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| 43. |
- Aas, Randi Wågö
(författare)
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Workplace-based sick leave prevention and return to work : exploratory studies
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Earlier research have revealed risk factors for sick leave in the workplace, and thus the workplace has become an important arena for sick leave prevention and return to work (RTW). Despite that, some of these aspects have received little attention in exploratory studies. Simultaneously, there is a need to translate and implement the growing knowledge base in this field in order to develop evidence-based practice (EBP). Aim: The aim of the present research was to explore some aspects of workplace-based sick leave prevention and RTW, such as workplace interventions (studies III, IV, and the appendix), leadership qualities (study I), and work demands (study II), and also to reveal challenges to translating scientific knowledge into intervention decisions in the RTW process, and possible solutions to these challenges (study III). Methods: Content analysis methods were applied on data from interview transcripts and documents. In addition, a Cochrane systematic review of the literature was conducted. Results: Study I identified 78 distinct leadership qualities and seven leadership types (n = 345 meaning units) perceived by 30 employees on long-term sick leave and their immediate supervisors. The three most valued leadership qualities were “ability to make contact”, “being considerate”, and “being understanding”. The three most valued leadership types were the Protector, the Problem-Solver, and the Contact-Maker. The subordinates gave more descriptions of the Encourager and the Recognizer, whereas the supervisors most often described the Responsibility-Maker and the Problem-Solver. The combination of leadership types reported most frequently was the Protector together with the Problem-Solver. In study II, eight employees on long-term sick leave due to musculoskeletal diseases and disorders described 51 work demands they had experienced. The demands were perceived in some cases as having only a negative or a positive impact on work performance, but in others as both. Only seven of the demands were physical in nature, and most involved emotional and cognitive challenges in mastering the work tasks. It was also experienced that most demands came from the employee (n = 36) and only a few from the employer/work environment (n = 7) or both those sources (n = 8). Study III was a hypothetical case study aimed at revealing the challenges associated with translating scientific evidence into intervention decisions in the RTW process. This investigation was performed according to EBP frameworks. The evidence seemed to differ depending on whether it came from preventive, curative, or rehabilitative interventions. Moreover, it appeared that evidence in some cases originated from “good-for-all” interventions but in others from “tailored-type” interventions. Thus, a need to differentiate the roles of evidence was revealed in terms of whether it inspired, challenged, enlightened, informed, or determined the intervention decision. In general, the evidence-based framework seemed to construct a confined decision process. Possible solutions, and revised EBP steps were suggested. In study IV, 15 workplace interventions were identified (n = 306 meaning units), which were intended to reduce sick leave rates in 12 municipalities. The interventions were divided into two groups according to their targets in the organizations: nine organizational-workplace interventions targeted structures, processes, and culture (n = 220 descriptions, 72%); six employee-workplace interventions targeted persons (n = 86 descriptions, 28%). Examples of organizational-workplace interventions were developing routines/systems, establishing cooperation/ collaboration, providing information/education, building culture/anchoring, and recruiting/staffing. Employee-workplace interventions involved well-being/lifestyle interventions, physical activity/exercise, redeployment, adaptation, follow-up of employees on sick leave, and RTW programmes. The intervention profiles varied considerably between the municipalities. In the appendix (study V), a Cochrane systematic review of the literature was conducted to reveal the content and effectiveness of workplace interventions for employees with neck pain. Of 1,995 references found, 10 randomized controlled trials (RCTs) were included. Two of the RCTs had low risk of bias, and eight of them examined office workers. Few were on sick leave. Only three of the ten studies assessed the outcome of sick leave. The workplace interventions varied considerably regarding complexity and content. Overall, evidence was of low quality and showed no significant impact of workplace interventions on pain reduction (seven RCTs, 2,368 workers). Furthermore, one RCT, with 415 workers revealed that workplace interventions were significantly more effective in reducing sick leave in the intermediate term (OR 0.56, 95% CI 0.33–0.95), but not in the short or the long term. Conclusions: The results reported in this thesis revealed a variety of terminology related to workplace interventions, leadership qualities, and work demands, which might contribute to more in-depth understanding of sick leave prevention and RTW at workplaces. It was a challenge to trying to use evidence from randomized controlled trials in the RTW process, and the results call for new EBP approaches to translate evidence into decisions concerning complex workplace interventions. The current research also revealed that knowledge about the effectiveness of workplace interventions is still limited.
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| 45. |
- Aasa, Mikael, et al.
(författare)
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Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction-Results of the Swedish Early Decision reperfusion Study (SWEDES) trial.
- 2010
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Ingår i: American heart journal. - : Elsevier BV. - 1097-6744 .- 0002-8703. ; 160:2, s. 322-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. METHODS: Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. RESULTS: Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be <$0, $50,000, and $100,000 respectively. CONCLUSION: In a 1-year perspective, there was a tendency toward lower costs and better health outcome after primary PCI, resulting in costs for PCI in comparison to thrombolysis that will be below the conventional threshold for cost-effectiveness in 88% of bootstrap replications.
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| 46. |
- Aasa, Mikael
(författare)
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Reperfusion therapy in acute ST-elevation myocardial infarction : a comparison between primary percutaneous intervention and thrombolysis in a short- and long-term perspective
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Approximately 35,000 people suffer from a heart attack in Sweden annually. Among them, approximately 8000 are diagnosed with a ST-elevation myocardial infarction (STEMI) where timely reperfusion has been shown to save lives. Previous studies that have compared the existing reperfusion strategies, thrombolysis (TL) and primary PCI (PPCI), made use of treatment regimens that since have been improved with the use of mechanical and medical adjunctives. The objective of this thesis was to compare both of these strategies employing updated regimens in accordance to current guidelines with respect to; 1) efficacy in restoring blood flow and myocardial perfusion, 2) clinical outcome and 3) cost-effectiveness. Methods and results: Between November 2001 and May 2003, 205 patients with STEMI were randomized to PPCI with adjunctive abciximab or TL. The low molecular weight heparin enoxaparin was used as anticoagulant in both groups. In 42% treatment was initiated in the pre-hospital phase. The primary end points were the rate of STsegment resolution (STRES) ≥ 50% 120 minutes after inclusion and the rate of normalized (TIMI 3) flow in the infarct related vessel 5-7 days after treatment, serving as surrogates for a beneficial outcome. Secondary end points were the ability to restore myocardial perfusion evaluated angiographically by TIMI Myocardial Perfusion Grade (TMPG) 5-7 days after inclusion in the study, clinical events at 30 days and one year cost-effectiveness. The patients were followed prospectively for one year and, in addition, information on survival status and major clinical events was collected from national registries for an extended follow up period of a median of 5.3 years. STRES≥ 50% was achieved in 68% following PPCI and 64% after TL (n.s.). However, the TIMI 3 rate was higher after PPCI compared to TL (71% vs. 54%, p=0.04). TMPG tended to be better in the PPCI group than in the TL group. An analysis of the evolution of TMPG in the PPCI cohort revealed that there was a significant improvement of myocardial perfusion in the week following PPCI. Thirty day mortality rates were low and similar in the groups. At one year PPCI was tended to be less costly ($-2,505) than TL ($-2,505; n.s.), mainly due to higher costs for re-hospitalizations in the TL group. Primary PCI also lead to an insignificant gain in quality-adjusted survival (0.031 QALYs). A bootstrap analysis indicated that PPCI has a high probability of being cost-effective when a threshold value of $50,000 is employed. A survival analysis at 5.3 years showed a significant benefit from PPCI in terms of the combination of all-cause death and recurrent infarction (p=0.03) as well as for cardiac mortality alone (p=0.02). Conclusion: Primary PCI is more efficient than thrombolysis in re-establishing antegrade flow in the infarct- related artery and offers a better long term clinical outcome with respect to major cardiac events without an increase in societal costs. Thus, based on the conditions under which this study was performed, primary PCI is a more efficient alternative than thrombolysis for the treatment of ST-elevation myocardial infarction.
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| 47. |
- Aasa, Mikael, et al.
(författare)
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Risk Reduction for Cardiac Events After Primary Coronary Intervention Compared With Thrombolysis for Acute ST-Elevation Myocardial Infarction (Five-Year Results of the Swedish Early Decision Reperfusion Strategy [SWEDES] Trial).
- 2010
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Ingår i: The American journal of cardiology. - : Elsevier BV. - 1879-1913 .- 0002-9149. ; 106:12, s. 1685-91
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Tidskriftsartikel (refereegranskat)abstract
- Primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction compares favorably to thrombolysis. In previous studies the benefit has been restricted to the early postinfarction period with no additional risk decrease beyond this period. Long-term outcome after use of third-generation thrombolytics and modern adjunctive pharmaceutics in the 2 treatment arms has not been investigated. This study was conducted to compare 5-year outcome after updated regimens of PPCI or thrombolysis. Patients with ST-elevation myocardial infarction were randomized to enoxaparin and abciximab followed by PPCI (n = 101) or enoxaparin followed by reteplase (n = 104), with prehospital initiation of therapy in 42% of patients. Data on survival and major cardiac events were obtained from Swedish national registries after 5.3 years. PPCI resulted in a better outcome with respect to the composite of death or recurrent myocardial infarction (hazard ratio 0.54, confidence interval 0.31 to 0.95) compared to thrombolysis. This was attributed to a significant decrease in cardiac deaths (hazard ratio 0.16, confidence interval 0.04 to 0.74). The difference evolved continuously over the 5-year follow-up. After adjustment for covariates, a significant benefit remained with respect to cardiac death or recurrent infarction but not for the composite of total survival or recurrent myocardial infarction (p = 0.07). The observed differences were not seen in patients in whom therapy was initiated in the prehospital phase. In conclusion, PPCI in combination with enoxaparin and abciximab compares favorably to thrombolysis in combination with enoxaparin with a risk decrease that stretches beyond the early postinfarction period. Prehospital thrombolysis may, however, match PPCI in long-term outcome.
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| 48. |
- Aasheim, V, et al.
(författare)
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Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum
- 2012
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley. - 1470-0328 .- 1471-0528. ; 119:9, s. 1108-16
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Tidskriftsartikel (refereegranskat)abstract
- Please cite this paper as: Aasheim V, Waldenström U, Hjelmstedt A, Rasmussen S, Pettersson H, Schytt E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012;119:1108-1116. Objective To investigate if advanced maternal age at first birth increases the risk of psychological distress during pregnancy at 17 and 30 weeks of gestation and at 6 and 18 months after birth. Design National cohort study. Setting Norway. Sample A total of 19 291 nulliparous women recruited between 1999 and 2008 from hospitals and maternity units. Methods Questionnaire data were obtained from the longitudinal Norwegian Mother and Child Cohort Study, and register data from the national Medical Birth Register. Advanced maternal age was defined as ≥32 years and a reference group of women aged 25-31 years was used for comparisons. The distribution of psychological distress from 20 to ≥40 years was investigated, and the prevalence of psychological distress at the four time-points was estimated. Logistic regression analyses based on generalised estimation equations were used to investigate associations between advanced maternal age and psychological distress. Main outcome measures Psychological distress measured by SCL-5. Results Women of advanced age had slightly higher scores of psychological distress over the period than the reference group, also after controlling for obstetric and infant variables. The youngest women had the highest scores. A history of depression increased the risk of distress in all women. With no history of depression, women of advanced age were not at higher risk. Changes over time were similar between groups and lowest at 6 months. Conclusion Women of 32 years and beyond had slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood compared with women aged 25-31 years.
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| 49. |
- Aasheim, Vigdis
(författare)
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Becoming a mother at an advanced age : pregnancy, outcomes, psychological distress, experience of childbirth and satisfaction with life
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objectives of this thesis were to investigate adverse pregnancy outcomes, and pregnancy and psychological experiences in women who become mothers in the later phase of the reproductive period. The age of first-time mothers has increased in most high-income countries in recent decades. Research into the postponement of childbirth phenomenon has predominantly focused on pregnancy and infant outcomes, and only to a lesser degree on psychological aspects of postponement. Study I is a population-based register study including 955 804 primiparous women from the Swedish and Norwegian Medical Birth Registers who gave birth between 1990-2010. It investigates the risk for preterm birth, infants small for gestation age, low Apgar score, stillbirth and neonatal death in women aged 30-34 years, 35-39 years and ≥40 years compared with women aged 25-29 years. Study I also compares risks associated with advanced maternal age with those associated with smoking and being overweight or obese. The adjusted Odds Ratios (aOR) of all outcomes increased with maternal age in a similar way in Sweden and Norway and the risk of fetal death already at age 30-35 years (Sweden OR 1.24; 95% CI 1.13-1.37, Norway aOR 1.26; 95% CI 1.12-1.41). The Swedish data showed that a maternal age of ≥30 years was associated with the same number of additional cases of fetal deaths as being overweight/obesity (251) and a larger number than smoking (67) compared with normal weight, nonsmokers aged 25-29 years, and estimated over the entire time period. Studies II-IV are longitudinal prospective population-based cohort studies based on data from the National Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health. Study II investigated psychological distress in 19 291nulliparous women from mid pregnancy to 18 months after the birth, comparing women of ≥32 years with those of 25-31 years. It was found that women in the oldest group had a slightly increased risk of psychological distress during pregnancy and the first 18 months of motherhood. Study III investigated 30 065 women’s experience of childbirth at six months postpartum in relation to antenatal expectations, using the same age categories as in Study II. The oldest women had a marginally higher risk of experiencing childbirth as worse than expected. Older women seemed to manage better than younger women when having an operative delivery. Study IV investigated 18 565 women’s satisfaction with life during pregnancy and the first three years of motherhood, comparing women of 32-37 years and ≥38 years respectively with the same reference groups as above. Women in the two oldest age groups reported a slightly lower degree of satisfaction with life, and the age effect was greatest three years after the birth. In conclusion, this thesis shows that the postponement of childbirth in high-income countries may increase the risk of adverse pregnancy outcomes at an earlier age than has previously been reported, and that it may have marginal negative effects on women’s emotional wellbeing and satisfaction with life. These findings should be included when giving reproductive health information to young people.
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