Publications by authors named "Karin Biering"

37 Publications

Mental disorders following electrical injuries-A register-based, matched cohort study.

PLoS One 2021 22;16(2):e0247317. Epub 2021 Feb 22.

Department of Occupational Medicine-University Research Clinic, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark.

Introduction: Electrical injuries happen every day in homes and workplaces. Not only may these injuries cause physical damage and disability, they may also cause mental disorders. The aim of this study was to investigate if persons with an electrical injury suffer from mental disorders in the following years.

Material And Methods: In a prospective matched cohort design, we identified 14.112 electrical injuries in two Danish registries and matched these with persons with dislocation/sprain injuries or eye injuries, respectively, as well as with persons from the workforce from the same occupation, using year of injury, sex and age as matching variables. We identified possible outcomes in terms of mental diagnoses in the Danish National Patient registry, based on literature, including reviews, original studies and case-reports as well as experiences from clinical praxis. The associations were analyzed using conditional cox- and logistic regression.

Results: We found that the following of the examined outcomes were associated with exposure to an electrical injury compared to the matched controls. Some of the outcomes showed the strongest associations shortly after the injury, namely 'mental disorders due to known physiological condition', 'anxiety and adjustment disorders', and especially the 'Post Traumatic Stress Disorder (PTSD)' subgroup. The same pattern was seen for 'Depression' although the associations were weaker. Other conditions took time to develop ('Somatoform disorders'), or were only present in the time to event analysis ('other non-psychotic mental disorders' and 'sleep disorders'). The findings were consistent in all three matches, with the highest risk estimates in the occupation match.

Conclusion: Electrical injuries may result in mental disorders, both acute and several years after. However, the absolute risk is limited as most of the outcomes are rare.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247317PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899322PMC
February 2021

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

Occup Environ Med 2021 01 2;78(1):54-60. Epub 2020 Nov 2.

Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, Herning, Denmark.

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.
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http://dx.doi.org/10.1136/oemed-2020-106858DOI Listing
January 2021

The long-term course of fatigue following breast cancer diagnosis.

J Patient Rep Outcomes 2020 May 18;4(1):37. Epub 2020 May 18.

AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark.

Purpose: Fatigue following breast cancer is a well-known problem, with both high and persistent prevalence. Previous studies suffer from lack of repeated measurements, late recruitment and short periods of follow-up. The course of fatigue from diagnosis and treatment to the long-time outcome status is unknown as well as differences in the level of fatigue between treatment regimens. The purpose of this study was to describe the long-time course of fatigue from the time of clinical suspicion of breast cancer, its dependence of patient characteristics and treatment regimens and the comparison with the course of fatigue among women with the same suspicion, but not diagnosed with breast cancer.

Methods: Three hundred thirty-two women referred to acute or subacute mammography was followed with questionnaires from before the mammography and up to 1500 days. Fatigue was measured by the Multidimensional Fatigue Inventory (MFI-20). The women reported their initial level of fatigue before the mammography and thus without knowledge of whether they had cancer or not. Both women with and without cancer were followed. Women with cancer were identified in the clinical database established by Danish Breast Cancer Cooperative Group (DBCG) to collect information on treatment regimen.

Results: Compared to fatigue scores before diagnosis, women with breast cancer reported a large increase of fatigue, especially in the first 6 months, followed by a slow decrease over time. Despite the long follow-up period, the women with breast cancer did not return to their level of fatigue at time of the mammography. Women without breast cancer, experienced a rapid decrease of fatigue after disproval of diagnosis followed by a steadier period.

Conclusions: Fatigue is a persistent problem in women diagnosed with breast cancer, even several years following diagnosis and treatment. The women with breast cancer were most affected by fatigue in the first 6 months after diagnosis.
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http://dx.doi.org/10.1186/s41687-020-00187-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235149PMC
May 2020

Subjective social status is an important determinant of perceived stress among adolescents: a cross-sectional study.

BMC Public Health 2020 Apr 16;20(1):396. Epub 2020 Apr 16.

Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, DK-7400, Herning, Denmark.

Background: Stress is an increasing public health problem, and the association between stress and subjective social status (SSS) among adolescents has received little attention. SSS in society have shown to be associated with perceived stress, but the association between SSS in school and stress has never been examined. The aim of this study was to explore the association between SSS and perceived stress in Danish adolescent boys and girls.

Methods: Data was collected in 2017 in frame of The Danish Occupation of Children and Adolescents Cohort (FOCA cohort), where Danish 9th graders (age 15/16) from 1746 schools participated in a survey (4527 girls, 3654 boys, aged 15 to 16 years). SSS in society and SSS in school were the exposure variables, and the level of perceived stress was the outcome variable. Associations between SSS in school and in society separately with perceived stress was analysed using linear regression models stratified by gender and adjusted to social and health-related factors (e.g. neighbourhood safety, home characteristics, grade meaning, homework load, self-rated health, smoking, alcohol consumption).

Results: The mean overall PSS score was 14.7; for girls the score was 16.3, and for boys it was 12.6. The analyses revealed a strong linear association between SSS, in both society and school, and perceived stress. The lower the SSS, the higher perceived stress. The associations were the same for both genders, but girls reported a higher level of stress than did boys.

Conclusion: We found that girls reported a higher level of perceived stress than boys. Furthermore, we found a strong association between low SSS in society and especially SSS in school and a high level of perceived stress among Danish adolescents.
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http://dx.doi.org/10.1186/s12889-020-08509-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161273PMC
April 2020

The Demand-Control model and work-related threats and violence: Short- and long-term associations.

Work 2020 ;65(3):573-580

Department of Psychology, University of Copenhagen, Denmark.

Background: Work-related violence and threats are frequent in human service sectors. Although previous studies have identified several psycho-social work environmental risk factors for work-related violence and threats, the research domain still remains mainly descriptive and non-theoretical in nature.

Objective: Using the Job-Demands-Control model we analysed the relationship between the psycho-social work environment and work-related threats and violence.

Method: Using a two-wave (2011 and 2015) longitudinal study of 2678 participants, we analysed the main and interactive effects of quantitative demands and job control on exposure to work-related violence and threats.

Results: High work demands and low job-control were associated with elevated risk of work-related threats in 2011 and in 2015. The associations of work demands and job control and work-related violence were mixed. There were not statistically significant interaction effects between high demands and low job control on neither work-related violence nor threats.

Conclusion: In sectors where work-related threats and violence are likely to occur, risk prevention may also require improving the work conditions for employees, more specifically by reducing work-demands and increasing job control for instance by differentiating between important and less important work demands and by implementing self-autonomous work-teams may be a way to increase job control.
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http://dx.doi.org/10.3233/WOR-203111DOI Listing
October 2020

Influences of childhood family factors on depressive symptoms in adolescence and early adulthood: A Danish longitudinal study.

Scand J Public Health 2020 Nov 21;48(7):715-725. Epub 2020 Jan 21.

Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Denmark.

The study examined the timing of family socio-economic factors during early (aged 0-8 years) and late (aged 9-14 years) childhood, as well as psychosocial variables in relation to depressive symptoms at the ages of 15, 18 and 21. This prospective cohort study included 3014 young people from western Denmark. Exposure variables were equivalised household income (income), mother's educational level and mother's labour market participation (LMP), derived from registers and self-reported variables family functioning, subjective social status and negative life events. The outcome variable was depressive symptoms. Associations were analysed using logistic regression, adjusted for other exposure variables and sex. In early childhood, mother's low LMP was associated with higher risk of depressive symptoms at the age of 15, whereas mother's low educational level and lower income was associated with higher risk of depressive symptoms at the age of 21. In late childhood, lower income, mother's low educational level and mother's low LMP was associated with higher risk of depressive symptoms at the ages of 15 and 21. Poorer family functioning was associated with depressive symptoms at the age of 15-21, with estimates ranging from 1.8 to 2.6. Reporting two or more negative life events were associated with depressive symptoms at the ages of 15 and 18.
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http://dx.doi.org/10.1177/1403494819870056DOI Listing
November 2020

Work-related exposure to violence or threats and risk of mental disorders and symptoms: a systematic review and meta-analysis.

Scand J Work Environ Health 2020 07 7;46(4):339-349. Epub 2020 Jan 7.

Department of Occupational and Environmental Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.

Objective This review aimed to examine systematically the epidemiological evidence linking work-related exposure to violence and threats thereof with risk of mental disorders and mental ill-health symptoms. Methods We searched PubMed, EMBASE, PsycINFO and Web of Science to identify original studies that provide quantitative risk estimates. The evidence was weighted according to completeness of reporting, potential common method bias, and bias due to differential selection and drop out, selective reporting, and misclassification of exposure and outcome. Results We identified 14 cross-sectional and 10 cohort studies with eligible risk estimates, of which 4 examined depressive disorder and reported an elevated risk among the exposed [pooled relative risk (RR) 1.42, 95% confidence interval (CI) 1.31-1.54, I =0%]. The occurrence of depressive and anxiety symptoms, burnout and psychological distress was examined in 17 studies (pooled RR 2.33, 95% CI 3.17, I =42%), and 3 studies examined risk of sleep disturbance (pooled RR 1.22, 95% CI 1.09-1.37, I2=0%). In most studies, common method bias and confounding could not be ruled out with confidence and strong heterogeneity in most outcome definitions invalidate the strict interpretation of most pooled risk estimates. Conclusion The reviewed studies consistently indicate associations between workplace violence and mental health problems. However, due to methodological limitations the causal associations (if any) may be stronger or weaker than the ones reported in this study. Prospective studies with independent and validated reporting of exposure and outcome and repeated follow-up with relevant intervals are highly warranted.
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http://dx.doi.org/10.5271/sjweh.3877DOI Listing
July 2020

Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study.

Qual Life Res 2020 May 3;29(5):1335-1347. Epub 2020 Jan 3.

AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, 7400, Herning, Denmark.

Purpose: We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRO-based follow-up).

Methods: We conducted a prospective cohort study among outpatients with epilepsy at the Department of Neurology at Aarhus University Hospital, Denmark. Included were all persons aged ≥ 15 years visiting the department for the first time during the period from May 2016 to May 2018. Patients received a questionnaire containing questions about health literacy, self-efficacy, patient activation, well-being, and general health. We also collected data regarding sociodemographic status, labour market affiliation, and co-morbidity from nationwide registers. Associations were analysed as time-to-event using the pseudo-value approach. Missing data were handled using multiple imputations.

Results: A total of 802 eligible patients were included in the register-based analyses and 411 patients (51%) responded to the questionnaire. The results based on data from registers indicated that patients were less likely to be referred to PRO-based follow-up if they lived alone, had low education or household income, received temporary or permanent social benefits, or if they had a psychiatric diagnosis. The results based on data from the questionnaire indicated that patients were less likely to be referred to PRO-based follow-up if they reported low levels of health literacy, self-efficacy, patient activation, well-being, or general health.

Conclusion: Both self-reported and register-based analyses indicated that socioeconomically advantaged patients were referred more often to PRO-based follow-up than socioeconomically disadvantaged patients.
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http://dx.doi.org/10.1007/s11136-019-02407-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190685PMC
May 2020

How does psychosocial stress affect the relationship between socioeconomic disadvantage and overweight and obesity? Examining Hemmingsson's model with data from a Danish longitudinal study.

BMC Public Health 2019 Nov 7;19(1):1475. Epub 2019 Nov 7.

Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400, Herning, Denmark.

Background: Chronic stress in childhood may increase the risk of overweight and obesity in young people. Erik Hemmingsson has suggested a new obesity causation model which focuses on psychosocial stress. The aim was to examine the associations between socioeconomic disadvantage and overweight and obesity and examine if these associations attenuate, when the effect of the different domains from Eric Hemmingsson's obesity causation model were taken into account.

Methods: A longitudinal study using data from The West Jutland Cohort Study (N = 2879). Outcome was overweight and obesity combined derived from self-reported weight and height at age 15, 18, 21 and 28 years. Exposure variables were equivalised household income, educational level and labour market participation of the mother derived from registers and psychosocial variables derived from questionnaires. A three-step adjustment model using logistic regression and stratified by gender was applied.

Results: Mother's low educational level was associated with a 3-fold increased odds of obesity in 18 year-old-girls, which attenuated when adjusting for the domains adult distress, disharmonious family environment and offspring distress. In 28 year-old girls, a 2.5-fold increased odds of obesity was observed, which attenuated when mutual adjusted for other socioeconomic variables and attenuated even further when adjusting for all the domains. In 18-year-old boys, a 3-fold increased odds of obesity was observed which attenuated after adjustments for adult distress, disharmonious family environment and offspring distress. In 21-year old boys, a four-fold increased odds of obesity was observed that attenuated after adjustments. At age 28 years, a three-fold increased odds of obesity was observed, which vanished in the fully adjusted model.

Conclusions: Our study confirms to some extent that the associations between socioeconomic disadvantage and overweight and obesity can be explained by the domains included in Erik Hemmingsson's model, although our results should be interpreted with caution. Adult distress, disharmonious family environment and offspring distress accounted for some of the association in girls, whereas in boys it was primarily offspring distress, which had the greatest impact. Young people's educational attainment can act as a buffer in the relationship between mother's lower educational level and obesity at age 28 years.
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http://dx.doi.org/10.1186/s12889-019-7699-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839153PMC
November 2019

Employees exposed to work-related threats and violence in human services sectors: Are any employees members particularly exposed to violence and threats and what role do supervisors play?

Work 2019 ;63(1):99-111

Danish Ramazzini Centre, Department of Occupational Medicine - University Research Clinic, Regional Hospital West Jutland, Herning, Denmark.

Background: The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others.

Objective: This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors.

Methods: Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses.

Results: We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant.

Conclusion: The results stress that effective prevention requires involvement of both employees and supervisors.
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http://dx.doi.org/10.3233/WOR-192911DOI Listing
July 2019

Depressive Symptoms Following Work-Related Violence and Threats and the Modifying Effect of Organizational Justice, Social Support, and Safety Perceptions.

J Interpers Violence 2019 Mar 2:886260519831386. Epub 2019 Mar 2.

1 Regional Hospital West Jutland, Herning, Denmark.

Work-related threats and violence is a major occupational hazard and the consequences for victims may be a range of physical and psychological symptoms. The purpose of this study was to examine the associations between exposure to work-related violence and threats and subsequent risk for depression and to examine whether the associations were modified by social support, organizational justice and safety perceptions. Questionnaire data was collected in 2010, 2011 and in 2015. A total of 5,342 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Services (PPS) participated in the first round in 2010. The analysis was performed by multivariate logistic regression. Staff exposed for work-related threats and violence had an increased risk for depression compared to non-exposed staff. The risk was highest for staff working in PPS. Compared to low levels, there were a tendency for high levels of social support, organizational justice and safety perception to attenuate the associations between work-related threats and violence and depression. However, none of the differences were statistically significant. Many employees working in human service sectors are exposed to work-related threats and violence which increases the risk for depression. The risk for depression following work-related threats and violence may be modified by social support, organizational justice and the perception of safety workplace. It is recommended that workplaces adopt an integrated organizational approach including both prevention of work-related threats and violence and intervention to modify the health consequences of work-related threats and violence.
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http://dx.doi.org/10.1177/0886260519831386DOI Listing
March 2019

How does childhood socioeconomic position affect overweight and obesity in adolescence and early adulthood: a longitudinal study.

BMC Obes 2018 3;5:34. Epub 2018 Dec 3.

1Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Gl. Landevej 61, 7400 Herning, Denmark.

Background: Childhood socioeconomic position (SEP) has previously been associated with increased risk of overweight among children and adolescents. However, it remains uncertain whether the timing of exposure is important in relation to developing overweight in early adulthood. We aimed to examine how SEP during early (0-8 years) and late childhood (9-14 years) relates to overweight at age 15, 18 and 21.

Methods: Longitudinal study in Western Denmark of 2879 young people (aged 15 in 2004). Exposure variables from registers were yearly household income, parental highest educational level and parental labour market participation (LMP), supplemented with questionnaire information about "family functioning" (age 15). Outcome variables were overweight and obesity, measured at three-time points.We analyzed the adjusted associations between childhood SEP and overweight and obesity using multinomial logistic regression, stratified on gender.

Results: Parental lower educational level increased girls' risk of overweight and obesity at age 18 and 21 between RR = 1.8 (95% CI 1.0;3.4) and RR = 5.2 (95% CI 1.4;19.3). Girls reporting poor "family functioning" had up to twice the risk of overweight and obesity at age 21. Boys, whose fathers had a lower level of education had up to 2.4 times the risk of obesity at age 21. Parental low LMP increased boys' risk of obesity at age 18 and 21 between RR = 2.2 (95% CI 1.3;3.8) and RR = 2.8 (95% CI 1.3;6.1). Parental lower level of education tripled the risk of overweight and obesity among girls at age 18 and among both genders at age 21.

Conclusion: This study confirmed to some extent that economic, social and psychological insecurity and inequality as measured by lower parental educational level, lower household income, low labour market participation and poor family function during childhood was associated with an increased risk of overweight and especially obesity in adolescence and early adulthood in both genders. Despite some imprecise measures, the direction of the associations pointed to several associations, which all were in the hypothesized direction. Timing of lower household income and parental low LMP in childhood seemed to be gender-specific in some way, but this warrants more studies.
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http://dx.doi.org/10.1186/s40608-018-0210-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276194PMC
December 2018

Work-related threats and violence and post-traumatic symptoms in four high-risk occupations: short- and long-term symptoms.

Int Arch Occup Environ Health 2019 Feb 30;92(2):195-208. Epub 2018 Oct 30.

Department of Occupational Medicine, Regional Hospital West Jutland, Herning, Denmark.

Objectives: To examine the associations between exposure to work-related violence and threats and subsequent PTSD among males and females in four high-risk occupations in human service work. Furthermore, we examined the modifying effect of coping style and self-efficacy.

Methods: Questionnaire data were collected in 2011 and in 2015 from 2678 employees working in psychiatric wards, in the elder sector, in special schools and in the Prison and Probation Service (PPS). Exposure to work-related violence and threats was measured in 2011, while PTSD was measured in 2011 and 2015 by the Impact of Event Scale-Revised. To assess the associations, logistic regression was conducted, adjusted for bullying, sexual harassment, negative acts, conflicts at work, other private traumas and baseline PTSD.

Results: There was an association between work-related threats and PTSD in 2011 and 2015. Furthermore, there was an association between work-related violence and PTSD in 2011. The associations were strongest in the PPS. Male staff had a higher risk for PTSD. Neither coping style nor self-efficacy did modify the associations between exposure to work-related violence and threats and subsequent PTSD.

Conclusion: The prevention of PTSD following work-related violence and threats should first of all be based on reducing the risk of work-related violence. In addition, supervisors should be trained to detect symptoms of PTSD after exposure to traumatic events.
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http://dx.doi.org/10.1007/s00420-018-1369-5DOI Listing
February 2019

Do frequent exposures to threats and violence at work affect later workforce participation?

Int Arch Occup Environ Health 2018 May 19;91(4):457-465. Epub 2018 Feb 19.

Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, 7400, Herning, Denmark.

Purpose: Threats and violence at work are common problems in the human service sector. It can result in physical and psychological health symptoms. The aim of this study was to examine the association between exposure to threats and violence and workforce participation in four human service sectors.

Methods: 5170 employees answered questionnaires about threats and violence in 2010 and were followed in a register for public transfer incomes for 3.5 years to identify episodes of sick leave, general workforce participation, and permanent health-related benefits.

Results: We found associations between exposures to threats and violence at work and workforce participation, though only a few specific types of threats and violence were associated on their own. Self-rated severity of both threatening and violent episodes was associated with overall low workforce participation, new sick leave episodes, and permanent health-related benefits. However, the latter was not statistically significant. The same pattern seems to be present in the relation between the total amount of exposure to threats and violence (threats score and violence score), respectively, and overall low workforce participation and new sick leave episodes. The threats score was also related to permanent health-related benefits.

Conclusion: Exposure to threats and violence is associated with temporary and permanent health-related benefits as well as with low workforce participation in general, although some of the associations were not statistically significant.
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http://dx.doi.org/10.1007/s00420-018-1295-6DOI Listing
May 2018

Work-related threats and violence in human service sectors: The importance of the psycho-social work environment examined in a multilevel prospective study.

Work 2018 ;59(1):141-154

Danish Ramazzini Centre, Department of Occupational Medicine-University Research Clinic, Regional Hospital West Jutland, Herning, Denmark.

Background: Threats and violence at work are major concerns for employees in many human service sectors. The prevention of work-related violence is a major challenge for employees and management.

Objective: The purpose of this study was to identify prospective associations between psycho-social work environment and work-related threats and violence in four high risk human service sectors.

Methods: Questionnaire data was collected from 3011 employees working at psychiatric wards, in the elder sector, in the Prison and Probation Service and at Special Schools. Associations between psycho-social work environment and work-related violence and threats were then studied using a one-year follow-up design and multilevel logistic regression analyses.

Results: The analyses showed that quantitative demands, high emotional demands, low level of influence over own work-situation, low predictability, low rewards at work, low role clarity, many role conflicts, many work-family conflicts and low organizational justice had statistically significant associations with high levels of work-related threats. Furthermore, high emotional demands, low predictability, low role clarity, many role conflicts, many work-family conflicts, low supervisor quality and low support from nearest supervisor had statistically significant associations with high levels of work-related violence. Finally, across the four sectors both similar and different associations between psycho-social work environment and work-related violence and threats were found.

Conclusion: The results of the study underline the importance of including the psycho-social work environment as a supplement to existing violence prevention methods and interventions aimed at reducing work-related violence and threats.
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http://dx.doi.org/10.3233/WOR-172654DOI Listing
September 2018

Long-term prognosis for neck-shoulder pain and disorders: a 14-year follow-up study.

Occup Environ Med 2018 02 23;75(2):90-97. Epub 2017 Aug 23.

Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland, University Research Clinic, Herning, Denmark.

Objectives: The long-term prognosis for neck-shoulder pain and disorders and the impact of shoulder exposure among former sewing machine operators were investigated in a 14-year follow-up study.

Methods: Information on neck-shoulder pain and disorders was collected by questionnaire and clinical examination at baseline in 243 female sewing machine operators and by questionnaire 14 years later. During follow-up, information on comorbidity and job exposures was obtained from registers and by linking register-based D-ISCO 88 codes with a job exposure matrix. Logistic regression analyses were performed to examine associations between neck-shoulder pain and disorders at baseline and neck-shoulder pain and physical functioning at follow-up.

Results: We found an association between neck-shoulder disorders at baseline and neck-shoulder pain at follow-up (OR 5.9;95% CI 1.9 to 17.7), and between neck-shoulder pain at baseline and neck-shoulder pain at follow-up (OR 8.2;95% CI 3.5 to 19.2). Associations between neck-shoulder disorders and pain at baseline and limited physical functioning at follow-up had ORs of 5.0 (95% CI 1.5 to 16.1) and 2.2 (95% CI 1.1 to 4.6), respectively. In women still working in 2008, the association between neck-shoulder pain in 1994 and in 2008 seemed to be stronger for those in jobs with high job shoulder exposure.

Conclusions: The results suggest a long-term adverse prognosis for neck-shoulder pain. High job shoulder exposure can worsen this prognosis for those who continue working. This knowledge could influence the counselling given to similar workers and emphasises the need to prevent neck-shoulder pain.
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http://dx.doi.org/10.1136/oemed-2017-104422DOI Listing
February 2018

Return to work after work-related stress: a randomized controlled trial of a work-focused cognitive behavioral intervention.

Scand J Work Environ Health 2017 09 26;43(5):436-446. Epub 2017 Jun 26.

Danish Ramazzini Centre, Dept. of Occupational Medicine, The Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.

Objectives This study aimed to evaluate the effect of a stress management intervention (SMI) on lasting return to work (RTW) among patients with work-related stress complaints. Methods Sickness benefit departments from three local municipalities referred patients on sick leave with work-related adjustment disorders or mild depression to the Department of Occupational Medicine, Regional Hospital West Jutland. A 2× randomization procedure allocated patients into one of three groups: intervention (N=58), control A (which received a clinical assessment; N=56), or control B (no assessment; N=49). Treatment comprised individual work-focused cognitive behavioral therapy (CBT) with an optional workplace intervention. The outcome was time until lasting RTW (16 and 44 weeks follow-up) using register data. Results Median number of weeks until lasting RTW was 15, 19, and 32 for the intervention group, control A, and control B respectively. However, for group B, clinical assessment was not part of the inclusion process, which may have introduced selection bias. In the fully-adjusted Cox regression model, the intervention group exhibited significantly faster lasting RTW at 44 weeks; hazard ratio (HR) 1.57 [95% confidence interval (95% CI) 1.01-2.44] relative to control group A, with a non-significant trend evident at 16 weeks; HR 1.70 (95% CI 0.94-3.10), when controlling for age, gender, occupation, sick leave during previous year, full or partial sick leave, and diagnosis. Unadjusted analyses remained directionally consistent but were reduced to marginal significance. Conclusions There was a tendency towards faster lasting RTW in the intervention group compared to control A, which received clinical assessment, in all analyses. The intervention group returned to work about 4 weeks earlier than control A, which could translate into substantial financial gains.
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http://dx.doi.org/10.5271/sjweh.3655DOI Listing
September 2017

Correction: .

Authors:
Karin Biering

Occup Environ Med 2017 07;74(7):542

Department of Occupational Medicine, Regional Hospital West Jutland, DK-7400 Herning, Denmark.

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http://dx.doi.org/10.1136/oemed-2016-103681corr1DOI Listing
July 2017

Neck-Shoulder Pain and Work Status among Former Sewing Machine Operators: A 14-year Follow-up Study.

J Occup Rehabil 2018 03;28(1):80-88

Department of Occupational Medicine, Danish Ramazzini Centre, Regional Hospital West Jutland - University Research Clinic, Gl. Landevej 61, 7400, Herning, Denmark.

Purpose A total of 243 Danish female sewing machine operators lost their jobs in 1996 because of outsourcing. The aim was to investigate the employment status during follow-up from 1996 to 2008, and to estimate to what extent former neck-shoulder pain had an impact on later work participation. Methods Assessment of neck-shoulder pain was based on questionnaires completed in 1994. The Danish Register-Based Evaluation of Marginalization (DREAM) register was used to describe employment status during the follow-up period. Register data were explored by sequence analyses and graphics, and the association between neck-shoulder pain and work participation was analyzed by logistic regression analysis. Results In all, 987 working years were lost during follow-up, and a sequence index plot revealed interrupted and heterogeneous courses of incomes. The odds ratio between neck and shoulder pain and a work participation score less than 75% was 1.49 (95% CI 0.84-2.67). Conclusions After outsourcing of the textile industry, the former sewing machine operators had decreased work participation and frequent transitions between different income types. Previous neck-shoulder pain tended to be associated with poor work participation. The results suggest that increased attention should be to given to dismissed workers from other industries that become outsourced, especially unskilled workers with similar work-related health limitations. Additionally, we concluded that time-to-event measures in research involving employment status are insufficient because of the many transitions that take place in working life.
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http://dx.doi.org/10.1007/s10926-017-9702-5DOI Listing
March 2018

Work injuries among migrant workers in Denmark.

Occup Environ Med 2017 03 22;74(4):235-242. Epub 2016 Aug 22.

Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark.

Objectives: Work migration into Denmark has increased during the recent decades, especially after the enlargement of the European Union (EU) in 2004. Whether or not migrant workers experience more work injuries than the native workforce has been debated and results are conflicting, most likely due to methodological difficulties and cultural disparities. We set out to meet these challenges using population-based work injury registers, targeting a specific and representative region in Denmark.

Methods: This population-based study used data on work injuries from an emergency department (ED) and reported injuries from the ED's catchment area to the Danish Working Environment Authority during 11 years. We calculated incidences of work injury for groups of migrant workers compared with native Danes and adjusted incidence rate ratios based on information on the complete working population.

Results: The incidences of work injuries among migrant workers from the new EU countries and from the rest of the world were higher compared with Danish workers and workers from the old EU countries and other Western countries. Especially migrants older than 30 years and in low-risk industries were at higher risk. Workers who had migrated recently were at even higher risk.

Conclusions: We found increased risk of work injuries among migrant workers. Studying migrants in registers is a methodological challenge as some migrants are not registered, for legal or illegal reasons; thus, only a selected group is studied, but this may most likely underestimate the risk.
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http://dx.doi.org/10.1136/oemed-2016-103681DOI Listing
March 2017

Self-rated health and return to work after first-time stroke.

J Rehabil Med 2016 Apr;48(4):339-45

AmbuFlex, Regional Hospital Jutland, Gl. Landevej 61, DK-7400 Herning, Denmark.

Objective: Self-rated health is an essential aspect of life after stroke, and return to work is considered one of the most important outcomes for younger stroke patients. The aim of this study was to examine whether self-rated health 3 months after stroke, clinical and demographic determinants are independently associated with return to work and subsequent work-stability.

Material And Methods: A total of 590 patients with first-time stroke were included from a Danish population-based cohort study. All patients were younger than 60 years and working or unemployed at the time of stroke. Information on self-rated health (Short Form 12; SF-12) was collected from questionnaires 3 months after stroke. Employment status was defined on a weekly basis using national register-data on transfer payments.

Results: Fifty percent were self-supporting or job-seeking 12 months after stroke, and the same proportion was found after 24 months. More than 70% of the patients who returned to work did not receive sickness benefits in the 12 months following return to work. Good self-rated health 3 months after stroke and minor stroke severity were strongly associated with return to work after 12 and 24 months.

Conclusion: Self-rated health 3 months after stroke was strongly associated with return to work and work-stability after stroke.
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http://dx.doi.org/10.2340/16501977-2061DOI Listing
April 2016

The association between leisure time physical activity in adolescence and poor mental health in early adulthood: a prospective cohort study.

BMC Public Health 2016 Jan 5;16. Epub 2016 Jan 5.

Danish Ramazzini Centre, Department of Occupational Medicine, University Research Clinic, Hospital West Jutland, Gl. Landevej 61, Herning, 7400, Denmark.

Background: The incidence of poor mental health (MH) is increasing in Denmark and worldwide, especially among 16-24 year olds. Low physical activity (PA) during adolescence seems to be a risk factor for poor MH in early adulthood. Among adults, it appears that a high level of PA may be protective against poor MH. We aimed to examine whether high levels of leisure time physical activity (LTPA) during adolescence reduced the risk of poor MH at age 20/21.

Methods: Prospective cohort study with data collected during 2004-2010 in the western part of Denmark. The study population was 3031 young people (age 14/15 in 2004). LTPA was the exposure variable and originates from questionnaires in 2004/2007. MH was the outcome variable and was measured at age 20/21 in 2010. MH was evaluated using a short version of the CES-DC. Logistic regression was used to analyse the associations between levels of LTPA and MH. All analyses were stratified by gender.

Results: 1,589 adolescents were included in the final analyses. Girls at 14/15 years of age with a low level of LTPA had an Adjusted Odds Ratio(AOR) of 1.63 (95% CI = 1.23-2.17) for poor MH as 20/21 year olds, compared to girls with a high level of LTPA. Among boys, the corresponding AOR = 1.19 (95% CI = 0.85-1.66). We found an exposure-response relationship between levels of LTPA and MH among girls, but not among boys. Girls with a reduction/persistent low level of LTPA between the ages of 15-18 had an increased risk for poor MH at age 20/21 compared to the reference group.

Conclusions: Among girls, we found an association between a low level of LTPA among 14/15 year olds as well as a reduction/persistent low level of LTPA over time with poor MH at 20/21 years. We found no association between low levels of LTPA and poor MH among 14/15 year olds boys however it appears that a reduction/persistent low level of LTPA over time may have some influence on the risk of poor MH at 20/21 years. It is important to address the change in habits of LTPA during adolescence to prevent poor MH.
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http://dx.doi.org/10.1186/s12889-015-2658-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700625PMC
January 2016

Admission-time-dependent variation in mortality in a Danish emergency department.

Dan Med J 2016 Jan;63(1):A5173

Introduction: The inflow of patients in emergency departments (ED) varies over time. If variations are not anticipated, accumulation of patients and treatment delay may occur. This may trigger adverse events causing excess mortality. The aim of this study was to determine if attending the ED after hours and during weekends was associated with an increased mortality.

Methods: We examined the medical records of 5,385 patients. Data were retrieved from the Electronic Patient Journal, the Danish National Patient Registry and the Danish Civil Registration System. Multinomial logistic regression and Cox regression were performed to analyse the associations between attendance time and mortality.

Results: The inflow of patients differed over the hours of the day and the days of the week. The findings tended towards a higher mortality for patients attending the ED during the evening shift than during the dayshifts, and during weekends than during weekdays. Patients attending the ED during the night shift had no excess mortality compared with the dayshifts. The combination of evening shift and weekday and the combination of dayshift and weekend reached significance. Associations with mortality were strongest for in-hospital mortality.

Conclusions: Indications of excess mortality were found for patients attending in the weekend compared with weekdays and in the evening hours compared with night and daytime hours. The causal mechanism is unknown.

Funding: none.

Trial Registration: not relevant.
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January 2016

Effect of Psychosocial Work Environment on Sickness Absence Among Patients Treated for Ischemic Heart Disease.

J Occup Rehabil 2015 Dec;25(4):776-82

Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark.

Introduction: During the last decades mortality has declined in patients with coronary heart disease due to improvements in treatments and changes in life style, resulting in more people living with chronic heart disease. This implies that focus on rehabilitation and re-integration to the work-force becomes increasingly important. Previous studies among healthy workers suggest that the psychosocial working environment is associated with sickness absence. Whether the psychosocial working environment plays a role for patients with existing cardiovascular disease on return to work and sickness absence is less studied.

Methods: A cohort of patients under 67 years and treated with percutaneous coronary intervention (PCI) was established in 2006. Three months after the procedure the patients (n = 625) answered a questionnaire about their psychosocial working environment. Patients were followed in registers for the following year. We examined the association between psychosocial working environment and sickness absence at 3 months, 1 year and new sick-listings during the first year with logistic regression.

Results: A total of 528 patients had returned to work 3 months after the PCI, while 97 was still sick-listed. After 1 year one was dead, 465 were working and 85 were receiving health related benefits, while 74 had left the workforce permanently. A number of 106 patients were sick-listed during the whole first year or had left the workforce permanently. After the initial return to work, 90 experienced a new sickness absence during the first year while the remaining 429 did not. High work pace, low commitment to the workplace, low recognition (rewards) and low job control were associated with sickness absence at 3 months, but not after 1 year. Low job control as well as job strain (combination of high demands and low control) was associated with new sick-listings.

Conclusion: The psychosocial working environment was associated with sickness absence 3 months after the PCI, but not 1 year after.
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http://dx.doi.org/10.1007/s10926-015-9587-0DOI Listing
December 2015

Psychosocial Working Environment and Risk of Adverse Cardiac Events in Patients Treated for Coronary Heart Disease.

J Occup Rehabil 2015 Dec;25(4):770-5

Department of Occupational Medicine, Danish Ramazzini Centre, University Research Clinic, Regional Hospital West Jutland, 7400, Herning, Denmark.

Introduction: During the last decades a possible association between psychosocial working environment and increased risk of coronary heart disease (CHD) has been debated and moderate evidence supports that high psychological demands, lack of social support and iso-strain (the combination of high job strain and lack of social support) is associated with primary CHD. Whether psychosocial working environment plays a role as risk factor for new cardiac events and readmissions in patients with existing cardiovascular disease is less studied.

Methods: A cohort of patients <67 years treated with percutaneous coronary intervention (PCI) was established in 2006. Three months after PCI patients answered a questionnaire about their psychosocial working environment. Patients were followed in the Danish National Patient Registry and the Danish Civil Registration System for 3+ years to identify adverse cardiac events and death. We analysed the association between psychosocial working environment and adverse cardiac events by Cox Regression.

Results: A number of 528 patients had returned to work 12 weeks after PCI, while 97 were still sick-listed. We identified 12 deaths and 211 other events during follow-up. We found no statistically significant associations between psychosocial working environment and risk of adverse cardiac events and readmissions or mortality.

Conclusion: The psychosocial working environment was not associated with adverse cardiac events.
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http://dx.doi.org/10.1007/s10926-015-9585-2DOI Listing
December 2015

Using multiple imputation to deal with missing data and attrition in longitudinal studies with repeated measures of patient-reported outcomes.

Clin Epidemiol 2015 16;7:91-106. Epub 2015 Jan 16.

Section of Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark.

Objective: Missing data is a ubiquitous problem in studies using patient-reported measures, decreasing sample sizes and causing possible bias. In longitudinal studies, special problems relate to attrition and death during follow-up. We describe a methodological approach for the use of multiple imputation (MI) to meet these challenges.

Methods: In a cohort of patients treated with percutaneous coronary intervention followed with use of repetitive questionnaires and information from national registers over 3 years, only 417 out of 1,726 patients had complete data on all measure points and covariates. We suggest strategies for use of MI and different methods for dealing with death along with sensitivity analysis of deviations from the assumption of missing at random, all with the use of standard statistical software. The Mental Component Summary from Short Form 12-item survey was used as an example.

Conclusion: Ignoring missing data may cause bias of unknown size and direction in longitudinal studies. We have illustrated that MI is a feasible method to try to deal with bias due to missing data in longitudinal studies, including attrition and nonresponse, and should be considered in combination with analysis of sensitivity in longitudinal studies. How to handle dropout due to death is still open for debate.
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http://dx.doi.org/10.2147/CLEP.S72247DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4303367PMC
February 2015

Self-reported health following percutaneous coronary intervention: results from a cohort followed for 3 years with multiple measurements.

Clin Epidemiol 2014 3;6:441-9. Epub 2014 Dec 3.

WestChronic, Regional Hospital West Jutland, Herning, Denmark ; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

Objective: Improvements in the treatment of coronary heart disease have increased the number of patients living with a chronic heart disease. Patient-reported outcomes are required to adequately describe prognosis. We report self-rated health in a population-based cohort of patients with coronary heart disease treated with percutaneous coronary intervention (PCI).

Methods: Over 3 years, we followed 1,726 patients under 65 years treated with PCI with eight repetitive questionnaires. With the use of multiple imputation, we described the course of self-rated health using the short form 12-item survey's mental component summary (MCS) and physical component summary (PCS) and analyzed adjusted differences by sex, age, educational level, indication for PCI, and left ventricular ejection fraction along with an analysis of decrease in health status.

Results: MCS scores increased during follow-up, while PCS scores were stable over time. Men rated higher in MCS and PCS than women, and older patients rated higher in MCS than younger. Other differences were negligible. Younger age was identified as a risk factor for marked decrease in mental health over time.

Conclusion: In a complete population-based cohort of PCI patients with multiple measurements, we found improvements in mental, but not physical health over time. Demographic differences in health were larger than disease-related differences.
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http://dx.doi.org/10.2147/CLEP.S65476DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259550PMC
December 2014

Assessing time to treatment and patient inflow in a Danish emergency department: a cohort study using data from electronic emergency screen boards.

BMC Res Notes 2014 Oct 6;7:690. Epub 2014 Oct 6.

Department of Emergency Medicine, Regional Hospital West Jutland, Herning, Denmark.

Background: The purpose of this study was to assess and describe the patient inflow during a 1-month period in a Danish emergency department and to evaluate if the intended times to treatment (TTT) related to category of triage were met.

Methods: Data from electronic emergency screen boards were extracted from the 1st to the 30th of April 2013. 2000 patients were enrolled of which 1011 were eligible for inclusion in the study of TTT. Patient inflow was described according to hours of the day and days of the week. Patients were divided into groups of triage and TTT was assessed in the different groups. Adjusted odds ratios of not being seen on time were calculated between triage groups and time of the day/week.

Results: The pattern of inflow differed between weekdays and weekends. On weekdays it peaked around midday and on weekends it peaked during the late afternoon/evening. The distributions of the different triage categories between days were similar. Monday had the most patient contacts while Saturday showed the least. Category II (orange) patients were the most prone to exceed the intended TTT. The risk of not being seen on time when compared to daytime, was on evenings OR 2.3 [1.1;4.9] and on nights OR 2.0 [1.2;3.9]. On weekends the odds ratio was OR 1.9 [0.8;4.7] compared to weekdays.

Conclusion: The results demonstrated varying patterns of patient inflow between weekdays and weekends. There was a significantly increased risk of being attended late when arriving on evenings and nights. Likewise higher acuity was associated with exceeded TTT.
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http://dx.doi.org/10.1186/1756-0500-7-690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195896PMC
October 2014

The predictive validity of RETTS-HEV as an acuity triage tool in the emergency department of a Danish Regional Hospital.

Eur J Emerg Med 2016 Feb;23(1):33-7

Departments of aEmergency bOccupational Medicine, Regional Hospital of Herning, Herning, Denmark.

Introduction: The Rapid Emergency Triage and Treatment System - Hospital Unit West (RETTS-HEV) is a triage system used in the emergency department (ED) in Herning, Denmark, since 2010. It categorizes patients according to priority and defines a time limit on how long patients can wait before being seen by a doctor depending on the severity of their condition. The purpose of this study was to determine the predictive validity of RETTS-HEV by measuring the association between triage scores and outcomes such as the admission rate, the length of stay (LOS), and mortality.

Materials And Methods: We performed an observational cohort study by examining the medical records of all patients who attended the ED from 1 September 2012 to 30 November 2012, at the Regional Hospital West Jutland in Herning, Denmark (N=4680). We defined the following outcomes to make associations with the patients' triage category: in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS and the admission rate, on the basis of complete information from the Danish National Patient Registry.

Results: The distribution of age, comorbidity, admission, LOS, and mortality over triage categories differed as expected. After making adjustments for these differences, we found a consistent association between triage categories and in-hospital mortality, and 30, 60, and 90-day mortalities, the hospital LOS, and the admission rate.

Conclusion: RETTS-HEV was found to be closely related to all examined outcomes, and therefore useful in the risk stratification of ED patients.
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http://dx.doi.org/10.1097/MEJ.0000000000000173DOI Listing
February 2016

Use of Patient-Reported Outcome (PRO) Measures at Group and Patient Levels: Experiences From the Generic Integrated PRO System, WestChronic.

Interact J Med Res 2014 Feb 11;3(1):e5. Epub 2014 Feb 11.

WestChronic, Regional Hospital West Jutland, Herning, Denmark.

Background: Patient-reported outcome (PRO) measures may be used at a group level for research and quality improvement and at the individual patient level to support clinical decision making and ensure efficient use of resources. The challenges involved in implementing PRO measures are mostly the same regardless of aims and diagnostic groups and include logistic feasibility, high response rates, robustness, and ability to adapt to the needs of patient groups and settings. If generic PRO systems can adapt to specific needs, advanced technology can be shared between medical specialties and for different aims.

Objective: We describe methodological, organizational, and practical experiences with a generic PRO system, WestChronic, which is in use among a range of diagnostic groups and for a range of purposes.

Methods: The WestChronic system supports PRO data collection, with integration of Web and paper PRO questionnaires (mixed-mode) and automated procedures that enable adherence to implementation-specific schedules for the collection of PRO. For analysis, we divided functionalities into four elements: basic PRO data collection and logistics, PRO-based clinical decision support, PRO-based automated decision algorithms, and other forms of communication. While the first element is ubiquitous, the others are optional and only applicable at a patient level. Methodological and organizational experiences were described according to each element.

Results: WestChronic has, to date, been implemented in 22 PRO projects within 18 diagnostic groups, including cardiology, neurology, rheumatology, nephrology, orthopedic surgery, gynecology, oncology, and psychiatry. The aims of the individual projects included epidemiological research, quality improvement, hospital evaluation, clinical decision support, efficient use of outpatient clinic resources, and screening for side effects and comorbidity. In total 30,174 patients have been included, and 59,232 PRO assessments have been collected using 92 different PRO questionnaires. Response rates of up to 93% were achieved for first-round questionnaires and up to 99% during follow-up. For 6 diagnostic groups, PRO data were displayed graphically to the clinician to facilitate flagging of important symptoms and decision support, and in 5 diagnostic groups PRO data were used for automatic algorithm-based decisions.

Conclusions: WestChronic has allowed the implementation of all proposed protocol for data collection and processing. The system has achieved high response rates, and longitudinal attrition is limited. The relevance of the questions, the mixed-mode principle, and automated procedures has contributed to the high response rates. Furthermore, development and implementation of a number of approaches and methods for clinical use of PRO has been possible without challenging the generic property. Generic multipurpose PRO systems may enable sharing of automated and efficient logistics, optimal response rates, and other advanced options for PRO data collection and processing, while still allowing adaptation to specific aims and patient groups.
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http://dx.doi.org/10.2196/ijmr.2885DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3936283PMC
February 2014