n = 10,308), aged 35-55 years at baseline, of whom 67% (6895) were men and 33% (3413) were women. The overall response rate for Whitehall II was 73% (74% for men and 71% for women). The analysis is based on 41% of the sample who had data on reasons for sickness absence and were administered all social support questions. Only 4.3% of participants did not complete all necessary questions and were excluded. MEASUREMENTS AND MAIN RESULTS--High levels of confiding/emotional support from the "closest person" predicted higher levels of both short and long spells of sickness absence. After adjusting for baseline physical and psychological health the effects were increased, suggesting that high levels of confiding/emotional support may encourage illness behaviour rather than generate illness. Social network measures showed a consistent but less striking pattern. Increased levels of negative aspects of social support resulted in higher rates of sickness absence. Material problems strongly predicted sickness absence, but the effect was diminished once adjustment for the covariables was made, suggesting that health status may be functioning as an intervening variable between chronic stressors and sickness absence. In addition, social support may buffer the effects of chronic stressors. Social support did not contribute to explaining the gradient in sickness absence by employment grade beyond that explained by the baseline covariables. CONCLUSIONS--Sickness absence from work is a complex phenomenon, combining illness and coping behaviours. High levels of confiding/emotional support, although not entirely consistent across samples, may either encourage people to stay at home when they are ill or may be accompanied by more social obligations at home prolonging sickness absence. Negative aspects of close relationships may jeopardize health and hence increase sickness absence.
PMCID: PMC1060150  PMID: 7499989

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