Lack of physical activity (PA) is a known risk factor for many health conditions. The workplace is a setting often used to promote activity and health. We investigated the effectiveness of an intervention on PA and productivity-related outcomes in an occupational setting.

Background The CoAct (Cocreating Activity) study is investigating a novel lifestyle intervention, aimed at the working population, with daily activity monitoring and distance counselling via telephone and secure web messages. The main purpose of this study is to evaluate the effectiveness of lifestyle counselling on the level of physical activity in an occupational health setting. The purposes include also analysing the potential effects of changes in physical activity on productivity at work and sickness absence, and healthcare costs. This article describes the design of the study and the participant flow until and including randomization. Methods/Design CoAct is a randomised controlled trial with two arms: a control group and intervention group with daily activity monitoring and distance counselling. The intervention focuses on lifestyle modification and takes 12 months. The study population consists of volunteers from 1100 eligible employees of a Finnish insurance company. The primary outcomes of this study are change in physical activity measured in MET minutes per week, work productivity and sickness absence, and healthcare utilisation. Secondary outcomes include various physiological measures. Cost-effectiveness analysis will also be performed. The outcomes will be measured by questionnaires at baseline, after 6, 12, and 24 months, and sickness absence will be obtained from the employer's registers. Discussion No trials are yet available that have evaluated the effectiveness of daily physical activity monitoring and distance counselling in an occupational health setting over a 12 month period and no data on cost-effectiveness of such intervention are available. Trial Registration ClinicalTrials.gov identifier: NCT00994565

Introduction In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators. Methods Age, gender, working status, severity of physical impairment, depression score, self-rated working ability, co-morbidity, and sickness absence characteristics in the previous 12 months were identified as potential effect modifiers ( n = 382). We conducted regression analyses with the potential effect modifiers and a mediator (treatment attendance as intended) as explanatory variables. The difference of sickness absence days during the previous year and the follow-up year was the dependent variable. Results The intervention was especially effective in the subgroups of workers who were certain that they will not be able to continue working in their current job due to health-related reasons (−74 days; 95% CI −105 to −43), had co-morbidities (−22.5 days; 95% CI −35.5 to −9.5), or severe physical impairment at work (−17.5 days; 95% CI −28.5 to −6.5). A modifying effect of age, gender, working status, depressive symptoms, or prior sickness absence on the effectiveness of this OH intervention was not found. Conclusions This targeted OH intervention seems especially suitable for workers who consider that they are no longer able to continue working due to health reasons and have high level of physical impairment or co-morbidities. The findings from these exploratory analyses should be tested in future RCTs.

Objectives: To determine whether, from a healthcare perspective, a specific occupational health intervention is cost effective in reducing sickness absence when compared with usual care in occupational health in workers with high risk of sickness absence. Methods: Economic evaluation alongside a randomised controlled trial. 418 workers with high risk of sickness absence from one corporation were randomised to intervention (n = 209) or to usual care (n = 209). The subjects in the intervention group were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Register data of sickness absence were available for 384 subjects and questionnaire data on healthcare costs from 272 subjects. Missing direct total cost data were imputed using a two-part regression model. Primary outcome measures were sickness absence days and direct healthcare costs up to 12 months after randomisation. Cost effectiveness (CE) was expressed as an incremental CE ratio, CE plane and CE acceptability curve with both available direct total cost data and missing total cost data imputed. Results: After one year, the mean of sickness absence was 30 days in the usual care group (n = 192) and 11 days less (95% CI 1 to 20 days) in the intervention group (n = 192). Among the employees with available cost data, the mean days of sickness absence were 22 and 24, and the mean total cost €974 and €1049 in the intervention group (n = 134) and in the usual care group (n = 138), respectively. The intervention turned out to be dominant—both cost saving and more effective than usual occupational health care. The saving was €43 per sickness absence day avoided with available direct total cost data, and €17 with missing total cost data imputed. Conclusions: One year follow-up data show that occupational health intervention for workers with high risk of sickness absence is a cost effective use of healthcare resources.

OBJECTIVES:To evaluate the effectiveness of two occupational health intervention programmes, both compared with usual care.METHODS:Based on a health survey, 1341 employees (88% males) in construction, service and maintenance work were classified into three groups: "low risk" (n = 386), "intermediate risk" (n = 537) and "high risk" (n = 418) of sickness absence. Two separate randomised trials were performed in the groups "high risk" and "intermediate risk", respectively. Those high risk subjects that were allocated to the intervention group (n = 209) were invited to occupational health service for a consultation. The intervention included, if appropriate, a referral to specialist treatment. Among the intermediate risk employees those in the intervention group (n = 268) were invited to call a phone advice centre. In both trials the control group received usual occupational health care. The primary outcome was sickness absence during a 12-month follow-up (register data).RESULTS:The high risk group, representing 31% of the cohort, accounted for 62% of sickness absence days. In the trial for the high risk group the mean sickness absence was 30 days in the usual care group and 19 days in the intervention group; the mean difference was 11 days (95% CI 1 to 20 days). In the trial for the intermediate risk group the mean sickness absence was 7 days in both arms (95% CI of the mean difference -2.3 to 2.4 days).CONCLUSIONS:The identification of high risk of work disability was successful. The occupational health intervention was effective in controlling work loss to a degree that is likely to be economically advantageous within the high risk group. The phone advice intervention for the intermediate risk group was not effective in controlling work loss primarily due to poor adherence.

Objectives: To study the associations between self-reported health problems and sickness absence from work. Methods: The results of a questionnaire survey were combined with archival data of sickness absence of 1341 employees 88 males; 62 blue-collar in the construction, service and maintenance work within one corporation in Finland. Sex, age and occupational grading were controlled as confounders. A zero-inflated negative binomial ZINB regression model was used in the statistical analysis of sickness absence data. Results: The prevalence of self-reported health problems increased with age, from 23 in 1830-year-olds to 54 in 5561-year-olds. However, in those aged 1830 years, 71 had been absent from work and in those aged 5561 years this proportion was 53. When health problems and occupational grading were accounted for in the ZINB model, age as such was not associated with the number of days on sick leave, but the young workers still had higher propensity for any sickness absence than the old. Self-rated future working ability and musculoskeletal impairment were strong determinants of sickness absence. Among those susceptible to taking sick leave, the estimated mean number of absence days increased by 14 for each rise of 1 unit of the impairment score scale 010. Conclusions: Young subjects had surprisingly high probability for sickness absence although they reported better health than their older colleagues. A higher total count of absence days was found among subjects reporting health problems and poorer working ability, regardless of age, sex and occupational grade. These findings have implications for both management and the healthcare system in the prevention of work disability.

OBJECTIVESThis multicentered randomized controlled trial evaluated the effect of worksite exercise intervention on perceived work ability and sick leaves.METHODSWomen (N = 260, mean age 40 years) engaged in physically demanding laundry work were individually randomized into an intervention (N = 133) or control (N = 127) group. Perceived work ability was assessed with questionnaires at 3, 8, 12, and 15 months. Sick leave information was obtained from the personnel administration. Follow-up attendance was 100% at 3 months but declined gradually to 90% by 15 months. Both the intervention and control subjects received a 30-minute feedback on their physical capacity from a physiotherapist and individual exercise prescription and counseling. The intervention subjects also participated in worksite exercise training guided by a physiotherapist. Sixty-minute sessions (N = 26) were held once a week for 8 months. About 50% of the intervention group participated in at least two-thirds of the sessions.RESULTSAccording to a dichotomized work ability index, at 12 months, workers with "good" or "excellent" work ability increased more in the intervention group than in the control group (11.0%, 95% CI 0.2-21.9), as did the health-related prognosis of work ability at 8 months (8.1%, 95% CI 0.5-16.3). There were no statistically significant differences between the two groups as regards job satisfaction, work ability index (including series of questions on 7 items), or sick leaves.CONCLUSIONSPhysical activity once a week at worksites improves the perceived work ability of women with physically demanding work only slightly. Perceived work ability and sick leaves cannot be affected very positively using single-component exercise intervention. Work ability promotion may need a more multiprofessional approach.

BACKGROUND:Bed rest and back-extension exercises are often prescribed for patients with acute low back pain, but the effectiveness of these two competing treatments remains controversial.METHODS:We conducted a controlled trial among employees of the city of Helsinki, Finland, who presented to an occupational health care center with acute, nonspecific low back pain. The patients were randomly assigned to one of three treatments: bed rest for two days (67 patients), back-mobilizing exercises (52 patients), or the continuation of ordinary activities as tolerated (the control group; 67 patients). Outcomes and costs were assessed after 3 and 12 weeks.RESULTS:After 3 and 12 weeks, the patients in the control group had better recovery than those prescribed either bed rest or exercises. There were statistically significant differences favoring the control group in the duration of pain, pain intensity, lumbar flexion, ability to work as measured subjectively, the Oswestry back-disability index, and number of days absent from work. Recovery was slowest among the patients assigned to bed rest. The overall costs of care did not differ significantly among the three groups.CONCLUSIONS:Among patients with acute low back pain, continuing ordinary activities within the limits permitted by the pain leads to more rapid recovery than either bed rest or back-mobilizing exercises.

Background. To determine whether the effect of live attenuated oral polio virus vaccine given to pregnant women increases pregnancy complications.Methods. A study of women who had been vaccinated against poliovirus during a national vaccination campaign and who had delivered by cesarean section in three obstetrical hospitals in southern Finland. One thousand seven hundred and forty‐seven vaccinated women (in three study cohorts), and their 2293 nonvaccinated controls (in two reference cohorts) were analyzed. Subjects are out of 22 000 deliveries evaluated earlier.Results. Vaccinated sectioned women did not show an excess of pregnancy complications. The mean rate of cesarean sections was 18.4% in the study cohorts and 18.9% in the reference cohorts counted from the 22 000 deliveries.Conclusions. Oral live attenuated polio virus vaccine does not increase pregnancy complications and is considered a safe alternative for vaccinating pregnant women.

Prompted by a nascent epidemic of poliomyelitis in Finland, a mass vaccination program with live oral poliovirus vaccine (OPV) was implemented in February and March 1985. The final rate of coverage was approximately 94%. Pregnant women were included, and a cohort study was launched to evaluate any harmful effects of OPV on the developing embryo. All records of births to mothers who were pregnant during the period of vaccination and whose infants were delivered at the three major hospitals in the Helsinki area were reviewed. Within the study cohort, mothers were grouped into three categories according to their trimester of pregnancy during the program. In addition, two reference cohorts were evaluated; these cohorts consisted of infants delivered at the same hospitals during the second half of 1984 and of 1986, respectively. Each of the three categories in the study cohort included approximately 3,000 children, while each reference cohort included approximately 6,000 children. Data were analyzed on the rate of intrauterine growth and the prevalences of stillbirth, neonatal death, congenital malformation, premature birth, perinatal infection, and neurological aberration. No differences were documented among the study and reference cohorts or among the three categories within the study cohort. Thus, under the conditions described here, the inclusion of pregnant women in programs of mass vaccination with OPV appears to be safe.

To examine the possible association between maternal vaccination with oral polio-virus and congenital malformations of the child, use was made of a nationwide mass vaccination in Finland. During a restricted period in 1985, a vaccination with trivalent oral poliovirus was implemented with coverage of 94% of the population. The study population was chosen from three major hospitals in the Greater Helsinki Region in Finland which deliver over 95% of the children of their catchment area. One study and two reference cohorts were delineated; the former consisted of pregnancies that were in their first trimester during the vaccination period. The two reference cohorts included mothers from the same hospitals whose pregnancies were likewise in the first trimester during the corresponding time period in 1984 and 1986, i.e., 12 months before and after the study period. Each cohort consisted of approximately 3,000 mothers/children whose delivery and hospital records were manually perused by trained nurses. All the structural malformations reflecting an impaired organogenesis during the sensitive first trimester were monitored. A total of 209 (2.3%) such malformations were recorded and characterized. There were no differences between the study and reference cohorts (risk ratio = 0.7, 95% confidence interval 0.5-1.0). According to the authors' power estimate, an additional prevalence greater than 0.5% would have been detected. The authors conclude that administration of oral poliovirus vaccine during early pregnancy was not associated with an elevated risk of congenital malformations.