Integrating perspectives in social medicine

Sammanfattning: In this thesis sickness absence was studied from a socio-medical perspective using both epidemiological and clinical data and methods of analysing. The specific aim of the epidemiological studies was to analyse sickness absence patterns and its changes in the total population of Östergötland. Furthermore, variations with gender, age and occupation were analysed. Gender trends in sickness absence concerning musculoskeletal diagnoses, its changes from 1985 to 1987 and association of numerical gender segregation in occupational categories with sickness absence due to musculoskeletal diagnoses was also investigated.The specific aim of the clinical studies was to estimate the frequency and character of psycho-social problems in a population with repeated short-term sickness absence. A clinical socio-medical supportive program for this patient-group was assessed. Finally, the vocational activity, program costs and possible benefits to society of a clinical, socio-medical case management program was evaluated.The results showed that women had much higher sickness absence than men generally and in particular in male-dominated occupational categories. The cumulative incidence percentage of siclmess absence in all diagnoses increased for both genders from 1985 to 1987. There were large variations between different occupational categories; blue-collar occupations were high-risk for sickness absence while white-collar occupations were low risk.Women had higher cumulative incidence than men in musculoskeletal diagnoses and also longer duration of sick leave days per sick leave insured person and per sick-listed person. The cumulative incidence for the diagnostic sub-group "neck/shoulder diagnoses" showed the highest percentage increase from 1985-87. The cumulative incidence in all musculoskeletal diagnostic groups was highest for both genders in extremely male-dominated occupational categories (>90% men).The study of repeated short-tenn sick leave showed that the underlying reasons were less medical and more of a socio-medical origin for 2/3 of the patients in comparison with an age- and sex-matched sample of patients at the general practitioner's surgery in the same area. A majority of patients, who had taken part in a socio-medical supportive program reported a better quality of life, although they did not specifically ascribe this to the socio-medical intervention.When investigating the long-term economic effect of a clinical case management program for patients with chronic minor disease, the benefit-cost ratio of the program was 4.9. Fifty per cent of the patients had been absent from working life for more than two years on admission to the program. The rehabilitation rate of patients back to work was 20.5% after one year and 11 .7% after five years.