Work engagement: a practical measure for workplace health promotion?

The objectives of this study were to investigate whether psychological job demands, personal control and social support affect the negative health measure of depression differently than the positive measure of work engagement and to investigate whether work engagement mediates the effects of job demands and resources on the level of depression. We discuss the implications of using engagement as an outcome measure in workplace health promotion. We performed a cross-sectional questionnaire study among a general working population in Norway (n = 605). In the multivariate analysis, high psychological job demands as well as high control and social support correlated significantly with high work engagement. High demands as well as low control and social support correlated significantly with high levels of depression. When we included engagement as an independent variable together with demands, control and social support in the multivariate analysis, the positive correlation between demands and depression remained as well as the significant correlations between the level of depression and control and social support became non-significant. This indicates that engagement mediates the effects of control and social support on the level of depression. Encouraging enterprises to improve engagement in addition to focusing on preventing diseases may be worthwhile in workplace health promotion. Promoting engagement may have more positive organizational effects than a more traditional disease prevention focus, because engagement is contagious and closely related to good work performance and motivation.

Ranking of information in the computerized problem-oriented patient record.

We propose a framework for a problem-oriented patient record for general practice 1 and defend that the problem-oriented medical record represents an intuitive way to organize the patient record. By adding a layer of knowledge to the electronic patient record the record system is able to better utilize the information stored in the record. If a record system is process aware, having knowledge of work processes and is able to distinguish between different contexts in use, the system can provide relevant and useful information during the handling of patients' medical problems. Information is ranked according to its relevancy in a given context by using action patterns - traces. Traces give valuable indications of what is going on during the process of patient care. Decision frames represents relevant contexts based on the information in the record. Both decision frames and traces provide an environment in which more optimal medical decisions can be made.

Diffusion of Electronic Health Records and electronic communication in Norway.

OBJECTIVE: To assess the diffusion of Electronic Health Record (EHR) systems over time in Norwegian health care. METHODS: This study was based on a retrospective cross-sectional questionnaire survey. Questionnaires for three groups of responders were based on two validated questionnaires from prior studies, which were further customized through workshops. The questionnaires were sent to a random sample of 180 municipalities and 150 general practices in all 26 hospitals in Norway. RESULTS: The diffusion curves for EHR systems from 1980 to 2008 were established and analyzed. The most striking finding was the length of time from the availability of the first adequate EHR systems until full coverage was achieved in general practice and in hospitals. Diffusion of EHRs into nursing homes and maternal and child health centers started ten years later, and the diffusion for these centers has also been slow. In general practice the diffusion seems to follow the classical s-curve of diffusion. Costs and the increasing complexity of EHR systems were regarded by respondents as the most important challenges and concerns for the future. Resistance among health personnel was seen only as a small problem. CONCLUSION: National strategic processes account for the slow diffusion and complexity of EHR systems in the health sector.

[The mentally retarded in the local community--occurrence, causes, medical treatment and follow-up]. / Psykisk utviklingshemmede i lokalsamfunnet--utbredelse, årsaker, medisinsk behandling og oppfølging.

An epidemiological study of mentally retarded persons in a Norwegian municipality was carried out in order to collect data about prevalence, causes, medical treatment and follow-up. The number of mentally retarded was found to be twice the average for the country as a whole. The causes of mental retardation indicated that this was due to a low degree of urbanization--a stable population, larger families, more births at home and long distance from hospital. The survey revealed that medical care had been seriously neglected. Several patients had never been given a diagnosis, and the number of contacts with a doctor for any reason was far below the average for the rest of the local population. Several were found to have unknown impaired vision and hearing, and many were being inadequately treated for common diseases like migraine, myalgia, stomach pain, diarrhoea etc. The neglect was worse among those living at home than among those living in the institutions for the mentally retarded.

[Information systems for health and social care planning. Information basis and information channels in the municipalities]. / Informasjonssystemer i helse- og sosialplanleggingen. Informasjonsgrunnlag og informasjonskanaler i kommunene.

The Norwegian Government has started to develop a new system for a better exchange of information between the central and the local authorities when planning health and social services. The plan is to base the system on nationwide collection and delivery of standardized indicators which will signal trends and enable comparisons. Several conclusions from an interview survey indicate that the new information system will not be particularly useful. Local authorities believe that their information is good enough already, and have little confidence in statistics prepared by the central authorities. On the other hand many of them called for more statistics that would enable comparisons between neighbouring municipalities, and several had themselves taken the initiative to collect data on various local needs and activities.

Factors affecting primary health care utilization.

Using a one-stage random probability sample of households, 5806 people in an area of Norway were interviewed about illness, use of medicines, self-treatment and visits to the doctor in the previous two weeks. Several social and demographic variables that might influence primary health care utilization were divided into five categories: need of medical care; self-care; availability of the doctor; sociodemographic factors; social network factors. Multiple classification analysis was used for the statistical analysis. The greatest influence on the percentage of people seeing the doctor was the need for medical care, the second largest influence was self-care. The availability of the doctor had a different effect according to whether the illness was chronic or non-chronic. Difficulties in reaching the doctor reduced the number of consultations for non-chronic diseases while the opposite was the case for chronic diseases. Among the sociodemographic variables neither level of education nor income had any influence on utilization when other variables were taken into account. Increasing age, however, caused a large increase in the percentage seeing the doctor, except after the age of 85 years when there was a large drop in consultation rate despite increasing illness. Social network factors had little effect on health care utilization.

[Long-term results of treatment of overweight in self-help groups]. / Langtidsresultater ved slanking i selvhjelpsgrupper.

The long-term results achieved by people trying to lose weight by participating in organised self-help groups have previously been reported as quite satisfactory. Our objective was to explore whether a change of diet and treatment policy produced a change of outcome. We report the results of a survey among 1,340 earlier participants in self-help groups, randomly sampled from the files of group leaders all over Norway. 657 (49%) responded; the mean follow-up time since first group participation was three years. The survey results was supplemented by information from the group leaders' files. The participants had on average kept 62% of their initial weight-loss. 39% of the participants had kept their initial weight-loss or had gone further down in weight. The result is among the best reported in the literature. Even if all participants who did not respond had regained all initial weight-loss, 16% of the total sample would in fact have kept their weight-loss. Exercise and adherence to nutrition advice in the groups were factors pointing to positive long-term results.

[The mentally retarded in the local community--living conditions, family situation, school attendance, work, leisure and aid activities]. / Psykisk utviklingshemmede i lokalsamfunnet--boforhold, familiesituasjon, skolegang, arbeid, fritidstilbud og hjelpetiltak.

The Norwegian Government has decided to reform the care of the mentally retarded by closing the institutions and by placing the whole responsibility for all mentally retarded with the local authorities. The idea is to integrate the mentally retarded into the community in order to normalize their living conditions. A survey on the demand for housing, work, schooling, leisure activities and home support was carried out in order to establish the consequences of the reform. 3/4 of the whole group are adults, and both the group now living at home and the group in institutions will need new housing, either individually or in small groups. The same groups will have to be offered specially adopted work. Several have never attended school or at most have very incomplete schooling compared with what the law prescribes. Offers of leisure activities and home support will have to be expanded by three or four times the present level. An important finding was that the group who lived at home were in greatest need of the care and activities for which the local authorities will be responsible. They have very old parents and for many of them the situation will soon become critical. The reform will have large economic consequences, and the Government is willing to pay only a part of these costs.

[Restriction of medical criteria for disability pensions. Effects on the local level]. / Skjerpingen av de medisinske vilkårene for å få uførepensjon. Virkninger på lokalplanet.

The objective of the analysis presented in this article is to assess the impact on a local level of the revised eligibility criteria for disability pensions in Norway. The setting was five mainly rural municipalities on the North-West coast of Norway and the city of Trondheim. The project was carried out as a document analysis of a sample of rejected applications for disability pensions, as they appeared in social security records from 1990/91, before the revision to the law, and from 1992, after the revision. Among a total of 146 such cases, 118 (81%) were available for the document analysis. Some national statistics were used for purposes of comparison. The percentage of rejected applications increased in all municipalities for both men and women. The new regulations accounted for 25% of the rejected cases. 31% of the rejected applications from women were based on the narrower criteria, as opposed to 17% of the men's. The impacts of the 1991 regulations have been considerable. The increased rejection rate adds to a falling rate of applications for disability pensions since 1989/90, accounting for an almost 50% reduction in the yearly incidence rate of granted pensions in Norway from 1989 to 1993.

[What happens to patients not granted disability pension?]. / Hvordan går det med dem som får avslag på søknad om uførepensjon?

Subsequent to a recent (1991) narrowing of the medical legibility criteria for granting disability pensions in Norway, we wanted to follow up rejected applicants with regard to main sources of income. As setting were chosen five mainly rural municipalities on the North-West coast of Norway and the city of Trondheim. The study was carried out as a historic prospective study of a sample of rejected applicants for a disability pension, mainly based on follow-up data from local social security offices. Among a sample of 146 applicants rejected in 1990/91 and 1992, 143 (87 women and 56 men) were available for the analysis in March 1994. A rather stable 20% of the sample were occupationally active throughout three years of follow-up, this percentage being slightly higher among women than among men. In spite of the initial rejection, 25% had been granted a disability pension after two years. The rest received other kinds of public social support, or had left the labour market and had no social security support (mostly women).

[Exchange of information between community and central health authorities. Development of an EDP system for information processing in the communities]. / Informasjonsutveksling mellom kommunal og sentral helsetjenesteforvaltning. Utvikling av en EDB-løsning for behandling av informasjonen i kommunene.

The Ministry of Health and Social Affairs has started a research program introducing information technology into the float of information between central and local authorities. The prospect is to make a better platform for statistics and planning. This article describes the process of designing a computer program designed to meet the needs of the local authorities. The result is a program that integrates sending and receiving of data with preparation of the local annual report. An evaluation revealed that the need of such computer tools and support is greatest in the small municipalities.

[What are the possibilities for public health care in a system based on physicians' patient lists?]. / Hvilke muligheter gir fastlegeordningen til å utvikle samfunnsmedisinen?

In Norway, primary health care is characterised by decentralisation of both care of patients and general public health services to municipal level. In all but the larger municipalities, both these services are carried out by the same primary health care doctors. In order to strengthen the quality of the doctor-patient relationship, and the associated responsibility, four municipalities are testing out a system where all inhabitants are placed on a specific doctor's list. Since the design of the test primarily emphasises the doctor-patient relationship, many community health doctors and planners are concerned about how this will affect local public health tasks. The authors discuss the experiences from these four municipalities as regards the impact on public health tasks and suggest new ways of organising public health at municipal level based on the doctors' overall responsibility for their listed patients.

[Medically treated injuries in Surnadal 1990-91. Incidence, risk, alcohol and other contributory conditions]. / Legebehandlede personskader i Surnadal 1990-91. Insidenser, risiko, alkohol og andre medvirkende forhold.

98 injuries per 1,000 inhabitants are medically treated per year. 4% are due to violence and 1% are self-inflicted. 34% are accidents in the home. 20% are occupational accidents where the highest risk exists in industry, followed by agriculture. The calculated risk of accidents in schools and kindergartens is on the level of the average at work. Alcohol is a contributing factor in 63% of the injuries caused by violence and 29% of the cases of self-inflicted injuries. 26% of the persons injured in the streets were under the influence of alcohol, and 8% of those involved in traffic accidents and 5% in accidents at home. No cases of alcoholic influence were registered in accidents at work. 11% of the injured persons referred to hospital had drunk alcohol.

Short-term and long-term effects of lay groups on weight reduction.

Three groups participated in a slimming programme run by lay people. The course lasted eight weeks, and the average weight loss was about 7 kg both in a small well-controlled study of 33 women and in a much larger one comprising over 10,000 people. Both studies were prospective. The long-term effect was studied in a random sample of about 1000 people. After four years 30-35% of the participants had kept the initial weight loss or were still reducing their weight, and only 15% had regained all the lost weight or more. That this result was better than usual may be because the programme operated through small groups of eight to 12 members run by the obese people themselves. The "slim-club hostesses' had all been obese and had succeeded in losing weight in the same programme. Group pressure and competition may also be important. Finally, the programme tried to change life styles, encouraging more exercise and reduced consumption of alcohol. The combination of scientific methods (behaviour therapy) and lay work may provide a clue for solving obesity and other serious health problems.

[Alcohol consumption among adolescents in 3 municipalities. A survey of local variations in alcohol consumption]. / Alkoholkonsumet blant ungdom i tre kommuner. Kartlegging av lokale variasjoner i alkoholforbruk.

Drinking habits among 663 adolescents 14, 15, 17 and 18 years of age in three local communities were investigated by means of a questionnaire. Half had tasted alcohol already at the age of 14 years. The total amount consumed per person per year averaged 3.5 litres pure alcohol. Geographical variations in consumption were more than six-fold. At the age of 17 years, boys began to consume more than girls. In both sexes, home distilled spirits was the most common beverage obtained or provided illegally. The main reason for drinking alcohol seems to be to get drunk.

[Development of drinking habit among adolescents. Factors connected with alcohol consumption]. / Utvikling av alkoholvaner blant ungdom. Faktorer som har sammenheng med alkoholkonsumet.

Factors related to drinking habits among 663 adolescents 14, 15, 17 and 18 years old were investigated in three municipalities by means of a questionnaire. In a multiple regression analysis, variation in alcohol consumption was examined using several independent variables describing access to alcohol, behavioural factors, environmental influences, attitudes and demographic background. The most important factors predicting high alcohol consumption were early drinking debut, being away from home at night without the parents' knowledge, having friends who drink a lot and early high consumption of unhealthy foods such as soft drinks, peanuts and chips. All these factors were again related to upbringing and home environment.

[Information for planning and comparison in municipalities. Use of data from the EDP medical records in general practice]. / Informasjon til planlegging og sammenlikning i kommunene. Bruk av data fra EDB-journalen i allmennpraksis.

There is a lack of systematic data on primary care which can be used for purposes of planning and evaluation. Ordinary data from computer-based journals in general practice were collected in four municipalities. 25 general practitioners participated for four months in 1992. The validity and reliability of the data have been investigated. The computer-based journal provides accurate information on the number and kind of contacts, and on who uses the primary health services. It also tells the nature of each contact, whether it leads to a referral, a prescription or a laboratory test. It does not give exact data on illness rates in the population, but there is a relatively stable relationship between illness and the number of contacts in general practice. This makes it possible to compare the diagnoses made in different areas. The data from the computer-based journal is also a convenient way of comparing effectiveness and costs in general practice.

[Information for quality assurance and self-evaluation in general practice. Use of data from the EDP medical records in general practice]. / Informasjon til kvalitetssikring og selvevaluering i allmennpraksis. Bruk av data fra EDB-journalen i allmennpraksis.

A project was carried out to study the usefulness of ordinary data from computer-based journals for comparing practices. 20 general practitioners from four municipalities participated for four months in 1992. The computer-based journal provides accurate information on the number and kind of contacts with patients, and on who visits the general practitioner. It also tells what is done at each contact, such as a referral, prescription or laboratory tests. Using the International Classification of Primary Care (ICPC) even the most common diagnoses do not account for more than 3% of the consultations. The practice of the different doctors varies considerably as regards classifying consultations on a symptom level (ICPC 1-29) or a diagnosis level (ICPC 70-99). The results brought to light marked differences with regard to what general practitioners do, and what kind of problems their patients present. The patient populations differed to a lesser degree with respect to sex, age and social status. The findings provided an interesting and useful platform for group discussions among the participating doctors.

[What is the situation for rehabilitation money recipients after the support ceases?]. / Hvordan går det med mottakere av rehabiliteringspenger når stønaden opphører?

The objective was to follow up clients who had reached the newly imposed 52-week limit for medical rehabilitation benefits in order to clarify future main sources of income. The setting was five municipalities in the county of Sør-Trøndelag in Norway, including the city of Trondheim. The study was carried out as a two-year historic prospective study of a sample of recipients of medical rehabilitation benefits, based on follow-up data from local National Insurance of offices. Among a sample of 260 clients on medical rehabilitation per 30 June 1993, 250 were available for analysis in June 1995. After two years' follow-up, 12% were occupationally active while nearly half the sample had been granted a disability pension. A major change of status occurred during the last three months before July 1994. After two years of follow-up, nine out of ten clients were still receiving support from the National Insurance Scheme. 37% were still on time-limited benefits. These data provide little support for limiting the time on rehabilitation benefits with the objective of getting people back to work.

Patients, diagnoses and processes in general practice in the Nordic countries. An attempt to make data from computerised medical records available for comparable statistics.

OBJECTIVE: To try out a collection of a standard set of data from computerised medical records. DESIGN: Retrospective extraction of ordinary patient record information put into the computer by general practitioners. SETTING: Encounters in office hours in strategically selected practices or health centres in Denmark, Finland, Iceland, Norway and Sweden. SUBJECTS: 59 general practitioners and a total study population of 97475 persons. MAIN OUTCOME MEASURES: Proportions, crude and specific rates of encounters, diagnoses and processes. RESULTS: In a 4-week period there was a threefold difference in the office encounter rates between the participating sites in the Nordic countries. Gender and age patterns were similar despite these differences. An access to several different denominators revealed diverse patterns of referring to the specialist, prescribing, ordering blood tests, X-rays and physiotherapy. Data from computerised medical records agree well with earlier studies in the Nordic countries using other methods. CONCLUSIONS: This survey demonstrates that valid and reliable data for routine statistics are available from computerised medical records in general practice. The major obstacle extracting more epidemiological data from computerised medical records is caused by information in the databases not being uniquely linked to episodes of care.