Municipality-level differences in disability retirement in Finland: The contribution of local social characteristics.

AIMS: Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement. METHODS: Individual-level register data were supplemented with 10 municipality-level characteristics from various databases. A 20% sample of the Finnish population (N=626,391) was followed for transition to disability retirement from 2016 to 2019 using multilevel Weibull models. RESULTS: Of the total variation in the risk of disability retirement, 4.3% was attributed to the municipal-level and decreased to 1.8% when individual-level characteristics (gender, age, education level and entitlement to special reimbursement for medical expenses, reflecting morbidity) were controlled for. Further adjustment for municipality-level characteristics fully erased the differences between municipalities. The proportion of municipality-level variation was larger for disability retirement due to somatic illnesses than mental disorders. Of the municipality-level characteristics, socioeconomic structure, unemployment rate, poverty, net migration between municipalities, dependency ratio, the amount of tax revenue per capita and morbidity were associated with the risk of disability retirement. CONCLUSIONS: The municipality-level variation in the risk of disability retirement is largely explained by the individual characteristics of the inhabitants. However, various characteristics of the municipalities show associations with the risk of disability retirement. Recognizing such factors is essential for shaping policies that mitigate disability retirement risk.

Health-related quality of life among adults living with chronic non-communicable diseases in the Ho Municipality of Ghana: a health facility-based cross-sectional study.

BACKGROUND: Morbidity and mortality rates from chronic non-communicable diseases (CNCDs) are increasing globally. In Ghana, CNCDs account for 43% of all deaths. We examined the Health-Related Quality of Life (HRQoL) and associated factors among adults living with CNCDs in the Ho Municipality. METHODS: This was a health facility-based descriptive cross-sectional study among 432 adults living with cancer, diabetes, chronic kidney disease (CKD), stroke, and hypertension in the Ho Municipality of Ghana. The study adopted the EQ-5D-5L instrument and the Ugandan value set to compute respondents' HRQoL index. Quantile regression models were used in analysing the data with STATA v17.0 at 95% Confidence Intervals, and statistical significance set at p < 0.05. RESULTS: 63.7% of our respondents reported having a problem across the five dimensions of the EQ-5D-5L. The most problems were reported in the dimensions "Anxiety/Depression" (94.4%) and "Pain/Discomfort" (91.4%). Divorced/separated respondents (aOR=-0.52, 95% CI=-0.71, -0.33) and those living with comorbidities (aOR=-0.95, 95% CI=-0.15, -0.04,) were less likely to report high index for HRQoL. However, respondents diagnosed with CKD (aOR = 0.26, 95% CI = 0.10, 0.42), diabetes (aOR = 0.28, 95% CI = 0.11, 0.45), hypertension (aOR = 0.35, 95% CI = 0.19, 0.50) and stroke (aOR = 0.26, 95% CI = 0.11, 0.40) were more likely to report higher index than those diagnosed with cancer. CONCLUSION: Our study revealed elevated proportions of reported problems in the "Anxiety/Depression" and "Pain/Discomfort" dimensions, indicating noteworthy concerns in these areas of HRQoL. The prevalent issues reported across HRQoL dimensions are cause for concern, posing potential exacerbation of health conditions. We advocate for collaborative efforts from the Ministry of Health, Ghana Health Service, and relevant stakeholders to scrutinize and implement interventions targeting social and psychological factors. These efforts should specifically address contributors to diminished health-related quality of life, particularly among less educated, divorced, and comorbid individuals.

Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults.

Oral health care is essential, and digital training may influence healthcare professionals' attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals' experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals' attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

Allocating municipal services to individuals with complex rehabilitation needs - a discourse analysis of individual administrative decision letters.

BACKGROUND: Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs. METHODS: The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities' recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach. RESULTS: The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention. CONCLUSIONS: The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.

Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.

OBJECTIVE: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. DESIGN: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. RESULTS: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. CONCLUSIONS: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

The Norwegian Infection Control Act gave comprehensive responsibility and authority for local COVID-19 pandemic management to the municipalities and the Municipality Chief Medical Officers (MCMOs).The MCMOs highlighted several challenges and shortcomings of the municipal crisis preparedness, of which lack of detailed organizational plans was the most prominent.Teamwork, digital networking and collective sensemaking seemed to enhance pandemic collaboration and resilience within and across municipalities.Most MCMOs gained a leading role at a higher organizational level within the municipality through the COVID-19 pandemic.To strengthen future crisis management, arrangements must be made, both organizationally and financially, for preparedness to remain on the agenda even between epidemics and pandemics.

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Closing the equity deficit: Sustainability justice in municipal climate action planning in Waterloo region.

There is growing recognition that often well-intended climate action solutions perpetuate and exacerbate manifestations of colonialism and racism due to the lack of equity and justice considerations in designing and implementing these solutions. There is limited research exploring why the integration of these considerations are lacking in municipal climate action planning. This exploratory descriptive qualitative study explored how municipal actors perceive and understand equity and justice in municipal climate action planning as a step toward addressing this issue. Semistructured interviews were conducted with seven members of the core management group from ClimateAction Waterloo region, and a template analysis of the interview data resulted in six themes. Findings suggested that those involved in municipal climate action planning understand and perceive justice and equity considerations as important to their work, however, translating this understanding to practice is a challenge due to structural (governmental and societal) and capacity (limited time, funding, resources, and knowledge) barriers. By better understanding how key actors consider justice and equity, we identify shifting colonial mental models as a potential pathway for transformative change given the central role of these actors.

Synergizing remote sensing and ecological indicators (RSEIs) for evaluating ecological environmental quality (EEQ) in Asansol Municipal Corporation: an integrated approach.

Human activities have dramatically affected global ecology over the past few decades. Geospatial technologies provide quick, efficient, and quantitative evaluation of spatiotemporal changes in eco-environmental quality (EEQ). This study focuses on a novel approach called remote sensing-based ecological indicators (RSEIs), which has used Landsat imagery data to assess environmental conditions and their changing trends. Four ecological indicators, mainly heatness, dryness, wetness, and greenness, have been used to assess the EEQ in Asansol Municipal Corporation Region (AMCR). Assembling all the indicators to generate RSEI, the principal component analysis (PCA) approach was applied. Our findings show that wetness and greenness favorably impact the province's EEQ, whereas dryness and heat create a negative impact. The RSEI assessment revealed that 24.53 to 28.83% of the area was poor and very poor, whereas the areas with very good decreased from 18.80 to 4.01% from 2001 to 2021 due to urban expansion and industrialization. The relative importance analysis indicates that greenness has a positive relation with RSEI, and dryness and heatness have a negative relation with RSEI. Finally, the receiving operating characteristic (ROC) was used for validation (AUC-0.885) of the RSEI. This study offers valuable insights for ecological management decision-making, guiding planners, and policymakers.

Estimated number of deaths attributable to NO2, PM10, and PM2.5 pollution in the Municipality of Milan in 2019.

BACKGROUND: there is growing evidence that exposure to environmental pollutants affects health, including mortality, chronic diseases, and acute diseases. The World Health Organisation has recently revised downwards the safety thresholds for exposure to environmental pollutants. The City of Milan (CoM) has particularly high levels of pollution; this is due both to the presence of various emission sources and to climatic and orographic conditions. OBJECTIVES: to describe the health effects of exposure to pollutants, measured by deaths due to environmental exposure to NO2, PM10, and PM2.5 in 2019. DESIGN: observational study. Using a pollutant concentration estimation model, annual mean values of NO2, PM10, and PM2.5 were estimated for the CoM in 2019. The number of deaths attributable to each exposure was estimated using risk functions available in the literature; the values recommended by the new World Health Organisation guidelines were used as counterfactual exposure limits. SETTING AND PARTICIPANTS: the population assisted by the Agency for Health Protection of Milan and resident in the CoM on 01.01.2019, aged 30 years or older. The place of residence was georeferenced and the population was followed up until 31.12.2019. Deaths and their causes were obtained from the Causes of Death Registry. MAIN OUTCOME MEASURES: deaths attributable to exposure from non-accidental causes, cardiovascular diseases, respiratory diseases, and lung cancer were estimated. RESULTS: in 2019, the estimated annual average level of NO2 was 36.6 µg/m3, that of PM10 was 24.9 µg/m3, and that of PM2.5 was 22.4 µg/m3, with levels varying across the city area. Concerning exposure to NO2, in 2019 10% of deaths for natural causes were estimated to be attributable to annual mean levels of NO2 above 10 µg/m3. As regard PM2.5, 13% of deaths for natural causes and 18% of deaths from lung cancer were attributable to an annual mean level above 5 µg/m3. The impact of exposure to particulate matter on mortality does not seem to be the same in all the areas of the CoM. CONCLUSIONS: the health impact of exposure to airborne particulate matter in the CoM population is high. It is important that citizens, policy-makers, and stakeholders address this issue, because of its impact on both health and healthcare costs.

Community-Working Occupational Therapists' Involvement in Research and Development Projects in Norway.

The aim of this study was to explore community-working occupational therapists' involvement in research and development projects. A cross-sectional survey of occupational therapists working in community-based services in Norway (n = 617) was conducted. In all, 117 of the 617 participants responded that they were involved in research and development projects. Greater likelihood of participation in research and development work were found for occupational therapists who had completed further education. Current and prioritized research topics were professional development and the development of interprofessional and professional service designs for occupational therapy. Service and quality development, rehabilitation and technology were areas where more knowledge was considered needed. To increase the growth and success of occupational therapy research and development, it is important that more occupational therapists in the municipality continue to complete further education. High-quality occupational therapy practice should be based on research and development projects in the municipalities.