Degenerative cervical spine changes among early career fighter pilots: a 5-year follow-up.

INTRODUCTION: Degenerative changes of the cervical spine often cause disability and flight duty limitations among Finnish Air Force (FINAF) fighter pilots. We aimed to study the effect of +Gz exposure on degenerative changes in the cervical spine by comparing cervical MRIs of FINAF fighter pilots and controls. METHODS: At baseline, the volunteer study population consisted of 56 20-year-old FINAF male fighter pilots (exposure group) and 56 21-year-old Army and Navy cadets (control group). Both groups underwent MRI of the cervical spine at the baseline and after 5 years. Degenerative changes evaluated using MRI included intervertebral disc (IVD) degeneration (Pfirrmann classification), disc herniations, uncovertebral arthrosis, Schmorl's nodes, Modic changes, spinal canal stenosis, kyphosis and scoliosis. RESULTS: The degree of IVD degeneration in the whole cervical spine increased significantly in both populations with no between-group differences. The prevalence of disc herniations also tended to increase in both populations with no difference in the incidence over the follow-up. However, pilots proved to have more disc herniations at the baseline and at the follow-up. There were virtually no between-group differences in other assessed degenerative changes. DISCUSSION: We found that IVD degeneration and the prevalence of disc herniations increased at a similar rate for fighter pilots and non-flying military students when all cervical levels were summed up. The lack of difference may be explained by the relatively low cumulative +Gz exposure during the first 5 years of a pilots' career.

Cultural adaptation, content, and protocol of a feasibility study of school-based "Let's learn about emotions" intervention for Finnish primary school children.

Introduction: Emotional awareness and emotion regulation are crucial for cognitive and socio-emotional development in children. School-based interventions on socio-emotional skills have the potential to prevent these problems and promote well-being of children. The Japanese school-based program, Universal Unified Prevention Program for Diverse Disorders (Up2-D2), has shown preventive effects on mental health of children in Japan. The aims of this protocol paper are to describe the unique process of adapting the Up2-D2 from Eastern to Western context, and to present a feasibility study of the intervention, conducted in Finland. Methods: The cultural adaptation process started with the linguistic translation of materials, followed by the modification of language to fit the Finnish context. While the Japanese ideology was saved, some content was adapted to fit Finnish school children. Further modifications were made based on feedback from pupils and teachers. The Finnish version of the program was named "Let's learn about emotions" and consisted of 12 sessions and targeted 8- to 12-year-old pupils. A teacher education plan was established to assist Finnish teachers with the intervention, including a workshop, teachers' manual, brief introductory videos, and online support sessions. A feasibility study involving 512 4th graders in the City of Hyvinkää, South of Finland, was conducted. It assessed emotional and behavioral problems, classroom climate, bullying, loneliness, perception of school environment, knowledge of emotional awareness, and program acceptability. Discussion: The originality of this study underlies in the East-West adaptation of a cognitive behavioral therapy-based program. If promising feasibility findings are replicated in Finland, it could pave the way for further research on implementing such programs in diverse contexts and cultures, promoting coping skills, awareness, social skills and early prevention of child mental health problems. Ethics: The ethical board of the University of Turku gave ethics approval for this research. The educational board of the City of Hyvinkää accepted this study.

Occupational health physicians as users of electronic health records.

BACKGROUND: Electronic health records (EHRs)' purpose is to facilitate the documentation of patient data and to improve the exchange of information between the professionals involved in a patient's care. AIMS: To investigate occupational health (OH) physicians' experiences of EHRs and the factors hampering work. METHODS: An electronic questionnaire was sent to physicians working in OH services in April 2017 and a total of 342 OH physicians participated in the study. The results were reported as quantities and percentages. The survey text was analysed using data-driven content analysis. RESULTS: The respondents considered their EHR stable in terms of technical features but the routine tasks with EHR were not straightforward. Also, the documentation of patient data for statistical purposes took an unreasonable amount of time and the access to patient data from other organizations was poor. Instead, a well-functioning feature of EHRs were electronic prescriptions. The factors, which hampered respondents' work, were constant or frequent time pressure, too little time to do their job properly and a stress caused by uncompleted tasks. CONCLUSIONS: This study showed that the usability problems of EHRs were the slowness, unexpected downtimes and difficulties in obtaining patient data. Also, respondents felt very often a lack of time in their work. OH physicians' work is best supported by EHRs that consider their specific role in healthcare, i.e. the assessment of work ability, the co-ordination of care and rehabilitation and support for return to work.

Documentation of work ability data in occupational health records.

BACKGROUND: In Finland, patient health records are structured in the same way. Patient data entries are grouped using national headings and each data entry must have at least one heading. AIMS: To determine the use of national headings for the documentation of work ability data and to gather the experience of professionals on usefulness, ease of use and usability of national headings in occupational health services (OHSs). METHODS: An electronic questionnaire and a semi-structured themed interview were used to collect data. Data were analysed using SPSS Statistics 24 and interview material was analysed by deductive content analysis using ATLAS.ti. RESULTS: A total of 359 people completed the questionnaire. Most of the work ability data were documented using the headings history, plan and current status. More than half of respondents felt that using national headings improved quality and allowed greater control. Almost all respondents thought that learning to use national headings was easy. During the interviews (n = 19), all respondents felt that use of national headings improved the quality of documentation. However, more than half stated that national headings were not well suited to documentation of work ability data. CONCLUSION: These results can be used to develop national documentation standards, as well as electronic health records, to support healthcare professionals' interactions with working-age patients. Earlier studies of national headings in OHSs were not found.

Persistent asthma, comorbid conditions and the risk of work disability: a prospective cohort study.

BACKGROUND: This study examined whether asthma alone or together with chronic comorbidity is associated with an increased risk of long-term work disability. METHODS: We examined data from 2332 asthmatic and 66 354 nonasthmatic public sector employees in Finland who responded to a survey between 1997 and 2004. Respondents were coded as persistent asthmatics based on the special reimbursement for continuous asthma medication by the Social Insurance Institution. Data on long-term work disability (sickness absences or disability pensions > 90 days) were obtained from national registers. The risk of work disability was examined by Cox proportional hazard models adjusted for age, gender, socioeconomic status, type of employment contract, and type of employer. RESULTS: Asthma increased the risk of all-cause long-term work disability with hazard ratio (HR) 1.8 (95% CI 1.62-2.09) compared with controls (no asthma). Asthma and one other chronic comorbidity increased the risk of long-term all-cause work disability with HR 2.2 (95% CI 1.78-2.83). Asthma together with two or more other chronic conditions increased the risk with HR 4.5 (95% CI 2.98-6.78). Asthma and depression increased the risk with HR 3.6, and the risk was especially high for permanent work disability (HR 6.8). Among those with asthma, there were more women, obese individuals (BMI ≥ 30), ex-smokers, and lower-grade nonmanual workers. CONCLUSIONS: Asthma is associated with an increased risk of long-term all-cause work disability. The risk increases further with chronic comorbidities and is especially high in patients with asthma and depression.

Violence and psychological distress among police officers and security guards.

BACKGROUND: Police officers and security guards are more exposed to violence during their work duties than the general workforce and it can damage their psychological health. Still research on specific forms of violence and a potential pathway through which violence may affect distress is scarce. AIMS: The aim of this study was to investigate the association of two forms of violence with distress among police officers and security guards and whether personal worry about future violence mediates this association. METHODS: Violence was specified as physically violent acts and threats or assaults with a deadly weapon. Symptoms of psychological distress were measured using the General Health Questionnaire-12 scale. RESULTS: Analyses of 1993 completed responses (response rate 58%) showed that the odds ratio of distress for 'physically violent acts was' 1.67 (95% CI = 1.11-2.51) and for 'threats or assaults with a deadly weapon' 1.62 (95% CI = 1.20-2.17). When personal worry about future violence was taken into account, the association between exposure to physically violent acts and distress was completely broken. Instead, with the same adjustment, the association between exposure to threats or assaults with a deadly weapon and distress held. The results indicate that the association between physically violent acts and distress is mediated by personal worry about future violence, while threats or assaults with a deadly weapon had a stronger and independent association with distress. CONCLUSIONS: It is concluded that there is association between violence and distress. Personal worry about future violence mediates this association.

Modelling the impact of varicella vaccination on varicella and zoster.

It has been suggested that the incidence of herpes zoster may increase due to lack of natural boosting under large-scale vaccination with the varicella vaccine. To study the possibility and magnitude of such negative consequences of mass vaccination, we built a mathematical model of varicella and zoster epidemiology in the Finnish population. The model was based on serological data on varicella infection, case-notification data on zoster, and new knowledge about close contacts relevant to transmission of infection. According to the analysis, a childhood programme against varicella will increase the incidence of zoster by one to more than two thirds in the next 50 years. This will be due to increase in case numbers in the 35 years age groups. However, high vaccine coverage and a two-dose programme will be very effective in stopping varicella transmission in the population.

Personal health promotion through personalized health technologies - Nuadu experience.

Poor lifestyles - overweight, unhealthy diet, physical inactivity, sleep deprivation, and stress - are significant risk factors to chronic illnesses, which cause majority of the health care costs. Hence, behavioral change towards healthy lifestyles is one of the keys to health care cost containment. Personal health systems (PHS) offer tools to support behavioral change. As health risks, personal needs and preferences vary from an individual to another, personalization of the PHS is needed. In Nuadu project we have developed a PHS integrating several different personal health technologies. This system was studied in a large (N=354) randomized controlled trial where employees with several health risks participated in a health promotion program. The study will finish in June 2009. User feedback and technology usage logs reveal that especially simple mobile technologies were actively used during the program. However, usage models varied between individuals and time, and there was a significant number of both active users and non-users. The results emphasize that "one size" does not fit all, and instead of individual "killer applications", PHS with different personalizable and interoperable options should be developed. In addition, screening and profiling methods should be developed to identify those users who would best accept and benefit from technology-supported health promotion. Successful technologies combine high usability and conceptual simplicity to clear and perceivable added value for the end users.

Finland introduces rotavirus vaccine into the national vaccination programme in September 2009.

Supported by an economic evaluation, rotavirus vaccine is introduced into the national immunisation schedule in Finland. The vaccination programme has been estimated to be reasonably cost-effective. Given at the age of two, three and five months, the vaccine is expected to prevent annually in Finland among children under the age of five years approximately 2,000 rotavirus diarrhoea episodes needing hospitalisation, and over 10,000 outpatient visits. The impact of the programme will be evaluated in 2011 by repeating the economic analysis and carefully monitoring adverse events.

Mitigating on-call symptoms through organizational justice and job control: a cross-sectional study among Finnish anesthesiologists.

BACKGROUND: On-call duty has been shown to be associated with health problems among physicians. However, it cannot be abolished, as patient safety has to be assured. Thus, we need to find factors that could mitigate the negative health effects of on-call duty. METHODS: The cross-sectional questionnaire of the buffering effects of organizational justice, job control, and social support on on-call stress symptoms was sent to all working Finnish anesthesiologists (n=550). RESULTS: The response rate was 60% (n=328, 53% men). High organizational justice, job control, and social support were associated with a low number of symptoms while on call or the day after in crude analysis and when adjusted for age, gender, and place of work. Only the association between justice and symptoms was robust to additional adjustments for on-call burden and self-rated health. In the interaction analysis among those being on call at the hospital, we found that the higher the levels of job control or organizational justice, the lower the number of symptoms. CONCLUSIONS: Job control and organizational justice successfully mitigated stress symptoms among those who had on-call hospital duties. It would be worth enhancing decision-making procedures, interpersonal treatment, and job control routines when aiming to prevent on-call stress and related symptoms.

High tetanus and diphtheria antitoxin concentrations in Finnish adults--time for new booster recommendations?

The tetanus and diphtheria vaccination programme in Finland has been running for 50 years. After primary doses, tetanus boosters have been offered to men in military service and decennial boosters recommended for all through the adult life. For 30 years a diphtheria booster was only offered to men in the military service. Not until 1989 diphtheria-tetanus (dT) and diphtheria (d) booster vaccines for adolescence and adults were introduced. In this study serum samples of 990 subjects from 30 years of age, participating in a population survey in 2000-2001, were used to assess the tetanus and diphtheria antitoxin concentrations. More than 70% of the adults up to 50 years of age were fully protected (antitoxin concentrations >0.1 IU mL) against tetanus and diphtheria. Of these adults more that 76% had antitoxin concentrations >1 IU/mL against tetanus, indicating long-term protection but also an increased risk for hyperimmunisation. A comparison of this study and two immunogenicity studies conducted in Finland in 1987-1988 and 1995-1996 shows the impact of an active decennial dT adult booster programme in a country with a high primary tetanus and diphtheria vaccination coverage in infants since the 1950s. Recommendations for limited decennial boosters by increase the time interval between dT boosters up to 20 years as suggested by this study and also studies performed, e.g., in Denmark and Portugal should be considered. Finnish adults born before 1930 should, however, still be vaccinated with decennial boosters, especially against tetanus.

Suicidality among Finnish anaesthesiologists.

BACKGROUND: Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians. METHODS: A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%. RESULTS: One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8-33.0), low social support (10.5, 4.0-27.9), and family problems (6.5, 3.4-12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3-7.1) and superiors (2.1, 1.2-3.6), on-call-related stress symptoms (3.9, 1.9-8.3) and low organizational justice (1.9, 1.1-3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor. CONCLUSIONS: The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians.

Attitudes to job turnover among Finnish anaesthetists.

BACKGROUND: Structural changes have led to higher workload and more frequent conflicts among hospital staff, which in turn has been shown to be associated with increased employee turnover. AIMS: To study the willingness of anaesthetists to change their employment and factors associated with it. Work-related, individual and family-related factors were investigated as potential influences on such willingness. METHOD: A postal questionnaire was sent to all working Finnish anaesthetists (N = 550). RESULTS: The response rate was 60%; 175 (53% of responders) were men. Of the respondents, 31% were willing to consider changing to another physician's job and 43% to a profession other than medicine. The most important correlates for these views were conflicts with superiors (odds ratio 6.1; 95% confidence interval 2.1-17.7) and co-workers (4.2; 1.4-12.2), low job control (2.6; 1.4-4.9), a sense of organizational injustice (2.4; 1.3-4.6), stress (6.5; 2.6-16.3) and job dissatisfaction (4.6; 2.4-8.8). CONCLUSIONS: The establishment of respect, trust and genuine dialogue between co-workers and superiors is needed to minimize the risk of loss of members of this occupational group.

Nuadu concept for personal management of lifestyle related health risks.

Majority of the health risks and diseases in the modern world are related to lifestyles, e.g., overweight, unhealthy diet, physical inactivity, sleep deprivation, and stress. Behavioral change towards healthy lifestyles is the key to the prevention and management of these risks, but early and efficient interventions are scarcely available. We present the Nuadu Concept, an ICT (Information and Communication Technologies) assisted wellness toolbox for the management of multiple, behavior-originated health risks. The concept is based on psychological models, which provide methods and motivation for behavior change. The individual is considered as the best expert of his/her own wellness. Thus, the Nuadu Concept provides a variety of personal wellness technologies and services, among which the user may freely choose the best tools for him/herself. We believe this approach has the potential to provide efficient, acceptable, available, and affordable wellness management support for a significant number of people.

Job satisfaction, work ability and life satisfaction among Finnish anaesthesiologists.

BACKGROUND: Organizational changes and relative growth of the ageing population together with related health problems seem to have increased stressfulness in the work of anaesthesiologists. However, little is known about their work-related well-being and the factors through which their situation could be improved. METHODS: A cross-sectional questionnaire study of the level and the determinants of job satisfaction, work ability and life satisfaction among female and male anaesthesiologists involved 258 Finnish anaesthesiologists working full time (53% men). RESULTS: The respondents had fairly high job satisfaction, work ability and life satisfaction. No gender differences appeared in these well-being indicators, but their determinants differed by gender. Job satisfaction was only associated with work-related factors in both genders: with job control in women and with job control and organizational justice in men. Work ability correlated with job control and health in both genders and with family life in women. Life satisfaction correlated with individual- and family related factors such as social support and family problems in both genders. Life satisfaction correlated with physical workload in men and health in women. Women had less job control, fewer permanent job contracts and more domestic workload than men. CONCLUSIONS: Job control and organizational justice were the most important determinants in work-related well-being. Work-related factors were slightly more important correlates of well-being in males, and family life seems to play a larger role in the well-being of female anaesthesiologists. Organizational and gender issues need to be addressed in order to maintain a high level of well-being among anaesthesiologists.

Respiratory effects of exposure to methacrylates among dental assistants.

BACKGROUND: Case reports of occupational asthma in dental personnel have been published, but there is little data on the risk of respiratory disorders related to occupational exposure to methacrylates in dental assistants. The objective of this study was to investigate the relation of exposure to methacrylates to occurrence of respiratory symptoms and diseases among dental assistants. METHODS: A cross-sectional study of female dental assistants from the membership register of the Finnish Association of Dental Hygienists and Assistants was conducted in the Helsinki metropolitan area. A CATI was carried out to collect information on health and exposures. A total of 799 dental assistants participated (response rate 87%). RESULTS: Daily use of methacrylates was related to a significantly increased risk of adult-onset asthma (adjusted OR 2.65, 95% CI 1.14-7.24), nasal symptoms (1.37, 1.02-1.84), and work-related cough or phlegm (1.69, 1.08-2.71). Nasal symptoms showed a dose-response relation with increasing years of exposure to methacrylates, and those with >10 years of exposure had also increased risk of hoarseness, dyspnoea, and wheezing with dyspnoea. Dental assistants with a history of atopic diseases were particularly susceptible to exposure to methacrylates, the adjusted OR for adult asthma being in this group 4.18 (95% CI 1.02-28.55) and for nasal symptoms 2.11 (1.08-4.19). CONCLUSIONS: This study provides new evidence that the risk of adult-onset asthma, nasal symptoms and other respiratory symptoms increase significantly with daily use of methacrylates in dental assistants' work. The results suggest that exposure to methacrylates poses an important occupational hazard for dental assistants.

On-call stress among Finnish anaesthetists.

We investigated on-call stress and its consequences among anaesthetists. A questionnaire was sent to all working Finnish anaesthetists (n = 550), with a response rate of 60%. Four categories of on-call workload and a sum variable of stress symptoms were formed. The anaesthetists had the greatest on-call workload among Finnish physicians. In our sample, 68% felt stressed during the study. The most important causes of stress were work and combining work with family. The study showed a positive correlation between stress symptoms and on-call workload (p = 0.009). Moderate burnout was present in 18%vs 45% (p = 0.008) and exhaustion in 32% and 68% (p = 0.015), in the lowest vs highest workload category, respectively. The symptoms were significantly associated with stress, gender, perceived sleep deprivation, suicidal tendencies and sick leave. Being frequently on call correlates with severe stress symptoms and these symptoms are associated with sick leave.

Pneumococcal vaccination policy in Europe.

Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been licensed since 2001 in Europe. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed to all 15 EU member states, Switzerland, Norway and the 10 accession countries in 2003 to ascertain current pneumococcal vaccination policy. Twenty three of the 27 target countries, constituting the current European Union (plus Norway and Switzerland), completed the questionnaire. PPV was licensed in 22 of the 23 responding countries and was in the official recommendations of 21. In all the 20/21 countries for which information was available, risk groups at higher risk of infection were targeted. The number of risk groups targeted ranged from one to 12. At least 17 countries recommend that PPV be administered to all those >65 years of age (in three countries, to those over 60 years of age). Thirteen countries had developed national recommendations for PCV in 2003. No country recommended mass infant immunisation at that time, but rather targeted specific risk groups (between 1 and 11), particularly children with asplenia (n=13) and HIV infection (n=12). PCV use was restricted to children under two years of age in seven countries, and in four countries to children under five years of age. Future decisions on use of pneumococcal vaccines in Europe will be decided on the basis of several factors including: local disease burden; the predicted impact of any universal programme, particularly the importance of serotype replacement and herd immunity (indirect protection to the unvaccinated population); the effectiveness of reduced dose schedules, and vaccine cost. Indeed, at least one country, Luxembourg, has since implemented a universal infant PCV immunisation policy.

Pneumococcal vaccination policy in Europe.

Infection due to Streptococcus pneumoniae (Pneumococcus) (Pnc) is an important cause of invasive clinical manifestations such as meningitis, septicaemia and pneumonia, particularly in young children and the elderly. A 23-valent polysaccharide Pnc vaccine (PPV) has been available for many years and a 7-valent conjugate Pnc vaccine (PCV) has been licensed since 2001 in Europe. As part of a European Union (EU) funded project on pneumococcal disease (Pnc-EURO), a questionnaire was distributed to all 15 EU member states, Switzerland, Norway and the 10 accession countries in 2003 to ascertain current pneumococcal vaccination policy. Twenty three of the 27 target countries, constituting the current European Union (plus Norway and Switzerland), completed the questionnaire. PPV was licensed in 22 of the 23 responding countries and was in the official recommendations of 21. In all the 20/21 countries for which information was available, risk groups at higher risk of infection were targeted. The number of risk groups targeted ranged from one to 12. At least 17 countries recommend that PPV be administered to all those >65 years of age (in three countries, to those over 60 years of age). Thirteen countries had developed national recommendations for PCV in 2003. No country recommended mass infant immunisation at that time, but rather targeted specific risk groups (between 1 and 11), particularly children with asplenia (n=13) and HIV infection (n=12). PCV use was restricted to children under two years of age in seven countries, and in four countries to children under five years of age. Future decisions on use of pneumococcal vaccines in Europe will be decided on the basis of several factors including: local disease burden; the predicted impact of any universal programme, particularly the importance of serotype replacement and herd immunity (indirect protection to the unvaccinated population); the effectiveness of reduced dose schedules, and vaccine cost. Indeed, at least one country, Luxembourg, has since implemented a universal infant PCV immunisation policy.

Modelling transmission, immunity and disease of Haemophilus influenzae type b in a structured population.

An individual-based stochastic simulation model was constructed to study the epidemiology of Haemophilus influenzae type b (Hib) transmission, immunity and invasive disease. Embedded in a demographic model, the transmission model of Hib carriage employs the most important social mixing patterns with three types of contact sites (family, day-care group, and school class). The model includes immunity against invasive Hib disease, initiated and boosted by Hib carriage and cross-reactive bacterial encounters. The model reproduces the observed age patterns in Hib carriage and disease in Finland before large-scale use of the Hib conjugate vaccines. The model was used to investigate characteristics of Hib transmission. The analysis emphasizes transmission between children and adults in families while pointing out the importance of pre-school and school-aged children in maintaining Hib circulation. Carriage in these age groups is thus identified as being essential to target for sustained effects of interventions by vaccination.