Is fighting against COVID-19 enough?

Tools of empirical epidemiology have been and are indispensable to focus political power on blocking the spreading of coronavirus disease 2019 (COVID-19) by stopping transmission. The present paper is a comment on E. Gibney's article 'Whose coronavirus strategy worked best?' (Nature 2020;581:15-6). The strategy for phase 2 should be more complex and interdisciplinary than described in the paper in Nature, especially in the period before a vaccine and specific treatments are available. The focus on reducing the mortality of COVID-19 will have side effects, including excess mortality from other causes. A part of this excess mortality will be based on the reduction of health-care offers as a consequence of the pandemic, and on structural limitations of the health-care system. A special challenge is to understand the relationship between death from and death with COVID-19, and therefore the relevance of severe acute respiratory syndrome coronavirus 2 infection in people with pre-existing burdens, for example coronary heart disease, cancer or older age. There is a need to extend the recently used tools to all available instruments, including physiological principles of prevention and promotion. The way to integrate global solidarity into the strategies of the different countries is critical not only for global health but also for the peace and long-term success for each individual country. The consequences of efforts against COVID-19 and the impact on reduced air pollution and climate change are also important to analyse from a global health perspective.

Understanding how prevocational training on care farms can lead to functioning, motivation and well-being.

PURPOSE: Prevocational training aims to improve basic vocational and social skills, supporting return to work for people who have been out of work for a long time. Care farms provide prevocational training; the aim of the study was to use the self-determination theory to gain an understanding of how these programmes can lead to healthy functioning and motivation for clients. METHOD: A total of 194 participants in prevocational training on care farms answered questions about demographic information, their perception of being a colleague, the social community on the farm, experiencing nature and animals and need satisfaction. A cross-sectional design resulting in a structural equation model was used to understand how elements of the care farm context influence satisfaction of three psychological needs. RESULTS: The results showed that a feeling of being a useful colleague led to competence, experiencing a sense of group belonging led to relatedness and autonomy, while receiving social support from the farmer led to satisfaction of all three needs for the participants. CONCLUSIONS: The results explain how prevocational training can stimulate participants' functionality, motivation and well-being. This understanding enables initiators and managers of prevocational training to understand and further strengthen the need-supportive elements of such programmes. Implications for Rehabilitation Prevocational training on care farms can facilitate motivation, functioning and well-being for clients. Making clients feel like useful colleagues that belong to a client group will strengthen the positive qualities of these programmes. Support, understanding and acknowledgement from the farmer are the most important elements for a positive development for the clients.

Differences in sickness absence between self-employed and employed doctors: a cross-sectional study on national sample of Norwegian doctors in 2010.

BACKGROUND: Doctors have a low prevalence of sickness absence. Employment status is a determinant in the multifactorial background of sickness absence. The effect of doctors' employment status on sickness absence is unexplored. The study compares the number of sickness absence days during the last 12 months and the impact of employment status, psychosocial work stress, self-rated health and demographics on sickness absence between self-employed practitioners and employed hospital doctors in Norway. METHODS: The study population consisted of a representative sample of 521 employed interns and consultants and 313 self-employed GPs and private practice specialists in Norway, who received postal questionnaires in 2010. The questionnaires contained items on sickness absence days during the last 12 months, employment status, demographics, self-rated health, professional autonomy and psychosocial work stress. RESULTS: 84% (95% CI 80 to 88%) of self-employed and 60% (95% CI 55 to 64%) of employed doctors reported no absence at all last year. In three multivariate logistic regression models with sickness absence as response variable, employment category was a highly significant predictor for absence vs. no absence, 1 to 3 days of absence vs. no absence and 4 to 99 days of absence vs. no absence), while in a model with 100 or more days of absence vs. no absence, there was no difference between employment categories, suggesting that serious chronic disease or injury is less dependent on employment category. Average or poor self-rated health and low professional autonomy, were also significant predictors of sickness absence, while psychosocial work stress, age and gender were not. CONCLUSION: Self-employed GPs and private practice specialist reported lower sickness absence than employed hospital doctors. Differences in sickness compensation, and organisational and individual factors may to a certain extent explain this finding.

A prospective study of the association between the readiness for return to work scale and future work participation in Norway.

AIM: The aim of the study was to investigate the associations between the Norwegian version of the Readiness for return to work (RTW) scale and future work participation among persons in inpatient occupational rehabilitation. METHODS: A prospective cohort with one year follow up. The participants (n = 179) were persons with reduced work ability who participated in a one-week inpatient rehabilitation program. Four readiness for RTW factors were identified at baseline using explorative factor analysis: 'RTW inability' and 'RTW uncertainty' among persons not working, and 'uncertain work maintenance' and 'proactive work maintenance' among persons working. Work participation was measured as days without sickness benefits in the year following the rehabilitation program. The associations between work participation and readiness for RTW factors were analyzed in multivariate linear regression models controlling for gender, age, subjective health complaints, employment status and previous sickness benefit. RESULTS: High scores on the RTW inability factor were associated with low future work participation among persons not working before the rehabilitation program. Among persons working before the program, the proactive work maintenance factor was associated with high future work participation. Neither the RTW uncertainty factor nor the uncertain work maintenance factor was associated with future work participation. CONCLUSIONS: The associations between two readiness for RTW factors (RTW inability and proactive work maintenance) and future work participation indicate that these factors can be used as screening tools to tailor occupational rehabilitation programs.

Social Factors of Sickness Absences and the Significance of the Nature-culture Interplay in Coping.

CONFLICT OF INTEREST: none declared. AIMS: The aim of this study was to focus on and to discuss how social factors influence sickness absence. There were two aims of this study: a) To explore and reveal the absentees experiences and perceptions of sickness absence in daily life b) To explore and reveal the absentees own perceptions and experiences of coping while being on sickness absence. Methods. Qualitative method through a pragmatic synthesis of elements of ethnography and grounded theory were used. The sample from the county of Oppland, Norway (n=30) had a mental or a musculoskeletal diagnosis in accordance with the ICPC-2 medical classification system. Results. The interplay between working conditions and private life burdens has an impact on the development of illness and sickness absence, reinforcing the perception of a total life burden situation for women; including caring responsibilities. Men experience stress and conflicts at work, mostly from the leadership and its organizational structure. The majority of the sample used different techniques and strategies to cope with their illnesses, highlighting the significance of the nature-culture interplay. Conclusion. A holistic approach that considers the whole life situation must also be considered in order to understand gender differences in sickness absence. The importance of being involved in daily activities, and feelings of belonging to a social network were important for both men and women. This research may also add important awareness and understanding of Nature-Culture-Health (NaCuHeal) benefits in public health.

Psychometric properties of the readiness for return to work scale in inpatient occupational rehabilitation in Norway.

AIM: To investigate internal consistency and construct validity of the Readiness for return to work (RTW) scale in a sample participating in a Norwegian inpatient occupational rehabilitation program. METHODS: A cross-sectional study was conducted on baseline measures from a prospective cohort study evaluating a 5 days inpatient occupational rehabilitation program. The participants in the program were 18-67 years, on sickness absence or at risk of sickness absence (N = 193). The Readiness for RTW scale, sociodemographic-, work- and health-related questionnaires were answered by the participants on their first day in the program. Statistical analysis included exploratory factor analyses, reliability analyses and correlations with related instruments. RESULTS: In the scale for those not working (N = 124) two factors were found, representing (1) RTW inability and (2) RTW uncertainty. These factors corresponded to the precontemplation and contemplation stages in a previous Canadian study. The original prepared for action stages were not identified in this sample. In the scale for those working shortly before the program (N = 60) two factors were identified, representing (1) Uncertain work maintenance and (2) Proactive work maintenance, comparable to the stages in the Canadian study. The factors had satisfactory internal consistency (Cronbach's alpha >0.7), except for proactive work maintenance (Cronbach's alpha = 0.59). Expected relationships were found between the readiness for RTW stages and the pain stages of change, fear avoidance beliefs for work, subjective health complaints, decision control and coping at work. CONCLUSION: Internal consistency and construct validity of the readiness for RTW stages found were satisfactory, except for proactive work maintenance. The results indicate that the construct of readiness for RTW may vary by culture and patient setting.

How music may promote healthy behaviour.

INTRODUCTION: Using music to promote healthy behaviour may enhance coping mechanisms in spite of illness. AIMS: 1) To explore the role and significance of music and musicking in the life of men and women with long-term illnesses in or through different life phases, situations, events, issues and contexts. 2) To increase knowledge on how participants, through exposure to and exchange of new musical materials and practices, may learn to use music as a ''technology of self '' in relation to health promotion and rehabilitation. METHODS: This exploratory study sought to instigate narratives about music's role in supporting health through a pragmatic synthesis of elements of action-research, ethnography and grounded theory. Music CDs were conceived as an interactive and dialectical tool. This longitudinal study involved eight in-depth ethnographic interviews per participant, involving nine men and 13 women, aged between 35 and 65 with long-term illnesses. RESULTS: Music is a motivational device for moving our bodies, releasing anger or aggression and even transcending pain. Personal preferences in music seemed to be important for these participants while exercising, substantiated in the importance of well-being and pleasure in everyday activities and situations. CONCLUSIONS: This study has contributed to an increase in self-awareness and consciousness, well-being and health for the majority of the participants in the study. It has brought to the level of consciousness forms of ''expert'' practice that may otherwise have occurred tacitly. Implementation of future health promotion and rehabilitation programmes ought to strengthen their focus on musical, cultural and physical activity both at an individual level and within local communities.

Legal aspects of prevention in Norway.

Prevention in Norway and in Europe more generally, is a multidisciplinary collaboration between many professions, organized largely in municipalities, villages, and counties. This paper addresses three questions: What relevant legislation on prevention currently exists? What are the perspectives of ongoing activities and their intentions? What are the strategic issues? Since 1984, Norway's primary health care system has been based on the Local Authority Health Care Act. In 1995, the Communicable Disease Control Act replaced the chapter on communicable diseases in the old Public Health Act of 1860. The new act emphasizes communicable disease control as more of a right rather than a duty for both the individual and the population. In Europe, future public health policy, practice, and research will need to focus not only causes of disease and injuries, but also on factors promoting health.

Long-term effects of community-based injury prevention on the island of Vaerøy in Norway: a 20-year follow up.

AIM: A multifactorial injury prevention programme started in 1981 and ran for about 10 years in an island community in Norway with a population of about 1,000. A study was undertaken to evaluate effects of the programme over a period of 20 years. METHODS: Injuries were recorded by the one medical doctor on the island for several years during the period 1970-2001. The programme was carried out very intensively from 1981 to 1987. The intensity gradually decreased to a medium level that lasted until about 1994, when it was further reduced to a low level. RESULTS: The injury incidence rate was reduced from 17.7% in 1980 (n = 188) to 9.7% in 1987 (n = 97) with relative risk reduced to 0.55 (95% CI 0.44-0.70, p < 0.0001). In 2001, an incidence rate of 9.6% was observed (n = 91). An even higher reduction was observed for serious injuries. The age groups 15-24 and 65+ showed the most distinct reductions from 1980 to 2001 while minor reduction was observed in children (0-14 years). The incidence rate of traffic injuries was reduced by 77% in spite of an increase in the number of motor vehicles. Occupational, home, and other injuries were reduced by 38%, 35%, and 49% respectively. The incidence rates were 2.6-3.0 times higher for men than for women through the 20-year observation period. CONCLUSION: This study indicates that a long-lasting multifactorial community-based intervention in a small community with defined aims may lead to a considerable and long-lasting reduction in injuries.

Nature-culture-health activities as a method of rehabilitation: an evaluation of participants' health, quality of life and function.

The dramatic increase in sickness absence and disability pensions in recent years are negative side-effects of our welfare society. Among others, people certified as long-term sick are offered participation in a programme of health-promoting activities (salutogenesis) in Asker, Norway. The aim of this study was to evaluate health, quality of life and function among participants included in a programme of community-based nature-culture-health activities. A qualitative evaluation study in 2003 included 30 men and 16 women aged 30-79 years old participating in 12 different health-promoting activities at the Nature-Culture-Health (NaCuHeal) Centre. The group activities were hiking, physical activities, gardening, music, singing, painting, dancing, dialogue groups for men or women, ethics, painting and local history. Around two-thirds of the participants reported to have improved their health status, quality of life and function, particularly when given the opportunity to utilize their own abilities and creativity. Belonging to a themed group seems to play a significant role in increasing self-efficacy and self-esteem. The majority of participants reported improved health, quality of life and functionality when considering returning to work due to their experiences in the NaCuHeal groups. Increasing the population's participation in health-promoting outdoor and cultural activities seem to be a useful method for enhance complete rehabilitation.