Reasons for presenteeism in different occupational branches in Sweden: a population based cross-sectional study.

OBJECTIVE: To compare the prevalence and reasons for presenteeism in occupations in three branches defined as employees handling people, handling things or handling symbols. METHOD: A cross-sectional population-based cohort study was conducted. The study group was drawn from a representative sample (n = 6230) aged 16-64, who had been interviewed in 2015 or in 2017 for the Swedish Work Environment Surveys (SWES). The odds ratios (ORs) stratified by occupational category for reasons of presenteeism, with 95% confidence intervals (CI), were estimated using binomial multiple logistic regression analysis. RESULTS: The study showed that presenteeism was more common among employees handling people (74%), when compared to employees handling things (65%) or handling symbols (70%). The most common reason for presenteeism among employees handling people was "I do not want to burden my colleagues", while "Because nobody else can carry out my responsibilities" was most common in the other two categories. After control for socio-demography, work environments and health, the differences in reasons mostly remained significant between the three occupational categories. CONCLUSION: The differences between occupational categories are important for prevalence and reasons for presenteeism. As presenteeism affects the future health of employees and the productivity of the work unit, attempts to reduce presenteeism may be important. Because the reasons vary between occupations, customized preventive measures should be applied in different occupational settings. Among employees handling people, covering up for absence in work team is relevant, while among employees handling symbols and handling things the corresponding focus could be on shared responsibilities for specific tasks.

Work environment risk factors for the duration of all cause and diagnose-specific sickness absence among healthcare workers in Sweden: a prospective study.

OBJECTIVES: Increasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on musculoskeletal and psychiatric diagnoses among healthcare workers. METHODS: The study sample consisted of healthcare workers (n=12 452) drawn from representative samples of workers aged 16 to 64, who participated in the Swedish Work Environment Surveys (SWES) between 1993 and 2013. The outcomes were either short-term (≤28 days) or long-term (>104 days) SA between 1994 and 2016. HRs and 95% CIs were calculated for the impact of physical and psychosocial working conditions on risk of subsequent short-term or long-term SA for 3 years after participation in SWES. RESULTS: Heavy physical work and strenuous work postures showed elevated HRs for short-term and long-term SA compared with those without these work exposures. Similarly, high job demands and low job control each increased the risk for both short-term and long-term SA compared with employees with low job demands and high job control. Low job support increased the risk for short-term SA compared with those with high job support. Working conditions were strongly related to short-term SA due to musculoskeletal diagnoses but not to short-term SA due to psychiatric diagnoses. None of the work characteristics, except strenuous postures, elevated the risk for long-term SA due to psychiatric diagnosis compared with employees without these characteristics. CONCLUSIONS: Ergonomic improvements and stress reduction among healthcare workers are likely to reduce the prevalence of SA foremost due to musculoskeletal diagnoses.

Social integration, socioeconomic conditions and type of ill health preceding disability pension in young women: a Swedish population-based study.

BACKGROUND: Disability pension has increased in recent decades and is seen as a public health and socioeconomic problem in Western Europe. In the Nordic countries, the increase has been particularly steep among young women. PURPOSE: The aim was to analyze the influence of low social integration, socioeconomic risk conditions and different measures of self-reported ill health on the risk of receiving disability pension in young women. METHOD: The study comprised all Swedish women born in 1960 to 1979, who had been interviewed in any of the annual Swedish Surveys of Living Conditions (1990-2002). The assumed predictors were related to disability pension by Cox proportional hazard regression. The mean number of years of follow-up for the 10,936 women was 7 years (SD 3.8), and the study base was restricted to the ages 16 to 43 years of age. RESULTS: An increased risk of receiving a disability pension was found among lone women, those who had sparse contacts with others, job-seeking women, homemakers, as well as women with low education, and poor private financial situations. A tenfold increase in the risk of receiving a disability pension was found among women reporting a long-standing illness and poor self-rated health, compared to women without a long-standing illness and good self-rated health. Psychiatric diagnoses and symptoms/unspecified illness were the strongest predictors of disability pension, particularly before 30 years of age. CONCLUSION: The study suggests that weak social relations and weak connections to working life contribute to increase the risk of disability pension in young women, also after control for socioeconomic conditions and self-reported ill health. Self-rated health was the strongest predictor, followed by long-standing illness and not having a job (job seekers and homemakers).

Activities and sources of income after a period of long-term sick leave--a population-based prospective cohort study.

BACKGROUND: There is limited knowledge about what happens to people after long-term sick leave. The aim of this report was to conduct a prospective study of individuals who were on prolonged sick leave during a particular year, considering their activities and sources of income during subsequent years. To enable comparison of different time periods, we used three cohorts of individuals with different starting years. METHODS: Using data from national registers, three separate cohorts were constructed that included all people living in Sweden who were 20-64 years of age (>5 million) in the years 1995, 2000 and 2005, respectively. The individual members of the cohorts were classified into the following groups based on their main source of income and activity in 1995-2008: on long-term sick leave, employed, old-age pensioner, long-term unemployed, disability pensioner, on parental leave, social assistance recipient, student allowance recipient, deceased, or emigrated. RESULTS: Most individuals on long-term (> 6 months) sick leave in 1995 were not employed 13 years later. Only 11% of the women and 13% of the men were primarily in employment after 13 years. Instead, a wide range of alternatives existed, for example, many had been granted disability pension, and about 10% of the women and 17% of the men had died during the follow-up period. A larger proportion of those with long-term sick leave were back in employment when 2005 was the starting year for the follow-up. CONCLUSIONS: The low future employment rates for people on long-term sick leave may seem surprising. There are several possible explanations for the finding: The disorders these people may have, might have entailed longstanding difficulties on the labor market. Besides, long-term absence from work, no matter what its causes were, might have worsen the chances of further employment. The economic cycles may also have been of importance. The improving labor market during later years seems to have improved the chances for employment among those earlier on long-term sick leave.

Is gender policy related to the gender gap in external cause and circulatory disease mortality? A mixed effects model of 22 OECD countries 1973-2008.

BACKGROUND: Gender differences in mortality vary widely between countries and over time, but few studies have examined predictors of these variations, apart from smoking. The aim of this study is to investigate the link between gender policy and the gender gap in cause-specific mortality, adjusted for economic factors and health behaviours. METHODS: 22 OECD countries were followed 1973-2008 and the outcomes were gender gaps in external cause and circulatory disease mortality. A previously found country cluster solution was used, which includes indicators on taxes, parental leave, pensions, social insurances and social services in kind. Male breadwinner countries were made reference group and compared to earner-carer, compensatory breadwinner, and universal citizen countries. Specific policies were also analysed. Mixed effect models were used, where years were the level 1-units, and countries were the level 2-units. RESULTS: Both the earner-carer cluster (ns after adjustment for GDP) and policies characteristic of that cluster are associated with smaller gender differences in external causes, particularly due to an association with increased female mortality. Cluster differences in the gender gap in circulatory disease mortality are the result of a larger relative decrease of male mortality in the compensatory breadwinner cluster and the earner-carer cluster. Policies characteristic of those clusters were however generally related to increased mortality. CONCLUSION: Results for external cause mortality are in concordance with the hypothesis that women become more exposed to risks of accident and violence when they are economically more active. For circulatory disease mortality, results differ depending on approach--cluster or indicator. Whether cluster differences not explained by specific policies reflect other welfare policies or unrelated societal trends is an open question. Recommendations for further studies are made.

Medically certified sickness absence with insurance benefits in women with and without children.

BACKGROUND: Sickness absence in Sweden is high, particularly in young women and the reasons are unclear. Many Swedish women combine parenthood and work and are facing demands that may contribute to impaired health and well-being. We compared mothers and women without children under different conditions, assuming increased sickness absence in mothers, due to time-based stress and psychological strain. METHODS: All women born in 1960-79 (1.2 million) were followed from 1993 to 2003. Information on children in the home for each year was related to medically certified sickness absence with insurance benefits the year after. We used age and time-stratified proportional hazard regression models accounting for the individual's changes on study variables over time. Data were retrieved from national administrative registers. RESULTS: Sickness absence was higher in mothers than in women without children, the relative risks decreased by age, with no effect after the age of 35 years. An effect appeared in lonely women irrespective of age, while in cohabiting women only for the ages 20-25 years. Mothers showed increased sickness absence in all subgroups of country of birth, education, income, sector of employment and place of residence. The relation between number of children and sickness absence was nonlinear, with the highest relative risks for mothers of one child. The upward trend of sickness absence at the end of 1990s was steeper for mothers compared to women without children. CONCLUSION: Despite the well-developed social security system and child care services in Sweden, parenthood predicts increased sickness absence, particularly in young and in lone women.

Workplace interventions for neck pain in workers.

BACKGROUND: Musculoskeletal disorders are the most common cause of disability in many industrial countries. Recurrent and chronic pain accounts for a substantial portion of workers' absenteeism. Neck pain seems to be more prominent in the general population than previously known. OBJECTIVES: To determine the effectiveness of workplace interventions (WIs) in adult workers with neck pain. SEARCH STRATEGY: We searched: CENTRAL (The Cochrane Library 2009, issue 3), and MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, OTseeker, PEDro to July 2009, with no language limitations;screened reference lists; and contacted experts in the field.   SELECTION CRITERIA: We included randomised controlled trials (RCT), in which at least 50% of the participants had neck pain at baseline and received interventions conducted at the workplace. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias. Authors were contacted for missing information. Since the interventions varied to a large extend, International Classification of Functioning, Disability and Health (ICF) terminology was used to classify the intervention components. This heterogeneity restricted pooling of data to only one meta-analysis of two studies. MAIN RESULTS: We identified 1995 references and included10 RCTs (2745 workers). Two studies were assessed with low risk of bias. Most trials (N = 8) examined office workers. Few workers were sick-listed. Thus, WIs were seldom designed to improve return-to-work. Overall, there was low quality evidence that showed no significant differences between WIs and no intervention for pain prevalence or severity. If present, significant results in favour of WIs were not sustained across follow-up times. There was moderate quality evidence (1 study, 415 workers) that a four-component WI was significantly more effective in reducing sick leave in the intermediate-term (OR 0.56, 95% CI 0.33 to 0.95), but not in the short- (OR 0.83, 95% CI 0.52 to 1.34) or long-term (OR 1.28, 95% CI 0.73 to 2.26). These findings might be because only a small proportion of the workers were sick-listed. AUTHORS' CONCLUSIONS: Overall, this review found low quality evidence that neither supported nor refuted the benefits of any specific WI for pain relief and moderate quality evidence that a multiple-component intervention reduced sickness absence in the intermediate-term, which was not sustained over time. Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. There is an urgent need for high quality RCTs with well designed WIs.

Gender policy developments and policy regimes in 22 OECD countries, 1979-2008.

This study investigates trends and clustering of gender policy in 22 OECD (Organization for Economic Cooperation and Development) countries during 1979-2008. The starting point was Sainsbury's gender policy regime framework, and the study included indicators reflecting the male bread-winner, individual earner-carer, and separate gender roles regimes. The indicators were followed over seven time points for mean, range, and distribution. Cluster analyses were performed for the years 1979, 1989, 1999, and 2004. In accordance with previous studies, the authors found a Nordic cluster of earner-carer countries, while several Southern European countries and the United States were marked by their low generosity and high pension requirements. Though aspects of the separate gender roles regime have become more widespread, no country could be classified as fully belonging to this regime type. The two aspects of the model--compensatory measures in the pension system, and benefits for caring activities--were never present simultaneously.

The changing nature of work - Job strain, job support and sickness absence among care workers and in other occupations in Sweden 1991-2013.

This study examined exposure changes in three psychosocial dimensions - job demands, job control, and social support - and the associations between these dimensions and sickness absence throughout the period 1991-2013. The analyses covered periods of economic ups and downs in Sweden and periods involving major fluctuations in sickness absence. Data on care workers (n = 16,179) and a comparison group of employees in other occupations (n = 82,070) were derived from the biennial Swedish Work Environment Survey and linked to register data on sickness absence. Eight exposure profiles, based on combinations of demands, control, and support, were formed. The proportion of individuals with work profiles involving high demands doubled among care workers (14%-29%) while increasing modestly in the comparison group (17%-21%) 1991-2013. The work profile that isolated high-strain (iso-strain), i.e., high demands, low control, and low social support, was more prevalent among care workers, from 4% in 1991 to 11% in 2013. Individuals with work profiles involving high-demand jobs had the highest number of days on sickness absence during the study period and those with the iso-strain work profile had the highest increase in sickness absence, from 15 days per year during 1993-1994, to 42 days during 2000-2002. Employees with a passive work profile (low job demands and low job control) had the lowest rate and the lowest increase in sickness absence. Individuals with active work profiles, where high demands are supposed to be balanced by high job control, had a rather high increase in sickness days around 2000. A conclusion is that there is a long-term trend towards jobs with high demands. This trend is stronger among care workers than among other occupations. These levels of job demands seem to be at such a level that it is difficult to compensate for with higher job control and social support.

Favorable Working Conditions Related to Health Behavior Among Nurses and Care Assistants in Sweden-A Population-Based Cohort Study.

Objective: To analyze the associations between favorable physical and psychosocial work factors and health behavior among healthcare employees (nurses and care assistants) with health complaints. Methods: The study was based on seven iterations (2001-2013) of a biennial Swedish work environment survey linked with data from public registers. In all, 7,180 healthcare employees, aged 16-64 years, who had reported health complaints, were included. Health behavior was operationalized through four combinations of sickness absence (SA) and sickness presence (SP): 'good health behavior' (Low SP/Low SA), 'recovery behavior' (Low SP/High SA), 'risk behavior' (High SP/Low SA), and 'poor health behavior' (High SP/High SA). Odds ratios (OR) were calculated by multinomial logistic regression with 95% confidence intervals (CI). Results: After adjusting for socio-demographic factors, those who rarely worked in strenuous postures had an increased probability of having 'good health behavior' (OR range: nurses 1.72-2.02; care assistants 1.46-1.75). Those who rarely experienced high job demands had increased odds for having 'good health behavior' (OR: nurses 1.81; OR range: care assistants 1.67-2.13), while having good job control was found to be related to 'good health behavior' only among care assistants (OR range 1.30-1.68). In the full model, after also considering differences in health, none of the work environment indicators affected 'good health behavior' among nursing professionals. Among care assistants, rarely having heavy physical work and having low psychosocial demands remained significantly associated with 'good health behavior' (OR range: 1.24-1.58) and 'recovery behavior' (OR range: 1.33-1.70). No associations were found between favorable work environment factors and 'risk behavior' among the two groups of employees. However, positive assessments of the work situation were associated with 'good health behavior,' even after controlling for all confounders for both groups (OR range: 1.43-2.69). Conclusions: 'Good health behavior' and 'recovery behavior' among care assistants were associated with favorable physical and psychosocial working conditions even when health was considered. This implies that reduced sickness presence and sickness absence among care assistants can be achieved through improved physical and psychosocial working conditions.