Study objective-The study is an empirical investigation of sickness presenteeism in relation to occupation, irreplaceability, ill health, sickness absenteeism, personal income, and slimmed down organisation. Design-Cross sectional design. Setting-Swedish workforce. Participants-The study group comprised a stratified subsample of 3801 employed persons working at the time of the survey, interviewed by telephone in conjunction with Statistics Sweden's labour market surveys of August and September 1997. The response rate was 87 per cent. Main results-A third of the persons in the total material reported that they had gone to work two or more times during the preceding year despite the feeling that, in the light of their perceived state of health, they should have taken sick leave. The highest presenteeism is largely to be found in the care and welfare and education sectors (nursing and midwifery professionals, registered nurses, nursing home aides, compulsory school teachers and preschool/primary educationalists. All these groups work in sectors that have faced personnel cutbacks during the 1990s). The risk ratio (odds ratio (OR)) for sickness presenteeism in the group that has to re-do work remaining after a period of absence through sickness is 2.29 (95% CI 1.79, 2.93). High proportions of persons with upper back/neck pain and fatigue/ slightly depressed are among those with high presenteeism (p< 0.001). Occupational groups with high sickness presenteeism show high sickness absenteeism ( = 0.38; p<.01) and the hypothesis on level of pay and sickness presenteeism is also supported ( = −0.22; p<0.01). Conclusions-Members of occupational groups whose everyday tasks are to provide care or welfare services, or teach or instruct, have a substantially increased risk of being at work when sick. The link between diYculties in replacement or finding a stand in and sickness presenteeism is confirmed by study results. The categories with high sickness presenteeism experience symptoms more often than those without presenteeism. The most common combination is low monthly income, high sickness absenteeism and high sickness presenteeism.

The study has identified different types of determinants of sickness presence. Under the assumption that there is a connection between high sickness presence and risk for future ill health, the results may provide assistance in the formulation of preventive measures.

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Objective: To determine whether self-reported sickness presence (SP) and self-reported sickness absence (SA) are specific risk factors for future health problems or reduced work ability in the active workforce. Materials and Methods: The study population consisted of a cohort based on a random sample (n = 2181) with data for 2004, 2005, and 2006. The subjects were employees aged from 25 to 50 years in 2004. Cross-tabulations were calculated to identify significant background factors (sex, age, education, socioeconomic position), work factors (work demands, control, adjustment latitude), and outcome factors. Block-wise multiple logistic regression analyses were performed for outcome factors (SP, SA, self-rated health, physical complaints, work ability, mental well-being). Results: SA and SP were found to have negative health consequences; this was particularly pronounced for those with frequent SP or SA. There was a dose-response relationship between the degree of SA, SP and the different health outcomes. The health risks remained, after control for background factors, prior working conditions and initial health. SP also appeared to lead to SA, whereas SA did not have a significant impact on future SP. Conclusions: The results suggest that both SP and SA are strong predictors of future poor health, physical complaints, low mental well-being and low work ability. The detrimental influence of frequent SP was most pronounced in relation to work ability and physical complaints, although all of the measured health factors were affected. The negative effects of SA on the different health outcomes were similar.

The aim of this study was to investigate unwinding and recuperation among teachers. Six items were used and combined to identify level of activation and recuperation during the 24 hr of each day. Cluster analysis was used to detect groups of individuals with similar activation-recuperation profiles. The study group comprised 472 teachers from 12 schools. Three clusters of teachers were identified: alert, in-between, and nonrecuperated. About 20% of the teachers fell into the nonrecuperated group. This group showed more (a) symptoms of ill health, (b) illness-related absences that were due to sickness, and (c) poorer attendance when sick than the other two groups. Failure to recuperate was related to aspects of the classroom, but not to teachers' perceptions of more general organizational circumstances.

Relationships between Self-Rating of Recovery from Work and Morning Salivary Cortisol: Klas GUSTAFSSON, et al. Department of Psychology, Stockholm University, Sweden-To date, the understanding of how recovery from work relates to cortisol output is poor. Considering this, the present study set out to investigate the associations between self-ratings of 15 items of rest and recovery and salivary cortisol sampled every second hour across two working days. Data came from 12 female and 13 male whitecollar workers and were analyzed by linear regression analyses and repeated measures ANOVA. Poor rest and recovery was associated with high levels of morning cortisol, with the strongest relationships emerging for "rested in the morning", "rested after a weekend", "feel energetic during the working day", "tired during the working day", "sufficient sleep" and "worry about something". Moreover, significant interaction effects emerged between sex and "rested after a weekend" and "worry about something". To conclude, the findings show that self-ratings of rest and recovery are related to cortisol, particularly to morning cortisol, and that self-ratings provide important information on physiological recovery in terms of cortisol output. (J Occup Health 2008; 50: 24-30 Lack of recovery, or poor unwinding, has been proposed as a key factor relating to the increasing levels of stress-related health problems among working women and men in industrialized countries [1][2][3][4] . This is based on research showing the inability to rest and recover from work having negative effects on individual health and well being. For instance, insufficient recovery has been associated with poor psychological and physical health, in terms of symptoms and burnout 5,6) . However, the understanding of the physiological mechanisms underlying the associations between poor recovery and health-related problems is poor.To describe the relationships between physiology and recovery, reliable methods to measure rest and recovery are needed. One of the most common methods to gain information on rest and recovery is to ask people to provide self-ratings in questionnaires. To determine whether answers to such questions are associated with health, self-ratings can be evaluated with respect to established biomarkers of physiological functioning, such as cortisol. Previous research 4,7) suggests that cortisol is associated with rest and recovery, but the hypothesis remains to be investigated 6)

Purpose -The purpose of this paper is to compare sickness presence (SP) and sickness absence (SA) regarding the strength of their relationship to health/ill-health. In a previous Canadian study a stronger association between SP and health/ill-health than between SA and health/ill-health was shown. Design/methodology/approach -Five Swedish data sets from the years 1992 to 2005 provided the study populations, including both representative samples and specific occupational groups (n ¼ 425-3,622). Univariate correlations and multiple logistic regression analyses were performed. The data sets contained questions on SP and SA as well as on various health complaints and, in some cases, self-rated health (SRH). Findings -The general trend was that correlations and odds ratios increased regularly for both SP and SA, with SP showing the highest values. In one data set, SRH was predicted by a combination of the two measures, with an explained variance of 25 percent. Stratified analyses showed that the more irreplaceable an individual is at work, the larger is the difference in correlation size between SP and SA with regard to SRH. SP also showed an accentuated and stronger association with SRH than SA among individuals reporting poor economic circumstances. Practical implications -The results support the notion that SA is an insufficient, and even misleading, measure of health status for certain groups in the labor market, which seem to have poorer health than the measure of SA would indicate. Orginality/value -A combined measure of sickness presence and absence may be worth considering as an indicator of both individual and organizational health status.

The results showed that combinations of frequent self-rated SP and SA are related to negative values in the four measured aspects of self-reported health 1 year later. Occupational medicine practitioners should therefore be concerned particularly with employees who report frequently occurring SP and SA.