How loss of nature through clear-cutting forestry affects well-being.

The United Nations declares that the global degradation of ecosystems represents a danger to human health. Deterioration of forests is one of several threats against the natural systems. The aim of this exploratory study was to investigate people's experiences with clear-cutting and how it had affected their health and well-being. Qualitative data from six people who valued forest ecosystems were collected through semi-structured interviews and analyzed in accordance with Graneheim and Lundman's qualitative content analysis (Graneheim, U. H. and Lundman, B. (2004) Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today, 24, 105-112). Clear-cutting was not regarded as an environment-friendly forestry method. The interviewees described emotional reactions such as grief and poor mental well-being when beloved forests were clear-felled. The grief was partly because of a personal loss of place and recreation area that was important for their physical and emotional well-being. Another part was grief on behalf of nature itself, that is, the loss of habitats of animals and plants and a worsening of the global climate. The interviewees held that emotions related to loss of nature were insufficiently communicated in public discourse. They felt powerless and unable to influence forestry because of what they experienced as an impenetrable industry. Clear-cutting of forests may result in poor well-being among people who value forest ecosystems. More focus on planetary health is needed, including healthy public policy promoting forest management that considers people's need for nature experiences and possible ecological grief when forests are totally and abruptly cleared.

Antecedents and outcomes of work engagement among nursing staff in long-term care facilities-A systematic review.

AIM: To determine antecedents and outcomes of work engagement (WE) among nursing staff in long-term care (LTC) using the Job Demand-Resources model. DESIGN: A systematic review following the Preferred Reporting Items for Systematic Review and Meta-Analysis statement and Synthesis Without Meta-analysis in systematic reviews guideline. A study protocol was registered in PROSPERO (registration number CRD42022336736). DATA SOURCES: The initial searches were performed in PsycInfo, Medline, Academic Search Premier, CINAHL and Scopus and yielded 3050 unique publications. Updated searches identified another 335 publications. Sixteen studies published from 2010 to 2022 were included. REVIEW METHODS: The screening of titles and abstracts, and subsequently full-text publications, was performed blinded by two author teams using the inclusion/exclusion criteria. When needed, a mutual consensus was obtained through discussion within and across the teams. A descriptive and narrative synthesis without a meta-analysis of the included studies was performed. RESULTS: The extent of research on WE in LTC facilities is limited and the factors examined are heterogeneous. Of forty-two unique antecedents and outcomes, only three factors were assessed in three or more studies. Antecedents-in particular job resources-are more commonly examined than outcomes. CONCLUSION: Existing literature offers scant evidence on antecedents and outcomes of WE among nursing staff in LTC facilities. Social support, learning and development opportunities and person-centred processes are the most examined factors, yet with ambiguous results. IMPACT: Antecedents and outcomes of engagement among nursing staff in LTC facilities have not previously been reviewed systematically. Engagement has been correlated with both more efficient and higher-quality service delivery. Our findings suggest opportunities to improve health and care services by enhancing engagement, whilst at the same time better caring for employees. This study lays the groundwork for more detailed research into the contributing factors and potential results of increasing caregivers' engagement. No patient or public contribution.

Nordic responses to covid-19 from a health promotion perspective.

On 30 January 2020, the disease covid-19 was declared by the World Health Organization to be an international threat to human health and on 11 March 2020, the outbreak was declared a pandemic. The aim of this study was to analyse policy strategies developed by the five Nordic countries during the first 3 months of the pandemic from a health promotion perspective in order to identify Nordic responses to the crisis. Although the Nordic countries have a long tradition of co-operation as well as similar social welfare policies and legislation, each country developed their own strategies towards the crisis. The strategies identified were analysed from a health promotion perspective emanating from five principles: intersectorality, sustainability, equity, empowerment and a lifecourse perspective. Denmark, Finland and Norway had lockdowns to varying degrees, whereas Sweden and Iceland had no lockdowns. Iceland implemented a test and tracking strategy from the very beginning. All countries based their recommendations and restrictions on appeals to solidarity and trust in institutions and fellow citizens. The analysis showed that the strategies in all countries could be related to health promotion principles with some differences between the countries especially regarding equity and sustainability. The Nordic governments took responsibility for protecting their citizens by developing policy strategies based on restrictions and recommendations congruent with the principles of health promotion. The findings also identified issues that will pose challenges for future pandemic strategies.

Sense of coherence in a general adult population in Northern Norway and its associations with oral health.

BACKGROUND: Sense of coherence (SOC) is a global orientation to life that may affect a person's way of acting and living within his or her life context, which can have an impact on general and oral health. The aims of this study were (i) to describe the distribution of SOC in a general adult population; (ii) to explore whether sociodemographic characteristics, oral health-related behaviours, self-reported oral health, and clinical oral status were associated with SOC; and (iii) to explore whether SOC was associated with self-reported oral health, controlling for sociodemographic characteristics, oral health-related behaviours, and oral clinical status. METHODS: This study was based on data from the cross-sectional population-based study Oral Health in Northern Norway (N = 1819 individuals, 923 women, mean age 47.1 ± 15.2 years). Data were collected between October 2013 and November 2014 in Troms County. Participants answered a questionnaire that included items on SOC, sociodemographic characteristics, oral health-related behaviours, and self-reported oral health. Clinical oral status (number of teeth, dental caries, and periodontal status) was determined through oral and radiographic examination. Linear regression analysis was used to examine factors associated with SOC. Logistic regression analysis was used to examine SOC and its association with self-reported oral health adjusted for sociodemographic characteristics, behaviours, and clinical oral status. RESULTS: The mean SOC score was 68.5 (standard deviation 10.5). The younger age groups (20-29 and 30-39 years) had mean SOC scores of 64.0 (95% CI: 62.7,65.3) and 67.2 (95% CI: 66.0,68.5), respectively, and the older age groups (40-79 years) had mean SOC scores between 69.8 and 70.1 (95% CI: 68.2,71.3). A higher mean SOC score was associated with older age, higher education level, higher income (all p < 0.001), being married/cohabiting (p = 0.005), and toothbrushing ≥ 2 times/day (p = 0.008). Approximately 49% of participants reported good oral health. SOC was positively associated with self-reported good oral health in the adjusted model (odds ratio:1.03 [95% CI: 1.02,1.05] p < 0.001). CONCLUSIONS: SOC was associated with sociodemographic characteristics and toothbrushing habits. There was no significant association between SOC and clinical oral status; however, SOC was positively associated with self-reported good oral health. This indicates that a person's SOC might have an impact on how an individual perceives their oral health, independent of sociodemographic characteristics and the presence of oral diseases.

Labor-force participation and working patterns among women and men who have survived cancer: A descriptive 9-year longitudinal cohort study.

AIMS: Our aim was to investigate labor-force participation, working hours, job changes, and education over 9 years among persons who have survived more than 10 years after cancer, and compare it to controls. METHODS: Register data on 2629 persons who survived cancer were stratified by gender and compared to data on 5258 matched controls. Persons who survived cancer were aged 30-50 when diagnosed with cancer and had a work contract prior to diagnosis. Descriptive analysis and t-tests were performed. RESULTS: The proportion of female persons who survived cancer in the labor force was reduced from 100% to 83.9% during follow-up, demonstrating a significant difference compared to controls for each year measured. The proportion of male persons who survived cancer dropped from 100% to 84.8%, but was only significantly different compared to controls in 2 years. The proportion of female persons who had survived cancer who worked full-time was lower in all years compared to both controls and male persons who survived cancer; in turn, male persons who had survived cancer worked full-time less than male controls. The proportion of female persons who had survived cancer who worked less than 20 hours per week increased compared to controls. The frequency of change of employer was higher among female persons who survived cancer compared to controls for some years, but no significant differences between male persons who survived cancer and controls were found. Female persons who survived cancer were in education more often than male persons who survived cancer. CONCLUSIONS: Persons who survived cancer experienced reduced labor-force participation and working hours 9 years after diagnosis, and the reduction was more pronounced for women than for men. Working patterns were also different between genders and between persons who survived cancer and controls.

Work Experiences During and After Treatment Among Self-Employed People with Cancer.

Purpose The proportion of self-employed people in the workforce is growing. However, most research on work participation among cancer survivors has focused on salaried workers. We aimed to explore how self-employed people experience work during and after cancer treatment. Methods In this qualitative study, we conducted semi-structured interviews with seven self-employed people who had been treated for cancer. To provide a variety of perspectives on work-related aspects of self-employed cancer survivors we also interviewed seven counselors in the Norwegian Labour and Welfare Administration (NAV) who had long experience in supporting self-employed people and cancer patients around work participation. The interviews were transcribed verbatim and thematic analysis was undertaken. Results Five themes related to owning a business during and after cancer treatment emerged: entrepreneurship and engagement; cancer treatment and late-effects; business-related worries; shame; and support. Because of high job engagement and high autonomy the self-employed survivors often worked during treatment. While working could provide a sense of normalcy and a distraction from cancer, it was also essential to keep the business running. Survivors struggled with several work-related issues (e.g. high work demands, low work ability), but financial issues related to running their business caused particular worry. Getting cancer and, consequently, struggling with financial problems elicited a sense of shame that was closely connected to their strong identity as (successful) self-employed business (wo)men. Conclusion To support self-employed cancer survivors to retain work following a cancer diagnosis it is necessary to focus on the specific challenges faced by this group of workers, particularly related to financial issues and keeping the business afloat. Support measures to secure production and thus prevent loss of customers and bankruptcy are needed. It is important for health and social care personnel to be aware that self-employed cancer survivors may suffer from shame related to the cancer, low work ability and financial struggles, but that they may have difficulties talking about this shame.

Work-Related Outcomes in Self-Employed Cancer Survivors: A European Multi-country Study.

Purpose To describe: (i) patterns of self-employment and social welfare provisions for self-employed and salaried workers in several European countries; (ii) work-related outcomes after cancer in self-employed people and to compare these with the work-related outcomes of salaried survivors within each sample; and (iii) work-related outcomes for self-employed cancer survivors across countries. Methods Data from 11 samples from seven European countries were included. All samples had cross-sectional survey data on work outcomes in self-employed and salaried cancer survivors who were working at time of diagnosis (n = 22-261 self-employed/101-1871 salaried). The samples included different cancers and assessed different outcomes at different times post-diagnosis. Results Fewer self-employed cancer survivors took time off work due to cancer compared to salaried survivors. More self-employed than salaried survivors worked post-diagnosis in almost all countries. Among those working at the time of survey, self-employed survivors had made a larger reduction in working hours compared to pre-diagnosis, but they still worked more hours per week post-diagnosis than salaried survivors. The self-employed had received less financial compensation when absent from work post-cancer, and more self-employed, than salaried, survivors reported a negative financial change due to the cancer. There were differences between self-employed and salaried survivors in physical job demands, work ability and quality-of-life but the direction and magnitude of the differences differed across countries. Conclusion Despite sample differences, self-employed survivors more often continued working during treatment and had, in general, worse financial outcomes than salaried cancer survivors. Other work-related outcomes differed in different directions across countries.

A Qualitative Study of Clinicians Experience with Rating of the Global Assessment of Functioning (GAF) Scale.

The severity of illness in psychiatry is rated using the Global Assessment of Functioning (GAF) scale. The GAF scale is often used in both research settings and in the clinic. The scale ranges from 1 to 100 and is subdivided into ten 10-point intervals, each with verbal rating instructions called anchor points and examples. GAF is an instrument that needs improvement. Studying clinicians' experiences with this rating system may be important for developing improvements. The aim of this study was to collect information from clinicians about their experiences with the GAF instrument, and to collect their ideas on how the GAF scale can be improved, particularly in the area of verbal instructions (i.e., anchor points and examples). Qualitative interviews were performed with 25 clinicians. Through this interview process, several weaknesses of the GAF scale were revealed. We found that clinicians have unique experiences that can be important for the development of a better GAF scale. Rating with the GAF scale also requires sufficient collection of patient information.

Facing unemployment: study protocol for the implementation and evaluation of a community-based intervention for psychological well-being promotion.

BACKGROUND: Economic crises and unemployment have profound impact on mental health and well-being. Main goal of the Healthy Employment (HE) project is to enhance intersectoral actions promoting mental health among unemployed, namely through the implementation and effectiveness-evaluation of short-term and sustainable group interventions. METHODS: The project follows a RE-AIM-based (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework for assessing a cognitive-behavioural and psychoeducational intervention that has been developed for promoting mental health among unemployed people. It is a short-term group intervention (five sessions, four hours each, 20 unemployed persons per group) focused on mental health literacy, interpersonal communication and of emotional regulation. Implementation of the intervention will be carried out by clinical psychologists, following a standardized procedure manual. Effectiveness will be assessed through a randomized field study with two arms (intervention and control). Participants are unemployed people (18-65 years old, both genders, having at least nine years of formal education) registered at public employment centres from different geographical regions for less than 12 months (including first-job seekers). Allocation to arms of the study will follow a random match-to-case process, considering gender, age groups and educational level. Three moments of evaluation will occur: before intervention (baseline), immediately after its ending and three months later. Main outcomes are mental health literacy, mental health related personal and perceived stigma, psychological well-being, satisfaction with life and resilience. Intention-to-treat and per-protocol analyses will be conducted. Cohen's d coefficient and odds ratio will be used for assessing the size of the intervention effect, when significant. DISCUSSION: Scientific and clinical knowledge will be applied to promote/protect psychological well-being of unemployed people. While the first phases of the project are funded by the European Economic Area Grants, long-term assessments of the intervention require a larger timeframe. Further funding and institutional support will be sought for this purpose. Already established intersectoral collaborations are key-assets to reach long-term sustainability of this project. TRIAL REGISTRATION: The study was registered with the Australian New Zealand Clinical Trials Registry; Prospectively registered number: ACTRN12616001432404 ; date of registration: 13 October 2016.

Gender differences in subjective health complaints in adolescence: The roles of self-esteem, stress from schoolwork and body dissatisfaction.

AIMS: The aims of this study were to examine subjective health complaints among Norwegian adolescents and assess the development of gender differences in subjective health complaints between age 14 and 16; to investigate whether self-esteem, stress from schoolwork or body dissatisfaction affected adolescents' subjective health complaints; and determine whether these factors could explain the excess of subjective health complaints among girls. METHODS: We used multiple linear regression analyses to analyse longitudinal survey data from 751 Norwegian adolescents at the ages of 14 and 16. The results from various cross-sectional and prospective analyses were compared. RESULTS: Girls reported more subjective health complaints than boys, and gender differences increased from age 14 to 16. Self-esteem and stress from schoolwork had cross-sectional and prospective associations with subjective health complaints. Stress from schoolwork at age 14 was also associated with changes in subjective health complaints from age 14 to 16. The cross-sectional mediation analyses indicated that self-esteem and stress from schoolwork accounted for 61% of the excess of subjective health complaints among girls at age 16. The same variables measured at age 14 accounted for 24% of the gender differences in subjective health complaints two years later. The investigated factors could not account for the increase in gender differences in subjective health complaints between ages 14 and 16. CONCLUSIONS: The findings showed that self-esteem and stress from schoolwork were associated with subjective health complaints during adolescence. These factors could partially explain the excess of subjective health complaints among girls.

Promoting health by addressing living conditions in Norwegian municipalities.

Worldwide, inequalities in health are increasing, even in well-developed welfare states such as Norway, which in 2012, saw a new public health act take effect that enshrined equity in health as national policy and devolved to municipalities' responsibility to act on the social determinants of health. The act deems governance structures and "Health in All Policies" approaches as important steering mechanisms for local health promotion. The aim of this study is to investigate whether Norway's municipalities address living conditions - economic circumstances, housing, employment and educational factors - in local health promotion, and what factors are associated with doing so. All Norway's municipalities (n= 428) were included in this cross-sectional study, and both register and survey data were used and were subjected to descriptive and bi- and multivariate regression analyses. Eighty-two percent of the municipalities reported that they were capable of reducing inequalities in health. Forty percent of the municipalities defined living conditions as a main challenge in their local public health promotion, while 48% cited it as a main health promotion priority. Our study shows that defining living conditions as a main challenge is positively associated with size of municipality, and also its assessment of its own capability in reducing inequalities in health. The latter factor was also associated with actually prioritizing living conditions in health promotion, as was having established cross-sectorial working groups or inter-municipal collaboration related to local health promotion. This study underlines the importance of inter-sectoral collaboration to promote health and well-being.

Health in All Policies: A cross-sectional study of the public health coordinators' role in Norwegian municipalities.

AIMS: The public health coordinator (PHC) is a municipal-government position in Norway whose role is to organise and oversee municipal policies and functions to support national public health goals. This cross-sectional study investigates conditions associated with use of PHCs by Norwegian municipalities in the period immediately before the new Public Health Act came into effect in 2012, decentralising responsibility for citizen health to the municipal level. This study provides descriptive baseline data regarding Norwegian municipalities' use of PHCs in this time - a marker for municipal engagement with inter-sectorial collaboration - before this policy was nationally mandated, and explores whether municipal characteristics such as structure, socio-economic status and extent of Health in All Policies (HiAP) implementation were associated factors. METHODS: All Norway's municipalities (N=428) were included. We combined Norwegian register data with survey data. Descriptive analyses and bi- and multivariate logistic regression analyses were performed. RESULTS: A total of 76% of Norwegian municipalities employed a PHC in the period just before 2012. Of the PHCs employed, 22% were employed full time and 28% were located within the staff of the chief executive office. Our study indicates that partnership for health promotion with county councils (OR=7.78), development of a health overview (OR=3.53), collaboration with non-government sectors (OR=2.85) and low socio-economic status (OR=0.46) are significantly associated with Norwegian municipalities having a PHC. CONCLUSIONS: This study suggests that the municipality's implementation of HiAP, as well as lower socio-economic indicators, is associated with the use of PHCs in Norway, but not factors related to municipal structure.

Is workplace health promotion research in the Nordic countries really on the right track?

AIMS: The aims of this scoping review of research on workplace health promotion interventions in the Nordic countries were to investigate: how the studies defined health; whether the studies intended to change the workplace itself (the settings approach); and whether the research focus regarding their definitions of health and use of settings approaches has changed in the past five-year period versus previous times. METHODS: Using scientific literature databases, we searched for intervention studies labelled as "health promotion" in an occupational setting in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) published from 1986 to 2014. We identified 63 publications and qualitatively analysed their content regarding health outcomes and their use of settings approaches. RESULTS: The reviewed studies focused primarily on preventing disease rather than promoting positive measures of health. In addition, most studies did not try to change the workplace but rather used the workplace as a convenient setting for reaching people to change their behaviour related to lifestyles and disease prevention. Participatory and non-participatory settings approaches to promote well-being and other positive health measures have been used to a minor degree. The recent studies' definitions of health and use of settings approaches did not differ much from the studies published earlier. CONCLUSIONS: workplace health promotion in the nordic countries should more often include positive health measures and settings approaches in intervention research it is important to anchor workplace health promotion among important stakeholders such as unions and employers by arguing that sustainable production is dependent on workers' health.

"Exploring job demands and resources influencing mental health and work engagement among physical therapists: a cross-sectional survey of Norwegian physical therapists."

BACKGROUND: Physical therapists play a vital role in the Norwegian health care system, and their work environment may be a significant determinant for their wellbeing and job performance. OBJECTIVE: 1) Assess differences in work environment, mental health problems, and work engagement between physical therapists working in specialist versus municipal health care services. 2) Assess the relationships between work environment factors and work engagement and mental health problems. METHODS: In this cross-sectional study, 273 physical therapists responded to the Survey for Workplace Health Promotion (response rate = 35%). Independent-sample t-tests, Pearson correlations, and multiple regression analyses were performed. RESULTS: This study did not find any significant differences between physical therapists working in Norwegian hospitals and therapists working in the municipal health care services. Analyses showed that general demands (ß = 0.21), fragmented work tasks (0.18), predictability (-0.17) and social support (-0.34) were associated with mental health problems, while meaningful work (0.41), the opportunity to use one's strengths and potential (0.14), and social support (0.25) were associated with higher work engagement. CONCLUSION: This study highlights the role of poor job design and professional isolation as hindrances to work engagement among physical therapists, whereas work related meaningfulness and peer support promote their health and wellbeing.

Change in employment status of 5-year cancer survivors.

AIMS: To follow the employment status of 5-year cancer survivors for 5 years after diagnosis with their first lifetime invasive cancer and to identify socio-demographic, work-related and cancer-related predictors of employment status after 5 years. METHODS: This prospective registry study concerned all 3278 people in Norway (18-61 years old) diagnosed with their first lifetime invasive cancer in 1999 and alive in 2004 and a cancer-free control group (n = 6368) matched by sex, age, educational level and employment status in 1998. RESULTS: The employment rate among male cancer survivors declined steadily every year, from 94% the year before diagnosis (1998) to 77% 5 years after diagnosis (2004). This change did not differ significantly from that of male controls. The employment rate of female survivors also declined steadily, from 87% (1998) to 69% (2004). This decline was greater than that among female controls, and in 2004 survivors had a significantly lower employment rate. For both men and women, the significant pre-diagnosis predictors of being employed in 2004 concerned higher socio-economic position. For both sexes, lung cancer survivors had the highest decline in employment rate, and male skin cancer survivors had a lower decline in employment rate than controls. Socio-demographic and work-related factors explained more of the variance in employment status than did cancer diagnosis. CONCLUSION: The employment rate among 5-year cancer survivors did not change significantly except for female survivors. Low socio-economic position is a risk factor for decline in employment rate and should be focused on to prevent cancer-related inequity.

Working environment, work engagement and mental health problems among occupational and physical therapists.

BACKGROUND: Working environment, work engagement and health among occupational and physical therapists in Norway have rarely been investigated. OBJECTIVES: (1) To compare the psychosocial working environment, work engagement and mental health problems of occupational therapists with those of physical therapists; (2) to compare the same measures among occupational therapists working in the specialist and municipal healthcare services, respectively; and (3) to identify job demands and resources that influence the work engagement and mental health problems of occupational therapists. MATERIAL AND METHODS: The Survey for Health Promoting Workplaces was used to collect data from 170 occupational therapists and 273 physical therapists (response rate =35%) working in specialist and municipal health care in Norway. Student's t-test, Pearson correlations and multiple regression analysis were used. RESULTS: Occupational therapists experienced higher job demands and poorer health than physical therapists. Occupational therapists in the municipal healthcare services were slightly more satisfied with their job resources than colleagues in specialist healthcare services. Meaningful work and the opportunity to use one's strengths and potential contributed the most to high work engagement. Low work engagement was the most important contributor to poor mental health. CONCLUSION AND SIGNIFICANCE: The mental health of occupational therapists seems to be closely related to the opportunity to perform high-quality therapy. It is important that work is organised so that occupational therapists have meaningful work tasks and opportunity to use their strengths and potential.

Worksite adjustments and work ability among employed cancer survivors.

OBJECTIVES: This study was conducted to determine how many cancer survivors (CSs) make worksite adjustments and what kinds of adjustments they make. Changes in work ability among employed CSs were explored, and clinical, sociodemographic, and work-related factors associated with the current total work ability were studied. METHODS: CSs of the ten most common invasive types of cancer for men and women in Norway completed a mailed questionnaire 15-39 months after being diagnosed with cancer. Included in the analyses were all participants who worked both at the time of diagnosis and at the time of the survey and who had not changed their labor force status since diagnosis (n = 563). The current total work ability was compared to the lifetime best (0-10 score). RESULTS: Twenty-six percent of the employed CSs had made adjustments at work, and the most common adjustment was changing the number of work hours per week. Despite the fact that 31% and 23% reported reduced physical and mental work abilities, respectively, more than 90% of the CSs reported that they coped well with their work demands. The mean total work ability score was high (8.6) among both men and women. Being self-employed and working part-time at the time of diagnosis showed significant negative correlations with total work ability, while a favorable psychosocial work environment showed a significant positive correlation. CSs with low work ability were more often in contact with the occupational health service and also made more worksite adjustments than others. CONCLUSION: The prospects of future work life seem optimistic for Norwegian employed CSs who return to work relatively soon after primary treatment.