Danish Public Hospitals Research Articles

Same position, different roles? How professional, organizational, and public policy logics shape frontline managers’ role conceptions

ABSTRACT This article integrates street-level bureaucracy and institutional logics theory to investigate how co-existing institutional logics shape frontline managers’ understanding of their managerial role. Based on 21 narrative interviews with managing medical doctors from 11 Danish public hospitals, the analysis shows that, although their formal positions are identical on paper, individual frontline managers understand their role in surprisingly different ways. The article contributes to extant scholarship by demonstrating that co-existing professional, organizational, and public policy logics are not only sources of cross-pressure; they also constitute important resources that allow frontline managers to conceptualize and enact different versions of their managerial role.

Night shift work and sickness absence – many for the few or few for the many?

Abstract Background Night shift work is related to adverse health outcomes. Yet, some choose working permanent night and it is speculated that they tolerate night work better. However, research on permanent night work is sparse. The aim was to study the association between organisation of night work and sickness absence. Should we allow many night shifts for the few or should we enforce few night shifts for the many? Methods Information on working hours, age (19-70 years), gender (women, men) and sickness absence (annual number of days) was obtained from 94 815 nurses and nurse assistants (88% women) from the Danish Working Hour Database (DAD). DAD contains daily information on working hours based on payroll data for all employees in Danish public hospitals (2017-2020). For each year with >50% work participation, individual schedules were classified into “no night shifts”, “1-50 night shifts”, “51-100 night shifts”, “101-150 night shifts” and “more than 150 night shifts”. We applied linear regression (with individual as random intercept) for risk of sickness absence the following year adjusted for age, gender and calendar year. Results Preliminary results showed night shift workers with more than 150 night shifts per year had 5.0 more sick days (95% CI: 3.5-6.4, p = <0.001) than employees with no night shifts. No statistically significant differences were observed between the four night shift groups. Conclusions Employees had more sickness absence the year after working during the night compared to employees without night shift work. However, no differences were seen when yearly comparing employees with many night shifts to those with few night shifts. The study adds to scientific support to guidelines on scheduling of shift work in governmental policies with the aim of securing healthy and safe workplaces. Key messages • Night shift workers have higher number of sick days compared to daytime workers; however, number of night shifts during a year did not affect the results. • The study adds value for the use of the scientific recommendations for minimizing health risk for night shift workers in governmental policies with the aim of securing healthy and safe workplaces.

Orchestrating moral bearability in the clinical management of second-trimester selective abortion

In present-day Denmark, second-trimester selective abortion has become a regular medical event, which has turned selective abortion care into a routinized task for health staff. In this article, we explore what forms of care practices abortion providers in Danish public hospitals engage in. Using in-depth interviews, medical documents and social media data, we show that at the center of selective abortion care provision is not only securing safe medical outcomes, but moral labor orientated towards achieving a morally manageable medical event, permeating institutionally developed clinical guidelines, relational face-to-face care, and ideologically driven encouragement of parental-fetal attachment through the use of material objects and visibility practices. We propose to view these entangled realms of practices as aiming towards generating what we term “moral bearability”, meaning that selective abortion care is orchestrated in particular ways to make the abortion, and the implied making and handling of death, simultaneously bearable for couples and health staff.

A data-driven decision support tool to improve hospital bed cleaning logistics using discrete event simulation considering operators’ behaviour

Beds are a critical resource for hospitals, requiring effective management to ensure the quality of care for patients. Beds operate in a closed-loop circuit and must be thoroughly cleaned between patients’ arrivals to prevent infections. Hospitals must implement efficient logistics systems to collect, transport, store, and clean unclean beds from discharged patients. These systems must be robust and efficient to meet the varying bed supply needs, given the available resources such as beds, staff and machines. This study aims to develop a decision support tool to optimise bed cleaning logistics and ensure the availability of sterile beds for incoming patients at all times. The study is based on the bed flow and cleaning organisation of a Danish public hospital. A discrete event simulation model (DES) of the back-end bed flow has been developed. The paper also presents a tension level indicator to reflect the behaviour of cleaning staff when facing variations in demand and bed stock. Using the organisational set-up (staff schedules, policies, and bed fleet size), the DES model: (1) evaluates the ability to provide sterile beds in a reasonable time, (2) measures the stress on cleaning staff, and (3) visualises resource usage. This study illustrates how to incorporate the staff’s perceived workload and resulting behaviour into a DES model to capture the behavioural aspect of staff’s decision-making.

The clinical profile of individuals with symptoms of knee osteoarthritis referred to secondary care in Denmark: Across-sectional study of 282 people.

The clinical profile of individuals with symptoms of knee osteoarthritis referred to secondary care in Denmark: Across-sectional study of 282 people.

Varying convalescence recommendations for sport and heavy lifting after groin hernia repair: a nationwide survey among leading hernia surgeons.

Recent international hernia guidelines state that work and leisure activities after inguinal hernia repair can be resumed after a convalescence of three to five days for most patients. There is no specific recommendation for convalescence duration before resuming sport and heavy lifting. This nationwide survey aimed to assess leading hernia surgeons' recommendations for convalescence after groin hernia repair and to explore their general opinions regarding convalescence. A validated questionnaire was sent to 32 leading groin hernia surgeons covering all Danish private and public hospitals. The primary outcome was convalescence recommendations following Lichtenstein and laparoscopic groin hernia repair for activities of daily living, light work, sport, and heavy lifting. A total of 29 surgeons (91%) responded to the questionnaire. The surgeons generally agreed on resuming daily activities and light work as soon as possible according to the level of pain. For resumption of sport, the surgeons recommended a median convalescence of 14days (IQR 10-23, range 7-30) after Lichtenstein repair and 14days (IQR 10-21, range 7-30) after laparoscopic repair. Most of the surgeons instructed patients with a defined number of days before resuming heavy lifting, which after Lichtenstein repair was median 14days (IQR 8-28, range 2-30) and after laparoscopic repair was median 21days (IQR 14-30, range 7-30). None of the surgeons routinely prescribed sick leave. Seventeen surgeons (61%) thought that recommending a too short convalescence could cause complications, primarily recurrence, hematoma, and pain. This study revealed that surgeons agreed on the resumption of daily activities and light work as soon as possible according to the level of pain. However, a broad spectrum of convalescence recommendations was revealed for sport and heavy lifting.

Ethical Leadership Understandings in Public Professional Organisations

Some scholars have incorporated specific ethical values such as altruism and compassion and fairness toward employees into generic conceptualisations of ethical leadership. It is important to consider whether these concepts including specific values characterise notions of ethical leadership in all contexts. Based on theoretical arguments and by means of 41 interviews with managers and employees at Danish public hospitals, this article theoretically discusses and empirically illustrates what organisational context can mean for ethical leadership understandings. The empirical case represents a public organisational context characterised by strong professional leaders and employees. The theoretical and empirical insights suggest that overall, the existing theoretical concept of ethical leadership seems useful to characterise ethical leadership understandings in Danish public hospitals, while individuals’ social group identification in this organisational context informs which specific ethical values an ethical leader should demonstrate and promote.

Readmission trends before and after a national reconfiguration of emergency departments in Denmark.

In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates. We included all unplanned hospital admissions (aged ≥18years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes. The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]). Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.

Chronic disorders, work-unit leadership quality and long-term sickness absence among 33 025 public hospital employees.

This study aimed to examine the association between work-unit level leadership quality and individual-level long-term sickness absence (LTSA) in the hospital sector and effect modification by chronic disorders. This longitudinal analysis included 33 025 Danish public hospital employees who were followed-up for one year after baseline in March 2014. Leadership quality was assessed by questionnaire with mean responses aggregated by work-unit and characterized in tertiles. LTSA during follow-up was determined from employer records. Chronic disorders at baseline was assessed from the Danish hospital and prescription registers. We performed multilevel logistic regression to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusting for potential confounders. We evaluated interaction between chronic illness and low leadership quality on multiplicative and additive scales. We identified employees as healthy (60.8%) or with somatic (31.6%), mental (3.3%), or both somatic and mental (4.3%) disorders. During follow-up, 6% of employees registered a LTSA. Medium and high leadership quality were associated with lower risk of LTSA with OR of 0.84 (95% CI 0.76-0.94) and 0.73 (95% CI 0.65-0.82) respectively, compared to low leadership quality. Associations were similar for healthy employees and employees with only somatic disorders, whereas no association was observed for employees with mental disorders (in presence or absence of somatic disorders). No statistically significant (α=0.05) interactions between leadership quality and chronic disorders on LTSA were observed. The findings suggest that the quality of leadership in work units is associated with risk of long-term sick leave in the Danish public hospital sector and that strong leadership protects employees against LTSA.

SO-29 Dihydropyrimidine dehydrogenase (DPD) genotype and phenotype among Danish cancer patients: Prevalence and correlation between DPYD-genotype mutations and P-uracil concentrations

Fluoropyrimidines (FP) are the cornerstone of chemotherapy of several, mainly gastrointestinal, solid tumors. FP includes 5-fluorouracil, capecitabine, and tegafur, all metabolized by dihydropyrimidine dehydrogenase (DPD) enzyme. Patients with decreased DPD-activity have a higher risk of getting severe toxicity if treated with standard FP doses. The DPD-activity is currently a standard test in Denmark with a DPYD-genotype-test and/or a measurement of the endogenous compound uracil (DPD-phenotype test). In Denmark, the recommended FP starting dose for patients diagnosed with partial DPD-deficiency is 50%. FP treatment is contraindicated in patients with complete DPD-deficiency due to a high risk of life-threatening adverse effects. Patients with one variant SNP and/or uracil concentrations above 16 ng/ml are categorized as having partial DPD deficiency. However, patients are categorized as having complete DPD deficiency if they are homozygous for one variant SNP or compound heterozygous (patients with≥ 2 different variant SNPs) and/or have uracil concentrations above 150 ng/ml. In France and the Netherlands, the prevalence of clinically relevant DPYD variants was 4.7% and 7.7% respectively. No studies have reported data on the prevalence of DPYD variants or P-uracil in Danish cancer patients. We collected data from all Danish public hospital laboratories performing DPYD-genotype and DPD-phenotype analysis from the 1st of July 2020 to the 31st of December 2021. Patients were genotyped for the four clinically relevant DPYD-variants: rs3918290, rs67376798, rs55886062, and rs56038477/rs75018182. Most of the samples were genotyped using the LAMP (loop-mediated isothermal amplification) technology (Lc-Dpd4mut-Lp-24-Lacar Mdx Technologies). Plasma uracil concentrations were measured using liquid chromatography-mass spectrometry (LC-MS). In total 4228 Danish cancer patients were tested. 1985 of the patients were only tested using one method (P-uracil=17, DPYD-genotype=1968). 2243 patients were tested using P-uracil and DPYD-genotyping. Of the 4215 DPYD-genotyped patients, 3895 (92.4%) was wild type and 316 (7.5%) was heterozygous for one of the tested variants (SNP'S). rs3918290 (1%, n=43), rs67376798 (1.4%, n=57), rs55886062 (0.2%, n=8) and rs56038477/rs75018182 (4.9%, n=208). Four patients (0.1%) were compound heterozygous. Among 2260 patients tested, 2132 (94.3%) had an uracil concentration below 16 ng/ml. The remaining 128 (5.7%) patients had uracil concentrations ≥ 16 ng/mL and < 150 ng/ml. No values above 150 ng/ml was found. Median uracil concentration was 8 ng/ml (range 5-82 ng/ml). Both geno- and phenotype were available for 2243 of the patients. Uracil concentrations among wild type patients were lower (mean 8.6 ng/ml) compared to patients with DPYD-variants (mean 11.2 ng/ml), mean difference of 2.7 ng/ml. (95% CI; 1.9-3.4 ng/ml). In 4.8% (n=99) of wild type patients, the uracil concentration was ≥ 16 ng/ml compared to 16.8% (n=29) in the group with DPYD-mutations. The prevalence of clinically relevant DPYD-mutations in Danish cancer patients is 7.6% and is in line with results from similar studies of other European populations. 5.7% of phenotyped patients had uracil concentrations ≥ 16 ng/ml. Patients with DPYD-variants had higher mean uracil concentrations compared to wild type, but the uracil concentrations varied substantially in both groups. Data regarding adverse events are needed to conclude on the clinical implications.

The association between sociodemographic characteristics and the event of undergoing first-time, simple lumbar discectomy: A case-control study

BackgroundIn disc herniation, nonsurgical treatments are recommended prior to elective discectomy but are often associated with consultation fees, whereas the discectomy itself may be without user payment. This may affect individual preferences in the choice of treatment. This retrospective case-control study examined the association between socioeconomic characteristics and the event of undergoing a first-time, single-level, simple lumbar discectomy. MethodsThe consecutively formed study population comprised patients undergoing elective lumbar discectomy at a Danish public hospital between 2010 and 2013. A national authority identified three gender- and age-matched controls per case for comparison. Measures investigated in this study were marital status, ethnicity, socioeconomic classification, educational level, the extent of sick leave 52 weeks prior to surgery, personal income, and equivalized disposable household income. All measures were provided by national registries. The associations were examined using uni- and multivariate logistic regression analysis. ResultsIn a study population of 888 operated patients (age (SD) 46 (14); ODI (SD) 47 (18); leg pain intensity (VAS) (iqr) 74 (33), EQ-5D (iqr) 0.26 (0.62)) compared to 2664 controls, the probability of undergoing lumbar discectomy was significantly associated with lower vs. higher educational levels ((OR 1.98-2.53), and with periods of sick leave exceeding two weeks within one year prior to surgery (OR 9.47 (95% CI 7.68-11.68)). In the multivariate analysis, the event of undergoing discectomy was insignificantly associated with any other socioeconomic characteristics, whereas the personal income was of significant importance in the univariate analysis. ConclusionThe event of undergoing free-of-fee elective first-time, single-level, simple lumbar discectomy is more common among individuals with low educational levels and unstable labor market attachment when examined in a case-control study. Being a multifactorial challenge, this calls upon the active engagement of several policy sectors.

Distribution and use of automated external defibrillators and their effect on return of spontaneous circulation in Danish hospitals

IntroductionAutomated external defibrillators (AEDs) increase survival after out-of-hospital cardiac arrest. However, the effect of AEDs for in-hospital cardiac arrest (IHCA) remains uncertain. This study aims to describe the distribution and use of AEDs in Danish hospitals and investigate whether early rhythm analysis is associated with return of spontaneous circulation (ROSC). MethodsAll Danish public hospitals with a cardiac arrest team were included and sent a questionnaire on the in-hospital distribution of AEDs and manual defibrillators. Further, we collected data on IHCAs including rhythm analysis, device type, cardiac arrest team arrival, and ROSC from the national database on IHCA (DANARREST). ResultsOf 46 hospitals, 93% had AEDs and 93% had manual defibrillators. AEDs were often placed in wards or non-clinical areas, whereas manual defibrillators were often placed in areas with high-risk patients. We identified 3,204 IHCAs. AEDs were used in 13% of IHCAs. After adjustment for confounders, chance of ROSC was higher if the first rhythm analysis was performed before the arrival of the cardiac arrest team (RR: 1.28 (95% CI: 1.12–1.46)). The relative risk of ROSC was 1.09 (0.84–1.41) when analyzing with an AED before cardiac arrest team arrival and 1.19 (1.00–1.41) when using a manual defibrillator. However, there was no significant effect modification for AED vs manual defibrillator (p = 0.26). ConclusionAEDs are widely distributed in Danish hospitals but less commonly used for IHCAs compared to manual defibrillators. Rhythm analysis before arrival of the cardiac arrest team was associated with ROSC without significant effect modification of device type.

Limited use of local anesthesia for open inguinal hernia repair: a qualitative study.

Local anesthesia for open inguinal hernia repair is recommended by guidelines but is rarely used in clinical practice in several countries. This study aimed to explore physician's considerations in choosing type of anesthesia and barriers for implementing local anesthesia for open hernia repair in clinical practice. We performed individual semi-structured interviews of surgeons and anesthesiologists. Transcribed data were condensed, coded, categorized, and formulated into themes in an inductive qualitative content analysis. Twenty two participants from seven public hospitals were included in the study. Participants described a standardized setup for general anesthesia with use of intravenous propofol/remifentanil and a laryngeal mask and were generally satisfied with this setup. Their considerations in choosing anesthesia could be described in four themes: (1) Intraoperativepain and quality of surgical technique, (2)Communication and teaching, (3) Logistics, and (4) Clinical routines. Participants considered intraoperative pain and quality of surgical technique, communication and teaching, logistics, and clinical routines as important factors when choosing anesthesia for open inguinal hernia repair and these factors acted as barriers for implementing of local anesthesia in Danish public hospitals. In this setting, implementation strategies should, therefore, be multimodal to address these barriers. The potential workload in such an effort should be justified by evidence supporting specific types of local anesthesia comapared with general anesthesia with use of propofol/remifentanil and a laryngeal mask.

Data Work in Health Care: The Case of Medical Secretaries.

This paper investigates the often neglected area of data work by medical secretaries, specifically in the context of hospitals in Denmark. Since the 1930s medical secretaries have played a steadily more central role in meeting the growing need for health data. With electronic health records (EHRs) and promises of data automation, the profession has been put at risk of redundancy. While there is a considerable base of research on the datafication of health care, the data work emerging from datafication remains undescribed. Hence, we are conducting a socio-technical study of clinical-administrative data work in contemporary Danish public hospitals. In this paper we present early insights of this research, indicating the vital role of medical secretaries' data work in securing clinical information at the point of care.

P–484 Progesterone supplementation in modified natural frozen embryo transfer (mNC-FET) does not cause mental health adverse effects - A sub-study of a multicenter RCT

Abstract Study question Do women undergoing mNC-FET with progesterone supplementation experience mental health adverse effects at a greater rate compared to a control group. Summary answer Progesterone supplementation does not affect mental wellbeing in women undergoing mNC-FET. What is known already Women and men undergoing assisted reproductive treatment more likely to experience stress and other adverse psychological effects than the background population. Various factors such as parental age, cause of infertility and treatment method have been shown to affect patient well-being. Progesterone supplementation is known to cause various physical adverse effects, yet few studies have investigated the potential mental health adverse effects of progesterone supplementation in FET. Study design, size, duration This is a sub-study of an ongoing RCT investigating the effect of luteal phase progesterone supplementation in mNC-FET. The aim is to investigate possible mental health adverse effects of progesterone. From 2019–2021 a total of 164 women were included (n = 84 and n = 82 in the progesterone and control group, respectively). The health and wellbeing self-reporting survey was fulfilled after randomization on hCG trigger + 11 days. Participants/materials, setting, methods A validated, electronic questionnaire in Danish was used to measure mental wellbeing in women aged 18–41 years undergoing mNC-FET with and without use of progesterone supplementation in the luteal phase at seven Danish public hospitals. Women were randomized to either progesterone treatment or no progesterone by a computerized randomization algorithm with minimization for female age &amp;gt; =37 years, previous oocyte retrievals and previous FET. Comparisons of survey responses were performed by chi-square tests. Main results and the role of chance The survey response rate was 68%. We observed no significant differences in any of the three items between the progesterone group and the control group. On the first item “to which degree have you felt sensitive due to treatment”, 56% and 52% responded “to a large degree” or “to some degree” sensitive in the progesterone vs. control group, while 25% and 34% vs. 19% and 13% responded “to a lesser extent” or “not at all” sensitive in progesterone vs. controls (P = 0.35). On the second item, “to which degree have you felt aggressive due to treatment”, 10% and 9% responded “to a large degree” or “to some degree”, 29% and 22% answered “to a lesser degree” and 62% and 70% responded “not at all” in the progesterone vs control group (P = 0.57). On the third item “to which degree have you cried unexpectedly due to treatment” 25% and 18% responded “to a large degree” or “to some degree” in the progesterone vs control group, 20% and 27% answered “to a lesser extent”, while 55% in both groups answered “not at all” (P = 0.44). Limitations, reasons for caution In a self-reported survey selection bias, due to a less than 100% response rate, and reporting bias cannot be excluded. However with the possibility to answer the survey online at leisure, the risk of reporting bias is minimized. Wider implications of the findings: A large concern for clinicians working with ART is patient wellbeing. Our study suggests that luteal phase support does not cause extra emotional distress, though further research is needed. Trial registration number NCT03795220

Time spent by hospital personnel on drug changes: A time and motion study from an in-and outpatient hospital setting.

Medicines used at Danish public hospitals are purchased through tendering. Together with drug shortage, tendering result in drug changes, known to compromise patient safety, increase medicine errors and to be resource demanding for healthcare personnel. Details on actual resources required in the clinic setting to manage drug changes are unknown. The aim of the study is to explore time spend by hospital personnel in a drug change situation when dispensing medicine to in- and outpatients in a hospital setting in the Capital Region of Denmark. A time and motion study, using direct observation combined with time-registration tools, such as eye-tracking, video recording and manual time tracking. Data were obtained from observing nurses and social and health care assistants with dispensing authority while dispensing or extraditing medicine before and after the implementation of drug changes in two clinical setting; a cardiology ward and a rheumatology outpatient clinic. Hospital personnel at the cardiology inpatient ward spent 20.5 seconds on dispensing a drug, which was increased up to 28.4 seconds by drug changes. At the rheumatology outpatient clinic, time to extradite medicine increased from 8 minutes and 6 seconds to 15 minutes and 36 seconds by drug changes due to tender. Similarly, drug changes due to drug shortage prolonged the extradition time to 16 minutes and 54 seconds. Statistical analysis reveal that drug changes impose a significant increase in time to dispense a drug for both in- and outpatients. Clinical hospital personnel spent significantly longer time on drug change situations in the dispensing of medicine to in- and outpatients in a hospitals. This study emphasizes that implementing drug changes do require extra time, thus, the hospital management should encounter this and ensure that additional time is available for the hospital personnel to ensure a safe drug dispensing process.

The Danish Shoulder Arthroplasty Registry

The Danish Shoulder Arthroplasty Registry (DSR) was established in 2004. The purpose of the registry is to monitor and improve the outcome of shoulder arthroplasty surgery in Denmark. The objective of this study was to describe the organization of the DSR and review published DSR papers with a special focus on patients with osteoarthritis. All Danish public and private hospitals report to the DSR. Since 2006, when reporting became mandatory, the completeness of reporting has been over 90% each year. Surgeons report patient and operative data electronically at the time of the operation. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index at 1 year is used as patient-reported outcome. A revision is defined as removal or exchange of any component or the addition of a glenoid component. The revision is linked to the primary procedure with use of a unique civil registration number, which is given to all Danish citizens at birth. The registry has published five papers focusing on patients with osteoarthritis. The WOOS score was significantly higher after anatomical total shoulder arthroplasty compared with hemiarthroplasty. The WOOS score after resurfacing hemiarthroplasty varied and was often disappointing especially in young patients. The WOOS score after revision arthroplasty for failed resurfacing hemiarthroplasty was low and disappointing. The short- and mid-term survival rates of anatomical total shoulder arthroplasty were high for both the stemmed and the stemless humeral components. The DSR has recorded significant changes in Danish surgeons’ approach to patients with osteoarthritis. Today, anatomical total shoulder arthroplasty with either a stemmed or a stemless humeral component is preferred in most cases.

Night work and postpartum depression: a national register-based cohort study.

Objective We aimed to investigate the association of night work during pregnancy with the risk of severe postpartum depression (PPD). Methods We performed a nationwide register-based cohort study of workers in all Danish public hospitals. Daily information on working hours was retrieved from the Danish Working Hour Database from January 2007 to December 2015. Pregnancies, covariates and outcome were identified from national registries for births and hospital contacts. We performed logistic regression of the risk of severe PPD in relation to the number and duration of night shifts, spells of consecutive night shifts, and short shift intervals during the first 32 pregnancy weeks. Analyses were adjusted for age, body mass index, socioeconomic status, parity, sickness absence three months prior to pregnancy, and prior diagnosis of severe depression. Results The study cohort comprised 25 009 singleton pregnancies from 19 382 workers. The majority were nurses or physicians. Overall, we did not observe an increased risk of PPD for any of the dimensions of night work analyzed. We found, however, an increased risk of PPD (adjusted odds ratio 2.08, 95% confidence interval 1.09-4.00) among women who stopped working night shifts after the first pregnancy trimester (N=3094). Conclusion Overall, our results do not support night work during pregnancy as a risk factor for severe PPD among hospital employees. However, we observed a 2-fold increased risk of PPD among women who stopped working night shifts after the first pregnancy trimester. This may reflect the influence of the healthy worker survivor effect and warrants further attention.

Night work and miscarriage: a Danish nationwide register-based cohort study

ObjectiveObservational studies indicate an association between working nights and miscarriage, but inaccurate exposure assessment precludes causal inference. Using payroll data with exact and prospective measurement of night work, the objective...

Night work and sick leave during pregnancy: a national register-based within-worker cohort study

ObjectiveThe aim of our study was to investigate the acute effect of night work during pregnancy on the risk of calling in sick the following day using register-based information and...