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.

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.

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.

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.

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.

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.

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.

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.

Acute effects of alcohol on anterior pituitary secretion of the tropic hormones.

The plasma or serum concentrations of GH, TSH, LH, PRL, testosterone, cortisol, T4, and T3, and the values of the T3 uptake test were monitored in 12 healthy male volunteers for a period of 20 h after administration of one large dose of ethanol (1.5 g/kg BW). The effects of TRH and LRH on the secretion of TSH, PRL, and LH were studied in these subjects once during the period of acute alcohol intoxication (4 h after the start of drinking) and once during the hangover period (14 h after the start of drinking). Each subject served as his own control by drinking water only during another experimental session. Alcohol had no significant effect on basal concentrations of GH, TSH, LH, T4, T3, or testosterone. The concentration of cortisol in plasma was elevated during the whole 20-h period after ingestion of alcohol, as compared with the control values. Alcohol also did not significantly alter the effects of TRH and LRH on plasma TSH and LH levels at 4 and 14 h. During the hangover period, the PRL response to TRH was totally blocked, but during alcohol intoxication, there was a slight increase in the PRL response to TRH. The lack of response of PRL to TRH during the hangover suggests that withdrawal symptoms are associated with increased dopaminergic activity in the hypothalamus.

Pneumococcal carriage in children during their first two years: important role of family exposure.

BACKGROUND: Close family and day-care contacts have been identified as risk factors for pneumococcal (Pnc) carriage. This study addresses the risk of Pnc carriage by infants 2 to 24 months of age in terms of simultaneous carriage of pneumococcus by family members. METHODS: Nasopharyngeal swabs were collected from 100 Finnish infants and their family members on 10 scheduled visits (when infant was 2, 3, 4, 5, 6, 9, 12, 15, 18 and 24 months of age). The 7 most common pneumococcal serogroups (4, 6, 9, 14, 18, 19, 23), also represented in the new heptavalent Pnc conjugate vaccine, were analyzed. Marginal logistic regression analyses were performed to assess the relative importance of different predictors for carriage. RESULTS: The carriage of the studied Pnc serogroups increased with age, being highest at the age of 18 months (28%). Among children older than 6 months of age, the strongest predictor of carriage was simultaneous carriage of the same serogroup by another family member (odds ratio, 3.8; 95% confidence interval, 2.1 to 6.9). At the age of 6 months or younger, carriage was rare and was not significantly associated with a family carriage. CONCLUSIONS: Young infants (< or =6 months old) were largely protected from pneumococcal carriage. After this age family transmission seemed very important despite the small family size. Contrary to some earlier studies communal day care was not associated with an increased risk of Pnc carriage. This could be partly because of the long parental leave in Finland and thus the late age of starting organized day care.

Nuclear DNA content of non-endemic Burkitt's lymphoma.

The nuclear DNA content of 26 non-endemic Burkitt's lymphomas was studied by flow cytometry. Eighteen of the tumours showed a pattern characteristic for diploid chromosome distribution, while eight of the tumours were aneuploid. Six of the aneuploid tumours showed an almost diploid, aneuploid DNA index, while two were tetraploid tumours. Patients with aneuploid tumours had a significantly worse prognosis (p less than 0.005) than those with diploid tumours. One of the aneuploid tumours was positive for Epstein-Barr virus DNA.

Metabolic interactions of xylitol and ethanol in healthy males.

The effects of oral administration of xylitol on the rate of ethanol elimination and on the ethanol-induced changes in blood concentrations of lactate and pyruvate were studied in seven healthy male subjects. Xylitol (1.0 g/kg body weight) was administered orally and ethanol (0.8 g/kg body weight) intravenously. In the control experiments glucose was given instead of xylitol. Xylitol had no significant effect on the rate of ethanol elimination or on the ethanol-induced increase in the blood lactate concentration. The ethanol-induced changes in the lactate/pyruvate ratio were not affected by xylitol. It is suggested that the ineffectiveness of xylitol is due to its low concentration in the liver after oral administration. Ethanol induced a 5--10 fold increase in the blood concentration of xylitol. This is most probably due to inhibition of xylitol oxidation in the liver by the ethanol-induced reduction in the hepatic redox state. The clinical significance of this finding is unknown.

Alkyl-substituted silica gel as a carrier in the controlled release of dexmedetomidine.

The effect of alkyl substitution of the silica xerogel matrix on the release rate of dexmedetomidine was evaluated. Silica sol was processed by either casting or spray drying. When the reaction precursor tetraethylorthosilicate (TEOS) was partially substituted with tri- or dialkoxysilane, the release of dexmedetomidine and degradation of the matrix were decreased compared with 100% TEOS-based gel. Increasing the number or length of the organic groups attached to silicon, modified the silica gel structure and reduced the release rate of dexmedetomidine from monoliths. The release of dexmedetomidine from alkyl-substituted silica gel microparticles, however, showed a burst in drug release. Subcutaneously administered silica xerogel matrices (manufactured by casting, containing 25 mol% dimethyldiethoxysilane at two different doses of dexmedetomidine) were studied in dogs. Sustained delivery of dexmedetomidine was obtained for at least 48 h.

Occurrence of asthma and chronic bronchitis among female hairdressers. A questionnaire study.

We carried out a retrospective cohort study using a self-administered questionnaire to assess the risk of hairdressers to develop asthma and chronic bronchitis. A representative sample of 4433 female hairdressers and an equal number of shop personnel in employment in 1980 was drawn from the Longitudinal Census Data File of Statistics Finland. Physician-diagnosed asthma, chronic bronchitis, and other respiratory diseases in 1980 and 1995 were inquired about in the respiratory part of the questionnaire. The response rate to the questionnaire was 82% for the hairdressers (n = 3484) and 79% for the referents (n = 3357). The prevalence of asthma among the hairdressers was 5.6% in 1980 and 10.1% in 1995, and the prevalence of chronic bronchitis was 3.9% in 1980 and 5.6% in 1995. The relative risk for asthma (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3 to 2.3 in 1980; and OR: 1.7, 95% CI: 1.4 to 2.2 in 1995) and for chronic bronchitis (OR: 2.2, 95% CI: 1.5 to 3.2 in 1980; and OR: 1.9, 95% CI: 1.4 to 2.6 in 1995) among hairdressers was almost twice that in the reference group. The incidence rate of asthma in 1980 through 1995 was 2.2 and of chronic bronchitis was 1.1 cases per 1000 person-years among hairdressers, whereas the rate in the reference group was 1.3 asthma cases and 0.9 chronic bronchitis cases per 1000 person-years. The relative risk for developing asthma during the 15 years observation time was 1.7 (95% CI: 1.1 to 2.5) and for chronic bronchitis was 1.2 (95% CI: 0.7 to 1.9) among hairdressers, compared with referents. Our results indicate that hairdressers are at higher risk for developing asthma.

Occupational skin and respiratory diseases among hairdressers.

OBJECTIVES: The occurrence and causes of hairdressers' occupational skin and respiratory diseases were studied. METHODS: Of a random sample of 500 female hairdressers aged 15-54 years, 355 were available for study. Of the 189 reporting work-related skin and respiratory symptoms in a computer-aided telephone interview on exposure and health, 130 underwent a physical examination, lung function tests, prick and patch testing, and nasal and lung provocation tests. An occupational disease was diagnosed when the causality between exposure and disease was probable and the clinical tests supported the diagnosis. RESULTS: The telephone interview revealed a life-time prevalence of 16.9% for hand dermatoses, 16.9% for allergic rhinitis, and 4.5% for asthma among the hairdressers. In the clinical investigations, the prevalence was 2.8% for occupational dermatoses, 1.7% for occupational rhinitis, and 0.8% for occupational asthma. Ammonium persulfate caused 90% of the respiratory diseases and 27% of the hand dermatoses. Paraphenylenediamine, natural rubber latex, and skin irritation were also causes of hand dermatitis. Allergy to human dandruff (8.6%) and Pityrosporum ovale (12.1%) was common. Previously diagnosed atopic diseases increased the risk for occupational skin or respiratory disease 3-fold (odds ratio 2.9, 95% confidence interval 1.1-7.9). Of the cases, 37.5% (6 of 16 persons) had to change occupations during a 3-year follow-up. CONCLUSIONS: Work-related skin and respiratory symptoms are common among hairdressers. Often a specific cause (eg, ammonium persulfate) can be found if occupational diseases are suspected and diagnosed. Hairdressers with atopic diseases are at risk of developing occupational skin and respiratory diseases.