Knowledge, Attitudes, and Practices of Finnish Dairy Farmers on Cryptosporidiosis.

Calf-mediated zoonotic cryptosporidiosis is an emerging occupational health risk among Finnish dairy farmers. We studied farmers' knowledge, attitudes, and practices (KAP) regarding cryptosporidiosis to reveal possible weaknesses, which might increase the risk of zoonotic infection. KAP study was carried out as a cross-sectional questionnaire survey (n = 243). A total of 400 cryptosporidiosis-negative and 138 cryptosporidiosis-positive dairy farms, with more than 50 cows, were invited to participate in the study. The response rate was 45%. Half (49%) of the respondents had adequate knowledge concerning zoonotic cryptosporidiosis. Knowledge score was associated with age (p < 0.01), level of education (p < 0.01), and cryptosporidiosis status of the farm (p < 0.01). Though most respondents had favorable attitudes, one-third (32.5%) had poor zoonotic transmission prevention practices. Use of a personal mobile device was the most common risky practice (90%) performed daily in the cowhouse. Most respondents (93%) reported gaining information about infectious diseases in animals from more than two information sources. Veterinarians were the most mentioned source (n = 228), whereas primary care physicians were among the least common sources (n = 16). Having favorable attitudes towards the prevention of zoonotic cryptosporidiosis was common. However, shortages in knowledge and several risky practices were identified in both cryptosporidiosis positive and negative farms. The role of the occupational health sector should be strengthened in work-related zoonotic disease prevention and may require further education of the personnel. A one-health approach to control zoonotic diseases is recommended.

Agriculture versus wastewater pollution as drivers of macroinvertebrate community structure in streams.

Water pollution is ubiquitous globally, yet how the effects of pollutants propagate through natural ecosystems remains poorly understood. This is because the interactive effects of multiple stressors are generally hard to predict. Agriculture and municipal wastewater treatment plants (WWTPs) are often major sources of contaminants for streams, but their relative importance and the role of different pollutants (e.g. nutrients or pesticides) are largely unknown. Using a 'real world experiment' with sampling locations up- and downstream of WWTPs, we studied how effluent discharges affected water quality and macroinvertebrate communities in 23 Swiss streams across a broad land-use gradient. Variation partitioning of community composition revealed that overall water quality explained approximately 30% of community variability, whereby nutrients and pesticides each independently explained 10% and 2%, respectively. Excluding oligochaetes (which were highly abundant downstream of the WWTPs) from the analyses, resulted in a relatively stronger influence (3%) of pesticides on the macroinvertebrate community composition, whereas nutrients had no influence. Generally, the macroinvertebrate community composition downstream of the WWTPs strongly reflected the upstream conditions, likely due to a combination of efficient treatment processes, environmental filtering and organismal dispersal. Wastewater impacts were most prominently by the Saprobic index, whereas the SPEAR index (a trait-based macroinvertebrate metrics reflecting sensitivity to pesticides) revealed a strong impact of arable cropping but only a weak impact of wastewater. Overall, our results indicate that agriculture can have a stronger impact on headwater stream macroinvertebrate communities than discharges from WWTP. Yet, effects of wastewater-born micropollutants were clearly quantifiable among all other influence factors. Improving our ability to further quantify the impacts of micropollutants requires highly-resolved water quality and taxonomic data with adequate spatial and temporal sampling. These improvements would help to better account for the underlying causal pathways that drive observed biological responses, such as episodic contaminant peaks and dispersal-related processes.

Lifting and pregnancy outcomes: feasibility of a randomized controlled trial.

Background: The highest incidence of preterm birth (18%) occurs in Africa but the causes are largely unknown. Some studies have reported adverse effects of maternal physical exertion on birth outcomes. A randomized controlled trial (RCT) is proposed to determine the effectiveness of an intervention reducing lifting and carrying in pregnant women in reducing preterm birth and low birthweight. Aims: To test the feasibility and acceptability of the proposed lift-less intervention RCT. Methods: We recruited pregnant women and midwives from antenatal clinics within the Greater Accra Region of Ghana. The midwives were trained to administer the intervention during a 5-week trial. Four intervention trial sessions were organized at weekly intervals. Results: Seven pregnant women and six midwives participated. After piloting, we observed a reduction in participants' self-reported daily exposure to heavy lifting and carrying. The daily average frequency of lifting by a participant within the first seven days of the study was 3.5 (SD 1.7) with an estimated mean total weight of 41.1 kg (SD = 13.3 kg). This had decreased to 2.3 (SD = 1.0) and the amount to 13.4 kg (SD = 10.9) within the last seven days of the study. Conclusions: The findings provide insight into the daily physical exertion experienced by pregnant women in Ghana. The lift-less intervention trial is feasible with modifications and has the potential to reduce excessive physical exertion among pregnant women in Ghana to improve birth outcomes.

Systematic review: Factors associated with return to work in burnout.

BACKGROUND: Professional burnout predicts sick leave and even permanent withdrawal from the labour force. However, knowledge of the barriers to and facilitators of return to work (RTW) in such burnout is limited. AIMS: To identify factors associated with RTW of burned-out individuals to inform occupational health care (OHC) RTW policy. METHODS: A systematic search of peer-reviewed quantitative and mixed-method studies published from January 2005 to July 2016 in English and Finnish in ARTO, CINAHL (EBSCO), Medic, PsycINFO (ProQuest), PubMed, Scopus and Web of Science databases, followed by a manual search. We included studies that identify burnout with valid burnout measures and measure the degree of RTW or sick leave as outcomes. We excluded studies with heterogeneous samples without subgroup analyses of RTW in burnout cases. RESULTS: We included 10 studies (three experimental and seven observational) of the initial 1345 identified. The studies reported work-related factors; enhanced communication (positive association) and low control at work (negative association) and individual-related factors; male gender (positive association), covert coping (negative association), high over-commitment to work (positive association) and burnout-related factors; unimpaired sleep (positive association), duration of sick leave over 6 months (negative association) and part-time sick leave (positive association) associated with RTW in burnout. Associations between burnout rehabilitation and RTW, and the level of symptoms and cognitive impairment and RTW remained unclear. CONCLUSIONS: Few quantitative studies, of varied methodological quality, explore factors associated with RTW in burnout. Further research is needed to build an evidence base and develop guidelines for supportive OHC actions.

Disclosure of Type 1 diabetes at work among Finnish workers.

AIMS: To determine which self-management factors and psychosocial work factors were associated with disclosing diabetes to colleagues, line managers and occupational health personnel among workers with Type 1 diabetes. METHODS: A total of 767 working-aged respondents with Type 1 diabetes completed a Finnish cross-sectional survey named 'People with Type 1 Diabetes in Worklife'. Factor analysis was carried out, followed by logistic regressions to estimate the associations between self-management factors, psychosocial work factors and the likelihood of disclosure separately to colleagues, line managers and occupational health personnel. The models were adjusted for sociodemographic, diabetes-related and work-related variables. RESULTS: A total of 52% of the respondents had disclosed their diabetes to their colleagues, 45% to occupational health personnel and 28% to their line manager. Receiving social support and having good psychosocial work ability were significantly associated with disclosure to colleagues, line managers and occupational health personnel. Relations at work were associated with disclosure to colleagues and the line manager. Furthermore, opportunity to self-manage diabetes at work was associated with disclosure to colleagues. CONCLUSIONS: Line managers and colleagues have a remarkable role to play in providing workplace support to workers with Type 1 diabetes. Disclosure of Type 1 diabetes should be encouraged as line managers can provide workers with the right support, implement work adaptations and facilitate job retention. As only half of respondents disclosed their Type 1 diabetes at work, further research is required into the reasons for and consequences of not disclosing a diagnosis.

Work ability among Finnish workers with type 1 diabetes.

BACKGROUND: Work ability represents the balance between individual resources, health status and job demands. As far as we are aware, these issues have not been examined in working people with type 1 diabetes (T1D). AIMS: To examine how work-related and diabetes-related factors are associated with work ability among male and female workers. METHODS: Questionnaires were mailed to a random sample of 2500 people with T1D from the Medication Reimbursement Register of The Social Insurance Institution of Finland. The associations of the predictors of poor work ability were examined in a logistic regression analysis. RESULTS: The final sample comprised 767 working people aged 18-64 with T1D; overall response rate 49%. One in every three working men and women with T1D had poor work ability. High job demands and low job control were associated with poor work ability in both genders. Physical work and low worktime control were significantly associated with poor work ability in men but not in women with T1D. A self-reported high value of glycosylated haemoglobin was the only diabetes-related variable associated with poor work ability in both men and women. CONCLUSIONS: Work-related factors and poor glycaemic control were associated with poor work ability in individuals with T1D. Thus, job control and worktime control should be taken into account in supporting the work ability of workers with T1D.

Does plasticity enhance or dampen phenotypic parallelism? A test with three lake-stream stickleback pairs.

Parallel (and convergent) phenotypic variation is most often studied in the wild, where it is difficult to disentangle genetic vs. environmentally induced effects. As a result, the potential contributions of phenotypic plasticity to parallelism (and nonparallelism) are rarely evaluated in a formal sense. Phenotypic parallelism could be enhanced by plasticity that causes stronger parallelism across populations in the wild than would be expected from genetic differences alone. Phenotypic parallelism could be dampened if site-specific plasticity induced differences between otherwise genetically parallel populations. We used a common-garden study of three independent lake-stream stickleback population pairs to evaluate the extent to which adaptive divergence has a genetic or plastic basis, and to investigate the enhancing vs. dampening effects of plasticity on phenotypic parallelism. We found that lake-stream differences in most traits had a genetic basis, but that several traits also showed contributions from plasticity. Moreover, plasticity was much more prevalent in one watershed than in the other two. In most cases, plasticity enhanced phenotypic parallelism, whereas in a few cases, plasticity had a dampening effect. Genetic and plastic contributions to divergence seem to play a complimentary, likely adaptive, role in phenotypic parallelism of lake-stream stickleback. These findings highlight the value of formally comparing wild-caught and laboratory-reared individuals in the study of phenotypic parallelism.

The quantitative genetic basis of adaptive divergence in the moor frog (Rana arvalis) and its implications for gene flow.

Knowledge on the relative contribution of direct genetic, maternal and environmental effects to adaptive divergence is important for understanding the drivers of biological diversification. The moor frog (Rana arvalis) shows adaptive divergence in embryonic and larval fitness traits along an acidification gradient in south-western Sweden. To understand the quantitative genetic basis of this divergence, we performed reciprocal crosses between three divergent population pairs and reared embryos and larvae at acid and neutral pH in the laboratory. Divergence in embryonic acid tolerance (survival) was mainly determined by maternal effects, whereas the relative contributions of maternal, additive and nonadditive genetic effects in larval life-history traits differed between traits, population pairs and rearing environments. These results emphasize the need to investigate the quantitative genetic basis of adaptive divergence in multiple populations and traits, as well as different environments. We discuss the implications of our findings for maintenance of local adaptation in the context of migrant and hybrid fitness.

Quantitative genetic inheritance of morphological divergence in a lake-stream stickleback ecotype pair: implications for reproductive isolation.

Ecological selection against hybrids between populations occupying different habitats might be an important component of reproductive isolation during the initial stages of speciation. The strength and directionality of this barrier to gene flow depends on the genetic architecture underlying divergence in ecologically relevant phenotypes. We here present line cross analyses of inheritance for two key foraging-related morphological traits involved in adaptive divergence between stickleback ecotypes residing parapatrically in lake and stream habitats within the Misty Lake watershed (Vancouver Island, Canada). One main finding is the striking genetic dominance of the lake phenotype for body depth. Selection associated with this phenotype against first- and later-generation hybrids should therefore be asymmetric, hindering introgression from the lake to the stream population but not vice versa. Another main finding is that divergence in gill raker number is inherited additively and should therefore contribute symmetrically to reproductive isolation. Our study suggests that traits involved in adaptation might contribute to reproductive isolation qualitatively differently, depending on their mode of inheritance.

Genetic divergence in morphology-performance mapping between Misty Lake and inlet stickleback.

Different environments should select for different aspects of organismal performance, which should lead to correlated divergence in morphological traits that influence performance. The result should be genetic divergence in aspects of performance, morphology and associations ('maps') between morphology and performance. Testing this hypothesis requires quantifying performance and morphology in multiple populations after controlling for environmental differences, but this is rarely attempted. We used a common-garden experiment to examine morphology and several aspects of swimming performance within and between the lake and inlet populations of threespine stickleback (Gasterosteus aculeatus) from the Misty system, Vancouver Island, Canada. Controlling for body size, lake stickleback had shallower bodies, larger caudal fins and smaller pelvic girdles. With or without morphological covariates, lake stickleback showed greater performance in both sustained and burst swimming. In contrast, inlet stickleback showed greater manoeuverability than did lake stickleback in some analyses. Morphology-performance relationships were decoupled when considering variation within vs. between populations. Moreover, morphology-performance mapping differed between the two populations. Based on these observations, we advance a hypothesis for why populations adapting to different environments should show adaptive genetic divergence in morphology-performance mapping.

Allen's rule revisited: quantitative genetics of extremity length in the common frog along a latitudinal gradient.

Ecogeographical rules linking climate to morphology have gained renewed interest because of climate change. Yet few studies have evaluated to what extent geographical trends ascribed to these rules have a genetic, rather than environmentally determined, basis. This applies especially to Allen's rule, which states that the relative extremity length decreases with increasing latitude. We studied leg length in the common frog (Rana temporaria) along a 1500 km latitudinal gradient utilizing wild and common garden data. In the wild, the body size-corrected femur and tibia lengths did not conform to Allen's rule but peaked at mid-latitudes. However, the ratio of femur to tibia length increased in the north, and the common garden data revealed a genetic cline consistent with Allen's rule in some trait and treatment combinations. While selection may have shortened the leg length in the north, the genetic trend seems to be partially masked by environmental effects.

Testing for mating isolation between ecotypes: laboratory experiments with lake, stream and hybrid stickleback.

Mating isolation is a frequent contributor to ecological speciation - but how consistently does it evolve as a result of divergent selection? We tested for genetically based mating isolation between lake and stream threespine stickleback (Gasterosteus aculeatus L.) from the Misty watershed, Vancouver Island, British Columbia. We combined several design elements that are uncommon in the studies of stickleback mate choice: (i) we used second-generation laboratory-reared fish (to reduce environmental and maternal effects), (ii) we allowed for male-male competitive interactions (instead of the typical no-choice trials) and (iii) we included hybrids along with pure types. Males of different types (Lake, Inlet, hybrid) were paired in aquaria, allowed to build nests and then exposed sequentially to females of all three types. We found that Lake and Inlet males differed in behaviours thought to influence stickleback mate choice (inter- and intra-sexual aggression, display and nest activities), whereas hybrids were either intermediate or apparently 'inferior' in these behaviours. Despite these differences, Lake and Inlet fish did not mate assortatively and hybrid males did not have a mating disadvantage. Our study reinforces the noninevitability of mating isolation evolving in response to ecological differences and highlights the need to further investigate the factors promoting and constraining progress towards ecological speciation.

Atherosclerosis-like lesions of the aortic valve are common in adults of all ages: a necropsy study.

OBJECTIVE: To determine the presence and size of atherosclerosis-like lesions in aortic valves of unselected adults of all ages. DESIGN: Necropsy study. SETTING: Departments of Forensic Medicine and Pathology at the University of Oulu and the Oulu University Hospital in Finland. SUBJECTS: 48 consecutive unselected adult subjects (15 subjects aged 20-40 years, 17 aged 41-60, and 16 aged >or= 61) undergoing necropsy. MAIN OUTCOME MEASURES: Detection of the presence of atherosclerosis-like lesions and mineralisation in aortic valves, and morphometrical measurement of the size of lesions. RESULTS: None of the necropsy subjects had aortic stenosis and only two subjects had macroscopic calcification of the aortic valve. Of 48 subjects, however, 45 had an atherosclerosis-like subendothelial thickening above the elastic lamina on the aortic side of at least one of the valve leaflets. Of 15 young subjects aged 20-40 years, eight had a lesion in the right coronary cusp of the aortic valve and 12 had a lesion in at least one of the three aortic valve leaflets. Of 17 middle aged subjects, 16 had an early lesion in the right coronary cusp and all had a lesion in at least one of the valve leaflets. In the oldest age group, all 16 subjects had a lesion in every valve leaflet. The mean lesion area in the three valve leaflets varied from 0.1-0.2 mm(2) in young subjects, 0.5-0.8 mm(2) in middle aged, and 1.3-2.3 mm(2) in elderly subjects (p < 0.001). Microscopic calcification in the right coronary cusp of the aortic valve was observed in 12 of 17 middle aged and 14 of 16 elderly subjects but only in one young subject. CONCLUSIONS: Atherosclerosis-like lesions in the aortic valve are prevalent in adults of all age groups, including young subjects aged 20-40 years, suggesting that the disease process leading to aortic stenosis is common, often beginning in early adulthood.

Latitudinal countergradient variation in the common frog (Rana temporaria) development rates--evidence for local adaptation.

Adaptive genetic differentiation along a climatic gradient as a response to natural selection is not necessarily expressed at phenotypic level if environmental effects on population mean phenotypes oppose the genotypic effects. This form of cryptic evolution--called countergradient variation--has seldom been explicitly demonstrated for terrestrial vertebrates. We investigated the patterns of phenotypic and genotypic differentiation in developmental rates of common frogs (Rana temporaria) along a ca. 1600 km latitudinal gradient across Scandinavia. Developmental rates in the field were not latitudinally ordered, but displayed large variation even among different ponds within a given latitudinal area. In contrast, development rates assessed in the laboratory increased strongly and linearly with increasing latitude, suggesting a genetic capacity for faster development in the northern than the southern larvae. Experiments further revealed that environmental effects (temperature and food) could easily override the genetic effects on developmental rates, providing a possible mechanistic explanation as to why the genetic differentiation was not seen in the samples collected from the wild. Our results suggest that the higher developmental rates of the northern larvae are likely to be related to selection stemming from seasonal time constrains, rather than from selection dictated by low ambient temperatures per se. All in all, the results provide a demonstration of environmental effects concealing substantial latitudinally ordered genetic differentiation understandable in terms of adaptation to clinal variation in time constrains.

Comparison of nitrate tolerance between different populations of the common frog, Rana temporaria.

Euthrophication-associated changes in the physical and biological environment of lakes and ponds are potentially a source of major stress for many aquatic organisms. In Scandinavia, the nitrate concentrations in lakes and ponds decrease towards north due to a naturally lower productivity of the habitats, but also due to lower supplementation of anthropogenic nitrogen. A chronic experiment using ecologically relevant concentrations of sodium nitrate (0-5000 micro gl(-1)) was used to test whether common frog (Rana temporaria L.) larvae from northern parts of Scandinavia are less well adapted to cope with high nitrate concentrations than those from the southern parts. Slight, but significant differences in nitrate tolerance, as measured in terms of growth rate and size at metamorphosis, between the two regions were found. High concentrations of nitrate reduced the growth rates and metamorphic size in north, but not in south. However, there was no clear-cut impact of high nitrate concentrations on developmental rate or on mortality until metamorphosis. The general lack of large effects of nitrate treatment on the response variables suggests that nitrates per se do not pose any significant threat to the development of R. temporaria tadpoles under a natural range of concentrations. This was confirmed in an acute test where results suggest that ammonia and nitrite, compounds seldom found in high concentrations in Fennoscandian lakes, are possibly responsible for the larger negative effects of "nitrate" observed in previous studies of amphibians.

Sickness absence in hospital physicians: 2 year follow up study on determinants.

OBJECTIVES: To identify determinants of sickness absence in hospital physicians. METHODS: The Poisson regression analyses of short (1--3 days) and long (>3 days) recorded spells of sickness absence relating to potential determinants of sickness absence were based on a 2 year follow up period and cohorts of 447 (251 male and 196 female) physicians and 466 controls (female head nurses and ward sisters). RESULTS: There were no differences in health outcomes, self rated health status, prevalence of chronic illness, and being a case on the general health questionnaire (GHQ), between the groups but physicians took one third to a half the sick leave of controls. All the health outcomes were strongly associated with sickness absence in both groups. Of work related factors, teamwork had the greatest effect on sickness absence in physicians but not in the controls. Physicians working in poorly functioning teams were at 1.8 (95% confidence interval (95% CI) 1.3 to 3.0) times greater risk of taking long spells than physicians working in well functioning teams. Risks related to overload, heavy on call responsibility, poor job control, social circumstances outside the workplace, and health behaviours were smaller. CONCLUSION: This is the first study of hospital physicians to show the association between recorded sickness absence and factors across various areas of life. In this occupational group, sickness absence is strongly associated with health problems, and the threshold for taking sick leave is high. Poor teamwork seems to contribute to the sickness absenteeism of hospital physicians even more than traditional psychosocial risks-such as overload and low job control. These findings may have implications for training and health promotion in hospitals.

Consumer satisfaction with occupational health services: should it be measured?

OBJECTIVES: To find answers in the literature to the questions if, why, and how consumer satisfaction with occupational health services (OHSs) should be measured. METHODS: Publications about the concept of consumer satisfaction with health care and surveys of consumer satisfaction with occupational health care were reviewed. RESULTS: For care providers, surveys of consumer satisfaction can be useful to improve quality or as indicators of non-compliant behaviour among patients. For clients, satisfaction surveys can be helpful for choosing between healthcare providers. Satisfaction is made up of an affective component of evaluation and a cognitive component of expectations. Also, in occupational health care, patient satisfaction is measured by dimensions such as the humanness and competence of the care provider similar to health care in general. However, there are dimensions that are specific to occupational health-such as the perceived independence of the physician, unclear reasons for visiting an OHS, and the perceived extent of knowledge of OHS professionals about the patient's working conditions. Dimensions of client satisfaction are mostly similar to patient satisfaction but include more businesslike aspects. They are different for the two groups of client, employers and employees. To measure consumer satisfaction in occupational healthcare specific questionnaires must be constructed. To achieve the highest possible reader satisfaction guidelines are provided for construction of a questionnaire. CONCLUSIONS: Consumer satisfaction is a complex theoretical concept, but it is relatively easy to measure in practice and can be a valuable tool for quality improvement. Consumers' evaluations of occupational health services will become increasingly important due to changes in the organisation of occupational health care. Occupational healthcare providers are encouraged to measure the consumer satisfaction of their services.

Self-reported health, illness, and self-care among finnish physicians: a national survey.

BACKGROUND: Physicians' health problems have been discussed mainly in relation to substance abuse and psychiatric disorders. In this study, the prevalence of common chronic diseases and their treatment were determined. OBJECTIVE: To find differences in self-reported health status, amount of sick leave, and the use of health services among physicians according to sex and specialty. Data were also compared with those of the total employed population. DESIGN AND SETTING: Cross-sectional postal questionnaire survey in Finland. PARTICIPANTS AND METHODS: A random sample of licensed physicians younger than 66 years (n = 4477) was randomly selected from the register of the Finnish Medical Association. A total of 3313 physicians (74%) responded. MAIN OUTCOME MEASURES: Perceived health, prevalence of diseases, self-treatment of diseases, amount of sick leave, and medical consultations. RESULTS: Female physicians assessed their health as being better than other female employees and had used health services and had been on sick leave more often than their male colleagues. Male physicians assessed their health as being equal to that of other men. Both female and male physicians had fewer sick leave than other employees. However, physicians-especially men-reported many common chronic illnesses as often or more often than other employees. Physicians had consulted other medical professionals less often than other employees, and they primarily self-treated their illnesses. Of the specialties, psychiatrists had used health services and had been on sick leave more often than other physicians. CONCLUSION: This study indicates that the usual form of care of physicians' diseases is self-treatment and "working through" illnesses. Arch Fam Med. 2000;9:1079-1085

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.

The performance follow-up of Finnish occupational health services.

OBJECTIVES: The aim of the study was to describe the structure, input and output figures of occupational health services (OHS) in Finland as basic data for a revised follow-up system. DESIGN: A cross-sectional postal survey. STUDY PARTICIPANTS: All OHS units in Finland (n = 1025). The response rate was 94%. The more extensive questionnaire was returned by 82% (n = 837), and an additional 12% (n = 127) returned a shorter questionnaire. MAIN OUTCOME MEASURES: The variation in structure (number and education of personnel, number of clients and size of client enterprises), input indicators (employees per full-time equivalent physician and nurse) and output indicators (worksite visits per 100 employees, health checks per 100 employees, office visits per 100 employees) were compared by the five prevailing OHS models and within the models. RESULTS: There were often two- to threefold differences in the median figures of the different manpower and performance indicators between the OHS models. Although the lowest and highest deciles were excluded, the differences within the models were usually even greater. CONCLUSIONS: We found a great variation in both input and output figures within OHS in Finland. Part of this variation can be explained by the different needs and contents of services. The data can serve as a basis for evaluation of OHS activities both at the national level and as benchmark data for the individual OHS units. However, these types of data do not allow us to assess the quality or outcome of services.