Purpose Multilevel interventions may prevent the negative consequences of emotional demands. However, a known barrier to implementing multilevel interventions is high workload, an increasing problem in the healthcare sector due to staff shortages and an aging population. This study investigates key factors for implementing a multilevel intervention targeting emotional demands at an entire hospital with staff shortages. Design/methodology/approach We conducted a process evaluation drawing on concepts from realist evaluation. We conducted individual semi-structured interviews before and after the intervention (39 in total) with managers, employees, the board of management, and intervention consultants. We also observed intervention activities, collected attendance registrations for all planned intervention activities, and analyzed data using thematic analysis. Findings In the context of staff instability, overcrowding and staff groups with low power distances we found that top-management support and a strong connection to patient safety could support a high degree of implementation. We found that the intervention activities led to participants experiencing improvements in social support, knowledge, action possibilities and prevention practices. Further quantitative analyses are needed to establish the effects of the intervention on more distal outcomes. Originality/value The study identified key factors for successful implementation of a multilevel intervention in hospitals allowing for implementation in a resource-scares environment. This knowledge is key for future efforts to prevent and manage emotional demands in healthcare.
BACKGROUND AND PURPOSE:Physical activity (PA) is a key recommendation for musculoskeletal pain, but social determinants of health (SDH) may limit older adults' participation. The purpose of this study was to assess the association of SDH with PA in a large representative sample of older Europeans with musculoskeletal pain. METHODS:A cross-sectional study was conducted based on data from the 9th wave of the SHARE (2021-2022), a representative survey of people aged 50 years and older in 27 European countries and Israel. People with back, hip, knee, or other joint pain were included. The SDH (exposures) examined were education, household income, current job status, and loneliness. Self-reported vigorous or moderate PA were the outcomes. Survey-weighted ordinal logistic regression models were applied, adjusting for age, sex, country, comorbidities, sleep problems, smoking, sadness, and pain characteristics. RESULTS:21,679 individuals (mean age: 70 years, 64% female) were included. Low educational level was consistently associated with reduced participation in moderate (OR: 0.79; 95% CI: 0.65-0.97) and vigorous PA (OR: 0.68; 95% CI: 0.57-0.82). Loneliness was consistently associated with reduced participation in moderate (OR: 0.78; 95% CI: 0.65-0.93) and vigorous PA (OR: 0.76; 95% CI: 0.67-0.87). Active employment was associated with a lower likelihood of engaging in vigorous PA (OR: 0.69; 95% CI: 0.60-0.79) but not moderate PA. No significant association was observed with income. DISCUSSION:Our findings highlight the need for educational interventions and targeted strategies addressing social support to promote physical activity in older adults with musculoskeletal pain.
Genetic factors can influence cardiovascular disease (CVD) risk through multiple behavioural and physiological mechanisms, including lipid metabolism, blood pressure regulation, and inflammatory responses. The present narrative review examines the impact of physical activity on the relationship between genetic susceptibility and CVD risk. Specifically, we synthesize evidence regarding gene-physical activity interplay and whether individuals with a genetic predisposition for CVD benefit more from physical activity than individuals with more health-favourable genotypes. Most single-gene studies on gene-physical activity interactions have shown that physical activity can significantly reduce CVD risk also in individuals with high genetic predisposition for CVD. Those with higher genetic risk may experience more substantial benefits from physical activity than those with lower genetic risk. Additionally, genetics may play a role in how people respond to exercise and why some people find it harder to adopt a healthy lifestyle. The evidence showed the central role of physical activity in reducing the CVD risk across different genetic profiles, highlighting the need for personalized preventive strategies to optimize cardiovascular health.
AIMS:Exposure to workplace bullying is associated with an increased risk of mental health conditions, yet it is debated whether the association is causal. This study aims to address this by examining whether onset of workplace bullying is associated with initiating treatment with psychotropic medication, here used as a proxy measure for onset of common mental disorders. METHODS:We used two longitudinal datasets from Sweden and Denmark (mean age: 47.4, women: 52.8%), combined with national registry data on psychotropic medication purchases. Using a target trial approach, the study population (N = 25 309) consisted of employees free of workplace bullying and psychotropic medication use at baseline. We used Cox proportional hazards regression (adjusted for sociodemographic variables, depressive symptoms and psychosocial work characteristics) to assess the association between onset of exposure to workplace bullying and incident treatment with psychotropic medication during 2 years. RESULTS:In total, 1490 individuals (5.9%) experienced onset of workplace bullying. Bullying onset was associated with incident treatment with any psychotropic medication (HR: 1.42, 95% CI 1.15-1.77, model adjusted for sociodemographic variables). This association was attenuated in the fully adjusted model (HR: 1.24, 95% CI 0.99-1.53). In analyses focusing on antidepressant treatment, the estimates were stronger (HR: 1.55, 95% CI: 1.15-2.09, fully adjusted model). The results further demonstrated an exposure-response relationship, such that higher frequency of bullying exposure was associated with an increased risk of initiating any psychotropic treatment and antidepressants. CONCLUSIONS:Individuals experiencing onset of workplace bullying were at higher risk of starting antidepressant treatment within 2 years. This is the first study showing that onset of workplace bullying can contribute to the development of mental health conditions requiring medical treatment. These results underline the importance of preventive interventions that reduce workplace bullying.
Asphalt paving is a source of carbonaceous particles originating from diesel exhaust and condensation of semi-volatile organic compounds from bitumen. While the latter furthermore serve as precursors for secondary organic aerosols and formation of ground level ozone over regional scales, emissions from asphalt are relevant for asphalt workers exposure and public health. Contemporary assessments of the total carbonaceous exposure is provided for elemental carbon (EC), particulate organic carbon (OC) and hazardous polycyclic aromatic hydrocarbons (PAH) in more than 90 personal exposures in Denmark. Measurement campaigns were designed to investigate effects of meteorological parameters, asphalt temperature and asphalt type, paving equipment and locations including highways, urban and rural road and parking lot with/without ambient traffic. Moreover, the exposures were divided into work tasks (operators of rollers and paving machines, foremen, and asphalt workers on the road) to evaluate their susceptibility to individual pollutants. Determinants of exposure included wind speed and wind direction, asphalt temperature and number of equipment operating. Geometric mean exposures varied from 0.81 to 2.16 μg m-3 EC, 33-200 μg m-3 OC, while the sum of the so called 16 priority PAHs varied from 86 to 4237 ng m-3 at different locations. Diesel exhaust and bitumen particles partly exceeded current occupational exposure limit values, while PAHs were well below. Since diesel exhaust particles and bitumen fumes are carcinogenic and possibly carcinogenic according to IARC, respectively, a set of recommendations were formulated for mitigation of these pollutants of importance for human and environmental exposure.
