Finnish Institute Of Occupational Health Research Articles

Examination of the structural components of the Abilitator-A self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position.

According to the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) panel, structural validity describes how well Patient-Reported Outcome Measures' (PROM) scores reflect the dimensions of the measured construct. The main purpose of this study was to examine the structural components of the Abilitator, a co-developed self-report questionnaire on work ability and functioning for the population in a weak labour market position. We examined to what extent the Abilitator has reflective and formative elements in its five summary scales: "C. Inclusion", "D. Mind", "E. Everyday life", "F. Skills", and "G. Body". The Abilitator data sample (n = 4555, men 51%, mean age 37 years) was collected in 2017-2022 by the Finnish Institute of Occupational Health in cooperation with the European Social Fund Priority 5 projects in which the participants have multiple challenges to gain employment. For the structural components and validity analysis we implemented both Confirmatory Factor Analysis (CFA) and Exploratory Factor Analysis (EFA). Based on the COSMIN criteria for structural validity, the Abilitator reached approximate model fit with CFA when we analysed the different concepts of the questionnaire separately rather than in one unified model. An exception was "E. Everyday life" which was a formative summary scale, and it did not reach approximate fit. EFA showed that the items in the Abilitator's summary scales loaded on ten factors. The Abilitator had both reflective and formative elements in its structure. It reached structural validity in those separate concepts that were based on a reflective model. This study revealed interesting connections between different aspects of the Abilitator and produced valuable information for further modification of the questionnaire.

Occupational asthma, rhinitis and contact urticaria from greenhouse work.

The current knowledge about occupational allergic diseases among greenhouse workers is scant. To describe greenhouse workers' occupational allergic diseases. We identified 28 greenhouse workers with occupational allergic diseases in 2002-2020 by conducting a systematic search in the patient register of the Finnish Institute of Occupational Health. All the patients worked in tomato- or cucumber-growing greenhouses and showed immunoglobulin-E-mediated sensitization to occupational agents. Specific inhalation challenges or workplace peak expiratory flow monitoring confirmed occupational asthma (OA), nasal allergen challenges confirmed occupational rhinitis (OR) and open skin tests confirmed occupational contact urticaria (OCU). Most patients had more than one occupational disease and were sensitized to several workplace agents. Tomato plants were the most common cause of occupational diseases and induced 22 allergic diseases in 14 patients. Cucumber plants caused occupational diseases in 10 patients (3 OA, 7 OR and 6 OCU). The pest control mite Amblyseius swirskii and a mixture of parasitic wasps Encarsia formosa and Eretmocerus eremicus both induced two OA cases. Three patients had an occupational disease caused by storage mites and three others had a work-related systemic reaction to a bumblebee sting. The greenhouse workers typically suffered from several occupational allergic diseases and were sensitized to cultivated plants, various pest control organisms and storage mites. All these can cause OA and OR, but in this study, OCU was only induced by cultivation plants. Cucumber plant is a novel cause of OA and OR, and A. swirskii is a novel cause of OA.

Predicting work disability among people with chronic conditions: a prospective cohort study

Few risk prediction scores are available to identify people at increased risk of work disability, particularly for those with an existing morbidity. We examined the predictive performance of disability risk scores for employees with chronic disease. We used prospective data from 88,521 employed participants (mean age 43.1) in the Finnish Public Sector Study including people with chronic disorders: musculoskeletal disorder, depression, migraine, respiratory disease, hypertension, cancer, coronary heart disease, diabetes, comorbid depression and cardiometabolic disease. A total of 105 predictors were assessed at baseline. During a mean follow-up of 8.6 years, 6836 (7.7%) participants were granted a disability pension. C-statistics for the 8-item Finnish Institute of Occupational Health (FIOH) risk score, comprising age, self-rated health, number of sickness absences, socioeconomic position, number of chronic illnesses, sleep problems, BMI, and smoking at baseline, exceeded 0.72 for all disease groups and was 0.80 (95% CI 0.80–0.81) for participants with musculoskeletal disorders, 0.83 (0.82–0.84) for those with migraine, and 0.82 (0.81–0.83) for individuals with respiratory disease. Predictive performance was not significantly improved in models with re-estimated coefficients or a new set of predictors. These findings suggest that the 8-item FIOH work disability risk score may serve as a scalable screening tool in identifying individuals with increased risk for work disability.

Analysis of the Return to Work Program for Disabled Workers during the Pandemic COVID-19 Using the Quality of Life and Work Ability Index: Cross-Sectional Study.

Occupational accidents are rising, but there is little evidence on the outcomes of patients who received case management during Return to work (RTW) programs. This study examined the case management-based on RTW program features that improve the work ability index (WAI) and quality of life (QoL). This cross-sectional research involved 230 disabled workers due to an occupational injury in Indonesia, 154 participated in RTW, and 75 did not participate in RTW (non-RTW) during the COVID-19 pandemic. Sociodemographic and occupational factors were used to examine the RTW results. We used the Finnish Institute of Occupational Health's WAI questionnaires to measure the work ability index and World Health Organization Quality of Life Brief Version (WHOQOL-BREF) for quality of life. The study found a statistically significant difference in working duration and preferred treatment for RTW between the groups (p-value = 0.039). Furthermore, the quality of life in the domain of environmental health and work ability index score also demonstrated a significant difference between the groups (p-value = 0.023 and 0.000, respectively). During the COVID-19 pandemic, this study found that the RTW program improved the quality of life and work abilities of disabled workers.

Practical recommendations for staff rostering justified by real-world optimization

Staff rostering is a difficult and time-consuming problem that every company or institution that has employees working on shifts or on irregular working days must solve. The main goal is the performance of staff on financial efficiency. Other important goals include fairer workloads and employee satisfaction. Furthermore, the staff rostering optimization should address the health, safety, and well-being of the employees. The Finnish Institute of Occupational Health, which operates under the Ministry of Social Affairs and Health, published their latest recommendations for shift work in 2019. The recommended values for more than ten individual factors are well justified. However, problems arise when all these recommendations should be satisfied together in real-world staff rostering. We show the gap between the ideal recommendations, theoretical expectations and the everyday reality. We publish our five most important practical recommendations for shift work that researchers should consider when they implement staff rostering algorithms. The PEASTP metaheuristic is used for optimization test runs.

Long-Term Outcome of Occupational Asthma From Irritants and Low-Molecular-Weight Sensitizers

The short-term asthma outcome of irritant-induced asthma (IIA) is poorer than that of low-molecular-weight (LMW) sensitizer-induced occupational asthma (OA). To evaluate the long-term asthma outcome of IIA and LMW-induced OA and to determine which baseline features are associated with a poor long-term outcome. This follow-up questionnaire study assessed 43 patients diagnosed with IIA and 43 patients with LMW-induced OA at the Finnish Institute of Occupational Health in 2004-2018. The baseline results were analyzed to detect features associated with uncontrolled asthma (Asthma Control Test [ACT] score of ≤19, or ≥2 exacerbations or ≥1 serious exacerbation within 1 year) at follow-up. The median interval since OA diagnosis was 6.3 years (interquartile range [IQR]: 4.4-11.3 years). Uncontrolled asthma was more frequent with IIA than with LMW-induced OA (58% vs 40%, adjusted odds ratio [OR]: 3.60, 95% confidence interval [CI]: 1.20-10.81). Poor symptom control was the main factor for this difference (median [IQR] ACT score of 18 [15-22] vs 21 [18-23], P= .036, respectively). Among all participants, older age (OR: 1.08 per year, 95% CI: 1.02-1.15), a fractional exhaled nitric oxide (FeNO) value <20 ppb (OR: 5.08, 95% CI: 1.45-17.80), and uncontrolled asthma at baseline (OR: 3.94, 95% CI: 1.31-11.88) were associated with uncontrolled asthma at follow-up. Long-term asthma control of IIA appears to be inferior to that of LMW-induced OA. Older age, a low FeNO value, and uncontrolled asthma at baseline might indicate a worse long-term outcome among those with IIA and LMW-induced OA.

The additive value of patch testing non-commercial test substances and patients' own products in a clinic of occupational dermatology.

Commercial patch test substances do not cover all occupational contact allergens. Workplace materials and in-house test substances are tested to complement the investigation of occupational skin disease (OSD). To quantify the additional value of testing workplace materials and non-commercial in-house test substances in the diagnosis of OSD. Patients files of 544 patients patch tested at the Finnish Institute of Occupational Health in 2015-2019 were reviewed for occupation, diagnoses and patch test results. OSD was diagnosed in 353 (64.9%) of the patients. A total of 206 (37.9%) patients had occupational allergic contact dermatitis (OACD). In 19 (3.5%) patients, the only clues to the diagnoses of OACD were positive reactions to workplace materials, and in 20 (3.7%) patients, the diagnosis of OACD was based on commercially unavailable test substances. In 167 OACD cases diagnosed by commercial test substances, additional causes were found in 17 by testing patients' own and non-commercial test substances. In 43 (7.9%) cases, positive reactions to workplace materials reinforced diagnoses based on commercial test substances. The overall additive value of testing own products was 16.7% (91 cases). We would have missed 39 (18.9%) of our 206 OACD cases if we had solely used commercial test substances.

Characterization of patients with occupational allergy to two new epoxy hardener compounds.

BackgroundThe practical importance of two recently described epoxy hardener allergens—1,3‐benzenedimethanamine, N‐(2‐phenylethyl) derivatives (1,3‐BDMA‐D) and hydrogenated formaldehyde benzenamine polymer (FBAP)—as occupational allergens remains to be defined.ObjectivesTo describe patients diagnosed at the Finnish Institute of Occupational Health (FIOH) with positive reactions to 1,3‐BDMA‐D or FBAP.MethodsWe searched FIOH's patch‐test files from January 2017 to December 2020 for patients examined due to suspected occupational contact allergy to epoxy compounds. We analyzed the patch‐test results and sources of exposure to various epoxy hardeners and focused on occupations, symptoms, and the sources of exposure to 1,3‐BDMA‐D and FBAP.ResultsDuring the study period, 102 patients were examined at FIOH for suspected occupational contact allergy to epoxy compounds. Of these, 19 (19%) were diagnosed with contact allergy to 1,3‐BDMA‐D (n = 10) or FBAP (n = 12). The largest occupational group was sewage pipe reliners (n = 8). Seven different hardener products contained FBAP, whereas 1,3‐BDMA‐D was present in only one hardener used by spray painters.ConclusionsA substantial number of patients with suspected occupational epoxy resin system allergy tested positive to in‐house test substances of 1,3‐BDMA‐D and/or FBAP.

Pulmonary Asbestos Fiber Burden Is Related to Patient Survival in Malignant Pleural Mesothelioma

IntroductionMalignant pleural mesothelioma (MPM) is associated with poor prognosis and is strongly associated with occupational asbestos exposure. Given the importance of asbestos exposure in MPM pathogenesis, we retrospectively analyzed the types and concentrations of asbestos fibers within the lung tissues of patients with MPM and investigated their effects on all-cause mortality. MethodsWe formed a national data set of patients with MPM identified from the Finnish Cancer Registry and Statistics Finland. These data were merged with pulmonary asbestos fiber analysis results received from the Finnish Institute of Occupational Health. ResultsWe identified 590 patients with MPM who underwent pulmonary asbestos fiber analysis. The median asbestos concentration within dry lung tissue was 3.20 million fibers/gram (range: 0 − 1700 million fibers/gram). Crocidolite and anthophyllite were the most prevalent asbestos fiber types detected in lung tissue. The multivariable risk of death analyses, where changes over time were accounted for, revealed that total asbestos fiber concentration was associated with increased mortality. Nevertheless, no difference in mortality was noted between different fiber types. ConclusionsOur study revealed that pulmonary fiber concentrations correlated with the manner of asbestos usage. Anthophyllite was identified as the sole fiber in a sizable proportion of cases, supporting its independent role in the pathogenesis of MPM. Our findings suggest that asbestos fiber burden, but not fiber type, may have an impact on the prognosis of MPM.

Effectiveness of a workplace intervention to reduce workplace bullying and violence at work: study protocol for a two-wave quasi-experimental intervention study

IntroductionBullying and violence at work are relatively common in Finnish public sector workplaces. Previous research has demonstrated their association with increased risk of poor health and well-being, but only few...

Diesel Engine Exhaust Exposure in the Ontario Civil Infrastructure Construction Industry.

Diesel engine exhaust (DEE) is a known lung carcinogen and a common occupational exposure in Canada. The use of diesel-powered equipment in the construction industry is particularly widespread, but little is known about DEE exposures in this work setting. The objective of this study was to determine exposure levels and identify and characterize key determinants of DEE exposure at construction sites in Ontario. Elemental carbon (EC, a surrogate of DEE exposure) measurements were collected at seven civil infrastructure construction worksites and one trades training facility in Ontario using NIOSH method 5040. Full-shift personal air samples were collected using a constant-flow pump and SKC aluminium cyclone with quartz fibre filters in a 37-mm cassette. Exposures were compared with published health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03 µg m-3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5 µg m-3 respirable EC). Mixed-effects linear regression was used to identify determinants of EC exposure. In total, 149 EC samples were collected, ranging from <0.25 to 52.58 µg m-3 with a geometric mean (GM) of 3.71 µg m-3 [geometric standard deviation (GSD) = 3.32]. Overall, 41.6% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 90.6% exceeded the DECOS limit. Underground workers (GM = 13.20 µg m-3, GSD = 1.83) had exposures approximately four times higher than below grade workers (GM = 3.56 µg m-3, GSD = 1.94) and nine times higher than above ground workers (GM = 1.49 µg m-3, GSD = 1.75). Training facility exposures were similar to above ground workers (GM = 1.86 µg m-3, GSD = 4.12); however, exposures were highly variable. Work setting and enclosed cabins were identified as the key determinants of exposure in the final model (adjusted R2 = 0.72, P < 0.001). The highest DEE exposures were observed in underground workplaces and when using unenclosed cabins. This study provides data on current DEE exposure in Canadian construction workers. Most exposures were above recommended health-based limits, albeit in other jurisdictions, signifying a need to further reduce DEE levels in construction. These results can inform a hazard reduction strategy including targeted intervention/control measures to reduce DEE exposure and the burden of occupational lung cancer.

Current diesel engine exhaust exposure in the Ontario construction industry

Introduction: Diesel engine exhaust (DEE) is a known carcinogen and a common occupational exposure in Canada, particularly within construction. The use of diesel-powered equipment in the construction industry is widespread, but little is known about DEE exposures and occupational disease in this work setting. The objective of this study was to characterize and identify key determinants of DEE exposure at construction sites in Ontario.&#x0D; Methods: Diesel particulate matter (DPM) measurements were taken from workers employed on seven infrastructure construction worksites in Ontario. Full-shift personal air samples were collected from workers using a constant-flow pump and SKC aluminum cyclone with 37-mm quartz fibre filters in an open-faced cassette. Samples were analyzed for elemental carbon (EC), a surrogate of DEE exposure, following NIOSH method 5040. Exposures were compared to recommended health-based limits, including the Dutch Expert Committee on Occupational Safety (DECOS) limit (1.03µg/m3 respirable EC) and the Finnish Institute of Occupational Health (FIOH) recommendation (5µg/m3 respirable EC). A determinants of exposure model was constructed.&#x0D; Results: In total, 126 DPM samples were collected, ranging from &lt;0.47-52.58µg/m3 with a geometric mean (GM) of 4.23µg/m3 (geometric standard deviation (GSD)=3.05). Overall, 44.8% of samples exceeded the FIOH limit, mostly within underground worksites (93.5%), and 88.8% exceeded the DECOS limit. Underground workers (GM=13.20µg/m3, GSD=1.83) had exposures approximately 4-times higher than below grade workers (GM=3.56µg/m3, GSD=1.94) and 9-times higher than aboveground workers (GM=1.49µg/m3, GSD=1.75). Work grade, enclosed cabs, and seasonality were identified as the major determinants of exposure.&#x0D; Conclusions: This study provides a better understanding of current DPM exposure in Canadian construction. Most exposures were above recommended health-based limits, signifying a need to further reduce DPM levels in construction. These results can inform a hazard reduction strategy including a new occupational exposure limit and targeted intervention/control measures to reduce DPM exposure and the burden of occupational cancer.

An architectural investigation of mitigating noise to improve speech intelligibility in an open studio environment

This research project proposes a series of solutions to mitigate noise and improve speech intelligibility within an open architectural studio environment. Open studio environments pose a unique challenge compared to conventional open office environments. In addition to typical sources of noise found in open offices, such as conversation between co-workers, open studios contain noise generating equipment, such as plotters, 3-D printers and laser cutters. There is substantial research and evidence from the Finnish Institute of Occupational Health and AINS Group which conclude that different sources of noise in an open office environment hinder employee productivity. However, there is limited research that focuses on open architectural studio environments. Existing research regarding productivity, as it relates to acceptable noise level, will serve as a basis for application of Digitally Enhanced Sonic Enclosures (DESE) to mitigate noise within the open studio. Revit 2020, Rhinoceros 6 and Ease 4.4 will be utilized to analyze thesonic environment as it relates to noise and speech intelligibility in the CityLab Orlando design studio. Ultimately, this research offers an effective series of solutions, which can serve as architectural design guides to noise-related challenges in open studio environments.

Investigating the Effect of Insomnia Severity on the Employees’ Work Ability in Construction Projects

Background: The work ability index (WAI) is a very important factor in planning a job and selecting suitable people for different occupations, and it can be affected by different factors. The aim of this study was to investigate the effect of insomnia severity on the employees’ work ability in a construction project.&#x0D; Methods: This descriptive-analytical research has studied 213 employees of construction projects. Morin insomnia severity index (ISI) was used to evaluate the insomnia severity. Moreover, work ability was assessed using a questionnaire designed by the Finnish Institute of Occupational Health. Statistical data analysis was performed by SPSS19.&#x0D; Results: The mean age and working experience of the individuals were respectively 36.2 and 11.27 years. The mean and standard deviation of the insomnia severity index was 6.76(2.5). Multiple linear regression analysis showed that insomnia severity, marital status, type of employment, and smoking had a significant effect on work ability index (WAI); so that the mentioned variables explained about 24% of the WAI variance.&#x0D; Conclusion: Since sleep disorders and poor sleep quality can significantly decrease the work ability of employees, it is important to pay attention to sleep-rest programs to maintain and increase work ability and productivity.

The effect of pain management group on chronic pain and pain related co-morbidities and symptoms. A stepped-wedge cluster randomized controlled trial. A study protocol

IntroductionIn primary care settings, pain-management group therapy is a tool potentially cost-effective but very much underused. MethodsOur purpose here is to provide useful scientific information on the effect of pain-management group participation on chronic pain and pain-related co-morbidities and symptoms, as well as practical information for primary and occupational health services to initiate pain-management group activity.This study will be carried out at primary care Occupational Health Helsinki (Helsinki city employees' occupational health services), with the Finnish Institute of Occupational Health as the research partner.This is a stepped-wedge cluster randomized controlled trial among both male and female municipal employees aged 18 to 65, all of whom had visited an occupational doctor, nurse, psychologist, or physiotherapist because of any chronic pain unrelated to malignant disease. An additional inclusion criterion is work disability risk being elevated, based on a short screening questionnaire (modified Örebro questionnaire). Each participant and each interviewer will be blinded at randomization. Three groups, 10 subjects in each, begin directly after recruitment with 6 weekly 2-h meetings and a follow-up meeting 6 months later. Three waiting-list groups begin 4 months later. Subjects complete self-administered questionnaires before and after the sixth meetings, also 6 months later. Primary outcomes are pain intensity, current work ability, pain self-efficacy, fear-avoidance beliefs, chronic pain acceptance, depressive symptoms, sleep problems, sickness absence days, and number of occupational health care contacts from OH's medical records. ResultsWe will publish our results in a peer-reviewed scientific journals.

The effect of pain management group on chronic pain and pain related co-morbidities and symptoms. A stepped-wedge cluster randomized controlled trial. A study protocol

IntroductionIn primary care settings, pain-management group therapy is a tool potentially cost-effective but very much underused. MethodsOur purpose here is to provide useful scientific information on the effect of pain-management group participation on chronic pain and pain-related co-morbidities and symptoms, as well as practical information for primary and occupational health services to initiate pain-management group activity.This study will be carried out at primary care Occupational Health Helsinki (Helsinki city employees' occupational health services), with the Finnish Institute of Occupational Health as the research partner.This is a stepped-wedge cluster randomized controlled trial among both male and female municipal employees aged 18 to 65, all of whom had visited an occupational doctor, nurse, psychologist, or physiotherapist because of any chronic pain unrelated to malignant disease. An additional inclusion criterion is work disability risk being elevated, based on a short screening questionnaire (modified Örebro questionnaire). Each participant and each interviewer will be blinded at randomization.Three groups, 10 subjects in each, begin directly after recruitment with 6 weekly 2-h meetings and a follow-up meeting 6 months later. Three waiting-list groups begin 4 months later. Subjects complete self-administered questionnaires before and after the sixth meetings, also 6 months later. Primary outcomes are pain intensity, current work ability, pain self-efficacy, fear-avoidance beliefs, chronic pain acceptance, depressive symptoms, sleep problems, sickness absence days, and number of occupational health care contacts from OH's medical records. ResultsWe will publish our results in a peer-reviewed scientific journals.

Perceived indoor air quality and psychosocial work environment in office, school and health care environments in Finland.

The study examined the extent and prevalence of perceived indoor environment-related (IE-related) symptoms environmental complaints and psychosocial work environmental factors in Finnish office, school and health care environments. The data were collected from non-industrial workplaces (N = 455) in 2011-2012 and 2015-2017 using the Finnish Institute of Occupational Health's Indoor Air Questionnaire (IA Questionnaire). Suspicion of IE-related problems was reported in 59% of workplaces. The data consisted of 28 826 employees' responses. The employees reported symptoms and environmental discomfort in office environments less often than in school or health care environments. The most often reported IE-related complaints were stuffy air (39% of respondents), dry air (34%) and insufficient ventilation (33%). The most often reported symptoms were irritation of the nose (27% of respondents), irritation of the eyes (26%), and hoarse or dry throat (24%). The results showed differences between the perceived IE in office, school and health care environments. Compared to earlier findings, the most often perceived IE-related symptoms and complaints have increased in Finnish health care environments. The office employees' perceptions of psychosocial work environment remained fairly unchanged whereas health care personnel more often assessed their psychosocial environment as positive compared to previous reports. Instead of exact reference values, comparing the results of IA Questionnaires with the distributions and mean values of the results of this study may be more informative for those striving to solve IE-related problems. The presented distribution and mean values of perceived symptoms, environmental complaints and psychosocial work environment might help to relate the results to other workplaces. This, in turn, might increase the understanding that IA Questionnaire results are influenced by many factors. The results presented can be used as new reference material when interpreting the results of IA Questionnaires in office, school and health care environments. Int J Occup Med Environ Health. 2020;33(4):479-95.

Towards an Ergonomic Assessment Framework for Industrial Assembly Workstations—A Case Study

Work-related musculoskeletal disorders (WMSD) are one of the main occupational health problems. The best strategy to prevent them lies on ergonomic interventions. The variety of industrial processes and environments, however, makes it difficult to define an all-purpose framework to guide these ergonomic interventions. This undefinition is exacerbated by recurrent introduction of new technologies, e.g., collaborative robots. In this paper, we propose a framework to guide ergonomics and human factors practitioners through all stages of assessment and redesign of workstations. This framework was applied in a case study at an assembly workstation of a large furniture enterprise. Direct observation of work activity and questionnaires were applied to characterize the workstations, the process, and the workers’ profiles and perceptions. An ergonomic multi-method approach, based on well-known and validated methods (such as the Finnish Institute of Occupational Health and Rapid Upper Limb Assessment), was applied to identify the most critical risk factors. We concluded that this approach supports the process redesign and tasks’ allocation of the future workstation. From these conclusions, we distill a list of requirements for the creation of a collaborative robot cell, specifying which tasks are performed by whom, as well as the scheduling of the human-robot collaboration (HRC).

Determinants of Good Work Ability among Organic and Conventional Farmers in Finland.

Based on earlier studies, farmers have poorer work ability compared to workers in most other occupations. The aim of this study was to explore if organic production has a positive effect on producers' work ability while controlling for demographic and production characteristics. This study used telephone interview data collected by the Finnish Institute of Occupational Health in 2014-2015. The material consisted of 2,164 farmers: 231 in organic production and 1,933 in conventional production. Work ability was measured with a single question regarding the farmers' current work ability compared with their lifetime best on a scale of 0 to 10, with 0 meaning unable to work. The data were analyzed using multivariable logistic regression. Organic production had a negative effect on work ability, while larger farm size, experiencing economic uncertainty rarely/never/occasionally (vs. often), age under 55 years, having occupational health coverage, and experiencing low amounts of physical strain or mental strain had positive effects in a multivariable model. While this study could not consider potential biases from the farmers' existing health status at the time of switching to organic production and other sources, it is clear that greater attention needs to be paid to improving worker health, safety, and wellness in organic farming.

Obituary

On 10 June 2019, the occupational health community received sad news on the passing of Professor Emeritus Sven Hernberg, MD, PhD, specialist in occupational medicine and Scientific Director of the Finnish Institute of Occupational Health (FIOH). Sven died at the age of 85 in Helsinki, Finland. Born in Helsinki, Sven completed his medical studies at the University of Helsinki and served in FIOH for 33 years. He began his residency in occupational medicine in FIOH’s Department of Occupational Medicine in 1960, and specialized in occupational medicine in 1964, obtained his PhD in the toxicology of lead in 1967, and served as an Adjunct Professor at the University of Helsinki’s Medical Faculty from 1970 to 1999. His main career comprised dual positions: Director of FIOH’s Department of Epidemiology and Biostatistics, 1972–1993, and Scientific Director of FIOH, 1974–1993. Sven published about 300 research articles, books, and book chapters, covering an immense number of different types of occupational exposures and outcomes. His contributions to research on occupational epidemiology were immeasurably important. As Scientific Director, he contributed to drawing up FIOH’s first ever multidisciplinary research strategy and took the lead role in its implementation, making FIOH one of the leading institutes of occupational health research. In addition to lead, mercury, cobalt, and carbon disulphide, Sven’s research covered a wide range of exposures such as diphenyl, industrial solvents, formaldehyde, wood dusts, chlorophenoxy herbicides, chlorophenols, work with video display units, asbestos, silica, and foundry work. He used a full range of epidemiologic methods, developed tests and strategies for biological monitoring, initiated several preventive actions, and demonstrated their impact in long-term follow-up studies. practical impact of his research changed many industrial practices in Finland to protect workers’ health better. Typically, the statistics on occupational diseases first showed an increase, as a consequence of the active detection of diseases, and then a gradually declining trend as a result of effective prevention. When this was observed, Sven turned to new challenges of occupational health. Sven was highly active in several arenas: Nordic, European, EU, and global. World Health Organization (WHO) relied on Sven as an expert resource for setting the WHO reference values for lead exposure and the early detection of adverse lead effects. He chaired the historical Expert Committee that launched the new concept of work-related diseases and established the work-relatedness criteria of workers’ health outcomes. Sven also served as an expert to the International Labor Office (ILO) among others by writing chapters for the ILO International Encyclopedia on Occupational Health and Safety. In the mid-seventies, Sven initiated, and together with the leaders of other Nordic Institutes, founded the high-quality Scandinavian Journal of Work Environment & Health . From 1975 to 2000, he served as Editor-in-Chief and, from 2000 to 2004, as Emeritus Editor. Sven followed clear principles in his editorial policy – only high-quality, relevant, and new results passed his scrutiny. In this respect, Sven was a faithful follower of Sir Austin Bradford Hill, whom he often cited: The reader can evaluate a study only if the researchers give sufficiently detailed descriptions of its design, materials, and methods. He never complained of the workload in addition to his other responsibilities because editing the Journal was a great joy for him. When looking back at decades of the Scandinavian Journal of Work Environment & Health , very logical tracks are visible: continuous quality improvement not only for scientific content but also for coverage of substance – according to the changing problems of the workplace and the environment – and expansion of dissemination worldwide. modern design and layout of the Journal was an important part of this development. Thanks to Sven and his successors, the Journal today represents elegance in outlook, strength in scientific content, and clarity in expression, with a 2018 impact factor of 3.491. Sven stated the following in his 1995 editorial on the occasion of the Journal`s 20th anniversary: “A modern journal, especially one in the applied field of occupational health, should do its best to meet these challenges by helping its readership by collecting and distributing the essentials of new knowledge in an easily accessible form. This approach calls for a deviation from the publishing policy and contents of what has been known as the classical or scientific journal”. Sven was invited as a member of the editorial boards of several international scientific journals, including the editorial board of the American Journal of Industrial Medicine and the advisory board of Lancet . Sven was a popular and highly respected educator as an Adjunct Professor at the University of Helsinki, and he lectured medical students and postgraduates in other Finnish universities as well as at FIOH. He organized epidemiology courses in FIOH, the Nordic fora, and at the WHO and trained a whole generation of epidemiologists in occupational health. He wrote textbooks on epidemiology and tutored several PhD students. He also trained junior experts in scientific writing and scientific presentation; his courses became popular also among advanced experts. Sven was invited to be a member of several high-level domestic and international scientific bodies, such as the Finnish Academy of Technical Sciences, the Swedish Academy of Technical Sciences, the Faculties of Occupational Medicine of the UK and Ireland Royal Colleges of Physicians and the New York Academy of Medical Sciences, to mention just a few. Of all of these, the International Commission on Occupational Health (ICOH) remained close to Sven’s heart throughout his professional career. He was active in three scientific committees: artificial fibers (secretary), toxicology of metals (member), and epidemiology in occupational health (chair). He was elected for full tenures as ICOH officer: Vice President (1981–1987) and President (1987–1993), and from 1993 to 2000 he served as Past President and Board Member. As Vice President, he renewed the system of scientific committees and as President he renewed ICOH`s Constitution, Bylaws, and Code of Ethics, all of which are still valid and have only undergone minor updating amendments. He led the organization of five ICOH Congresses and substantially improved their scientific weight and organizational practices. Sven was appointed Honorary Member of ICOH in 2000 and was honored with the ICOH Centennial Award in 2006. In honoring him, we – his co-workers, colleagues, and friends from our FIOH and ICOH times and the national and global occupational health community – remember Sven Hernberg with the highest respect and gratitude. We learned so much from him. As a scientist and expert, he was creative, intelligent, vigilant and followed the highest professional standards; he was careful and exacting in problem definition, rigorous with methodological criteria, and critical when making inferences. As the professional and institutional leader of FIOH and ICOH, he was fair and attracted the best people to work with him, guiding and encouraging them to find and develop the best of their capacities. As a colleague and friend, he was always trusted, due to his fairness, honesty and highest ethical standards. Sven was a distinguished figure who will remain among the most prominent leaders in our occupational health community. Quoting Mihaly Csikszentmihalyi, Sven shared a trait typical of all creative people: they “tend to bring the entire range of human possibilities within themselves”. We express our sincere condolences and sympathy to Sven’s family, his daughter Dr Micaela Hernberg, PhD, his sons Kim and Goran, and his five grandchildren, for the immeasurable loss of their dear father and grandfather.