Quality of life, work ability, and self employment: a population survey of entrepreneurs, farmers, and salary earners.

OBJECTIVES: Self employment is increasing but it is not yet known how its different forms affect health, quality of life, and work ability. We compared the work ability, subjective quality of life (QoL), and health-related quality of life (HRQoL) of entrepreneurs both with and without personnel, farmers, and salaried workers. We investigated which domains of HRQoL are associated with work status. METHODS: A nationally representative general population sample comprising 5834 Finns aged between 30 and 64. Work ability was measured using the work ability index (WAI), HRQoL using 15D and EQ-5D, and QoL with self reported global quality of life. RESULTS: Entrepreneurs with personnel had better work ability than salary earners, but there were no differences in QoL or HRQoL between the entrepreneurs and salary earners. Farmers scored lowest on all measures; this finding remained even after adjusting for age, sex, marital status, education, and chronic conditions. The low WAI score of farmers was mainly explained by poor subjective work ability, while their low 15D score was mainly the result of poor functioning in the psychosocial domains of HRQoL. The low EQ-5D score of farmers was explained by problems with mobility, usual activities, and with pain or discomfort. CONCLUSIONS: Farmers have poorer work ability, QoL, and HRQoL than other working groups, but this does not appear to be caused by physical health problems. From a research point of view, farmers should be categorised separately from other forms of entrepreneurship. From a public health point of view, improving farmers' wellbeing may require psychosocial interventions exceeding traditional health promotion.

Health promotion in the Finnish shipping industry.

In autumn 1997 a pilot project was started in Finland to develop methods for promoting the health of sailors. Four Finnish shipping companies, (4 cargo ships and 2 passenger-cruise ferries), with altogether 730 sailors participated in the project. Special attention was paid to individuals with health problems and those who generally did not take care of their own health or fitness. Three-quarters of the respondents saw their health as good and one fifth as fair. Thirty-four persons responded that their working capacity was poor. 154 sailors were selected into further physical fitness evaluations. The main task of the project team was to activate sailors to take care of their own health and well-being. The health-promoting activities were directed especially at those persons who needed it. Information lectures concerning healthier eating habits and meals were given. Anti-smoking and anti-alcohol drinking information was given. On board one cruise ferry a project was started on how to react as early as possible to alcohol abuse among seafarers. Courses on shore for sailors were arranged to improve their physical fitness and to increase their resting benefit between working periods at sea. The intervention time was one year. Information about smoking and alcohol led to reduced alcohol consumption. The sailors had started to exercise more often both on board ship and on shore. Those who had increased their physical exercise during free time more often found their own health and working ability to have improved than those who had not changed their exercise habits. It appeared that health intervention projects are really needed especially by older sailors. The results also showed that positive effects could be achieved in the fitness of sailors. Better fitness was good for their health and also increased the work safety.

Critical incident stress debriefing (CISD) in a shipping company.

Critical incident stress debriefing (CISD) is a method used successfully to reduce suffering from stress-related ailments such as insomnia, depression, anger, headaches etc. The resources of the shipping company are very limited and, thus, networking with existing organizations and specialists is necessary to carry out CISD effectively. The present company model has been adopted to take into account various situations and levels of disaster. The model has been adopted at three levels of events:Level 1. Serious accidents on shore, sudden deaths, severe events and threats. Events involving one or only few persons. Level 2. Life-threatening occupational accidents on board ship, suicide of a workmate, sudden death and fire on board ship. Events involving one person or limited group of persons. Level 3. Disasters at sea. Severe events involving all or nearly all persons on board ship. Actions at different levels: Level 1: A leaflet describing CISD, situations where it would be appropriate and where it is available, is given to each sailor. The victim is encouraged to seek CISD from public health care centres, most of which have their own services in Finland. Level 2. Training of about 8 hours is carried out by an experienced crisis psychologist for supervisors and officers on board ship. After the training they are able to identify stressful situations. At each harbour, the shipping company has made agreements with experienced crisis psychologists to act as specialists and contact persons on shore. These nominated psychologists will initiate CISD actions when necessary. If they need extra manpower they will turn to other psychologists. Level 3. In such serious accidents, the company's own resources alone are insufficient to provide effective CISD. All available public and private resources will he needed (health care organizations, Red Cross, Church etc.).

Xylitol for messrooms--a method worth trying to prevent caries among seafarers.

Oral diseases seem to be the most common health problem of seafarers world-wide. Seafaring as an occupation may create a risk for the dental health of crews of ships. Sitting in messrooms and eating snacks in between regular meals is a popular way of spending free time during the ships voyage. This means not only high caloric intake which contributes to overweight but also to high dental caries incidence among crews. During long sea voyages, the access of seamen to dental services is very limited and making regular check ups and treatment of caries is difficult. The best solution to the problem of poor teeth is a preventive one. Conventional methods for preventing caries are health education, restrictions the use of sugar-containing products, good oral hygiene and use of fluorides. A newer method to prevent caries is systematic use of xylitol. Scientific evidence shows that the addition of small quantities of xylitol, a natural carbohydrate sweetener, to the diet causes a significant reduction in the incidence of dental caries.

Mortality among Finnish sea pilots 1956-85: a retrospective cohort study.

The National Board of Navigation in Finland employed 942 sea pilots in 1956-85, during which time 262 of them died (SMR = 77, 95% CI = 68-86). The male population in southwest Finland served as control. The causes of deaths were collected from death certificates. The mortality rate for all cardiovascular diseases and lung cancer was lower among sea pilots than in the comparison population (SMR = 83, 95% = CI 69-97 and SMR = 67, 95% CI = 37-97) while for ischaemic heart diseases, it was similar to that of the population as a whole (SMR = 96, 95% CI = 77-115). Health selection due to ischaemic heart disease was seen in the lower mortality rates among young pilots who started work in 1956-85. Otherwise, the slightly higher rates may indicate a possibility of adverse health effects of sea piloting.

Cancer incidence among Finnish seafarers, 1967-92.

A cohort of 30,940 male and 11,529 female seafarers registered in the files of Seafarers' Pension Fund in Finland was followed up through the Finnish Cancer Registry for cancer in 1967-92. Among male seafarers, there were 1,199 cases of cancer, which corresponds to the average cancer incidence in Finnish men. There was a statistically significant excess of non-melanoma skin cancer (standardized incidence ratio [SIR] = 1.8, 95 percent confidence interval [CI] = 1.2-2.5) and mesothelioma (SIR = 2.9, CI = 1.2-5.6) in the follow-up category of 20 or more years since the first employment. Alcohol-related cancers were increased among seafarers (SIR for cancer of the mouth and pharynx = 1.5; esophagus = 1.4; and liver = 1.5; combined CI = 1.1-1.9). Deck crews had a significantly high risk of cancer of the pancreas (SIR = 2.0) and also prostate after 10 years since first employment (SIR = 1.6). Occupational asbestos exposure among seafarers is likely strong enough to cause excess cases of mesothelioma but not of lung cancer. Occupational exposures also may be associated with increased risk of cancers of the kidney, pancreas, prostate and old-age brain cancer in some of the main occupational categories. Cumulative ultraviolet radiation likely doubles the risk of non-melanoma skin cancer among older men and repeated sunburns that of skin melanoma in ages below 30 (SIR among deck and engine crew = 4.6, CI = 3.1-6.5). Female ship personnel had a significantly elevated total cancer risk (observed number of cases = 732) which increased over follow-up time (SIR in the category > or = 20 years since the first employment was 1.3, CI = 1.1-1.5). This excess was attributable primarily to lung cancer (SIR = 2.6, CI = 2.0-3.3). Also cancers of the cervix uteri, vulva, and vagina showed significant excess after 10 to 20 years since first employment aboard.

Cardiac status and cardiovascular risk factors among Finnish sea pilots.

Sea pilots have been reported to form an occupational population with high risk for coronary artery diseases. In the present study the cardiovascular risk factors were studied by laboratory and bicycle-exercise tests among 135 Finnish sea pilots above 45 years of age. The most common risk factors were: elevated blood cholesterol, low physical activity and elevated blood pressure. Most sea pilots had 2-3 separate risk factors, only three of them did not have any risk factor for coronary disease, one had as many as eight. Abnormal bicycle-exercise ECG-findings were seen in 15 pilots, four of them with suspected coronary artery disease. There were no differences in laboratory results between those with normal or abnormal exercise-ECG-findings. Sea pilots had lower blood pressure, cholesterol and HDL-cholesterol values than the male population on shore. The prevalence of risk factors among sea pilots was compared with data on risk factors among the Finnish male population of the same age group, published recently.

Free-time activities among seafarers on board Finnish cargo ships.

Seafarers' free time activities on board ship and on shore were investigated by means of a questionnaire sent to 507 seafarers working on 35 ships. All the seafarers were Finnish citizens and all the ships in Finnish ownership. The questionnaire was returned by 245 seafarers (22 of them were women) from a total of 34 ships. Reading was the most popular way of spending free time while on board ship. Next came watching television or listening to the radio; then chatting with friends and sleeping/keeping to oneself. About one in four put physical exercise and sauna baths among the three most common ways of spending free time. The most common ways of spending free time on shore were meeting friends and acquaintances and watching TV or listening to the radio. In third place were "other ways of spending leisure time", most of which included being out of door, hunting, going to the summer cottage and gardening. Physical exercise activity was greater on shore than on board ship. The respondents were grouped into four categories: A) reader/student/hobbyist: B) sociable: C) exercise enthusiast D) TV watcher/radio listener Group A considered the ship's atmosphere and the spirit of solidarity on board better than the others. Group B had more often a good friend on board ship and less often suffered from anxiety or depression. Group C more often considered their health and working capacity good. Group D had no positive differences over the other groups. More attention should be paid to developing the ways in which free time is spent not only on board but also during the compensatory free time on shore.

Seafaring: a risk for seamen's oral health?

Information about the oral status and dental health behavior and the working history of 369 Finnish seamen on different types of ships was gathered by means of a questionnaire. A control group of workers on shore was formed for sailors 35-44 years of age. Removable dentures were worn by 16% of the seamen. Oral disorders during the week before the study were reported by one-third. During the previous 2 years 14% of the sailors had had at least one episode of oral troubles, 15% twice and 9% three or even more times. One-third of seamen with oral trouble had needed pain-killing tablets or antibiotics. Sick leave days had been needed by 3% of respondents during the previous 2 years because of oral disorder (mean length of sick leave period was 1.4 days). The control group reported gum bleeding more often than the seafarers. Even though there were no signs of poorer dental condition in sailors than in the controls on shore, the possibility that the seafaring could constitute a risk for the oral health of seamen in other age groups cannot be excluded.

Postgraduate medical training for deck officers.

347 Finnish deck officers completed the questionnaire on medical training, knowledge and skills. The following conclusions could be drawn: a. Medical training must be based on generally accepted standards, both nationally and internationally. b. More practical exercises should be included in the training. c. Refresher medical training clearly increases knowledge and skills but it also gives the possibility to train, maintain and repeat practical routines. d. Evaluation of the skills should be a part of qualification. e. Good medical knowledge on board ship needs radio-medical services and vice versa.

Utilization of dental services by Finnish seamen.

Utilization of dental services by Finnish seamen was surveyed late in 1990. Three hundred and sixty-five respondents on different vessels at sea for more than 5 days returned a pretested questionnaire. A randomly drawn control group of 230 workers at a ventilation-equipment-producing plant was also surveyed. Fifty-five per cent of the seamen studied and 73% of the control group stated they had visited a dentist within the year before the survey. One-third of the seamen stated that an acute dental condition had been the reason for their last dental visit. Almost one-third of the seamen and 5% of the control group reported having last visited a dentist at a health center. When questioned separately, 14% of the seamen stated that they had not received dental treatment fast enough when needed. One-third of the seamen surveyed offered ideas for improving their dental services, half of them suggesting an increase in facilities and personnel at health centers for seamen. Periodic oral examinations for and full use of oral health self-care procedures by seamen are recommended.

Is there need for change of health examinations for sea pilots?

Sea pilots must be capable of carrying out their work in all situations. Thus, they must not have any disease or defect, that could impair their job performance. By periodic medical examinations attempts are made to ensure their working capacity. In most countries these examinations are carried out by a general practitioner and they include only few if any objective laboratory tests. The aim of the present investigation was to study the effectiveness of the periodic medical examinations to find out in the population of pilots examined persons with health risks, especially risks for cardiovascular diseases. All the pilots examined were over 45 years old (n = 135, response rate 88%). Self-evaluation of health was carried out by a questionnaire. Blood analyses were made and chest X-ray as well as exercise-ECC were taken. The most common subjective symptoms concerned musculoskeletal and gastrointestinal systems; sleep disturbances were also quite common. The three most frequent diseases diagnosed earlier by a doctor were musculoskeletal and gastrointestinal diseases, and arterial hypertension. About 24% of pilots had a lower physical working capacity than predicted. The body mass index indicated at least 11% overweight in half of the cases. At exercise-ECG four pilots appeared to have an ischaemic heart disease and additionally eleven pilots had abnormal ECG. Over 80% of pilots had a serum cholesterol value higher than 5 mmol/l, and serum triglyceride values exceeded the normal value of 2.0 mmol/l in every fourth case. Serum glutamyl transaminase was pathological in over 20% of the cases, and serum glucose level in 8%. The findings by routine physical examinations were very few consisting of stiffness in musculoskeletal system, two cases of elevated blood pressure, two heart murmurs, varicose veins etc. In two cases an inguinal hernia was suspected. The current periodic health examinations does not seem to effectively prevent a person with possible health defect from working as a sea pilot. More objective tests must be included in these examinations and more attention should be paid to prevention of overweight, effective treatment of musculoskeletal symptoms, improving physical working capacity and helping pilots to manage their psychic stress.

Time dependent effects of medroxyprogesterone acetate on hepatic ultrastructure in rats.

The present study demonstrates that MPA treatment may alter liver ultrastructure in rats. This was seen as a slight cytoplasmic vacuolization in light microscopy. In electron microscopy the most striking findings were the increase in the size of hepatocytes, the volume of smooth endoplasmic reticulum (SER) and the number of mitochondria. Minor changes in mitochondrial size and structure, and SER outline were also obtained. The amount of rough endoplasmic reticulum was decreased and bleb formation was common. The effect of MPA on liver ultrastructure was time-dependent. The main changes were found in rats receiving MPA daily for seven days. Most of the observed changes disappeared within 17 days after the cessation of the regimen. MPA induced alterations in liver morphology may partly be due to induction phenomenon although the hormonal property of MPA also may play some etiological role.

Reversibility of rat liver cirrhosis by medroxyprogesterone acetate.

The possible effects of a synthetic progesterone, medroxyprogesterone acetate (MPA), on carbon tetrachloride/phenobarbital (CCl4/PB)-induced rat liver injury were studied by morphological methods. CCl4/PB-treated rats showed extensive liver fibrosis consisting of procollagen type III aminoterminal propeptide-positive strands and fibres with concomitant extensive basement membrane deposits and fibronectin synthesis. MPA treatment after CCl4/PB-induced liver damage reduced alterations in cytoplasmic organelles, inflammation and hemorrhages and reversed the fibrosis, mostly around individual liver cells, possibly due to the normalization of cellular structure and function with a decrease in fibronectin deposits.

Medroxyprogesterone acetate (MPA) enhances liver NADPH-generating enzyme activities in normal rats.

The aim of the present study was to evaluate the effects of medroxyprogesterone acetate (MPA), an inducer of liver drug metabolism, on the ability of liver to generate NADPH, a reducing cofactor for drug oxidation reactions in normal rats and to compare these results with those obtained in rats receiving phenobarbital (PB), a well known inducer of liver drug metabolism. The results showed that: 1. Administration of MPA (100 mg/kg body wt) for a week increased liver wt and NADPH cytochrome P-450 reductase activity, suggesting that the compound induced liver drug metabolism. 2. The regimen also increased the activities of two NADPH generating enzymes, isocitrate dehydrogenase and malic enzyme, suggesting that MPA enhanced the capacity of normal liver tissue to produce NADPH. 3. Phenobarbital treatment increased the activities of three NADPH generating enzymes, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase and malic enzyme, suggesting that MPA and PB differ in their effects on the liver NADPH-producing system.

Hepatic mixed function oxidase system and enzymatic glucose metabolism in rats.

Therapy with enzyme inducing drugs may improve glycemic control in patients with non-insulin-dependent diabetes mellitus. We evaluated the role of a mixed function oxidase system on glucose metabolism with an animal model. Rats were treated with an inducer (phenobarbital), an inhibitor (cimetidine) and a hepatotoxin (carbon tetrachloride) for a week to cause alterations in the liver. The mixed function oxidase system was assayed by determination of the cytochrome P-450 content and NADPH cytochrome c reductase in liver. Carbohydrate metabolism was evaluated by determining blood glucose, enzymes associated with glucose phosphorylation in the liver (glucokinase, hexokinase), glucose storage as glycogen and enzymatic delivery, glucose-6-phosphatase, and peripheral tissue by determining phosphorylating enzyme (hexokinase) and a key glycolytic enzyme (pyruvate kinase) and glycogen content in muscles. The therapy with the inducer enhanced glucose utilization in liver and storage in muscles. The inhibitor decreased the mixed function oxidase system, reduced glucose phosphorylating, but not gluconeogenetic enzymes, in the liver and increased glycolysis in muscles. Carbon tetrachloride, a hepatotoxin, impaired mixed function oxidase, glucose phosphorylating and delivering enzyme activity in liver, reduced blood glucose and caused glycogen accumulation in muscles. The function of liver microsomal enzyme system seems to be closely related to enzymatic glucose metabolism in the liver and muscles.