Contacts with general practitioner, sick leave and work participation after electrical injuries: a register-based, matched cohort study.

OBJECTIVE: Exposure to electrical current may cause injury with both mental and physiological consequences. This may lead to increased contacts with general practitioners (GP) and the injured person may develop reduced ability to work. We aimed to examine these outcomes in terms of work-participation, long-term sick leave and contacts with GPs. METHODS: In a matched cohort design, we identified 14 112 electrical injuries in two registries and matched these with both patients with distorsion injuries or eye injuries, and with persons from the same occupation, using year of injury, sex and age for matching. We defined the outcomes based on register information regarding contacts with GPs and public transfer income. After the injury, we determined if the person had a long-term sick leave episode during the first 6, 12 months and 5 years. We calculated work participation during the year and 5 years and the number of GP contacts in the year of the injury, the year after and 5 years after the injury and dichotomised this at twice the mean number of contacts in the study population. The associations were analysed using conditional logistic regression. RESULTS: We found increased risk for all defined outcomes, with the highest estimates in the occupation match. The risk estimates were similar over time. Adjusting for previous work participation increased the estimates slightly, whereas adjusting for previous contacts with GPs reduced the estimates. Restricting to those with at longer hospitalisation increased the estimates. CONCLUSION: Electrical injuries increase risk of long-term sick leave, low work participation and increased contacts with GPs.

Measurement properties of the musculoskeletal health questionnaire (MSK-HQ): a between country comparison.

BACKGROUND: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages. OBJECTIVE: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain. METHODS: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts. RESULTS: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients' own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8-10 points and 26% for the DK cohort and 6-8 points and 29% for the UK cohort. CONCLUSIONS: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.

The relationship between macroeconomic and industry-specific business cycle indicators and work-related injuries among Danish construction workers.

OBJECTIVES: The current study examines and compares the relationship between both macroeconomic and industry-specific business cycle indicators, and work-related injuries among construction workers in Denmark using emergency department (ED) injury data and also officially reported injuries to the Danish Working Environment Authority (WEA). METHODS: The correlations between ED and WEA injury data from the catchment area of Odense University Hospital during the period 1984-2010 were tested separately for variability and trend with two general macroeconomic indicators (gross domestic product and the Danish unemployment rate) and two construction industry-specific indicators (gross value added and the number of employees). RESULTS: The results show that injury rates increase during economic booms and decrease during recessions. However, the regression coefficients were generally weak for both the ED (range 0.14-0.20) and WEA injuries (range 0.13-0.36). Furthermore, although there is some variability in the strength of the relationship of the different business cycle indicators, the relationships are generally not stronger for the WEA injuries than for the ED injuries, except for general unemployment. Similarly, no substantial differences in strength of relation between industry-specific and macroeconomic indicators were identified. CONCLUSIONS: The study shows that there was no difference in the relationship between business cycle indicators, and WEA and ED injury data. This indicates that changes in reporting behaviour do not seem to play a major role in the relation between the business cycle and workplace injuries in a Danish context.

Patterns of work injuries: cases admitted to emergency room treatment compared to cases reported to the Danish Working Environment Authority during 2003-2010.

OBJECTIVE: To compare work injuries treated in an emergency department (ED) and injuries reported to the Danish Working Environment Authority (DWEA). METHODS: Work injuries of the ED, Odense University Hospital, and injuries from the geographical catchment area reported to the DWEA between 2003 and 2010 were included. The injuries included in both datasets were identified by merging the ED file and the DWEA file using the civil registry number and injury date information as key. RESULTS: Approximately 50 000 work injuries occurred in the catchment area of the ED. The intersection between the two injury registration systems was 16%. A major discordance concerned the type of injuries, as some injuries were seen frequently in the ED but not reported to the DWEA to any significant extent, for example 'eye injuries' and 'superficial lacerations or wounds'. On the other hand, some injuries are rarely seen in the ED, but often reported to the DWEA, for example 'low back pain'. Additionally, younger workers visit the ED more often than older workers, and injuries in the high risk sectors have the lowest reporting proportion. CONCLUSIONS: Neither the ED nor DWEA injury files alone give a complete picture of work injuries. But merged, they represent a significant number of injuries, taking into account differences in data sources, for example concerning uneven distribution of age, sex, type of injury and type of industry. Obviously, not all serious work related ED injuries resulting in lost work time are reported to the DWEA.

Work-related stressors and occurrence of adverse events in an ED.

OBJECTIVE: The purpose of this study was to investigate the relationship between 12 work-related stressors and the occurrence of adverse events in an emergency department (ED). METHODS: Nurses and physicians, working in an ED at a Danish regional hospital, filled out a questionnaire on occurrence and emotional impact of 12 work-related stressors after each shift during a 4-week period. The questionnaire also instructed the participants to describe any adverse events that they were involved in during the shift. RESULTS: Two hundred fourteen adverse events were reported during the 979 studied shifts. During the same period, only 27 adverse events were reported to the mandatory national reporting system, and only 10 of these were duplicates. A high variability of stressors and emotional impact among the different groups of participants was found. Linear regression analysis showed an association between involvement in adverse events and the occurrence and emotional impact of stressors across groups, whereas no significant association was found for age, seniority, shift type, or length. CONCLUSION: The study showed an association between the occurrence and impact of 12 work-related stressors and involvement in adverse events across the groups of participants. Furthermore, the study showed that most adverse events were not reported to the mandatory national reporting system.

Musculoskeletal Health Climate Is a Prognostic Determinant of Sickness Absence Among Female Eldercare Workers: A Prospective Cohort Study.

OBJECTIVES: The present study investigated the association between musculoskeletal health climate, that is, the shared perceptions among workers concerning musculoskeletal health, and sickness absence. METHODS: Questionnaire data on two domains of musculoskeletal health climate, perceived management priority (PMP) and pain acceptance at work (PAW), were collected at baseline. Data on sickness absence were extracted at 1-year follow-up. Data were analyzed using negative binomial multivariable regression. RESULTS: The final study population comprised 390 female eldercare workers. Compared with participants with low PMP scores, participants with high PMP scores had lower risk of sickness absence (incidence rate ratio, 0.6; 95% confidence interval, 0.4-0.9). Participants with high PAW scores had higher risk of sickness absence than participants with low PAW scores (incidence rate ratio, 1.4; 95% confidence interval, 0.9-2.2). CONCLUSIONS: The results showed an association between the musculoskeletal health climate and sickness absence.

SARS-CoV-2 Infection Rates Following Use of Regular Compared With Defective Respirators When Caring for COVID-19 Patients: A Retrospective Follow-up Study.

BACKGROUND: There is strong observational evidence that respirators are highly effective in protecting the users from being infected with Middle East respiratory syndrome and severe acute respiratory syndrome coronavirus (SARS-CoV), but the evidence for SARS-CoV-2 during daily work is limited. This study utilized a subset of healthcare workers' temporary use of a new brand respirator with frequent defects when caring for coronavirus disease 2019 (COVID-19) patients to assess the protective effect of regular respirators against SARS-CoV-2 infection. METHODS: We retrospectively followed 463 participants wearing a regular respirator and 168 wearing the new brand respirator day-by-day when caring for COVID-19 patients until testing polymerase chain reaction positive for SARS-CoV-2 between 27th December 2020 and 14th January 2021. RESULTS: We observed seven and eight incident SARS-CoV-2-infected cases. This corresponded with daily infection rates of 0.2 and 0.5%, an incidence rate ratio of 0.4 [95% confidence interval (CI) 0.1; 1.0], and an incidence rate difference of 0.3% (95% CI -0.1; 0.8) when comparing a regular with the new brand respirator. DISCUSSION: We regard the new brand respirator a sham intervention, and this study thus provides further evidence for the protective effect of respirators when exposed to SARS-CoV-2 virus.

Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel - a cross-sectional study.

BACKGROUND: Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. METHODS: Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. RESULTS: Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality. CONCLUSIONS: Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands.

Musculoskeletal health climate is associated with musculoskeletal pain and sickness absence among workers: a cross-sectional study.

OBJECTIVES: This study aimed to investigate whether a musculoskeletal health climate, expressing the shared perceptions among workers concerning musculoskeletal health, is associated with number of musculoskeletal pain sites and sickness absence. DESIGN: Cross-sectional study. SETTING: Six slaughterhouses from 2 companies in Denmark and 6 home-nursing units and 12 nursing homes from 1 municipality in Jutland, Denmark. PARTICIPANTS: A total of 1092 slaughter house workers and 410 care workers completed an online questionnaire from February to October 2019. OUTCOME MEASURES: The exposure variable was musculoskeletal health climate assessed by two domains; (1) perceived management priority of musculoskeletal health measured by a modified subscale from the Nordic Safety Climate Questionnaire and (2) work group pain acceptance which was a modified version of the activity engagement subscale of the chronic pain acceptance scale. Outcomes variables were number of musculoskeletal pain sites (0-6) and days with sickness absence. RESULTS: The associations between the two subscales, number of musculoskeletal pain sites and sickness absence were calculated using mixed linear and generalised estimating equation regression models. Higher perceived management priority scores were associated with a lower number of musculoskeletal pain sites across both job groups: ß=-.57 (95% CI -0.91 to -0.23) and sickness absence (>5 days) due to musculoskeletal pain prevalence ratio (PR) 0.79 (95% CI 0.57 to 1.08). In contrast higher work group pain acceptance scores were associated with higher number of musculoskeletal pain sites: ß=0.38 (0.11 to 0.66), whereas associations with sickness absences seemed to be modified by job groups; PR 1.59 care workers and PR 0.86 slaughterhouse workers. CONCLUSION: The observed relationship between musculoskeletal health climate, musculoskeletal pain sites and sickness absence indicate that cultural factors should receive increased attention in work place preventive interventions.

Incidence and immediate consequences of electrical shocks among Danish electricians: a cohort study.

OBJECTIVES: The health-related consequences of electrical shocks are mostly studied in patients from selected cohorts in hospital burn units, by making internal comparisons of subgroups, but without comparing them to unexposed individuals, or considering information regarding the preinjury health of the injured persons. Often, little is known about the details of the electrical shocks. Our purpose was to do a longitudinal study of Danish electrical workers, to monitor exposure to electrical shocks weekly over a 6-month period and to determine whether these shocks have short-term, health-related consequences. DESIGN: Prospective cohort study with weekly measurements. SETTING: Members of the Danish Union of Electricians. PARTICIPANTS: Of the 22 284 invited, 6960 electricians (31%) participated in the baseline data collection, and the participation rate in the weekly follow-up ranged from 61% to 81% during the 6 month follow-up. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was an electrical shock and secondary outcomes were the immediate health-related consequences of the shocks. RESULTS: A total of 2356 electrical shocks were reported by 1612 (23%) of the participants during the 26-week follow-up. Alternating current and voltage below 1000 V were the most common forms of electricity. In most cases, the fingers/hands were the entry and exit points, but many were unable to specify the exit point. The participants categorised 73% of the electrical shocks as 'not at all severe', and most of the shocks did not cause any immediate physical damage. However, flashbacks were more common than physical consequences. Only a few of the participants contacted health services following an electrical shock, and even fewer were absent from work. CONCLUSION: Nearly one-fourth of Danish electricians experienced one or more electrical shocks during a 26-week period, but most of the shocks are not perceived as severe, and have only limited immediate consequences.

Symptoms reported by SARS-CoV-2 seropositive and seronegative healthcare and administrative employees in Denmark from May to August 2020.

BACKGROUND: The distribution and nature of symptoms among SARS-CoV-2 infected individuals need to be clarified. METHODS: Between May and August 2020, 11 138 healthcare and administrative personnel from Central Denmark Region were tested for SARS-CoV-2 antibodies and subsequently completed a questionnaire. Symptom prevalence and overall duration for symptoms persisting for more than 30 days were calculated. Logistic regression models were used to estimate adjusted odds ratios (ORs) with 95% CIs. RESULTS: In total, 447 (4%) of the participants were SARS-CoV-2-seropositive. Loss of sense of smell and taste was reported by 50% of seropositives compared with 3% of seronegatives. Additionally, seropositives more frequently reported fever, dyspnoea, muscle or joint ache, fatigue, cough, headache and sore throat, and they were more likely to report symptoms persisting for more than 30 days. In adjusted models, they had a higher risk of reporting symptoms, with the strongest association observed for loss of sense of taste and smell (OR = 35.6; 95% CI: 28.6-44.3). CONCLUSION: In this large study, SARS-CoV-2-seropositive participants reported COVID-19-associated symptoms more frequently than those who were seronegative, especially loss of sense of taste and smell. Overall, their symptoms were also more likely to persist for more than 30 days.

Collaboration and patient safety at an emergency department - a qualitative case study.

Purpose The purpose of this paper is to examine how conflicts about collaboration between staff at different departments arose during the establishment of a new emergency department and how these conflicts affected the daily work and ultimately patient safety at the emergency department. Design/methodology/approach This qualitative single case study draws on qualitative semi-structured interviews and participant observation. The theoretical concepts "availability" and "receptiveness" as antecedents for collaboration will be applied in the analysis. Findings Close collaboration between departments was an essential precondition for the functioning of the new emergency department. The study shows how a lack of antecedents for collaboration affected the working relation and communication between employees and departments, which spurred negative feelings and reproduced conflicts. This situation was seen as a potential threat for the safety of the emergency patients. Research limitations/implications This study presents a single case study, at a specific point in time, and should be used as an illustrative example of how contextual and situational factors affect the working environment and through that patient safety. Originality/value Few studies provide an in-depth investigation of what actually takes place when collaboration between professional groups goes wrong and escalates, and how problems in collaboration may affect patient safety.

Learning and feedback from the Danish patient safety incident reporting system can be improved.

INTRODUCTION: The perceived usefulness of incident reporting systems is an important motivational factor for reporting. The usefulness may be facilitated by well-established feedback mechanisms and by learning processes. The aim of this study was to investigate how feedback mechanisms and learning processes were implemented at four Danish hospital units all located in one of the five Danish regions. METHODS: Based on the concepts of feedback and learning from incident processes, a questionnaire was developed and distributed to 335 patient safety representatives from 200 departments at four Danish hospital units in one of the five Danish regions. RESULTS: The study showed that external reporters were rarely contacted for dialogue, grouped front-line staff were sparsely involved in the learning process, few evaluated the effectiveness of implemented interventions and personal factors were frequently perceived as a primary contributory factor to these incidents. In contrast, the patient safety representatives perceived their competencies as sufficient for the job, internal reporters were often contacted for dialogue, evaluation was widely used and management supported the work with incident reports. CONCLUSIONS: The results of the study identified several shortcomings in the implementation of learning processes and feedback mechanisms. The apparent existence of a person-focused approach stands out as an element of notice. The insufficient implementation we observed indicates that there is room for improvement in the efforts made to maximise learning from incidents in the investigated population. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

Cross-cultural adaptation and validation of the Danish consensus version of the 10-item Perceived Stress Scale.

OBJECTIVES: The aims of the present study were to (i) cross-culturally adapt a Danish consensus version of the 10-item Perceived Stress Scale (PSS-10) and (ii) evaluate its psychometric properties in terms of agreement, reliability, validity, responsiveness, and interpretability among patients with work-related stress complaints. METHODS: A consensus-building process was performed involving the authors of the three previous Danish translations and the consensus version was back-translated into English and pilot-tested. Psychometric properties of the final version were examined in a sample of 64 patients with work-related stress complaints. RESULTS: The face validity, reliability, and internal consistency of the Danish consensus version of the PSS-10 were satisfactory, and convergent construct validity was confirmed. Receiver operating characteristic (ROC) curves of the change scores showed that the ability of the PSS-10 to correctly classify patients as improved or unchanged according to the patients' own judgment was acceptable. The estimates of minimal clinically important change were 11 points and 28% for absolute and relative change scores, respectively. CONCLUSION: The Danish consensus version of the PSS-10 appears to be feasible for use in clinical research settings and has good psychometric properties in terms of agreement, reliability, validity, responsiveness, and interpretability.

Work environment influences adverse events in an emergency department.

INTRODUCTION: The psychosocial work environment has been recognised as a factor that contributes to the occurrence of errors and adverse events at hospitals. There has been a strong focus on stress factors at intensive care units and emergency departments. The purpose of this study was to investigate the occurrence of adverse events and to examine the relationship between work-related stressors, safety culture and adverse events at an emergency department. MATERIAL AND METHODS: A total of 98 nurses and 26 doctors working in an emergency department at a Danish regional hospital filled out a questionnaire on the occurrence and pattern of adverse events, psychosocial work environment factors, safety climate and learning culture. RESULTS: The participants had experienced 742 adverse events during the previous month. The most frequent event types were lack of documents, referrals not performed, blood tests not available and lack of documentation. Problems related to reporting and learning and insufficient follow-up and feedback after serious events were the most frequent complaints. A poor patient safety climate and increased cognitive demands were significantly correlated to adverse events. CONCLUSION: This study supports previous findings of severe underreporting to the mandatory national reporting system. The issue of reporting bias related to self-reported data should be born in mind. Among work environment issues, the patient safety climate and stress factors related to cognitive demands had the highest impact on the occurrence of adverse events. FUNDING: The project was funded by Trygfonden (grant no 7-10-0949). TRIAL REGISTRATION: not relevant.