This thesis is an example of an ear to loaf process:

A Preliminary Essential Data Set (PEDS) for Ear, Nose and Throat (ENT) diagnostics in Primary Health Care (PHC) was established by infologic modelling of existing tractates, between the specialist organisations of ENT and PHC, and four contemporary text-books on the subject (I). The PEDS was then compared to the aggregated data from a sample of case-files from a Swedish PHC centre. The quality of the individual medical record was found to be poor and not sufficient for follow-up and Quality Management (QM) purposes (II). The aggregated data from the case-file sample was processed by an inductive "expert" computer program that generated a decision-tree, based on the total number of decisions (diagnoses) in the data-base. This was nearly identical to the PEDS and somewhat less complicated. Infological modelling of the PEDS and the decision-tree resulted in the proposed Essential Data Set (EDS) for ENT diagnostics in PHC. The decision tree was "pruned" to achieve simplicity and ease of use (III). It was converted into a Computer-aided Decision Support System (CDSS) and put on the Internet using World Wide Web (WWW) tools (IV). This system was then implemented in the Skänninge PHC centre where an Electronic Medical Record System (EMRS) was in everyday use. Due to technical difficulties no integration between the two systems was possible. The CDSS was run on a computer outside the centre and this raised the question of secrecy and security (V). Prior to the implementation, and after a study period of four months attitudes towards, and the acceptance of, new Information Technology (IT) was explored by using focus group methodology (VI). It is important that those who are to use the system are intimately involved in its development. The results showed, that participation of the end-users during implementation is crucial for its acceptance. The need for a uniform and agreed terminology was obvious to facilitate co-operation and QM. The importance of nurses and physicians using the same terminology for documentation, was paramount.

Background and objective: Dyspepsia, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (GORD) involve a substantial cost to Swedish society. There is a lack of up-to-date nationwide cost estimates after 1985. This study was conducted to present a comprehensive and updated cost analysis and study the change over time of the national cost of these disorders. Design and setting: Primarily, data from National Swedish databases and secondly, data from databases from the County of Uppsala for 1997 were used for the calculations and estimations. Perspective: Swedish societal perspective. Results: The total cost to Swedish society of dyspepsia, PUD and GORD in 1997 was $US424 million, or $US63 per adult. Direct costs totalled $US258 million (61%) while indirect costs totalled $US166 million (39%). The highest proportions of costs were due to drugs and sick leave, these being 37 and 34%, respectively. Conclusions: The cost of dyspepsia and GORD is substantial for patients, health providers and society. Since 1985, drug costs have increased substantially while the cost of sick leave has decreased.

Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647

Objective - The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseases and management, and to evaluate whether there is a difference between the genders. Design - Descriptive retrospective investigation. Setting - ┼tvidaberg community situated in southeast Sweden, 12 400 inhabitants. Patients - 256 patients treated for symptomatic HF. Main outcome measures - Prevalence, aetiology, diagnostic procedures and management of HF and differences between the genders. Results - The diagnosis of HF was based on an objective evaluation of cardiac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy included diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) and digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objective diagnostic test (echocardiography) in only 20%. Women were prescribed ACE inhibitors to a lesser extent (43%) than men (64%) and with a lower optimal dose (44% versus 56% in men). Conclusion - There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not generally based on an objective evaluation of cardiac function and where the treatment to a lesser extent than in men includes ACE inhibitors.

Objectives: The principle of achieving the most cost-effective level of care in relation to needs is an essential aim for all health care systems. However, it is not certain that the corresponding knowledge and attitudes with respect to the appropriate level of care for different symptoms can be found in the general population. There may be age-related differences in illness behaviour that manifest in ‘overutilisation’ of the system. We studied illness behaviour with regard to attitudes and inclination to seek care for different symptoms at various levels in the health care system.Methods: The study group consisted of a random selection of 296 persons, born in the 1940s, ′50s and ′60s, and living in a defined region in Sweden. In a questionnaire they had to choose between different levels of care for twelve symptom descriptions with varying degrees of severity. The answers were scored according to the level of care, adequacy and overutilisation.Results: The vast majority of participants chose an adequate level of care. However, overutilisation was found, particularly among women born in the 1960s and to some extent among men born in the 1940s. These two groups together constituted about 70% of all the individuals who tended to overutilise the health care in their expressed preferences.Conclusions: These individuals do not receive cost-effective care, or the most adequate care with regard to their needs. The results indicate, however, that the problem was more a question of attitude rather than a lack of knowledge and information.

Objectives To compare patients with coronary artery disease and healthy controls with respect to cognitive function and driving performance.

Design and setting A controlled study conducted between April 1999 and January 2001.

Subjects Forty-four patients with stable coronary artery disease scheduled for cardiac intervention with coronary artery bypass surgery or percutaneous coronary intervention. Forty volunteers of similar age without symptoms of coronary artery disease served as controls.

Main outcome measures On-road driving scores in five specific test areas with a rating scale from 1 to 5. Neuropsychological test scores, including 12 tests.

Results Compared with controls, patients with coronary artery disease had lower scores in all areas of the on-road driving test (p<0.05) and in the neuropsychological tests assessing psychomotor speed, visual and verbal memory, focused attention and simultaneous capacity (p<0.05). The difference between the groups in the on-road driving test appeared to be more pronounced among those above 65 years-of-age. Both patients and controls rated their performance significantly higher than the traffic inspector (p<0.05).

Conclusions Cognitive function and driving performance may be impaired in patients with coronary artery disease.

Abstract

Heart failure is common in the elderly population and carries a serious prognosis. Identification of risk factors for cardiovascular mortality among primary care patients is important.

Aim

To evaluate EDTA-plasma brain natriuretic peptide (BNP) and the aminoterminal fragment of proBNP (N-terminal proBNP) as prognostic markers in elderly with symptoms of mild to moderate heart failure.

Methods

From 474 patients attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema blood was sampled in plastic tubes containing EDTA in order to measure BNP by non-extraction immunoradiometric assay and of N-terminal proBNP by non-extraction radioimmunoassay. Patients were evaluated with respect to history and clinical- and laboratory examinations with particular reference to cardiac structure and function. Follow-up time was 6 years. A Cox regression analysis was performed to identify the weight of risk variables.

Conclusion

During the follow-up period of 6 years the total mortality was 16 % (75 patients out of 474), and cardiovascular mortality was 11% (52 patients). Cardiovascular mortality increased with increased plasma concentration of BNP or N-terminal proBNP. Both pep tides were useful prognostic markers for cardiovascular mortality in patients with heart failure. In those with the highest quartile of plasma concentration of BNP and N=terminal proBNP, 9.9 times and 5.0 times increased risk for CV death were identified respectively.

Heart failure is common in the elderly population and carries a serious prognosis. We evaluated EDTA-plasma B-type natriuretic peptide (brain natriuretic peptide, BNP) and the aminoterminal fragment of proBNP (N-terminal proBNP) as prognostic markers in elderly primary care patients with symptoms of heart failure. Methods: From 474 patients attending primary care for symptoms of dyspnea, fatigue and/or peripheral edema, blood was sampled in plastic tubes containing EDTA to measure BNP by non-extraction immunoradiometric assay and N-terminal proBNP by non-extraction radioimmunoassay. Patients were evaluated with respect to history and function by NYHA classification and Doppler echocardiography. Follow-up time was 6 years. Cox regression analysis was performed to identify the weight of risk variables. Conclusion: Total 6-year mortality was 20% (102 patients out of 510), and cardiovascular (CV) mortality was 14% (71 patients, 70% of total mortality). BNP and N-terminal proBNP were essentially equally useful as prognostic markers. In patients with the highest quartiles of plasma concentration of BNP and N-terminal proBNP, respectively, the risk of cardiovascular mortality was 10 and 4.8 times, respectively, higher than that in those in the lowest quartile. Peptide concentrations varied widely within all functional groups including those with normal echocardiographic findings. Plasma concentrations of BNP and N-terminal proBNP give important prognostic information concerning risk of cardiovascular mortality. Cost-effective "clinical pathways" should be outlined for patients with elevated peptide concentrations. © 2005 Elsevier Ireland Ltd. All rights reserved.

Little is known about the prognosis and clinical variables influencing the prognosis among elderly patients in primary health care with mild to moderate heart failure.

Aim: To evaluate the risk of cardiovascular mortality in elderly patients with symptoms of heart failure with respect to systolic and diastolic function, and functional impairment. To evaluate prognostic determinants and to risk-stratify the patients.

Methods: A cardiologist examined 510 patients, out of 548 invited, attending primary care for symptoms of dyspnoea, fatigue and/or peripheral oedema and assessed New York Heart Association (NYHA) functional class. Examination by Doppler echocardiography was done in 454 patients, 56 patients being excluded because of, e.g., atrial fibrillation. Abnormal systolic function was defined as ejection fraction <40%. The diastolic function was evaluated using the mitral inflow and pulmonary venous flow variables. Different clinical and echocardiographic variables were analysed using a Cox regression analysis to identify those most influencing the risk of cardiovascular mortality.

Conclusion: Abnormal systolic and/or diastolic function was found in 219 patients (48% of the 454 patients who could be echocardiographically completely investigated). The follow-up period was 6 years. Total mortality was 20%, and cardiovascular mortality was 14% (70% of total mortality). Cardiovascular mortality was high in patients with severely impaired functional capacity and ejection fraction <40% at the start of the study. Risk variables identified were male gender, diabetes mellitus, impaired functional capacity and abnormal cardiac function by echocardiography. A prognostic score model using simple clinical variables (gender, NYHA class, cardiac function) was developed to assess the risk of cardiovascular death in order to identify patients with high, moderate or low risk. In a ROC curve analysis, the AUC for clinical variables was only 0.75, whereas the AUC for clinical variables and echocardiography was 0.78, indicating that the additional prognostic information obtained by Doppler echocardiography was rather small.

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.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

En genomsnittlig svensk läkare är varje år inblandad i försäkringsmedicinska frågeställningar som betingar kostnader i storleksordningen 2–3 miljoner kronor. Trots detta ingår inte försäkringsmedicin som eget kompetensområde i läkarnas grundbildning. Enligt en nyligen gjord enkät saknar mer än hälften av läkarna utbildning i vissa basala kunskaper såsom att skriva ett arbetsskadeintyg. Denna lärobok, skriven av 12 experter inom området, avser primärt att svara mot behovet av grundläggande kunskaper inom försäkringsmedicinens område för läkare under utbildning. En central del i en svensk lärobok i försäkringsmedicin är den allmänna försäkringen som bl.a. ligger till grund för sjukpenning och förtidspension. Privata livförsäkringar har funnits i många år, men ställer allt större krav på läkaren i takt med att nya tester utvecklas, bl.a. genetiska som kan förutsäga risker för förtida sjukdom och död. Andra försäkringar, t.ex. privata sjukförsäkringar, har blivit vanligare och frågor kring dessa belyses i boken. Det finns också andra försäkringar som är viktiga ur försäkringsmedicinsk synpunkt och som berör ansvarsfrågor och skadestånd, t.ex. patientförsäkring och läkemedelsförsäkring, vilka också behandlas. Boken innehåller även en översikt över viktiga juridiska frågor, liksom sekretess. Etiska frågeställningar är mycket vanliga inom försäkringsmedicinen och boken avslutas med ett kapitel om etik. Boken vänder sig i första hand till läkarstuderande men kan även fungera som referens- och uppslagsbok för personer verksamma inom sjukvård, försäkringsbolag och försäkringskassan.

There is growing interest in assistive technology (AT) as a means of enabling participation in everyday activities for persons with dementia and their relatives. Health economic assessment of AT in dementia is of importance due to the consequences of the disease for both patients and relatives and to the high societal costs for dementia care. The aim of this article is to outline a model for assessment of AT interventions for persons with dementia. The model expands existing assessment models as it also includes evaluation of the intervention process. Methodological challenges and possibilities in making health economic assessments, including outcomes and costs, as well as process evaluation, are discussed in the article. © 2007 IOS Press. All rights reserved.

A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15 y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p <0.001). Antibiotic prescribing decreased from 55% to 48% (p <0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI. © 2005 Taylor & Francis.

Background: In ‘workplace health promotion’, empowerment is assumed to promote health. Nevertheless, few studies have examined the relationship between empowerment in working life, and health.

Aim: To study the impact of empowerment in working life on health, with special focus on gender differences.

Material and methods: Paper I is a review of the scientific literature, examining instruments intended to measure empowerment in working life. The second study (paper II) was a cross-sectional survey, assessing the relationship between psychological empowerment, and self-rated health and burnout among employees. Papers III and IV encompass a two-year longitudinal survey study of the gender-specific relationships between baseline levels of psychological empowerment, and the combination of psychological support and social support, and self-rated health and burnout two years later among employees. Study five (paper V) is a qualitative study, using focus-group interviews and phenomenography to evaluate a theory-based intervention method, problem-based learning, for workplace health promotion with regard to possible facilitation of empowerment processes.

Results: In paper I, nine questionnaires were found and analysed. Most of the questionnaires focused on intra-individual issues, while a smaller number dealt with the interaction between individual and organisation. Control and competence were frequently used dimensions. The Psychological Empowerment Instrument had undergone the most comprehensive investigation, showing satisfactory validity and reliability. In paper II, men reported a greater degree of psychological empowerment than women in terms of self-determination and impact. Associations were found between psychological empowerment, and self-rated health and burnout (p<0.05). Men and women with higher levels of empowerment reported significantly better health, compared with those who had lower levels of empowerment. Papers III and IV show that for women, increasing levels of psychological empowerment at work at baseline were associated with better self-rated health as measured by the SF-36 scales physical role function, bodily pain, and mental health at the 2-year follow-up (p<0.05). Also for women, a combination of high psychological empowerment and high social support at the workplace was associated (p<0.05) with better self-rated health (bodily pain, general health, vitality, social functioning, emotional role, mental health, EQ-5D VAS, and EQ-5D index) and lower levels of work-related burnout at the 2-year follow-up. For men, psychological empowerment at baseline, and a combination of psychological empowerment and social support at the workplace, were associated with self-rated health at follow-up as measured by the EQ-5D VAS (p<0.05). Combinations of psychological empowerment and social support were associated with work-related burnout at the two-year follow-up for women only (p=0.002). The differences between men and women were confirmed in the gender×empowerment and social support interaction analysis for the measures bodily pain, social function, and work-related burnout (p<0.05). The phenomenographic analysis in paper V resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and action. The results correspond to established theories on components of empowerment processes. The method “problem-based learning” initiated processes of change at organisational, workplace and individual levels. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realisation.

Conclusions: This thesis demonstrates that psychological empowerment is associated with self-rated health and burnout. Psychological empowerment also impacts mental and somatic health after two years. The impact on health becomes more extensive when psychological empowerment is combined with social support at the workplace. Empowerment and social support are crucial core characteristics in ‘workplace health promotion’, but effects may differ for men and women. Empowerment processes can be facilitated by implementation of the participative intervention method known as “problem-based learning”. Practitioners and researchers who are active in health enhancement in working life should gain from implementing these findings, whether the focus is on health promotion, disease prevention, or rehabilitation back to work.

The aim of this study was to evaluate a theory-based method for workplace health promotion (WHP) with regard to possible facilitation of empowerment processes. The intervention tool was the pedagogic method known as problem-based learning (PBL). The aim of the intervention was to promote empowerment and health among the employees. The intervention was implemented in three organizations within the public sector in Sweden, in a bottom-up approach. All employees, including management, in each organization, were offered the opportunity to participate (n = 113) and 87% (n = 97) participated. The intervention was implemented in 13 groups of six to eight participants who met once a week over a period of 4 months. The predetermined overall goal of the intervention was to promote employee health within the organizational setting. A facilitator in each group and a group-specific mutual agreement guided the intervention, as did the problem solving process. The participants set goals and developed strategies to reach their goals between the meetings. Thirty informants were interviewed in seven focus groups after the intervention about the intervention method and the process, following a semi-structured theme guide. The phenomenographic analysis resulted in six descriptive categories: reflection, awareness and insight, self-direction and self-management, group coherence, social support and actions. The results correspond to established theories of components of empowerment processes. The method initiated processes of change at organizational, workplace and individual levels as the participants examined their work situation, determined problems and initiated solutions. Social support and group coherence were expressed as essential in order to transform challenging strategies into action and goal realization. The findings indicate that systematic improvements of social support and group coherence among employees ought to be facilitated by the organization as a health-promoting arena. PBL appears to be a profitable and powerful instrument with the potential to enable empowerment.

This study identifies and describes questionnaires that measure empowerment in working life. Theoretical bases and empirical examination of the questionnaires are also reported. Nine questionnaires emerged from a database search including AMED, CINAHL, ERIC, MEDLINE and PSYCINFO. The main target groups were employees in general. Most authors share the same theoretical basis. Most of the questionnaires focus on intra- individual issues, while a smaller number deal with the interaction between individual and organization. Control and competence are frequently used dimensions. Cronbach's alpha for complete questionnaires ranged between 0.62 and 0.96. No comparisons with outcome of health were reported. Spreitzer's questionnaire [54] has undergone the most comprehensive investigation. Research is required to achieve better understanding of the interplay between conditions at work and empowerment and health.

PURPOSE: To explore the gender-specific longitudinal association between psychological empowerment at the workplace and self-rated health and burnout in a working population.

MATERIAL AND METHOD: The participants were employees working in the public service sector in central Sweden. The baseline survey was carried out in 2001 and the follow-up in 2003. The questionnaire was answered by 715 respondents at both points in time (overall response rate 67%). Measures used were Psychological Empowerment Instrument by Spreitzer, the SF-36, the EQ-5D, and the Copenhagen Burnout Inventory. Gender specific differences in average score for self-rated health and burnout at follow-up were assessed using multiple linear regression adjusted for age, education, study cohort and self-rated health and burnout at baseline. An analysis on interactional effects due to gender was also performed.

RESULTS: For women, increasing levels of psychological empowerment at work at baseline are associated with less bodily pain, better physical role function and mental health in the multivariate analysis at follow-up two years later. For men, increased psychological empowerment at baseline is significantly associated with better self-rated health as measured by the EQ-5D VAS at follow-up in the multivariatc analysis. Higher levels of psychological empowerment at baseline show a statistically significant association with a lower degree of burnout at follow-up in the univariate analysis for men and women. However, the associations diminished after adjustments in the multivariate analyses. No significant gender x empowerment interaction appeared.

CONCLUSION: Psychological empowerment in working life was associated with somatic and mental aspects of SRH two years later for women. Men seem to be less affected by psychological empowerment, yet an association with the EQ-5D V AS appeared. Psychological empowerment did not predict burnout two years later for either men or women.

PURPOSE: To explore the gender-specific association between psychological empowerment and self-rated health and burnout in a working population.

MATERIAL AND METHOD: A cross-sectional survey was carried out among 1,243 employees (response rate 81% (n=1007), 65 % females). Psychological empowerment was measured by the Spreitzer questionnaire, developed for a working life context. The questionnaire includes the subscales: meaning, competence, self-determination and impact. Self-rated health was evaluated with EQ-5D and SF-36 and the Copenhagen Burnout Inventory was used to measure burnout.

RESULTS: Men reported a greater degree of empowerment than women in terms of self-determination and impact. Significant associations (p<0.05) were found between psychological empowerment and self-rated health and burnout. Men and women with higher levels of empowerment reported significantly better health compared to those with lower levels of empowerment. In multivitriate analyses, all four subscales of empowerment were associated with burnout among both men and women. The most pronounced association with self-rated health was seen for the subscale impact. These associations were particularly strong among women.

CONCLUSION: Psychological empowerment in working life is associated with self-rated health and burnout. Interventions aiming to promote health at work or aiming to prevent burnout may therefore benefit if they comprise empowerment in terms of impact, self-determination, meaning and competence. Also, workplace health promotion that includes empowerment processes should be gender conscious.

PURPOSE: To explore the gender-specific longitudinal association between a combination of psychological empowerment and social support at the workplace and self-rated health and burnout in a working population.

MATERIAL AND METHOD: The participants were employees working in the public service sector in central Sweden. The baseline survey in two cohorts was carried out in 2001 and the follow-up in 2003. The questionnaire was answered by 715 respondents at both points in time (overall response rate 67%). Measures used were the Psychological Empowerment Instrument by Spreitzer, the social support dimension in the Demand-Control-Support Questionnaire, the SF-36, the EQ-5D, and the Copenhagen Burnout Inventory. Based on empirical medians, psychological empowerment and social support at baseline were combined into four categories. Mlltivariate comparisons adjusted for age, education, study cohort and SRH and burnout at baseline were performed using multiple linear regression analysis. The genderxempowerment and social support interaction effect was assessed in the multiple linear regression analysis. All analyses were performed for men and women separately.

RESULTS: For women, a combination of high psychological empowerment and high social support at the workplace, in comparison with a combination of low psychological empowerment and low social support, is strongly associated with better SRH (bodily pain, general health, vitality, social functioning, emotional role, mental health, the EQ-5D VAS, and EQ-5D index) and lower levels of work-related burnout at the 2-year follow-up after adjusting for demographics and baseline SRH and burnout. For men, there are univariate associations with burnout and some associations with SRH. After adjustments for demographics and baseline SRH and burnout, psychological empowerment and social support is associated with SRH as measured by the EQ-5D VAS for men. The gender x empowerment and social support interaction analyses confirm gender differences regarding bodily pain, social function, and work-related burnout.

CONCLUSION: A combination of psychological empowerment and social support in working life strongly affects SRH and work-related burnout two years later for women, but only in part for men.

In Sweden, a change of the legislation for sickness absence became effective on 1st October, 1995. The purpose of the change was to reduce costs for sickness absence by exclusion of non-medical criteria for sick-listing, more part-time sick-listing and faster rehabilitation. This study was conducted in order to describe and analyse certification practice of various physician categories, before and after the change in legislation. Thirty-one thousand seven hundred and thirty certificates for sickness absence, collected by the local offices of the National Social Insurance Board in eight Swedish counties, fulfilled the inclusion criteria. The number of certificates decreased temporarily. The number of certified net days, i.e. crude days multiplied by degree, tended to increase and there was no shift from full to partial sick-listing during the period. There were small changes regarding case mix, i.e. patient characteristics, and sick-listing physician category. The results were almost unchanged when these small changes were taken into account. General practitioners issued significantly shorter periods of sick-leave than the other categories both years. The goals of the legislative change were thus not met. The result of the study indicates that other factors than the legislation may be more important for physicians' practice. ⌐ 2002 Elsevier Science Ireland Ltd. All rights reserved.