Health and work well-being associated with employment precariousness among permanent and temporary nurses: A cross-sectional survey

Nursing is at risk of becoming precarious employment with low wages, poor working conditions, heavy workload and underdeveloped career development possibilities. This study aimed to explore employment precariousness, health and work well-being among permanent and temporary practical nurses and registered nurses. The data were collected from Finnish nurses (n = 5867) using an online questionnaire in autumn 2020. This cross-sectional study was reported by applying the STROBE guidelines. Temporary nurses perceived their health and work well-being as being better than permanent nurses; however, they also perceived higher employment precariousness. Vulnerability, such as being treated in an authoritarian manner, had the strongest negative association with health and work well-being among permanent and temporary nurses. Practical nurses and registered nurses perceived employment precariousness in several dimensions, but this needs to be further studied because the results of this study are somewhat contradictory. Also, further studies are required to survey post-COVID-19 care work, as the pandemic likely affected the study, resulting in higher experiences of precariousness.</p

Cost-effectiveness calculators for health, well-being and safety promotion: a systematic review

BackgroundThe health, well-being and safety of the general population are important goals for society, but forecasting outcomes and weighing up the costs and benefits of effective promotional programmes is challenging. This study aimed to identify and describe the cost-effectiveness calculators that analyze interventions that promote health, well-being and safety.MethodsOur systematic review used the CINAHL, PsycINFO, SocINDEX, EconLit, PubMed and Scopus databases to identify peer-reviewed studies published in English between January 2010 and April 2020. The data were analyzed with narrative synthesis.ResultsThe searches identified 6880 papers and nine met our eligibility and quality criteria. All nine calculators focussed on interventions that promoted health and well-being, but no safety promotion tools were identified. Five calculators were targeted at group-level initiatives, two at regional levels and two at national levels. The calculators combined different data sources, in addition to data inputted by users. This included empirical research and previous literature. The calculators created baseline estimates and assessed the cost-effectiveness of the interventions before or after they were implemented. The calculators were heterogeneous in terms of outcomes, the interventions they evaluated and the data and methods used.ConclusionThis review identified nine calculators that assessed the cost-effectiveness of health and well-being interventions and supported decision-making and resource allocations at local, regional and national levels, but none focussed on safety. Producing calculators that work accurately in different contexts might be challenging. Further research should identify how to assess sustainable evaluation of health, well-being and safety strategies.</p

Kohdennettu ja ennakoitu hyvinvoinnin, terveyden ja turvallisuuden edistäminen: vaikutusten ja kustannusten arviointityökalut

Hankkeen tarkoituksena oli kuvata hyvinvoinnin, terveyden ja turvallisuuden edistämisen vaikutusten arviointiin käytettäviä työkaluja. Tutkimushankkeessa toteutettiin kansainvälinen systemoitu kirjallisuuskatsaus, verkkohaut, asiantuntijapaneeli sekä menestysanalyysi. Tutkimushankkeen tulosten mukaan paikalliselle, alueelliselle ja kansalliselle tasolle suunnatut hyvinvoinnin, terveyden ja turvallisuuden edistämisen arviointityökalut kohdistuvat yksilön toiminnan muutoksiin kansanterveyden ja elintapojen, sosiaalisen ja alueellisen hyvinvoinnin ja turvallisuuden sekä työpaikan terveyden ja turvallisuuden interventioissa. Näyttöön perustuvia arviointityökaluja on rajallisesti saatavilla ja niiden käyttöönotto edellyttää kansallisiin tarpeisiin sovittamista. Työkaluja voidaan hyödyntää paitsi taloudellisten vaikutusten arvioinnissa, myös tiedolla johtamisen välineenä ja ennaltaehkäisevän työn osoittamisessa. Työkalujen luotettavuutta ja käyttökelpoisuutta lisää se, että ne perustuvat tieteelliseen näyttöön ja niissä käytettävä tieto on vaivattomasti ja viiveettömästi saatavissa. Hyvinvoinnin, terveyden ja turvallisuuden edistämiseen kohdistuvien arviointityökalujen tarve lyhyen ja pitkän aikavälin suunnittelussa ja päätöksenteossa on ilmeinen. Jotta työkaluja voitaisiin käyttää ja kehittää pitkäjänteisesti, on niiden kansallinen arviointi, ohjaus ja koordinointi välttämätöntä.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Cost-effectiveness calculators on health and social services planning and evaluation: an explorative interview study of key informants

The aim of this study was to examine the views of key experts on developing and using cost-effectiveness calculators to plan and evaluate health and wellbeing promotion interventions in health and social services. Data for this qualitative interview study were collected from 14 Finnish experts in health and wellbeing coordina-tion, health and social service management and research and health economics in spring 2021. A semi-structured interview method with thematic analysis was used. The experts said that there is a need for cost-effectiveness evaluation tools that support local evidence-based decision-making. This would enable organiza-tions to plan and allocate scarce resources for interventions that promote equitable and effective health and wellbeing. However, practical tools and calculators that enable users to make decisions based on the best available evidence are not widely used. Local decision-makers, researchers and service providers all need to be involved in agreeing goals and selecting the right target groups and measures. They also need to make decisions about the best available data sources and how to use calculators to define and evaluate outcomes. Cost-effectiveness calculators are needed for local evidence-based decision-making, so that municipalities can allocate scarce resources to effective services that increase the wellbeing and equality of residents. This requires key stakeholders to work together to plan, develop and evaluate comprehensive, easy-to-use cost-effectiveness calculators.</p

The nationwide Finnish anticoagulation in atrial fibrillation (FinACAF) : study rationale, design, and patient characteristics

Atrial fibrillation (AF) is a major cause of ischemic stroke and the number of AF patients is increasing. Thus, up-to-date multifaceted data about the characteristics of AF patients, their treatments, and outcomes are urgently needed. The Finnish anticoagulation in atrial fibrillation (FinACAF) study has collected comprehensive data on all Finnish AF patients from 1st January 2004 to 31st December 2018. The aim of this paper is to describe the study rationale, the process of integrating data from the applied resources and to define the study cohort. Using national unique personal identification number, individual patient data is linked from nationwide health care registries (primary, secondary, and tertiary care), drug purchases, education, and socio-economic status as well as places of domicile, incomes, and taxes. Six regional laboratory databases (similar to 282,000, 77% of the patients) are also included. The study cohort comprises of a total of 411,000 patients. Since the introduction of the national primary care register in 2012, 9% of all AF patients were identified outside hospital care registers. The prevalence of AF in Finland-4.1% of whole population-is for the first time now established. The FinACAF study allows a unique possibility to investigate the epidemiology and socio-medico-economic impact of AF as well as the cost effectiveness of different AF management strategies in a completely unselected, nationwide population. This article provides the rationale and design of the study together with a summary of the characteristics of the cohort.Peer reviewe

Income and outcomes of patients with incident atrial fibrillation

Background Socioeconomic disparities can be associated with adverse outcomes in patients with cardiovascular diseases. The impact of personal income on the outcomes of patients with atrial fibrillation (AF) is unclear. Methods Nationwide observational registry-based study on patients with incident AF in Finland during 2007-2018. Results 203 154 patients (mean age 73.0 +/- 13.5; females 49.0%) were diagnosed with incident AF during the study period. Overall, 16 272 (8.0%) patients experienced first-ever ischaemic stroke and 63 420 (31.2%) died (mean follow-up 4.3 +/- 3.3 years). After adjusting for confounding factors, low personal income was associated with increased risk of overall mortality in all age strata and the incidence of first--ever stroke in patients aged = 75 years. The magnitude of this effect was greatest in patients aged Conclusions Personal annual income has a significant impact on the incidence of first-ever ischaemic stroke and overall mortality among patients with incident AF, particularly among patients of working age. Low-income indicate the need for intervention strategies to improve outcomes of AF.Peer reviewe

IKÄPIHA – ikäihmisten pitkäaikaispalvelujen harmonisointi maakunnissa

Yhdenvertaisuus on keskeinen arvo suomalaisessa sote-palvelujärjestelmässä, ja sille on myös lainsäädännölliset perusteet. Ikääntyneiden palvelujen käytössä on alueellisia vaihteluja. Tämä johtuu ainakin osittain muusta kuin ikärakenteesta tai sairastavuudesta. Selvityksen tarkoituksena oli tarkastella ikääntyneiden pitkäaikaispalvelujen nykyrakenteita ja arvioida palvelujen myöntämisperusteiden harmonisoinnin vaikutuksia palvelujen peittävyyteen ja kustannuksiin maakunnissa. Raportissa kuvataan palvelujen harmonisoitumista perustuen muutamaan maakuntaan, joissa on jo nykyisin yksi maakunnallinen järjestäjäorganisaatio sekä arvioidaan harmonisoinnin potentiaalisia vaikutuksia laskennallisesti. Selvitys osoitti, että harmonisoinnilla olisi merkittäviä vaikutuksia sekä palvelujen peittävyyksiin että kustannuksiin. Selvityksessä tarkastellun esimerkkipalvelurakenteen mukaisesti toteutettuna harmonisointi tuottaisi nykyisellä väestörakenteella noin puolen miljardin euron vuosittaiset kustannussäästöt koko maan tasolla yhteen laskettuna. Laskelma on kuitenkin vain teoreettinen, koska se perustuu mallinnettuihin kustannuksiin. Lisäksi säästöjen aikaan saaminen edellyttäisi todellisuudessa mittavaa kehitystyötä palvelurakenteiden keventämiseksi. Harmonisoituminen, jonka havaittiin jo osittain tapahtuneen palvelujaan yhdenmukaistaneissa maakunnissa, tarkoittaisi nykyistä yhdenmukaisempia palvelurakenteita ja yhdenvertaisempaa palveluihin pääsyä, mikä olisi jo itsessään arvokas lopputulos. Harmonisointi on yksi osatekijä ikääntyvän väestön palvelujen järjestämisessä yhdenvertaisesti ja taloudellisesti kestävästi, mutta palvelutarpeisiin ja kustannuksiin on jatkossa pyrittävä vaikuttamaan yhtäaikaisesti monin eri tavoin.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa. (tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Mental Health Conditions and Nonpersistence of Direct Oral Anticoagulant Use in Patients With Incident Atrial Fibrillation : A Nationwide Cohort Study

BACKGROUND: Mental health conditions (MHCs) are associated with poor outcomes in patients with atrial fibrillation. However, persistence of oral anticoagulation therapy in patients with atrial fibrillation and MHCs is unknown. We aimed to evaluate the effect of MHCs on the persistence of direct oral anticoagulant (DOAC) use in patients with atrial fibrillation based on a nationwide cohort. METHODS AND RESULTS: The nationwide registry-based FinACAF (Finnish Anticoagulation in Atrial Fibrillation) cohort included 67 503 patients with incident atrial fibrillation and indication for permanent oral anticoagulation (CHA(2)DS(2)-VASc score >1 in men and >2 in women) starting DOAC therapy between 2011 and 2018. MHCs of interest were depression, bipolar disorder, anxiety disorder, schizophrenia, and composite of any MHC. The main outcome was nonpersistence of DOAC use, defined as the first 120-day period without DOAC purchases after drug initiation. The mean age of the patients was 75.3 +/- 8.9 years, 53.6% were women, and the prevalence of any MHC was 17.8%. Persistence after 1 year from DOAC initiation was 79.3% in patients without MHCs and 77.2% in patients with any MHC, and after 2 years were 64.4% and 60.6%, respectively (P CONCLUSIONS: MHCs are associated with nonpersistence of DOAC use.Peer reviewe

Socioeconomic factors and bleeding events in patients with incident atrial fibrillation : A Finnish nationwide cohort study

Background: Low socioeconomic status has been associated with higher risk of ischemic stroke and death in patients with atrial fibrillation (AF). However, whether socioeconomic status affects risk of bleeding events is unknown. We assessed the hypothesis that low income and educational attainment are associated with higher risk of bleeding in patients with AF.Methods: The registry-based FinACAF study covers all patients with AF in Finland during 2007-2018. Patients were divided into income quartiles and three categories based on their educational attainment. Outcomes of interest were the first-ever gastrointestinal (GI), intracranial (IC) and any bleeding.Results: We identified 205 019 patients (50.9 % female; mean age 72.3 (SD 13.4) years) with incident AF without prior bleeding. Mean follow-up time was 4.0 (SD 3.2) years, during which 25 013 (12.2 %) patients experienced first-ever any bleeding (incidence rate 3.07 (95 % CI 3.03-3.10) /100 patient-years). Low income was inde-pendently associated with hazard of any bleeding as well as GI and IC bleeding (adjusted hazard ratios (HRs) comparing lowest vs highest income quartile: 1.13 (1.08-1.17), 1.32 (1.23-1.41) and 1.15 (1.06-1.24), respectively). Income-related bleeding disparities were larger among younger patients under 65 years and among men. Education-related bleeding disparities were smaller than income related-disparities (adjusted HRs comparing lowest vs highest educational category: any bleeding 1.06 (1.02-1.11), GI bleeding 1.16 (1.08-1.24), IC bleeding 1.10 (0.93-1.09))Conclusions: Patients with AF and low income are at higher risk of bleeding, especially GI bleeding.Peer reviewe