Factors related to self-rated health: a survey among patients and their general practitioners.

OBJECTIVE: To explore associations between general practice patients' SRH and symptoms, diagnoses, chronic conditions, unexplained conditions, and life stressors. DESIGN: A cross-sectional study. Data were collected from GP and patient questionnaires. SETTING: General practices in Southeast Norway. SUBJECTS: 47 general practitioners (GPs) who included 866 consecutive patients. MAIN OUTCOME MEASURES: SRH was measured with a single question from the COOP-WONCA overall health chart and dichotomized into good/poor SRH. Binary logistic regression models were used in the analyses. RESULTS: Poor SRH was reported by 48% of the patients in the past week. A higher prevalence of poor SRH was found for women, middle-aged, recipients of social security grants, patients diagnosed with asthenia, lower back pain, and depression/anxiety, and for patients with reported life stressors and unexplained conditions. We found an almost linear association between the number of symptoms and the likelihood of reporting poor SRH. The probability of reporting poor SRH increased along with an increasing number of symptoms for common diagnoses. In a multivariate analysis, the only number of symptoms, being in receipt of social security grants and being retired was associated with poor SRH. CONCLUSION: The likelihood of reporting poor SRH increased with an increasing number of symptoms, partly independent of the diagnosis given by GPs. This result coincides with our previous findings of a strong association between the number of symptoms, function, and health. The symptom burden thus appears to be an important factor for SRH among patients in general practice.KEY POINTSThere is a high prevalence of poor SRH in general practice patients.The likelihood of reporting poor SRH is partly independent of the diagnosis given.The number of symptoms was the factor strongest associated with poor SRH.

Case-specific colleague guidance for general practitioners' management of sickness absence.

BACKGROUND: General practitioners (GPs) report sickness absence certification as challenging. They express need for support with functional assessment beyond guidelines and reforms. Case-specific collegial one-to-one guidance for other clinical topics has proved popular with GPs and may be an acceptable and effective way to improve GPs skills and competence in sickness absence certification. AIMS: To present a new model of case-specific colleague guidance focusing on the management of long-term sickness absence and to describe its feasibility in terms of application and reception among GPs, and also GPs' self-reports of effects on their practice. METHODS: Randomly selected GPs received case-specific collegial guidance over a 12-month period, in two Norwegian trials, delivered by former GPs employed by the social security administration. We measured reception and perceived effects by GPs' self-report and registered participation and withdrawal rates. RESULTS: The participation rate (n = 165) was 94%, and no GPs withdrew during training. Among the 116 GPs responding to the survey (70%), 112 (97%; 95% CI 92-99) stated they would recommend it to their colleagues. Considerable benefit from the guidance was reported by 68 (59%; 95% CI 50-68). The GPs self-reported other effects on their sickness absence certification, specifically an increased use of part-time sickness absence (Fit-Note equivalent). CONCLUSIONS: This model of case-specific colleague guidance to aid GPs' management of long-term sickness absence is feasible and was popular. This type of guidance was perceived by GPs to be somewhat beneficial and to alter their sickness absence certification behaviour, though the true impact requires further testing in controlled trials.

Work factors as predictors of sickness absence attributed to airway infections; a three month prospective study of nurses' aides.

AIMS: To identify the work factors that are related to sickness absence attributed to airway infections (AAI) in nurses' aides. METHODS: The sample comprised 5563 Norwegian nurses' aides, not on sick leave when they completed a mailed questionnaire in 1999. Of these, 4931 (88.6%) completed a second questionnaire three months later. The outcome measure was the three month incidence proportion of certified AAI (>3 days), assessed by self reports at follow up. RESULTS: Working in a paediatric ward (odds ratio (OR) 2.42; 95% confidence interval (CI) 1.39 to 4.21), perceived lack of encouraging and supportive culture in the work unit (OR 1.78; 95% CI 1.21 to 2.61), and reporting medium (OR 1.52; 95% CI 1.09 to 2.12), and high levels (OR 1.60; 95% CI 1.13 to 2.26) of role conflicts at work were associated with an increased risk of AAI, after adjustments for baseline health complaints, demographic and familial factors, smoking, and a series of physical, psychological, and organisational work factors. The individual level factors male gender, smoking 10 cigarettes per day or more, having widespread pain, having had an accident related neck injury, and having long term health problems also predicted AAI. CONCLUSIONS: In nurses' aides, sickness absence attributed to airway infections seems to be related to the type of ward in which the aides are working, and to psychological and social work factors. Declaring airway infections as occupational diseases would have important consequences for the social security system.

[Disability pension after a factory close-down--eight years after]. / Uføretrygdet etter bedriftsnedleggelse--åtte år etter.

A follow-up study of 97 persons who were granted a disability pension in 1987 or 1988 after closure of a shipyard showed 82 alive in 1995. The predominant diagnoses were musculoskeletal complaints, heart disease and psychiatric disorders. The 82 who were still alive were in good health and satisfied with their pension. However, if the factory had not been closed down, many of them could probably have continued in work. For many of them, and especially the youngest, the first year on disability pension was difficult. Based on today's more restricted rules, we have estimated that 25% of the applications for disablement benefit would have been refused.

[Patients' advocate or defender of the welfare state?]. / Pasientens advokat eller velferdsstatens vokter?

The author discusses the general practitioner's difficult role of working for the best of the individual patient and at the same time being obliged to follow rules and regulations that limit this role. Attention is drawn to the particularly difficult task of defending the patient's interests, parallel to checking the patient for the social insurance system. Doctors in general, and general practitioners in particular, cannot avoid working with different and to some extent contradictory objectives.

Effects of information on smoking behaviour in families with preschool children.

An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested. A total of 443 consecutive families with one or two smoking parents, attending mother and child health centres in Oslo, Norway, were randomly allocated to an intervention group (n = 221) and a control group (n = 222). Eighty families (18%) dropped out during the study period. For the intervention group, the communication between the health visitor and the family was prolonged at one well-child visit with a brief session on smoking, and the parents were given three brochures. The families in the control group received no information on smoking. Changes in practical measures to prevent passive smoking by the children (e.g. no smoking indoors) as well as changes in daily smoking and smoking quantity were assessed by parental reports. We found no significant differences between the groups with respect to change in smoking behaviour.

Fibromyalgia and disability. Report of the Moss International Working Group on medico-legal aspects of chronic widespread musculoskeletal pain complaints and fibromyalgia.

The present article is the result of a working group conference held in Moss, Norway, in June 1993, financed by the Royal Norwegian Ministry of Health and Social Affairs. Its purpose was to review and focus upon problems and needs related to the medico-legal aspects of fibromyalgia and chronic widespread musculoskeletal complaints: thus to define directions for future work on issues which have generally not been addressed within the medical community. Our report describes specific problems in this area in regard to definition, evaluation and recommendation, and in currently available work and disability statistics. We have recommended international efforts to establish research programs through organizations such as the International Social Security Association and the World Health Organization. While our recommendations call for research into medico-legal interactions, causes and pathogenic mechanisms, prevention and treatment are also key and relevant concerns in the medico-legal setting.

Measuring functional status in a population survey. The Dartmouth COOP functional health assessment charts/WONCA used in an epidemiological study.

In a population study, a random sample of 398 persons from 20 to 72 years answered the six item version of the Dartmouth COOP functional health assessment charts/WONCA. The results according to age and sex are presented. The charts have been developed primarily for use in clinical settings. In a cross-sectional study in a normal population, the instrument seems feasible in use and it differentiates between the sexes and age groups.

Occupational factors in sickness certification.

Physical work load was assessed by doctors and patients to have contributed to the health problems leading to sickness certification in 48.4% of 1413 patients certified sick by 118 general practitioners in Buskerud county, Norway (1986). Correspondingly, psychological factors were considered contributory in 32.1%. The potential for prevention of health problems underlying sickness certificates was reported in 37.1%. As expected, the frequency of sickness certification in which physical work load and psychological factors were considered to have contributed varied with the patients' occupation, type of work, and health problem. Physical work load was assessed as contributory particularly in patients with musculoskeletal/connective tissue diseases whose work involved much walking and lifting (93.2%) or was physically strenuous (94.0%). Psychological factors were assessed as contributory in a high percentage of cases whose work was mostly sedentary. The findings indicate that the potentials for prevention as assessed by doctors and patients were highest when the health problems underlying sickness certification were associated with musculoskeletal/connective tissue diseases. The results indicate a potential for prevention and limitation of sickness certification which may be utilized by a better collaboration between community medicine and occupational health services.

Incidence of sickness certification. Proposal for use as a health status indicator.

Cause-, sex-, and age-specific incidences of sickness certification in a total population are reported. The population at risk of having a sickness certificate issued was 106,019 employed persons 16-69 years of age. The annual incidence of sickness certification was estimated at 580 per 1,000 employed persons per year (females 596, males 568). The most frequent causes of sickness certification, according to diagnostic groups, were diseases of the respiratory system, musculoskeletal/connective tissue diseases, mental disorders, and injuries. Adjusted for age, injuries were found to be less frequent causes of sickness certification among females than males (p less than 0.001), while the reverse was true for mental disorders (p less than 0.01). Among single diagnoses, "other nonarticular rheumatism" (including myalgia) was more frequent among females than males, while the opposite was true for "backpain without radiating symptoms" (p less than 0.001). Comparisons with morbidity studies indicate that diagnoses stated on initial certificates, issued to employed persons in the total population, give a reflection of a population's health problems. This suggests that sickness certification may provide a basis for a health status indicator which may prove useful in planning and evaluation of occupational health, general practice, and community health.