Norway is internationally known today for its political and socio-economic prioritization of equity. The 2012 Public Health Act (PHA) aimed to further equity in the domain of health by addressing the ...social gradient in health. The PHA's main policy measures were (1) delegation to the municipal level of responsibility for identifying and targeting underserved groups and (2) the imposition on municipalities of a "Health in All Policies" (HiAP) approach where local policy-making generally is considered in light of public health impact. In addition, the act recommended municipalities employ a public health coordinator (PHC) and required a development of an overview of their citizens' health to reveal underserved social segments. This study investigates the relationship between changes in municipal use of HiAP tools (PHC and health overviews) with regard to the PHA implementation and municipal prioritization of fair distribution of social and economic resources among social groups.
Data from two surveys, conducted in 2011 and 2014, were merged with official register data. All Norwegian municipalities were included (N=428). Descriptive statistics as well as bi- and multivariate logistic regression analyses were performed.
Thirty-eight percent of the municipalities reported they generally considered fair distribution among social groups in local policy-making, while 70% considered fair distribution in their local health promotion initiatives. Developing health overviews after the PHA's implementation was positively associated with prioritizing fair distribution in political decision-making (odds ratio OR = 2.54; CI: 1.12-5.76), compared to municipalities that had not developed such overviews. However, the employment of PHCs after the implementation was negatively associated with prioritizing fair distribution in local health promotion initiatives (OR = 0.22; CI: 0.05-0.90), compared to municipalities without that position.
Development of health overviews - as requested by the PHA - may contribute to prioritization of fair distribution among social groups with regard to the social determinants of health at the local level.
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.
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.
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.
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 (
= 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.
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.
Aims: One of the goals of the Norwegian Public Health Act is to reduce health inequities. The act mandates the implementation of policies and measures with municipalities and county municipalities to ...accomplish this goal. The article explores the prerequisites for municipal capacity to reduce health inequities and how the capacity is built and sustained. Methods: The paper is a literature study of articles and reports using data from two surveys on the implementation of public health policies sent to all Norwegian municipalities: the first, a few months before the implementation of the Public Health Act in 2012; the second in 2014. Results: Six dimensions are included in the capacity concept. Leadership and governance refers to the regulating tool of laws that frame the local implementation of public health policies. Municipalities implement inter-sectoral working groups and public health coordinators to coordinate their public health policies and measures. Financing of public health is fragmented. Possibilities for municipalities to enter into partnerships with county municipalities are not equally distributed. Owing to the organisational structures, municipalities largely define public health as health policy. Workforce and competence refers to the employment of public health coordinators, and knowledge development refers to the mandated production of health overviews in municipalities. Conclusions: The capacity to reduce health inequities varies among municipalities. However, if municipalities build on the prerequisites they control, establishing inter-sectoral working groups and employing public health coordinators in authoritative positions, national governance instruments and regional resources may sustain their capacity.
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 crosssectorial 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.
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.
Pain after surgery remains a major health problem, calling for optimized treatment regimens to maximize the efficacy of pharmacological interventions. In this randomized controlled trial, we tested ...in a routine surgical treatment setting whether postoperative pain can be reduced by a brief preoperative intervention, ie, positive verbal suggestions in combination with sham acupuncture, designed to optimize treatment expectations. We hypothesized that the expectancy intervention as add-on to patient-controlled intravenous analgesia with morphine reduces patient-reported postoperative pain and improves satisfaction with analgesia. Ninety-six women undergoing breast cancer surgery were randomized at 2 stages: Before surgery, anesthesiologists delivered either positive or neutral verbal suggestions regarding the benefits of acupuncture needling on postoperative pain ("information condition"). Patients were then randomized to receive sham acupuncture or no sham acupuncture during postoperative care ("sham acupuncture condition"). Average pain during the 24-hour observation period after surgery as primary and satisfaction with analgesia as secondary outcome was assessed with standardized measures and analyzed with analysis of covariance accounting for morphine dose, surgery-related, and psychological parameters. Postoperative pain ratings were significantly reduced in patients who received positive treatment-related suggestions (F = 4.45, P = 0.038, main effect of information). Moreover, patients who received an intervention aimed at optimized treatment expectations reported significantly greater satisfaction with analgesia (F = 4.89, P = 0.030, interaction effect). Together, our proof-of-concept data support that optimizing treatment expectations through verbal suggestions may offer a promising approach to improve patient-reported outcomes. Future translational and clinical studies are needed to test such psychological strategies in different surgical interventions, patient groups, and pharmacological treatment regimens.
Die beiden gesetzgebenden Körperschaften der Bundesrepublik Deutschland, der Bundestag und der Bundesrat, prägen mit ihrer Arbeit maßgeblich den politischen Kurs und die Geschehnisse in der ...Bundesrepublik. Die Mikrofiche-Edition Verhandlungen des Bundestages und des Bundesrates macht die früher nicht veröffentlichte Parlamentsdokumentation einem weiten Kreis von Wissenschaftlern und Interessenten aus den Bereichen Zeitgeschichte und Politik in praktischer und platzsparender Form zugänglich. Da die Arbeit von Bundestag und Bundesrat in vielfältiger Weise ineinandergreift, ist diese Dokumentation von vornherein zusammenhängend angelegt. Die Edition enthält: * Alle stenographischen Berichte. Diese geben jede Sitzung des Bundestages und des Bundesrates in ihrem genauen Verlauf und Wortlaut wieder. * Alle Drucksachen. Diese bestehen aus Gesetzesvorlagen der Bundesregierung, von Parlamentariern oder vom Bundesrat; außerdem gehören internationale Vereinbarungen, parlamentarische Anfragen, Haushaltspläne, Berichte der Bundesregierung etc. dazu. * Umfassende und genaue Sachregister auf den Mikrofiches, die von der gemeinsamen Dokumentationsstelle von Bundestag und Bundesrat erstellt werden. Zusätzlich wird der Zugang zu den Themen jeder Wahlperiode durch die zum Lieferumfang gehörenden gedruckten Registerbände erleichtert. Das Ergebnis der parlamentarischen Arbeit wird hiermit als ein Stück selbstverständlicher Demokratie für Wissenschaftler, Gerichte und Behörden bereitgestellt.
Introduction
In rare disease areas representative data are scarce. Routine sick fund claims data provide a meaningful and reliable base for the in- and outpatient treatment landscape. This real-world ...data (RWE) from Germany was used to describe treatment patterns for Diffuse Large B-cell Lymphoma (DLBCL), the most frequent and aggressive non-Hodgkin lymphoma type in adults.
Methods
Claims data from several sick funds of 4.8 Million insured were analyzed. Diagnosis of non-follicular Lymphoma (C83) was confirmed in 2.178 patients, DLBCL (C83.3) in 819 patients. The analysis was age- and gender-adjusted, observational period was 2014 and 2015. Treatments were analyzed for hospitalization and medication based on ATC-Code, Pharma Central Number and coded diagnoses (per ICD).
Results
Mean age of DLBCL patients was 60.3 years, with two peaks at 50-54 and 70-74 years. Total costs for patients with DLBCL averaged 25.048 EUR versus 1.259 EUR in healthy insured. Charlson comorbidity index (CCI) of 4.58 indicates clinical relevance and severity. Comorbidities included several psychiatric diagnoses such as depression in every fifth patient. Mean 3.2 hospitalizations with average 31.5 hospital days were observed in DLBCL patients. Forty-seven percent of patients during observational time-frame did not receive oncological treatment, including relapsed / refractory patients. Only few patients received stem cell transplantation (2.6 percent) or radiation (3.9 percent). Most pharmacological treatments were Rituximab (RTX) + CHOP (57 percent), followed by RTX mono therapy (25 percent) or RTX in combination with Bendamustine (8 percent).
Conclusions
Despite limitations in sick fund claims analyses, these provide a reasonable database for rare diseases. They allow standard treatment pathway- and longitudinal analyses. All DLBCL patients frequently required hospitalization and generated significant costs. A high unmet medical need exists for treatments other than palliative care, especially for a tolerable and effective outpatient therapy in elderly relapsed / refractory DLBCL.
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