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Biomedical subjects

B Claussen

Publications and source records attributed to B Claussen.

At least 19 recordsLinked to original sources
PubMed1999

[Applications for disability benefits before and after the 1991 restrictions].

In 1991, the eligibility criteria for disability benefits were restricted in Norway. Some effects are described in the present evaluation. Based on documents, first time applicants in 1990 and in 1993 in two counties were analysed according to social and medical variables. "Social security careers" before application are described, and proposals from physicians and the local social security office are compared with the decisions made by the county social security administration. Over a three-month period, applications decreased from 2.2 per 1,000 inhabitants in 1990 to 1.4 in 1993, a 39% decrease. About the same decrease was observed in all social and diagnostic groups. The proportion on vocational rehabilitation before application increased from 19% to 23% (p = 0.02). The certifying physicians proposed refusals in 9% and 8% in the two samples, and the local social security office did so in 12% and 13%. The refusal rate increased from 8% in 1990 to 21% in 1993. Refusals were mostly given to women, the middle-aged, those living alone, those with short education, and applicants with medically unclear conditions. It is pointed out that the restrictions on disability benefits in 1991 had the greatest impact on applicants with few resources.

Adult↗
PubMed1999

[Sources of income after being denied disability pension].

Restrictions in eligibility criteria for disability pension were introduced in Norway in 1991. The effect of these restrictions on sources of income is an important question in social policy. 157 first time applicants from two counties who were denied disability pension before (1990) and after (1993) the restrictions were studied three years later. Sources of income were established through searches in registers of wages and social security benefits. NOK 3,000 per month was set as the lowest income allowing economic independence. Of the applicants in 1990, 14% were in the workforce three years later. In the post-restriction 1993 sample, this proportion was 21% (p = 0.29). The proportions receiving disability pension were 25% and 22% respectively. The spouse supported 33% of the 1990 applicants, and 22% in the 1993 sample (p = 0.13). Social welfare was the main source of income for 6% and 10% (p = 0.25). Changes in main sources of income following the restriction were relatively small. The main result of this study is that family support is the most prevalent source of income when disability benefits are denied. This is not in accordance with the Government's policy of promoting gainful employment.

Adult↗
PubMed1999

Health and re-employment in a five-year follow-up of long-term unemployed.

OBJECTIVES: To study health and re-employment in a five-year follow-up of a community sample of long-term unemployed people. METHODS: A random sample registered for more than 12 weeks at the labour offices in Grenland, Norway, were given medical check-ups in 1988 and 1990, and a postal questionnaire in 1993. RESULTS: Only 37% were employed five years after the first spell of long-term unemployment. Recovery after re-employment was demonstrated, indicating that unemployment causes poor mental health. Health-related selection to continuous unemployment was only found for medical diagnoses. The unemployed who might be selected to continuous unemployment because of poor health at the two-year follow-up seemed to deteriorate most. CONCLUSION: The high morbidity of mental health problems among unemployed people is mostly explained by the causal hypothesis. This is a challenge to preventive medicine. Sick unemployed people should be given special attention.

Adult↗
PubMed1998

[Protective gloves].

Explore the source record for details and available documents.

Dermatitis, Allergic Contact↗
PubMed1998

Physicians as gatekeepers: will they contribute to restrict disability benefits?

OBJECTIVE: To study how general practitioners (GPs), specialists, and National Insurance Administration (NIA) medical consultants reacted to the narrowed eligibility criteria for disability benefits in Norway from 1991. DESIGN: Records of first-time applicants for disability benefits from the first quarters of 1990 and 1993 were analysed for proposals from the physicians in relation to the decision. SETTING: Two Norwegian counties, Ostfold and Møre and Romsdal. SUBJECTS: 668 applicants--half the granted cases, and all the refused ones. RESULTS: The number of applicants fell by 39% from 1990 to 1993 and the refusal frequency increased from 8 to 21%. Nevertheless, GPs recommended refusal to about the same extent as before, 8-9% of all cases, with probably a minor fall from 52 to 42% of the refused ones (p = 0.19). Specialists did not recommend more refusals than the GPs. Cases evaluated by the NIA medical consultants increased from 29 to 41%, and their concordance with the patients' GPs seemed to be approximately 50%. GPs did not give more detailed medical descriptions in 1993 than in 1990, and discussed eligibility criteria but slightly more comprehensively. CONCLUSION: GPs are willing to act as gatekeepers for social insurance benefits for their patients, also when eligibility criteria become restricted.

Adolescent↗
PubMed1998

Suicidal ideation among the long-term unemployed: a 5-year follow-up.

Suicidal ideation was monitored in a 5-year follow-up of a representative sample of long-term unemployed Norwegians. Four items from the General Health Questionnaire-28 were used as a Suicidal Ideation Index, which showed a prevalence of 17% in the present sample of unemployed subjects, higher than the value of 11% in a sample of Australian students used to construct the Index. Five years later, suicidal ideation was found in 6% of those who had been re-employed and 22% of those still unemployed, indicating that the high prevalence of suicidal ideation may be due to unemployment. Routine clinical examination was also tried for preventive purposes. In total, 8% of the unemployed subjects showed clinically significant suicidal ideation. They were referred to a psychologist or their GP, and were given the standard advice about suicide prevention. A Resource Centre, which many employees at the Labour Office have missed, has now been set up in the area under the National Plan for Suicide Prevention.

Adolescent↗
PubMed1998

Restricting the influx of disability beneficiaries by means of law: experiences in Norway.

OBJECTIVES: To study effects of restricting eligibility criteria for disability pension in Norway 1991. METHODS: Documents of 288 applicants from 1990 and 1993 in one county were analysed for social and medical variables as well as for the determination and its causes. RESULTS: Incidence of applications for disability benefits during a three-month period was 223 per 100,000 inhabitants in 1990. The focused group of 'medically imprecise' musculoskeletal diagnoses concerned 26% of all applicants, while 'precise' musculoskeletal diagnoses were given to 15%, 'imprecise' psychiatric diagnoses to 7% and 'precise' ones to 6%. The number of applicants fell by 39%, surprisingly about the same in all social and diagnostic groups. Denial rate increased from 8% to 21%. Denials mostly struck women, middle-aged, those living alone, those with short education, and applicants with 'medically imprecise' diagnoses. CONCLUSIONS: Restriction of disability benefits affected applicants with the least resources the hardest, and seems to contribute to the on-going process of marginalizing the weaker part of the population.

Adolescent↗
PubMed1998

[Unemployment as a challenge for general practice].

Tasks for general practitioners in this field are discussed in connection with a two-year follow up of a randomised community sample of 310 unemployed persons in Norway. This study supported both the selective and causative mechanisms for explaining high morbidity among the unemployed. Thus, medicine is faced with both clinical and preventive tasks. Unemployed patients must be cared for by proper somatic and/or psychiatric diagnosing. A sociomedical diagnosis of the main unemployment problem is suggested. Counselling should be an important part of the treatment of unemployed patients. General practitioners may be the only independent counsellors of the many possibilities within the social security system. Secondary prevention may also be necessary to encourage passive unemployed patients to participate in activation programmes offered by the community (education, work opportunity programmes, sports, cultural activities, etc.). Primary prevention should help to avoid unemployment of more than three months' duration. Physicians are encouraged to lobby such measures in their communities.

Forecasting↗
PubMed1997

Rehabilitation efforts before and after tightening eligibility for disability benefits in Norway.

This paper reports the use of vocational rehabilitation among applicants for disability benefits in Norway before and after the eligibility criteria were tightened in 1991. The data sources were documents of 668 applicants from 1990 and 1993 in two countries. Vocational rehabilitation is the preferred benefit in the National Insurance Act, and was a core issue in the restriction reform. Nevertheless, rehabilitation was tried by only 14% of the applicants in 1990, and by no more than 19% in 1993. Eight per cent of the applicants were referred to an employment officer before determination in 1990, and 14% in 1993. In order to study different pathways from work to applying for disability benefits, six types of 'social security careers' were constructed. The commonest comprised sick pay only, the second led through unemployment, and the third included rehabilitation. Rehabilitation may also be offered to applicants who are refused disability benefits. This was the alternative determination for 4% of the refused cases in 1990, a proportion that increased to 12% after the reform. The main reason for the relatively infrequent use of rehabilitation is probably the continuous downgrading over many years of resources and institutions for this task.

Adult↗
PubMed1994

[Unemployed patients in 60 family practices].

In a one week registration of consultations by 60 general practitioners, 7% (95% confidence interval 6-8%) of all patients aged 16 to 66 were registered as unemployed. This was 145% of the mean unemployment rates in the municipalities where the doctors practiced. The age and gender composition of the unemployed patients was the same as for all registered unemployed. Psychiatric diagnoses were nearly twice as prevalent among the patients. A fifth of the unemployed patients attended for illnesses and conditions which seemed to relate to the unemployment. Most of them had somatic or mental disorders which probably were caused or worsened by lack of paid work. A few needed to discuss social insurance issues. The study did not support the idea that general practitioners medicalize unemployment problems, but provided no decisive evidence on this complicated question, which will be elaborated further during the next stage of the study.

Adolescent↗
PubMed1994

[Patients who are in danger of being dropped from the labour-market. A study from family practice].

During one week, 60 general practitioners in different parts of Norway registered those of their patients whom they believed were in danger of falling out of the labour market. Patients who risked losing their job completely constituted 12% (95% confidence interval 10-14%) of all patients aged 16-66 years. The fear of possible permanent lack of employment arose in connection with plans for a disability pension in 39% of the patients, vocational rehabilitation in 18%, current unemployment in 18% and long-term sickness certification in 16%. The doctors considered a disability pension in the case of only a quarter of the patients, while more patients, one third, had plans to apply for one. The doctors did not seem to act as promoters of early retirement. On the contrary, they often recommended vocational rehabilitation, even though earlier studies have shown that doctors are generally pessimistic about the chances of success in present day Norway. If the Government wants the doctors' help in promoting its policy of employment rather than social security benefit it will have to take practical steps to support their efforts to encourage vocational rehabilitation.

Adolescent↗
PubMed1994

[ICPC diagnoses in 60 offices of general practitioners].

The new classification system ICPC was used by 60 general practitioners to record consulting room encounters during one week. The study focused on unemployed and marginalized patients, and provided experience in the use of ICPC shortly after the system was made mandatory by National Insurance Administration. One to five months afterwards, 85% of the GPs used ICPC fully and 10% to some extent. We had no problems in coding the remaining text diagnoses, nor in recoding to the chapters of the diagnostic system ICHPPC. A quarter of the main diagnoses concerned the component of symptoms. Within the problematic chapters of psychiatric and musculosceletal illnesses, the doctors applied diagnoses of symptoms and diseases to very varying degrees. ICPC makes it possible to exclude gender-related causes for the consultation. Consequently, the gender differences in the distribution of components and chapters virtually disappeared. The female surplus among the patients was reduced to 10%, of which 6.5% can be attributed to the larger share of women among the elderly. Thus, ICPC seems to be a useful tool in epidemiology.

Adult↗
PubMed1993

The Alcohol Use Disorders Identification Test (AUDIT) in a routine health examination of long-term unemployed.

A representative sample of 310 long-term unemployed in Norway was followed for 2 years with clinical examinations and the AUDIT questionnaire. 30% of the men and 8% of the women scored over the cut-off point for an alcohol use disorder. This gives a probable prevalence of 16%. The test predicted return to employment in this sample. The AUDIT answers were also used as a basis for dividing into three groups: 'normal', 'hazardous' and 'harmful'. At 2 year follow-up, 27% had changed group, 32 respondents to the worse and 24 to the better. This 'unstable' group was characterized by weaker social network and more frequent drinking. The AUDIT was judged as a useful instrument both in a routine health examination and as an epidemiological tool.

Adolescent↗
PubMed1993

Health and re-employment in a two year follow up of long term unemployed.

STUDY OBJECTIVE: The aim was to examine re-employment and changes in health during a two year follow up of a representative sample of long term unemployed. DESIGN: This was a cross sectional study and a two year follow up. Health was measured by psychometric testing, Hopkins symptom checklist, General health questionnaire, and medical examination. Health related selection to continuous unemployment and recovery by re-employment was estimated by logistic regression with covariances deduced from the labour market theories of human capital and segmented labour market. SETTING: Four municipalities in Greenland, southern Norway. SUBJECTS: Participants were a random sample of 17 to 63 year old people registered as unemployed for more than 12 weeks. MAIN RESULTS: In the cross sectional study, the prevalence of depression, anxiety, and somatic illness was from four to 10 times higher than in a control group of employed people. In the follow up study, there was considerable health related selection to re-employment. A psychiatric diagnosis was associated with a 70% reduction in chances of obtaining a job. Normal performance on psychometric testing showed a two to three times increased chance of re-employment. Recovery of health following re-employment was less than expected from previous studies. CONCLUSIONS: Health related selection to long term unemployment seems to explain a substantial part of the excess mental morbidity among unemployed people. An increased proportion of the long term unemployed will be vocationally handicapped as years pass, putting a heavy burden on social services.

Adolescent↗