Publications by authors named "Inger Haukenes"

20 Publications

  • Page 1 of 1

Trends in treatment for patients with depression in general practice in Norway, 2009-2015: nationwide registry-based cohort study (The Norwegian GP-DEP Study).

BMC Health Serv Res 2021 Jul 15;21(1):697. Epub 2021 Jul 15.

Research Unit for General Practice, NORCE Norwegian Research Centre, Årstadveien 17, N-5009, Bergen, Norway.

Background: Depression is highly prevalent, but knowledge is scarce as to whether increased public awareness and strengthened government focus on mental health have changed how general practitioners (GPs) help their depressed patients. This study aimed to examine national time trends in GP depression care and whether trends varied regarding patient gender, age, and comorbidity.

Methods: Nationwide registry-based cohort study, Norway. The study population comprised all residents aged 20 years or older with new depression diagnoses recorded in general practice, 2009-2015. We linked reimbursement claims data from all consultations in general practice for depression with information on demographics and antidepressant medication. The outcome was type(s) of GP depression care during 12 months from the date of diagnosis: (long) consultation, talking therapy, antidepressant drug treatment, sickness absence certification, and referral to secondary mental health care. Covariates were patient gender, age, and comorbidity. The data are presented as frequencies and tested with generalized linear models.

Results: We included 365,947 new depression diagnoses. Mean patient age was 44 years (SD = 16), 61.9 % were women, 41.2 % had comorbidity. From 2009 to 2015, proportions of patients receiving talking therapy (42.3-63.4 %), long consultations (56.4-71.8 %), and referral to secondary care (16.6-21.6 %) increased, while those receiving drug treatment (31.3-25.9 %) and sick-listing (58.1-50 %) decreased. The trends were different for gender (women had a greater increase in talking therapy and a smaller decrease in sick-listing, compared to men), age (working-aged patients had a smaller increase in talking therapy, a greater increase in long consultations, and a smaller decrease in antidepressant drug use, compared to older patients) and comorbidity (patients with mental comorbidity had a smaller increase in talking therapy and a greater increase in long consultations, compared to those with no comorbidity and somatic comorbidity).

Conclusions: The observed time trends in GP depression care towards increased provision of psychological treatment and less drug treatment and sick-listing were in the desired direction according to Norwegian health care policy. However, the large and persistent differences in treatment rates between working-aged and older patients needs further investigation.
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http://dx.doi.org/10.1186/s12913-021-06712-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8283991PMC
July 2021

Chronic hyperglycemia, hypercholesterolemia, and metabolic syndrome are associated with risk of tendon injury.

Scand J Med Sci Sports 2021 May 8. Epub 2021 May 8.

Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery M, Copenhagen University Hospital - Bispebjerg and Frederiksberg and Center for Healthy Aging, Institute of Sports Medicine Copenhagen, University of Copenhagen, Copenhagen, Denmark.

Tendon injury is a considerable problem affecting both physically active and sedentary people. The aim of this study was to examine the relationship between markers for metabolic disorders (hyperglycemia, hypercholesterolemia, and metabolic syndrome) and the risk of developing tendon injuries requiring referral to a hospital. The Copenhagen City Heart Study is a prospective study of diabetic and non-diabetic individuals from the Danish general population with different physical activity levels. The cohort was followed for 3 years via national registers with respect to tendon injuries. Data from 5856 individuals (median age 62 years) were included. The overall incidence of tendon injury in both upper and lower extremities that required an out-patient or in-house visit to a hospital was ~5.7/1000 person years. Individuals with elevated HbA1c (glycated hemoglobin) even in the prediabetic range (HbA1c>5.7%) had a ~3 times higher risk of tendon injury in the lower extremities only, as compared to individuals with normal HbA1C levels. Hypercholesterolemia (total cholesterol>5 mmol/L) increased risk of tendon injury in the upper extremities by ~1.5 times, and individuals with metabolic syndrome had ~2.5 times higher risk of tendon injury in both upper and lower extremities. In conclusion, these data demonstrate for the first time in a large cohort with different physical activity levels that the indicators for metabolic syndrome are a powerful systemic determinant of tendon injury, and two of its components, hyperglycemia and hypercholesterolemia, each independently make tendons susceptible for damage and injury.
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http://dx.doi.org/10.1111/sms.13984DOI Listing
May 2021

The Female Menstrual Cycles Effect on Strength and Power Parameters in High-Level Female Team Athletes.

Front Physiol 2021 22;12:600668. Epub 2021 Feb 22.

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Purpose: The female menstrual cycle (MC) is characterized by hormonal fluctuations throughout its different phases. However, research regarding its effect on athletic performance in high level athletes is sparse. The aim of this study was to (i) investigate the female MCs effect on strength and power performance in highly trained female team athletes throughout the MC and (ii) examine whether eumenorrheic participants with natural hormonal fluctuations displayed enhanced performance in the follicular phase (FP) versus the luteal phase (LP), compared to controls using hormonal contraceptives.

Materials And Methods: A total of 29 athletes (Age 21.2 ± 3.3 years; weight 65.6 ± 8.7 kg; height 170.2 ± 8.0 cm; and fat free mass 52.7 ± 7.1) completed the study after a 6-week testing period (8 eumenorrheic participants and 21 hormonal contraceptive controls). Participants were recruited from the team sports soccer, handball and volleyball. Testing protocol consisted of maximal voluntary isometric grip strength, 20-m sprint, countermovement jump and pneumatic leg-press. Based on self-reported use of hormonal contraceptives, participants were divided into non-hormonal contraceptive group and hormonal contraceptive group, the latter working as a control group. Differences in performance between the FP and LP were investigated. MC phase was confirmed by serum hormonal levels through venous blood samples in the non-hormonal contraceptive group.

Results: There were no statistically significant changes for the two different phases of the MC, in terms of physical performance for the whole group. Further, there was no significant difference between groups during the MC for any of the outcome variables, maximal voluntary isometric grip strength (3.29) = 0.362; 20-m sprint (3.24) = 0.710; countermovement jump (3.26) = 2.361; and leg-press (3.26) = 1.746.

Conclusion: In high level female team athletes, no difference in performance was observed based on hormonal contraceptive status. This suggests that the MC does not alter acute strength and power performance on a group level in high level team athletes.
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http://dx.doi.org/10.3389/fphys.2021.600668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7937612PMC
February 2021

GPs' drug treatment for depression by patients' educational level: registry-based study.

BJGP Open 2021 Apr 26;5(2). Epub 2021 Apr 26.

Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.

Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.

Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and to what extent sex and age influence the association.

Design & Setting: A nationwide registry-based cohort study was undertaken in Norway from 2014-2016.

Method: The study comprised all residents of Norway born before 1996 and alive in 2015. Information was obtained on all new depression diagnoses in general practice in 2015 (primary care database) and data on all dispensed depression medication (Norwegian Prescription Database [NorPD]) 12 months after the date of diagnosis. Independent variables were education, sex, and age. Associations with drug treatment were estimated using a Cox proportional hazard model and performed separately for sex.

Results: Out of 49 967 patients with new depression (61.6% women), 15 678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.88 to 0.98) than women with low education. No such differences appeared among men. Women aged 20-29 years were more likely to be treated with drugs than those aged 30-59 years, and women aged ≥70 years were more likely to receive drugs (HR = 1.65; 95% CI = 1.54 to 1.77) than those aged 20-29 years. The pattern was similar but less pronounced for men.

Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be explored.
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http://dx.doi.org/10.3399/BJGPO-2020-0122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170601PMC
April 2021

General practitioners' drug treatment for depression by patients' educational level: registry-based study.

BJGP Open 2021 Apr 26;5(2). Epub 2021 Apr 26.

Department of Global Public Health and Primary Care, University of Bergen Department of Medicine, Bergen, Norway.

Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.

Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and how gender and age influence the association.

Design And Setting: Nationwide registry-based cohort study, Norway, 2014-2016.

Method: The study comprised all residents of Norway born before 1996 and alive in 2015. We obtained information on all new depression diagnoses in general practice in 2015 (Primary Care Database) and data on all dispensed depression medication (Norwegian Prescription Database) 12-months after the date of diagnosis. Independent variables were education, gender, and age. Associations with drug treatment were estimated using a Cox proportional hazard model, for genders separately.

Results: Out of 49,967 patients with new depression (61.6% women), 15,678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (Hazard Ratio (HR) =0.93, 95% CI (0.88 - 0.98)) than women with low education. No such differences appeared among men. Women aged 20-29 were more likely to be treated with drugs than those aged 30-59, and women aged 70+ were more likely to receive drugs (HR=1.65, (1.54 - 1.77)) than those aged 20-29. The pattern was similar but less pronounced for men.

Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be.
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http://dx.doi.org/10.3399/BJGPO.2020.0122DOI Listing
April 2021

Variation in general practitioners' depression care following certification of sickness absence: a registry-based cohort study.

Fam Pract 2021 06;38(3):238-245

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Background: Depression is more prevalent among women and people with low socio-economic status. Uncertainties exist about how general practitioner (GP) depression care varies with patients' social position.

Objective: To investigate associations between patients' gender and educational status combined and GP depression care following certification of sickness absence.

Methods: Nationwide registry-based cohort study, Norway, 2012-14. Reimbursement claims data from all consultations in general practice for depression were linked with information on socio-demographic data, social security benefits and depression medication. The study population comprised all individuals aged 25-66 years with taxable income, sick-listed with a new depression diagnosis in general practice in 2013 (n = 8857). We defined six intersectional groups by combining educational level and gender. The outcome was type of GP depression care during sick leave: follow-up consultation(s), talking therapy, medication and referral to secondary care. Associations between intersectional groups and outcome were estimated using generalized linear models.

Results: Among long-term absentees (17 days or more), highly educated women were less likely to receive medication compared to all other patient groups [relative risk (RR) ranging from 1.17 (95% confidence interval 1.03-1.33) to 1.49 (1.29-1.72)] and more likely to receive talking therapy than women with medium [RR = 0.90 (0.84-0.98)] or low [RR = 0.91 (0.85-0.98)] education.

Conclusions: Our findings suggest that GPs provide equitable depression care regarding consultations and referrals for all intersectional groups but differential drug treatment and talking therapy for highly educated women. GPs need to be aware of these variations to provide personalized care and to prevent reproducing inequity.
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http://dx.doi.org/10.1093/fampra/cmaa120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211146PMC
June 2021

Independent medical evaluation of general practitioners' follow-up of sick-listed patients: a cross-sectional study in Norway.

BMJ Open 2020 03 18;10(3):e032776. Epub 2020 Mar 18.

NORCE Norwegian Research Centre AS, Bergen, Norway.

Objectives: The study was designed to examine the sufficiency of general practitioners' (GPs) follow-up of patients on sick leave, assessed by independent medical evaluators.

Design: Cross-sectional study SETTING: Primary health care in the Western part of Norway. The study reuses data from a randomised controlled trial-the Norwegian independent medical evaluation trial (NIME trial).

Participants: The intervention group in the NIME trial: Sick-listed workers having undergone an independent medical evaluation by an experienced GP at 6 months of unremitting sick leave (n=937; 57% women). In the current study, the participants were distributed into six exposure groups defined by gender and main sick leave diagnoses (women/musculoskeletal, men/musculoskeletal, women/mental, men/mental, women/all other diagnoses and men/all other diagnoses).

Outcome Measure: The independent medical evaluators assessment (yes/no) of the sufficiency of the regular GPs follow-up of their sick-listed patients.

Results: Estimates from generalised linear models demonstrate a robust association between men with mental sick leave diagnoses and insufficient follow-up by their regular GP first 6 months of sick leave (adjusted relative risk (RR)=1.8, 95% CI=1.15-1.68). Compared with the reference group, women with musculoskeletal sick leave diagnoses, this was the only significant finding. Men with musculoskeletal diagnoses (adjusted RR=1.4, 95% CI=0.92-2.09); men with other diagnoses (adjusted RR=1.0, 95% CI=0.58-1.73); women with mental diagnoses (adjusted RR=1.2, 95% CI=0.75-1.77) and women with other diagnoses (adjusted RR=1.3, 95% CI=0.58-1.73).

Conclusions: Assessment by an independent medical evaluator showed that men with mental sick leave diagnoses may be at risk of insufficient follow-up by their GP. Efforts should be made to clarify unmet needs to initiate relevant actions in healthcare and work life. Avoiding marginalisation in work life is of the utmost importance.

Trial Registration Number: NCT02524392; Post-results.
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http://dx.doi.org/10.1136/bmjopen-2019-032776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202711PMC
March 2020

Healthcare professionals' perspectives on mental health service provision: a pilot focus group study in six European countries.

Int J Ment Health Syst 2020 6;14:16. Epub 2020 Mar 6.

11Division of Mental and Physical Health, Norwegian Institute of Public Health & Department of Psychosocial Science, University of Bergen, Bergen, Norway.

Background: The mental healthcare treatment gap (mhcGAP) in adult populations has been substantiated across Europe. This study formed part of MentALLY, a research project funded by the European Commission, which aimed to gather qualitative empirical evidence to support the provision of European mental healthcare that provides effective treatment to all adults who need it.

Methods: Seven focus groups were conducted with 49 health professionals (HPs), including psychologists, psychiatrists, social workers, general practitioners, and psychiatric nurses who worked in health services in Belgium, Cyprus, Greece, the Netherlands, Norway and Sweden. The focus group discussions centered on the barriers and facilitators to providing quality care to people with mild, medium, and severe mental health problems. Analyses included deductively and inductively driven coding procedures. Cross-country consensus was obtained by summarizing findings in the form of a fact sheet which was shared for triangulation by all the MentALLY partners.

Results: The results converged into two overarching themes: (1) Minding the treatment gap: the availability and accessibility of Mental Health Services (MHS). The mhcGAP gap identified is composed of different elements that constitute the barriers to care, including bridging divides in care provision, obstacles in facilitating access via referrals and creating a collaborative 'chain of care'. (2) Making therapeutic practice relevant by providing a broad-spectrum of integrated and comprehensive services that value person-centered care comprised of authenticity, flexibility and congruence.

Conclusions: The mhcGAP is comprised of the following barriers: a lack of funding, insufficient capacity of human resources, inaccessibility to comprehensive services and a lack of availability of relevant treatments. The facilitators to the provision of MHC include using collaborative models of primary, secondary and prevention-oriented mental healthcare. Teamwork in providing care was considered to be a more effective and efficient use of resources. HPs believe that the use of e-mental health and emerging digital technologies can enhance care provision. Facilitating access to a relevant continuum of community-based care that is responsive coordinated and in line with people's needs throughout their lives is an essential aspect of optimal care provision.
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http://dx.doi.org/10.1186/s13033-020-00350-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7060571PMC
March 2020

The gender gap in accrued pension rights - an indicator of women's accumulated disadvantage over the course of working life. The Hordaland Health Study (HUSK).

Scand J Public Health 2018 May 4;46(3):417-424. Epub 2017 Jul 4.

1 Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway.

Aims: Economic gender equality is one of the goals of the Nordic Welfare states. Despite this, there is a considerable gender gap in pensionable income in the European Union, and an unmet need for measures that absorb more of the complexity associated with accumulated (dis)advantages across gender and population groups. The aims of the present study were to examine the gender difference in association between average earned pension points and 1) education and 2) current occupational prestige, and to discuss pension points as a possible indicator of accumulated disadvantages.

Methods: We linked a community-based survey, the Hordaland Health study (HUSK), to the national register of insurance benefits (FD-trygd). This made it possible to trace gendered patterns of economic (dis)advantages associated with educational level, career development and gainful work over the life course for 17,275 individuals.

Results: We found profound differences in earned accrued pension rights between men and women across socioeconomic strata, and a significant interaction between pension rights and gender in the association with education and occupational prestige. Our findings indicate that men, as a group, may have lower educational attainment and occupational prestige than women, and still earn more pension points throughout their career. These differences place women at risk for future economic strain and deprivation over and above their similarly educated and positioned male counterparts.

Conclusions: We suggest that accrued pension rights may be a relevant measure of accumulated (dis)advantages over the course of working life, and a useful indicator when gender equality is measured and discussed.
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http://dx.doi.org/10.1177/1403494817715845DOI Listing
May 2018

Developing a Tool for Increasing the Awareness about Gendered and Intersectional Processes in the Clinical Assessment of Patients--A Study of Pain Rehabilitation.

PLoS One 2016 7;11(4):e0152735. Epub 2016 Apr 7.

Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

Objective: There is a need for tools addressing gender inequality in the everyday clinical work in health care. The aim of our paper was to develop a tool for increasing the awareness of gendered and intersectional processes in clinical assessment of patients, based on a study of pain rehabilitation.

Methods: In the overarching project named "Equal care in rehabilitation" we used multiple methods (both quantitative and qualitative) in five sub studies. With a novel approach we used Grounded Theory in order to synthesize the results from our sub studies, in order to develop the gender equality tool. The gender equality tool described and developed in this article is thus based on results from sub studies about the processes of assessment and selection of patients in pain rehabilitation. Inspired by some questions in earlier tools, we posed open ended questions and inductively searched for findings and concepts relating to gendered and social selection processes in pain rehabilitation, in each of our sub studies. Through this process, the actual gender equality tool was developed as 15 questions about the process of assessing and selecting patients to pain rehabilitation. As a more comprehensive way of understanding the tool, we performed a final step of the GT analyses. Here we synthesized the results of the tool into a comprehensive model with two dimensions in relation to several possible discrimination axes.

Results: The process of assessing and selecting patients was visualized as a funnel, a top down process governed by gendered attitudes, rules and structures. We found that the clinicians judged inner and outer characteristics and status of patients in a gendered and intersectional way in the process of clinical decision-making which thus can be regarded as (potentially) biased with regard to gender, socio-economic status, ethnicity and age.

Implications: The clinical implications of our tool are that the tool can be included in the systematic routine of clinical assessment of patients for both awareness raising and as a base for avoiding gender bias in clinical decision-making. The tool could also be used in team education for health professionals as an instrument for critical reflection on gender bias.

Conclusions: Thus, tools for clinical assessment can be developed from empirical studies in various clinical settings. However, such a micro-level approach must be understood from a broader societal perspective including gender relations on both the macro- and the meso-level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152735PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4824419PMC
August 2016

Is there a gender bias in recommendations for further rehabilitation in primary care of patients with chronic pain after an interdisciplinary team assessment?

J Rehabil Med 2015 Apr;47(4):365-71

Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A , Umeå University, SE-901 87 Umeå, Sweden.

Objective: To examine potential gender bias in recommendations of further examination and rehabilitation in primary care for patients with chronic musculoskeletal pain after an interdisciplinary team assessment.

Methods: The population consisted of consecutive patients (n = 589 women, 262 men) referred during a 3-year period from primary healthcare for assessment by interdisciplinary teams at a pain specialist rehabilitation clinic. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation. The outcome was defined as the examination or rehabilitation that was specified in the patient's record.

Results: Men had a significantly higher likelihood than women of being recommended physiotherapy and radiological examination, and the gender difference was not explained by confounding variables and covariates (age, marital status, ethnicity, education, working status, pain severity, pain interference, pain sites, anxiety and depression). There was no significant gender difference in recommendations to treatment by specialist physician, occupational therapist, psychologist or social worker.

Conclusion: Our findings indicate that the interdisciplinary teams in specialist healthcare may discriminate against women with chronic pain when physiotherapy and radiological investigation are recommended. The team's choice of recommendations might be influenced by gendered attitudes, but this field of research needs to be studied further.
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http://dx.doi.org/10.2340/16501977-1936DOI Listing
April 2015

Low-educated women with chronic pain were less often selected to multidisciplinary rehabilitation programs.

PLoS One 2014 21;9(5):e97134. Epub 2014 May 21.

Umeå Centre for Gender Studies in Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.

Background: There is a lack of research about a potential education-related bias in assessment of patients with chronic pain. The aim of this study was to analyze whether low-educated men and women with chronic pain were less often selected to multidisciplinary rehabilitation than those with high education.

Methods: The population consisted of consecutive patients (n = 595 women, 266 men) referred during a three-year period from mainly primary health care centers for a multidisciplinary team assessment at a pain rehabilitation clinic at a university hospital in Northern Sweden. Patient data were collected from the Swedish Quality Registry for Pain Rehabilitation National Pain Register. The outcome variable was being selected by the multidisciplinary team assessment to a multidisciplinary rehabilitation program. The independent variables were: sex, age, born outside Sweden, education, pain severity as well as the hospital, anxiety and depression scale (HADS).

Results: Low-educated women were less often selected to multidisciplinary rehabilitation programs than high-educated women (OR 0.55, CI 0.30-0.98), even after control for age, being born outside Sweden, pain intensity and HADS. No significant findings were found when comparing the results between high- and low-educated men.

Conclusion: Our findings can be interpreted as possible discrimination against low-educated women with chronic pain in hospital referrals to pain rehabilitation. There is a need for more gender-theoretical research emphasizing the importance of taking several power dimensions into account when analyzing possible bias in health care.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0097134PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029603PMC
June 2015

Physical health-related quality of life predicts disability pension due to musculoskeletal disorders: seven years follow-up of the Hordaland Health Study Cohort.

BMC Public Health 2014 Feb 14;14:167. Epub 2014 Feb 14.

Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, Bergen NO-5018, Norway.

Background: Musculoskeletal diseases are characterized by a high degree of comorbidity with common mental disorders and are a major cause of health-related exclusion from working life. Using a prospective design we aimed to examine the relative importance of physical and mental health-related quality of life as predictors of disability pension due to musculoskeletal diseases.

Methods: A subsample (N = 18,581) born 1953-1957, participated in the The Hordaland Health Study (HUSK) during 1997-1999, and was followed through December 31st 2004. Baseline measures of health-related quality of life were estimated using the Physical (PCS) and Mental Component Summary (MCS) of the Short Form-12 (SF-12). Further information on education, occupation, smoking, physical activity, number of musculoskeletal pain sites and BMI were provided by questionnaires and health examination. The association between self-perceived physical and mental health and subsequent disability pension, obtained from the national database of health and social benefits was estimated using Cox regression analyses.

Results: Participants reporting poor physical health (quartile 1) had a marked increased risk for disability pension due to musculoskeletal diseases (age and gender-adjusted hazard ratio = 22.1, 95% CI = 12.5-39.0) compared with those reporting good/somewhat good physical health (quartiles 4 and 3 combined). Adjustment for socioeconomic status and lifestyle factors slightly attenuated the association (hazard ratio = 16.7), and adding number of reported pain sites weakened the association even more (hazard ratio = 7.1, 95% CI = 3.8-12.8). Also, participants reporting poor mental health had a higher risk for disability pension due to musculoskeletal diseases (age and gender adjusted hazard ratio = 1.8, 95% CI = 1.3-2.6); however, in the final model the risk was not statistically significant.

Conclusions: The physical component in health-related quality of life (SF-12) was a strong predictor of disability pension due to musculoskeletal diseases, whereas the mental component played a less prominent role.
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http://dx.doi.org/10.1186/1471-2458-14-167DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928899PMC
February 2014

Smokers' increased risk for disability pension: social confounding or health-mediated effects? Gender-specific analyses of the Hordaland Health Study cohort.

J Epidemiol Community Health 2013 Sep 25;67(9):758-64. Epub 2013 May 25.

Public Health and Primary Health Care, University of Bergen, Bergen, Norway.

Background: Studies indicate that cigarette smokers have an increased risk for disability pension, presumably mediated by adverse health effects. However, smoking is also related to socioeconomic status. The current study examined the association between smoking and subsequent disability pension, and whether the association is explained by social confounding and/or health-related mediation.

Methods: A subsample of 7934 men and 8488 women, aged 40-46, from the Hordaland Health Study, Norway (1997-1999), provided baseline information on smoking status, self-reported health measures and socioeconomic status. Outcome was register-based disability pension from 12 months after baseline to end of 2004. Gender stratified Cox regression analyses were used adjusted for socioeconomic status, physical activity, self-reported health and musculoskeletal pain sites.

Results: A total of 155 (2%) men and 333 (3.9%) women were granted disability pension during follow-up. The unadjusted disability risk associated with heavy smoking versus non-smoking was 1.88 (95% CI 1.23 to 2.89) among men and 3.06 (95% CI 2.23 to 4.20) among women. In multivariate analyses, adjusting for socioeconomic status, HRs were 1.33 (95% CI 0.84 to 2.11) among men and 2.22 (95% CI 1.58 to 3.13) among women. Final adjustment for physical activity, self-reported health and musculoskeletal pain further reduced the effect of heavy smoking in women (HR=1.53, 95% CI 1.09 to 2.16).

Conclusions: Socioeconomic status confounded the smoking-related risk for disability pension; for female heavy smokers, however, a significant increased risk persisted after adjustment. Women may be particularly vulnerable to heavy smoking and to its sociomedical consequences, such as disability pension.
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http://dx.doi.org/10.1136/jech-2012-202182DOI Listing
September 2013

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

BMC Public Health 2013 Apr 10;13:329. Epub 2013 Apr 10.

Department of Community Medicine and Public Health, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.

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.
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http://dx.doi.org/10.1186/1471-2458-13-329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3626677PMC
April 2013

The regular general practitioner and sickness absence--a register-based study.

Tidsskr Nor Laegeforen 2013 Jan;133(1):28-32

Forskningsgruppe for sosial epidemiologi, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, Norway.

Background: Undertaking research on the role of regular GPs with regard to rates of sickness absence is methodologically challenging, and existing results show a wide divergence. We investigated how long-term sickness absence is affected by the characteristics of doctors and their patient lists.

Material And Methods: The study encompassed all those vocationally active residents of Oslo and Bergen in 2005-2006 who had the same regular GP throughout 2006 (N = 298,039). Encrypted data on sickness absence for each individual in 2006, as well their age, gender and level of education were merged with data on the regular GPs (N = 568) and their patient lists, and subsequently analysed with the aid of logistic regression. The outcome variable was at least one period of sickness absence which had been paid for by the Norwegian Labour and Welfare Administration (NLWA). The explanatory variables included the age, gender, list length and list status (open/closed) of the regular GPs, as well as variables that characterised the composition of the patient lists. The analyses were stratified by gender and controlled for individual age and education.

Results: The age, gender and list length of the regular GPs were not associated with sickness absence paid for by the NLWA. The odds ratio for sickness absence > 16 days was reduced for both women and men when the list contained many highly educated patients, a high proportion of elderly people and few disability pensioners. Men on lists with a high proportion of men and lists with a high proportion of vocationally active patients also had lower odds rates for sickness absence > 16 days. Among women, the rate of sickness absence was lower for those on open lists than for those on closed lists.

Interpretation: In addition to well-known individual factors, the study shows that the likelihood of sickness absence is affected by the socio-demographic composition of the patient list to which one belongs.
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http://dx.doi.org/10.4045/tidsskr.11.1340DOI Listing
January 2013

Attending work or not when sick - what makes the decision? A qualitative study among car mechanics.

BMC Public Health 2012 Sep 21;12:813. Epub 2012 Sep 21.

Uni Health, Uni Research, Bergen, Norway.

Background: High prevalence of sickness absence in countries with generous welfare schemes has generated debates on mechanisms that may influence workers' decisions about calling in sick for work. Little is known about the themes at stake during the decision-making process for reaching the choice of absence or attendance when feeling ill. The aim of the study was to examine decisions of absence versus attendance among car mechanics when feeling ill.

Methods: Interviews with 263 male car mechanics from 19 companies were used for the study, analysed by systematic text condensation and presented as descriptions and quotations of experiences and opinions.

Results: Three major themes were at stake during the decision-making process: 1) Experienced degree of illness, focusing on the present health condition and indicators of whether you are fit for work or not; 2) daily life habits, where attending work was a daily routine, often learned from childhood; 3) the importance of the job, with focus on the importance of work, colleagues, customers and work environment.

Conclusions: The car mechanics expressed a strong will to attend work in spite of illness. Knowledge about attitudes and dilemmas in reaching the decision regarding sickness absence or sickness attendance is useful in the prevention of sickness absence.
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http://dx.doi.org/10.1186/1471-2458-12-813DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490847PMC
September 2012

Women's higher likelihood of disability pension: the role of health, family and work. A 5-7 years follow-up of the Hordaland Health Study.

BMC Public Health 2012 Aug 31;12:720. Epub 2012 Aug 31.

Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, NO-5018, Bergen, Norway.

Background: Women's higher risk of disability pension compared with men is found in countries with high female work participation and universal welfare schemes. The aim of the study was to examine the extent to which self-perceived health, family situation and work factors explain women's higher risk of disability pension. We also explored how these factors influenced the gender difference across educational strata.

Methods: The population-based Hordaland Health Study (HUSK) was conducted in 1997-99 and included inhabitants born in 1953-57 in Hordaland County, Norway. The current study included 5,959 men and 6,306 women in paid work with valid information on education and self-perceived health. Follow-up data on disability pension, for a period of 5-7 years, was obtained by linking the health survey to a national registry of disability pension. Cox regression analyses were employed.

Results: During the follow-up period 99 (1.7%) men and 230 (3.6%) women were awarded disability pension, giving a twofold risk of disability pension for women compared with men. Except for a moderate impact of self-perceived health, adjustment for family situation and work factors did not influence the gender difference in risk. Repeating the analyses in strata of education, the gender difference in risk of disability pension among the highly educated was fully explained by self-perceived health and work factors. In the lower strata of education there remained a substantial unexplained gender difference in risk.

Conclusions: In a Norwegian cohort of middle-aged men and women, self-perceived health, family situation and work factors could not explain women's higher likelihood of disability pension. However, analyses stratified by educational level indicate that mechanisms behind the gender gap in disability pension differ by educational levels. Recognizing the heterogeneity within gender may contribute to a deeper understanding of women's higher risk of disability pension.
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http://dx.doi.org/10.1186/1471-2458-12-720DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3508825PMC
August 2012

Disability pension by occupational class--the impact of work-related factors: the Hordaland Health Study Cohort.

BMC Public Health 2011 May 30;11:406. Epub 2011 May 30.

Department of Public Health and Primary Health Care, University of Bergen, Kalfarveien 31, NO-5018 Bergen, Norway.

Background: The social gradient in disability pension is well recognized, however mechanisms accounting for the gradient are largely unknown. The aim of this study was to examine the association between occupational class and subsequent disability pension among middle-aged men and women, and to what extent work-related factors accounted for the association.

Methods: A subsample (N = 7031) of the population-based Hordaland Health Study (HUSK) conducted in 1997-99, provided self-reported information on health and work-related factors, and were grouped in four strata by Erikson, Goldthorpe and Portocareros occupational class scheme. The authors obtained follow-up data on disability pension by linking the health survey to national registries of benefit (FD-trygd). They employed Cox regression analysis and adjusted for gender, health (medical conditions, mental health, self-perceived health, somatic symptoms) and work-related factors (working hours, years in current occupation, physical demands, job demands, job control).

Results: A strong gradient in disability pension by occupational class was found. In the fully adjusted model the risk (hazard ratio) ranged from 1.41 (95% CI 0.84 to 2.33) in the routine non-manual class, 1.87 (95% CI 1.07 to 3.27) in the skilled manual class and 2.12 (95% CI 1.14 to 3.95) in the unskilled manual class, employing the administrator and professional class as reference. In the gender and health-adjusted model work-related factors mediated the impact of occupational class on subsequent disability pension with 5% in the routine non-manual class, 26% in the skilled manual class and 24% in the unskilled manual class. The impact of job control and physical demands was modest, and mainly seen among skilled and unskilled manual workers.

Conclusions: Workers in the skilled and unskilled manual classes had a substantial unexplained risk of disability pension. Work-related factors only had a moderate impact on the disability risk. Literature indicates an accumulation of hazards in the manual classes. This should be taken into account when interpreting the gradient in disability pension.
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http://dx.doi.org/10.1186/1471-2458-11-406DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125372PMC
May 2011

A survey of occupational health in the Royal Norvegian Navy.

Int Marit Health 2008 ;59(1-4):35-44

Department of Public Health and Primary Health Care, Occupational and Environmental Medicine, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway.

Objective: The aim of this article is to describe possible risk factors in the work environment that can affect the health of staff of the Royal Norwegian Navy (RNoN). The article presents the main results from a subproject related to a major surveillance of the health and work environment in this population. The project was performed as a response to general concerns regarding harmful work environment and negative health effects for these employees.

Participants And Methods: In 2002, a questionnaire was sent out to all the employees in RNoN, and they answered during a period of three months. The overall response rate was 58% (n=2265), 2001 men and 250 women (14 unknown sex). 1581 military employees and 580 civilians participated (104 unknown). Mean age was 38 (range 18-70). Questions about years at work, exposure to chemical, physical and ergonomic hazards were developed for this particular study. Questions about allergy, asthma, hand eczema, hearing loss, cardiovascular disease, diabetes mellitus and cancer were asked. Musculoskeletal disorders were obtained by a standardized instrument.

Results: Exposure to noise, heavy lifting, twisted work positions and work close to antennas and communication equipment occurred often in this population. The most commonly reported diseases that might be work related were hand eczema, hearing loss and low back pain.

Conclusions: The results indicate the presence of several possible risk factors to health related to the work environment in this population. The project gives a basis for further action regarding the Health Safety and Environment work within RNoN.
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April 2009
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