Can sickness absence be predicted at the pre-placement health assessment?

Indications of a Scarring Effect of Sickness Absence Periods in a Cohort of Higher Educated Self-Employed

Objectives

Little is known regarding incidence and recurrence of sickness absence in self-employed. The primary aim of this study was to evaluate the influence of the number of prior episodes of sickness absence on the risk of subsequent periods of sickness absence in higher educated self-employed.

Methods

In a historic register study based on the files of a Dutch private disability insurance company all sickness absence periods of 30 days or more were analysed.

Results

A total of 15,868 insured persons contributed 141,188 person years to the study. In total, 5608 periods of sickness absence occurred during follow-up. The hazard of experiencing a new period of sickness absence increased with every previous period, ranging from a hazard ratio of 2.83 in case of one previous period of sickness absence to a hazard ratio of 6.72 in case of four previous periods. This effect was found for both men and women and for all diagnostic categories of the first period of sickness absence.

Conclusions

Our study shows that for all diagnostic categories the hazard of experiencing a recurrence of sickness absence is appreciably higher than for experiencing a first episode. This suggests that this increased hazard may be related to the occurrence of sickness absence itself rather than related to characteristics of the insured person or of the medical condition. These findings could indicate that sickness absence periods may have a scarring effect on the self-employed person experiencing the sickness absence.

Pre-employment examination for low back risk in workers exposed to manual handling of loads: French guidelines

BACKGROUND

Low back pain (LBP) is a major cause of sickness absence and disability in the working population, and the pre-employment examination should insure that worker's state of health is compatible with the requirements of proposed job. This paper summarizes the main recommendations of the good practice guidelines of the French Society of Occupational Medicine for pre-employment examination in workers exposed to manual handling of loads apart from pre-employment test.

METHODS

The recommendations were developed according to the Clinical Practice Guidelines proposed by the French National Health Authority and based on a systematic search of the literature 1990-2012 in several databases. The guidelines were written and reviewed by two multidisciplinary committees. On the basis of the level of evidence in the literature, the proposed guidelines are classified as grade A, B, C or expert consensus.

RESULTS

The main recommendations of these guidelines are as follows: (1) medical contraindications alone should not exclude employment in a job associated with a low back risk on the basis of a history of "simple" nonspecific LBP; (2) the relevance of examining a previous history of LBP, which is the best predictor of future LBP due to the recurrent nature of LBP.

CONCLUSIONS

These guidelines correspond to a constant concern with prevention of occupational risk. Primarily intended for occupational physicians, they are also intended for general practitioners who carry out pre-employment examinations in many countries and are likely to be increasingly faced with this type of situation because of the combination of increasing work constraints with ageing of the workforce.

Predictors of sickness absence in college and university educated self-employed: a historic register study

Background

Despite a large proportion of the workforce being self-employed, few studies have been conducted on risk factors for sickness absence in this population. The aim of this study is to identify risk factors for future sickness absence in a population of college and university educated self-employed.

Methods

In a historic register study based on insurance company files risk factors were identified by means of logistic regression analysis. Data collected at application for private disability insurance from 634 applicants were related to subsequent sickness absence periods of 30 days or more during a follow-up period of 7.95 years. Variables studied were self-reported lifestyle variables, variables concerning medical history and present health conditions and variables derived from the general medical examination including blood tests and urinary analysis.

Results

Results from analysis of data from 634 applicants for private disability insurance show that previous periods of sickness absence (OR 2.07), female gender (OR 2.04), health complaints listed in the health declaration (OR 1.88), elevated erythrocyte sedimentation rate (ESR) (OR 4.05) and the nature of the profession were related to a higher risk of sickness absence.

Conclusions

Sickness absence was found to be related to demographic variables (gender, profession), medical variables (health complaints and erythrocyte sedimentation rate) and to variables with both a medical and a behavioural component (previous sickness absence).

The predictive capacity of declared musculoskeletal disorder at pre-employment screening

BACKGROUND

This study was undertaken at a major UK airport in response to management concerns about levels of sickness absence and impaired work capacity in the security department in order to investigate the possibility of achieving reductions through changes in pre-employment screening procedures.

AIMS

To determine the predictive capacity of a declared musculoskeletal disorder (MSD) at pre-employment screening.

METHODS

This study was based on the pre-employment health declarations of security workers. Work outcomes measured included sickness absence rates (including total and MSD-related absence), work restriction and ill-health retirement rates. Pre-employment questionnaires (PEQs) were analysed for 594 individuals who joined as security staff from 1993-2002. Those who declared an MSD were compared with those who did not using data from the human resources department and the occupational health records.

RESULTS

Subjects who disclosed MSDs at pre-employment had significantly higher rates of subsequent total absence, MSD-related absence and work restrictions compared with those who did not. Potential confounders included sex, smoking, age and years in employment.

CONCLUSIONS

Pre-employment health screening can predict subsequent work outcomes. It is suggested that greater scrutiny is applied to declarations of an MSD at pre-employment screening in the potentially adverse manual handling environment of airport security work and that more advice is given to management about future risks of sickness absence and impaired work capacity.

Evidence base for pre-employment medical screening

This paper examines the evidence base for the use of pre-employment/pre-placement medical examinations. The use of pre-employment examinations is often driven more by cultural practices than evidence. There is a lack of evidence on their effectiveness in preventing health-related occupational risks. Hypertension screening is highlighted as a common pre-employment practice for which there is no standardized criteria to use to determine fitness for work. There are inherent problems in screening for psychiatric disorders and substance abuse as well as potential for racial bias and other unintended negative effects. This paper questions the economic case for this practice and also expresses concerns about paternalism related to identified risk factors. Health assessments should only be included when appropriate to the task environment and the general use of pre-employment exams and drug screening should be eliminated. Generally, a health assessment by questionnaire should suffice. Occupational health providers should advise against the application of physical or mental standards that are not relevant to fulfilment of the essential job functions. Consensus development regarding best practice, as well as consideration for acquiring outcome data related to pre-employment practice, is recommended.

Can pre-placement health assessments predict subsequent sickness absence?

BACKGROUND

Sickness absence is a growing economic problem, due largely to the financial losses it incurs. The ability to identify employees likely to take greater than average sickness absence may provide managers with useful information at the pre-placement stage.

AIM

To confirm whether specific risk factors identified at the pre-placement health assessment could predict subsequent sickness absence.

METHODS

A total of 400 National Health Service pre-placement health questionnaires were analysed to allocate employees to low-, medium- or high-risk categories for subsequent sickness absence, using the risk table developed by C. J. M. Poole (Can sickness absence be predicted at the pre-placement health assessment? Occup Med (Lond) 1999; 49:337-339) [1]. Subsequent sickness absence was analysed to assess if there was an association between the allocated category and sickness absence taken.

RESULTS

Mean sickness absence hours per 1000 h worked were 22.5 (95% CI 18.2-27.2) in the low-risk group, 33.6 (27.2-40.7) in the medium-risk group and 44.7 (25.1-69.9) in the high-risk group (analysis of variance, P <or= 0.002), demonstrating a statistically significant difference in sickness absence taken in subsequent years.

CONCLUSIONS

The results confirmed Poole's hypothesis that future sickness absence can be predicted at the pre-placement health assessment. Certain risk factors, namely female sex, age, smoking, history of at least two previous episodes of low-back pain and previous days sickness absence identified at pre-placement assessment, predict a greater than average subsequent sickness absence. However, the best model using identified risk factors only predicted 10-12% of the variation in sickness absence.

Criteria and methods used for the assessment of fitness for work: a systematic review

The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966-2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre-offer or post-offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost-effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from "fit" to "unfit", with other possible intermediate categories such as "fit subject to work modifications", "fit with restrictions" or "conditionally fit (temporarily, permanently)". Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision-making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.