Labour market integration among young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) at working age.

METHODS: Multiple Swedish nationwide registers were used to identify 8045 individuals, aged 20-29, with an incident diagnosis of ADHD 2006-2011. Labour market integration was conceptualized according to the core-peripheral model as a continuum from a strong (core) to a weak (peripheral) connection to the labour market. Sequence analyses categorized clusters of labour market integration, from 1 year before to 5 years after their ADHD diagnosis for individuals diagnosed with ADHD and a matched control group without ADHD. Multinomial logistic regression computed odds ratios (ORs) with 95% confidence intervals (CIs) between sociodemographic factors and comorbid disorders and the identified clusters. RESULTS: About one-fourth of the young adults diagnosed with ADHD belonged to clusters characterized by a transition to a mainly peripheral labour market position, which was approximately four-times higher compared to controls without ADHD. Foremost, those living in small cities/villages (OR 1.9; CI 1.5-2.2), those having comorbid autism-spectrum disorder (OR 13.7; CI 6.8-27.5) or schizophrenia/psychoses (OR 7.8; CI 3.8-15.9) were associated with a transition towards a peripheral labour market position throughout the study period. Those with a high educational level (OR 0.1; CI 0.1-0.1), and men (OR 0.7; CI 0.6-0.8) were less likely to have a peripheral labour market position. CONCLUSIONS: Young adults diagnosed with ADHD are four-times more likely to be in the peripheral labour market position compared to those without ADHD. To increase labour market participation, special attention is warranted to those with low educational level, those living outside big cities and those with comorbid mental disorders.

Diagnosis-specific sickness absence among injured working-aged pedestrians: a sequence analysis.

BACKGROUND: The knowledge about the long-term consequences in terms of sickness absence (SA) among pedestrians injured in a traffic-related accident, including falls, is scarce. Therefore, the aim was to explore diagnosis-specific patterns of SA during a four-year period and their association with different sociodemographic and occupational factors among all individuals of working ages who were injured as a pedestrian. METHODS: A nationwide register-based study, including all individuals aged 20-59 and living in Sweden, who in 2014-2016 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Diagnosis-specific SA (> 14 days) was assessed weekly from one year before the accident up until three years after the accident. Sequence analysis was used to identify patterns (sequences) of SA, and cluster analysis to form clusters of individuals with similar sequences. Odds ratios (ORs) with 95% confidence intervals (CIs) for association of the different factors and cluster memberships were estimated by multinomial logistic regression. RESULTS: In total, 11,432 pedestrians received healthcare due to a traffic-related accident. Eight clusters of SA patterns were identified. The largest cluster was characterized by no SA, three clusters had different SA patterns due to injury diagnoses (immediate, episodic, and later). One cluster had SA both due to injury and other diagnoses. Two clusters had SA due to other diagnoses (short-term and long-term) and one cluster mainly consisted of individuals with disability pension (DP). Compared to the cluster "No SA", all other clusters were associated with older age, no university education, having been hospitalized, and working in health and social care. The clusters "Immediate SA", "Episodic SA" and "Both SA due to injury and other diagnoses" were also associated with higher odds of pedestrians who sustained a fracture. CONCLUSIONS: This nationwide study of the working-aged pedestrians observed diverging patterns of SA after their accident. The largest cluster of pedestrians had no SA, and the other seven clusters had different patterns of SA in terms of diagnosis (injury and other diagnoses) and timing of SA. Differences were found between all clusters regarding sociodemographic and occupational factors. This information can contribute to the understanding of long-term consequences of road traffic accidents.

Sickness absence and disability pension among injured working-aged pedestrians - a population-based Swedish register study.

BACKGROUND: The knowledge is scarce about sickness absence (SA) and disability pension (DP) among pedestrians injured in a traffic-related accident, including falls. Thus, the aim was to explore the frequencies of types of accidents and injuries and their association with SA and DP among working-aged individuals. METHODS: A nationwide register-based study, including all individuals aged 16-64 and living in Sweden, who in 2010 had in- or specialized outpatient healthcare after a new traffic-related accident as a pedestrian. Information on age, sex, sociodemographics, SA, DP, type of accident, injury type, and injured body region was used. Frequencies of pedestrians with no SA or DP, with ongoing SA or full-time DP already at the time of the accident, and with a new SA spell >14 days in connection to the accident were analyzed. Crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for new SA were estimated by logistic regression. RESULTS: In total, 5576 pedestrians received healthcare due to a traffic-related accident (of which 75% were falls, with half of the falls related to snow and ice). At the time of the accident, 7.5% were already on SA and 10.8% on full-time DP, while 20% started a new SA spell. The most common types of injuries were fractures (45%) and external injuries (30%). The body region most frequently injured was the lower leg, ankle, foot, and other (in total 26%). Older individuals had a higher OR for new SA compared with younger (OR 1.91; 95% CI 1.44-2.53, for ages: 45-54 vs. 25-34). The injury type with the highest OR for new SA, compared with the reference group external injuries, was fractures (9.58; 7.39-12.43). The injured body region with the highest OR for new SA, compared with the reference group head, face, and neck, was lower leg, ankle, foot, and other (4.52; 2.78-7.36). CONCLUSIONS: In this explorative nationwide study of the working-aged pedestrians injured in traffic-related accidents including falls, one fifth started a new SA spell >14 days. Fractures, internal injuries, collisions with motor vehicle, and falls related to snow and ice had the strongest associations with new SA.

Sequence analysis of sickness absence and disability pension in the year before and the three years following a bicycle crash; a nationwide longitudinal cohort study of 6353 injured individuals.

BACKGROUND: Bicyclists are the road user group with the highest number of severe injuries in the EU, yet little is known about sickness absence (SA) and disability pension (DP) following such injuries. AIMS: To explore long-term patterns of SA and DP among injured bicyclists, and to identify characteristics associated with the specific patterns. METHODS: A longitudinal register-based study was conducted, including all 6353 individuals aged 18-59 years and living in Sweden in 2009, who in 2010 had incident in-patient or specialized out-patient healthcare after a bicycle crash. Information about sociodemographic factors, the injury, SA (SA spells > 14 days), and DP was obtained from nationwide registers. Weekly SA/DP states over 1 year before through 3 years after the crash date were used in sequence and cluster analyses. Multinomial logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with each identified sequence cluster. RESULTS: Seven clusters were identified: "No SA or DP" (58.2% of the cohort), "Low SA or DP" (7.4%), "Immediate SA" (20.3%), "Episodic SA" (5.9%), "Long-term SA" (1.7%), "Ongoing part-time DP" (1.7%), and "Ongoing full-time DP" (4.8%). Compared to the cluster "No SA or DP", all other clusters had higher ORs for women, and higher age. All clusters but "Low SA and DP" had higher ORs for inpatient healthcare. The cluster "Immediate SA" had a higher OR for: fractures (OR 4.3; CI 3.5-5.2), dislocation (2.8; 2.0-3.9), sprains and strains (2.0; 1.5-2.7), and internal injuries (3.0; 1.3-6.7) compared with external injuries. The cluster "Episodic SA" had higher ORs for: traumatic brain injury, not concussion (4.2; 1.1-16.1), spine and back (4.5; 2.2-9.5), torso (2.5; 1.4-4.3), upper extremities (2.9; 1.9-4.5), and lower extremities (3.5; 2.2-5.5) compared with injuries to the head, face, and neck (not traumatic brain injuries). The cluster "Long-term SA" had higher ORs for collisions with motor vehicles (1.9;1.1-3.2) and traumatic brain injury, not concussion (18.4;2.2-155.2). CONCLUSION: Sequence analysis enabled exploration of the large heterogeneity of SA and DP following a bicycle crash. More knowledge is needed on how to prevent bicycle crashes and especially those crashes/injuries leading to long-term consequences.

Bicycle crashes and sickness absence - a population-based Swedish register study of all individuals of working ages.

BACKGROUND: In recent years, bicycle injuries have increased, yet little is known about the impact of such injures on sickness absence (SA) and disability pension (DP). The aim was to explore SA and DP among individuals of working ages injured in a bicycle crash. METHOD: A nationwide register-based study, including all individuals aged 16-64 years and living in Sweden, who in 2010 had in- or specialized out-patient healthcare (including emergency units) after a bicycle crash. Information on age, sex, sociodemographics, SA, DP, crash type, injury type, and injured body region was used. We analyzed individuals with no SA or DP, with ongoing SA or full-time DP already at the time of the crash, and with new SA > 14 days in connection to the crash. Crude and adjusted odds ratios (OR) with 95% confidence intervals for new SA were estimated by logistic regression. RESULTS: In total, 7643 individuals had healthcare due to a new bicycle crash (of which 85% were single-bicycle crashes). Among all, 10% were already on SA or full-time DP at the time of the crash, while 18% had a new SA spell. The most common types of injuries were external injuries (38%) and fractures (37%). The body region most frequently injured was the upper extremities (43%). Women had higher OR (1.40; 1.23-1.58) for new SA than men, as did older individuals compared with younger (OR 2.50; 2.02-3.09, for ages: 55-64 vs. 25-34). The injury types with the highest ORs for new SA, compared with the reference group external injuries was fractures (8.04; 6.62-9.77) and internal injuries (7.34; 3.67-14.66). Individuals with traumatic brain injury and injuries to the vertebral column and spinal cord had higher ORs for SA compared with other head, face, and neck injuries (2.72; 1.19-6.22 and 3.53; 2.24-5.55, respectively). CONCLUSIONS: In this explorative nationwide study of new bicycle crashes among individuals of working ages, 18% had a new SA spell in connection to the crash while 10% were already on SA or DP. The ORs for new SA were higher among women, older individuals, and among individuals with a fracture.

Sleep Apnea, Disability Pensions, and Cause-Specific Mortality: A Swedish Nationwide Register Linkage Study.

Sleep apnea is a common problem affecting daily functioning and health. We evaluated associations between sleep apnea and receipt of a disability pension and mortality in a prospective study of 74,543 cases of sleep apnea (60,125 outpatient, 14,418 inpatient) from the Swedish Patient Register (2000-2009 inclusive). Cases were matched to 5 noncases (n = 371,592) and followed from diagnosis/inclusion to December 31, 2010, via nationwide registers. During a mean follow-up period of 5.1 (standard deviation, 2.7) years, 13% of men and 21% of women with inpatient sleep apnea received a disability pension. Inpatient sleep apnea was associated with higher total mortality (for men, hazard ratio (HR) = 1.71, 95% confidence interval (CI): 1.59, 1.84; for women, HR = 2.33, 95% CI: 2.04, 2.67), with associations being strongest for deaths due to ischemic heart disease (for men, HR = 2.27, 95% CI: 1.94, 2.65; for women, HR = 5.27, 95% CI: 3.78, 7.34), respiratory disorders (for men, HR = 3.29, 95% CI: 2.45, 4.42; for women, HR= 5.24, 95% CI: 3.52, 7.81), and suicide (for men, HR = 1.76, 95% CI: 1.19, 2.60; for women, HR = 4.33, 95% CI: 1.96, 9.56). There were no associations of inpatient sleep apnea with cancer mortality. Outpatient sleep apnea was associated with a higher risk of receiving a disability pension but not higher total mortality. In conclusion, inpatient sleep apnea is related to a higher risk of disability pension receipt and mortality a decade after diagnosis.

Life satisfaction of women of working age shortly after breast cancer surgery.

PURPOSE: To explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery. METHODS: This cross-sectional study included 605 women, aged 20-63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression. RESULTS: Compared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables-having children, being in work, having emotional and informational social support, and having good physical and emotional functioning-were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning. CONCLUSIONS: One month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.

A study to examine the influence of health professionals' advice and support on work capacity and sick leave after breast cancer surgery.

PURPOSE: The aim of this study was to investigate how women, shortly after breast cancer surgery, experienced encounters with, and information from, healthcare professionals regarding work and sick leave and if these experiences were associated with self-reported work capacity and sick leave. METHODS: This is a cross-sectional study based on questionnaire data from 605 women who had had breast cancer surgery, aged 20-63 years. Exclusion criteria were known distant metastases, pre surgical therapy, and/or previous breast cancer. Data on age, type of surgery, global health, and work environment were included as covariates in multivariable logistic regression analysis. RESULTS: Five percent of the women had not received any advice concerning work or sick leave. Women reporting receiving useful advice or support related to paid work had lower risk of reporting reduced physical or psychological/social work capacity due to the cancer or treatment (OR 0.46 (95 % CI 0.26-0.81) respective OR 0.45 (95 % CI 0.26-0.77)). There were no associations between having received useful advice or support concerning work and being on sick leave. Women encouraged to take sick leave had an OR of 2.17 (95 % CI 1.39-3.37) of being sickness absent. They also to a higher extent had reduced physical and psychological/social work capacity. Women who reported to have been encouraged to work were sickness absent to a lower extent (OR 0.64; 95 % CI 0.41-0.98) and reported higher physical work capacity. CONCLUSIONS: Work and sick leave is being discussed during consultations with women with breast cancer and the advice given seems to be in line with the women's subjective work capacity.

Occurrence of sickness absence and disability pension in relation to childbirth: A 16-year follow-up study of 6323 Swedish twins.

BACKGROUND: Pregnancy, delivery, and the postpartum period may imply morbidity leading to work incapacity; however, this is seldom studied. This study aimed to compare twin sisters giving or not giving birth regarding occurrence of sickness absence (SA) and disability pension (DP). METHODS: This population-based cohort study included all 6323 female twins born in Sweden 1959-1990, using register data for 1994-2010 about SA and DP. Average number of SA/DP days/year was calculated in relation to the year of the first delivery, or, if not giving birth, the year when the twin sister gave birth. Twin pairs discordant for delivery were used to investigate the importance of genetic and environmental factors for occurrence of SA and DP. RESULTS: In all, 52% had a first delivery during 1994-2010. Except for the year of delivery, the average number of SA days/year was similar when comparing women who gave birth to those who did not, while number of DP days was significantly higher in women who did not give birth. Differences between the groups seem attributable to genetic factors. Women who delivered once had higher levels of SA and DP than those who had several deliveries. DP with mental diagnoses was more common among women who had not delivered whereas DP with musculoskeletal diagnoses occurred more often among women who delivered. CONCLUSIONS: Levels of SA were similar among women who gave birth and who did not. Women not giving birth had significantly higher levels of DP, indicating health selections into childbirth.

The joint contribution of diabetes and work disability to premature death during working age: a population-based study in Sweden.

AIMS: We aimed to examine how newly diagnosed diabetes and work disability jointly predict death during working age. METHODS: We used prospective population-based register data of 25-59-year-old adults who had lived in Sweden since 2002. All those with onset of diabetes recorded in 2006 were included (n=14266). A 2% random sample (n=78598) was drawn from the general population, comprising people with no indication of diabetes during 2003-2010. Net days of sickness absence and disability pension in 2005-2006 were examined; the follow-up time for mortality was 2007-2010. Cox regression models were fitted (hazard ratios, HR, 95% confidence interval, CI) adjusting for sociodemographics and time-dependent health conditions. RESULTS: Individuals with diabetes and work disability for over 6 months were at a higher risk of premature death (HR=14.2, 95% CI 12.0-16.8) than their counterparts without diabetes and work disability. A high risk was also observed among people without diabetes but equally prolonged work disability (HR=6.4, 95% CI 5.4-7.6). Diabetes was associated with premature death even without work disability (HR=3.5, 95% CI 2.8-4.4). The associations were particularly attenuated after adjustment for health conditions assessed over the follow-up. CONCLUSIONS: DIABETES AND WORK DISABILITY JOINTLY INCREASE THE RISK OF DEATH DURING WORKING AGE DIABETES WITH LONG-TERM WORK DISABILITY IS ASSOCIATED WITH THE HIGHEST RISK OF PREMATURE DEATH, WHICH HIGHLIGHTS THE IMPORTANCE OF THEIR PREVENTION AND EARLY DETECTION.

Work disability before and after diabetes diagnosis: a nationwide population-based register study in Sweden.

OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis. METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009. RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability. CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.

Occupational health physicians have better work conditions for handling sickness certification compared with general practitioners: results from a nationwide survey in Sweden.

AIMS: To study whether occupational health physicians (OPs) have a better work situation regarding handling of sickness certification compared with other physicians, in particular general practitioners (GPs), and to analyze associations between OPs' experiences of assessing and providing a long-term prognosis of patients' work capacity and some potentially interrelated factors. METHODS: Answers to a nationwide survey from physicians who had sickness certification consultations at least once monthly were analyzed. Differences among OPs (n=481), GPs (n=4257) and physicians working in other clinical settings (n=9452) were estimated by chi square tests. Associations between OPs' experiences as above and potentially interrelated factors were estimated using logistic regression analyses. RESULTS: Among OPs, a lower proportion experienced clinical work situations related to sickness certifications as 'very problematic', compared with the other physicians, and especially so compared with GPs. A higher proportion of OPs also had organizational support for handling sickness certifications. For OPs, experience of sickness certification consultations as problematic once a month or less often, not experiencing sickness certification tasks as a work environment problem, and having a well-established workplace policy regarding sickness certification matters were significantly positively associated with finding assessing and providing a long-term prognosis of work capacity as 'not at all/somewhat problematic'. CONCLUSIONS: OPs' work situation regarding sickness certifications was favorable compared with that of other physicians, and especially compared with that of GPS. Our results underline the importance of organizational support for ensuring physicians' experience of having professional competence in handling assessments of patients' work capacity.

Functional impairment due to bereavement after the death of adolescent or young adult offspring in a national population study of 1,051,515 parents.

PURPOSE: This study addresses the burden of grief after the death of an adolescent or young adult offspring. Parental bereavement following the death of an adolescent or young adult offspring is associated with considerable psychiatric and somatic impairment. Our aim is to fill a research gap by examining offspring death due to suicide, accidents, or natural causes in relation to risk of parental sickness absence with psychiatric or somatic disorders. METHODS: This whole population-based prospective study included mothers and fathers of all offspring aged 16-24 years in Sweden on December 31, 2004 (n = 1,051,515). This study had no loss to follow-up and exposure, confounders, and the outcome were recorded independently of each other. Cox survival analysis was used to model time to sickness absence exceeding 30 days, adjusting for parental demographic characteristics, previous parental sickness absence and disability pension, and inpatient and outpatient psychiatric and somatic healthcare prior to offspring death in 2001-2004. This large study population provided satisfactory statistical power for stratification by parents' sex and adolescent and young adults' cause of death. RESULTS: Mothers and fathers of offspring suicide and accident decedents both had over tenfold higher risk for psychiatric sickness absence exceeding 30 days as compared to parents of live offspring. Fathers of suicide decedents were at 40 % higher risk for somatic sickness absence. CONCLUSIONS: This is the largest study to date of parents who survived their offspring's death and the first study of work-related outcomes in bereaved parents. This study uses a broad metric of work-related functional impairment, sickness absence, for capturing the burden of sudden offspring death.

Cross-national comparisons of sickness absence systems and statistics: towards common indicators.

We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons.

Sickness absence and disability pension after road traffic accidents, a nationwide register-based study comparing different road user groups with matched references.

Background: Being injured in a road traffic accident may affect individuals' functional ability and in turn lead to sickness absence (SA) and disability pension (DP). Knowledge regarding long-term consequences in terms of SA and DP following a road traffic accident is lacking, especially comparing different groups of road users and compared to the general population. The aim was to estimate excess diagnosis-specific SA and DP among individuals of different road user groups injured in a road traffic accident compared to matched references without such injury. Methods: A nationwide register-based study, including all working individuals aged 20-59 years and living in Sweden who in 2015 had in- or specialized outpatient healthcare after a new traffic-related injury (n = 20 177) and population-based matched references (matched on: sex, age, level of education, country of birth, living in cities) without any traffic-related injury during 2014-2015 (n = 100 885). Diagnosis-specific (injury and other diagnoses) SA and DP were assessed during 5 years: 1 year before and 4 years following the accident. Mean SA and DP net days/year for each road user group and mean differences of (excess) SA and DP net days/year compared with their matched references were calculated with independent t-tests with bootstrapped 95% confidence intervals (CIs). Results: A third of all injured road users were bicyclists, 31% were car occupants, 16% were pedestrians (including fall accidents), and 19% were other and unspecified accidents. Pedestrians and other road users were the groups with the highest mean number of SA days during the first year following the accident (51 and 49 days/year respectively). The matched references had between 8 and 13 SA days/year throughout the study period. The excess SA days/year were elevated for all road user groups all five studied years. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Excess SA due to diagnoses other than injuries were about eight days/year during the whole study period for pedestrians and car occupants and about zero for the bicyclists. The excess DP was low, although it increased every year after the accident for pedestrians and car occupants; for bicyclists no excess DP was seen. Conclusion: Higher levels of SA due to injury diagnoses were seen among all road user groups during the first year after the accident compared to their references. Pedestrians and car occupants had more excess SA due to other diagnoses and more excess DP four years after the accident than bicyclists and other road users.

High prevalence of sickness absence and disability pension among multiple sclerosis patients: a nationwide population-based study.

INTRODUCTION: Although multiple sclerosis (MS) often implies substantial disability, there is little knowledge about sick leave and disability pension among MS patients. OBJECTIVES: The purpose of this study was to estimate the prevalence rates of sick leave and disability pension among MS patients and to explore how socio-demographics are associated with such rates. METHODS: The register data of all people who lived in Sweden in 2005 and were 16-64 years old was used to identify 9721 MS patients and matched controls. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated and effect modifications were evaluated with Wald X(2) tests. RESULTS: In 2005, 61.7% of the MS patients were on partial or full disability pension compared to 14.2% among the controls. Of the others, 36.8% had ≥ 1 sick-leave spell for >14 days during that year. Socio-demographics were similarly associated with sick leave and disability pension among MS patients and controls, with the noteworthy exceptions that female gender and immigration status were less potent risk factors in the MS population (p<0.05). CONCLUSION: In spite of widespread access to modern health care including disease-modifying drugs, the majority of MS patients of working ages were on a disability pension. Strategies enabling MS patients to retain their footing in the labour market are needed.

Problems experienced by gynecologists/obstetricians in sickness certification consultations.

OBJECTIVE: To explore frequencies and experiences with problems in sickness certification consultations among gynecologists and obstetricians in two different years. DESIGN: Cross-sectional surveys on two occasions; in 2004 and 2008. SETTING: Gynecological, obstetric and maternal health care. SAMPLE: Physicians working in gynecology, obstetrics or maternal health care in two Swedish counties from two samples: in 2004 (n = 315), and in 2008 (n = 327). METHODS: Data regarding sickness certification consultations were obtained from comprehensive questionnaires that had been mailed to the physicians in two Swedish counties in 2004 and in 2008, respectively. OUTCOME MEASURES: Frequencies and types of problems in sickness certification consultations, organizational support, and need to acquire more competence. RESULTS: The majority experienced that patients requested to be on sick leave for a reason other than work incapacity due to disease or injury, at least a few times per year (85% in 2004 and 88% in 2008). The most problematic situation to handle was when the physician and the patient had different opinions about the need for sick leave (2004: 66% and 2008: 58%). The physicians expressed a need for more competence about the options and responsibilities of employers, social insurance officers and physicians in sickness certification cases. CONCLUSIONS: Most gynecologists/obstetricians find sickness certification consultations problematic and especially when encountering patients requesting to be on sick leave for reasons other than disease. The physicians expressed a need for more competence in insurance medicine, especially about their own and other stakeholders' options and responsibilities.

Reasons for and factors associated with issuing sickness certificates for longer periods than necessary: results from a nationwide survey of physicians.

BACKGROUND: Physicians' work with sickness certifications is an understudied field. Physicians' experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certifying for longer periods than necessary among physicians working in different clinical settings; b) to examine main reasons for issuing sickness certificates for longer periods than necessary; and c) to examine factors associated with unnecessary issued sickness certificates. METHODS: In 2008, all physicians living and working in Sweden (a total of 36,898) were sent an invitation to participate in a questionnaire study concerning their sick-listing practices. A total of 22,349 (60.6%) returned the questionnaire. In the current study, physicians reporting handling sickness certification consultations at least weekly were included in the analyses, a total of 12,348. RESULTS: The proportion of physicians reporting issuing sickness certificates for longer periods than actually necessary varied greatly between different types of clinics, with the highest frequency among those working at: occupational medicine, orthopedic, primary health care, and psychiatry clinics; and lowest among those working in: eye, dermatology, ear/nose/throat, oncology, surgery, and infection clinics. Logistic analyses showed that sickness certifying for longer periods than necessary due to limitations in the health care system was particularly common among physicians working at occupational medicine, orthopedic, and primary health care clinics. Sickness certifying for longer periods than necessary due to patient-related factors was much more common among physicians working at psychiatric clinics. In addition to differences between clinics, frequency of sickness certificates issued for longer periods than necessary varied by age, physicians' experiences of different situations, and perceived problems. CONCLUSIONS: This study showed that physicians issued sickness certificates for longer periods than actually necessary quite frequently at some types of clinics. Differences between clinics were to a large extent associated with frequency of problems, lack of time, delicate interactions with patients, and need for more competence.

Fall and collision related injuries among pedestrians, sickness absence and associations with accident type and occupation.

OBJECTIVES: This study explores pedestrian fall accidents and collisions with other road users in the Swedish road transport system, and sickness absence (SA) in relation to accident type, injury, and occupation. Further, it studies the associations between accident type, occupation, and duration of SA. METHODS: Data from several national registers were used that included 15,359 working age pedestrians (20-64 years) receiving healthcare after a fall or collision throughout 2014-2016. Individual characteristics, accident type, injury, and occupation were presented and related to SA. Logistic regression was used to estimate odds ratios (OR), with 95% confidence intervals, for associations between accident type, occupation, and SA duration. RESULTS: About 11,000 pedestrians (72%) were involved in fall accidents in the road traffic environment and well over 4,000 in collisions with another road user; 22% of all injured pedestrians had a new SA. The population had a higher proportion of women and individuals in older age groups (≥45). Of the falls, 31% were due to snow or ice, and these were associated with a higher OR for both short SA (<90 days) 1.76 (95% CI 1.56-1.98) and long SA (≥90 days) 1.81 (95% CI 1.51-2.18), compared to the group slipping, tripping, and stumbling. The working sectors health & social care, and construction had the highest ORs for SA. A higher OR was found for health & social care, short SA 1.58 (95% CI 1.38-1.81), long SA 1.79 (95% CI 1.45-2.20) and for construction, short SA 1.56 (95% CI 1.24-1.96), long SA 1.75 (95% CI 1.26-2.44), compared to the sector finance, communication, & cultural service. CONCLUSIONS: The OR for having short and long SA was higher in falls due to snow or ice and differed between occupational sectors. PRACTICAL IMPLICATIONS: This information contributes to the knowledge base for planning a safe road transport system for pedestrians.

Sustainable labour market participation among working young adults with diagnosed attention deficit/hyperactivity disorder (ADHD).

Background: The aims were to study the sustainability of labour-market participation five years after an incident diagnosis of attention-deficit/hyperactivity disorder (ADHD) among young adults with gainful employment, and to examine the impact of sociodemographic-, work- and health-related factors on these findings. Methods: Swedish registers identified 2517 individuals, 19-29 years old, with an incident diagnosis of ADHD and gainful employment during 2006-2011. Labour-market participation was measured by the core-peripheral model, a model that measures the connection to the labour market from a weak connection (peripheral) to a strong connection (core). Sequence analysis analysed clusters of labour-market participation, from one year before and up to five years after diagnosis. Odds ratios (OR) with 95% confidence intervals (CI) between sociodemographic factors, comorbid disorders, and the identified clusters were analysed by multinomial logistic regression. Results: Five clusters of labour-market participation were identified: 60% of individuals belonged to a cluster that maintained labour-market participation throughout the study period (core, close to core); 20% belonged to a cluster with a transition to a weak connection to the labour market (close to peripheral, peripheral); and 20% belonged to a cluster with "middle" labour-market participation, characterised by having long periods of sick leave and unemployment. Individuals with elementary school as highest attained education (OR:4.03;CI:2.35-6.93), comorbid mental disorders (OR:2.77;CI:2.10-3.66), or living in villages/small cities (OR:1.77;CI:1.25-2.51) were most likely to belong to a cluster transitioning towards a "peripheral" labour-market participation. Men were less likely to have peripheral labour-market participation than women (OR:0.55;CI:0.40-0.75). Conclusions: Over half of working individuals with ADHD maintain a strong attachment to the labour market several years after their first diagnosis of ADHD. Therefore, it is important to target those who have problems maintaining a position in the labour market, including women, those with low educational levels, and those living outside large cities.