Danish Working Environment Authority

Feeding the large future population is associated with severe environmental challenges to which climate change is adding further complications and stress to the global food supply system. The strategies to the challenges posed on ecosystem conservation and climate neutrality would be best achieved by integrating the most current scientific findings in ‘best practice’ policies and their implementation. This paper presents the outcomes from the fourth International Catchment Science Conference in Ireland, a three-day multi-actor conference, and calls for action to improve soil fertility, reduce GHG emissions, increase carbon sequestration, and reduce pollution loss to waters. It was concluded that an accountable management of the agricultural landscape requires a multi-actor, multidisciplinary and multi-scale approach with collaboration between the scientific community, policy makers and farmers. Importantly there should be a focus on linking research, technology, education, information, engagement and innovation. Following needed requirements were identified: (i) long-term monitoring, high-temporal and high-spatial resolution data collection, (ii) combining temporarily and spatially rich datasets, (iii) long-term planning horizons to be adopted by key institutional stakeholders, (iv) mitigation strategies to adapt to changing climate and agricultural practices, and (v) an adequate advisory support and training for farmers. Some progress has been achieved to a situation where it is possible to counter or mitigate some of the more urgent issues in the food systems under consideration in the review.

Danmark har fået en ny National strategi for arbejdsmiljøforskning (Beskæftigelsesministeriet 2020). I 2017 viste det sig, at der var problemer med at opfylde målene i den strategi for arbejdsmiljøet, man havde arbejdet ud fra siden 2011. Der var ikke sket det målsatte fald i belastningerne i såvel det psykiske som i det fysisk arbejdsmiljø – tværtimod. For at tage højde for den manglende succes med at opfylde målene, blev der i 2018 nedsat et ’Ekspertudvalg om udredning af arbejdsmiljøindsatsen’, og det forholdt sig også til forskning. Den manglende succes med at sænke belastningerne blev bl.a. set som en konsekvens af, at arbejdspladserne manglede relevant viden, som understøttede dem i at løse arbejdsmiljøproblemerne. Ekspertudvalget lagde i deres anbefalinger i 2019 bl.a. op til, at der skulle udformes en national arbejdsmiljøforskningsstrategi – det er den, vi har fået i oktober 2020 – og at vi skulle blive bedre til at måle effekterne af indsatsen; samt at formidlingen af forskningen skulle fungere med en klarere ’rollefordeling’. Selve forskningsstrategien ligger i forlængelse af ekspertudvalgets anbefalinger om en mere brugbar forskning: Forskningen skal være et redskab til at skabe et bedre arbejdsmiljø. Dette baserer sig dog på, at feltet bliver bedre til at oversætte den viden, som ligger i forskningen og i organisationerne til konkrete praksisser. Det er således ikke blot mere forskningsviden, der efterlyses, men også nye måder at forstå og facilitere en udveksling og bearbejdning af viden mellem forskere, relevante mellemled og forskningsbrugere.

Health care delivery is moving toward a value-based environment, which calls for increased integration between physician groups and health systems. Health executives sit at a key nexus point for determining how and when physician-system integration occurs. The objective of this study was to identify the organizational factors that health executives perceived to have made physician-system integration successful. We used a multiple-case study research design. We conducted semistructured, qualitative interviews with 25 health executives in the roles of CEO, chief medical officer, chief financial officer and physician group chief executives from eight of Washington State's largest integrated delivery systems. To guide our analysis, we employed open systems theory and Porter's Value Chain to identify physician group and hospital factors that were integral to successful integration. Using the executives' perspectives, the factors grouped into three themes: (1) organizational structure-a mix of integration contracts united by common structural characteristics between physician groups and hospitals); (2) organizational culture-alignment of leadership between physician groups and hospitals; and (3) strategic resources-designated resources to establish and support care coordination activities. Our work indicates that health systems should focus on the pathway to integration success through the alignment of structure (not just the integration contract), culture, and resources and not on an end goal of the physician employment model. Health system executives are key drivers for when and how physician groups are integrated into health services organizations. This article provides executives with an evidence-based model to aid in formulating integration approaches that combine elements of organizational structure, organizational culture, and strategic resources.

ObjectivesSickness absence has been used as a central indicator of work disability, but has mainly been examined in single diseases, with limited follow-up time. This study identified the risk of long-term sickness absence (LTSA) of 32 chronic disease groups in the first year after diagnosis and the subsequent years.SettingWe identified chronic disease groups prevalent in the work force (26 physical and 6 mental conditions) requiring all levels of care (primary, secondary, tertiary), by national registers of diagnoses from all hospital visits and prescribed medicine in Denmark from 1994 to 2011.ParticipantsA general population sample within the working age range (18–59 years) was drawn by Statistics Denmark. Participants not working before and during the follow-up period were excluded. A total of 102 746 participants were included.Primary and secondary outcome measuresHRs of transitions from work to LTSA of each of the chronic conditions were estimated in Cox proportional hazards models for repeated events—distinguishing between risk within the first (<1 year) and subsequent years of diagnosis (≥1 year) and an HR ratio (HRR): HR ≥1 year divided by HR <1 year.ResultsAlmost all the conditions were associated with significantly increased risks of LTSA over time. The risks were generally more increased in men than in women. Three main patterns of LTSA were identified across diseases: strong decreases of LTSA from the first to subsequent years (eg, stroke in men <1 year: HR=7.55, 95% CI 6.45 to 8.85; ≥1 year HR=1.43, 95% CI 1.20 to 1.74; HRR=0.23). Moderate or small decreases in LTSA (HRR between 0.46 and 0.76). No changes (HRR between 0.92 and 0.95) or increases in elevated risks of LTSA over time (HRR between 1.02 and 1.16).ConclusionsThe 32 chronic diseases were associated with three different risk patterns of LTSA over time. These patterns implicate different strategies for managing work disability over time.

BackgroundThe aim of this study was to investigate whether a multidimensional public-private partnership intervention, focussing on improving the quality and efficiency of sickness benefit case management, reduced the sickness benefit duration and the duration until self-support.MethodsWe used a difference-in-difference (DID) design with six intervention municipalities and 12 matched control municipalities in Denmark. The study sample comprised 282,103 sickness benefit spells exceeding four weeks. The intervention group with 110,291 spells received the intervention, and the control group with 171,812 spells received ordinary sickness benefit case management. Using register data, we fitted Cox proportional hazard ratio models, estimating hazard ratios (HR) and confidence intervals (CI).ResultsWe found no joint effect of the intervention on the sickness benefit duration (HR 1.02, CI 0.97–1.07) or the duration until self-support (HR 0.99, CI 0.96–1.02). The effect varied among the six municipalities, with sickness benefit HRs ranging from 0.96 (CI 0.93–1.00) to 1.13 (CI 1.08–1.18) and self-support HRs ranging from 0.91 (CI 0.82–1.00) to 1.11 (CI 1.06–1.17).ConclusionsCompared to receiving ordinary sickness benefit management the intervention had on average no effect on the sickness benefit duration or duration until self-support. However, the effect varied considerably among the six municipalities possibly due to differences in the implementation or the complexity of the intervention.

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Detailed knowledge about the composition of the intestinal microbiota may be critical to unravel the pathogenesis of ulcerative colitis (UC), a human chronic inflammatory bowel disease, since the intestinal microbes are expected to influence some of the key mechanisms involved in the inflammatory process of the gut mucosa. The aim of this study was to investigate the faecal microbiota in patients either with UC in remission (n=6) or with active disease (n=6), and in healthy controls (n=6). The composition of Gram-negative bacteria and Gram-positive bacteria was examined. Antigenic structures of Gram-negative bacteria such as lipopolysaccharides have been related to the inflammatory responses and pathogenesis of inflammatory bowel disease. Dice cluster analysis and principal component analysis of faecal microbiota profiles obtained by denaturing gradient gel electrophoresis and quantitative PCR, respectively, revealed that the composition of faecal bacteria from UC patients with active disease differed from the healthy controls and that this difference should be ascribed to Gram-negative bacteria. The analysis did not show any clear grouping of UC patients in remission. Even with the relatively low number of subjects in each group, we were able to detect a statistically significant underrepresentation of Lactobacillus spp. and Akkermansia muciniphila in UC patients with clinically active disease compared to the healthy controls. In line with previous communications, we have shown that the microbiota in UC patients with active disease differ from that in healthy controls. Our findings indicate that alterations in the composition of the Gram-negative bacterial population, as well as reduced numbers of lactobacilli and A. muciniphila may play a role in UC.

Inhalation of bitumen fumes is potentially carcinogenic to humans. We conducted a study of 29,820 male workers exposed to bitumen in road paving, asphalt mixing and roofing, 32,245 ground and building construction workers unexposed to bitumen, and 17,757 workers not classifiable as bitumen workers, from Denmark, Finland, France, Germany, Israel, the Netherlands, Norway, and Sweden, with mortality follow-up during 1953-2000. We calculated standardized mortality ratios (SMRs) and 95% confidence intervals (CIs) based on national mortality rates. Poisson regression analyses compared mortality of bitumen workers to that of building or ground construction workers. The overall mortality was below expectation in the total cohort (SMR 0.92, 95% CI 0.90-0.94) and in each group of workers. The SMR of lung cancer was higher among bitumen workers (1.17, 95% CI 1.04-1.30) than among workers in ground and building construction (SMR 1.01, 95% CI 0.89-1.15). In the internal comparison, the relative risk (RR) of lung cancer mortality among bitumen workers was 1.09 (95% CI 0.89-1.34). The results of cancer of the head and neck were similar to those of lung cancer, based on a smaller number of deaths. There was no suggestion of an association between employment in bitumen jobs and other cancers. European workers employed in road paving, asphalt mixing and other jobs entailing exposure to bitumen fume might have experienced a small increase in lung cancer mortality risk, compared to workers in ground and building construction. However, exposure assessment was limited and confounding from exposure to carcinogens in other industries, tobacco smoking, and other lifestyle factors cannot be ruled out.