Health check-ups as interventions for work disability management: supervisors and occupational healthcare follow the recommendations to a great extent.

OBJECTIVES: Work disability management is a problem globally. This study was designed to find out whether the initiation, process and outcome of health check-ups (HCUs) follow the national legislation and whether supervisors and occupational healthcare (OHC) units act according to the legislation-based recommendations. METHODS: Data of 1092 employees with reduced work ability were collected during 2013-2018 in 15 OHC units across Finland. Nine reasons for HCUs, eight process activities and three recommendations were analysed. Cross-tabulation and multinomial logistic regression analysis were used in the analyses. RESULTS: Employees themselves initiated an HCU for early support more often (OR with 95% CI 2.37; 1.04 to 5.40) compared with supervisors. Personnel in OHC units initiated an HCU in musculoskeletal disorders more often (OR 1.58; 95% CI 1.05 to 2.37) and in mental disorders less often (OR 0.52; 95% CI 0.35 to 0.76) compared with supervisors. These findings were reflected in the recommendations after the HCU, where rehabilitation was recommended for employees with musculoskeletal disorders more often than for employees with mental disorders (ORs 5.48; 95% CI 1.91 to 15.67 and 1.59; 95% CI 0.74 to 3.43, respectively). CONCLUSION: Supervisors and OHC units followed the recommendations for management of work disability to a great extent. Employees were active in looking for help early when they had problems with work ability. This positive finding should be promoted even more. OHC units did not initiate HCUs or recommend rehabilitation in mental disorders as actively as they did in musculoskeletal disorders. Support of employees with mental disorders should be improved and studied more. Registration of the study The study protocol was approved and registered on 22 September 2017 by the Doctoral Program of Health Sciences, Faculty of Medicine, University of Eastern Finland, registration no. 189067.

Occupational health care personnel tackling alcohol overuse - an observational study of work processes and patient characteristics.

BACKGROUND: Overuse of alcohol is a significant risk factor for early retirement. This observational study investigated patient characteristics and work processes in occupational health care (OHC) affecting practices in tackling alcohol overuse. METHODS: The data were from 3089 patient contacts gathered for quality improvement purposes in fifteen OHC units during the years 2013-2019 in Finland. A two-proportion z-test was performed to find associations between reason for contact, and 17 other factors, and the probability of alcohol use being checked and overuse tackled. RESULTS: OHC personnel checked alcohol use twice as often with male patients as with female patients. Employees at risk of needing sick leave were checked for alcohol use more often (55.4, 95% confidence interval 49.2-61.6%) than those on > 30-day sick leave or working with permanent work disability (p < 0.01). Alcohol use was checked in 64.1% (59.5-68.7%) of patients while making an individual health promotion plan compared to 36.9% of those without a plan (33.1-40.6%, p < 0.0001). Patients with depression were actively checked for alcohol use, especially in cases of major depression (72.7%, 64.0-81.0%). Work processes in which OHC should have been more active in checking and tackling alcohol use included assessing the need for rehabilitation (36.5%, 32.0-41.0%) and health check-ups (HCUs) for mental reasons (43.8%, 38.1-49.4%). HCUs where alcohol overuse was detected led to brief interventions to tackle the overuse in 58.1% (43.4-72.9%) of cases. CONCLUSIONS: The study showed factors that increased OHC personnel's practices in checking and tackling alcohol use and work processes where the activity should be improved. Discussions about alcohol use took place more often with working-aged men than women, the younger the more. OHC personnel checked actively alcohol use with patients in danger of sick leave, patients treated for depression, while making an individual health promotion plan, and in planned HCUs with a confirmed protocol. More improvement is needed to conduct brief interventions in disability prevention processes, and especially when overuse is detected.

Educational interventions for preventing lead poisoning in workers.

BACKGROUND: Occupational lead exposure can lead to serious health effects that range from general symptoms (depression, generalised ache, and digestive signs, such as loss of appetite, stomach ache, nausea, diarrhoea, and constipation) to chronic conditions (cerebrovascular and cardiovascular diseases, cognitive impairment, kidney disease, cancers, and infertility). Educational interventions may contribute to the prevention of lead uptake in workers exposed to lead, and it is important to assess their effectiveness. OBJECTIVES: To assess the effect of educational interventions for preventing lead uptake in workers exposed to lead. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, CINAHL, and OSH UPDATE to 5 June 2020, with no language restrictions. SELECTION CRITERIA: We sought randomised controlled trials (RCT), cluster-RCTs (cRCT), interrupted time series (ITS), controlled before-after studies (CBA) and uncontrolled before-after studies that examined the effects of an educational intervention aimed at preventing lead exposure and poisoning in workers who worked with lead, for which effectiveness was measured by lead levels in blood and urine, blood zinc protoporphyrin levels and urine aminolevulinic acid levels. DATA COLLECTION AND ANALYSIS: Two review authors independently screened the search results, assessed studies for eligibility, and extracted data using standard Cochrane methods. We used the ROBINS-I tool to assess the risk of bias, and GRADE methodology to assess the certainty of the evidence. MAIN RESULTS: We did not find any RCT, cRCT, ITS or CBA studies that met our criteria. We included four uncontrolled before-after studies studies, conducted between 1982 and 2004. Blood lead levels Educational interventions may reduce blood lead levels, but the evidence is very uncertain. In the short-term after the educational intervention, blood lead levels may decrease (mean difference (MD) 9.17 µg/dL, 95% confidence interval (CI) 4.14 to 14.20; one study with high baseline blood lead level, 18 participants; very low-certainty evidence). In the medium-term, blood lead levels may decrease (MD 3.80 µg/dL, 95% CI 1.48 to 6.12; one study with high baseline blood lead level, 34 participants; very low-certainty evidence). In the long-term, blood lead levels may decrease when the baseline blood lead levels are high (MD 8.08 µg/dL; 95% CI 3.67 to 12.49; two studies, 69 participants; very low-certainty evidence), but not when the baseline blood lead levels are low (MD 1.10 µg/dL, 95% CI -0.11 to 2.31; one study, 52 participants, very low-certainty evidence). Urine lead levels In the long-term, urinary lead levels may decrease after the educational intervention, but the evidence is very uncertain (MD 42.43 µg/L, 95% CI 29.73 to 55.13; one study, 35 participants; very low-certainty evidence). Behaviour change The evidence is very uncertain about the effect of educational intervention on behaviour change. At medium-term follow-up after the educational intervention, very low-certainty evidence from one study (89 participants) found inconclusive results for washing before eating (risk ratio (RR) 1.71, 95% CI 0.42 to 6.91), washing before drinking (RR 1.37, 95% CI 0.61 to 3.06), and not smoking in the work area (RR 1.04, 95% CI 0.74 to 1.46). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.87, 95% CI 1.16 to 3.01), and prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 4.25, 95% CI 1.72 to 10.51), however, the results were inconclusive for the adequate provision of protective clothing (RR 1.40, 95% CI 0.82 to 2.40). At long-term follow-up, very low-certainty evidence from one study (89 participants) suggested that workers may improve washing before drinking (RR 3.24, 95% CI 1.09 to 9.61), but results were inconclusive for washing before eating (RR 11.71, 95% CI 0.66 to 208.33), and for not smoking in the work area (RR 1.56, 95% CI 0.98 to 2.50). Very low-certainty evidence from one study (21 participants) suggested that employers may improve the provision of fit testing for all respirator users (RR 1.70, 95% CI 1.09 to 2.63), may provide adequate protective clothing (RR 2.80, 95% CI 1.23 to 6.37), and may prohibit eating, drinking, smoking, and other tobacco use in the work area (RR 2.13, 95% CI 1.19 to 3.81). Improved knowledge or awareness of the adverse health effects of lead The evidence is very uncertain about the effect of educational intervention on workers' knowledge. At medium-term follow-up, questionnaires found that workers' knowledge may improve (MD 5.20, 95% CI 3.29 to 7.11; one study, 34 participants; very low-certainty evidence). At long-term follow-up, there may be an improvement in workers' knowledge (MD 5.80, 95% CI 3.89 to 7.71; one study, 34 participants; very low-certainty evidence), but results were inconclusive for employers' knowledge (RR 1.67, 95% CI 0.74 to 3.75; one study, 21 participants; very low-certainty evidence). None of the studies measured the other outcomes of interest: blood zinc protoporphyrin levels, urine aminolevulinic acid levels, air lead levels, and harms. One study provided the costs of each component of the intervention. AUTHORS' CONCLUSIONS: Educational interventions may prevent lead poisoning in workers with high baseline blood lead levels and urine lead levels but this is uncertain. Educational interventions may not prevent lead poisoning in workers with low baseline blood lead levels but this is uncertain.

Health-improving interventions for obtaining employment in unemployed job seekers.

BACKGROUND: Unemployment is associated with decreased health which may be a reason or a consequence of becoming unemployed. Decreased health can inhibit re-employment. OBJECTIVES: To assess the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. SEARCH METHODS: We searched (3 May 2018, updated 13 August 2019) the Cochrane Central Register of Controlled Trials, MEDLINE, Scopus, PsycINFO, CINAHL, SocINDEX, OSH Update, ClinicalTrials.gov, the WHO trials portal, and also reference lists of included studies and selected reviews. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of the effectiveness of health-improving interventions for obtaining employment in unemployed job seekers. The primary outcome was re-employment reported as the number or percentage of participants who obtained employment. Our secondary outcomes were health and work ability. DATA COLLECTION AND ANALYSIS: Two authors independently screened studies, extracted outcome data, and assessed risk of bias. We pooled study results with random-effect models and reported risk ratios (RRs) with 95% confidence intervals (CIs) and assessed the overall quality of the evidence for each comparison using the GRADE approach. MAIN RESULTS: We included 15 randomised controlled trials (16 interventions) with a total of 6397 unemployed participants. Eight studies evaluated therapeutic interventions such as cognitive behavioural therapy, physical exercise, and health-related advice and counselling and, in seven studies, interventions were combined using therapeutic methods and job-search training. Therapeutic interventions Therapeutic interventions compared to no intervention may increase employment at an average of 11 months follow-up but the evidence is very uncertain (RR = 1.41, 95% CI 1.07 to 1.87, n = 1142, 8 studies with 9 interventions, I² = 52%, very low-quality evidence). There is probably no difference in the effects of therapeutic interventions compared to no intervention on mental health (SMD 0.12, 95% CI -0.06 to 0.29, n = 530, 2 studies, low-quality evidence) and on general health (SMD 0.19, 95% CI -0.04 to 0.41, n = 318, 1 study, moderate-quality evidence). Combined interventions Combined interventions probably increase employment slightly compared to no intervention at an average of 10 months follow-up (RR 1.12, 95% CI 1.06 to 1.20, n = 4101, 6 studies, I² = 7%). There were no studies that measured work-ability, adverse events, or cost-effectiveness. AUTHORS' CONCLUSIONS: Interventions combining therapeutic methods and job-search training probably have a small beneficial effect in increasing employment. Therapeutic interventions may have an effect on re-employment, but we are very uncertain. Therapeutic interventions may not improve health in unemployed job seekers. Large high-quality RCTs targeting short-term or long-term unemployed people are needed to increase the quality of the evidence. A cost-effectiveness assessment is needed of the small beneficial effects.

Return-to-Work Coordinators' Practices for Workers with Burnout.

Introduction Return-to-work (RTW) coordinators facilitate RTW of workers with work disabilities. However, little is known about RTW coordinators' practices for workers with burnout. The aims of this study were to describe RTW coordinators' activities in supporting workers with burnout during the RTW process, and their experiences with factors influencing the support. Methods Interviews and essay assignments were conducted with 15 RTW coordinators employed in universities and central hospitals in Finland. Data were analyzed using qualitative content analysis. Results RTW coordinators were involved in the RTW process during early intervention, off-work, and work resumption phases. Seven groups of activities were identified: monitoring staff well-being; initiating RTW process; planning RTW; providing tools to support recovery; monitoring progress of the RTW process; supporting re-engagement with work; and monitoring coping with work. RTW coordinators' activities depended on their institutional positions. Factors influencing the support included common understanding about burnout syndrome: co-occurring illnesses, dimensions of burnout, unpredictability of the recovery, personality characteristics, private life psychosocial factors, conflicts within the work community, and openness about burnout and its causes. Conclusions Complexity of the burnout problem challenges the support from the RTW coordinators. Understanding the causes and the consequences of burnout is important for the RTW coordinators to provide adequate and timely support for the workers with burnout in collaboration with the other stakeholders involved in the RTW process. Burnout-, individual-, and work-related factors should be considered in the RTW coordination to prevent and to reduce the negative consequences of burnout.

An Overview of Strategies for Reducing Upper Extremity Physical Exposure Associated With Floor Mopping: A Systematic Review.

OBJECTIVE: This systematic review synthesizes literature on upper extremity physical exposure associated with floor mopping, in order to (a) assess the impact of changes in mopping systems on physical exposure and (b) propose recommendations for strategies to reduce exposure. BACKGROUND: Floor-cleaning tools and equipment have undergone major improvements. Existing studies have focused on mop design modifications and cleaning efficiency. However, less is known about strain responses caused by modern tools and methods. METHOD: Studies from 1987 to February 2017 were identified by electronic and manual search. All selected studies underwent a quality assessment. The evidence was organized into categories representing different strategies for reducing exposure. The levels of evidence were determined using a best evidence synthesis approach. RESULTS: Eleven studies were included. Based on the review findings, currently there is moderate evidence suggesting that reduced physical exposure has been achieved through development of mopping systems. Levels of evidence for strategies associated with positive effects on physical exposure were: moderate evidence for mop design and handle type, insufficient evidence for mopping technique, and mixed evidence for mopping methods and environment modifications. Therefore, the present study suggests the use of adjustable mop handles as a strategy for reducing physical exposure. CONCLUSION: A more comprehensive approach to reducing physical exposure concerning floor mopping work is necessary. APPLICATION: Knowledge regarding physical exposure reduction can be applied as the basis for decision making in cleaning practice. Information can be incorporated into future research regarding development of floor-cleaning methods.

Maternity leave duration and adverse pregnancy outcomes: An international country-level comparison.

AIM: Preterm birth and low birthweight (LBW) lead to infant morbidity and mortality. The causes are unknown. This study evaluates the association between duration of maternity leave and birth outcomes at country level. METHOD: We compiled data on duration of maternity leave for 180 countries of which 36 specified prenatal leave, 190 specified income, 183 specified preterm birth rates and 185 specified the LBW rate. Multivariate and seemingly unrelated regression analyses were done in STATA. RESULTS: Mean maternity leave duration was 15.4 weeks ( SD=7.7; range 4-52 weeks). One additional week of maternity leave was associated with a 0.09% lower preterm rate (95% confidence interval [CI] -0.15 to -0.04) adjusting for income and being an African country. An additional week of maternity leave was associated with a 0.14% lower rate of LBW (95% CI -0.24 to -0.05). Mean prenatal maternity leave across 36 countries was six weeks ( SD=2.7; range 2-14 weeks). One week of prenatal maternity leave was associated with a 0.07% lower preterm rate (95% CI -0.10 to 0.24) and a 0.06% lower rate of LBW (95% CI -0.14 to 0.27), but these results were not statistically significant. By adjusting for income status categories, the preterm birth rate was 1.53% higher and the LBW rate was 2.17% higher in Africa compared to the rest of the world. CONCLUSIONS: Maternity leave duration is significantly associated with birth outcomes. However, the association was not significant among 36 countries that specified prenatal maternity leave. Studies are needed to evaluate the correlation between prenatal leave and birth outcomes.

Manual handling of burdens as a predictor of birth outcome-a Finnish Birth Register Study.

Background: Negative effects of manual handling of burdens on pregnancy outcomes are not elucidated in Finland. This study examines the association between perinatal outcomes and occupational exposure to manual handling of burdens. Methods: The study cohort was identified from the Finnish Medical Birth Register (MBR, 1997-2014) and information on exposure from the Finnish job-exposure matrix (FINJEM) 1997-2009. The cohort included all singleton births of mothers who were classified as 'service and care workers' representing the exposure group (n=74 286) and 'clerks' as the reference (n=13 873). Study outcomes were preterm birth (PTB) (<37 weeks), low birthweight (LBW) (<2500 g), small for gestational age (<2.5th percentile), perinatal death (stillbirth or early neonatal death within first seven days) and eclampsia. We used logistic regression analysis to calculate odds ratio (OR) and adjusted for maternal age, marital status, BMI, parity and smoking during pregnancy. Results: The risks of PTB [OR 1.16, 95% confidence interval (CI) 1.06-1.27], LBW (OR 1.12, 95% CI 1.01-1.25) and perinatal death (OR 1.51, 95% CI 1.09-2.09) were significantly higher among the high exposure group than in the reference group. All adverse outcomes were statistically insignificant among primiparous women except perinatal death (OR=1.95, 95% CI 1.13-3.39). Conclusions: The study indicates that the risk of adverse pregnancy outcomes might be more common among women that are highly exposed to occupational manual handling of burdens. The results should be interpreted with caution due to the use of occupational level exposure. Further studies with information on individual level exposure and start of maternity leave are recommended.

Working people with type 1 diabetes in the Finnish population.

BACKGROUND: The incidence of type 1 diabetes is increasing worldwide. Since so little is known about work life of individuals with type 1 diabetes, we examined incidence and prevalence trends of type 1 diabetes among working-aged Finns. We also investigated the employment rate and how workers with type 1 diabetes perceive their health and work ability, and their intended retirement age. METHODS: We analyzed changes in the incidence, prevalence, and employment rate using nationwide multi-register-based FinDM data, and estimated a Self-Rated Health, Work Ability Score, and inquired about retirement intentions of 767 working individuals with type 1 diabetes in a cross-sectional survey. All estimates were compared to the corresponding data of the Finnish general population. RESULTS: The average annual age-standardized incidence rate of type 1 diabetes among men aged 18-39 was 29 per 100,000/year; the incidence rate has increased by 33% from 1992 to 2007. Among women, the incidence remained at 16 per 100,000/year. Among working-aged (18-64) people, the age-standardized prevalence of type 1 diabetes increased by 39% among women and 33% among men. Two out of every three working aged individuals with type 1 diabetes were in the labor force; this is about 10% lower than in the Finnish population. The average age-standardized employment rate among those individuals with type 1 diabetes belonging to the labor force was 82%, compared to 84% in the general population. Working individuals with type 1 diabetes rated their health and work ability as being slightly lower than the general working population, but nonetheless, there were no significant differences in retirement intentions. CONCLUSIONS: Between 1992 and 2007, the number of working-aged people and workers with type 1 diabetes increased by 35%. Most workers with type 1 diabetes manage as well at work as the general population. Special attention should be paid to workers with type 1 diabetes when they are diagnosed and/or report moderate or poor work ability.

Use of health services by Finnish employees in regard to health-related factors: the population-based health 2000 study.

OBJECTIVES: The aims of this study were to describe the use of occupational health services and other health care of Finnish employees and to examine associations between health problems and risks, and primary care visits to occupational health nurses and physicians and other health care. METHODS: A nationally representative sample of 3,126 employees aged 30-64 participated in the Health 2000 study, which consisted of a health interview, questionnaires, a clinical health examination, and the Composite International Diagnostic Interview. The use of health services was measured by self-reported visits. RESULTS: During the previous 12 months, 74 % of the employees visited occupational health services or municipal health centers, 52 % visited only occupational health services. From a third to a half of employees with lifestyle risks, depressive disorders or other health problems visited occupational health professionals. Obesity, burnout, insomnia, depressive mood, chronic impairing illnesses, and poor work ability were associated with visits to occupational health nurses. Among women, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to occupational health physicians. Lower educational level, smoking, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to health center physicians. CONCLUSIONS: This study showed the importance of occupational health services in the primary health care of Finnish employees. However, a considerable proportion of employees with lifestyle risks, depressive mood, and other health problems did not use health services. Occupational health professionals are in an advantageous position to detect health risks in primary care visits.

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.

The association between chronotype and sleep quality among female home care workers performing shift work.

There is a scarcity of evidence on the association between shift work, sleeping parameters, heart rate variability (HRV), and chronotype, i.e., morningness and eveningness. The aims of this study were to 1) compare participants with different chronotypes (morning (M), evening (E), or neither (N)) in terms of their total sleep time, sleep efficiency, and HRV parameters, taking their age into account, and 2) examine whether self-reported work-related stress, the length of the working career and years performing shift work affect this association. The participants of the study were home care workers working in two shifts in one municipality in Eastern Finland (N = 395). Of these, 52 females (mean age 42.78 y, SD 12.92 y) completed the study questionnaire and participated in physiological measurements. Several sleep-related parameters were assessed (total sleep time, sleep efficiency, number of awakenings, and length of awakening) and indices of autonomic nervous system based on HRV were calculated. The participants worked in two shifts: a morning shift (7:00-15:00 h) and an evening shift (14:00-21:30 h). All these parameters were assessed during the night before the first work shift (N1), the night before the second work shift (N2), the night before the final work shift (N3), and the night before the first day off work (N4). According to the results, 21.2% of the participants were M-types, 17.3% were E-types, and 61.5% were N-types. On average, the participants had been in working life for 18.8 years and performing shift work for 13.7 years. On night N3, E-types had a significantly shorter total sleep time and spent less time in bed compared to M- and N-types. The total sleep time of M-type and N-type participants was on average 66 minutes and 82 minutes longer, respectively, when compared to E-types on night N3. There were no statistically significant differences in actigraphy-based sleep quality parameters between M-, N-, and E-types on nights N1, N2, and N4. Our results together indicate that M- and N-type individuals may have better sleep quality than E-types, which was also reflected in HRV parameters. Further research with longitudinal study design and workplace interventions is needed to determine how the chronotype can be optimally and individually utilized to improve the health and well-being of morning-type and evening-type people. This is particularly important for both younger and older workers entering the workforce to support healthier and longer working lives.

Interventions to reduce risky sexual behaviour for preventing HIV infection in workers in occupational settings.

BACKGROUND: The workplace provides an important avenue to prevent HIV. OBJECTIVES: To evaluate the effect of behavioral interventions for reducing HIV on high risk sexual behavior when delivered in an occupational setting. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and PsycINFO up until March 2011 and CINAHL, LILACS, DARE, OSH Update, and EPPI database up until October 2010. SELECTION CRITERIA: Randomised control trials (RCTs) in occupational settings or among workers at high risk for HIV that measured HIV, sexual transmitted diseases (STD), Voluntary Counseling and Testing (VCT), or risky sexual behaviour. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected studies for inclusion, extracted data and assessed risk of bias. We pooled studies that were similar. MAIN RESULTS: We found 8 RCTs with 11,164 participants but one study did not provide enough data. Studies compared VCT to no VCT and education to no intervention and to alternative education.VCT uptake increased to 51% when provided at the workplace compared to a voucher for VCT (RR=14.0 (95% CI 11.8 to16.7)). After VCT, self-reported STD decreased (RR = 0.10 (95% CI 0.01 to 0.73)) but HIV incidence (RR=1.4 (95% CI 0.7 to 2.7)) and unprotected sex (RR=0.71 (0.48 to 1.06)) did not decrease significantly. .Education reduced STDs (RR = 0.68 (95%CI 0.48 to 0.96)), unprotected sex (Standardised Mean Difference (SMD)= -0.17 (95% CI -0.29 to -0.05), sex with a commercial sex worker (RR = 0.88 (95% CI 0.81 to 0.96) but not multiple sexual partners (Mean Difference (MD) = -0.22 (95% CI -0.52 to 0.08) nor use of alcohol before sex (MD = -0.01 (95% CI of -0.11 to 0.08). AUTHORS' CONCLUSIONS: Workplace interventions to prevent HIV are feasible. There is moderate quality evidence that VCT offered at the work site increases the uptake of testing. Even though this did no lower HIV-incidence, there was a decrease in self-reported sexual transmitted diseases and a decrease in risky sexual behaviour. There is low quality evidence that educational interventions decrease sexually transmitted diseases, unprotected sex and sex with commercial sex workers but not sex with multiple partners and the use of alcohol before sex.More and better randomised trials are needed directed at high risk groups such as truck drivers or workers in areas with a very high HIV prevalence such as Southern Africa. Risky sexual behaviour should be measured in a standardised way.

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.

Adverse perinatal outcomes among practical nurses: The Finnish Medical Birth Register Study.

INTRODUCTION: Work as a practical nurse (nurse assistant) may have an effect on pregnancy outcomes. Exposure to chemical, physical and biological hazards are common among hospital personnel. Stressful work conditions such as shift work, prolonged standing and long working hours have been reported among practical nurses. The aim of this study was to examine whether working as a practical nurse is associated with adverse perinatal outcomes. METHODS: Data were obtained from the Finnish Medical Birth Register of 1997-2014. We included 58512 singleton newborns of practical nurses as cases, and 8765 and 39485 newborns of secretaries and housewives, respectively, as controls. Outcomes included preterm birth (<37 weeks), low birthweight (<2500 g), perinatal death (stillbirth or neonatal death within the first seven days), SGA (<2.5th percentile), and breech presentation, among others. Logistic regression analysis was performed and adjusted for confounders such as maternal age, parity, smoking, and diabetes. RESULTS: Being a practical nurse had lower likelihood of low birthweight (OR=0.88; 95% CI: 0.81-0.96), perinatal death (OR=0.77; 95% CI: 0.62-0.96), SGA (OR=0.79; 95% CI: 0.72-0.86) and episiotomy (OR=0.90; 95% CI: 0.86-0.94). Practical nursing was significantly related to higher odds of instrumental delivery (OR=1.08; 95% CI: 1.00-1.17), but not with preterm birth, breech presentation, shoulder presentation, or caesarean section. CONCLUSIONS: After adjusting for confounding variables, working as a practical nurse was associated with higher likelihood of instrumental delivery, particularly vacuum delivery. The risk for shoulder presentation was nearly two-fold compared to controls. Further studies to determine when mothers started their maternity leave and the consequent effect on pregnancy outcome is highly recommended.

Heart rate variability and chronotype - a systematic review.

There is a scarcity of evidence on the association between heart rate variability (HRV) and chronotype, i.e., morningness and eveningness. The aim of this systematic review was to examine the association between chronotype, HRV, mood and stress response. We searched PubMed, Web of Science, Scopus, Cinahl, PsycINFO and Google Scholar for peer-reviewed articles published in English between January 2000 and June 2020. A total of 11 articles met the inclusion criteria and were on study population, assessment of HRV and chronotype, main results and study limitations. Seven of the included studies were experimental and four were crossovers. The sample size varied from 9 to 221 participants, and both females and males were included. HRV was assessed using mostly time-domain and frequency-domain parameters; nonlinear parameters were used in only one study. The most used assessments for measuring chronotype were the Horne-Östberg Morningness-Eveningness Questionnaire (MEQ) and the Munich Chronotype Questionnaire (MCTQ). The results showed that chronotype was associated with HRV, but the study designs were situation-specific, focusing, for example, on the effects of shiftwork, stressful situations, exercise, or sleep deprivation on HRV. In addition, some studies showed that evening types (E-type) performed better during evening or nighttime tasks, whereas morning types (M-type) performed better during morning activities. Specifically, E-types showed decreased HRV and HRV recovery in relation to tasks performed during morning or daytime when compared to M-types. As the findings are somewhat contradictory and include some methodological limitations (e.g., small sample sizes, age groups), it is important for future studies to evaluate the association between chronotype and HRV in a longitudinal setting. In addition, further research is needed to determine how chronotype can be optimally and individually utilized to increase the health and well-being of M-type and E-type individuals.

Work community factors, occupational well-being and work ability in home care: A structural equation modelling.

AIM: To examine how work community factors are related to occupational well-being and work ability, and how occupational well-being is related to work ability. DESIGN: A cross-sectional study was conducted among home care workers in one municipality in Finland. METHODS: A self-administered survey on work and well-being was filled out by 167 employees working two shifts in 2019. Structural equation modelling was used to analyse the association between work community factors, occupational well-being and work ability. RESULTS: The only work community factor directly affecting Occupational well-being was Information and work organization; the effect of the other two factors, Social support and Influence on work shifts, was indirect. All work community factors indirectly affected Work ability. Home care should emphasize information provision and work organization with optimal time use. This requires social support, a well-functioning work atmosphere and providing employees with opportunities for influence and participation.

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.

Quality improvement activity in occupational healthcare associated with reduced need for disability retirement: A Bayesian mixed effects modelling study in Finland.

Objectives There is evidence that occupational healthcare (OHC) may improve employees' work ability. This research was designed to study whether common quality improvement (QI) activities in the OHC quality network (OQN) - a voluntary collaborative forum - can reduce the need for disability pensions. Methods The study population comprised employees under the care of 19 OHC units in Finland affiliated with the OQN. The association of 12 QI activities with new disability pensions during the years 2011-2017 was analyzed by Bayesian mixed effects modelling. Results Patients of OHC units affiliated with the OQN have fewer full permanent disability pensions [odds ratio (OR) 0.77, 95% credible interval (CI) 0.60-0.98] and full provisional disability pensions (OR 0.68, 95% CI 0.53-0.87) than patients of unaffiliated units. Of the studied QI activities, the measurements of intervening in excessive use of alcohol had the strongest association with the incidence of all disability pensions (OR 0.53, 95% CI 0.41-0.68). Participation in the focus of work measurements and quality facilitator training was also associated with the reduced incidence of disability pensions (OR 0.84, 95% CI 0.71-0.98, and OR 0.92, 95 CI 0.84-0.99, respectively). Conclusions Affiliation with a quality network seemed to improve outcomes by reducing full disability pensions or replacing them by partial disability pensions. Some QI activities in the OQN were associated with a reduction of disability pensions.

Networking of occupational health care units promotes reduction of permanent disability pensions among workers they care: A register-based study controlled by benchmarking with a 5-year follow-up.

OBJECTIVES: Early retirement due to disability is a problem in Finland. That causes pension costs that are heavy for the society. This study was designed to find out whether a quality network can support the reduction in incident disability pensions and promote a shift from full to partial disability pensions. METHODS: The study population (N = 41 472 in 2016) consisted of municipal employees whose occupational health care (OHC) was provided by the members of the Finnish Occupational Health Quality Network (OQN). The comparison population consisted of all municipality employees whose OHC was provided by non-members of the OQN (N = 340 479 in 2016). The outcomes were measured by comparing the trends in incident disability pensions of full and partial permanent pension and full and partial provisional pension, partial/full pension indexes from 2011 to 2016 according to the principles of Benchmarking Controlled Trials. Linear regression models were used to explore the dynamics of different pension forms. Regression coefficients were calculated to show the average change per year. RESULTS: The incidence of permanent disability pensions decreased faster in the study population (P for trend .03) and the study group showed a stronger shift from full to partial permanent pensions (P for trend <.001). CONCLUSION: Quality networking between OHC units including common goal setting, systematic quality improvement, and repeated quality measurements decreased new permanent disability pensions and increased partial permanent pensions. Such changes are important while thriving for increased work participation.