Workload, staff composition, and sickness absence: findings from employees in child care centers

Persistently, high workload may raise sickness absence with associated costs to firms and society. We proxy workload by the number of adults per child in Norwegian child care centers and find that more educated teachers per child are associated with lower sickness absence. However, more assistants with low or no higher education per child are associated with higher sickness absence, suggesting that observed variation in sickness absence at the center level may be driven by differences in staff composition rather than workload. The importance of the educational composition of employees on sickness absence is supported by findings from fixed-effects models and a fuzzy regression discontinuity design relying on variation from municipal elections.acceptedVersio

Neonatal outcomes associated with time from a high fetal blood lactate concentration to operative delivery

Introduction: Adjunctive technologies to cardiotocography intend to increase the specificity of the diagnosis of fetal hypoxia. If correctly diagnosed, time to delivery could affect neonatal outcome. In the present study, we aimed to investigate the effect of time from when fetal distress is indicated by a high fetal blood sample (FBS) lactate concentration to operative delivery on the risk of adverse neonatal outcomes. Material and methods: We conducted a prospective observational study. Deliveries with a singleton fetus in cephalic presentation at 36+0weeks of gestation or later were included. Adverse neonatal outcomes, related to decision-to-delivery interval (DDI), were investigated in operative deliveries indicated by an FBS lactate concentration of at least 4.8 mmol/L. We applied logistic regression to estimate crude and adjusted odds ratios (aOR) of various adverse neonatal outcomes, with associated 95% confidence intervals (CI), for a DDI exceeding 20 minutes, compared with a DDI of 20 minutes or less. ClinicalTrials.gov Identifier: NCT04779294. Results: The main analysis included 228 women with an operative delivery indicated by an FBS lactate concentration of 4.8 mmol/L or greater. The risk of all adverse neonatal outcomes was significantly increased for both DDI groups compared with the reference group (deliveries with an FBS lactate below 4.2 mmol/L within 60 minutes before delivery). In operative deliveries indicated by an FBS lactate concentration of 4.8 mmol/L or more, there was a significantly increased risk of a 5-minute Apgar score less than 7 if the DDI exceeded 20 minutes, compared with a DDI of 20 minutes or less (aOR 8.1, 95% CI 1.1–60.9). We found no statistically significant effect on other short-term outcomes for deliveries with DDI longer than 20 minutes, compared with those with DDI of 20 minutes or less (pH ≤7.10: aOR 2.0, 95% CI 0.5–8.4; transfer to the neonatal intensive care unit: aOR 1.1, 95% CI 0.4–3.5). Conclusions: After a high FBS lactate measurement, the increased risk of adverse neonatal outcome is further augmented if the DDI exceeds 20 minutes. These findings give support to current Norwegian guidelines for intervention in cases of fetal distress.publishedVersio

Lutte étagée ciblée et pulvérisation à très bas volume. Une protection insecticide du cotonnier moins onéreuse et plus respectueuse de l'environnement

La lutte étagée ciblée consiste à évaluer le niveau des populations de ravageurs la veille du traitement. Les insectes observés sont les chenilles des capsules ou des feuilles, les acariens, les aleurodes et les pucerons. Les niveaux de population sont confrontés à des seuils d'intervention et les résultats obtenus guident les choix des doses et des types d'insecticides utilisés. En 1995, 1 519 postes d'observateurs saisonniers ont été créés, pour une rémunération globale de 56 millions de francs CFA. Prévulgariséesur 407 ha en 1990, la lutte étagée ciblée a été vulgarisée sur 85 000 ha en 1995. Cette innovation nécessite la mise en oeuvre d'importants moyens dans le domaine de la formation et du suivi. La pulvérisation à très bas volume (TBV) épand 10 litres de bouillie aqueuse par hectare. Les insecticides utilisés sont des concentrés émulsionnables, moins chers que les insecticides pour ultra bas volume. A dose de matière active égale, un traitement TBV est 20 % moins cher qu'un traitement ULV. Les anciens appareils de traitement ultra bas volume ont été adaptés pour la pulvérisation TBV par un changement de buse et l'adjonction d'un réservoir auxiliaire. L'utilisation de la pulvérisation TBV a réduit les risques d'intoxication des opérateurs par inhalation (nuage de pulvérisation moins volatile) et par contact (bouillies insecticides aqueuses et moins concentrées). En permettant des économies de matières actives atteignant 30 à 40 %, la lutte étagée ciblée a permis de limiter les effets néfastes potentiels de la protection insecticide sur l'environnement. En 1992, la protection insecticide coûtait 9 005 francs CFA à l'hectare. En 1995, malgré la dévaluation, elle a coûté 10 700 francs CFA à l'hectare. En francs CFA constants, le coût de la protection insecticide a chuté de 41 % entre 1992 et 1995. Pour la campagne agricole 1995, l'économie réalisée a dépassé 900 millions de francs CFA

Comorbidities treated in primary care in children with chronic fatigue syndrome

Background: Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a complex condition. Causal factors are not established, although underlying psychological or immunological susceptibility has been proposed. We studied primary care diagnoses for children with CFS/ME, with children with another hospital diagnosis (type 1 diabetes mellitus [T1DM]) and the general child population as comparison groups. Methods: All Norwegian children born 1992–2012 constituted the study sample. Children with CFS/ME (n = 1670) or T1DM (n = 4937) were identified in the Norwegian Patient Register (NPR) (2008-2014). Children without either diagnosis constituted the general child population comparison group (n = 1337508). We obtained information on primary care diagnoses from the Norwegian Directorate of Health. For each primary care diagnosis, the proportion and 99 % confidence interval (CI) within the three groups was calculated, adjusted for sex and age by direct standardization. Results: Children with CFS/ME were more often registered with a primary care diagnosis of weakness/general tiredness (89.9 % [99 % CI 88.0 to 91.8 %]) than children in either comparison group (T1DM: 14.5 % [99 % CI: 13.1 to 16.0 %], general child population: 11.1 % [99 % CI: 11.0 to 11.2 %]). Also, depressive disorder and anxiety disorder were more common in the CFS/ME group, as were migraine, muscle pain, and infections. In the 2 year period prior to the diagnoses, infectious mononucleosis was registered for 11.1 % (99 % CI 9.1 to 13.1 %) of children with CFS/ ME and for 0.5 % (99 % CI (0.2 to 0.8 %) of children with T1DM. Of children with CFS/ME, 74.6 % (1292/1670) were registered with a prior primary care diagnosis of weakness / general tiredness. The time span from the first primary care diagnosis of weakness / general tiredness to the specialist health care diagnosis of CFS/ME was 1 year or longer for 47.8 %. Conclusions: This large nationwide registry linkage study confirms that the clinical picture in CFS/ME is complex. Children with CFS/ME were frequently diagnosed with infections, supporting the hypothesis that infections may be involved in the causal pathway. The long time span often observed from the first diagnosis of weakness / general tiredness to the diagnosis of CFS/ME might indicate that the treatment of these patients is sometimes not optimal.publishedVersio