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Integrating perspectives in social medicine
Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In this thesis sickness absence was studied from a socio-medical perspective using both epidemiological and clinical data and methods of analysing. The specific aim of the epidemiological studies was to analyse sickness absence patterns and its changes in the total population of Östergötland. Furthermore, variations with gender, age and occupation were analysed. Gender trends in sickness absence concerning musculoskeletal diagnoses, its changes from 1985 to 1987 and association of numerical gender segregation in occupational categories with sickness absence due to musculoskeletal diagnoses was also investigated.

The specific aim of the clinical studies was to estimate the frequency and character of psycho-social problems in a population with repeated short-term sickness absence. A clinical socio-medical supportive program for this patient-group was assessed. Finally, the vocational activity, program costs and possible benefits to society of a clinical, socio-medical case management program was evaluated.

The results showed that women had much higher sickness absence than men generally and in particular in male-dominated occupational categories. The cumulative incidence percentage of siclmess absence in all diagnoses increased for both genders from 1985 to 1987. There were large variations between different occupational categories; blue-collar occupations were high-risk for sickness absence while white-collar occupations were low risk.

Women had higher cumulative incidence than men in musculoskeletal diagnoses and also longer duration of sick leave days per sick leave insured person and per sick-listed person. The cumulative incidence for the diagnostic sub-group "neck/shoulder diagnoses" showed the highest percentage increase from 1985-87. The cumulative incidence in all musculoskeletal diagnostic groups was highest for both genders in extremely male-dominated occupational categories (>90% men).

The study of repeated short-tenn sick leave showed that the underlying reasons were less medical and more of a socio-medical origin for 2/3 of the patients in comparison with an age- and sex-matched sample of patients at the general practitioner's surgery in the same area. A majority of patients, who had taken part in a socio-medical supportive program reported a better quality of life, although they did not specifically ascribe this to the socio-medical intervention.

When investigating the long-term economic effect of a clinical case management program for patients with chronic minor disease, the benefit-cost ratio of the program was 4.9. Fifty per cent of the patients had been absent from working life for more than two years on admission to the program. The rehabilitation rate of patients back to work was 20.5% after one year and 11 .7% after five years.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2002. , 61 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 754
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-26341Local ID: 10865ISBN: 91-7373-199-4 (print)OAI: oai:DiVA.org:liu-26341DiVA: diva2:246889
Public defence
2002-11-20, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-18Bibliographically approved
List of papers
1. Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987: A three year longitudinal study with focus on gender, age and occupation
Open this publication in new window or tab >>Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987: A three year longitudinal study with focus on gender, age and occupation
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1994 (English)In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 22, no 1, 27-34 p.Article in journal (Refereed) Published
Abstract [en]

In order to get a better epidemiological base for preventive intervention in the county of Östergötland, Sweden, a comprehensive study of sickness absence was done. During the years 1985, 1986 and 1987, all new periods of sick-leave exceeding seven days were registered with demographic variables. This information was related to data about the total population of Östergötland. Each year approx. 45,000 persons had approx. 61,000 sickness spells. These figures were stable over the years while the number of sick-leave days increased. Blue-collar occupations had the highest sick-leave rates and the female sick-leave rate was higher in general and much higher in most male-dominated occupations. The male rate was lower within female-dominated areas, except among secretaries and textile workers. Females in extremely male-dominated groups had the highest rates, while both male and female sick-leave rates were lower in more gender-integrated occupations.

Place, publisher, year, edition, pages
Sage Publications, 1994
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-81533 (URN)10.1177/140349489402200105 (DOI)8029663 (PubMedID)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2016-02-11Bibliographically approved
2. Gender trends in sick-listing with musculoskeletal symptoms in a Swedish county during a period of rapid increase in sickness absence
Open this publication in new window or tab >>Gender trends in sick-listing with musculoskeletal symptoms in a Swedish county during a period of rapid increase in sickness absence
1998 (English)In: Scandinavian Journal of Social Medicine, ISSN 1403-4948, Vol. 26, no 3, 204-213 p.Article in journal (Refereed) Published
Abstract [en]

Sickness absence and disability pension due to musculoskeletal diagnoses has increased in Sweden.

Study objective — To study gender trends in sickness absence with musculoskeletal diagnoses and its changes in 1985—87.

Design — A prospective population-based study of all new sick-leave spells exceeding seven days in 1985—87. Sickness absence with "all diagnoses'' was compared to "all musculoskeletal diagnoses'', the latter group was also divided into three sub-groups.

Setting — The county of Östergötland, Sweden.

Participants — All sick-leave insured aged 16—65; 107,000 women and 100,000 men.

Results — More women than men were sick-listed in "all diagnoses'' in 1985. There were corresponding gender differences in sickness absence with musculoskeletal diagnoses except with the diagnosis "low back pain''. Sick-listing with musculoskeletal diagnoses increased for both women and men from 1985 to 1987, but the increase was consistently much higher for women, especially for younger women.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81534 (URN)10.1177/14034948980260031101 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2012-09-18Bibliographically approved
3. Sickness absence due to musculoskeletal diagnoses: association with occupational gender segregation
Open this publication in new window or tab >>Sickness absence due to musculoskeletal diagnoses: association with occupational gender segregation
2004 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 32, no 2, 94-101 p.Article in journal (Refereed) Published
Abstract [en]

Background: Musculoskeletal disorders represent a considerable public health problem and the most common diagnoses behind sickness absence and disability pensions. However, little is known about how sickness absence with these diagnoses varies with the strong gender segregation of the labour market.

Aims: A study was undertaken to investigate the association between musculoskeletal-related sickness absence and occupational gender segregation.

Methods: The study was population based, and included all new sick-leave spells exceeding seven days due to musculoskeletal diagnoses, comprising neck/ shoulder pain, low back pain, and osteoarthritis in Östergötland county, Sweden, which has 393,000 inhabitants (5% of the national population). The participants were all sick-leave insured employed persons in Östergötland (n=182,663) in 1985.

Results: Cumulative incidence of musculoskeletal-related sickness absence (>7 days) was higher for women (7.5%, 95% confidence interval [C.I.] 7.3-7.7) than for men, (5.8%, C.I. 5.6-5.9), and the same was true for the mean number of sick-leave days (women 81, C.I. 78-83; men 65, C.I. 63-68). Grouping occupations according to degree of numerical gender segregation revealed the highest incidence and duration of sickness absence for women in male-dominated occupations. For both genders, the lowest cumulative incidence and duration occurred in gender-integrated occupations.

Conclusions: Our results indicate a strong association between occupational gender segregation and musculoskeletal-related sickness absence. Further studies are needed to elucidate gender segregation of the labour market in relation to health and rehabilitation measures.

Keyword
Gender, Gender segregation, Men, Musculoskeletal diagnoses, Sick-leave, Women
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-45572 (URN)10.1080/14034940310006195 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
4. Repeated short-term sick-leave as a possible symptom of psycho-social problems
Open this publication in new window or tab >>Repeated short-term sick-leave as a possible symptom of psycho-social problems
1984 (English)In: Scandinavian Journal of Social Medicine, ISSN 1403-4948, Vol. 12, no 4, 165-169 p.Article in journal (Refereed) Published
Abstract [en]

As part of a research project concerning repeated short-term sick-leave an intensive study has been performed aiming at estimating the frequency and character of psycho-social problems in a population with a minimum of six short sick spells during a 12-month period, in comparison with an age- and sex-matched sample of patients who went to the local general practitioner in the same area. The results show that psycho-social problems are twice as common in the group with repeated short-term sick-leave.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81536 (URN)10.1177/140349488401200406 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2012-09-18Bibliographically approved
5. Repeated short-term sick-leave and quality of life: An evaluation of a clinical socio-medical intervention
Open this publication in new window or tab >>Repeated short-term sick-leave and quality of life: An evaluation of a clinical socio-medical intervention
1990 (English)In: Scandinavian Journal of Social Medicine, ISSN 1403-4948, Vol. 18, no 2, 91-95 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim of this study was to evaluate a clinical socio-medical supportive program for repeated short-term sickleavers who exhibited no evident reason for their prolonged absence. Attention was drawn to changes in the quality of life of the participants. Ninety-nine persons took part in the full program. The sex distribution was even and the mean age was 32 years. The average number of days of sick-leave during the year preceding the entrance into the program was 28. The most common self-stated diagnosis was upper respiratory infection or gastro-intestinal problems. The evaluation showed a significant change for the better in the quality of life and well-being of the patients, although more than every other patient did not explicitly attribute any personal benefit to the intervention itself. The results coincide irrespective of measuring method and, are by and large, consistent over most areas of life and components of well-being assessed. Thus the design and the results of the evalution look very promising concerning reliability, validity and especially sensitivity. A corresponding model may be applicable more generally when evaluating health- and medical care.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81537 (URN)10.1177/140349489001800202 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2012-09-18Bibliographically approved
6. Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life
Open this publication in new window or tab >>Long-term economic effects of team-based clinical case management of patients with chronic minor disease and long-term absence from working life
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1997 (English)In: Scandinavian Journal of Social Medicine, ISSN 0300-8037, Vol. 25, no 4, 229-237 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To examine the socio-economic effects of team-based clinical case management of patients with chronic minor disease bound for early retirement.

Design: Marginal analysis of programme costs and benefits to society compared with no-programme baseline of costs occurring in society due to productivity loss. Prospective patient data collection on admission, discharge, and at one year and five years after discharge to determine programme effectiveness.

Setting: Out-patient clinic at the department of social medicine in tertiary care hospital.

Subjects: 239 patients with minor disease and long-term vocational absence consecutively admitted to the study. At the one-year evaluation, 17 patients had been readmitted to the team, 7 could not be found, 6 declined the interview and 2 were deceased. At the five-year evaluation of 49 patients who were active after one year, one was deceased and 10 were unable to be found.

Main outcome measures: Vocational activity. Programme costs. Benefits to society measured by decrease in indirect costs.

Results: The one-year vocational rehabilitation rate from the program was 20.5% and the five-year rehabilitation rate was 11.3%. The total discounted cost for case management of the 239 patients was 7.6 MSEK (£600,000). The decrease in the indirect costs to society from the 28 patients found active after five years was 35.1 MSEK (£2,500,000). The net present value of the programme at the 1991 price level was 27.5 MSEK (£2,365,000).

Conclusions: Tertiary care level team-based clinical case management for vocational rehabilitation of patients with chronic minor disease has a positive cost-benefit ratio. A cross-boundary awareness at a health policy level is needed of the societal costs involved for this group of patients who fall between the traditional services in health care and social work.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81538 (URN)10.1177/140349489702500402 (DOI)
Available from: 2012-09-18 Created: 2012-09-18 Last updated: 2013-09-05Bibliographically approved

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