Työkyvyttömyyden ehkäisyn taloudelliset vaikutukset : kohdistettujen työterveysinterventioiden hyöty-kustannus-analyysi

Työkyvyttömyydestä koituu paitsi kärsimystä myös taloudellisia seurauksia yksilöille, työnantajille ja yhteiskunnalle. Työkyvyttömyyden ehkäisyä voi pitää erityisen merkityksellisenä ja hyödyllisenä Suomen kaltaiselle maalle, jonka haasteisiin sisältyy merkittävän julkisen sektorin ylläpito laskevassa työvoiman osallistumisasteessa. Aiemmat tutkimukset osoittavat, että terveyden edistämistä tukevat ohjelmat työpaikoilla voivat ehkäistä työkyvyttömyyttä kohdistettuina työkyvyttömyysriskissä oleville henkilöille. Kohdistetuista työterveysinterventioista on voitu aiemmin osoittaa positiivista kustannusvaikuttavuutta lyhytaikaiseen työkyvyttömyyteen. Laajempaa hyöty-kustannus-analyysiä ei kohdistetuista työterveysinterventioista ole kuitenkaan aiemmin tehty, eikä kohdistettuja työterveysinterventioita ole aiemmin tarkasteltu samanaikaisesti sekä lyhyt- että pitkäaikaisen työkyvyttömyyden näkökulmista. Tässä tutkimuksessa tarkastellaan kohdistettujen työterveysinterventioiden vaikutusta työkyvyttömyyden ehkäisystä muodostuviin yhteiskunnallisiin nettohyötyihin. Lyhytaikaista työkyvyttömyyttä tarkastellaan sairauspoissaolojen avulla, ja pitkäaikaista työkyvyttömyyttä edustavat työkyvyttömyysjärjestelmän työkyvyttömyysetuudet. Työkyvyttömyyden ehkäisyn toimenpiteet ja kustannukset on rajattu tutkimuksessa terveydenhuollon palvelujen käyttöön. Tutkimus on seurantatutkimus, ja empiirinen analyysi muodostetaan retrospektiivisenä tarkasteluna prospektiivisesti kerätystä rekisteriaineistosta. Aineisto käsittää terveys- ja työkyvyttömyystietoja yli 20 000 työntekijältä Suomessa. Pääanalyysissa 1 679 hoidettua työntekijää, joille on tunnistettu korkea työkyvyttömyysriski, verrataan 2 107 hoitamattomaan korkean riskin työntekijään. Hyöty-kustannus-analyysissä yhdistetään keskimääräisen hoitovaikutuksen (Average Treatment Effect) ja nettohyötyjen (Net Benefits) viitekehykset. Tulokset muodostetaan kovarianssianalyysillä (ANCOVA). Muita työssä hyödynnettäviä menetelmiä ovat polynomiregressio, MICE-moni-imputointialgoritmi (Multiple Imputation of Chained Equations), propensiteettipisteytys (Propensity Score), ja Inverse Probability Weighting -painotusmenetelmä. Tutkimuksen tulokset osoittavat, että kohdistettujen työterveysinterventioiden yhteiskunnallinen vaikutus on todennäköisesti positiivinen: keskimääräinen hoitovaikutus nettohyötyihin korkean riskin työntekijää kohden, 1 875 euroa ja tämän 95 prosentin luottamusväli -759 eurosta 4 509 euroon (p-arvo: 0,155) (ANCOVA) osoittavat, että kohdistettuja työterveysinterventioita voi pitää keskimäärin yhteiskunnallisesti kannattavina. Tutkimusasetelmassa muodostuneet nettohyödyt olivat käytännössä täysin peräisin pitkäaikaisen työkyvyttömyyden ehkäisystä. Interventiolla ei ollut vaikutusta lyhytaikaisen työkyvyttömyyden kustannuksiin tai käytettyjen terveydenhuollon palvelujen kustannuksiin. Herkkyysanalyysi osoittaa, että kohdistetut työterveysinterventiot eivät ole keskimäärin vaikuttavia, kun ne kohdistetaan työntekijöille, joille ei ole tunnistettu työkyvyttömyysriskiä.Disability imposes personal suffering but also economic consequences for individuals, employers, and the society. Finding an optimal method for disability prevention can be considered beneficial and increasingly important for a country with a prominent public sector and a weakening labor force participation rate like Finland. Previous studies show evidence of the effectiveness of worksite health promotion programs that target care for employees who face a high risk for disability. Evidence shows positive cost-effectiveness of targeted occupational health interventions in preventing short-term disability but a wider benefit-cost analysis of targeted occupational health interventions with a view on both short-term and long-term disability prevention has not previously been conducted. This study untangles the treatment effect of targeted occupational health interventions on societal net benefits resulted from disability prevention. Short-term disability as a concept is viewed through sickness absence, and long-term disability is represented by the disability benefits granted by the Finnish disability benefit system. The costs of disability preventing actions are limited to health care utilization. The research setting of this study has been observational, and the empirical analysis is conducted as a retrospective review of prospectively collected register data. The data registers cover health and disability related information of over 20,000 employees in Finland. In the main analysis, 1,679 treated employees identified with a high risk for disability are compared to 2,107 untreated high-risk employees. The benefit-cost analysis is constructed with the Average Treatment Effect framework combined with Net Benefits framework. The treatment of the framework of this study is an attendance to a targeted, pre-planned health check after an occupational health survey. The outcome of the framework is the net benefits that result from prevention of sickness absence workdays and granted disability benefits, and the investment costs resulted from health care utilization. The results are formed with Analysis of Covariance. Other methods to conduct the empirical analysis include polynomial regression, Multiple Imputation of Chained Equations, Propensity Scores, and Inverse Probability Weighting. The results of this study show that targeted occupational health interventions are likely to impose positive net benefits to the society. The Average Treatment Effect on the net benefits of high-risk employees, 1,875 euros with a 95% confidence interval from -759 to 4,509 euros (p-value: .155) (ANCOVA), can be considered worthwhile to the society. In the research setting, the net benefits were in practice gained from the prevention of long-term disability. The treatment was not effective on the costs of short-term disability or the total health care utilization costs per employee. Sensitivity analyses indicate that targeted occupational health interventions are not on average effective when predicted to employees without a disability risk

Associations of co-occurring psychosocial and lifestyle factors with multisite musculoskeletal pain during late adolescence-A birth cohort study

Background Musculoskeletal (MS) pain is common. It often exists in several sites and is recurrent. Psychosocial difficulties and unhealthy behaviours have been related to multisite MS pain, but no literature has assessed the impact of accumulated psychosocial and lifestyle factors on recurrent multiple MS pain. Methods Our data were gathered from two questionnaires of the well-known Northern Finland Birth Cohort 1986 (NFBC1986), sent to members when they were aged 16 and 18. A total of 1,625 adolescents (712 boys and 913 girls) answered questions on smoking, physical activity, sedentary behaviour, sleeping and emotional and behavioural problems at 16 years and on musculoskeletal pain at 16 and 18 years. Weight and height measurements were taken at a health examination at baseline. A latent class analysis and multinomial regression analysis were conducted. Results We identified four clusters among both sexes. "Externalizing behavior" among both genders (OR 2.98, CI 1.73-5.13 among boys; OR 2.38, CI 1.38-4.11 among girls), "Multiple risk behaviors" among girls (OR 2.73, CI 1.30-5.71) and a "Sedentary" cluster among boys (OR 1.85, CI 1.21-2.82) were associated to recurrent multisite MS pain. "Obese" clusters had no significant associations with recurrent multiple MS pain. Conclusions Adolescents with psychosocial difficulties and/or several adverse health behaviours were at an increased risk of recurrent multisite MS pain, which emphasizes the importance of simultaneously studying multiple rather than single factors. The identification of risk groups may help more accurately target preventive interventions. Significance This study found subgroups of adolescents at risk of recurrent multisite musculoskeletal pain during late adolescence. The accumulation of multiple adverse behaviours is likely to provide new perspectives for understanding the multidimensional nature of multiple MS pains.Peer reviewe

Value creation with shared application programming interfaces in value network

Organisaatioiden kiinnostus omien palveluidensa tarjoamiseen verkottuneessa toimintaympäristössä on lisääntynyt viime vuosina voimakkaasti. Ajurina kehitykselle on ollut liiketoiminnan skaalauttaminen ja organisaation oman kehityssyklin nopeuttaminen. Konkreettisena tuloksena erilaisten rajapintojen ja muiden ohjelmallisten palveluiden jakelukanavien tarjonta on nykyään hyvin laajaa ja niiden varaan ollaan kiinnostuneita kehittämään erilaisia liiketoimintamalleja. Tutkimuksessa selvitettiin, kuinka organisaatio voi luoda arvoa liiketoimintaverkoston yhteiskäytössä olevien rajapintojen avulla. Tutkimusongelmaan vastattiin tutkimalla organisaation asemointia liiketoimintaverkostossa, rajapintapohjaisten palveluiden kehitysprosessia ja arvonluonnin kehittymistä organisaation kypsyessä. Tutkimus toteutettiin pääasiassa kirjallisuuskatsauksena, jota tuettiin kahdella puolia- voimella asiantuntijahaastattelulla. Sisällöllisesti tutkimus jakautuu rajapintoihin, arvonluontiin liiketoimintaverkostossa ja tutkimusongelmaan vastaamiseen. Kirjallisuuskatsauksen ja haastatteluiden kvalitatiivista aineistoa käsiteltiin sisältö- analyysin avulla, jolla tunnistettiin erilaisia tutkimusongelmaan vastaamiseen relevantteja teemoja. Näitä teemoja käsitellään sopivan asiayhteyden alla ja kaikista keskeisimmät havainnot on otettu mukaan varsinaiseen tutkimusongelmaan vastaavaan osaan. Tutkimuksessa havaittiin, että rajapintapohjaisessa arvonluonnissa on tyypillistä palveluntuottajan ja asiakkaan roolien sekoittuminen. Rajapintapohjaisten palveluiden kehittämiseen esitellään iteratiivinen malli, jonka kehityssykliä toistamalla yritys voi edetä rajapintapohjaisissa palveluissa kokeilujen asteelta kestävään liiketoimintaan

Time series analysis of the incidence of acute upper respiratory tract infections, COVID-19 and the use of antibiotics in Finland during the COVID-19 epidemic : a cohort study of 833 444 patients

Objective To evaluate the trajectories of acute upper respiratory tract infections (URTIs), COVID-19, and the use of antibiotics in Finland during the COVID-19 epidemic. Design Population-based cohort study. Setting Electronic medical records from a nationwide healthcare chain in Finland. Participants 833 444 patients from a cohort of 1 970 013 Finns who had used medical services between 2017 and 2020. Main outcome measures Number of weekly patients of acute URTIs, COVID-19, and the prescribed number of antibiotics in Finland between 6 January 2020 and 21 June 2020. We estimated the respective expected numbers from 1 March 2020 onward using autoregressive integrated moving average model from 1 January 2017 to 1 March 2020. We assessed the public interest in COVID-19 by collecting Google search trend frequencies. Results There was a rapid increase in COVID-related internet searches between weeks 10 and 12. At the same time, there was a 106% increase in diagnoses of acute URTIs, from 410 per 100 000 inhabitants to 845 per 100 000. The first COVID-19 cases were diagnosed on week 11. Prescriptions for URTI-related antibiotics declined by 71% (403 per 100 000 to 117 per 100 000) between weeks 11 and 15 while no relevant change took place in prescriptions of antibiotics for urinary tract infections. Conclusions At the beginning of the epidemic, many people contacted healthcare professionals with relatively mild symptoms, as indicated by the reduced rate of URTI-antibiotics prescriptions. Our findings indicate that health service providers should be prepared for rapid variations in service demand. Securing access of true COVID-19 patients to proper diagnostics, care and isolation measures may help in preventing the spread of the disease.Peer reviewe

Self-reported health problems in a health risk appraisal predict permanent work disability : a prospective cohort study of 22,023 employees from different sectors in Finland with up to 6-year follow-up

Purpose Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk-a health risk appraisal (HRA)-also predicts permanent WD. Methods HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine-Gray model estimates the predictors of WD during 6-year follow-up. Results The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as "WD risk factors", predicted DB when controlling for age and prior SA. Hazard ratios were 10.9 or over with the lower limit of the 95% confidence interval 3.3 or over among those with two simultaneous WD risk factors. 14% of the females and 17% of the males with three or more simultaneous WD risk factors had received a DB, whereas the respective figures among those without findings were 1.9% and 0.3%. Conclusions Self-reported health problems in the HRA, especially multiple simultaneous WD risk factors, predict permanent WD among both genders across occupational groups. Screening WD risk with a self-administered questionnaire is a potential means for identifying high-risk employees for targeting occupational healthcare actions.Peer reviewe

Self-reported health problems and obesity predict sickness absence during a 12-month follow-up : a prospective cohort study in 21 608 employees from different industries

Objectives To study whether self-reported health problems predict sickness absence (SA) from work in employees from different industries. Methods The results of a health risk appraisal (HRA) were combined with archival data of SA of 21 608 employees (59% female, 56% clerical). Exposure variables were self-reported health problems, labelled as ' work disability (WD) risk factors' in the HRA, presence of problems with occupational well-being and obesity. Age, socioeconomic grading and the number of SA days 12 months before the survey were treated as confounders. The outcome measure was accumulated SA days during 12-month follow-up. Data were analysed separately for males and females. A Hurdle model with negative binomial response was used to analyse zero-inflated count data of SA. Results The HRA results predicted the number of accumulated SA days during the 12-month follow-up, regardless of occupational group and gender. The ratio of means of SA days varied between 2.7 and 4.0 among those with ' WD risk factors' and the reference category with no findings, depending on gender and occupational group. The lower limit of the 95% CI was at the lowest 2.0. In the Hurdle model, ' WD risk factors', SA days prior to the HRA and obesity were additive predictors for SA and/or the accumulated SA days in all occupational groups. Conclusion Self-reported health problems and obesity predict a higher total count of SA days in an additive fashion. These findings have implications for both management and the healthcare system in the prevention of WD. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.Peer reviewe

Accumulated unhealthy behaviors and psychosocial problems in adolescence are associated with labor market exclusion in early adulthood - a northern Finland birth cohort 1986 study

BackgroundThe relevance of health-related behaviors to exclusion from the labor market in early adulthood remains poorly studied in relation to the magnitude of the problem. We explored whether adolescents' accumulated unhealthy behaviors and psychosocial problems are associated with later labor market exclusion, and whether multisite musculoskeletal pain (MMSP) impacts these relations.MethodsWe gathered questionnaire data on unhealthy behaviors and psychosocial problems and MMSP among adolescents aged 15 to 16 belonging to the Northern Finland Birth Cohort 1986. The findings were combined with registry data on unemployment, employment and permanent work disability during a five-year follow-up between the ages of 25 and 29 (n=6692). In the statistical modeling we used education, family leave and socioeconomic status of childhood family as potential confounders, as well as latent class and logistic regression analyses.ResultsThe Externalizing behavior cluster associated with over one year of unemployment (RR 1.64, CI 1.25-2.14) and permanent work disability (OR 2.49, CI 1.07-5.78) in the follow-up among the men. The Sedentary cluster also associated with over one year (RR 1.41, CI 1.13-1.75) and under one year of unemployment (RR 1.25, CI 1.02-1.52) and no employment days (RR 1.93, CI 1.26-2.95) among the men. Obese male participants were at risk of over one year of unemployment (RR 1.50, CI 1.08-2.09) and no employment days (RR 1.93, CI 1.07-3.50). Among the women, the Multiple risk behavior cluster related significantly to over one year of unemployment (RR 1.77, CI 1.37-2.28). MMSP had no influence on the associations.ConclusionsUnhealthy behavior patterns and psychosocial problems in adolescence have long-term consequences for exclusion from the labor market in early adulthood, especially among men. Simultaneously supporting psychological well-being and healthy behaviors in adolescence may reduce labor market inclusion difficulties in the early phase of working life.Peer reviewe

Return to work after subacromial decompression, diagnostic arthroscopy, or exercise therapy for shoulder impingement : a randomised, placebo-surgery controlled FIMPACT clinical trial with five-year follow-up

Background: Arthroscopic subacromial decompression is one of the most commonly performed shoulder surgeries in the world. It is performed to treat patients with suspected shoulder impingement syndrome, i.e., subacromial pain syndrome. Only few studies have specifically assessed return-to-work rates after subacromial decompression surgery. All existing evidence comes from open, unblinded study designs and this lack of blinding introduces the potential for bias. We assessed return to work and its predictors in patients with shoulder impingement syndrome in a secondary analysis of a placebo-surgery controlled trial. Methods: One hundred eighty-four patients in a randomised trial had undergone arthroscopic subacromial decompression (n = 57), diagnostic arthroscopy, a placebo surgical intervention, (n = 59), or exercise therapy (n = 68). We assessed return to work, defined as having returned to work for at least two follow-up visits by the primary 24-month time point, work status at 24 and 60 months, and trajectories of return to work per follow-up time point. Patients and outcome assessors were blinded to the assignment regarding the arthroscopic subacromial decompression vs. diagnostic arthroscopy comparison. We assessed the treatment effect on the full analysis set as the difference between the groups in return-to-work rates and work status at 24 months and at 60 months using Chi-square test and the predictors of return to work with logistic regression analysis. Results: There was no difference in the trajectories of return to work between the study groups. By 24 months, 50 of 57 patients (88%) had returned to work in the arthroscopic subacromial decompression group, while the respective figures were 52 of 59 (88%) in the diagnostic arthroscopy group and 61 of 68 (90%) in the exercise therapy group. No clinically relevant predictors of return to work were found. The proportion of patients at work was 80% (147/184) at 24 months and 73% (124/184) at 60 months, with no difference between the treatment groups (p-values 0.842 and 0.943, respectively). Conclusions: Arthroscopic subacromial decompression provided no benefit over diagnostic arthroscopy or exercise therapy on return to work in patients with shoulder impingement syndrome. We did not find clinically relevant predictors of return to work either.Peer reviewe

Responsiveness of different pain measures and recall periods in people undergoing surgery after a period of splinting for basal thumb joint osteoarthritis

Background Basal thumb joint osteoarthritis (OA) is a common painful condition of the hand often treated surgically if non-operative care does not provide sufficient pain relief. Many instruments are available to measure pain for this condition including single item and multidimensional measures. To inform our choice of instrument for the purpose of evaluating the value of surgery for people with thumb OA, the aim of this study was to compare the longitudinal validity and signal to noise ratio of a single item numeric rating scale (NRS) for pain and the Patient-rated Wrist and Hand Evaluation (PRWHE) pain subscale, and to assess if recall period affects longitudinal validity of the NRS pain and reported pain levels. Methods We invited 52 patients referred for surgical treatment of basal thumb joint OA to participate in this study. All wore a splint for six weeks followed by surgery. Pain during the past day, week, and month and the PRWHE were collected at baseline, operation day, and 3, 6, 9 and 12 months after surgery. Responsiveness was assessed with two methods: 1) using participant-reported global improvement and PRWHE function subscale as external anchors (longitudinal validity) and 2) comparing Standardized Response Means (SRM). Results The Spearman's rho between PRWHE pain and participant-reported global improvement was better (0.71) compared with NRS past day (0.55), past week (0.62), or past month (0.59). Similar findings were found with PRWHE function as anchor (Pearson's r for PRWHE pain 0.78; NRS past day 0.68; past week 0.73; past month 0.69). The SRM of PRWHE pain subscale (2.8) and NRS past week (2.9) outperformed pain past day (2.3) and month (2.4). Mean pain was 0.3 points (on a 0 to 10 scale) worse during past week when compared with past day and 0.3 worse during past month than during past week. Conclusions All studied pain measures captured the change in pain over time. For clinical trials, we recommend PRWHE pain subscale or NRS past week due to their better signal noise ratio.Peer reviewe