In the final part of the paper we find that a higher sick absenteeism is associated with a higher risk of becoming unemployed, suggesting that unemployment might play a role as workers' discipline device, although we cannot exclude that this relationship might be driven by different mechanisms.
But if selection bias in health is a severe problem this ought to be reflected in a higher sick leave absence in the years prior to onset of distress in the intervention group compared to the control group [ 11].
For instance, a municipality with a higher than average level of long-term sick leaves would have a higher level of claims, but as long as the high sick leave pattern is a trait of the municipality it does not affect the analysis of change associated with the electronic prescription system in a fixed effect model.
On group- and organizational level, the informants described how high sick leave was a twofold problem for the units.
In 2003 the municipality in this study received orders from the Norwegian Labor Inspectorate due to a high level of unhealthy time pressure and high sick leave in the home care services (HCS).
Finally, a feedback loop is indicated: municipal stakeholders respond to high sick leave and other indicators of work overload by attempting to improve working conditions.
The mayor argued that very little of the high sick leave rate could be attributed to the attacks and their aftereffects, and said in December: "You have a contract, both parties have to live up to that contract.
The present preliminary investigation examined the effects of a brief Acceptance and Commitment Therapy (ACT) intervention for the treatment of public health sector workers who showed chronic stress/pain and were at risk for high sick leave utilization.
As prolonged high sick leave represents high costs as well as human suffering, it is a puzzle that HCS administrators have not been able to deal with the problem in the aftermath of the unsuccessful initial interventions.
However, HCWs in 2009 still seemed exposed to several occupational risk factors, musculoskeletal health complaints, and high sick leave rate [ 21].
