What is the difference between an episode and a spell

First incident sickness absence spell across all duration categories was associated with an increased risk of inpatient- age- and sex adjusted HR 1. The associations remained statistically significant while controlling for covariates or familial confounding. First incident sickness absence spell increases the risk of inpatient care or specialized outpatient care regardless of the duration of the sickness absence spell.

Hence, incident sickness absence spells should be noted and targeted to actions at workplaces as well as in primary and occupational health care. Peer Review reports. Consequences of SA such as permanent work incapacity in terms of disability pension, morbidity or mortality [ 3 , 4 , 5 ] have merited interest in recent years as the impact is considerable for the individuals, employers and for society.

Furthermore, the consequences of SA influence medical such as hospitalization , psychosocial comorbidity or related to exclusion from the labour market , but also economic i.

For those being on SA it is always an option to return to work, i. SA is targeted to allow an individual to recover and retain work capacity. However, a recent study based on Swedish twins indicated that SA due to mental diagnoses predicted both inpatient and specialized outpatient care and mortality although not accounting for the duration of SA [ 4 ]. Until now, relatively few studies have investigated the consequences of various SA spell durations in terms of health care utilization [ 12 , 13 ] which would be important for public health in terms of preventive actions of increase in need of care.

As SA is common, one could consider that early attention to SA could be a trigger or an indicator for initiation of potential preventive means such as workplace or occupational health care interventions. Genetics is an influential factor that play a role in SA and in many influential factors including age and socioeconomic status, and in consequences of SA e.

Studies have shown familial factors i. Genetics also play a role in many chronic conditions that usually require healthcare, including high blood pressure [ 21 ], low back pain [ 22 ], or migraine [ 23 ].

Thus, associations between SA duration and health care utilization should preferably be adjusted for familial confounding, an elegant feature provided by twin studies. In this study based on a population-based sample of Swedish twins with comprehensive coverage of national register data for SA and in- and outpatient care, we hypothesized that the associations between SA and patient care would differ by spell duration in a dose-response manner but also by the patient care type.

This study aimed to a investigate SA in various spell durations as a predictor for subsequent inpatient- and specialized outpatient care and b to study if familial confounding plays a role in these associations.

We limited the STODS data to those alive and living in Sweden in and at the time not on SA or disability pension, and present not emigrated or died during the follow-up.

Furthermore, those unemployed, disability pensioned or retired, can have patient care equally as employed hence we did not account them as censoring. The inpatient- and specialized outpatient care included dates and diagnoses from the National Board of Health and Welfare.

Since we had data for care until the end of , we also restricted all the other data sources until the end of including emigration from Statistics Sweden the Longitudinal Integration Database for Health Insurance and Labor Market Studies Register [LISA by Swedish acronym] [ 26 ] and deaths that were censored.

Date of death was available from the causes of death register from the National Board of Health and Welfare. Hence, the final study sample included 24, individuals Fig. Furthermore, we accounted for the fact that our sample included International Classification of Diseases 10th Revision codes ICD-codes OO Pregnancy, childbirth and the puerperium both for SA and inpatient and specialized outpatient care.

As pregnancy and childbirth are not considered as illnesses and many will have SA and inpatient or specialized outpatient care during that time, we excluded them from the analyses. Inpatient or outpatient care due to OO99 for individuals were included in the analyses for censoring reasons. Mean age at baseline was The first incident inpatient- and specialized outpatient care episode with main diagnosis code ICD 10 after first incident SA spell were our study outcomes.

The follow-up was from 1. We used the unique ten-digit Swedish identification number for the linkage of data from the national registers. Data on covariates including age and sex from STR, family situation i. We included these covariates due to their known association both with SA [ 27 ] and study outcomes [ 28 ]. First, we calculated frequencies and proportions to describe the sample. Then we added the covariates education, family status and living area all at the same time to the model i.

We also conducted conditional Cox proportional hazard regression models for discordant twin pairs to investigate the potential confounding by familial factors i.

Conditional Cox models calculates the HRs for same-sex twin pairs discordant for study outcomes; i. This allows each twin pair to have their own baseline hazard and controls for familial confounding. These conditional models can be interpreted by comparing the results to the models of the whole cohort. If familial confounding plays a role, then the associations should exist in the analyses of the whole cohort but not in the conditional models. On the other hand, no familial confounding is suggested if the association is also found within discordant twin pairs i.

As the proportionality of hazards was violated, we estimated Kaplan-Meier survival curves across SA spell durations to assess their differences but also utilized log-rank tests to analyze survival differences.

All statistical analyses were conducted with Stata version The mean follow-up time was 4. Note that the 0 in follow-up time denotes 1 day i. Sociodemographic characteristics were the same across inpatient, specialized outpatient and no care groups, except for age: inpatient care was more frequent among older age groups than among those with specialized outpatient care or no care Table 1.

All categories of duration of a SA spell predicted both inpatient and specialized outpatient care analyzed separately and the covariates played a minor role Table 2. While comparing those with SA across various spell durations with those without any SA, the results indicate that SA spell in any duration is a very strong predictor for both inpatient and specialized outpatient care Table 2.

The HRs for SA spell duration categories where only slightly higher in longer duration categories hence indicating no trend of dose-response. Kaplan-Meier survival curves for durations of a SA spell are shown in Fig.

This was further confirmed by incidence rates, although the overall relatively low incidence rates followed the trend towards the higher SA spell duration — the higher incidence rate Supplemental Table 2. In this comprehensive register data of almost 25, Swedish twins we investigated SA spell durations in association with subsequent inpatient or specialized outpatient care.

Although SA research with interest in patient care has been recently conducted [ 3 , 4 , 5 ], this might have been among the first studies with a focus on SA spell durations. Our results indicate that there is no difference between SA spell duration categories i.

This finding confirms the earlier results of the existing link between SA and morbidity in terms of patient care [ 3 , 4 ] but adds to the literature by a similar role for increased risk of inpatient- and specialized outpatient care across all five SA spell duration categories. Studies of SA and morbidity in terms of patient care have been relatively rare which may reflect the fact that health care utilizations often are followed from onset of a disease, symptom or medication that has required medical attention in a care unit [ 29 , 30 ].

Alternatively, studies of consequences of SA have focused on mortality, including suicide [ 3 , 9 , 11 ]. Our approach from SA to consequences in terms of patient care stemmed from the hypotheses that associations between a SA spell and patient care would differ by spell duration i. Our survival curves showed no differences across SA spell durations for inpatient nor for specialized outpatient care indicating no support for the hypotheses.

The finding of no differences of spell durations is in line with earlier studies in Sweden for suicide or morbidity [ 3 , 12 ]. However, our results might indicate a need to investigate diagnosis-specific patient care to shed further light on the hypotheses. From a practical point of view considering working life or occupational health care this emphasizes the role of SA regardless of duration as an indicator of compromised health and work ability.

Therefore, special attention with relevant actions for prevention should be paid following incidence of SA to avoid any consequences, but patient care in specific. Specifically, the risk estimates were higher for both inpatient and specialized outpatient care when compared to those without SA than in comparison to short SA.

Breath-holding spells are usually caused by either a change in the child's breathing or a slowing of the heart rate. These reactions may be brought on by pain or by strong emotions. In some children, breath-holding spells may be related to iron deficiency anemia , a condition in which the body doesn't produce a normal number of red blood cells.

Doctors can usually diagnose breath-holding spells based on what happens during a spell. The doctor will examine your child and ask you to describe the spells. It may help for you to keep a record of what happens during each spell.

If your doctor thinks that your child has a seizure disorder or another condition, such as iron deficiency anemia, your child may need other tests. Most children don't need treatment for breath-holding spells. Spells will go away as your child gets older. If your doctor thinks that a medical condition is causing the spells, your child may need treatment. To decrease the chance of more spells, make sure that your child gets plenty of rest, and try to help your child feel secure. Be sure to tell your child's doctor if your child starts to have spells more often or if they seem worse or different than before.

Breath-holding spells can be frustrating for parents. If you have trouble dealing with your child's spells or find yourself getting angry, talk with your doctor or a counsellor. Try to keep in mind that your child isn't having spells on purpose. To protect your child during a spell, lay your child on the floor and keep his or her arms, legs, and head from hitting anything hard or sharp. Your child may stop breathing for up to 1 minute 60 seconds during a spell. If your child doesn't wake up quickly and start breathing again, call or other emergency services.

The operator may tell you to give your child rescue breaths while you wait for help to arrive. After the spell, reassure your child. Don't punish him or her for having the spell. Author: Healthwise Staff. To put under the influence of a spell; to affect by a spell; to bewitch; to fascinate; to charm. To constitute; to measure. To tell or name in their proper order letters of, as a word; to write or print in order the letters of, esp.

To discover by characters or marks; to read with difficulty; -- usually with out; as, to spell out the sense of an author; to spell out a verse in the Bible. To form words with letters, esp. To study by noting characters; to gain knowledge or learn the meaning of anything, by study. Example Sentences: 1 We outline a protocol for presenting the diagnosis of pseudoseizure with the goal of conveying to the patient the importance of knowing the nonepileptic nature of the spells and the need for psychiatric follow-up.

Words possibly related to " episode ".