Dilemmatic group memberships of hard-of-hearing employees during the process of acquiring and adapting to the use of hearing aids.

We describe how hard-of-hearing (HOH) employees renegotiate both their existing and new group memberships when they acquire and begin to use hearing aids (HAs). Our research setting was longitudinal and we carried out a theory-informed qualitative analysis of multiple qualitative data. When an individual discovers that they have a hearing problem and acquire a HA, their group memberships undergo change. First, HOH employees need to start negotiating their relationship with the HOH group. Second, they need to consider whether they see themselves as members of the disabled or the nondisabled employee group. This negotiation tends to be context-bound, situational, and nonlinear as a process, involving a back-and-forth movement in the way in which HOH employees value different group memberships. The dilemmatic negotiation of new group memberships and the other social aspects involved in HA rehabilitation tend to remain invisible to rehabilitation professionals, occupational healthcare, and employers.

Long-Lasting Obesity Predicts Poor Work Ability at Midlife: A 15-Year Follow-Up of the Northern Finland 1966 Birth Cohort Study.

OBJECTIVE: To investigate the effect of adulthood obesity on work ability in early midlife during a 15-year follow-up. METHODS: The study population included men and women (n = 5470), born in northern Finland in 1966. Participants evaluated their current perceived work ability compared with their lifetime best at the age of 46. Participants' weight and height were measured at 31 years and self-reported at 46 years, and body mass indexes were calculated. RESULTS: Obesity at both ages, and developing obesity between the ages of 31 and 46 increased the relative risk of poor work ability at 46 years among sexes, and among those in both low and high physically strenuous work. CONCLUSIONS: Long-term obesity and developing obesity in mid-adulthood increase the risk of poor work ability. Thus, the promotion of healthy behaviors by policies, healthcare services, and at workplaces is important.

Use of health services by Finnish employees in regard to health-related factors: the population-based health 2000 study.

OBJECTIVES: The aims of this study were to describe the use of occupational health services and other health care of Finnish employees and to examine associations between health problems and risks, and primary care visits to occupational health nurses and physicians and other health care. METHODS: A nationally representative sample of 3,126 employees aged 30-64 participated in the Health 2000 study, which consisted of a health interview, questionnaires, a clinical health examination, and the Composite International Diagnostic Interview. The use of health services was measured by self-reported visits. RESULTS: During the previous 12 months, 74 % of the employees visited occupational health services or municipal health centers, 52 % visited only occupational health services. From a third to a half of employees with lifestyle risks, depressive disorders or other health problems visited occupational health professionals. Obesity, burnout, insomnia, depressive mood, chronic impairing illnesses, and poor work ability were associated with visits to occupational health nurses. Among women, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to occupational health physicians. Lower educational level, smoking, musculoskeletal diseases, chronic impairing illnesses, and poor work ability were associated with visits to health center physicians. CONCLUSIONS: This study showed the importance of occupational health services in the primary health care of Finnish employees. However, a considerable proportion of employees with lifestyle risks, depressive mood, and other health problems did not use health services. Occupational health professionals are in an advantageous position to detect health risks in primary care visits.

Work-related primary care in occupational health physician's practice.

INTRODUCTION: Primary care is frequently integrated in Finnish occupational health services (OHS). This study examines the frequency of work-related health problems in occupational health (OH) physicians' consultations for primary care and associations between health problems and interventions carried out by OH physicians. METHODS: OH physicians assessed the health problems of 651 consecutive visits in a private OHS unit. The health problem was regarded as work-related if it was caused or aggravated by work, or involved impaired work ability. Interventions carried out by OH physicians were analysed by logistic regression analysis. RESULTS: The main health problem was caused either partially or mainly by work or symptoms were worsened by work (27%), or symptoms impaired work ability (52%). Musculoskeletal and mental disorders were the main work-related reasons for visits. In two-thirds of the cases of mental health problems, work caused or worsened symptoms, and the majority of long sickness absences were issued due to these problems. OH physicians carried out interventions concerning work or workplace in 21% of visits. Mental disorders were associated most strongly (OR 7.23, 95% CI 3.93-13.32) with interventions. The strongest association (OR 16.09, 95% CI 9.29-27.87) with work-related visits was, when the health problem was both work-induced and impaired work ability. CONCLUSIONS: Work-related health problems comprise a considerable part of Finnish OH physicians' work. OH physicians play an important role in early treatment, in the prevention of disability, and in interventions aimed at workplaces based on the knowledge they get through primary care in OHS.

Primary care visits to occupational health physicians and nurses in Finland.

AIMS: In Finland, 91% of employer-arranged occupational health services (OHS) include primary care for employees. Occupational health (OH) physicians and OH nurses carry the main responsibility for primary care in OHS. This study analyses work- and health-related factors associated with primary care visits to OH physicians and OH nurses. METHODS: This population-based cross-sectional survey encompassed 1636 randomly selected working employees aged 25-64 covered by OHS which included primary care. The associations between factors and visits during the previous 6 months were tested by Poisson regression analysis. RESULTS: The proportion of employees who visited OH physicians or OH nurses was 57%. Men visited OH nurses more often than women, but the number of visits to OH physicians was similar. Long-standing illnesses impairing work ability, work-related symptoms, and type of OHS provision were associated with visits to both OH physicians and nurses. Moderate psychological stress was associated with visits to OH physicians. Among men, the requirement of obtaining a sick-leave certificate on the first day of absence was associated with visits. Less possibilities to influence one's work was associated with visits to OH nurses, and among women also to OH physicians. Poor support from supervisors and co-workers had non-significant or inverse associations. CONCLUSIONS: The wide use of OHS and both the type and similarities between factors associated with visits may signify that both OH physicians and OH nurses are likely to encounter work-related health problems through primary care in OHS.

Motivators and barriers to exercise among adults with a high risk of type 2 diabetes--a qualitative study.

PURPOSE: Type 2 diabetes (T2D) can be prevented through lifestyle changes. Regular exercise for more than 4 hours per week, combined with weight loss and changes in dietary habits reduces the incidence of T2D. The aim of this study was to describe motivators and barriers to exercise among adults with a high risk of T2D. METHODS: Altogether, 74 subjects participated in a study on the Effectiveness and Feasibility of Activating Counseling Methods and Videoconferences in Dietary Group Counseling of Subjects with high risk of T2D. The qualitative data were gathered from video-recorded group counselling sessions and were analysed using content analysis. RESULTS: Enjoyment from exercise, social relationships related to exercise, encouragement from others, benefits to health, and the aim of weight control motivated subjects to exercise. The wish to join people with an active lifestyle, admiration of active friends and willingness to serve as an example for children reflected why exercise was an important value in life. The barriers to exercise were weather/season, health problems, lack of time, work-related factors and lack of interest. CONCLUSIONS: Adults with high risk of T2D experienced many individually meaningful motivators. They experienced few barriers to exercise and highlighted the motivators. Thus, we present that they had a positive attitude towards increasing exercise during participation to counselling. The results can be used when developing counselling methods because they provide concrete content for counselling discussion such as importance of work-related factors, family exercise, time management skills and social support for regular exercise.

Feasibility of videoconferencing in lifestyle group counselling.

OBJECTIVES: The rapid increase in the prevalence of type 2 diabetes (T2D) has created an urgent need to develop new practices to prevent and treat it. One possibility is to provide specialists services to remote areas through videoconferencing (VC). Therefore, the aim was to study the feasibility of short-term group counselling by a clinical nutritionist (4 sessions at 1.5-hour each at 2-week intervals from baseline, and the session 5 at 6 months) performed by videoconferencing (VC). STUDY DESIGN: We recruited 74 subjects at high risk of T2D, and compiled 5 VC groups (each group included 5-9 subjects, total n=33) and 6 face-to-face groups (FF, total n=44). The subjects were also asked to participate in a follow-up visit 15 months after the last counselling session. METHODS: Data were collected by a questionnaire (satisfaction with group counselling via videoconferencing), by theme interviews (experiences on group counselling) and by metabolic measures (laboratory tests). RESULTS: Only one of the 74 subjects dropped out during the first 6 months. The proportion of subjects who had received social support from group peers was higher in the videoconferencing group than in the face-to-face groups (p=0.001). The experiences of group counselling transmitted by videoconferencing were positive. Waist circumference decreased significantly at 0 to 6 months of counselling (p<0.01), and was significantly lower at 21 months than at baseline in FF groups (p=0.015). However, no significant differences were observed in most of the measurements between VC and face-to-face groups. CONCLUSIONS: Short-term group counselling by a clinical nutritionist through videoconferencing is a feasible way and a practical model to provide specialists services to remote areas, and thus can be used as an option to diminish inequality related to restricted health care services in sparsely inhabited areas.

Pedometer use among adults at high risk of type 2 diabetes, Finland, 2007-2008.

INTRODUCTION: A pedometer helps adults exercise more, but sedentary adults need instruction and advice to be motivated to use one. We conducted this qualitative study to describe the experiences of participants at high risk of type 2 diabetes who began using a pedometer. METHODS: A total of 74 people at high risk of type 2 diabetes participated in 6 months of group counseling. From April 2007 to April 2008, we collected data through questionnaires, theme interviews (n = 22) and video recordings of counseling sessions. From October 2007 through June 2008, we analyzed the data. RESULTS: Pedometers were useful tools for observing levels of exercise, setting personal goals for walking, and helping evaluate whether daily goals were met. Negative experiences were associated with functional failures, pedometers' unsuitability for exercise other than walking, and the goal of 10,000 steps, which some participants considered too high. CONCLUSION: Sedentary adults can be motivated to use a pedometer if we inform them that regular users find it a useful instrument for increasing their level of exercise. These adults should set realistic goals for walking and receive adequate instructions for using pedometers.

Employee well-being, early-retirement intentions, and company performance.

OBJECTIVE: To explore the relationship between employee well-being and early-retirement intentions, and the extent to which early-retirement intentions are associated with company performance. METHODS: This study is based on cross-sectional survey data on the ageing employees of the Finnish metal industry and retail trade, collected in 2007 (company-level n = 129, employee-level n = 1281). It was analyzed using multinomial logistic and multiple regression analysis. RESULTS: Poor work ability, frequent emotional exhaustion, low organizational commitment, and job control were associated with the prevalence of early-retirement intentions among aging employees in both industries. Metal industry employees' early-retirement intentions were associated with weaker company performance measured by the perceptions of the manager. CONCLUSION: By enhancing well-being, employees may stay at work for longer rather than retiring early. Early-retirement intentions can be counterproductive for companies.

Cocreating a health-promoting workplace.

OBJECTIVE: Managing well-being at work has so far been quite fragmented, and we do not currently have a well-defined holistic method for promoting health and well-being at work. We present a cocreation method, a comprehensive tool to enable organizations to do this. METHODS: The TEDI cocreation method is based on the salutogenic approach to health promotion, positive organizational scholarship, and a solution-based way of acting. The cocreation is founded on participation, commitment, and empowerment. RESULTS: When piloting this method, well-being at work was seen broadly. Everyone's participation enabled finding the most relevant and possible development actions. This method also made positive aspects of well-being at work visible. CONCLUSIONS: The TEDI cocreation method is a management tool for overseeing the promotion of health and well-being in its entirety, thus achieving productive and sustainable development in the organization.

Factors associated with visits to occupational health physicians in Finland.

BACKGROUND: In Finland, employers can offer primary care to employees in addition to obligatory occupational health services (OHS). AIMS: To analyse factors associated with visits to seek primary care from occupational health physicians (OH physicians) and compared with visits to physicians in municipal health centres, private clinics and hospital outpatient clinics. METHODS: The subjects of this population-based cross-sectional survey comprised 1753 randomly selected employed Finns aged 25-64 years covered by OHS including primary care. The associations between visits to physicians during the past 6 months and factors related to work and perceived health were tested using Poisson regression analysis. RESULTS: Provision of primary care in OHS increased visits to OH physicians but decreased visits to municipal health centre physicians. Among both genders, long-standing illnesses impairing work ability had the strongest associations with visits to all physicians. Among men, the factors associated with visits to OH physicians were long-standing illnesses without effect on work ability, requirement of sickness certificate from the first day of sickness, OHS arranged in private clinics and moderate stress symptoms. Among women, lower vocational level, OHS arranged in private clinics or joint-model OHS units, moderate stress symptoms and workplace harassment were associated with visits to OH physicians. CONCLUSIONS: Primary care in OHS enables OH physicians to reach workers with work-related health problems, thus enabling interventions on working conditions and work ability. Moreover, OHS seem to be a very important health care provider in Finland.

Work health promotion, job well-being, and sickness absences--a systematic review and meta-analysis.

OBJECTIVE: The aim of this systematic literature analysis was to study the association between work health promotion and job well-being, work ability, absenteeism, and early retirement. This systematic review is a part of a large research project studying multiple workplace factors and interventions that may affect workers' health and well-being. METHODS: Original articles published in 1970 to 2005 were searched in Medline and PsycINFO databases, the main search terms being health promotion, well-being, work ability, sick leave, and disability pension. Out of 1312 references and 35 potentially eligible publications, 10 studies were included in the analysis. Other sources producing 36 eligible studies, 46 studies in total were included in the analysis. RESULTS: There is moderate evidence that work health promotion decreases sickness absences (risk ratio [RR], 0.78; range, 0.10 to 1.57) and work ability (RR, 1.38; range, 1.15 to 1.66). It also seems to increase mental well-being (RR, 1.39; range, 0.98 to 1.91), but not physical well-being. There is no evidence on disability pension. Exercise seems to increase overall well-being (RR, 1.25; range, 1.05 to 1.47) and work ability (RR, 1.38; range, 1.15 to 1.66), but education and psychological methods do not seem to affect well-being or sickness absences. Sickness absences seem to be reduced by activities promoting healthy lifestyle (RR, 0.80; range, 0.74 to 0.93) and ergonomics (RR, 0.72; range, 0.13 to 1.57). CONCLUSIONS: Work health promotion is valuable on employees' well-being and work ability and productive in terms of less sickness absences. Activities involving exercise, lifestyle, and ergonomics are potentially effective. On the other hand, education and psychological means applied alone do not seem effective. Work health promotion should target both physical and psychosocial environments at work.