The association between self-efficacy and sick-leave among men and women: a cross-sectional study of the general working population in Sweden

Background: The aim of this study was to investigate if low self-efficacy was associated with increased risk for sickness absence, in a general population of employed women and men. The aim was also to analyse differences in self-efficacy concerning age, education, income, and socio-economic position. Methods: This cross-sectional study was based on data collected in western Sweden, 2008. The study population consisted of 2,900 employed sick-listed individuals (E-SL) and 2,649 random working population individuals (R-WP). Both mailed questionnaire, including the General Self-Efficacy Scale (GSE) and register data on age, education, income and socio-economic position were used. A continuous mean score of the total GSE was calculated for each individual. A low GSE-score indicated low general self-efficacy. Results: Lower general self-efficacy had an increased odds ratio (OR) of belonging to a sick-listed general working population among both men (OR=1.60; 95% CI 1.32–1.94) and women (OR=1.26; 95% CI 1.08–1.47). The OR remained significant after adjustments for socio-demographic variables. Yet, men in the R-WP and women in both the R-WP and E-SL with lower education, income or socio-economic position had lower general self-efficacy compared with those in each cohort with higher education, income or socio-economic position. Conclusions: Low self-efficacy was associated with increased probability to belong to a sick-listed general working population. Although more research is needed, it seems highly relevant to take both self-efficacy and socio-economic factors into account, in preventive and rehabilitation work targeting persons on sickness absence

General Beliefs about Medicines among Pharmacy Clients, Healthcare Students and Professionals - Group Differences and Association with Adherence

Background: only about 50% of all medicines are used as the prescriber intended. If medicines are prescribed in an adequate way, an optimised adherence can decrease mortality and hospitalisation and improve health-related outcomes. Beliefs about medicines have been shown to be an important factor in adherence. Furthermore, beliefs can also bias the content of patient communication, which is central to patient-centred care. Research shows that it has been difficult to optimise adherence with existing knowledge. To increase the knowledge about pharmacy clients’ and healthcare professionals’ beliefs about medicines could be a new angle in adherence research. Aims: to examine general beliefs about medicines among Swedish pharmacy clients, healthcare students and professionals. A further aim was to analyse the association between general beliefs about medicines and self-reported adherence in pharmacy clients. Methods: the thesis is based on four quantitative, cross-sectional studies. Participants in the studies were pharmacy clients, healthcare students, doctors, nurses and pharmacy employees. The data collections were done through questionnaires including the general part of Beliefs about Medicines Questionnaire (BMQ), Medicine Adherence Report Scale (MARS) and background questions: sex, age, occupation, education, country of birth and own experience of medicines. Results: differences in general beliefs about medicines were found between pharmacy clients and practising healthcare professionals. Pharmacy clients believed medicines to be more harmful than practising healthcare professionals did. Doctors, pharmacists and dispensing pharmacists had more beneficial and less harmful beliefs about medicines compared with nurses. Similar patterns were seen for medical, pharmacy and nursing students. Furthermore, third-year medical and pharmacy students were more positive about medicines than first-year students were in these educations. Education, origin and own medicine use were important factors in general beliefs about medicines. Furthermore, beliefs about medicines as something harmful were associated with self-reported non-adherence in pharmacy clients. Conclusions: there were distinct differences in general beliefs about medicines between pharmacy clients and healthcare professionals. If these differences are not acknowledged there could be consequences for patient communication and the interrelationship between doctors, nurses and pharmacy employees. It is also important to increase knowledge about how general beliefs about medicines and adherence are associated. The results of this thesis can be used for future interventions and research aiming for improved adherence

Cumulative incidence of sickness absence and disease burden among the newly sick-listed, a cross-sectional population-based study

Background: Sickness absence is a public health problem with economic consequences for individuals and society. Although sickness absence and chronic diseases are correlated, few studies exist concerning the role of chronic disease in all-cause sickness absence. The aim was to assess the cumulative incidence of sickness absence and examine the accompanying burden of chronic diseases among the sick-listed. Methods: A cross-sectional study was performed with data from 2008. Cumulative incidence of all-cause sickness absence (≥14 days) was calculated based on all newly sick-listed individuals (N = 12,543). The newly sick-listed sample and a randomized general population sample (n = 7,984) received a questionnaire (participation rates: 54% and 50%).To assess the burden of self-reported chronic diseases, standardized incidence ratios (SIR) were calculated. Results: Estimated one-year cumulative incidence was 11.3% (95% CI: 11.2–11.3), 14.0% (13.9–14.1) for women and 8.6% (8.5–8.6) for men. Gender differences were consistent across all age groups, with highest cumulative incidence among women aged 51–64 years, 18.2% (18.0–18.5). For women, the burden of chronic disease was significantly higher for nine out of twelve disease groups, corresponding numbers for men were nine out of eleven disease groups (standardized for age and socio-economic status). Neoplastic diseases had the highest SIR with 4.3 (3.4–5.2) for women and 4.2 (2.8–5.6) for men. For psychiatric and rheumatic diseases the respective SIR’s were 1.7 for women and 1.8 for men. The remaining disease groups had an elevated risk of 20-60% (SIR 1.2–1.6). The risk of reporting a co-morbidity was increased for women (SIR 1.4 (95% CI 1.4–1.5)) and men (SIR 1.5 (1.4–1.7)) among the sick-listed. Conclusions: Register data was used to estimate of the cumulative incidence of sickness absence in the general population. A higher burden of chronic disease among the newly sick-listed was found. Targeting long-term health problems may be an important public health strategy for reducing sickness absence

General beliefs about medicines among doctors and nurses in out-patient care: a cross-sectional study

Abstract Background Doctors and nurses are two natural partners in the healthcare team, but they usually differ in their perspectives on how to work for increased health. These professions may also have different beliefs about medicines, a factor important for adherence to medicines. The aim was to explore general beliefs about medicines among doctors and nurses. Methods Questionnaires were sent to 306 private practitioners (PPs), 298 general practitioners (GPs) and 303 nurses in the county of Västra Götaland, Sweden. The questionnaire included sociodemographic questions and the general part of the Beliefs about Medicines Questionnaire (BMQ), which measures the beliefs people have about medicines in general. General beliefs about medicines in relation to background variables were explored with independent t-tests and ANOVA analyses. Differences between occupations and influences of interaction variables were analysed with multiple linear regression models for general beliefs about medicines. Results The data collection resulted in 616 questionnaires (62.1% PPs; 61.6% GPs; 80.5% nurses). The majority of the PPs and 40% of the GPs were male but most of the nurses were female. The GPs' mean age was 47 years, PPs' 60 years and nurses' 52 years. Few nurses originated from non-Nordic countries while 15% of the PPs and 25% of the GPs did. Nurses saw medicines as more harmful and less beneficial than did PPs and GPs. These differences could not be explained by the included interaction variables. GPs with a Nordic background saw medicines as more beneficial and less harmful than did GPs with a non-Nordic background. Furthermore, GPs of non-Nordic origin were most likely to believe that medicines were overprescribed by doctors. Conclusion Doctors were more positive about medicines than nurses. The differences in beliefs about medicines found between doctors and nurses could not be explained by any of the included interaction variables. These differences in beliefs may be useful in discussions among future and practising doctors and nurses to enhance understanding of each other's profession and teamwork.</p

Characteristics of women who continue smoking during pregnancy: A cross-sectional study of pregnant women and new mothers in 15 European countries

Background: Some women continue smoking during pregnancy despite the extensive information available on the dangers smoking poses to their fetus. This study aimed to examine the prevalence and determinants of smoking before and during pregnancy and the extent of smoking during pregnancy from a European perspective in relation to maternal sociodemographic characteristics, health literacy, morbidity, and pregnancy-related factors. Methods: This multinational, web-based study evaluated pregnant women and new mothers in 15 European countries recruited from October 2011 to February 2012. Data were collected via an anonymous online questionnaire. Results: Of 8344 women included, 2944 (35.3%) reported smoking before pregnancy, and 771 (26.2%) continued smoking during pregnancy, 88 (11.4%) of whom smoked more than 10 cigarettes per day. There was a wide variation among the 15 European countries in smoking rates before and during pregnancy, ranging from 25.0% (Sweden) to 50.0% (Croatia) before and 4.2% (Iceland) to 18.9% (Croatia) during pregnancy. Women who lived in Eastern Europe, without a spouse/partner, with a low education level and unplanned pregnancy, who did not take folic acid, and consumed alcohol during pregnancy were the most likely to smoke before pregnancy. Women who lived in Eastern or Western Europe, without a spouse/partner, with a low education level and health literacy, being a housewife, having previous children and unplanned pregnancy, and who did not take folic acid were the most likely to continue smoking during pregnancy. Women who smoked more than 10 cigarettes per day during pregnancy were the most likely to be living in Eastern Europe and to have a low education level. Conclusion: Women with fewer resources living in Western or Eastern Europe are more likely not only to smoke before pregnancy but also to continue smoking during pregnancy. These high-risk women are characterized as living alone, having high school or less as highest education level, having low health literacy, being a housewife, having previous children, having unplanned pregnancy, and no use of folic acid. Our findings indicated that focus on smoking cessation is important in antenatal care in Europe as many women smoke before pregnancy, and still continue to do so in pregnancy

Refill adherence in relation to substitution and the use of multiple medications : A nationwide population based study on new ACE-inhibitor users

Objective: Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden. Study Design and Setting: New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance. Results: The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis. Conclusion: The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications

Early identification in primary health care of people at risk for sick leave due to work-related stress – study protocol of a randomized controlled trial (RCT)

Abstract Background Early identification of persons at risk of sickness absence due to work-related stress is a crucial problem for society in general, and primary health care in particular. Tho date, no established method to do this exists. This project’s aim is to evaluate whether systematic early identification of work-related stress can prevent sickness absence. This paper presents the study design, procedure and outcome measurements, as well as allocation and baseline characteristics of the study population. Method/design The study is a two-armed randomized controlled trial with follow-up at 3, 6 and 12 months. Non-sick-listed employed women and men, aged 18 to 64 years, who had mental and physical health complaints and sought care at primary health care centers (PHCC) were eligible to participate. At baseline work-related stress was measured by the Work Stress Questionnaire (WSQ), combined with feedback at consultation, at PHCC. The preventive intervention included early identification of work-related stress by the WSQ, GP training in the use of WSQ, GP feedback at consultation and finding suitable preventive measures. A process evaluation was used to explore how to facilitate future implementation and structural use of the WSQ at the PHCC. The primary outcome to compare the preventive sick leave intervention by the general practitioner (GP) versus treatment as usual is sick leave data obtained from the Swedish Social Insurance Agency register. Discussion Early screening for sick leave due to work-related stress makes it possible not only to identify those at risk for sick leave, but also to put focus on the patient’s specific work-related stress problems, which can be helpful in finding suitable preventive measures. This study investigates if use of the WSQ by GPs at PHCCs, combined with feedback at consultation, prevents future sickness absence. Trial registration ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 201