Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study.

OBJECTIVES: This study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of 2-3 months RTW during recovery after lumbar discectomy and hip and knee arthroplasty among Finnish working-age population. METHODS: Cohorts on patients aged 18-65 years old with lumbar discectomy or hip or knee arthroplasty were extracted from the electronic health records of eight Finnish hospital districts in 2015-2021 and compiled with retirement and sickness benefits. The overall effect of the CRtW model on the average RTW period was calculated as a weighted average of area-specific mean differences in RTW periods between 1 year before and 1 year after the implementation. Longer-term effects of the model were examined with an interrupted time series design estimated with a segmented regression model. RESULTS: During the first year of the CRtW model, the average RTW period shortened by 9.1 days (95% CI 4.1 to 14.1) for hip arthroplasty and 14.4 days (95% CI 7.5 to 21.3) for knee arthroplasty. The observed differences were sustained over longer follow-up times. For lumbar discectomy, the first-year decrease was not statistically significant, but the average RTW had shortened by 36.2 days (95% CI 33.8 to 38.5) after 4.5 years. CONCLUSIONS: The CRtW model shortened average RTW periods among working-age people during the recovery period. Further research with larger samples and longer follow-up times is needed to ensure the effectiveness of the model as a part of the Finnish healthcare system.

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.

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.

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.

Factors associated with self-assessed work ability.

BACKGROUND: Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting. AIMS: This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors. METHODS: During 723 illness-related visits to occupational physicians, questionnaires covering personal data, main health problems, their work relatedness, duration and effect on work ability were completed by the employee and physician. Factors associated with self-assessed work ability were studied in a multinomial logistic regression model. RESULTS: The majority of employees considered themselves as being able or partially able to work despite the health problem. Independent predictors of impaired work ability were mental or musculoskeletal disorders, self-assessed work relatedness of the disease, older age, blue-collar work and short duration of the symptoms. If the patient was convinced about the benefits of work-related interventions, the risk for disability was significantly reduced. CONCLUSIONS: Special attention should be paid to the recognition and modification of potential work-related causes of disability. In addition, patients with partial work ability should be encouraged to stay at work instead of taking sick leave. For effective disability management, accommodated work and other evidence-based interventions are needed at the workplace.

Evidence on the effectiveness of occupational health interventions.

BACKGROUND: At present there exists no overview of the range of evidence currently available regarding the effectiveness of occupational health interventions (OHI). METHODS: Articles published in 2000 and 2001 in 16 general and specialized biomedical journals were searched for evaluations of OHI studies. RESULTS: Out of 8,687 articles searched there were 148 OHI studies. In 21% of the studies the study design was a randomized controlled trial, in 28% it was a controlled trial, an interrupted time-series in 7% and a different design in 44%. The occupational health outcome was exposure in 27% of the studies, worker behavior in 12%, disease symptoms in 30%, disability or sickness absence in 24%, injuries in 4%, and quality of care in 3%. CONCLUSIONS: High quality evaluation studies are conducted in all areas of occupational health. However, it is clear that more are needed and the methodology used could be improved.

Building an evidence base for occupational health interventions.

This article summarizes arguments for building an evidence base for occupational health. Evidence is needed on the most effective ways of eliminating health hazards in the workplace and at work, enhancing healthy behavior or the empowerment of workers, and preventing and treating occupational diseases and occupational disability. An evidence base for occupational health must include systematic reviews. The Cochrane Collaboration has brought together some of the evidence; however, a search for systematic reviews on the top priorities in occupational health research showed that systematic reviews are lacking in many areas. Current reviewing methods can be adapted to the special features of occupational health. It is concluded that more effort should be invested in the preparation, maintenance, and dissemination of systematic reviews in order to create a necessary evidence base for occupational health interventions. Occupational health could benefit considerably from greater awareness of the evidence for and against various types of intervention.

Increased personal medication use among Finnish physicians from 1986 to 1997.

This study was based on a nationwide survey of 2671 Finnish physicians in 1986 and 3313 in 1997. The results showed that the proportion of physicians who often or regularly reported using any medication increased significantly from 1986 to 1997 (men 27.8% versus 44.3%, P = 0.001; women 28.8% versus 48.6%, P = 0.001). Among the general practitioners working in the public sector, the increase was from 31.2% to 49.3%. Gastrointestinal diseases (74%), asthma (63%) and mental disorders (62%) were the most commonly self-medicated conditions in 1997.

Social context for workplace health promotion: feasibility considerations in Costa Rica, Finland, Germany, Spain and Sweden.

We constructed a simple, flexible procedure that facilitates the pre-assessment of feasibility of workplace health promotion (WHP) programmes. It evaluates cancer hazards, workers' need for hazard reduction, acceptability of WHP, and social context. It was tested and applied in 16 workplace communities and among 1085 employees in industry, construction, transport, services, teaching and municipal works in Costa Rica, Finland, Germany, Spain and Sweden. Social context is inseparable from WHP. It covers workers' organizations and representatives, management, safety committees, occupational health services, health and safety enforcement agencies, general health services, non-government organizations, insurance systems, academic and other institutions, regulatory stipulations pertaining WHP, and material resources. Priorities, risk definitions, attitudes, hazard profiles, motivations and assessment methods were highly contextual. Management preferred passive interventions, helping cover expert costs, participating in planning and granting time. Trade unions, workers' representatives, safety committees and occupational health services appeared to be important operational partners. Occupational health services may however be loaded with curative and screening functions or be non-existent. We advocate participatory, multifaceted WHP based on the needs and empowerment of the workers themselves, integrating occupational and lifestyle hazards. Workforce in irregular and shift work, in agriculture, in small enterprises, in the informal sector, and immigrant, seasonal and temporary workers represent groups in need of particular strategies such as community health promotion. In a more general framework, social context itself may become a target for intervention.

Networking between occupational health services, client enterprises and other experts: difficulties, supporting factors and benefits.

This study explores difficulties, supporting factors and benefits of networking to studied enterprises and other network partners (focus on OHS and client enterprises). The study also explores social capital as a resource produced in network relations, and trust as a core dimension of social capital, and trust as a binding element in networking. The study is a mixed methods research (both qualitative and quantitative research materials). The most important supporting factors were: committed and active focus person, teamwork skills, long relationships, familiarity, trust and two-way communication in co-operation, shared goals, norms and values, an equal cost and benefit ratio, and the high quality of services. The biggest problems were the lack of skills to operate in the network and difficulties in maintaining the network, weak communication, lack of confidence, inconvenient size or composition of the network, overlapping information, cliques, nodes and missing links. The benefits were versatile: knowledge and skills accumulate, the network multiplies resources, fluency of co-operation, innovations, commitment and trust increase, good practices expand, and moreover, the quality, many-sidedness and appropriateness of operations improve. Networking is beneficial but demanding. There are many limitations. Networks are not equal for every network partner (inequality in cost and benefit ratio). Networks produce social capital for participants. Successful networking requires trust relations between network partners.

Occupational health services and maintenance of work ability at workplaces.

This paper describe the concept of maintenance of work ability (MWA) at workplaces and the contribution of occupational health services (OHS). Changing working life and its demands increase the need for MWA. The concept of MWA is approximately ten years old in Finland. It has attained large popularity in media and is a central trend in the promotion of well-being at workplaces. It has received wide approval in politics and labour market as one of the main topics of internal policies. The maintenance of work ability has become the main service of occupational health. The activities of MWA are increasing. It is considered profitable and it has many positive effects at workplaces, but has not yet been established properly as a part of everyday work processes. Occupational health services play a significant role in different phases of MWA process, but it should be more significant, especially in small workplaces. More trust, communication and collaboration are needed.