Objectives
Despite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric ...disability, recovery, or death, by analysing sequences of labour market participation.
Methods
The RETIRE register database includes information regarding all persons (
n
= 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period.
Results
Only 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes.
Conclusions
The complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.
BackgroundIntegrating evidence-based midwifery practices improves healthcare quality for women and newborns, but an evidence-to-practice gap exists. Co-created quality improvement initiatives led by ...midwives could bridge this gap, prevent resource waste and ensure intervention relevance. However, how to co-create a midwife-led quality improvement intervention has not been scientifically explored.ObjectiveThe objective of this study is to describe the co-creation process and explore the needs and determinants of a midwife-led quality improvement targeting evidence-based midwifery practices.MethodsA qualitative deductive approach using the Consolidated Framework for Advancing Implementation Science was employed. An analysis matrix based on the framework was developed, and the data were coded according to categories. Data were gathered from interviews, focus group discussions, observations and workshops. New mothers and birth companions (n = 19) were included through convenience sampling. Midwives (n = 26), professional association representatives, educators, policymakers, managers, and doctors (n = 7) were purposely sampled.ResultsThe co-creation process of the midwife-led Quality Improvement intervention took place in four stages. Firstly, core elements of the intervention were established, featuring a group of midwife champions leading a quality improvement initiative using a train-the-trainers approach. Secondly, the intervention needs, context and determinants were explored, which showed knowledge and skills gaps, a lack of shared goals among staff, and limited resources. However, there was clear relevance, compatibility, and mission alignment for a midwife-led quality improvement at all levels. Thirdly, during co-creation workshops with new mothers and companions, the consensus was to prioritise improved intrapartum support, while workshops with midwives identified enhancing the use of birth positions and perineal protection as key focus areas for the forthcoming Quality Improvement intervention. Lastly, the findings guided intervention strategies, including peer-assisted learning, using existing structures, developing educational material, and building stakeholder relationships.ConclusionsThis study provides a practical example of a co-creation process for a midwife-led quality improvement intervention, which can be relevant in different maternity care settings.
•Quality improvement (QI) programs are warranted in sub-Saharan African countries owing to the existing substandard quality of care currently being associated with poor maternal and neonatal health ...outcomes.•Knowledge on costs and cost drivers for this and similar future Quality Improvement (QI) programs can inform implementation planning, budgeting, resource requirements and resource mobilization approaches both for scale-up and sustainability.•Implementation of evidence-based midwifery quality improvement (QI) practices (DBP, SSC, DCC practices) under the MIDWIZE framework is clinically feasible at reasonable economic and financial costs for a health facility (based on scenario 1 and 2 of implementation) in resource-constrained settings using the collaborative program implementation approaches.•From a programmatic scenario approach (scenario 3) that assumes that the health facility does not have donor funding, higher financial and economic costs to achieve similar adoption levels for the QI practices (DBP, SSC, DCC practices adoption levels in collaborative approaches) are required to be mobilized by the health facility through expanded budgetary allocation support as well as from alternative facility financing and resource mobilization strategies.•Reproductive health leaders, health facility managers and policy makers can use this information on scenarios of costs and resource requirements to project, plan, and budget for scaling the QI implementation in similar settings and in covering major costs drivers’ especially financial and economic costs for the capacity building for a QI leader.
Three evidence-based midwife-led care practices: dynamic birth positions (DBP), immediate skin-to-skin contact (SSC) with zero separation between mother and newborn, and delayed cord clamping (DCC), were implemented in four sub-Saharan African countries after an internet-based capacity building program for midwifery leadership in quality improvement (QI). Knowledge on costs of this QI initiative can inform resource mobilization for scale up and sustainability.
We estimated the costs and intermediate outcomes from the implementation of the three evidence-based practices under the midwife-led care (MIDWIZE) framework in a single facility in Kenya through a pre- and post-test implementation design. Daily observations for the level of practice on DBP, SSC and DCC was done at baseline for 1 week and continued during the 11 weeks of the training intervention. Three cost scenarios from the health facility perspective included: scenario 1; staff participation time costs ($515 USD), scenario 2; staff participation time costs plus hired trainer time costs, training material and logistical costs ($1318 USD) and scenario 3; staff participation time costs plus total program costs for the head trainer as the QI leader from the capacity building midwifery program ($8548 USD).
At baseline, the level of DBP and SSC practices per the guidelines was at 0 % while that of DCC was at 80 %. After 11 weeks, we observed an adoption of DBP practice of 36 % (N = 111 births), SSC practice of 79 % (N = 241 births), and no change in DCC practice. Major cost driver(s) were midwives’ participation time costs (56 %) for scenario 1 (collaborative), trainers’ material and logistic costs (55 %) in scenario 2(collaborative) and capacity building program costs for the trainer (QI lead) (94 %) in scenario 3 (programmatic). Costs per intermediate outcome were $2.3 USD per birth and $0.5 USD per birth adopting DBP and SSC respectively in Scenario 1; $6.0 USD per birth adopting DBP and $1.4 USD per birth adopting SSC in Scenario 2; $38.5 USD per birth adopting DBP and $8.8 USD per birth adopting SSC in scenario 3. The average hourly wage of the facility midwife was $4.7 USD.
Improving adoption of DBP and SSC practices can be done at reasonable facility costs under a collaborative MIDWIZE QI approach. In a programmatic approach, higher facility costs would be needed. This can inform resource mobilization for future QI in similar resource-constrained settings.
Abstract
Background
The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to ...the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services.
Methods
Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who became unemployed in 2017 (N = 1,999), their propensity matched controls (N = 1,999), and unmatched controls (N = 58,459) in a quasi-experimental design. Use of outpatient healthcare services was examined in one-month periods from 12 months before to 12 months after the onset of unemployment. Several socio-demographic factors, along with sickness and employment histories, were used for propensity score matching. Difference-in-differences analysis was used to measure the differences in the use of outpatient healthcare services between the unemployed and their matched controls.
Results
The use of healthcare services decreased significantly after the onset of unemployment. This was due to a decrease in the use of occupational healthcare services. No change related to job loss was observed in the use of public or private healthcare services. The number of healthcare visits increased again after the unemployment ended. Difference-in-differences analyses showed that compared to propensity score matched controls, becoming unemployed reduced the use of healthcare services.
Conclusions
When access to occupational healthcare services ceases, other healthcare services do not appear to fill the gap among those who become unemployed. Adequate healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status.
Key messages
• The overall use of outpatient healthcare services decreases significantly after job loss in Finland because of a decrease in the use of occupational healthcare services.
• Adequate and easily accessible healthcare services should be guaranteed to all population groups equally based on need, irrespective of the labour market status or other socio-demographic factors.
Abstract
Background
Understanding how the combination of unemployment and work disability affects future labour market pathways is important. We followed labour market pathways among those who were ...unemployed at the start of a sickness allowance spell.
Methods
Register data covered disability pensions (DP), rehabilitation spells, sickness allowance spells, unemployment spells and employment spells, retrieved for unemployed Finnish 18-58 years old persons who had a new sickness allowance spell in 2016. Sequence analysis and clustering were used to identify latent homogenous subgroups. Using multinomial regressions, demographic, socioeconomic, and disability-related covariates were examined.
Results
Preliminary analyses revealed six clusters with unique pathways and identities. 1) Unemployment; 2) Employment; 3) Rehabilitation spells, recurring disability and unemployment; 4) Unknown sources of income; 5) Permanent disability pension; and 6) Temporary disability pensions. Compared to the cluster with emphasis on return-to-work, other clusters were associated with less pre-LTSA employment days, having a pre-LTSA chronic illness, and a mental disorder.
Conclusions
Unemployed persons starting an LTSA have very different labour market pathways. For many, there are low chances for employment or regained work ability in the following years. Persons with poor health, long history outside employment, older age, low educational level and a mental disorder could benefit from targeted support.
Key messages
• Despite heterogeneous pathways found, for most of the unemployed, sickness allowance spells are followed by recurring unemployment, recurring sickness allowance, or disability retirement.
• Since the unemployed with work disability rarely regain work ability in the following years, supporting their work ability is crucial in preventing permanent exclusion from working life.
We use functionalized iron oxide magnetic multi-core particles of 100nm in size (hydrodynamic particle diameter) and AC susceptometry (ACS) methods to measure the binding reactions between the ...magnetic nanoparticles (MNPs) and bio-analyte products produced from DNA segments using the rolling circle amplification (RCA) method. We use sensitive induction detection techniques in order to measure the ACS response. The DNA is amplified via RCA to generate RCA coils with a specific size that is dependent on the amplification time. After about 75min of amplification we obtain an average RCA coil diameter of about 1µm. We determine a theoretical limit of detection (LOD) in the range of 11 attomole (corresponding to an analyte concentration of 55 fM for a sample volume of 200µL) from the ACS dynamic response after the MNPs have bound to the RCA coils and the measured ACS readout noise. We also discuss further possible improvements of the LOD.
•Biosensing using Brownian relaxation of functionalized magnetic nanoparticles.•Rolling circle amplification and magnetic nanoparticles enables biosensing.•Theoretical limit of detection estimated from the signal noise gives about 55fM.
•The net-based programme seems appropriate to the country contexts.•Leaders with various professional backgrounds strengthened the programme.•Midwives can work in interdisciplinary teams, providing ...effective midwifery practice.•The medical and midwifery associations can support the capacity building of midwives.•Collaboration between leaders in the countries can be achieved through an alumni network.
The Swedish care model MIDWIZE defined as midwife-led interdisciplinary care and zero separation between mother and newborn, was implemented in 2020–21 in Ethiopia, Kenya, Malawi, and Somalia in a capacity building programme funded by the Swedish Institute.
To determine the feasibility of using an internet-based capacity building programme contributing to effective midwifery practices in the labour rooms through implementation of dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of newborns in the immediate postnatal period.
The design is inspired by process evaluation. Focus group discussions with policy leaders, academicians, and clinicians who participated in the capacity building programme were carried out. Before and after the intervention, the numbers for dynamic birthing positions, delayed umbilical cord clamping and skin-to-skin care of the newborn in the immediate postnatal period were detected.
Participants believed the internet-based programme was appropriate for their countries’ contexts based on their need for improved leadership and collaboration, the need for strengthened human resources, and the vast need for improved outcomes of maternal and newborn health.
The findings provide insight into the feasibility to expand similar online capacity building programmes in collaboration with onsite policy leaders, academicians, and clinicians in sub-Saharan African countries with an agenda for improvements in maternal and child health.
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