Mortality among seafarers: a register-based follow-up study.

BACKGROUND: Seafarers are exposed to many occupational risk factors. AIMS: To study whether there are differences in mortality between seafarers and other employees, whether there are variations in seafarers' mortality between different seafaring occupations and whether these differences can be explained by sociodemographic factors. METHODS: A register-based study of all seafarers aged 25-64 years, resident in Finland in 2000 with minimum 5 years of cumulative seafaring experience on Finnish vessels and other employees, followed for mortality 2001-13. Analysis methods included age standardized death rates, mortality ratios (SMR) and Cox proportional hazard model. RESULTS: During the follow-up period 2001-13, there were 81,035 person years and 382 deaths in the cohort of seafarers. Seafarers had 1.3 times higher risk of death (men SMR 132, 95% confidence intervals [CI] 118-147, women SMR 125, 95% CI 99-157) than other employees. Mortality was especially high in alcohol-related causes (men SMR 172, 95% CI 126-233, women SMR 262, 95% CI 131-525) and causes related to smoking. Controlling for sociodemographic characters strengthened the risk compared to other occupations. Mortality was high among male deck and engine crew and among male and female galley personnel. The mortality differences between different seafaring occupations were partly explained by adjustments of sociodemographic characters. CONCLUSIONS: Seafarers still have increased mortality among men after adjustment of sociodemographic characters. Results by causes of death suggest that changing practices to enable healthy behaviour are important.

How consistently distributed are the socioeconomic differences in severe back morbidity by age and gender? A population based study of hospitalisation among Finnish employees.

AIMS: To study the socioeconomic distribution of severe back morbidity by age and gender, and to examine to what extent the differences in back morbidity between socioeconomic groups are particularly related to manual work in different age groups. METHODS: Hospital admissions in 1996 for back disorders of 25-64 year old men (3123 of a total 743,961) and women (3043 of 773,936) from the Finnish Hospital Discharge Register were linked with demographic and socioeconomic data from the 1995 population census. Poisson regression analysis was used to calculate the rate ratios for back related hospitalisation by occupational class and education. The distribution of cases according to occupational status and education was presented in relation to the whole occupationally active workforce by age and gender. RESULTS: Blue-collar (manual) workers had a higher risk of being hospitalised because of back disorders compared with white-collar employees (non-manual) in all age groups among both genders. Manual work versus non-manual work was associated with a 1.3 to 1.4-fold risk (95% CI 1.0 to 1.8) among women and a 1.3 to 1.6-fold risk (95% CI 1.1 to 2.2) among men. The risk of hospitalisation was further inversely associated with educational level within manual and non-manual work in all other age groups except in those aged 55-64 years. Gender related differences were much smaller compared with the socioeconomic ones. CONCLUSIONS: Socioeconomic differences in back morbidity leading to hospitalisation were consistent by age and gender. The results suggest that not only the physical strenuousness of work, but also other causes of severe back disorders are clustered around a subject's socioeconomic status, indicated by formal education. This may have implications for prevention and the planning of rehabilitation.

Inpatient hospital care for lumbar intervertebral disc disorders in Finland in relation to education, occupational class, income, and employment.

The object of the study was to describe socioeconomic and demographic determinants of inpatient hospital care for lumbar intervertebral disc disorders (LIDD) in Finland. Information from the 1996 Finnish Hospital Discharge Register was linked with the 1995 Population Census. Poisson regression analyses were made with the total and the gainfully employed workforce aged 20-64 y as reference. All 48 public and seven private acute care general hospitals treating LIDD patients in Finland. In the workforce, 4643 patients aged 20-64 y (3692 among the gainfully employed) were admitted to the hospital due to LIDD (ICD-10: M51.1-M51.9) in 1996. About one-half were treated surgically. The duration of unemployment in 1995 was inversely associated with hospitalisation for LIDD in 1996, allowing for age, sex, education and personal income (unemployed for 12 months vs 0 months: rate ratio 0.66; 95% CI 0.57-0.77). Among those employed for 12 months in 1995, the level of education was inversely associated with the hospital admission rate. The rate was also higher in manual occupations as compared with the upper white-collar employees. The associations were clearer among the medically than the surgically treated patients. Hospitalisation for back disorder was, however, less common in the lowest income group as compared with the highest (0.65; 0.57-0.77) allowing for education, occupational class, age and sex. Women were less often admitted to the hospital than men, allowing for the socioeconomic factors (0.83; 0.77-0.90). When indicated by education or occupation, low socioeconomic status was associated with a relatively high rate of inpatient hospital care for LIDD. When indicated by personal income, the situation was the reverse. Unemployment and female gender predicted a relatively low rate of hospitalisation.

Mortality transition in the Ovamboland region of Namibia, 1930-1990.

Few long-term statistical series exist that can document the mortality transition in Africa. This paper uses data from the parish registers of the Evangelical Lutheran Church in Namibia to study morality in Ovamboland between 1930 and 1990. The paper identifies significant discontinuities and reversals in the trend in mortality. Much of the mortality transition occurred in a rapid breakthrough concentrated between the early 1950s and early 1960s. Adult mortality fell more than existing model life tables would predict and the pattern of relatively high early-age mortality typical of modern Africa emerged only at this time. While a range of developments in Ovamboland contributed to the overall decline in mortality, the most important factor was the establishment, by the Finnish Mission, of a Western system of health care. In Ovamboland, the drive to 'good health at low cost' was articulated not through political institutions but through the church.

Perceived work conditions and work-related symptoms among employed Finns.

The aim of the study was to determine the number and nature of perceived harmful work conditions and perceived work-related symptoms among employed Finns by sex and socioeconomic group. The associations between perceived harmful work conditions and perceived symptoms were also investigated. Knowledge of perceived work-related ill health can serve as a basis for health promotion at work. In a computer-assisted telephone interview of 2744 salaried employees and wage-earners, the respondents were asked about perceived harmful work conditions as well as perceived health complaints, and their relatedness to work. At least one harmful factor at work was reported by 94% of the respondents, and half of them reported more than three such factors. The most commonly occurring harmful factors were increased work pace, mental demand, repetitive movements, and noise. Of the symptoms perceived as work-related, musculoskeletal symptoms were the most common. They were reported by 44% of the respondents, followed by mental symptoms (26%), psychosomatic symptoms (19%), and respiratory or sensory symptoms (15%). Both the reporting of perceived harmful work factors and perceived work-related symptoms varied by socioeconomic group and sex. Perceived work-related musculoskeletal symptoms were associated with perceived ergonomic harmful work factors among both the men and the women, with physical or chemical work factors among the men, and with psychosocial or work organizational factors among the women. Perceived work-related respiratory symptoms were associated with perceived harmful physical or chemical work factors among both the men and the women, and both groups also reported mental and psychosomatic symptoms in relation to harmful psychosocial or organizational work factors. Among the women psychosomatic symptoms and harmful ergonomic work factors were also related. Perceived harmful factors at work and work-related symptoms are common among the work force. Even though the degree of work-related ill health was related to socioeconomic group, the reporting of particular symptoms indicated the probability of a particular work factor being considered harmful independently of socioeconomic group, although there was some relationship to sex. The implications for occupational health services are evident; employees' work-related symptoms can serve as an indicator of (preventable) perceived problems at work.

Work-related interventions during office visits to occupational health physicians.

BACKGROUND: Systematically applied work-related interventions during visits to occupational health (OH) physicians support the preventive and health promotive goals of OH. The proportion of the visits including a work-related intervention was analyzed according to patient, health problem, and physician determinants in a sample of visits to OH physicians in Finland. METHODS: A cross-sectional study was carried out among 55 Occupational Health Services (OHS) units. Office encounters with 4,404 male and 5,373 female employed patients ages 18-64 years, recorded by 114 OHS physicians, were analyzed. RESULTS: Altogether 856 (8.8%) encounters included a work-related intervention. The work-related interventions were distributed across all the main disease categories, the majority of which were musculoskeletal diseases. Of the patient determinants, occupational group (the residual group of non-white-collar or non-blue-collar workers) associated positively with a work-related intervention, while age or gender did not. The physician's female gender and experience associated positively with work-related interventions. Work-related interventions took place more often in integrated and joint model OHS than in municipal health care centers and private medical centers. CONCLUSIONS: Work-related interventions are used by OH physicians for diverse health problems. More research is needed to better understand the reasons for the observed differences in work-related interventions. Also, research is needed to evaluate the efficiency of such interventions.

Cancer incidence among Finnish farmers, 1979-93.

A cohort of approximately 120,000 male and 85,000 female farmers registered in the Farm Register of Finland was followed-up for cancer incidence through the Finnish Cancer Registry in 1979-93. Nearly 17,000 cancer cases were observed. Compared with the total cancer incidence of the Finnish population, both genders experienced a 17 to 18 percent decreased risk of cancer. The risks were low in smoking-related cancers, cancers associated with an urbanized way of life, and cancers inversely associated with multiparity. The only cancer sites showing significantly raised standardized incidence ratios (SIR) were lip cancer (SIR = 1.51, 95 percent confidence interval [CI] = 1.35-1.66) and Hodgkin's disease (SIR = 1.35, CI = 1.08-1.67) in males. Poisson regression was used in working out the roles of the size and type of farm after adjustment for gender, age, and geographic location of the farm. Risk of Hodgkin's disease was highest in farms without animals (SIR = 1.74, CI = 1.12-2.59). Multiple myeloma was found in excess among farmers on pig or poultry farms but not on other types of farms.

[Fertility decline in China and family planning programs]. / Syntyvyyden pieneneminen Kiinassa ja Kiinan perhesuunnitteluohjelmat.

"The article looks in detail at the population development in China since the 1950s, highlighting some dramatic changes. In the late 1950s the country was hit by widespread famine, which resulted in increased mortality and decreased fertility. Infant mortality climbed to almost 300/1,000. During the 1960s fertility began to increase again and mortality declined. From the beginning of the 1970s fertility started to decline, dropping from about six to just over two children per woman in the late 1980s. Today, fertility is thought to be below replacement level. The main reason for this fertility decline lies in the highly efficient family planning programmes implemented in China since the 1950s and particularly since the 1970s. The decline in infant mortality and the favourable socio-economic development have also been important factors in the decline in fertility. Although fertility in China is currently at a low level, the country's population is still set to grow." (SUMMARY IN ENG)

Prevalence of hand dermatoses among Finnish farmers.

OBJECTIVES: The goal of this study was to determine the prevalence and risk factors of hand dermatosis among farmers. METHODS: A questionnaire survey was carried out in a geographically defined sample of the Finnish farming population between the ages of 18 and 64 years (N = 10,847). RESULTS: The one-year prevalence of self-reported hand and forearm dermatoses was 16% for the women and 7% for the men. These figures were similar to the prevalence of hand eczema in two large Scandinavian questionnaire surveys. The highest one-year prevalence of hand dermatoses was found for women on farms with more than nine dairy cows (20%). Atopy (both the personal history of atopic dermatitis and respiratory atopy), female gender, and, among the women, also age under 35 years were the most important risk factors for the occurrence of hand dermatosis. Work-related risk factors were handling disinfectants daily, handling silage preservatives, milking cows, and machine servicing. CONCLUSIONS: Occupational risk factors for hand dermatoses were found, especially for dairy farming. The results may be useful for the prevention of hand dermatoses in farming since they direct attention to related occupational hazards, and they may also aid vocational guidance for the atopic population. In order to lower the prevalence of hand dermatoses in dairy farming, both preventive and protective measures should become everyday practice in farming work.

Time trends in mortality in forestry and construction workers in Finland 1970-85 and impact of adjustment for socioeconomic variables.

STUDY OBJECTIVE: This study aimed firstly to describe the development of cause-specific mortality in forestry workers, farmer/forestry workers, and skilled and semiskilled construction workers between 1970 and 1985 in Finland, and to compare this with mortality in the total working male population. The second aim was to evaluate how well the cause-specific mortality differences between the occupations could be explained by differences in socioeconomic status, marital status, or in the region of residence. DESIGN AND SETTING: This is a follow up study based on the 1970, 1975, and 1980 census records in Finland linked with all death certificates for 1971-75, 1976-80, and 1981-85 respectively. Log-linear regression analysis was used. SUBJECTS: All economically active men in Finland aged between 35 and 64 years in 1971-85 were studied. The number of person-years in the period totals about 10 million. MAIN RESULTS: Semiskilled construction workers had the highest mortality rate almost independent of the cause of death. The mortality of forestry workers was the second highest. Compared with the reference population, however, the differences were small with regard to neoplasms and cardiovascular diseases. With regard to other diseases, only the mortality of semiskilled workers was fairly high. Differences in mortality as a result of accidents were the highest. Both suicide and accidental death rates were high in semi-skilled construction workers and forestry workers. During the study total mortality fell by about 30% but mortality differences between groups did not decline. CONCLUSIONS: The high mortality of forestry and semiskilled construction workers is partly explained by socioeconomic factors such as marital status and housing conditions. These factors do not, however, explain the high suicide and accident mortality rates of forestry workers or semiskilled construction workers. More research is needed to explain these findings.

Role of the occupational health services as a part of illness-related primary care in Finland.

The aim of the study was to evaluate the employees' illness-related utilization of physicians' services in Finland with special reference to Occupational Health Services (OHS). The data are based on a national health-survey conducted by a Computer Assisted Telephone Interview (CATI) in autumn 1991. There were 1,856 people aged 25-64 interviewed. The "risk" of having visited a physician in six months was in association with perceived chronic illness and gender. Half of those employees who were covered by OHS (90% of all) usually visited their OHS unit for health problems. The potential use of the OHS unit depended on the OHS model. The study shows that the Finnish employees use OHS units for physicians' services a lot and this might have implications in the planned reorganization of the Finnish primary care to the so-called population responsibility-based system.

Farmers' occupational health program in Finland, 1979-1988: from research to practice.

The Kuopio Regional Institute of Occupational Health, in collaboration with the Social Insurance Institution and the National Board of Health, conducted and evaluated a national model for the farmers' occupational health services. In January 1985 the National Board of Health instructed the Finnish municipal health centers to start the provision of farmers' occupational health services based on the recommendation given by the research group. The service was evaluated by experiments carried out during 1982, 1985, and 1986. The main problem in function of the services was that the health hazards (exposures) were difficult to observe and evaluate. The system of how the occupational health nurse evaluates the working conditions should be further developed. The efficiency of the services was studied by postal inquiries in 1982 and 1986. Farmers' knowledge about the appropriate means of reducing hazardous exposures had increased significantly due to the occupational health services. At the local level, the main problem in providing services for occupational farmers is that health centers do not have the resources to offer services for all farmers at the same time. Altogether by the end of 1986, about 30% of all active farmers in Finland (45,000 farmers) were willing to have occupational health services, which is voluntary for self-employed farmers.

Farmers' occupational health programme in Finland, 1979-1987.

At the beginning of 1985, the National Board of Health in Finland issued directives for the initiation of farmers' occupational health services in municipal health care centres. The directives were based on the evaluation study on farmers' occupational health services in Finland. The main aim of this study is to analyse the current problems of the farmers' occupational health care system and to analyse how effective the system is. The efficiency of the occupational health services has been surveyed with postal inquiries twice, first in 1982 and later in 1986. The farmers' knowledge of appropriate means for reducing hazardous exposures had improved significantly since the initiation of the occupational health services. The effect of the occupational health services was evident particularly in the more effective use of personal safety devices. The limited resources at the municipal health care centres form the main obstacle in the provision of occupational health services for all farmers who would like to have them. 25-35% of the farmers in Finland (total 45,000 farmers) are willing to participate in the occupational health care system. Participation is voluntary for self-employed farmers.

Mortality among female farmers in Finland in 1979-1985.

In this study cause-specific mortality of female farmers in Finland was examined by size of farm, by type of farm production, and by geographic area. It was shown that mortality of female farmers was higher for those with small farms. In particular, mortality due to cardiovascular diseases, diseases of the respiratory system and mortality due to accidents, poisonings and violence was slightly increased (statistically not significantly) among those with small farms. Assessed by type of farm production, the differences in mortality were small. Mortality differences among female farmers were smaller than among male farmers.

Mortality among male farmers in Finland during 1979-1983.

In this study the cause-specific mortality of male farmers in Finland was compared with the mortality of all economically active men. Mortality was also examined by size of farm, by type of farm production, and by geographic area. It was shown that, compared to the mortality of all economically active men, that of the farmers was generally low. The only exception was mortality due to respiratory diseases, for which the mortality rate of the farmers was about 40-50% higher than that of all economically active men. The rate ratio, which was higher for those men with small farms, was almost independent of the cause of death. The rate ratio was highest for farmers in eastern and northern Finland. Assessed by type of farm production, the differences in mortality were small. It was supposed that the high rate ratio of respiratory deaths among farmers was, at least partly, work-related. The high mortality of the men with a small farm was shown to be associated with the higher proportion of smokers among this group of farmers.