Important collaborative conditions for successful economic outcomes of work disability management: A mixed methods multiple case study.

BACKGROUND: Work disability management (WDM) interventions have usually focused on a single factor and its impact on outcomes such as employee health or work disability costs. Research on company-level WDM activities and their economic impact is scarce. OBJECTIVE: The aim of this study was to explain the change in company-level work disability costs and their relation to WDM practices, and to identify the mechanisms of impact through which the successful economic outcome emerged. METHODS: The study design was a convergent mixed methods design with a multiple case study. The data from 14 business units concerned business context, personnel, investments in and processes of WDM, and the costs of work disability in 2010-2013. The data were constructed into case descriptions which were analysed using qualitative comparative analysis. The economic analysis was carried out from the employers' perspective. RESULTS: Five business units gained net benefits of approximately 1.5-2.5% of the payroll sum from their investments in WDM. These benefits were characterised by a combination of four strategic processes: i) dismantling barriers to co-operation, ii) improving the visibility of the strategic goals of work ability management in everyday practice, iii) WDM actions targeting the company's main work disability risks, and iv) the facilitation of multi-actor co-operation through co-ordination and flow of information. CONCLUSION: Strategic processes to support the effectiveness of WDM were found. When aiming for economic success in work disability management, in addition to measuring and managing disability costs, it is also essential to maintain collaborative operations in everyday practice.

Occupational health check-ups and health-promoting programs and asthma.

BACKGROUND: The focus in occupational health check-ups is in work and health, but they offer also a possibility to assess health behavior and give guidance e.g. on weight control. We wanted to study whether having occupational health checks-up, receiving physicians' advice to change health behavior or participation in health promotion programs had an effect on obesity in a five-year follow-up from 1998 to 2003 in asthmatic and non-asthmatic workers. METHODS: Altogether 23,220 individuals aged 20-54 years were picked up from a randomized Finnish population sample. Univariate and multivariate logistic regression analysis was used to calculate the risk for obesity in 2003. The variables used in the modelling were gender, age, smoking, asthma, depression, and physical workload. RESULTS: Both asthmatic and non-asthmatic workers gained weight during the follow-up. Of the asthmatics 48 and 47% of the non-asthmatics had occupational health-check-up in the last 5 years. Of the asthmatics 18 and 14% of the non-asthmatics had received physician's advice to change their health behavior (p < 0.001). Associated factors for obesity (BMI > 30) in 2003 were gender (men OR 1.19), older age (OR 1.25), smoking (OR 1.07) or depression (OR 1.44). CONCLUSIONS: Results show that having occupational health checks-up or receiving physicians' advice to change health behavior or participation in health promotion programs did not stop gain of weight during a five-year follow-up. Asthmatic workers did not differ from non-asthmatics. Male gender, older age, smoking, and depression were associated with obesity but not the physical workload.

Fuel Staging and Air Staging To Reduce Nitrogen Emission in the CFB Combustion of Bark and Coal.

Nitrogen oxide (NO) and nitrous oxide (N2O) formation in the circulating fluidized bed (CFB) combustion can be controlled by air staging and fuel staging. An extensive test campaign was carried out with a pilot-scale CFB test rig to observe the possibilities of the methods in the spruce bark and bituminous coal combustion as well as in co-combustion. Fuel staging with liquid petroleum gas (LPG) was done alternately from three locations with three intensities. Air staging was studied alone and during the fuel staging experiment. The experimental trends for NO and N2O emission formation during fuel staging and air staging are presented in this study. It was observed that air staging and fuel staging can have opposing effects on nitrogen oxide emission formation, and thus, when used together, a clear understanding of the fuel behavior and conditions, as well as NO x chemistry in the combustor, is needed. Under the tested conditions, it was observed that if air staging is effective, then fuel staging does not bring further benefits in the NO reduction. Instead, the LPG feed can increase the emission in the lack of oxygen. However, if it is not possible to carry out air staging, then fuel staging can be used in generating oxygen-lean reducing zones for NO. The N2O concentration was also further reduced with LPG in the tests with effective air staging.

[Effectiveness of health examinations by occupational health services]. / Työterveyshuollon terveystarkastusten vaikuttavuus.

Health examinations are part of the activities of occupational health services in preventing diseases and promoting occupational health. Their aim is to protect workers from health risks on one hand but also to promote the worker's own resources and health in order to maintain their capacity for work. Initiation of preventive, corrective and rehabilitative measures and those directed toward the workplace is attempted at the earliest possible stage. When interpreting the examination data it is in fact important to recognize whether it is the effectiveness of the health examination visit or the subsequent procedures that is being evaluated.

Personal health technologies in employee health promotion: usage activity, usefulness, and health-related outcomes in a 1-year randomized controlled trial.

BACKGROUND: Common risk factors such as obesity, poor nutrition, physical inactivity, stress, and sleep deprivation threaten the wellness and work ability of employees. Personal health technologies may help improve engagement in health promotion programs and maintenance of their effect. OBJECTIVE: This study investigated personal health technologies in supporting employee health promotion targeting multiple behavioral health risks. We studied the relations of usage activity to demographic and physiological characteristics, health-related outcomes (weight, aerobic fitness, blood pressure and cholesterol), and the perceived usefulness of technologies in wellness management. METHODS: We conducted a subgroup analysis of the technology group (114 subjects, 33 males, average age 45 years, average BMI 27.1 kg/m(2)) of a 3-arm randomized controlled trial (N=352). The trial was organized to study the efficacy of a face-to-face group intervention supported by technologies, including Web services, mobile applications, and personal monitoring devices. Technology usage was investigated based on log files and questionnaires. The associations between sustained usage of Web and mobile technologies and demographic and physiological characteristics were analyzed by comparing the baseline data of sustained and non-sustained users. The associations between sustained usage and changes in health-related outcomes were studied by repeated analysis of variance, using data measured by baseline and end questionnaires, and anthropometric and laboratory measurements. The experienced usability, usefulness, motivation, and barriers to using technologies were investigated by 4 questionnaires and 2 interviews. RESULTS: 111 subjects (97.4%) used technologies at some point of the study, and 33 (29.9%) were classified as sustained users of Web or mobile technologies. Simple technologies, weight scales and pedometer, attracted the most users. The sustained users were slightly older 47 years (95% CI 44 to 49) versus 44 years (95% CI 42 to 45), P=.034 and had poorer aerobic fitness at baseline (mean difference in maximal metabolic equivalent 1.0, 95% Cl 0.39 to 1.39; P=.013) than non-sustained users. They succeeded better in weight management: their weight decreased -1.2 kg (95% CI -2.38 to -0.01) versus +0.6 kg (95% CI -0.095 to 1.27), P=.006; body fat percentage -0.9%-units (95% CI -1.64 to -0.09) versus +0.3%-units (95% CI -0.28 to 0.73), P=.014; and waist circumference -1.4 cm (95% CI -2.60 to -0.20) versus +0.7 cm (95% CI -0.21 to 1.66), P=.01. They also participated in intervention meetings more actively: median 4 meetings (interquartile range; IQR 4-5) versus 4 meetings (IQR 3-4), P=.009. The key factors in usefulness were: simplicity, integration into daily life, and clear feedback on progress. CONCLUSIONS: Despite active initial usage, less than 30% of subjects continued using Web or mobile technologies throughout the study. Sustained users achieved better weight-related outcomes than non-sustained users. High non-usage attrition and modest outcomes cast doubt on the potential of technologies to support interventions.

Formation of the actor's/speaker's formant: a study applying spectrum analysis and computer modeling.

HYPOTHESIS: A strong peak between 3 and 4 kHz in the long-term average spectrum (LTAS) of speech has been found to be one correlate of a good male speaking voice, for example, among actors. The actor's or speaker's formant (resembling the singer's formant) can be established by certain vocal training. This study investigates the origin of the speaker's formant. STUDY DESIGN AND SETTING: The immediate effects of a vocal exercise series on speaking voice were studied in a Finnish male actor, who is an experienced teacher of the exercises. They consist of nasal vowel syllable strings and words containing nasals. Before and after a 30-minute exercising, the subject (1) read aloud at three loudness levels and (2) phonated the Finnish vowels at habitual level. METHODS: Formant frequencies were estimated from spectra of the vowel samples. LTAS was made and equivalent sound level (L(eq)) was measured for the text samples. Formant frequencies were used as the input for a one-dimensional (1D) mathematical model. RESULTS: After the exercise, the peak at 3.5 kHz in the LTAS of the reading samples was stronger, although L(eq) was the same as before, suggesting a level-independent resonance change. Reading samples after exercising were evaluated to sound better in voice quality than before exercising. The strong peak at 3.5 kHz was present in all vowels, and it was mainly formed by clustering of F4 and F5. CONCLUSIONS: A 1D model-based optimization suggested that this kind of a formant cluster could be best established by simultaneously narrowing the epilaryngeal tube, widening the pharynx and narrowing the front of the oral cavity.

Long-term average spectrum in screening of voice quality in speech: untrained male university students.

Voice quality has mainly been studied in trained speakers, singers, and dysphonic patients. Few studies have concerned ordinary untrained university students' voices. In light of earlier studies of professional voice users, it was hypothesized that good, poor, and intermediate voices would be distinguishable on the basis of long-term average spectrum characteristics. In the present study, voice quality of 50 Finnish vocally untrained male university students was studied perceptually and using long-term average spectrum analysis of text reading samples of one minute duration. Equivalent sound level (Leq) of text reading was also measured. According to the results, the good and ordinary voices differed from the poor ones in their relatively higher sound level in the frequency range of 1-3 kHz and a prominent peak at 3-4 kHz. Good voices, however, did not differ from the ordinary voices in terms of the characteristics of the long-term average spectrum (LTAS). The strength of the peak at 3-4 kHz and the voice-quality scores correlated weakly but significantly. Voice quality and alpha ratio (level difference above and below 1 kHz) correlated likewise. Leq was significantly higher in the students with good and ordinary voices than in those with poor voices. The connections between Leq, voice quality, and the formation of the peak at 3-4 kHz warrant further studies.

Assessment of vocal capacity of Finnish university students.

This article summarizes the results for a total of 189 female and 63 male university students (mean age 23 and 26 years, respectively) from the following vocal capacity tests: measurement of (1) vital capacity, (2) average airflow in phonation (on [o:]), (3) maximum duration of sustained blowing, (4) maximum phonation time (on [o:, z:]), (5) maximum duration of [s:], (6) the ratio of the duration of [s:] to [z:] (s/z ratio), (7) phonation quotient (the ratio between vital capacity and maximum phonation time), (8) the lowest possible tone, (9) mean fundamental frequency (F0) in normal and loud text reading and in shouting, (10) difference between the lowest tone and mean F0 in text reading and in shouting, (11) F0 range in text reading, (12) equivalent sound level of normal and loud reading and of shouting in maximum loudness, (13) phonetogram (voice range profile) and (14) long-term average spectrum of text reading. Voice quality is also evaluated perceptually, and additionally, data on subjects' self-reported vocal fatigue symptoms in general or after a vocally loading task were collected. The value of these measurements from the point of view of assessment of vocal capacity will be discussed.

A concept for ICT assisted health promotion in the occupational healthcare.

Lifestyle related health risks, such as overweight, work stress, and physical inactivity, have become pervasive in most modern societies. These risk factors have a debilitating impact on the wellbeing of citizens and play a major role in the onset of many chronic diseases. As a result, working life is affected due to impaired work ability, decreased productivity, absenteeism, and disability pensions. Lifestyle changes are the key to managing these problems, but they are often difficult to accomplish and maintain. We present a concept for ICT (Information and Communication Technology) assisted health promotion in the occupational healthcare. ICT tools are provided for employees participating in a face-to-face intervention, which is designed to address several health risks. We believe that through ICT, we can provide the employees with more personalized health management support more efficiently than before. The ICT system will be implemented by integrating different technologies into an interoperable system.

Effects of two-month vocal exercising with and without spectral biofeedback on student actors' speaking voice.

Twelve student actors (6 males, 6 females) were given voice training for two months. Randomly selected, half of the students (3 males, 3 females) was trained in the traditional way, while the other half was given biofeedback with real-time spectrum analysis. The aim was a ringing voice quality with strong overtones at 3-5 kHz. Text samples read at different loudness levels were recorded before and after training. Fundamental frequency (F0), sound pressure level (SPL) and long-term-average spectrum (LTAS) analyses were made. Voice quality was evaluated by two voice trainers. Sound energy at 3-5 kHz increased by 3-4 dB (1.5-14.5 dB) across groups after training. This change, which was slightly larger for the biofeedback (BF) group, did not correlate with SPL. F0 increased slightly in the BF group and decreased in the control group. The relative dB level of fundamental decreased significantly more in the BF group probably suggesting a tighter adduction. Voice quality improved in both groups. Visual feedback seems to add some efficacy in voice training. However, there is a danger of hyperfunctional voice production if other sensory feedback is neglected.