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Akerstrom M, Severin J, Miech EJ, Wikström E, Roczniewska M. Reducing sickness absence among public-sector healthcare employees: the difference-making roles of managerial and employee participation. Int Arch Occup Environ Health 2024; 97:341-351. [PMID: 38409534 PMCID: PMC10944807 DOI: 10.1007/s00420-024-02048-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
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.
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Affiliation(s)
- M Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Carl Skottbergs Gata 22B, 413 19, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - E J Miech
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, USA
| | - E Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - M Roczniewska
- Procome Research Group, Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Institute of Psychology, SWPS University, Sopot, Poland
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Akerstrom M, Sengpiel V, Hadžibajramović E, Carlsson Y, Graner S, Andersson O, Jonsson M, Naurin E, Veje M, Wessberg A, Linden K. The COPE Staff study: Study description and initial report regarding job satisfaction, work-life conflicts, stress, and burnout among Swedish maternal and neonatal healthcare workers during the COVID-19 pandemic. Int J Gynaecol Obstet 2023; 162:989-997. [PMID: 36998146 DOI: 10.1002/ijgo.14772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 03/13/2023] [Accepted: 03/16/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To describe the study design of the COPE Staff cohort study on working conditions for maternal and neonatal healthcare workers (MNHCWs), and present baseline data regarding job satisfaction, work-life conflicts, stress, and burnout. METHODS Between January and April 2021, 957 MNHCWs (administrative and medical staff) completed a baseline survey. Average levels of job satisfaction, work-life conflicts, stress, and burnout, and associations to perceived workload were assessed. RESULTS The average levels of job satisfaction, work-life conflicts, stress, and burnout were 68.6 (95% confidence interval [CI] 64.3-72.8), 42.6 (95% CI 37.3-48.0), 42.0 (95% CI 37.7-46.3), and 1.9 (95% CI 1.6-2.2), respectively. The respondents scoring above critical values indicating clinical burnout ranged between 3% and 18%, respectively, for the four burnout sub-dimensions. Women reported significantly higher levels of stress and burnout. Younger participants had lower job satisfaction and higher levels of work-life conflicts, stress, and burnout. Higher perceived workload was significantly associated with lower job satisfaction levels and higher levels of work-life conflicts, stress, and burnout. CONCLUSIONS Our results indicate associations between MNHCWs perceived workload and job satisfaction, work-life conflicts, stress, and burnout during the COVID-19 pandemic. Eighteen percent scored above critical values for exhaustion.
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Affiliation(s)
- Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emina Hadžibajramović
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Carlsson
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Graner
- Department of Medicine, Center for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
- BB Stockholm, Danderyd Hospital, Stockholm, Sweden
| | - Ola Andersson
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
- Department of Neonatology, Skåne University Hospital, Malmö, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Malin Veje
- Department of Infectious Diseases, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Wessberg
- Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Dahlqvist I, Ståhl C, Severin J, Akerstrom M. Shifting from an individual to an organizational perspective in work environment management - a process evaluation of a six-year intervention program within the Swedish public sector. BMC Public Health 2023; 23:1108. [PMID: 37291519 PMCID: PMC10248951 DOI: 10.1186/s12889-023-16059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Working systematically with the work environment, particularly the organizational and psychosocial work environment entails several challenges for employers. There is a lack of knowledge on how to best undertake this work. Thus, the aim of this study is to evaluate the process of a six-year organizational-level intervention program where workplaces could apply for additional funds to implement preventive intervention measures, with the intention of improving working conditions and reducing sickness absence within the Swedish public sector. METHODS The program management process was studied using a mixed-method approach combining qualitative document and content analyses based on process documentation produced between 2017 and 2022 (n = 135), interviews with internal occupational health services professionals in 2021 (n = 9) and quantitative descriptive analyses of submitted applications with decisions from 2017 to 2022 (n = 621). RESULTS Qualitative analyses of the process documentation revealed concerns from the project group regarding access to sufficient competence and resources among stakeholders and participating workplaces, and role conflicts and ambiguities between the program and everyday operations. To address these challenges, the application process was developed over time using the knowledge gained from previous years. A change in the mental models in work environment management, from an individual to an organizational perspective, was seen among the project group and the internal occupational health services responsible for implementing most of the granted intervention measures. In addition, the proportion of granted intervention measures on an organizational level increased throughout the years from 39% in 2017 to 89% in 2022. The changes in the application process were believed to be the main contributor to the change among the applying workplaces. CONCLUSIONS Results indicate that a long-term organizational-level workplace intervention program may be used, by the employer, as a tool for shifting from an individual- to an organizational perspective in the work environment management. However, additional measures on multiple levels need to be implemented to secure a sustainable shift in perspective within the organization.
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Affiliation(s)
- I Dahlqvist
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
| | - C Ståhl
- Department of Behavioural Sciences and Learning, Division of Education and Sociology, Linköping University, Linköping, Sweden
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
- Institute of Stress Medicine, Region Västra Götaland, Carl Skottbergs gata 22B, Gothenburg, 413 19, Sweden.
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Veje M, Linden K, Sengpiel V, Carlsson Y, Jonsdottir IH, Degl'Innocenti A, Ahlstrom L, Wijk H, Akerstrom M. Working conditions for healthcare workers at a Swedish university hospital infectious disease department during the COVID-19 pandemic: barriers and facilitators to maintaining employee wellbeing. Front Psychol 2023; 14:1183084. [PMID: 37275708 PMCID: PMC10233109 DOI: 10.3389/fpsyg.2023.1183084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Healthcare workers (HCWs) at infectious disease departments have held the frontline during the COVID-19 pandemic. This study aimed to identify barriers and facilitators to maintaining the employees' wellbeing that may be used to increase preparedness for future pandemics within ID Departments. Methods In September 2020, a web-based survey on demographics and work environment was distributed to all HCWs at the Infectious Disease Department at Sahlgrenska University Hospital. Results were compared with a pre-COVID-19 survey from October 2019. A quantitative analysis of the overall effects of the pandemic on the working conditions of HCWs was conducted; in addition, a qualitative content analysis of open-ended responses was performed. Results In total, 222 and 149 HCWs completed the pre-COVID-19 and COVID-19 surveys (84 and 54% response rate), respectively. Overall, we found significant changes regarding increased workload, lack of emotional support in stressful work situations, and inability to recover after shifts. These factors correlated both with younger age and concern of becoming infected. The open-ended answers (n = 103, 69%) revealed five generic categories (Workload; Organizational support; Worry and ethical stress; Capability; and Cooperation and unity) with a total of 14 identified factors representing plausible individual and organizational-level barriers or facilitators to sustained employee wellbeing. Conclusion Younger HCWs as well as those expressing worries about contracting the infection were found to be particularly affected during the COVID-19 pandemic and these groups may require additional support in future outbreaks. Factors both increasing and decreasing the pandemic-induced negative health consequences for HCWs were identified; this knowledge may be utilized in the future.
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Affiliation(s)
- Malin Veje
- Department of Infectious Diseases, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Institute of Biomedicine, Department of Infectious Diseases, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Center of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ylva Carlsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Center of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alessio Degl'Innocenti
- Center for Ethics, Law, and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Gothia Forum for Clinical Trials, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Quality Strategies, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Magnus Akerstrom
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Björk L, Corin L, Akerstrom M, Jonsdottir IH, Innocenti AD, Wijk H, Ahlstrom L. Under pressure - The working situation of Swedish healthcare managers during the first wave of COVID-19. Front Psychol 2023; 13:1052382. [PMID: 36710753 PMCID: PMC9874142 DOI: 10.3389/fpsyg.2022.1052382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction The aim of this study is to provide insight into the psychosocial work situation of hospital managers during the first wave of the COVID-19 pandemic. Methods Mixed-effect modelling was used on survey data on job demands, job resources, job motivation, and work-life balance among over 500 managers working in 55 departments of a large Swedish university hospital in 2019 and 2020. Responses from 6011 employees were then used to stratify the analysis for COVID-19 exposure. Inductive content analysis was applied to open-ended questions on the managers' views on organisational prerequisites during the onset of the pandemic. Results The proportion of managers reporting difficulties with role clarity, quantitative demands, decision-making authority, and emotional support, time for recovery at work, motivation deficits, or problems with work-life balance clearly increased during the first wave of the pandemic. The proportion of managers reporting negative responses was higher in departments with high COVID-19 exposure. The qualitative analysis shows that overall governance in terms of clear, fair, and well-communicated routines, resource allocation, and division of responsibilities constituted an important framework for managerial during the crisis. First-line managers also require a mandate to re-organize their roles and their teams to successfully adapt to the situation. Organisational and social support was also important resources. Discussion This is the first study investigating healthcare managers' work situation during the first wave of the COVID-19 pandemic in a Swedish context. As expected, it indicates an increasingly strained work situation during the crisis, but it also provides findings on organisational prerequisites that allow healthcare managers to cope with stressful situations. In line with previous research on organisational resilience, the study provides suggestions for how higher-level managers can act in order to provide front-line managers with the organisational prerequisites they need to adapt, learn and develop successfully during times of unpredictability, insecurity, and rapid change in order to offer the best possible support to health care workers.
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Affiliation(s)
- Lisa Björk
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden,Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden,*Correspondence: Lisa Björk, ✉
| | - Linda Corin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden,Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H. Jonsdottir
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Alessio Degl Innocenti
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Region Västra Götaland, Sahlgrenska University Hospital, Gothia Forum for Clinical Trials, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Quality Strategies, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden,Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,Department of Orthopedics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wådell M, Örtqvist AK, Linden K, Akerstrom M, Andersson O, Carlsson Y, Graner S, Jonsson M, Naurin E, Sengpiel V, Veje M, Wessberg A, Zaigham M. Challenges imposed by the COVID-19 pandemic on the Obstetrics and Gynecology residency program: a mixed-methods Swedish survey in the COPE Staff cohort study. BMC Med Educ 2022; 22:602. [PMID: 35927725 PMCID: PMC9354310 DOI: 10.1186/s12909-022-03631-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND To outline how the training program and work situation of residents in Obstetrics and Gynecology (OB-GYN) was affected by the pandemic and to illuminate how residents experienced these changes. METHODS As part of the COVID-19 in Pregnancy and Early Childhood Staff (COPE Staff) cohort study, between January and May 2021, all participating residents were invited to answer a 28-question online Resident Survey focusing on their specialist education, work situation and experiences during the COVID-19 pandemic. Descriptive statistics were given in percentages for categorical variables and means and standard deviations (SD) for continuous variables. Univariate comparative analyses were performed with the use of the Pearson's Chi-2-test for dichotomous data. The association between residents' worry about the quality and length of their specialist training, with extra clinical hours and transfer to other healthcare institutions were assessed by multivariate logistic regression. Free text responses were analyzed by content analysis. RESULTS Of the 162 participating OB-GYN residents, 69% expressed concern that the pandemic would have a negative impact on their training. Ninety-five (95%) reported cancellation/postponement of educational activities, 70% performed fewer surgeries and 27% had been transferred to other healthcare institutions where about half reported having gained more general knowledge as a physician. Working extra clinical hours was reported by 69% (7.4 ± 5.3 hours per week) and 14% had considered changing their profession due to the pandemic. Senior residents, compared to junior residents, more often experienced cancelled/postponed clinical rotations (30% vs 15%, P=0.02) and reported performing fewer surgeries (P=0.02). The qualitative analysis highlighted the lack of surgical procedural training as a major concern for residents. CONCLUSION The COVID-19 pandemic has strongly impacted the training program and work situation of OB-GYN residents in Sweden. Residents were concerned over the negative impact of the pandemic on their training program and senior residents reported more missed educational opportunities as compared to junior residents. Program directors, head of institutions and clinical supervisors can use the problem areas pinpointed by this study to support residents and compensate for missed educational opportunities. While hands-on-training and operating time cannot be compensated for, the authors hope that the findings of the study can help develop new strategies to minimize the negative impact of the current and future pandemics on resident education and work situation.
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Affiliation(s)
- Matilda Wådell
- Department of Obstetrics and Gynecology, Hudiksvall Hospital, Hudiksvall, Sweden
| | - Anne K Örtqvist
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Visby County Hospital, Visby, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Akerstrom
- Region Västra Götaland, The Institute of Stress Medicine, Gothenburg, Sweden
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ola Andersson
- Pediatrics, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neonatology, Skåne University Hospital, Malmö, Sweden
| | - Ylva Carlsson
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sofie Graner
- Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- BB Stockholm, Danderyds Hospital, 182 88, Danderyd, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Obstetrics and Gynecology, Uppsala University Hospital, Uppsala, Sweden
| | - Elin Naurin
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin Veje
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Wessberg
- Region Västra Götaland, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mehreen Zaigham
- Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
- Department of Obstetrics & Gynecology, Lund University and Skåne University Hospital, 205 01, Malmö, Sweden.
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Akerstrom M, Carlsson Y, Sengpiel V, Veje M, Elfvin A, Jonsdottir IH, Degl'Innocenti A, Ahlstrom L, Wijk H, Linden K. Working conditions for hospital-based maternity and neonatal health care workers during extraordinary situations - A pre-/post COVID-19 pandemic analysis and lessons learned. Sex Reprod Healthc 2022; 33:100755. [PMID: 35853385 PMCID: PMC9273518 DOI: 10.1016/j.srhc.2022.100755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022]
Abstract
Objective The aim of this study was to investigate how the changed work routines during the COVID-19 pandemic has been affecting the working environment for hospital-based maternity and neonatal health care workers, and to identify preventive measures to be used in future situations when health care organizations are under pressure. Methods All maternity and neonatal health care workers in a Swedish university hospital were surveyed during October 2019 and September 2020. The data was analyzed by document analysis of implemented changes in working routines, a quantitative analysis of the overall effects on the working conditions, and a qualitative analysis of open-ended responses. Results A total of 660 maternity and neonatal health care workers completed the pre-COVID-19 survey (74% response rate) and 382 the COVID-19 survey (35% response rate). Lack of personal protective equipment, worry about becoming infected, uncertainty whether implemented changes were enough, and challenges in communicating updated routines had negative effects on maternity and neonatal health care workers’ working conditions. Team spirit and feeling valued by peers had a positive effect. Conclusions Results suggest that negative effects on maternity and neonatal health care workers’ health can partly be prevented in future critical situations by creating a work climate that acknowledges the employees’ worry about being infected, securing adequate pre-conditions for managers, creating a strong psychosocial safety climate and systematically improving the working conditions for the maternity and neonatal health care workers, as well as maintaining the positive perceived effects of increased team spirit and feeling valued by peers.
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Affiliation(s)
- Magnus Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - Ylva Carlsson
- Region Västra Götaland, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Verena Sengpiel
- Region Västra Götaland, Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Sweden; Centre of Perinatal Medicine and Health, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Malin Veje
- Region Västra Götaland, Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Elfvin
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Paediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden; School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Alessio Degl'Innocenti
- Centre for Ethics, Law and Mental Health (CELAM), Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Gothia Forum for Clinical Trials, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Region Västra Götaland, Department of Quality Strategies, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
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Ståhl C, Gustavsson IN, Jonsdottir IH, Akerstrom M. Multilevel, risk group-oriented strategies to decrease sickness absence in the public sector: evaluation of interventions in two regions in Sweden. Int Arch Occup Environ Health 2022; 95:1415-1427. [PMID: 35451629 PMCID: PMC9273540 DOI: 10.1007/s00420-022-01864-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
Purpose Sickness absence has been identified as needing to be addressed through multilevel interventions, but knowledge regarding optimal design and implementation of such interventions is scarce. The aim of this study was to evaluate the implementation and effects of a large-scale multilevel intervention in the public sector in Sweden. Methods The overall effect of the intervention was assessed using mixed-effect models. Sickness absence data (before, and 6 or 12 months after the intervention) for 90 intervention groups and 378 reference groups was retrieved from administrative personnel systems from the two participating regional councils. The implementation processes were evaluated using qualitative content analysis of qualitative interviews conducted at two timepoints. Results The results show that the vast majority of implemented measures were on an individual level and the integration of the intervention differed between the two regions. The reception and perception of the intervention activities seem to have been influenced by the implementation process, and how well the interventions were communicated and integrated, both regarding the integration of the different interventions and their integration into the discrete context and existing routines. No short-term overall effects on sickness absence were found. Conclusions The results point to the many challenges in implementing complex interventions, especially where organizational measures are involved—including adequate participation by, and communication between, the involved actors, as well as sufficient resources. The results indicate potential learning effects regarding the awareness of organizational factors in sick leave, after implementing and integrating multilevel strategies.
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Affiliation(s)
- Christian Ståhl
- Department of Behavioral Sciences and Learning, Linköping University, 581 83, Linköping, Sweden. .,HELIX Competence Center, Linköping University, 581 83, Linköping, Sweden.
| | - Isa Norvell Gustavsson
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden
| | - Ingibjörg H Jonsdottir
- The Institute of Stress Medicine, Region Västra Götaland, 413 19, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 405 30, Gothenburg, Sweden
| | - Magnus Akerstrom
- The Institute of Stress Medicine, Region Västra Götaland, 413 19, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at the University of Gothenburg, 405 30, Gothenburg, Sweden
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9
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Wikström E, Severin J, Jonsdottir IH, Akerstrom M. Process facilitators shifting between the support and expert roles in a complex work environment intervention in the Swedish healthcare sector. J Health Organ Manag 2021; 36:25-47. [PMID: 34985224 DOI: 10.1108/jhom-10-2021-0382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Process facilitation as part of a complex intervention for changing or improving practices within workplaces is becoming a common work method. The aim of this study was to investigate what characterizes the process-facilitating role in a complex intervention. DESIGN/METHODOLOGY/APPROACH The present study focuses on a complex work environment intervention targeting eight organizational units (workplaces) in the Swedish healthcare sector. The study applies a mixed-method approach and has been carried out in two steps. First, a qualitative process evaluation was performed. Secondly, an evaluation was conducted to see to what extent these identified conditions and mechanisms affected the quantitative intervention effect in term of sickness absence. FINDINGS The analysis shows that the facilitating role consisted of three overlapping and partially iterative phases. These phases involved different activities for the facilitating role. Depending on how the facilitating role and the intervention were designed, various supporting conditions were found to significantly affect the outcome of the intervention measured as the total sickness absence. RESEARCH LIMITATIONS/IMPLICATIONS It is concluded that the facilitation is not static or fixed during the change process. Instead, the facilitation role develops and emerges through the process of support during the different implementation phases. PRACTICAL IMPLICATIONS The facilitative role of performing support is based on a combination of support role activities and expert role activities. The support role focuses on support activities, while the expert role includes capacity building through knowledge- and legitimacy-oriented activities. ORIGINALITY/VALUE This study contributes to earlier research by developing a methodological approach for carrying out process facilitation in complex interventions.
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Affiliation(s)
- Ewa Wikström
- Department of Business Administration, School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden
| | - Jonathan Severin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
| | - Ingibjorg H Jonsdottir
- Institution of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Institute of Stress Medicine, Gothenburg, Sweden
| | - Magnus Akerstrom
- Occupational and Environmental Medicine, Institute of Medicine, School of Public Health and Community Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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10
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Akerstrom M, Severin J, Imberg H, Jonsdottir IH, Björk L, Corin L. Methodological approach for measuring the effects of organisational-level interventions on employee withdrawal behaviour. Int Arch Occup Environ Health 2021; 94:1671-1686. [PMID: 33772378 PMCID: PMC8384822 DOI: 10.1007/s00420-021-01686-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/19/2021] [Indexed: 11/13/2022]
Abstract
Background Theoretical frameworks have recommended organisational-level interventions to decrease employee withdrawal behaviours such as sickness absence and employee turnover. However, evaluation of such interventions has produced inconclusive results. The aim of this study was to investigate if mixed-effects models in combination with time series analysis, process evaluation, and reference group comparisons could be used for evaluating the effects of an organisational-level intervention on employee withdrawal behaviour. Methods Monthly data on employee withdrawal behaviours (sickness absence, employee turnover, employment rate, and unpaid leave) were collected for 58 consecutive months (before and after the intervention) for intervention and reference groups. In total, eight intervention groups with a total of 1600 employees participated in the intervention. Process evaluation data were collected by process facilitators from the intervention team. Overall intervention effects were assessed using mixed-effects models with an AR (1) covariance structure for the repeated measurements and time as fixed effect. Intervention effects for each intervention group were assessed using time series analysis. Finally, results were compared descriptively with data from process evaluation and reference groups to disentangle the organisational-level intervention effects from other simultaneous effects. Results All measures of employee withdrawal behaviour indicated statistically significant time trends and seasonal variability. Applying these methods to an organisational-level intervention resulted in an overall decrease in employee withdrawal behaviour. Meanwhile, the intervention effects varied greatly between intervention groups, highlighting the need to perform analyses at multiple levels to obtain a full understanding. Results also indicated that possible delayed intervention effects must be considered and that data from process evaluation and reference group comparisons were vital for disentangling the intervention effects from other simultaneous effects. Conclusions When analysing the effects of an intervention, time trends, seasonal variability, and other changes in the work environment must be considered. The use of mixed-effects models in combination with time series analysis, process evaluation, and reference groups is a promising way to improve the evaluation of organisational-level interventions that can easily be adopted by others.
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Affiliation(s)
- M Akerstrom
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden. .,Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
| | - J Severin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden
| | - H Imberg
- Department of Mathematical Sciences, Chalmers University of Technology and The University of Gothenburg, Gothenburg, Sweden
| | - I H Jonsdottir
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.,Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - L Björk
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.,Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
| | - L Corin
- Region Västra Götaland, Institute of Stress Medicine, Gothenburg, Sweden.,Department of Sociology and Work Science, University of Gothenburg, Gothenburg, Sweden
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11
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Akerstrom M, Corin L, Severin J, Jonsdottir IH, Björk L. Can Working Conditions and Employees' Mental Health Be Improved via Job Stress Interventions Designed and Implemented by Line Managers and Human Resources on an Operational Level? Int J Environ Res Public Health 2021; 18:1916. [PMID: 33669481 PMCID: PMC7922402 DOI: 10.3390/ijerph18041916] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/08/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022]
Abstract
Organisational-level interventions are recommended for decreasing sickness absence, but knowledge of the optimal design and implementation of such interventions is scarce. We collected data on working conditions, motivation, health, employee turnover, and sickness absence among participants in a large-scale organisational-level intervention comprising measures designed and implemented by line managers and their human resources partners (i.e., operational-level). Information regarding the process, including the implementation of measures, was retrieved from a separate process evaluation, and the intervention effects were investigated using mixed-effects models. Data from reference groups were used to separate the intervention effect from the effects of other concurrent changes at the workplace. Overall, working conditions and motivation improved during the study for both the intervention and reference groups, but an intervention effect was only seen for two of 13 evaluated survey items: clearness of objectives (p = 0.02) and motivation (p = 0.06). No changes were seen in employees' perceived health, and there were no overall intervention effects on employee turnover or sickness absence. When using operational-level workplace interventions to improve working conditions and employees' health, efforts must be made to achieve a high measure-to-challenge correspondence; that is, the implemented measures must be a good match to the problems that they are intended to address.
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Affiliation(s)
- Magnus Akerstrom
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (L.C.); (J.S.); (I.H.J.); (L.B.)
- Occupational Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Linda Corin
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (L.C.); (J.S.); (I.H.J.); (L.B.)
- Department of Sociology and Work Science, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Jonathan Severin
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (L.C.); (J.S.); (I.H.J.); (L.B.)
| | - Ingibjörg H. Jonsdottir
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (L.C.); (J.S.); (I.H.J.); (L.B.)
- Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Lisa Björk
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (L.C.); (J.S.); (I.H.J.); (L.B.)
- Department of Sociology and Work Science, University of Gothenburg, 405 30 Gothenburg, Sweden
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12
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Severin J, Björk L, Corin L, Jonsdottir IH, Akerstrom M. Process Evaluation of an Operational-Level Job Stress Intervention Aimed at Decreasing Sickness Absence among Public Sector Employees in Sweden. Int J Environ Res Public Health 2021; 18:1778. [PMID: 33673076 PMCID: PMC7918230 DOI: 10.3390/ijerph18041778] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/29/2021] [Accepted: 02/07/2021] [Indexed: 11/16/2022]
Abstract
Work-related sickness absence carries large societal costs, and interventions aimed at decreasing sickness absence need to be performed in an effective way. This study evaluated the implementation process of an operational-level job stress intervention, implemented between 2017 and 2018 in the public sector, by assessing the extent to which the allocated resources reached the intended target group, if the planned measures could be expected to address the relevant work environmental challenges, and if the planned measures were implemented. Data were collected from applications for funding in the intervention (n = 154), structured interviews (n = 20), and register data on sickness absence (n = 2912) and working conditions (n = 1477). Thematic analysis was used to classify the level of the work environmental challenges, the level and perspective of the suggested measures, and the "measure-to-challenge correspondence". Overall, participating workplaces (n = 71) had both higher sickness absence (p = 0.01) and worse reported working conditions compared to their corresponding reference groups. A measure-to-challenge correspondence was seen in 42% of the measures, and individual-level measures were mostly suggested for organisational-level work environment challenges. Almost all planned measures (94%) were ultimately implemented. When performing operational-level interventions, managers and their human resource partners need support in designing measures that address the work environmental challenges at their workplace.
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Affiliation(s)
- Jonathan Severin
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (J.S.); (L.B.); (L.C.); (I.H.J.)
| | - Lisa Björk
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (J.S.); (L.B.); (L.C.); (I.H.J.)
- Department of Sociology and Work Science, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Linda Corin
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (J.S.); (L.B.); (L.C.); (I.H.J.)
- Department of Sociology and Work Science, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Ingibjörg H. Jonsdottir
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (J.S.); (L.B.); (L.C.); (I.H.J.)
- Social Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Magnus Akerstrom
- Region Västra Götaland, The Institute of Stress Medicine, 413 19 Gothenburg, Sweden; (J.S.); (L.B.); (L.C.); (I.H.J.)
- Occupational Medicine, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, 405 30 Gothenburg, Sweden
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13
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Alexiou E, Steingrimsson S, Akerstrom M, Jonsdottir IH, Ahlstrom L, Finizia C, Wijk H, Degl'Innocenti A. A Survey of Psychiatric Healthcare Workers' Perception of Working Environment and Possibility to Recover Before and After the First Wave of COVID-19 in Sweden. Front Psychiatry 2021; 12:770955. [PMID: 34912253 PMCID: PMC8666504 DOI: 10.3389/fpsyt.2021.770955] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/27/2021] [Indexed: 01/26/2023] Open
Abstract
Objective: This study aimed to investigate the impact of the first wave of the COVID-19 pandemic on perceived working environment, including the possibility to recover, among psychiatric healthcare workers (PHCWs) in comparison with pre-pandemic measures. Method: A link to an anonymous, web-based COVID-19 related survey was sent via email to all PHCWs at a university hospital in Sweden (n = 1,618) in September 2020. The response rate was 38% (566 of 1,507 eligible participants). Working environment survey responses collected in 2019 were used as pre-pandemic comparators. Statistical analyses were performed to assess overall impact over time on work demands, support, motivation, and recovery, stratified by professional role, and considering variables such as access to personal protective equipment. Results: The percentage of individuals responding negatively to statements about working environment increased significantly for most items after the first wave. Similarly, the increase of five of the investigated factors indicated a more negative perception of recovery during the pandemic. Registered nurses reported a greater negative impact of the pandemic on perceived working conditions and ability to recover than other professional groups. PHCWs working with patients with COVID-19 (35%) who reported being worried about becoming infected (12%) or infecting others (17%), or lacking adequate personal protective equipment (22%) were more negatively impacted regarding work environment-related items than those who did not. Conclusions: PHCWs' working environment and possibility for recovery were impacted by the first wave of the COVID-19 pandemic, nurses being most affected. Although psychiatric services do not directly care for patients with severe COVID-19 infection, the results from this study suggests that mental health services should also prepare for future pandemics.
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Affiliation(s)
- Eirini Alexiou
- Department of Psychiatry, Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Center for Ethics, Law, and Mental Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Department of Psychiatry, Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Akerstrom
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingibjörg H Jonsdottir
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden.,School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Linda Ahlstrom
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Caterina Finizia
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Research, Development, Education and Innovation, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Quality Strategies, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Alessio Degl'Innocenti
- Center for Ethics, Law, and Mental Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Gothia Forum for Clinical Trials, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
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14
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Almerud P, Akerstrom M, Andersson EM, Strandberg B, Sallsten G. Low personal exposure to benzene and 1,3-butadiene in the Swedish petroleum refinery industry. Int Arch Occup Environ Health 2017; 90:713-724. [PMID: 28578463 PMCID: PMC5583277 DOI: 10.1007/s00420-017-1234-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/24/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Petroleum refinery workers are exposed to the carcinogens benzene and 1,3-butadiene. Declining exposures have been reported internationally but information on current exposure in the Swedish refinery industry is limited. The aim was to examine refinery workers' personal exposure to benzene and 1,3-butadiene and increase awareness of exposure conditions by collaboration with involved refineries. METHODS Altogether 505 repeated personal exposure measurements were performed among workers at two refineries. Full-shift measurements were conducted in different exposure groups using Perkin Elmer diffusive samplers filled with Carbopack X. Mean levels were calculated using mixed-effects models. A large fraction of measurements below the limit of detection (LOD) required imputation of computer-generated data. RESULTS Mean benzene exposure among process technicians was 15.3 µg/m3 (95% CI 10.4-22.5 µg/m3) and 13.7 µg/m3 (95% CI 8.3-22.7 µg/m3) for Refinery 1 and 2, respectively. Process technicians working outdoors had higher exposure than maintenance workers (20.7 versus 5.9 µg/m3, p < 0.01). Working in the harbour and tank park (Refinery 1), compared with the process area, was associated with higher exposure. The 1,3-butadiene exposure was low, 5.4 and 1.8 µg/m3, respectively. The total variation was generally attributed to within-worker variability. CONCLUSIONS Low benzene and 1,3-butadiene levels were found among refinery workers. Mean benzene exposure was about 1% of the Swedish occupational limit (1500 µg/m3) and for 1,3-butadiene, exposure was even lower. A large fraction of values below the LOD can be managed by carefully modelled, computer-generated data.
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Affiliation(s)
- Pernilla Almerud
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden.
| | - M Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - E M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - B Strandberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Gothenburg, Sweden
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15
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Akerstrom M, Barregard L, Lundh T, Sallsten G. Relationship between mercury in kidney, blood, and urine in environmentally exposed individuals, and implications for biomonitoring. Toxicol Appl Pharmacol 2017; 320:17-25. [DOI: 10.1016/j.taap.2017.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/28/2017] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
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Akerstrom M, Almerud P, Andersson EM, Strandberg B, Sallsten G. Personal exposure to benzene and 1,3-butadiene during petroleum refinery turnarounds and work in the oil harbour. Int Arch Occup Environ Health 2016; 89:1289-1297. [PMID: 27568022 PMCID: PMC5052356 DOI: 10.1007/s00420-016-1163-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/22/2016] [Indexed: 11/28/2022]
Abstract
Purpose Petroleum refinery workers’ exposure to the carcinogens benzene and 1,3-butadiene has decreased during normal operations. However, certain occupational groups or events at the refineries still involve a risk of higher exposures. The aim of this study was to examine the personal exposure to benzene and 1,3-butadiene at refinery turnarounds and during work in the oil harbour. Methods Personal exposure measurements of benzene and 1,3-butadiene were taken during work shifts, with a priori assumed higher benzene exposure, using PerkinElmer diffusive samplers filled with Carbopack X. Mean exposure levels were calculated, and repeated exposure measurements, when available, were assessed using mixed effect models. Group and individual compliance with the Swedish occupational exposure limit (OEL) was tested for the different exposure groups. Results Mean benzene exposure levels for refinery workers during the three measured turnarounds were 150, 610 and 960 µg/m3, and mean exposures for oil harbour workers and sewage tanker drivers were 310 and 360 µg/m3, respectively. Higher exposures were associated with handling benzene-rich products. Most occupational groups did not comply with the Swedish OEL for benzene nor did the individuals within the groups. The exposure to 1,3-butadiene was very low, between <1 and 3 % of the Swedish OEL. Conclusions Work within the petroleum refinery industry, with potential exposure to open product streams containing higher fractions of benzene, pose a risk of personal benzene exposures exceeding the OEL. Refinery workers performing these work tasks frequently, such as contractors, sewage tanker drivers and oil harbour workers, need to be identified and protected.
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Affiliation(s)
- M Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden.
| | - P Almerud
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - E M Andersson
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - B Strandberg
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
| | - G Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, 405 30, Göteborg, Sweden
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17
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Fagerstrom P, Sallsten G, Akerstrom M, Haraldsson B, Barregard L. Urinary albumin excretion in healthy adults: a cross sectional study of 24-hour versus timed overnight samples and impact of GFR and other personal characteristics. BMC Nephrol 2015; 16:8. [PMID: 25616740 PMCID: PMC4417247 DOI: 10.1186/1471-2369-16-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 01/13/2015] [Indexed: 12/02/2022] Open
Abstract
Background Urinary albumin can be measured in 24 h or spot samples. The 24 h urinary albumin excretion rate is considered the gold standard, but is cumbersome to collect. Instead, often an overnight sample is collected, and adjusted for dilution. Proxies for 24 h excretion rate have been studied in diabetics, but seldom in healthy individuals. Our aims were to compare 24 h and overnight albumin excretion, to assess the impact of personal characteristics, and to examine correlations between the 24 h excretion rate and proxies such as the albumin to creatinine ratio (ACR). Methods Separate 24 h and overnight urine samples were collected from 152 healthy kidney donors. Urinary creatinine, specific gravity, collection time, and sample volume determined. Differences between 24 h and overnight samples were examined, and the effects of age, sex, smoking, body mass, glomerular filtration rate, and urinary flow rate were assessed. Results The 24 h albumin excretion rate and ACR were both significantly higher than their overnight counterparts. Unadjusted albumin was unsurprisingly higher in the more concentrated overnight samples, while concentrations adjusted for specific gravity were similar. In multivariate analysis, the 24 h excretion rate and proxies were positively associated with glomerular filtration rate, as was ACR in overnight samples. There were positive associations between urinary albumin and body mass. Conclusions Proxies for the 24 h albumin excretion rate showed relatively high correlations with this gold standard, but differences due to sampling period, adjustment method, and personal characteristics were large enough to be worth considering in studies of albumin excretion in healthy individuals.
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Affiliation(s)
- Peter Fagerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
| | - Borje Haraldsson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 414, Gothenburg, S-405 30, Sweden.
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Fransson MN, Barregard L, Sallsten G, Akerstrom M, Johanson G. Physiologically-based toxicokinetic model for cadmium using Markov-chain Monte Carlo analysis of concentrations in blood, urine, and kidney cortex from living kidney donors. Toxicol Sci 2014; 141:365-76. [PMID: 25015660 DOI: 10.1093/toxsci/kfu129] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The health effects of low-level chronic exposure to cadmium are increasingly recognized. To improve the risk assessment, it is essential to know the relation between cadmium intake, body burden, and biomarker levels of cadmium. We combined a physiologically-based toxicokinetic (PBTK) model for cadmium with a data set from healthy kidney donors to re-estimate the model parameters and to test the effects of gender and serum ferritin on systemic uptake. Cadmium levels in whole blood, blood plasma, kidney cortex, and urinary excretion from 82 men and women were used to calculate posterior distributions for model parameters using Markov-chain Monte Carlo analysis. For never- and ever-smokers combined, the daily systemic uptake was estimated at 0.0063 μg cadmium/kg body weight in men, with 35% increased uptake in women and a daily uptake of 1.2 μg for each pack-year per calendar year of smoking. The rate of urinary excretion from cadmium accumulated in the kidney was estimated at 0.000042 day(-1), corresponding to a half-life of 45 years in the kidneys. We have provided an improved model of cadmium kinetics. As the new parameter estimates derive from a single study with measurements in several compartments in each individual, these new estimates are likely to be more accurate than the previous ones where the data used originated from unrelated data sets. The estimated urinary excretion of cadmium accumulated in the kidneys was much lower than previous estimates, neglecting this finding may result in a marked under-prediction of the true kidney burden.
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Affiliation(s)
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Gunnar Johanson
- Institute of Environmental Medicine, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Akerstrom M, Barregard L, Lundh T, Sallsten G. Variability of urinary cadmium excretion in spot urine samples, first morning voids, and 24 h urine in a healthy non-smoking population: implications for study design. J Expo Sci Environ Epidemiol 2014; 24:171-9. [PMID: 24022669 DOI: 10.1038/jes.2013.58] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/13/2013] [Accepted: 07/13/2013] [Indexed: 05/25/2023]
Abstract
When selecting the least biased exposure surrogate, for example, the concentration of a biomarker in a urine sample, information on variability must be taken into consideration. We used mixed-effects models to estimate the variability and determinants of urinary cadmium (U-Cd) excretion using spot urine samples collected at six fixed times during 2 days about 1 week apart, from 24 healthy non-smokers. The urine samples were analysed for U-Cd, the concentrations were adjusted for dilution, and the excretion rates were calculated. Between-individual variability dominated the total variability for most measures of U-Cd excretion, especially for 24 h urine and first morning samples. The U-Cd excretion showed a circadian rhythm during the day, and time point of sampling was a significant factor in the mixed-effects models, thus a standardised sampling time, such as first morning urine samples, needs to be applied. Gender, urinary flow rate, age, and urinary protein excretions were also significant determinants for U-Cd excretion. The choice of biomarker for U-Cd excretion was found to be more important in individually-based studies of exposure-response relationships than in studies of comparing Cd levels of groups. When planning a study, this variability of U-Cd in spot samples must be acknowledged.
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Affiliation(s)
- Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Barregard
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Lundh
- Department of Occupational and Environmental Medicine, Lund University Hospital, Lund, Sweden
| | - Gerd Sallsten
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, Gothenburg, Sweden
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Akerstrom M, Barregard L, Lundh T, Sallsten G. The relationship between cadmium in kidney and cadmium in urine and blood in an environmentally exposed population. Toxicol Appl Pharmacol 2013; 268:286-93. [PMID: 23454399 DOI: 10.1016/j.taap.2013.02.009] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/14/2013] [Accepted: 02/17/2013] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Cadmium (Cd) is toxic to the kidney and a major part of the body burden occurs here. Cd in urine (U-Cd) and blood (B-Cd) are widely-used biomarkers for assessing Cd exposure or body burden. However, empirical general population data on the relationship between Cd in kidney (K-Cd), urine, and blood are scarce. Our objectives were to determine the relationship between cadmium in kidney, urine, and blood, and calculate the elimination half-time of Cd from the kidney. METHODS Kidney cortex biopsies, urine, and blood samples were collected from 109 living kidney donors. Cd concentrations were determined and the relationships between K-Cd, U-Cd, and B-Cd were investigated in regression models. The half-time of K-Cd was estimated from the elimination constant. RESULTS There was a strong association between K-Cd and U-Cd adjusted for creatinine (rp=0.70, p<0.001), while the association with B-Cd was weaker (rp=0.44, p<0.001). The relationship between K-Cd and U-Cd was nonlinear, with slower elimination of Cd at high K-Cd. Estimates of the K-Cd half-time varied between 18 and 44years. A K-Cd of 25μg/g corresponds to U-Cd of 0.42μg/g creatinine in overnight urine (U-Cd/K-Cd ratio: about 1:60). Multivariate models showed Cd in blood and urinary albumin as determinants for U-Cd excretion. DISCUSSION In healthy individuals with low-level Cd exposure, there was a strong correlation between Cd in kidney and urine, especially after adjustment for creatinine. Urinary Cd was also affected by Cd in blood and urinary albumin. Previous estimates of the U-Cd/K-Cd ratio may underestimate K-Cd at low U-Cd.
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Affiliation(s)
- Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden.
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Akerstrom M, Sallsten G, Lundh T, Barregard L. Associations between urinary excretion of cadmium and proteins in a nonsmoking population: renal toxicity or normal physiology? Environ Health Perspect 2013; 121:187-91. [PMID: 23128055 PMCID: PMC3569687 DOI: 10.1289/ehp.1205418] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 10/31/2012] [Indexed: 05/19/2023]
Abstract
BACKGROUND Associations between cadmium (Cd) and kidney function have been reported even at low levels of exposure in the general population. Recently, the causality of these associations has been questioned. OBJECTIVES We examined associations between urinary Cd (U-Cd; a biomarker of exposure) and urinary proteins that are used as biomarkers of kidney effects, based on repeated short-term sampling in healthy subjects. METHODS Twenty-four hour urine samples were collected on 2 separate days at six fixed times from 30 healthy nonsmoking men and women (median age 39 years). We analyzed the samples (N = 354) for Cd (i.e., U-Cd) and two proteins used as kidney function biomarkers: urinary albumin (U-Alb) and alpha-1-microglobulin (U-A1M). Concentrations were adjusted for creatinine concentration or for specific gravity, and excretion rates (mass per hour) were calculated. Possible associations were assessed within each individual participant, and mean correlations and regressions were evaluated. RESULTS We found clear positive mean associations within individuals between the excretion of U-Cd [mean, 0.11 µg/g creatinine (range, 0.01-0.52 µg/g creatinine)] and both U-Alb and U-A1M. The associations were stronger for excretion rates and concentrations adjusted for specific gravity than for concentrations adjusted for creatinine. We also found significant positive associations of urinary flow with excretion of U-Cd, U-Alb, and U-A1M. CONCLUSIONS Associations between short-term changes in U-Cd and markers of kidney function within individual nonsmoking study participants are unlikely to reflect effects of Cd toxicity. A more likely explanation is that these associations result from normal variation in renal function, including changes in urinary flow, that influence the urinary excretion of both Cd and proteins in the same direction. These effects of normal variability may result in overestimation of the adverse effects of Cd on kidney function at low-level Cd exposure.
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Affiliation(s)
- Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden.
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Svensson E, Akerstrom M, Andersson E. Quantitative analyses of mycobacteria in water: Adapting methods in clinical laboratories. J Microbiol Methods 2011; 87:114-5. [DOI: 10.1016/j.mimet.2011.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 07/05/2011] [Accepted: 07/06/2011] [Indexed: 12/27/2022]
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Akerstrom M, Lundh T, Barregard L, Sallsten G. Sampling of urinary cadmium: differences between 24-h urine and overnight spot urine sampling, and impact of adjustment for dilution. Int Arch Occup Environ Health 2011; 85:189-96. [PMID: 21656121 DOI: 10.1007/s00420-011-0658-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/24/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Urinary cadmium (U-Cd) sampling can be done either by 24-h urine or spot urine sampling, and adjustment for dilution is usually needed. The choice of sampling period and adjustment technique could, however, potentially induce bias. The aim of the study was to compare 24-h urine and spot urine sampling and two dilution adjustment techniques, when assessing U-Cd. METHODS Separate 24-h urine (U24) and timed overnight spot urine (UON) samples were collected from 152 healthy kidney donors. U-Cd, creatinine concentration (U-Crea) and specific gravity (SG) were analysed. Differences between U24 and UON samples were tested using paired t test, and the effect of urinary flow rate (UF) was assessed by linear regression. RESULTS The cadmium excretion rate (U-Cd/h) was lower in the UON than in U24 samples (mean 0.017 μg/h vs. 0.021 μg/h; p < 0.001). This decrease was found also for the creatinine-adjusted U-Cd (U-CdCrea) (mean 0.36 μg/gC and 0.41 μg/gC; p < 0.001). For U-Cd adjusted for specific gravity (U-CdSG), the difference was reversed, but not statistically significant. The creatinine excretion rate (U-Crea/h) decreased at low UF, especially in the UON. CONCLUSIONS Since U-Cd/h was lower in UON than in U24 samples, the former will underestimate the true Cd excretion. This was seen for U-CdCrea but not for U-CdSG. However, it may be an advantage that the U-CdSG is similar, irrespective of sampling strategy. At low UF, U-CdCrea will be biased upwards. Whether U24 or UON samples adjusted for U-Crea or SG best reflect kidney-Cd is still unknown.
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Affiliation(s)
- Magnus Akerstrom
- Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital and Academy, University of Gothenburg, PO Box 414, SE-405 30, Gothenburg, Sweden.
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