Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation.

PURPOSE: Evaluations of organizational-level interventions to prevent work-related illness have identified enabling factors, but knowledge of necessary and sufficient conditions for intervention success is needed. The aim was to identify difference-making factors that distinguish intervention groups with and without a positive intervention effect on sickness absence. METHODS: An organizational-level intervention designed to decrease sickness absence by providing support from process facilitators was implemented at eight healthcare workplaces in Sweden between 2017 and 2018. We applied coincidence analysis (CNA) to analyze 34 factors and determine which factors were necessary and sufficient for a successful implementation of tailored interventional measures on an organizational level (dichotomous) and reduced sickness absence (trichotomous). RESULTS: Two factors perfectly explained both the presence and absence of a successful implementation: "a high sense of urgency" and "good anchoring and participation from the strategic management". The presence of either of these factors alone was sufficient for successful implementation, whereas the joint absence of both conditions was necessary and sufficient for the absence of successful implementation and an intervention effect. In addition, high employee participation was both necessary and sufficient for a high intervention effect. For organizations without high employee participation, successful implementation led to a medium-effect size. CONCLUSIONS: This study identified participation as a difference-maker in the implementation process. Participation from different stakeholders turned out to be important in different phases. When implementing organizational-level interventions, high participation from both strategic management and employees appears to be crucial in terms of the intervention's effect on sickness absence.

Systemic anti-inflammatory treatment of atopic dermatitis during conception, pregnancy and breastfeeding: Interdisciplinary expert consensus in Northern Europe.

Treating atopic dermatitis (AD) in pregnant or breastfeeding women, and in women and men with AD aspiring to be parents is difficult and characterized by uncertainty, as evidence to inform decision-making on systemic anti-inflammatory treatment is limited. This project mapped consensus across dermatologists, obstetricians and patients in Northwestern Europe to build practical advice for managing AD with systemic anti-inflammatory treatment in men and women of reproductive age. Twenty-one individuals (sixteen dermatologists, two obstetricians and three patients) participated in a two-round Delphi process. Full consensus was reached on 32 statements, partial consensus on four statements and no consensus on four statements. Cyclosporine A was the first-choice long-term systemic AD treatment for women preconception, during pregnancy and when breastfeeding, with short-course prednisolone for flare management. No consensus was reached on second-choice systemics preconception or during pregnancy, although during breastfeeding dupilumab and azathioprine were deemed suitable. It may be appropriate to discuss continuing an existing systemic AD medication with a woman if it provides good disease control and its benefits in pregnancy outweigh its risks. Janus kinase (JAK) inhibitors, methotrexate and mycophenolate mofetil should be avoided by women during preconception, pregnancy and breastfeeding, with medication-specific washout periods advised. For men preconception: cyclosporine A, azathioprine, dupilumab and corticosteroids are appropriate; a 3-month washout prior to conception is desirable for methotrexate and mycophenolate mofetil; there was no consensus on JAK inhibitors. Patient and clinician education on appropriate (and inappropriate) AD treatments for use in pregnancy is vital. A shared-care framework for interdisciplinary management of AD patients is advocated and outlined. This consensus provides interdisciplinary clinical guidance to clinicians who care for patients with AD before, during and after pregnancy. While systemic AD medications are used uncommonly in this patient group, considerations in this article may help patients with severe refractory AD.

Factors that may promote the learning of person-centred care: an ethnographic study of an implementation programme for healthcare professionals in a medical emergency ward in Sweden.

While person-centred care has gained increasing prominence in recent decades as a goal for healthcare systems, mainstream implementation remains tentative and there is a lack of knowledge about how to develop person-centred care in practice. This study therefore aimed to explore what may be required in order for person-centred care programmes to be successful. The study used an ethnographic method of data collection. This consisted of closely following an implementation programme on a medical emergency ward in a Swedish hospital. Data consisted of participant observation and informal interviews with healthcare providers and their management leaders while they were in the process of training to use person-centred care. These interlocutors were using action learning methods under the guidance of facilitators. Our findings revealed that although the programme resulted in some of the processes that are central for person-centred care being developed, organisational factors and a lack of attention to ethics in the programme counteracted these positive effects. The study highlights the importance of facilitating mechanisms to produce desired results. These include management leaders' learning about the dynamic and collective nature of learning processes and change. They also include allowing for inter-professional dialogue to enable managers and professionals to reflect deeply on professional boundaries, disciplinary knowledge and power relations in their teams. Teamwork is essential for the development of person-centred care and documentation, in accordance with this specific implementation programme, is also indispensable. The space for inter-professional dialogue should also accommodate their various perspectives on the aims of care and organizational reality.

T1ρ MRI of the talar articular cartilage is increased in those with chronic ankle instability.

OBJECTIVE: To determine if individuals with chronic ankle instability (CAI) demonstrate different talar cartilage T1ρ relaxation times compared to uninjured controls. DESIGN: Fifteen CAI (21.13 ± 1.81 years, 4.00 ± 2.07 previous ankle sprains) and fifteen controls (21.07 ± 2.55 years, no previous ankle sprains) participated. CAI inclusion criteria was in accordance with the International Ankle Consortium guidelines. Greater T1ρ relaxation times were interpreted as greater degenerative changes. Participants were non-weight bearing for 30-minutes prior to scanning to unload the cartilage. Voxel by voxel T1ρ relaxation times were calculated from a five image sequence. Segmentation of the talar cartilage was performed manually using ITK-SNAP software. T1ρ relaxation time means and variability across the entire talus and in the anteromeidal, anterolateral, posteromedial, and posterolateral regions of interest (ROIs) were compared between groups using mean differences and effect sizes (ES) with their corresponding 95% confidence intervals (95%CI). RESULTS: Individuals with CAI demonstrated higher T1ρ relaxation times (mean ± standard deviation) across the entire talus (CAI: 65.97 ± 10.45 ms, Control: 58.84 ± 7.68 ms; ES = 0.76, 95%CI = 0.02-1.50), in the anterolateral (ES = 1.00, 95%CI = 0.24-1.48), posteromedial (ES = 0.74, 95%CI = 0.01-1.49), and posterolateral region of interest (ES = 3.84, 95%CI = 2.63-5.04). The T1ρ relaxation time variability (mean ± standard deviation) also differed across the overall talus (CAI: 32.78 ± 4.06 ms, Control: 28.23 ± 4.45 ms; ES = 1.04, 95%CI = 0.28-1.80), in the anteriolateral, (ES = 1.07, 95%CI = 0.31, 1.84) and posteriolateral (ES = 1.00, 95%CI = 0.24-1.75) ROIs. CONCLUSIONS: Individuals with CAI demonstrate greater T1ρ relaxation times and higher T1ρ variability compared to uninjured controls. This finding supports the existing literature illustrating early degenerative joint tissue changes consistent with early onset posttraumatic osteoarthritis in individuals with CAI.

Health care managers learning by listening to subordinates' dialogue training.

PURPOSE: Middle managers in health care today are expected to continuously and efficiently decide and act in administration, finance, care quality, and work environment, and strategic communication has become paramount. Since dialogical communication is considered to promote a healthy work environment, the purpose of this paper is to investigate the ways in which health care managers experienced observing subordinates' dialogue training. DESIGN/METHODOLOGY/APPROACH: A qualitative study using semi-structured interviews and documents from eight middle managers in a dialogue programme intervention conducted by dialogue trainers. Focus was on fostering and assisting workplace dialogue. Conventional qualitative content analysis was used. FINDINGS: Managers' experiences were both enriching and demanding, and consisted of becoming aware of communication, meaning perceiving interaction between subordinates as well as own silent interaction with subordinates and trainer; Discovering communicative actions for leadership, by gaining self-knowledge and recognizing relational leadership models from trainers--such as acting democratically and pedagogically--and converting theory into practice, signifying practising dialogue-promoting conversation behaviour with subordinates, peers, and superiors. RESEARCH LIMITATIONS/IMPLICATIONS: Only eight managers participated in the intervention, but data afforded a basis for further research. PRACTICAL IMPLICATIONS: Findings stressed the importance of listening, and of support from superiors, for well-functioning leadership communication at work. ORIGINALITY/VALUE: Studies focusing on health care managers' communication and dialogue are few. This study contributes to knowledge about these activities in managerial leadership.

Dynamic postural control but not mechanical stability differs among those with and without chronic ankle instability.

The purpose of this investigation was to compare dynamic postural control and mechanical ankle stability among patients with and without chronic ankle instability (CAI) and controls. Seventy-two subjects were divided equally into three groups: uninjured controls, people with previous ankle injury but without CAI, and people with CAI. Subjects completed a single-leg hop-stabilization task, and then had an anterior drawer test and lateral ankle radiograph performed bilaterally. The dynamic postural stability index was calculated from the ground reaction forces of the single-leg hop-stabilization task. Ankle joint stiffness (N/m) was measured with an instrumented arthrometer during the anterior drawer test, and fibula position was assessed from the radiographic image. Patients with previous ankle injuries but without CAI demonstrated higher frontal plane dynamic postural stability scores than both the uninjured control and CAI groups (P<0.01). Patients with and without CAI had significantly higher sagittal plane dynamic postural stability scores (P<0.01) and increased ankle joint stiffness (P=0.045) relative to the control group. The increased frontal plane dynamic postural control may represent a component of a coping mechanism that limits recurrent sprains and the development of CAI. Mechanical stability alterations are speculated to result from the initial ankle trauma.

Failed jump landing trials: deficits in neuromuscular control.

The purpose of this investigation was to compare neuromuscular control variables during successful and failed jump landings in multiple directions (sagittal, diagonal, and lateral). All data were collected during a single leg hop stabilization maneuver, which required subjects to stand 70 cm from the center of a force plate, jump off both legs, touch a designated marker placed at a height equivalent to 50% of their maximum vertical jump, and land on a single leg for all directions. Twenty-six subjects [10 males (22+/-3.9 years of age, 70.9+/-7.6 kg, and 176.8+/-0.5 cm) and 16 females (20.6+/-0.5 years of age, 65.6+/-9.1 kg, and 166.4+/-5.9 cm)] volunteered to participate in this investigation. Muscle activation times, average preparatory, and reactive electromyographic (EMG) amplitudes were calculated for the vastus medialis, semi-membranosis, lateral gastrocnemius, and tibialis anterior. EMG data revealed that successful jump landing trials had earlier activation times and higher preparatory and reactive EMG amplitudes. There was no difference for EMG activation times or amplitudes among directions. The results indicate neuromuscular control differences between successful and failed trials because of earlier muscle onset and greater amplitude. The results also suggest that in a healthy population, the direction of the jump protocol will not affect lower extremity EMG characteristics.

The influence of level and chlorine source on the formation of mono- to octa-chlorinated dibenzo-p-dioxins, dibenzofurans and coplanar polychlorinated biphenyls during combustion of an artificial municipal waste.

The formation of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and the three coplanar polychlorinated biphenyls (pPCBs) was studied during labscale fludized bed combustion of eight artificial municipal solid waste (MSW) fuel mixtures. The level of chlorine as well as the chlorine source varies within the different fuel mixtures. Four different chlorine sources were studied, viz, an inorgnaic (NaCl) and three organic sources, pure PVC plastic and two products (floor and cable) and the total chlorine level varies between 0.28% and 1.1%. The experiments were performed in a 5 kW laboratory scale fluidized bed reactor. A correlation between the total chlorine in the fuel and the formation of the hepta- and octa-chlorinated PCDD/F homologues was found. However, the most important variable for changes in the PCDDs/Fs and pPCBs formation was disturbance in the combustion condition and not the variation in chlorine content of the fuel. Furthermore, no differences in formation between the chlorine sources could be seen.

Mono- to tri-chlorinated dibenzodioxin (CDD) and dibenzofuran (CDF) congeners/homologues as indicators of CDD and CDF emissions from municipal waste and waste/coal combustion.

Total homologue concentrations and select congener concentrations from amongst the mono- to tri-chlorinated dibenzodioxins (CDDs) and dibenzofurans (CDFs) are used to model both Total (mono- to octa-) CDD + CDF emissions and the toxicity equivalent (TEQ) of the 2,3,7,8-chlorine-substituted emissions. Analysis of emission data from two facilities indicates that use of total homologue concentrations shows limited, facility-specific correlations with Total CDDs/CDFs and TEQ. Concentrations of select mono- to tri-CDD/CDF congeners show promising correlation with CDD/CDF TEQ across facilities, suggesting that these compounds can act as TEQ indicators.

Lipoxin A4-induced release of thromboxane in the guinea-pig lung: studies of its characteristics using lipoxin A4-methyl ester.

It was the aim of this study to reexamine the contradictory findings regarding the characteristics of LXA4-induced contractions in guinea-pig lung parenchymal strips, with particular respect to release of thromboxane A2 (TXA2). The contraction produced was similar to that evoked by leukotriene C4 (LTC4) regarding both the time course and release of TXA2, measured as TXB2 by RIA of bath-fluid. When release of TXA2 was abolished by pretreatment with the cyclooxygenase inhibitor, indomethacin, the initial component of the contractile response was depressed. Administration of the cysteinyl-leukotriene antagonists FPL 55712 or ICI 198,615 blocked the contractile response to LXA4. Furthermore, FPL 55712 also blocked TXA2-release evoked by LXA4. Maximally precontracted and depolarized preparations retained their ability to release TXA2 in response to LXA4. These findings indicate that LXA4 releases TXA2 by direct activation of a receptor similar to that utilized by the cysteinyl-leukotrienes and that release of TXA2 was not a mere consequence of the contractile response.