Reorganization increases long-term sickness absence at all levels of hospital staff: panel data analysis of employees of Norwegian public hospitals

Background: The Norwegian specialist health service has undergone many processes of reorganization during the last three decades. Changes are mainly initiated to increase the efficiency and quality of health care serving an ageing population under the condition of a diminishing labour supply. The aim of this study is to investigate the effects of reorganization on long-term sickness absence among different levels of hospital staff. Methods: The study draws on panel data on employees of Norwegian public hospitals in 2005 and 2007 (N = 106,715). National register data on individual employees’ days of medically certified long-term (>16 days) sickness absence were linked with survey measures of actual reorganization executed at each hospital in each year. The surveys, answered by hospital administration staff, measured five types of reorganization: merging units, splitting up units, creating new units, shutting down units and reallocation of employees. The variation in sickness absence days was analysed using random and fixed effects Poisson regression with level of reorganization as the main explanatory variable. Results: The fixed effects analysis shows that increasing the degree of organizational change at a hospital from a low to a moderate or high degree leads to an increase in the number of days of long-term sickness absence of respectively 9% (95% CI: 1.03-1.15) and 8% (95% CI: 1.02-1.15). There are few significant differences between employees in different education categories. Only physicians have a significantly higher relative increase in days of long-term sickness absence than the control group with lower tertiary education. Conclusions: Increased long-term sickness absence is a risk following reorganization. This risk affects all levels of hospital staff

Hospital Mergers in Norway: Employee Health and Turnover to Three Destinations

This article investigates the probability of turnover to three destinations following hospital merg- ers: within the hospital sector, out of the hospital sector, and out of work. It is hypothesized that mergers increase turnover to nonemployment among employees with poor health and increase turnover to employment outside of the hospital sector among healthy employees. Discrete-time survival analyses show that mergers increase turnover within the hospital sector for all employ- ees, regardless of health. Turnover to other sectors and out of work does not increase. Possible explanations for the limited turnover out of the sector associated with mergers are aspects of the Norwegian labor market such as the institution of employee participation, low unemployment, and labor shortages within hospitals.

Bruk av skolebibliotekets ressurser i tospråklig opplæring

Temaet i denne oppgaven er bruk av skolebibliotekets ressurser i morsmålsopplæring for minoritetselever. Jeg har gjort feltarbeid på en skole på Østlandet med stor andel minoritetselever. Skolen har siden høsten 2007 vært med på et forskningsbasert skoleutviklingsprosjekt i samarbeid med lærerutdanningen ved Høgskolen i Oslo, Høgskolen i Buskerud og Drammensbiblioteket. FoU-prosjektet “Multiplisitet, myndiggjøring, medborgerskap. Inkludering gjennom bruk av skolebiblioteket som læringsarena (MMM-prosjektet)” dreier seg om bruk av skjønnlitteratur og faglitteratur i undervisningen, og bruken av skolebiblioteket som læringsarena. På bakgrunn av prosjektet startet skolen med morsmålsundervisning på skolebiblioteket våren 2010, der hensikten var at minoritetselevene skulle få tilgang til et rikt utvalg litteratur på sitt eget morsmål i undervisningen. Jeg gjorde en kvalitativ studie på Trollskogen skole i fem uker, der jeg brukte forskningsdesignet ”case study”. Hoveddelen av forskningen min besto i observasjon av morsmålstimene på skolebiblioteket, men jeg gjennomførte også intervjuer med rektor, skolebibliotekar og to morsmålslærere. Rektor er opptatt av å ha en bevissthet rundt ressurssynet på mangfold. For at alle elevenes bakgrunn skal bli anerkjent har skolen lagt vekt på at opplæringen skal tilpasses den enkelte elev slik at hver elev opplever mestring. Målet skal ikke bare være resultatoppnåelse, men også at kulturelt, etnisk og språklig mangfold blir anerkjent i utdanningen. Begrepet “tilpasset opplæring” får et nytt innhold gjennom bruken av morsmålslitteratur på skolebiblioteket og bygger dermed argumenter for tospråklig opplæring. Trollskogen kan plasseres innenfor ”New Literacy Studies” da de ønsker å bevare flerkulturelle litterasiteter blant tospråklige og flerspråklige barn, og ser på dette som noe verdifullt. Biblioteket er et rom der både integrering, tilpasset opplæring, litterasitet og funksjonell tospråklighet kan virkeliggjøres. Her kan elevene velge bøker utfra eget mestringsnivå og interesser. De kan velge bøker fra sitt eget opprinnelseslandet på morsmål, bøker av norske forfattere oversatt til deres morsmål og bøker på norsk av forfattere fra eget hjemland, noe som kan styrke identitetsfølelsen til elevene, og gi dem muligheten til å definere sin egen identitet. Skolen har forsøkt å involvere foreldrene i bruken av morsmålslitteratur på skolebiblioteket. Dette er en utfordring skolen må jobbe videre med. Prosjektet på Trollskogen er i en oppstartfase, og både morsmålslærer og skolebibliotekar arbeider kontinuerlig for å forbedre innholdet og utviklingen av undervisningen på skolebiblioteket.The theme of my research is use of the school library’s resources in mother tongue teaching for minority students. My research was conducted in a school with a large percentage of minority students who have been a part of a research based school development project since 2007. This project, called the Multiplicity project (MMM), included Oslo University College, Buskerud University College and Drammen library. The MMM-project emphasizes the use of literature and the use of the school library in teaching. The school started with mother tongue teaching on the school library in the spring of 2010. The intention was that minority students should have a complex selection of literature on their mother tongue in teaching. My research questions were as follows; “What pedagogical arguments argue for the use of the school library and multilingual literature in bilingual education? How do mother tongue teachers use the pupil’s first language literature in the school library?” Over the course of five weeks at Trollskogen school I used a case study design at the school library to perform a qualitative study in answer to these questions. As well as interviewing the principal, the school librarian and two mother tongue teachers, I attended and observed mother tongue lessons at the school library. The principal gives importance of having a resource view on diversity. Because of this, the school has emphasized that teaching should be adapted to each student so that each pupil’s cultural, ethnic and linguistic background be recognized in their education. The term 'adapted education' acquires a new content through the use of mother tongue literature in the school library, thereby including arguments for bilingual education. Trollskogen can be placed within ”New Literacy Studies” as they seek to conserve multicultural literacies among bilingual and multilingual pupils, and see this as valuable. The school library is a room where integration, adapted education, literacy and functional bilingualism can become a reality. It is a place where minority students can choose books that are compatible to their reading levels and interests. They have a choice of books from their family´s culture, providing them with the means and opportunity to define their own identity. The school has also tried to involve the parents in the use of mother tongue literature at the school library, a challenge the school keeps a continued focus on. The project is still young, and the school librarian and the mother tongue teachers are continuously working to improve the content and development of the mother tongue classes at the school library.Master i flerkulturell og internasjonal utdannin

Wake-up strokes are linked to obstructive sleep apnea and worse early functional outcome

Background and Aims Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested. We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. Material and Methods An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS. Results OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). Conclusion Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.Peer reviewe

Relationship between SDB and short-term outcome in Finnish ischemic stroke patients

Objectives Presence of sleep-disordered breathing (SDB) affects negatively recovery from stroke. The aim of this study is to evaluate the relationships between sleep-disordered breathing (SDB) and outcome measures in Finnish stroke unit cohort: mRS, need of rehabilitation and hospitalization time. Material and Methods An observational longitudinal study consisted of 95 patients referred to the Stroke Unit of Satakunta Hospital District over a period of November 2013 to March 2016. Patients were tested for SDB within 72 hr from the hospital admission because of ischemic stroke or TIA. The patients underwent polysomnography with NOX T3 wireless recorder. Results There are 37% (n = 35) non-OSA patients, 20% (n = 19) of patients have mild obstructive sleep apnea (OSA) and 39% (n = 37) have moderate/severe OSA and 4% (n = 4) have CSA. Patients with OSA have higher proportion of disability scores of mRS 3-5 (38%) compared to non-OSA (11%) and mild OSA (5%) patients on registration day (mRS0), and the same trend is seen at hospital discharge 35% versus 9% and 5%. (p = .009). Proportion of patients with OSA who needed rehabilitation is 65% (n = 19) versus non-OSA patients 17.5% (n = 4) and mild OSA patients 17.5% (n = 4;p = .039). We observed longer duration of hospitalization (5-15 days) in 29% of OSA patients compared to mild OSA patients 47% and OSA patients 54%. (p = .045). Conclusion Ischemic stroke patients with OSA have higher disability, higher need of rehabilitation, and longer hospitalization length. Prescreening tools for recognizing these stroke patients in acute phase could be valuable. That could result in earlier initiation of treatment and might prevent worse recovery from stroke.Peer reviewe

Overvannshåndtering: Fra kommuneplanens arealdel til detaljreguleringsplan - En studie av Nittedal og Ullensaker kommune

Klimaendringer medfører økte nedbørsmengder og regnhendelser av mer intens karakter. Befolkningsvekst og politisk fokus på fortetting har ført til flere tette flater i byer og tettsteder. Kombinasjonen av dette vil føre til større utfordringer med overvann i framtiden, og stiller krav til god klimatilpasning og overvannshåndtering. Arealene rundt oss må planlegges på en helhetlig måte for å unngå overvannsskader. De senere årene har det blitt økt fokus på at arealplanlegging på alle plannivå må ta hensyn til økte nedbørsmengder. Kommunen er en sentral aktør for å sikre at hensynet til overvann ivaretas. Hensikten med denne oppgaven er å undersøke hvordan overvannshåndtering ivaretas i kommuneplanens arealdel, og videre sikres til detaljreguleringsplaner. For å undersøke dette har vi foretatt en kvalitativ studie av Nittedal og Ullensaker kommune, basert på dokumentstudier og intervjuer. Vi har tatt utgangspunkt i relevant litteratur, veiledere og forskning for å belyse oppgavens problemstilling. Planteoretiske tilnærminger, klimatilpasningsbarrierer og urban robusthet er benyttet som teoretisk rammeverk i oppgaven. Nittedal og Ullensaker kommune har et bevisst fokus på håndtering av overvann fra kommuneplanens arealdel til detaljreguleringsplaner. Kommunene har bestemmelser i kommuneplanens arealdel som tar stilling til hva utbygger må foreta av overvannshåndtering i detaljreguleringsplan. I plankartet er grønnstruktur lite benyttet til håndtering av overvann, og det er kun Nittedal som har hensynssone for overvannsflom. For å sikre ivaretakelse av overvannshåndtering fra kommuneplanens arealdel til detaljreguleringsplan er strategiplan/temaplan, områdereguleringsplan, kartlegging og VA-norm viktig. I Nittedal og Ullensaker kommune er ressurser og kunnskap avgjørende for å oppnå robusthet i møte med økte nedbørsmengder. Lokal kartlegging i kommunene er helt sentralt for å stille gode bestemmelser, utnytte plankartet, og sikre helhetlig overvannshåndtering fra kommuneplanens arealdel til detaljreguleringsplan. Det er viktig at kommunene prioriterer å innhente kunnskap og ressurser til overvannskartlegging.Climate change leads to increased precipitation and rain events of a more intense character. Population growth and political focus on densification have resulted in more dense areas in cities and towns. This combination leads to greater challenges with stormwater in the future and requires climate adaptation and stormwater management. The areas around us must be planned in a comprehensive way to avoid stormwater damage. In recent years, there has been an increased focus on the fact that spatial planning at all levels must take account of increased rainfall, and the municipality has a key role in ensuring stormwater management. The purpose of this thesis is to examine how stormwater management is ensured from the land-use element of the municipal master plan, to detailed zoning plans. To investigate this, we have carried out a qualitative study of Nittedal and Ullensaker municipality, based on document studies and interviews. Relevant literature, policy handbooks, and former research are used to answer the main research question. Planning theory, climate adaptation barriers, and urban resilience are used as theoretical framework in the thesis. Nittedal and Ullensaker municipality have a conscious focus on managing stormwater from the land-use element of the municipal master plan to detailed zoning plans. The municipalities have provisions in the land-use element of the municipal master plan that decides what developers must do concerning stormwater management in the detailed zoning plans. In the map of the land-use element of the municipal master plan, green structure is rarely used for managing stormwater, and only Nittedal has a zone requiring special consideration for stormwater flooding. Strategic/thematic plans, area zoning plans, mapping and VA norms are important to ensure that stormwater management is included from the land-use element of the municipal master plan to detailed zoning plans. In Nittedal and Ullensaker municipality, resources and knowledge are essential to achieve resilience in the face of climate change. Local mapping in the municipalities is essential to make good provisions, make use of the planning map, and ensuring overall stormwater management from the land-use element of the municipal plan to detailed zoning plans. The municipalities must prioritize acquiring knowledge and resources for stormwater mapping

Wake-up strokes are linked to obstructive sleep apnea and worse early functional outcome

Background and Aims: Presence of sleep-disordered breathing (SDB) and especially obstructive sleep apnea (OSA) is a known risk factor for ischemic stroke. Additionally, SDB effects negatively on recovery after stroke. Up to one fourth of strokes are present on awakening. The link between OSA and wake-up stroke (WUS) has been suggested. We aim to determine the association between OSA and WUS in a Finnish stroke unit cohort. Material and Methods: An observational prospective longitudinal study consisted of 95 TIA (transient ischemic attack) and mild to moderate stroke patients referred to a Stroke Unit in Finland. Respiratory polygraphy was performed within 72 h of hospital admission. Patients were classified into WUS and non-WUS, and functional outcome measures (mRS, rehabilitation, hospitalization time) were collected. Functional outcomes and prevalence of OSA were compared between non-WUS and WUS. Results: OSA (AHI > 15/h) was more frequent among WUS than non-WUS (71% and 36%, respectively, p = 0.009). Functional outcome measured with mRS was worse in patients with WUS than non-WUS on registration day and at hospital discharge (p = 0.001). Need for rehabilitation in WUS was 43% of cases compared to 23% of non-WUS (p = 0.067). Hospitalization time was longer (5-15days) in 55% of WUS and 41% of non-WUS patients (p = 0.261). Conclusion: Moderate-to-severe OSA is related to WUS compared to non-WUS. In addition, WUS have worse short-term outcomes measured in mRS. Further studies are needed to determine if OSA is causally linked to WUS.</p