Occupational Health Care Units Research Articles

Health check-ups as interventions for work disability management: supervisors and occupational healthcare follow the recommendations to a great extent

ObjectivesWork disability management is a problem globally. This study was designed to find out whether the initiation, process and outcome of health check-ups (HCUs) follow the national legislation and whether...

How the ‘HIV/TB co-epidemic–HIV stigma–TB stigma’ syndemic impacts on the use of occupational health services for TB in South African hospitals: a structural equation modelling analysis of the baseline data from the HaTSaH Study (cluster RCT)

IntroductionTuberculosis (TB) has become an occupational health hazard in South African hospitals where healthcare workers (HCWs) are additionally confronted daily with HIV and its associated stigma, causing a syndemic. Early...

Occupational health care personnel tackling alcohol overuse \u2013 an observational study of work processes and patient characteristics

BackgroundOveruse of alcohol is a significant risk factor for early retirement. This observational study investigated patient characteristics and work processes in occupational health care (OHC) affecting practices in tackling alcohol overuse.MethodsThe data were from 3089 patient contacts gathered for quality improvement purposes in fifteen OHC units during the years 2013–2019 in Finland. A two-proportion z-test was performed to find associations between reason for contact, and 17 other factors, and the probability of alcohol use being checked and overuse tackled.ResultsOHC personnel checked alcohol use twice as often with male patients as with female patients. Employees at risk of needing sick leave were checked for alcohol use more often (55.4, 95% confidence interval 49.2–61.6%) than those on > 30-day sick leave or working with permanent work disability (p < 0.01). Alcohol use was checked in 64.1% (59.5–68.7%) of patients while making an individual health promotion plan compared to 36.9% of those without a plan (33.1–40.6%, p < 0.0001). Patients with depression were actively checked for alcohol use, especially in cases of major depression (72.7%, 64.0–81.0%). Work processes in which OHC should have been more active in checking and tackling alcohol use included assessing the need for rehabilitation (36.5%, 32.0–41.0%) and health check-ups (HCUs) for mental reasons (43.8%, 38.1–49.4%). HCUs where alcohol overuse was detected led to brief interventions to tackle the overuse in 58.1% (43.4–72.9%) of cases.ConclusionsThe study showed factors that increased OHC personnel’s practices in checking and tackling alcohol use and work processes where the activity should be improved. Discussions about alcohol use took place more often with working-aged men than women, the younger the more. OHC personnel checked actively alcohol use with patients in danger of sick leave, patients treated for depression, while making an individual health promotion plan, and in planned HCUs with a confirmed protocol. More improvement is needed to conduct brief interventions in disability prevention processes, and especially when overuse is detected.

Skin sensitivity to capsaicin, perceived stress and burn out among patients with building-related symptoms

ObjectiveThe mechanisms behind building-related symptoms have remained unknown despite many years of research. It is known that environmental and psychosocial factors are of importance. Some receptors in the Transient Receptor Potential family elicit the same symptoms when stimulated, as reported by those suffering from building-related symptoms. The aim of this study was to compare capsaicin sensitivity between people with and without skin symptoms. A second aim was to investigate perceived stress among individuals with different levels of capsaicin sensitivity.MethodsPeople referred to an occupational health care unit and judged to have building-related symptoms by a physician answered a questionnaire regarding their symptoms. Solutions with different capsaicin concentrations were applied to participants’ nasolabial folds. Self-reported stress and burnout were assessed using two questionnaires: the Perceived Stress Scale (PSS) and the Shirom-Melamed Burnout Questionnaire (SMBQ).ResultsWe found that people who reported facial erythema or itching, stinging, tight or burning facial skin were more sensitive than those without symptoms and similarities with Sensitive Skin are discussed. We also found that participants who reacted to the lowest capsaicin concentrations scored significantly higher on scales for stress and burnout.ConclusionsWe found associations between sensitivity to capsaicin and skin symptoms among people with building-related symptoms, as well as associations between capsaicin sensitivity and perceived stress/burnout.

Networking of occupational health care units promotes reduction of permanent disability pensions among workers they care: A register-based study controlled by benchmarking with a 5-year follow-up.

ObjectivesEarly retirement due to disability is a problem in Finland. That causes pension costs that are heavy for the society. This study was designed to find out whether a quality network can support the reduction in incident disability pensions and promote a shift from full to partial disability pensions.MethodsThe study population (N = 41 472 in 2016) consisted of municipal employees whose occupational health care (OHC) was provided by the members of the Finnish Occupational Health Quality Network (OQN). The comparison population consisted of all municipality employees whose OHC was provided by non‐members of the OQN (N = 340 479 in 2016). The outcomes were measured by comparing the trends in incident disability pensions of full and partial permanent pension and full and partial provisional pension, partial/full pension indexes from 2011 to 2016 according to the principles of Benchmarking Controlled Trials. Linear regression models were used to explore the dynamics of different pension forms. Regression coefficients were calculated to show the average change per year.ResultsThe incidence of permanent disability pensions decreased faster in the study population (P for trend .03) and the study group showed a stronger shift from full to partial permanent pensions (P for trend <.001).ConclusionQuality networking between OHC units including common goal setting, systematic quality improvement, and repeated quality measurements decreased new permanent disability pensions and increased partial permanent pensions. Such changes are important while thriving for increased work participation.

Stigma as a barrier to the use of occupational health units for tuberculosis services in South Africa.

Tuberculosis (TB) is the leading cause of death in South Africa, and health care workers (HCWs) are disproportionally affected. The resulting absenteeism strains the already overburdened health system. Although hospital occupational health care units (OHUs) are cost-effective and of crucial importance in tackling the TB epidemic, the fear of being stigmatised by other colleagues might lead HCWs to avoid using OHUs. To investigate whether the perception of TB stigma among colleagues has a negative effect on the willingness to use OHUs for TB services. In the Free State Province, South Africa, a representative sample of 804 HCWs from six hospitals were surveyed on workplace stigma as a predictor for the use of OHUs for TB services. Applying structural equation modelling, we also controlled for exogenous variables. There was a significant negative relationship between the perception of stigmatising attitudes and behaviours among co-workers and the use of OHUs for TB screening (β -0.21, P = 0.000), treatment (β -0.16, P = 0.001) and isoniazid preventive therapy (β -0.17, P = 0.000). The negative effect of TB stigma on OHU use among HCWs can impact upon their health and increase hospital costs. This needs to be addressed by interventions combating TB stigma among HCWs in the workplace.

Visual Food Diary for Social Support, Dietary Changes and Weight Loss

Background: To find out to what degree health-improving dietary behavior (eg, increasing consumption of vegetables and fruits) can be furthered in virtual peer support groups moderated by a nutrition professional using a mobile app.

The Effect of an Early Rehabilitation on Alexithymia among First Ever Depressive Occupational Health Care Clients

Objectives: Depression is a common psychiatric disorder. Alexithymia and depression are highly associated. We explored the impact of an early vocationally orientated, eclectic rehabilitative intervention on alexithymia among clients with first ever diagnosed depressive episode. Methods: Clients from occupational health care units were screened for depression with the Beck Depression Inventory (BDI) and diagnosed with the Structured Clinical Interview for DSM-IV. The participants were randomized into intervention and control groups. The intervention group received eclectic early rehabilitative intervention and the control group was treated as usual. The intervention (N=134) and control groups (N=100) were compared using the Toronto Alexithymia Scale (TAS-20) at the baseline and after one year follow-up. Results: The prevalence of alexithymia decreased both in the intervention group (from 20.1% to 18.9%) and in the control group (from 16.0% to 7.1%). The prevalence of alexithymia was significantly lower at the follow up in the control group than in the intervention group (p=0.010). The changes in the mean scores of the four alexithymia variables between the groups were not statistically significant after adjusting for confounding factors. Conclusions: The findings were against our hypothesis that alexithymia would diminish in the intervention group more than in the control group. There are several explanations for this unexpected result. We believe that the reasons were that the intervention was too short and that the group-shaped method was too demanding for the subjects with alexithymia.

Promoting walking among office employees - evaluation of a randomized controlled intervention with pedometers and e-mail messages.

BackgroundThe purpose of the study was to evaluate a 6-month intervention to promote office-employees’ walking with pedometers and e-mail messages.MethodsParticipants were recruited by 10 occupational health care units (OHC) from 20 worksites with 2,230 employees. Voluntary and insufficiently physically active employees (N = 241) were randomized to a pedometer (STEP, N = 123) and a comparison group (COMP, N = 118). STEP included one group meeting, log-monitored pedometer-use and six e-mail messages from OHC. COMP participated in data collection. Reach, effectiveness, adoption, implementation, maintenance (RE-AIM) and costs were assessed with questionnaires (0, 2, 6, 12 months), process evaluation and interviews (12 months).ResultsThe intervention reached 29% (N = 646) of employees in terms of participation willingness. Logistic regression showed that the proportion of walkers tended to increase more in STEP than in COMP at 2 months in “walking for transportation” (Odds ratio 2.12, 95%CI 0.94 to 4.81) and at 6 months in “walking for leisure” (1.86, 95%CI 0.94 to 3.69). Linear model revealed a modest increase in the mean duration of “walking stairs” at 2 and 6 months (Geometric mean ratio 1.26, 95%CI 0.98 to 1.61; 1.27, 0.98 to 1.64). Adoption and implementation succeeded as intended. At 12 months, some traces of the intervention were sustained in 15 worksites, and a slightly higher number of walkers in STEP in comparison with COMP was observed in “walking stairs” (OR 2.24, 95%CI 0.94 to 5.31) and in “walking for leisure” (2.07, 95%CI 0.99 to 4.34). The direct costs of the intervention were 43 Euros per participant.ConclusionsThe findings indicate only modest impact on some indicators of walking. Future studies should invest in reaching the employees, minimizing attrition rate and using objective walking assessment.Trial registerationISRCTN79432107

Randomized controlled trial of back school with and without peer support.

The aim of this trial was to determine whether social interaction between patients with long-lasting nonspecific back pain reduces subjective or objective disability. The participants were selected from persons visiting an occupational health care unit because of back pain. After a clinical examination in a university clinic, subjects without a specific diagnosis and having no disabilities preventing active rehabilitation were selected for study. The subjects (n = 108) were randomized into treatment (n = 54) and control groups (n = 54). Altogether 18 study groups, 9 treatment groups and 9 groups for controls, were formed. Before starting the back schools altogether 15 subjects dropped out. Both the treatment groups (n = 47) and the controls (n = 46) attended a back school consisting of 10 lessons and demonstrations supervised by a physiotherapist. The participants in treatment groups, but not the controls, had physical exercise and social intercourse with other members within the group. The clinical examination was repeated after 6 and 12 months. Both the treatment groups and the controls showed improvement in perceived functional capacity (assessed with Oswestry disability questionnaire) and in perceived life quality (assessed with 15D score). At the 6-month follow-up life quality had improved statistically significantly more among the participants in treatment groups than among the controls, and at the 12-month follow-up the Oswestry index showed corresponding improvement. Among subjects suffering from nonspecific back pain, social support improves the results of active rehabilitation.

Occupational health nurses' work and expertise in Finland: occupational health nurses' perspective.

The purpose of this study was to describe Finnish occupational health nurses' (OHNs) work in terms of its contents, characteristics, necessities, meanings, development areas, changes, and expertise. The data were gathered via essays handwritten by OHNs (n = 20). Qualitative content analysis revealed that occupational health nursing practice included work with individuals, work communities, and various collaborative partners, office tasks, and other duties. Responses about OHNs' work were classified as characteristics of OHNs and of their work with advantages as well as disadvantages. The work of OHNs requires a multidisciplinary knowledge basis, professional skills, certain personal characteristics, and other features. These should be maintained and developed through continual education. The outcomes of OHNs' work were better health and healthier habits for employers, higher productivity for employers and occupational health care units, and health care savings for society. The most significant change that has occurred over the last 20 years was the move from an individual and medicine orientation toward a focus on the work community and on nursing. Expert OHNs were expected to be competent and multiskilled professionals who apply multidisciplinary knowledge in practice. This study brought out the need for further study with a focus on the client's perspective.

Effect of organisational downsizing on health of employees

Reduction of personnel by businesses and other organisations (organisational downsizing) is common in Europe, but little is known about its effects on the health of employees. We used employers' records to investigate the relation between downsizing and subsequent absenteeism because of ill health in 981 local-government workers who remained in employment in Raisio, south-western Finland, during a period of economic decline (1991-95). Data were separated into three time periods: 1991, before downsizing; 1993, major downsizing in some workplaces and occupations; and 1993-95, after downsizing. We obtained data on sick leave from records kept by the occupational health-care unit in Raisio. We also investigated whether the effects of downsizing were dependent on ten other predictors of sick leave. There was a significant association between downsizing and medically certified sick leave. The rate of absenteeism was 2.3 times greater (95% CI 2.0-2.7) after major downsizing, classified by occupation, than after minor downsizing. The corresponding rate ratios for musculoskeletal disorders and trauma were 5.7 (4.1-8.0) and 2.7 (1.7-4.2), respectively. The effects of downsizing by workplace depended on the age distribution of the staff. When the proportion of employees who were older than 50 years was high, downsizing increased the individual risk of absence because of ill health by 3.2-14.0 times, depending on diagnostic category. When the proportion of employees over 50 years was low, downsizing had only slight effects on health. Other risk factors that increased rates of sick leave after downsizing were age over 44 years, a large workplace, poor health before downsizing, and high income. Downsizing is a risk to the health of employees. But this risk varies according to individual factors, such as age, socioeconomic status, and health, as well as factors related to place of work, for example, size and age structure of the staff.

Symptoms of the musculoskeletal system and exposure to magnetic fields in an aluminium plant.

The study was performed to examine the influence of the exposure to magnetic fields in the potrooms of an electrolysis plant on the occurrence of musculoskeletal symptoms among the employees. The study was performed after much discussion and worry in the aluminium industry about this issue. A retrospective cohort study was performed at an aluminium plant. The occurrence of musculoskeletal symptoms registered at health controls performed by the occupational health care unit in 1986 and 1991 was assessed from employees exposed to magnetic fields in the potrooms (n = 342) and from a control group (n = 277). The data were collected before the discussion about the effects of magnetic fields started. The exposure to static magnetic fields was found to be 3-20 mT inside the potrooms. Ripple components (alternating currents (AC fields)) were registered as well. No difference between the exposed and unexposed groups was found for the reported musculoskeletal symptoms in 1986 or in 1991. There seems to be no relation between work in potrooms with exposure to static magnetic fields and the occurrence of musculoskeletal symptoms.

Dry chemistry instruments in primary care. II. Comparison of users with non-users.

One way of studying the impact of dry chemistry desk-top instruments in primary care is by comparing users and non-users of this technology with respect to practice setting and changes in everyday practice, as well as to elucidate reasons for not implementing this technology. We therefore mailed a similar questionnaire to all users of the most-used dry chemistry instruments in Norway (n = 298) and to a 14% random sample of general practitioners (n = 381), and a 40% random sample of doctors in occupational health care units (n = 181). The response rate was 77-79% and 200 users and 281 non-users could be included. In general practice, more users were solo practitioners and more users had a cell counter in the office laboratory; fewer occupational health care users kept computerized records. Users reported improvement in diagnosis and treatment and claimed that patient satisfaction had improved. In general, an increase in the number of tests was estimated. Non-users were more pessimistic with regard to improvements in office laboratory service, and stated perceived problems regarding cost, workload and analytical quality as well as good service from the hospital laboratory as reasons for not implementing such instruments in their practice.

The comparison of accidents in a foreign construction project with construction in Finland

The town of Kostomuksha in the Soviet Union and its associated mining companies were built as a joint project by Finland and the Soviet Union in 1977–1985. At the height of the construction period, 3,500 Finns were working at the site. The safety level and the characteristics of accidents at the project were ascertained by analyzing 20% of the accidents that occurred during construction. Comparisons were made with Finnish construction activities. More accidents occurred at the foreign project site, but the accidents were less severe than those that occurred in construction in Finland. There were several reasons for the project's higher accident level: (a) the disorder in the working environment (especially when Finns and Soviets were working simultaneously), (b) the unstable labor force, and (c) the separation of safety activities from line organization and planning. On the other hand, injury severity may have been affected by a well organized and readily available occupational health care unit at the project site. Other findings showed that: (a) the number and severity of accidents increased with the duration of the project; (b) the learning and experience acquired during the project were used more to tighten time schedules than to improve safety; (c) more accidents occurred during autumn than the other seasons; and (d) the incidence rate was more closely related to the amount of natural light than to the temperature or the depth of the snow.