Kimmo Räsänen

Factors associated with visits to occupational health physicians in Finland.

BACKGROUND In Finland, employers can offer primary care to employees in addition to obligatory occupational health services (OHS). AIMS To analyse factors associated with visits to seek primary care from occupational health physicians (OH physicians) and compared with visits to physicians in municipal health centres, private clinics and hospital outpatient clinics. METHODS The subjects of this population-based cross-sectional survey comprised 1753 randomly selected employed Finns aged 25-64 years covered by OHS including primary care. The associations between visits to physicians during the past 6 months and factors related to work and perceived health were tested using Poisson regression analysis. RESULTS Provision of primary care in OHS increased visits to OH physicians but decreased visits to municipal health centre physicians. Among both genders, long-standing illnesses impairing work ability had the strongest associations with visits to all physicians. Among men, the factors associated with visits to OH physicians were long-standing illnesses without effect on work ability, requirement of sickness certificate from the first day of sickness, OHS arranged in private clinics and moderate stress symptoms. Among women, lower vocational level, OHS arranged in private clinics or joint-model OHS units, moderate stress symptoms and workplace harassment were associated with visits to OH physicians. CONCLUSIONS Primary care in OHS enables OH physicians to reach workers with work-related health problems, thus enabling interventions on working conditions and work ability. Moreover, OHS seem to be a very important health care provider in Finland.

Evidence-based medicine in de praktijk

SamenvattingEvidence-based medicine (EBM) heeft de laatste jaren een grote vlucht genomen in veel gebieden van de geneeskunde, maar over de toepasbaarheid van deze methode in de bedrijfsgeneeskunde is relatief weinig bekend. Aan de hand van vier verschillende vraagstukken uit de dagelijkse praktijk zijn met behulp van de EBM-methode, zoekvragen opgesteld die met de publiek toegankelijke database van medische literatuur Medline, zijn beantwoord.In korte tijd werden bruikbare antwoorden gevonden met toepassingsmogelijkheden in de praktijk. Systematische literatuuroverzichten en risicomaten bleken schaars. Evidence-based medicine is ook in de bedrijfsgeneeskunde een bruikbare en nuttige methode, ofschoon voor de meeste bedrijfsen verzekeringsartsen enige aanvullende instructie en training welkom zal zijn.

Work-Related Primary Care in Occupational Health Physician’s Practice

Introduction Primary care is frequently integrated in Finnish occupational health services (OHS). This study examines the frequency of work-related health problems in occupational health (OH) physicians’ consultations for primary care and associations between health problems and interventions carried out by OH physicians. Methods OH physicians assessed the health problems of 651 consecutive visits in a private OHS unit. The health problem was regarded as work-related if it was caused or aggravated by work, or involved impaired work ability. Interventions carried out by OH physicians were analysed by logistic regression analysis. Results The main health problem was caused either partially or mainly by work or symptoms were worsened by work (27%), or symptoms impaired work ability (52%). Musculoskeletal and mental disorders were the main work-related reasons for visits. In two-thirds of the cases of mental health problems, work caused or worsened symptoms, and the majority of long sickness absences were issued due to these problems. OH physicians carried out interventions concerning work or workplace in 21% of visits. Mental disorders were associated most strongly (OR 7.23, 95% CI 3.93–13.32) with interventions. The strongest association (OR 16.09, 95% CI 9.29–27.87) with work-related visits was, when the health problem was both work-induced and impaired work ability. Conclusions Work-related health problems comprise a considerable part of Finnish OH physicians’ work. OH physicians play an important role in early treatment, in the prevention of disability, and in interventions aimed at workplaces based on the knowledge they get through primary care in OHS.

Disclosure of Type 1 diabetes at work among Finnish workers.

To determine which self‐management factors and psychosocial work factors were associated with disclosing diabetes to colleagues, line managers and occupational health personnel among workers with Type 1 diabetes.

Randomized controlled trials are needed to close the evidence gap in the prevention of preterm birth.

Pregnant women have been advised to avoid heavy lifting during pregnancy due to concerns of adverse pregnancy outcomes including premature delivery. To date there is no evidence on the effectiveness of advice in preventing preterm birth as found in a recent systematic search and appraisal of published literature. This letter employs the findings of the review to inform future studies.

Primary care visits to occupational health physicians and nurses in Finland

Aims: In Finland, 91% of employer-arranged occupational health services (OHS) include primary care for employees. Occupational health (OH) physicians and OH nurses carry the main responsibility for primary care in OHS. This study analyses work- and health-related factors associated with primary care visits to OH physicians and OH nurses. Methods: This population-based cross-sectional survey encompassed 1636 randomly selected working employees aged 25—64 covered by OHS which included primary care. The associations between factors and visits during the previous 6 months were tested by Poisson regression analysis. Results: The proportion of employees who visited OH physicians or OH nurses was 57%. Men visited OH nurses more often than women, but the number of visits to OH physicians was similar. Long-standing illnesses impairing work ability, work-related symptoms, and type of OHS provision were associated with visits to both OH physicians and nurses. Moderate psychological stress was associated with visits to OH physicians. Among men, the requirement of obtaining a sick-leave certificate on the first day of absence was associated with visits. Less possibilities to influence one’s work was associated with visits to OH nurses, and among women also to OH physicians. Poor support from supervisors and co-workers had non-significant or inverse associations. Conclusions: The wide use of OHS and both the type and similarities between factors associated with visits may signify that both OH physicians and OH nurses are likely to encounter work-related health problems through primary care in OHS.

Systematic review: Factors associated with return to work in burnout

Background Professional burnout predicts sick leave and even permanent withdrawal from the labour force. However, knowledge of the barriers to and facilitators of return to work (RTW) in such burnout is limited. Aims To identify factors associated with RTW of burned-out individuals to inform occupational health care (OHC) RTW policy. Methods A systematic search of peer-reviewed quantitative and mixed-method studies published from January 2005 to July 2016 in English and Finnish in ARTO, CINAHL (EBSCO), Medic, PsycINFO (ProQuest), PubMed, Scopus and Web of Science databases, followed by a manual search. We included studies that identify burnout with valid burnout measures and measure the degree of RTW or sick leave as outcomes. We excluded studies with heterogeneous samples without subgroup analyses of RTW in burnout cases. Results We included 10 studies (three experimental and seven observational) of the initial 1345 identified. The studies reported work-related factors; enhanced communication (positive association) and low control at work (negative association) and individual-related factors; male gender (positive association), covert coping (negative association), high over-commitment to work (positive association) and burnout-related factors; unimpaired sleep (positive association), duration of sick leave over 6 months (negative association) and part-time sick leave (positive association) associated with RTW in burnout. Associations between burnout rehabilitation and RTW, and the level of symptoms and cognitive impairment and RTW remained unclear. Conclusions Few quantitative studies, of varied methodological quality, explore factors associated with RTW in burnout. Further research is needed to build an evidence base and develop guidelines for supportive OHC actions.

Association Among Sociodemograhic Factors, Work Ability, Health Behavior, and Mental Health Status for Young People After Prolonged Unemployment

The purpose of this study was to explore the associations of prolonged unemployment, health, and work ability among young workers using data from the 2008-2010 Occupational Health Counselling project in Kuopio, Eastern Finland. The total sample for this study was 190 young unemployed adults. The questionnaire included the Work Ability Index (WAI), the Beck Depression Inventory, the Alcohol Use Disorders Identification Test, and the Occupational Health Counselling Survey. Multivariate analyses revealed that men had a higher prevalence of prolonged unemployment than women. Using drugs for purposes other than treatment was associated independently with an increased prevalence of prolonged unemployment. Low WAI scores were associated with a higher prevalence of prolonged unemployment. This study showed that attention should be paid to male workers, those who have poor or moderate work ability and workers who use drugs. Young unemployed workers should be recognized at an early stage. A comprehensive, flexible network of community resources is essential to support young unemployed adults.

Work ability among Finnish workers with type 1 diabetes

BACKGROUND Work ability represents the balance between individual resources, health status and job demands. As far as we are aware, these issues have not been examined in working people with type 1 diabetes (T1D). AIMS To examine how work-related and diabetes-related factors are associated with work ability among male and female workers. METHODS Questionnaires were mailed to a random sample of 2500 people with T1D from the Medication Reimbursement Register of The Social Insurance Institution of Finland. The associations of the predictors of poor work ability were examined in a logistic regression analysis. RESULTS The final sample comprised 767 working people aged 18-64 with T1D; overall response rate 49%. One in every three working men and women with T1D had poor work ability. High job demands and low job control were associated with poor work ability in both genders. Physical work and low worktime control were significantly associated with poor work ability in men but not in women with T1D. A self-reported high value of glycosylated haemoglobin was the only diabetes-related variable associated with poor work ability in both men and women. CONCLUSIONS Work-related factors and poor glycaemic control were associated with poor work ability in individuals with T1D. Thus, job control and worktime control should be taken into account in supporting the work ability of workers with T1D.

Agricultural injuries in Korea and errors in systems of safety

INTRODUCTION Agriculture is known to be a dangerous industry in Korea, as well as in other countries. According to earlier studies, the root cause of occupational injury can be identified with errors in the various systems of safety, and such identification is helpful for the prevention of occupational injury. OBJECTIVE The aims of this study were to examine the root causes of cases of agricultural injury in Korea, based on insurance claims and identification of errors in systems of safety. MATERIALS AND METHOD Using the Korean Mutual Aid Insurances injury claim database, 277 injury cases were identified, of which 68 were contacted. Root causes were categorized, using the logic tree diagramming method and the systems of safety described in the literature. RESULTS Seventy-five percent of all injuries were attributable to falls, strangulation, amputation and collision from flying and falling objects. 194 root causes were found for all injuries. The percentages of errors in all the systems of safety for each root cause were 24.7% - training/procedure, 20.3% - design, 11.9% - mitigation, 9.3% - human factor, 6.2% - maintenance/inspection, and 1.0% - warning/notification. The percentage of root causes which could not be categorized due to a shortage of information was 18.6%. CONCLUSIONS It was found that most agricultural injuries were caused by a complex layer of root causes which were classified as errors in the systems of safety. This result indicates that not only training and personal protective equipment, but also regulation of safety design, mitigation devices, inspection/maintenance of workplaces, and other factors play an important role in preventing agricultural injuries. The identification of errors will help farmers to implement easily an effective prevention programme.