Simulation-based training facilitates learning of advanced laparoscopic surgical procedures. Such procedures are challenging to master due to their technical complexity, which can elicit stress responses in surgical trainees. Previous research has demonstrated the impact of stress on trainees’ learning processes in skills lab. However, there is limited data comparing trainees’ stress responses during advanced procedural training using box-trainers in skills lab, to those experienced during operating training in realistic simulation environments. This study aims to explore the physiological responses, self-reported stress responses, and experiences of stress of surgical trainees during advanced laparoscopic procedural training in two different simulation environments. Insights into stress mechanisms may suggest improvements for the design of future training courses. This observational study explored participants’ stress experiences through semi-structured interviews and investigated their stress responses by measuring the heart rate variability, saliva cortisol levels, and trainees’ self-reported stress using a validated instrument. Participants performed advanced laparoscopic procedures on box-trainers and live animal models in operating room settings. Twelve experienced surgical trainees were included in the study. No differences were observed for physiological parameters between training activity on the box-trainer simulator and live animal models. In interviews, trainees reported experiencing higher stress levels during procedural training in operating room environment. The main themes related to elevated stress were realism and functional task alignment, perceived level of risk, and interpersonal dynamics in simulation environments. The trainees perceived the increased stress response levels as beneficial for their focus and for performing advanced procedures. In this study, no significant differences were identified in trainees’ physiological or self-reported stress responses across the two simulation settings. However, qualitative interview data revealed that trainees perceived greater stress when training with animal models in highly realistic operating room environments, suggesting the potential educational value of such immersive simulation environments.

Gender mainstreaming was chosen as a major strategy for the promotion of gender equality in the Beijing Platform for Action in 2002. This approach has been adopted in research policy in many countries, including Norway. We ask: Has the share of published research that includes sex and/or gender perspectives increased during the last decade in Norway? And, during the same period, has the female project manager share and female author share increased? We harvested all the research publications written in English or Norwegian, having at least one author with a Norwegian affiliation and being published in 2011 or later from the Norwegian research publication database and institutional academic repositories. The publications were filtered on a predefined lexicon using a keyword-in-context-analysis followed by manual filtering to identify publications with a sex and/or gender perspective. The resulting dataset of 4,548 publications was supplemented by a second dataset containing the funding status and gender composition of all the research project proposals submitted to the Research Council of Norway during the same period. No change is identified in the share of publications with a sex and/or gender perspective over the period. During the same period, we also find that the female project manager share and the female author share, are both unaltered. The applied theory suggests that high levels of ambiguity and conflict imply symbolic policy implementation. We conclude that attempts at instituting gender mainstreaming in research policy do not seem to have impacted the share of research with a sex and/or gender perspective in Norway.

BACKGROUND:Electronic Health Record (EHR) implementations significantly affect healthcare professionals' work routines. Previous Epic implementations in Scandinavian hospitals have led to negative outcomes, highlighting the need for a thorough evaluation of employee experiences. OBJECTIVE:To qualitatively explore hospital employees' experiences six months after Epic EHR implementation and assess implications for employee well-being and patient safety. METHODS:A qualitative study conducted at a Norwegian university hospital, six months post-implementation. Free-text responses from 950 employees (out of 2,115 survey respondents) were analyzed using reflexive thematic analysis within a phenomenological framework. Data were triangulated with focus group interviews and observational findings. RESULTS:Employees reported deep concerns and high emotional intensity post-implementation. Analysis revealed 13 themes, with usability being most prominent (n = 682 quotes). Participants described the system as cumbersome, inefficient, and counterintuitive. Other major themes included work strain and own health (n = 385), administration of medicine and patient safety (n = 201), and politics and hospital management (n = 184). Many employees experienced shifts in professional identity, with some expressing job abandonment intentions. CONCLUSIONS:Poorly executed EHR implementations hinder professional performance, compromise patient care, and amplify emotional distress. Addressing workflow barriers and setting realistic expectations is critical for improving adoption. Future implementations must integrate employee perspectives and evidence-based strategies to ensure EHR systems enhance rather than obstruct healthcare delivery.

Young adults not in education, employment, or training (NEET) represent a significant global issue, with varying challenges across different countries. Research indicates a strong association between NEET status and negative outcomes such as mental health difficulties, low self-esteem, and social exclusion, though the direction of causality is often complex and bidirectional. This scoping review aimed to provide a comprehensive mapping of international research on NEETs, including risk factors, characteristics, and effective interventions to inform future policy and practice. This scoping review was conducted following the Joanna Briggs Institute (JBI) framework, incorporating the PRISMA-ScR checklist. The review included six key stages: identifying the research question, identifying relevant studies, selecting studies, charting the data, collating, Summarizing, and reporting the results, and consultation. A systematic search was conducted in PubMed, Scopus, and Web of Science, covering literature from 2021 to April 2024. Eligibility criteria were established using the population-concept-context (PCC) framework. A total of 159 studies were included, classified into 11 topics. The review identified a diverse range of factors that influence the status of NEET, including individual, family, and systemic elements. Key determinants such as cognitive abilities, noncognitive skills, and socioeconomic background were highlighted. Psychological issues, including mental health problems and low self-esteem, were prevalent among NEETs. Social issues such as inequality, discrimination, and social exclusion were also significant. The review found that NEET status is associated with long-term socioeconomic disadvantages, including lower educational attainment, higher unemployment rates, and increased mental health risks. The effectiveness of the interventions varied, some showing positive outcomes in terms of employment and mental health, while others had limited impact. The NEET phenomenon is complex and requires a holistic approach that integrates the health, welfare and work life sectors. Effective interventions should be tailored to the specific needs of NEET individuals, considering their mental health, self-esteem, and social connections. Policymakers should focus on developing comprehensive support systems that address the diverse challenges faced by NEETs, ensuring sustainable transitions to education, employment, or training. More research is needed to explore the long-term effectiveness of various interventions and to identify best practices to support NEETs worldwide.

A more comprehensive understanding of the causal relationships between body mass index (BMI) and sick leave is needed. We aimed to examine the effect of BMI on the risk of cause-specific and all-cause long-term sick leave using an instrumental variable approach. The study included 21,918 adults participating in the two latest surveys of the population-based HUNT Study (HUNT3, 2006-2008 and HUNT4, 2017-2019) linked with registry data on cause-specific sick leave, including musculoskeletal and mental disorders. We used Cox regression to estimate risk of long-term sick leave per standard deviation (SD) increase in z-score of BMI, applying both conventional analysis of own BMI and instrumental variable analysis based on offspring BMI. In the conventional analyses, hazard ratios per SD increase in z-score of BMI ranged from 1.04 (95% confidence interval (CI) 0.99-1.08) for mental health disorders in women to 1.17 (95% CI 1.13-1.22) for musculoskeletal disorders in men. The instrumental variable approach supported that higher BMI increased the risk of long-term sick leave, except for sick leave due to mental health disorders in men. The analyses suggested that offspring BMI as an instrument is not independent of shared confounding. The results from both the conventional and instrumental variable analyses show that higher BMI increases the risk of long-term sick leave, except for sick leave due to mental health disorders in men. The instrumental variable method is likely to remove bias due to reverse causation, but residual bias due to shared confounding factors cannot be ruled out.

Introduction: The study reports the results from piloting an 8-step program for social skills training using VR technology in a municipal mental health service. Method: 14 mental health service users were recruited to test the 8-step programme. Eight mental health professionals delivered the programme and registered information about the participants and their experiences. Results: All participants lived socially isolated lives before they started, and various social and personal problems contributed to the complexity of their situation. Seven participants completed the programme, while seven did not. Two participants did not complete because they stopped isolating themselves before completing and these two, and the seven that completed the programme, experienced a positive effect on their social skills. Two of those who did not complete were able to attend group therapy sessions instead, and two were too ill to complete. The last one just stopped showing up to the appointments. Conclusion: The pilot study shows promising results and efforts should now be made to develop relevant, flexible, and high-quality VR scenarios, as this technology has the potential to help socially isolated persons become more socially active and thus increase their quality of life.

OBJECTIVE:The aim of this study was to assess how different groups of health professionals evaluated the usability of a new electronic health record (EHR) and to investigate the association between the usability and burnout, insomnia and turnover intention. METHODS:This cross-sectional study included 1424 health professionals who worked at a Norwegian University Hospital. The usability was measured with the System Usability Scale (SUS) 6 months after the previous electronic record was replaced with a more comprehensive, sector-wide, patient-centred EHR in 2022. RESULTS:The median SUS score was 25 (IQR 12.5-37.5) out of 100 and ranged from 15 (IQR 7.5-25.0) among medical doctors to 40 (IQR 27.6-55.0) among laboratory technicians. Nurses reported a score of 25 (IQR 12.5-40.0). In clinical contexts, the median SUS score ranged from 15 (IQR 10.0-30.0) within radiology to 27.5 (IQR 15.0-42.5) within internal medicine, whereas laboratory medicine reported a score of 37.5 (IQR 27.5-55.0). In multivariable analyses using health professionals in the highest quarter of the SUS as the reference, those in the lowest quarter were more likely to report burnout (OR 3.05, 95% CI 1.86 to 5.00), insomnia (OR 1.72, 95% CI 1.18 to 2.50) and turnover intention (OR 2.35, 95% CI 1.53 to 3.64). CONCLUSION:Most health professionals across all occupational groups and clinical contexts reported low usability of a new EHR 6 months after go-live. Those who reported the lowest usability were more likely to report burnout, insomnia and turnover intention.

Abstract Background Simulation-based training courses in laparoscopy have become a fundamental part of surgical training programs. Surgical skills in laparoscopy are challenging to master, and training in these skills induces stress responses in trainees. There is limited data on trainees’ stress levels, the stress responses related to training on different laparoscopic simulators, and how previous experiences influence trainees’ stress response during a course. This study investigates physiologic, endocrine and self-reported stress responses during simulation-based surgical skills training in a course setting. Methods We conducted a prospective observational study of trainees attending basic laparoscopic skills training courses at a national training centre. During the three-day course, participants trained on different laparoscopic simulators: Two box-trainers (the D-box and P.O.P. trainer) and a virtual reality simulator (LAPMentor™). Participants’ stress responses were examined through heart rate variability (HRV), saliva cortisol, and the State Trait Anxiety Inventory-6 (STAI-6). The correlation between previous laparoscopic experiences and stress response measurements was explored. Results Twenty-four surgical trainees were included in the study. Compared to resting conditions, stress measures were significantly higher during simulation-training activity (the D-box (SDNN = 58.5 ± 23.4; LF/HF-ratio = 4.58 ± 2.71; STAI-6 = 12.3 ± 3.9, P < 0.05), the P.O.P trainer (SDNN = 55.7 ± 7.4; RMSSD = 32.4 ± 17.1; STAI-6 = 12.1 ± 3.9, P < 0.05), and the LAPMentor™ (SDNN = 59.1 ± 18.5; RMSSD = 34.3 ± 19.7; LF/HF-ratio = 4.71 ± 2.64; STAI-6 = 9.9 ± 3.0, P < 0.05)). A significant difference in endocrine stress response was seen for the simulation-training activity on the D-box (saliva cortisol: 3.48 ± 1.92, P < 0.05), however, no significant differences were observed between the three simulators. A moderate correlation between surgical experience, and physiologic and endocrine stress response was observed (RMSSD: r=-0.31; SDNN: r=-0.42; SD2/SD1 ratio: r = 0.29; Saliva cortisol: r = 0.46; P < 0.05), and a negative moderate correlation to self-reported stress (r=-0.42, P < 0.05). Conclusion Trainees have a significant higher stress response during simulation-training compared to resting conditions, with no difference in stress response between the simulators. Significantly higher cortisol levels were observed on the D-box, indicating that simulation tasks with time pressure stress participants the most. Trainees with more surgical experience are associated with higher physiologic stress measures, but lower self-reported stress scores, demonstrating that surgical experience influences trainees’ stress response during simulation-based skills training courses.

Municipal home-healthcare services are becoming increasingly important as growing numbers of people are receiving healthcare services in their home. The COVID-19 pandemic represented a challenge for this group, both in terms of care providers being restricted in performing their duties and care receivers declining services for fear of being infected. Furthermore, preparedness plans were not always in place. The purpose of this study is to investigate the consequences for recipients of home healthcare in Norway of the actual level of COVID-19 infection spread in the local population, as observed by licensed nurses working in home-healthcare services. Approximately 2100 nurses answered the survey. The most common adverse consequences for home-healthcare recipients were increased isolation and loneliness, increased health concerns, and the loss of respite care services. An increased burden for relatives/next of kin and fewer physical meetings with service providers were frequently observed and reported as well. This study shows that there were more adverse consequences for service users in municipalities with higher levels of contagion than in those with lower levels of contagion. This indicates that the municipalities adapted measures to the local rate of contagion, in line with local municipal preparedness strategies.

To determine changes to people’s social contact during COVID-19, and whether reduced social contact was associated with changes to psychosocial wellbeing. Questionnaire data were collected from a sample of adult respondents (18 years or more) in two Norwegian counties participating pre-COVID-19 (September 2019–February 2020; n = 20,196) and at two time points during COVID-19 (June [Mid] and November/December [Late] 2020; n = 11,953 and n = 10,968, respectively). The main outcome measures were participants' self-reported changes to social contact, loneliness, psychological distress, and life satisfaction. The proportion of respondents reporting less social contact due to COVID-19 decreased from 62% in Mid-2020 to 55% in Late-2020. Overall, reported psychological wellbeing remained unchanged or improved from pre-COVID-19 to Mid-2020. From Mid-2020 to Late-2020, however, a reduction in psychological wellbeing was observed. Poorer psychological wellbeing was found for those with less social contact during the pandemic compared with people reporting unchanged social contact. This effect increased over time and was observed for all age groups at Late-2020. At Mid-2020, the importance of change in social contact for change in psychological wellbeing was greatest among young adults (< 30 years), while no significant differences were found for the oldest age group. The association between COVID-19-era changes to social contact and loneliness, psychological distress, and life satisfaction is complex and appears to be age-dependent. Future studies should consider the quality of social contact and cultural contexts in which social restrictions are imposed.

Siden opptrappingsplanen for psykisk helse (1999–2008) har forskere i Sintef på oppdrag fra Helsedirektoratet fulgt kommunenes arbeid med psykisk helse, og fra 2015 ble også kommunalt rusarbeid inkludert i den årlige kartleggingen (IS-24/8) i alle landets kommuner. De siste åtte årene (2015–2022) har kommunenes arbeid med selvmord, overdoser og selvskading vært tema i de årlige datainnsamlingene, og i denne artikkelen presenteres resultatene. Temaene inkluderer blant annet om tjenestene har etablert skriftlige rutiner for håndtering av ulike situasjoner, hvordan de involveres etter selvmordsforsøk, bruk av veiledende materiell som er utviklet for kommunene, ivaretagelse av pårørende og om de gjennomfører kompetansehevende tiltak innen selvmordsforebygging. Resultatene viser at noen kommuner har kommet langt, mens andre har en lengre vei å gå for å få på plass planer, rutiner og prosedyrer. Kommunene må først og fremst øke kompetansen blant de ansatte på disse temaene, og forbedre samarbeidet med spesialisthelsetjenestene. Selv om fagpersoner oppgir knapphet på ressurser som hovedutfordring, er det i dagens arbeidsmarked vanskelig å se at kommunene skal få mange flere ansatte i årene fremover. Dermed blir det viktig å få til god organisering av tjenestene og etablere gode sammensetninger av tverrfaglige team og utnytte fagkompetansen som finnes i kommunene på tvers av tjenestene. Det er en stor oppgave for kommunene å skulle styrke forebyggingsarbeidet samtidig som de ivaretar og følger opp mennesker med alvorlige og kroniske psykiske lidelser og/eller rusproblemer med store tjenestebehov.

IntroductionPeople with severe mental illness often have a small or no network of friends and limited contact with their family and live social isolated lives. We developed a social skills training programme to be administered by public mental health professionals in helping those with mental illness to overcome their social isolation.MethodsThe programme was developed over 3 years in close collaboration among psychologists, service users, municipal mental health professionals, mental health service researchers and a local firm providing virtual reality (VR) training. We started with the simplest available equipment, that is, a cardboard headset combined with a smartphone, then we used Oculus Quest and now Oculus Quest 2.ResultsThe resulting programme is comprised of eight steps from: 1) identify service user's primary and secondary goals to 8) three-month follow-up.ConclusionSeveral factors made adoption and implementation of VR technology possible in a relatively short timeframe: namely, the municipality and service users were involved from the beginning of the development process, efforts were made to introduce VR to mental health professionals and allow them to reflect on its usability, solutions were low-tech and low cost, and the long-term research collaboration was established without municipal financial obligations.

BACKGROUND:Identifying occupational health hazards among Registered Nurses (RNs) and other health personnel and implementing effective preventive measures are crucial to the long-term sustainability of health services. The objectives of this study were (1) to assess the 12-month prevalence rates of exposure to workplace aggression, including physical violence, threats of violence, sexual harassment, and bullying; (2) to identify whether the perpetrators were colleagues, managers, subordinates, or patients and their relatives; (3) to determine whether previous exposure to these hazards was associated with RNs' current turnover intention; and (4) to frame workplace aggression from an occupational health and safety perspective.METHODS:The third version of the Copenhagen Psychosocial Questionnaire (COPSOQ III) was used to assess RNs' exposure to workplace aggression and turnover intention. A national sample of 8,800 RNs in Norway, representative of the entire population of registered nurses in terms of gender and geography, was analysed. Binary and ordinal logistic regression analyses were conducted, and odds for exposure and intention to leave are presented, with and without controls for RNs' gender, age, and the type of health service they work in.RESULTS:The 12-month prevalence rates for exposure were 17.0% for physical violence, 32.5% for threats of violence, 12.6% for sexual harassment, and 10.5% for bullying. In total, 42.6% of the RNs had experienced at least one of these types of exposure during the past 12 months, and exposure to more than one of these hazards was common. Most perpetrators who committed physical acts and sexual harassment were patients, while bullying was usually committed by colleagues. There was a strong statistical association between exposure to all types of workplace aggression and RNs' intention to leave. The strongest association was for bullying, which greatly increased the odds of looking for work elsewhere.CONCLUSIONS:Efforts to prevent exposure to workplace aggression should be emphasised to retain health personnel and to secure the supply of skilled healthcare workers. The results indicate a need for improvements. To ensure the sustainability of health services, labour and health authorities should join forces to develop effective workplace measures to strengthen prevention, mitigation, and preparedness regarding incidents of workplace aggression in health services and the response and recovery regarding incidents that could not be prevented.

BACKGROUND:Employers are legally obligated to ensure the safety and health of employees, including the organizational and psychosocial working environment. The Copenhagen Psychosocial Questionnaire (COPSOQ III) covers multiple dimensions of the work environment. COPSOQ III has three parts: a) work environment b) conflicts and offensive behaviours and c) health and welfare. We translated all three parts into Norwegian and evaluated the statistical properties of the 28 work environment dimensions in part a), using a sample of registered nurses.METHODS:The original English version was translated into Norwegian and back translated into English; the two versions were compared, and adjustments made. In total, 86 of 99 items from the translated version were included in a survey to which 8804 registered nurses responded. Item response theory models designed for ordinal manifest variables were used to evaluate construct validity and identify potential redundant items. A standard confirmatory factor analysis was performed to verify the latent dimensionality established in the original version, and a more exploratory factor analysis without restrictions is included to determine dependency between items and to identify separable dimensions.RESULTS:The measure of sampling adequacy shows that the data are well suited for factor analyses. The latent dimensionality in the original version is confirmed in the Norwegian translated version and the scale reliability is high for all dimensions except 'Demands for Hiding Emotions'. In this homogenous sample, eight of the 28 dimensions are found not to be separate dimensions as items covering these dimensions loaded onto the same factor. Moreover, little information is provided at the low and high ends of exposure for some dimensions in this sample. Of the 86 items included, 14 are found to be potential candidates for removal to obtain a shorter Norwegian version.CONCLUSION:The established Norwegian translation of COPSOQ III can be used in further research about working environment factors and health and wellbeing in Norway. The extended use of the instrument internationally enables comparative studies, which can increase the knowledge and understanding of similarities and differences between labour markets in different countries. This first validation study shows that the Norwegian version has strong statistical properties like the original, and can be used to assess work environment factors, including relational and emotional risk factors and resources available at the workplace.

IntroductionStress can affect the ability to acquire technical skills. Simulation-based training (SBT) courses allow surgical trainees to train their technical skills away from stressful clinical environments. Trainees' subjective experiences of stress during SBT courses on laparoscopic surgery remains understudied. Here, we explored the subjective stress experiences of surgical trainees during mandatory laparoscopic SBT courses. We aimed to obtain a broader understanding of which factors of the simulation training the trainees perceived as eliciting stress.MethodsA qualitative study with semistructured individual interviews was undertaken to explore trainees' subjective experiences of stress. Twenty surgical trainees participated while attending courses at a national training center for advanced laparoscopic surgery. Questions explored trainees' stress experiences during the SBT courses with a focus on perceived stressors related to laparoscopic simulation training on two box-trainers and one virtual reality simulator. Interview data were analyzed using inductive, qualitative content analysis methods to identify codes, categories, and themes.ResultsFindings indicated that trainees have a variety of stress experiences during laparoscopic SBT. Three main themes were identified to be related to stress experiences: simulation task requirements, psychomotor skill levels and internal pressures, with subcategories such as task difficulty and time requirements, unrealistic haptic feedback and realism of graphics, inconsistent and poor technical performance, and self-imposed pressures and socio-evaluative threats.ConclusionsInsights into surgical trainees' experience of stress during laparoscopic SBT courses showed that some stress experiences were directly related to simulation training, while others were of psychological nature. The technical and efficiency requirements of simulation tasks elicited stress experiences among trainees with less laparoscopic experience and lower levels of psychomotor skills. Self-imposed pressures played an integral part in how trainees mobilized and performed during the courses, suggesting that levels of stress might enhance laparoscopic simulation performance. For course facilitators aiming at optimizing future laparoscopic SBT courses, attending to the realism, providing clarity about learning objectives, and having awareness of individual differences among trainees' technical level when designing the simulation tasks, would be beneficial. Equally important to the laparoscopic SBT is to create a psychological safe learning space in order to reduce the internal pressures of trainees.

The Covid-19 pandemic has revealed the importance of social protection systems, including income security, when health problems arise. The aims of this study are to compare the follow-up regimes for sick-listed employees across nine European countries, and to conduct a qualitative assessment of the differences with respect to burden and responsibility sharing between the social protection system, employers and employees. The tendency highlighted is that countries with shorter employer periods of sick-pay typically have stricter follow-up responsibility for employers because, in practice, they become gatekeepers of the public sickness benefit scheme. In Germany and the UK, employers have few requirements for follow-up compared with the Nordic countries because they bear most of the costs of sickness absence themselves. The same applies in Iceland, where employers carry most of the costs and have no obligation to follow up sick-listed employees. The situation in the Netherlands is paradoxical: employers have strict obligations in the follow-up regime even though they cover all the costs of the sick-leave themselves. During the pandemic, the majority of countries have adjusted their sick-pay system and increased coverage to reduce the risk of spreading Covid-19 because employees are going to work sick or when they should self-quarantine, except for the Netherlands and Belgium, which considered that the current schemes were already sufficient to reduce that risk.

Abstract Background The COVID-19 pandemic has revealed the importance of social protection systems including income security when health problems arise. Particularly the protection of those with precarious work felt short in some countries. For some time there has been an interest in the European variation in sick-pay schemes but still we still lack knowledge on country differences and similarities. This is particularly the case regarding precarious workers, while they have higher chances for sickness absence. Our aim is to understand, in the context of precarious work, the differences in risk sharing of sickness absence between employer, worker and social insurance. Methods Data had been collected in a study on sickness absence follow-up regimes in nine countries (the Nordic countries (Sweden, Denmark, Finland, Norway and Iceland) and in Germany, the Netherlands, Belgium and the UK). Comparative statistics were collected and scholars familiar with their countries system were invited to answer a list of 51 questions on system characteristics. Data were re-analysed from the perspective of precarious work, using actor-network theory and insider-outsider theory of employment. Results Countries with shorter employer periods of sick pay have stricter follow-up responsibility for employers as they are regarded gatekeeper except for The Netherlands. The tax-based systems that target all citizens offer more protection for precarious workers while the employee-focused systems define their target population more strictly, leaving precarious workers underserved. There is a large difference in how self-employed are supported or not. Conclusions Despite small economic differences in the nine countries studied, the systems for dealing with sickness absence in the context of precarious work vary largely. Even though, in all systems those with secure jobs seem insiders and those with precarious work outsiders. Social protection systems should be updated to avoid an increasing inequality. Speakers/Panellists Anita Tisch Working time and Organization, Federal Institute for Occupational Safety and Health, Dortmund, Germany Angelique De Rijk Department of Social Medicine, Maastricht University, Maastricht, Netherlands

Background: Although sick leave is a complex phenomenon, it is believed that there is potential for prevention at the workplace. However, little is known about this potential and what specific measures should be implemented. The purpose of the study was to identify perceived reasons to take work-related sick leave and to suggest preventive measures. The study was completed before the COVID-19 pandemic emerged, and the risk factors identified may have been amplified during the pandemic. Methods: An in-depth cross-sectional survey was conducted across a randomly selected sample of hospital nurses in Norway. The national sample comprised 1,297 nurses who participated in a survey about their sick leave during the previous 6 months. An open-ended question about perceived reasons for work-related sick leave was included to gather qualitative information. Results: Among hospital nurses, 27% of the last occurring sick leave incidents were perceived to be work-related. The most common reasons were high physical workload, high work pace, sleep problems, catching a viral or bacterial infection from patients or colleagues, and low staffing. Conclusions: Over a quarter of the last occurring sick leave incidents among Norwegian hospital nurses are potentially preventable. To retain and optimize scarce hospital nursing resources, strategies to reduce work-related sick leave may provide human and financial benefits. Preventive measures may include careful monitoring of nurses’ workload and pace, optimizing work schedules to reduce the risk of sleep problems, and increasing staffing to prevent stress and work overload.

BACKGROUND:Suicidal ideation may signal potential risk for future suicidal behaviors and death. We examined the prevalence of recent suicidal ideation in patients with mental illness and concurrent substance use and explored the clinical and sociodemographic factors associated with suicidal ideation in this patient subgroup, which represents a particular risk group for adverse psychiatric outcomes.METHODS:We used national cross-sectional census data in Norway collected from 25,525 patients in specialized mental health services. The analytic sample comprised 3,842 patients with concurrent substance use, defined as having a co-morbid substance use disorder or who reported recent regular alcohol use/occasional illicit drug use. Data included suicidal ideation measured in relation to the current treatment episode, sociodemographic characteristics and ICD-10 diagnoses. Bivariate and multivariate analyses were used to examine differential characteristics between patients with and without suicidal ideation.RESULTS:The prevalence of suicidal ideation was 25.8%. The suicidal ideation rates were particularly high for those with personality disorders, posttraumatic stress disorder, and depression, and for alcohol and sedatives compared with other substances. Patients with suicidal ideation were characterized by being younger, having single marital status, and having poorly perceived social relationships with family and friends.CONCLUSION:Suicidal ideation in patients with mental illness and concurrent substance use was associated with a number of distinct characteristics. These results might help contribute to an increased focus on a subgroup of individuals at particular risk for suicidality and support suicide prevention efforts in specialized mental health services.

INTRODUCTION:Low back pain (LBP) and neck pain (NP) are common and costly conditions. Self-management is a key element in the care of persistent LBP and NP. Artificial intelligence can be used to support and tailor self-management interventions, but their effectiveness needs to be ascertained. The aims of this trial are (1) to evaluate the effectiveness of an individually tailored app-based self-management intervention (selfBACK) adjunct to usual care in people with LBP and/or NP in secondary care compared with usual care only, and (2) to compare the effectiveness of selfBACK with a web-based self-management intervention without individual tailoring (e-Help).METHODS AND ANALYSIS:This is a randomised, assessor-blind clinical trial with three parallel arms: (1) selfBACK app adjunct to usual care; (2) e-Help website adjunct to usual care and (3) usual care only. Patients referred to St Olavs Hospital, Trondheim (Norway) with LBP and/or NP and accepted for assessment/treatment at the multidisciplinary outpatient clinic for back or neck rehabilitation are invited to the study. Eligible and consenting participants are randomised to one of the three arms with equal allocation ratio. We aim to include 279 participants (93 in each arm). Outcome variables are assessed at baseline (before randomisation) and at 6-week, 3-month and 6-month follow-up. The primary outcome is musculoskeletal health measured by the Musculoskeletal Health Questionnaire at 3 months. A mixed-methods process evaluation will document patients' and clinicians' experiences with the interventions. A health economic evaluation will estimate the cost-effectiveness of both interventions' adjunct to usual care.ETHICS AND DISSEMINATION:The trial is approved by the Regional Committee for Medical and Health Research Ethics in Central Norway (Ref. 2019/64084). The results of the trial will be published in peer-review journals and presentations at national and international conferences relevant to this topic.TRIAL REGISTRATION NUMBER:NCT04463043.