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Abstract Book of 2nd NOVO Symposium: Sustainable Nordic Health Care Systems, 3. - 4.12.2008 Espoo, Finland
- 2008
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Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- Preface The Nordic Council of Ministers has since year 2007 granted establishment and development of a Nordic Network for scientists “NOVO-nätverket” (NOrdisk FoU-nätverk inom Vård och Omsorg) regarding research on work environment and efficiency in the health care sector. An additional aim of the network is to communicate with and to practitioners within the field regarding recent research advances with practical implications. The vision of the NOVO network is a “Nordic Model for sustainable systems” in the health care sector. One of the aims of the NOVO-network is to organise a yearly symposium to expose and discuss present and planned research within the field. During the year 2008 dialog meetings with practitioners within the health care sector have been organised in Denmark, Norway and Sweden. The aim was to collect information from the end users of our research regarding their needs of knowledge in their strive towards development of “sustainable production systems”. The conclusions from these meetings will be presented at the meeting to create a basis for discussions on how to match our research with the needs of the practitioners. In addition, two key-note speakers will contribute by summing up “state-of-art”. Professor Paul Lillrank presents an overview on “Productivity in Health Care and the work environment” and Dr Harriet Finne-Soveri’s presents an overview on “Care quality and work environment through standardised assessments”. Finally, we have managed to get a good and strong sample of ongoing research in the Nordic countries within the field covered by the NOVO network. The symposium is conducted with the financial assistance of the Nordic Council of Ministers. We want to thank Tuire Westerholm for her professional assistance in the preparation of the symposium.
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| 4. |
- Bao, Shihan, et al.
(författare)
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Ergonomic effects of a management-based rationalization in assembly work — a case study
- 1996
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Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870 .- 1872-9126. ; 27:2, s. 89-99
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Tidskriftsartikel (refereegranskat)abstract
- Due to unsatisfactory productivity, a large company in the Swedish manufacturing industry decided to rationalize their assembly system. The intended rationalization comprised several changes with deliberate ergonomic implications. The main aim of the present study was to evaluate the impact of the rationalization on the physical work load of the operators. The work load was assessed before and after the changes using expert observations, company records and direct technical measurements. The results indicate that the intervention led to only minor changes in muscle load, body postures and movement patterns. Several of the planned initiatives were never implemented, e.g. teaching the workers multiple skills and designing work stations at which a major part of the assembly sequence could be performed. This was mainly due to a policy revision caused by changes in the market situation. In spite of the company's original intentions, the revised production system contained only minor ergonomic improvements. Thus, the realization of the ergonomic potential in a rationalization seems to depend on management culture, as well as factors outside the company.
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| 5. |
- Bao, Shihan, et al.
(författare)
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Interactive effect of ergonomics and production engineering on shoulder-neck exposure — A case study of assembly work in China and Sweden
- 1997
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Ingår i: International Journal of Industrial Ergonomics. - 0169-8141 .- 1872-8219. ; 20:1, s. 75-85
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Tidskriftsartikel (refereegranskat)abstract
- Ergonomic improvements of work station design have been widely embraced as a measure for reduction of physical work load (mechanical exposure) and prevention or control of occupational shoulder-neck disorders. However, other elements of work rationalization, more in the hands of production engineers, may also influence the mechanical exposure. The present study concerns shoulder-neck exposure in a Chinese and a Swedish assembly line workplace. Interactive effects of ergonomic work station design, and production engineering (in terms of assembly line balancing and sensitivity of assembly line layout to production irregularities) on shoulder-neck exposure have been studied. It was shown that the Swedish workplace has a better ergonomic work station design, reflected in more favorable work postures during assembly operations. At the same time, the Swedish assembly line is better balanced and less sensitive to production irregularities, which probably reduces the total duration of idle time during assembly compared with the Chinese line. On the Swedish assembly line, arm movements are more frequent, and trapezius and infraspinatus muscle activation is more repetitive. Muscle activation levels are similar on the two lines. However, a larger proportion of low level muscle activities were found on the Chinese line compared with the Swedish line. On the basis of these results, it is suggested that the mechanical exposure of the assembly workers is a result of counteracting effects of improved ergonomic design of work stations and more effective production engineering.
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| 7. |
- Bao, Shihan, et al.
(författare)
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Prevalence of musculoskeletal disorders at workplaces in the People's Republic of China
- 2000
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Ingår i: International Journal of Occupational Safety and Ergonomics. - : Informa UK Limited. - 1080-3548 .- 2376-9130. ; 6:4, s. 557-574
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents 2 musculoskeletal disorders questionnaire surveys in 10 different Chinese occupational groups. Data collected from 1,603 workers using a modified Nordic musculoskeletal disorders symptom questionnaire showed that the 12-month prevalence of musculoskeletal disorders, particularly in the low back and shoulder-neck regions, was high at many Chinese workplaces. Significant differences existed between occupational groups. Assembly workers usually had higher neck-shoulder complaints compared to workers in most other occupations. However, the nature of assembly seemed also to influence the prevalence rate. Workers at a cassette recorder and a TV set assembly plant appeared to have more neck complaints compared with a group of thermos flask assemblers.
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| 8. |
- Bendix, Tom, et al.
(författare)
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An evaluation of a tiltable office chair with respect to seat height, backrest position and task
- 1986
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Ingår i: European Journal of Applied Physiology and Occupational Physiology. - : Springer Science and Business Media LLC. - 0301-5548 .- 1432-1025 .- 1439-6327. ; 55:1, s. 30-36
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Tidskriftsartikel (refereegranskat)abstract
- The amount of spontaneous movement during seated office work was estimated by analysing the tilting movements of a tiltable office chair. Both movement frequency and amplitude range were considered. The seat inclinations and subjective acceptability were also recorded.The seat was moved more frequently and with a greater range when adjusted 6 cm above popliteal level compared to 1 cm below, or when the backrest was pushed anteriorly or posteriorly compared to a middle position. The greatest acceptability occurred with the highest seat adjustment and the backrest in the middle position. Typing or desk-work influenced movement to a similar extent.
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| 11. |
- Bjerre, Mette, et al.
(författare)
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Serum osteoprotegerin as a long-term predictor for patients with stable coronary artery disease and its association with diabetes and statin treatment : A CLARICOR trial 10-year follow-up substudy
- 2020
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Ingår i: Atherosclerosis. - : Elsevier BV. - 0021-9150 .- 1879-1484. ; 301, s. 8-14
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: Elevated circulating levels of osteoprotegerin (OPG) are known to add to the prediction of cardiovascular mortality. Our objective was to clarify the long-term risk associated with serum OPG and the possible influence of diabetes and statins on OPG levels in patients with stable coronary artery disease (CAD).METHODS: We assessed the placebo-treated group (n = 1998) from the CLARICOR trial (NCT00121550), a cohort with stable CAD. At entry, 15% of the participants had diabetes and 41% received statins. Serum OPG levels were measured in blood drawn at randomization. Participants were followed through public registers for 10 years.RESULTS: OPG levels correlated positively with diabetes status, age, CRP and female sex, but negatively with the use of statins. CAD participants with diabetes had significantly elevated serum OPG levels compared to participants without diabetes, p < 0.0001. The participants without diabetes treated with statins presented with significantly lower serum OPG levels than the corresponding non-statin-users (p < 0.0001). However, statin use showed no association with OPG levels in the participants with diabetes. High OPG levels at entry showed long-term associations with all-cause mortality and cardiovascular events (hazard ratio associated with factor 10 OPG increase 15.9 (95% CI 11.0-22.9) and 6.38 (4.60-8.90), p = 0.0001, even after adjustment for standard predictors (3.16 (1.90-5.25) and 2.29 (1.53-3.44), p < 0.0001).CONCLUSIONS: Circulating OPG holds long-term independent predictive ability for all-cause mortality and cardiovascular events in CAD participants. OPG levels were associated with diabetes, age, and female sex and statin treatment was associated with lower OPG levels in the absence of diabetes.
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| 13. |
- Brännmark, Mikael, et al.
(författare)
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Researching Lean: Methodological Implications of Loose Definitions
- 2012
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Ingår i: Quality Innovation Prosperity. - : Technical University of Kosice, Faculty of Materials, Metallurgy and Recycling. - 1335-1745 .- 1338-984X. ; 16:2, s. 35-48
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Tidskriftsartikel (refereegranskat)abstract
- Recently, Lean Production (Lean) has become a prevailing management concept in Sweden. However, previous research seems to show that the Lean concept and the impact of Lean vary considerably between organizations. This paper illustrates some key methodological issues that need to be considered when researching loosely defined management concepts such as Lean. The paper is based on a review of the literature and five comparative Swedish cases studies. Our study indicates that Lean has changed over time and that operationalization and interpretations of the concept vary considerably. This study concludes that future Lean studies should include a thorough assessment of the Lean interventions, study settings, and in particular non-Lean factors mediating the outcomes of Lean-inspired change programs.
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| 14. |
- Carlsson, Axel C, et al.
(författare)
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10-Year Associations between Tumor Necrosis Factor Receptors 1 and 2 and Cardiovascular Events in Patients with Stable Coronary Heart Disease : A CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) Trial Substudy.
- 2018
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 7:9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We aimed to assess the associations and predictive powers between the soluble receptors for tumor necrosis factor (TNF)-α (TNFR1 and TNFR2) and cardiovascular outcomes in patients with stable coronary heart disease.METHODS AND RESULTS: CLARICOR (Effect of Clarithromycin on Mortality and Morbidity in Patients With Ischemic Heart Disease) is a randomized clinical trial comparing clarithromycin with placebo in patients with stable coronary heart disease. The primary outcome was a composite of nonfatal acute myocardial infarction, unstable angina pectoris, cerebrovascular disease, and all-cause mortality. Patients were followed up for 10 years; discovery sample, those assigned placebo (1204 events in n=1998); and replication sample, those assigned clarithromycin (1220 events in n=1979). We used Cox regression adjusted for C-reactive protein level, established cardiovascular risk factors, kidney function, and cardiovascular drugs. After adjustments, higher serum levels of TNFR1 and TNFR2 were associated with the composite outcome in the discovery sample (hazard ratio per SD increase, 1.13; 95% confidence interval, 1.05-1.22; P=0.001 for TNFR1; hazard ratio, 1.16; 95% confidence interval, 1.08-1.24; P<0.001 for TNFR2). The associations were similar in the replication sample. The associations with the composite outcome were mainly driven by acute myocardial infarction, cardiovascular mortality, and noncardiovascular mortality. The addition of TNFR1 and TNFR2 to established cardiovascular risk factors improved prediction only modestly (<1%).CONCLUSIONS: Increased concentrations of circulating TNFR1 and TNFR2 were associated with increased risks of cardiovascular events and mortality in patients with stable coronary heart disease. Yet, the utility of measuring TNFR1 and TNFR2 to improve risk prediction in these patients appears limited.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00121550.
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| 15. |
- Cyrén, Henrik, et al.
(författare)
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Task Specific Exposure Information as a Basis for Production System Design
- 1998
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This publication was written during a period of time when the authors were engaged in an extensive research programme financed by the National Institute for Working Life in Solna (Cooperative for Optimisation of industrial production systems regarding Productivity and Ergonomics COPE).
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| 18. |
- Edwards, Kasper, et al.
(författare)
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A method for effect modifier assessment (EMA) in ergonomic intervention research
- 2018
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Ingår i: Applied Ergonomics. - : Elsevier BV. - 0003-6870. ; 72, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- The numerous opportunities for effect modifications pose a major challenge in ergonomic intervention research. Even studies in systematic reviews that are assessed as being of high quality generally lack any proper consideration of the potential effect modifiers. We have developed a method for effect modifier assessment (EMA) in intervention research. The EMA method uses a participatory workshop consisting of representatives from all occupational groups in the investigated organization. The workshop identifies both intervention and modifier events including “confounders” and “effect modifiers” according to epidemiologic terminology. These are categorized into themes, then analyzed and evaluated for their potential effects on the investigated outcomes. The overall impact of the pooled modifier themes is finally estimated in relation to the estimated impact of the intervention events. In the present study, the EMA method was tested in two cases. The findings suggest that it provides information that strengthens inferences about the impact of the investigated ergonomic interventions. Further evaluation of the method is recommended.
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| 19. |
- Edwards, Kasper, et al.
(författare)
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A method for Effect Modifier Assessment in ergonomic intervention research – The EMA method
- 2016
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Ingår i: Abstract book of the 10th NOVO symposium, Reykjavík, 10 – 11 November, 2016. s. 13. - 9789935926555
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Ergonomic intervention research includes studies in which researchers arrange (or follow) changes in working conditions to determine the effects in risk factors and/or health. Often this research takes place at workplaces and not in a controlled environment of a laboratory. The effects may thus be due to other factors in addition to the investigated intervention – i.e. due to effect modifiers. Such effect modifiers need to be identified and assessed in terms of potential impact on the investigated outcome before proper inference can be drawn. A preliminary review of the literature revealed lack of or poor consideration of effect modifiers in ergonomic intervention research. We present a method that has been developed over the course of several years parallel to intervention studies in healthcare. Material and methods: The EMA method is a type of group interview including 3-6 employees representing the occupational groups in the investigated organization. With reference to the investigated period they are asked to recall important changes/events in and around the ward; 1) in general, 2) in work processes and equipment and 3) regarding their work environment. In each step the participants write their individual answer on post-it notes. The answers are then discussed in plenum, one at a time, and the post-it note is placed on a timeline. At the end this illustrates the sequence of significant events. All identified events are assessed for being caused by either the investigated intervention(s) or other causes (“the effect modifiers”) and their impact on the work environment. Following the workshop, events are entered into a database and reassessed by triangulation based on scientific evidence, researcher knowledge, reading the transcribed audio recorded workshop and other local sources. Conclusion: The EMA method seems to offer a feasible procedure to obtain significant knowledge on potential effect modifiers in ergonomic intervention research. However, further development and validation is suggested.
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| 20. |
- Edwards, Kasper, et al.
(författare)
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A method for Effect Modifier Assessment in intervention research – The EMA method
- 2017
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Ingår i: European Association of Work and Organizational Psycholog. Dublin, Ireland: 17-20 May.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: Intervention research includes studies in which researchers arrange (or follow)changes in working conditions to determine the effects on risk factor, health and/or performance. Often this research takes place at workplaces and not in a controlled laboratory environment. Effects may thus be due to other factors in addition to the intervention – i.e. effect modifiers. These need to be identified and assessed in terms of potential impact on studied outcomes before proper inference can be drawn. We present a method to estimate potential effects of modifiers in intervention research. Methodology: The EMA method is a type of group interview including 3-6 employees representing the occupational groups in the investigated organization. With reference to the investigated period they are asked to recall important changes/events in and around the organization; 1) in general, 2) in work processes and equipment and 3) regarding their work environment. In each step the participants write their individual answers on post-it notes which are then discussed in plenum, one at a time, and placed on a timeline. All identified events are assessed as due to the investigated intervention(s) or other causes (“effect modifiers”). Their impact on the outcomes is estimated by triangulation. Following the workshop, events are entered into a database and analyzed. Results: Preliminary evaluations of the method suggest that it offers a relevant overview of potential effect modifiers. Limitations: Further validation is needed. Implications: Using the EMA-method seems to facilitate proper inference regarding the impact of a workplace intervention. Originality: The EMA-method is a novel and systematic approach to estimate potential effect modifiers.
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| 21. |
- Edwards, Kasper, et al.
(författare)
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Accounting for effect modifiers in ergonomic intervention research
- 2016
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Ingår i: Proceedings of the 48th annual conference of Nordic Ergonomics and Human Factors Society (NES) “NES2016 - Ergonomics in Theory and practice”. Kuopio, Finland, August 14-17, 2016. - 1798-5730. - 9789526121925
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Konferensbidrag (refereegranskat)abstract
- The impact of ergonomic interventions may be offset by other changes at the work place, primarily rationalizations. These have previously been shown to imply a dominant negative effect on health and risk factors, thus causing effect modification. We present a method identifying potential effect modifiers in ergonomic intervention studies.
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| 23. |
- Edwards, Kasper, et al.
(författare)
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Effect Modifier Assessment in intervention research by the EMA method - a variant of Chronicle Workshop
- 2018
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Ingår i: Proceedings of the 20th Congress of the International Ergonomics Association (IEA) 2018.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- A Chronicle Workshop (CW) is a participatory method for collecting information regarding defined events during a defined time period of an organization. The CW intends to facilitate a group-based process centered around their shared history. Occupational intervention research investigates whether defined changes at worksites have the desired positive work environment outcomes. However, the outcome may be affected also by other events not part of the investigated interventions, i.e. modifiers. Consequently, we developed a new method for effect modifier assessment (the EMA method) in ergonomic intervention studies including significant elements of the CW (Edwards and Winkel, conditionally accepted). This paper presents the method and includes preliminary examinations of its applicability in intervention case studies at Danish workplaces. Methodology: The EMA method estimates both modifier and intervention events and their impact on the investigated outcome(s). It is, as the CW method, using a type of group interview with 3-6 employees representing the occupational groups in the investigated organization. With reference to the investigated period they are asked to recall important changes/events in and around the organization; 1) in general, 2) regarding work processes and equipment and 3) regarding their work environment. The three levels form a funnel going from general to specific events. In each step the participants write their individual answer on post-it notes, which are then discussed in plenum, one at a time, and placed on a timeline. All identified events are assessed for being caused by either the investigated intervention(s) or other causes (“the effect modifiers”) and their impact on the outcomes. These assessments are thereafter validated by triangulation, entered into a database and analyzed. The EMA method has been tested in 51 workshops and some results are presented below. Results and Discussion: IndustryWorkshopsInterventionModifiers Bed wards6Ergonomic Value stream mappingSignificant changes in the wards modify intervention effect. Mixed wards13Relational coordination as a change approach.Low compliance to intervention. Surgical ward6Lean project to improve performance and well-being.Poor leadership, managers not following rules. Merger caused collaboration problems. Industry3Agile State-Gate development in mid-sized hardware companiesMethod assumptions and procedures not met. Banking23Natural experiment - Investigating social capital and performancePerformance management influence collaboration negatively. Total51 The 51 workshops were performed as integrated parts of our development of the final version of the EMA method. Thus, not all the workshops have followed the instructions of the final version of the EMA method. Limitations: The event assessments and their impact are based on the participants’ subjective perceptions. A key issue is therefore the validity of these assessments. This may partly be reduced by the suggested triangulation. Further validations, such as inter-method reliability tests, are needed.
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| 24. |
- Edwards, K, et al.
(författare)
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Ergonomic Value stream Mapping (ErgoVSM) – potential for integrating work environment issues in a Lean rationalization process at a Danish hospital
- 2013
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Ingår i: 7th NOVO Symposium: A Nordic Model for Sustainable Systems in the Health Care Sector, Helsinki 25 – 26 November, 2013. - 2323-363X. - 9789523020580
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Lean is used in healthcare as a tool for business development and rationalization. Lean aims at contributing value from a holistic perspective including reduction of waste. Previous research indicates that this often creates work intensification with possible negative implications for the working environment (WE). WE considerations generally take a back seat on the rationalization process and are most often introduced later in a separate process. This paper reports findings from the Danish part of a Nordic Multicenter Study where WE considerations have been integrated into a rationalization process based on Value Stream Mapping (VSM). ErgoVSM incorporates aspects of the physical and psychosocial WE into the VSM process. The abstract presents pros and cons for using ErgoVSM in relation to VSM at 2 wards at Odense University Hospital based on some of our preliminary data. Materials and Methods: The case ward (“Ca”) used the ErgoVSM tool and the control ward (“Co”) the VSM tool. The resulting Action Plans comprised interventions, which were categorized according to impact at “Task”, “Work Content” and “Work Situation” levels (Westlander 1993) and each amendment was analyzed by a researcher regarding expected impact on performance (P) and WE. Results: The Action Plan from Ca comprised 25 interventions and from Co 18 interventions. For Ca 48% of the interventions focused on performance and the corresponding result for Co was 61%. For Ca one of the interventions was expected to imply negative impact on both WE and P, and none for Co. The Action Plan of Ca comprised 44% interventions with expected positive impact on work environment and for Co 61%. For Ca 60% of the interventions concerned Tasks, 12% Work Content and 28% Work Situation. The corresponding results for Co were 39%, 28% and 33% respectively. Discussion and Conclusions: Ca generated more interventions than Co. Co had more interventions focused on performance supporting the hypothesis that VSM in general is more performance oriented. However, Co had more interventions with expected positive impact on WE, contradicting the hypothesis that VSM promotes P rather than WE. However, the expected WE improvements were mainly due to improved role clarity e.g. better description of and responsibility for tasks, which is also important for improving P.
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| 26. |
- Edwards, Kasper, et al.
(författare)
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Some key issues in the development of ergonomic intervention tools
- 2016
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Ingår i: Proceedings of the 48th annual conference of Nordic Ergonomics and Human Factors Society (NES) “NES2016 - Ergonomics in Theory and practice”. - 1798-5730. - 9789526121925 ; , s. 175-178
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Konferensbidrag (refereegranskat)abstract
- Literature reviews suggest that tools facilitating the ergonomic intervention processes should be integrated into rationalization tools, particular if such tools are participative. Such a tool has recently been developed as an add-in module to the Lean tool “Value Stream Mapping” (VSM). However, in the investigated context this module seems not to have any direct impact on the generation of proposals with ergonomic consideration. Contextual factors of importance seem to be e.g. allocation of sufficient resources and if work environment issues are generally accepted as part of the VSM methodology.
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| 27. |
- Edwards, K, et al.
(författare)
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Using Chronicle Workshop to quantify impact of context in case studies
- 2014
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Ingår i: In: Kasper Edwards & Jørgen Winkel (Eds.) Abstract book, The 8th Novo symposium: Sustainable Health Care Production Systems, Copenhagen, November 6 - 7, 2014, Technical University of Denmark..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 32. |
- Forsman, Mikael, et al.
(författare)
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Mechanical exposures in serial flow assembly - a proactive intervention research approach
- 2013
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The EU End of Life Vehicle (ELV) Directive 2000/53/EC has prompted rationalization initiatives to facilitate recycling of material and components from ELVs. In the present study, technical recordings were used to assess operators' mechanical exposures in a new serial flow system for full material recovery in car disassembly as compared with those of a previous study of traditional craft-type-parallel disassembly. Estimated task-specific mechanical exposures served as a base to simulate how further rationalisation may affect ergonomics in car disassembly. The time proportion of ‘direct work’ (deemed value-adding tasks) was about 30% in both systems, i.e. substantially lower than in modern forward factories. Movement velocities were higher in the new serial system, implying a higher risk for musculoskeletal disorders, while mixed results were found in the comparison of postures.Simulations revealed increased mechanical exposures, illustrated by increased time in high risk conditions, and decreased duration in low-exposure conditions, when indirect tasks and disturbances (deemed non-value-adding) were removed.This may illustrate the underlying mechanism of how rationalisations to eliminate "waste" can reduce valuable recovery time and increase employee injury risk over time.
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| 44. |
- Gellerstedt, Sten, et al.
(författare)
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Health and Performance in Mechanised Forest Operations
- 2006
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Ingår i: Proceedings of the International Ergonomics Association (IEA) Conference, July 2006, The Netherlands. Elsevier Ltd.. - : Elsevier.
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Konferensbidrag (refereegranskat)
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