Living through uncertainty: a qualitative study on leadership and resilience in primary healthcare during COVID-19

BACKGROUND

Resilience is often referred to when assessing the ability of health systems to maintain their functions during unexpected events. Primary healthcare forms the basis for the health system and thus its resilient responses are vital for the outcomes of the whole system. Understanding how primary healthcare organisations are able to build resilience before, during, and after unexpected or sudden shocks, is key to public health preparedness. This study aims to identify how leaders responsible for local health systems interpreted changes in their operational environment during the first year of COVID-19, and to elucidate how these views reflect aspects of resilience in healthcare.

METHODS

The data consist of 14 semi-structured individual interviews with leaders of local health systems in Finland representing primary healthcare. The participants were recruited from four regions. An abductive thematic analysis was used to identify entities from the viewpoints of the purpose, resources, and processes of resilience in the healthcare organisation.

RESULTS

Results were summarised as six themes, which suggest that embracing uncertainty is viewed by the interviewees a basis for primary healthcare functioning. Leading towards adaptability was regarded a distinct leadership task enabling the organisation to modify its functions according to demands of the changing operational environment. Workforce, knowledge and sensemaking, as well as collaboration represented what the leaders viewed as the means for achieving adaptability. The ability to adapt functioned to comprehensively meet the population's service needs built on a holistic approach.

CONCLUSIONS

The results showed how the leaders who participated in this study adapted their work during changes brought on by the pandemic, and what they viewed as critical for maintaining organisational resilience. The leaders considered embracing uncertainty as a principal feature of their work rather than viewing uncertainty as aberrant and something to avoid. These notions, along with what the leaders considered as critical means for building resilience and adaptability should be addressed and elaborated in future research. Research on resilience and leadership should be conducted more in the complex context of primary healthcare, where cumulative stresses are encountered and processed continuously.

Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters

OBJECTIVE

To determine the relationship between different physical loading conditions and findings of knee osteoarthritis (OA).

METHODS

We selected 117 male former top-level athletes (age range 45-68 years) who had participated in sports activities with distinctly different loading conditions: 28 had been long-distance runners, 31 soccer players, 29 weight lifters, and 29 shooters. Histories of lifetime occupational and athletic knee loading, knee injuries, and knee symptoms were obtained, and subjects were examined clinically and radiographically for knee findings of OA.

RESULTS

The prevalence of tibiofemoral or patellofemoral OA based on radiographic examination was 3% in shooters, 29% in soccer players, 31% in weight lifters, and 14% in runners (P = 0.016 between groups). Soccer players had the highest prevalence of tibiofemoral OA (26%), and weight lifters had the highest prevalence of patellofemoral OA (28%). Subjects with radiographically documented knee OA had more symptoms, clinical findings, and functional limitations than did subjects without knee OA. By stepwise logistic regression analysis, the risk for having knee OA was increased in subjects with previous knee injuries (odds ratio [OR] 4.73), high body mass index at the age of 20 (OR 1.76/unit of increasing body mass index), previous participation in heavy work (OR 1.08/work-year), kneeling or squatting work (OR 1.10/work-year), and in subjects participating in soccer (OR 5.21).

CONCLUSION

Soccer players and weight lifters are at increased risk of developing premature knee OA. The increased risk is explained in part by knee injuries in soccer players and by high body mass in weight lifters.

The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men

STUDY DESIGN

Historical cohort, including selected subgroups.

OBJECTIVES

To understand the long-term effects of exercise on back-related outcomes, back pain, sciatica, back-related hospitalizations, pensions, and magnetic resonance imaging findings were studied among former elite athletes.

SUMMARY OF BACKGROUND DATA

Exercise and sports participation have become increasingly popular, as have recommendations of exercises for back problems, but little is known about their long-term effects.

METHODS

Questionnaires were returned by 937 former elite athletes and 620 control subjects (83% response rate). Identification codes allowed record linkage to hospital discharge and pension registers. Magnetic resonance images were obtained of selected subgroups with contrasting physical loading patterns.

RESULTS

Odds ratios for back pain were lower among athletes than among control subjects, with significant differences in endurance, sprinting and game sports, and wrestling and boxing. No differences in the occurrence of sciatica or in back-related pensions and hospitalizations were seen. When comparing lumbar magnetic resonance images of 24 runners, 26 soccer players, 19 weight lifters, and 25 shooters, disc degeneration and bulging were most common among weight lifters; soccer players had similar changes in the L4-S1 discs. No significant differences were seen in the magnetic resonance images of runners and shooters.

CONCLUSIONS

Maximal weight lifting was associated with greater degeneration throughout the entire lumbar spine, and soccer with degeneration in the lower lumbar region. No signs of accelerated disc degeneration were found in competitive runners. However, back pain was less common among athletes than control subjects and there were no significant differences in hospitalizations or pensions. No benefits were shown for vigorous exercise compared with lighter exercise with respect to back findings.

Supracondylar fractures of the humerus in children

Supracondylar fractures of the humerus in children were studied in Kuopio University Central Hospital during 1974-1984. The total number of the fractures was 86. Fifty-two patients were examined 13 months to 11 years after the accident. Only severe cases (grade 3 and 4 after Holmberg's classification) were included. Twenty patients were treated operatively, 17 with traction and 15 conventionally with reposition and plaster cast. The age of the patients at the time of the accident was from 21 months to 12 years and at follow-up from five to 23 years. The purpose of this study was to evaluate late results of these three methods. There was no statistical difference between the late results of the treatment groups. Regardless of treatment method careful reposition and controlling retention for both varus, flexion and extension and rotation deformities are essential for good end results.