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BARENTS

AP

Newsletter
on
Occupational
Health
and Safety

2014 17 3
Vol. No.

Musculoskeletal
disorders and
return to work

BARENTS
AP

Newsletter on
Occupational
Health and
Safety

2014 17 3
Vol.

No.

Publisher
Finnish Institute of Occupational Health

Topeliuksenkatu 41 a A
FI-00250 Helsinki, Finland
Editor in Chief
Suvi Lehtinen
Editor
Mirkka Salmensaari
Layout
Guassi Oy
Translations
Anatoly Vinogradov
The responsibility for opinions, expressed in signed articles,
studies and other contributions rests solely with the authors,
and publication does not constitute an endorsement by
the Finnish Institute of Occupational Health of the opinions
expressed in them.
,
,
;
,

.

Contents

71 Light at the end of the tunnel for prevention of disability due to


musculoskeletal disorders
Eira Viikari-Juntura, Finland
72 ,
- :
-,
73 Reducing work disability related to musculoskeletal
disorders solutions in Finland
Kari-Pekka Martimo, Finland
75
- :
- ,
78 Musculoskeletal disorders and return to work in Estonia
Mari Jrvelaid, Estonia
79 -


81 Workplace health promotion should be based on the needs of
the workplace
Anne Salmi1, Jaana Lerssi-Uskelin1, Leila Hopsu1, Lsma Kozlova2,
Svetlana Lakia2, 1Finland, 2Latvia

The electronic version of the Barents Newsletter on


Occupational Health and Safety on the Internet can be
accessed at the following address:
http://www.ttl.fi/BarentsNewsletter.

85

1, -1, 1,
2, 2, 1, 2



: http://www.ttl.fi/BarentsNewsletter.

89 OCCSET project examines companies attitudes to workers health


and well-being in Russia

Printed publication ISSN 1455-8459

90 OCCSET

On-line publication ISSN 1458-5952


Photograph on the cover page
Iisakki Hrm

91 Physiotherapists and optometrists in occupational health services


experts in workplace health promotion
Leena Noronen, Juha Pllysaho, Elisa Mkinen, Finland
94

, , ,

2014

97 The 20th Annual Meeting of the Baltic Sea Network


discussed training of occupational health personnel
Mirkka Salmensaari, Finland
99

,

PHOTO Viikari-Juntura

Light at the end of the tunnel


for prevention of disability
due to musculoskeletal disorders
Professor Eira Viikari-Juntura
Finland

lthough general health and functional capacity have improved


over time in many Western
countries, work disability due to musculoskeletal problems in particular has
remained at a high level, especially in
older age groups. Good musculoskeletal
health and functional capacity are crucial factors, if we want older people to
stay at work for longer.
Loss of work capacity due to musculoskeletal disorders is typically partial
most people with these problems report that they can perform most of their
tasks, but not all, or cannot work for a
full day. This means that work modification aimed at either reducing high
physical loads or working time, or both,
could promote return to work or work
retention. Indeed, evidence has accumulated that workplace interventions,
including ergonomic adjustments to reduce workload, are effective in reducing
work disability due to low back and upper extremity pain.
In the Nordic countries, several
changes have been made to the legislation on sickness benefits to support disability prevention. There is already research evidence on the effects of some
of these changes, such as the introduction of the partial sickness benefit in
Finland in 2007 to compensate for loss
of earnings due to partial sick leave.
A 1.5-year follow-up of those who received the benefit showed that they less
frequently received full disability pension and more frequently partial disability pension than a corresponding group
of people on full sick leave. Work participation among the partial sick leave
group was 5% higher than among the
full sickness benefit receivers. The difference in the work participation of the
two groups was even higher in cases
of mental disorders and older workers,
whereas it was not so evident in cases
of musculoskeletal diseases. One reason
for this may be the requirement at that

time of a continuous period of 60 days of


full sickness absence before partial sick
leave could be granted. This legislation
was changed in 2010, making partial
sickness benefit possible already from
the first day of sickness allowance. The
effect of this change remains to be studied. However, an earlier randomized trial
on partial sick leave at the early stage of
disability due to musculoskeletal diseases showed increased sustainable return
to regular activities compared with fulltime sick leave.
In summary, after many years of
persistently high disability rates due to
musculoskeletal disorders, there is increasing evidence for ways to tackle the
problem. This new evidence needs to be
maximally implemented in practice.

Literature
1.

2.

3.

4.

5.

Kausto J. Effect of partial sick leave


on work participation. Doctoral thesis,
University of Helsinki, 2014.
https://helda.helsinki.fi/handle/
10138/42340.
Kausto J, Solovieva S, Virta LJ, ViikariJuntura E. Partial sick leave associated
with disability pension: propensity score
approach in a register-based cohort
study. BMJ Open 2012 Nov 8;2(6). pii:
e001752. doi: 10.1136/
bmjopen-2012-001752.
Shiri R, Martimo KP, Miranda H, Ketola
R, Kaila-Kangas L, Liira H, Karppinen
J, Viikari-Juntura E. The effect of workplace intervention on pain and sickness
absence caused by upper-extremity
musculoskeletal disorders. Scand J Work
Environ Health 2011 Mar;37(2):1208.
van Oostrom SH, Driessen MT, de
Vet HC, Franche RL, Schonstein E,
Loisel P, van Mechelen W, Anema JR.
Workplace interventions for preventing
work disability. Cochrane Database Syst
Rev 2009 Apr 15;(2):CD006955. doi:
10.1002/14651858.CD006955.pub2.
Viikari-Juntura E, Kausto J, Shiri R,
Kaila-Kangas L, Takala EP, Karppinen
J, Miranda H, Luukkonen R, Martimo
KP. Return to work after early parttime sick leave due to musculoskeletal
disorders: a randomized controlled trial.
Scand J Work Environ Health 2012
Mar;38(2):13443.

Contact information
Eira Viikari-Juntura
Research Professor, Director,
Disability Prevention Centre
Finnish Institute of Occupational
Health
Topeliuksenkatu 41 a A
00250 Helsinki, Finland
Email: eira.viikari-juntura@ttl.fi

Barents Newsletter on Occupational Health and Safety 2014;17:71

71

PHOTO Viikari-Juntura

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Reducing work disability related to


musculoskeletal disorders

solutions in Finland
Kari-Pekka Martimo
Finland
photo by Iisakki Hrm

of prolonged or permanent disability than


any one specific MSD. Previous studies
have shown that the higher the number of
painful areas in the musculoskeletal system, the more likely MSDs are to cause
longer disability (4). In addition, half of
employees with chronic MSD also suffer
from depression. This comorbidity causes more often and longer work disability
than MSDs alone (5).

Work and disability

usculoskeletal disorders (MSDs)


comprise medical conditions
affecting the bones, muscles,
joints, tendons, and other related structures. The usual symptoms are pain and reduced mobility, resulting in impaired functional capacity and work disability. MSDs
are multi-etiological by nature, i.e., they
are caused and aggravated by many simultaneous modifiable and non-modifiable
factors, including age, gender, genetics,
physical and mental health, and lifestyleand work-related factors.
A Finnish survey among the working-age population (1) showed that only
one third of the respondents had not experienced any pain in the musculoskeletal system during the preceding month.

The most common complaints were low


back pain (35%), neck/shoulder pain
(2030%), and knee pain (20%). The
prevalence of MSDs has not changed in
recent decades.
According to national statistics,
MSDs are the most common medical
reasons for work disability (2). This
applies to both short-term (33% of all
compensated disability periods lasting
less than a year) and permanent disability (35% of all disability pensions). The
cost of work disability related to MSDs
is significant, not only in terms of lost
working days, but in particular, reduced
productivity at work (3).
Two important factors associated
with MSDs lead to an even greater risk

The Finnish Employers Confederation


annually collects information from companies on working days lost due to medical conditions and accidents (6). From
one year to the next, the lowest sickness absence rate continues to be among
white collar workers, and the highest
among blue collar workers.
The need and decision to take sick
leave is influenced not only by the individual, but, to a greater extent, by workrelated factors. By definition, work
disability can be seen as an imbalance
between the capacity of an employee
and the perceived or explicit demands of
work. The ability to modify their work is
one of the main reasons why white collar
workers have less sick leaves than blue
collar workers.
The most common MSD, low back
pain, has been associated with both
physical and mental workload. Effective prevention of back pain must aim
at reducing harmful exposures at work.
Although all MSDs cannot be prevented, due to their complicated etiology,
employees with MSDs are more likely
to cope with the demands of work in a
safe and health-promoting work environment.

Crucial role of incentives


National jurisdictions differ in relation
to criteria for disability benefits and the
financial burden of work disability to

Barents Newsletter on Occupational Health and Safety 2014;17:7374

73

the employee and the employer. Financial incentives to help employees with
disabilities remain at work or return to
work are related to the costs of sickness
absence and permanent disability to the
employer. In Finland, the employer pays
full salary during the two first weeks
of absence. After this, the Social Insurance Institution (SII) reimburses part of
the salary to the employer for up to two
months. In longer cases, the employee
receives a disability benefit only, paid
directly by SII.
After one year of sickness absence,
if the employee is eligible for disability
pension, the employer is partly responsible for the total costs. Depending on
the size of the workplace, the age of the
employee and his/her salary, the cost of
this to the employer may be significant.
Therefore, most companies have become
interested in work disability prevention,
not only to reduce expenses related to
sickness absence, but especially those
related to permanent disability.

Partial sick leave


In 2007, a law was passed in Finland to
enable partial sick leave. Our study (7)
showed that employees with MSDs who
continue part-time in suitable work return to regular work sooner. They also
have fewer sickness absence days after
the intervention than those on full-time
sick leave. We found no differences in
any health-related measures, including
pain.
A register-based study showed that
in a longer follow-up, partial sick leave
lowered the risk of full-time disability
pension, and that the probability of partial disability pension was higher than
among those on full-time sick leave (see
editorial by Eira Viikari-Juntura). Therefore, part-time sick leave is a scientifically valid option for employees with
MSDs, in regards to their successful
staying at or return to work.

Vocational rehabilitation
Rehabilitation is one solution for reducing the functional restrictions related to
medical conditions. In addition to medical rehabilitation, vocational rehabilitation has become a novel possibility. The
discrepancy between the employees
condition of health and the demands of
work can be corrected by offering the option to retrain and change jobs. Cases of
retraining and work trials have increased
year by year, and the results have been
convincing. One additional year at work
gained through vocational rehabilitation
means that its costs are covered.

74

Early support model


One financial incentive is better reimbursement of the costs of occupational
health services (OHS) to the employer.
This requires the employer to have a realistic model for the early support for employees with health problems and work
disability. These models usually include
a system to monitor sickness absence in
collaboration with OHS, and to actively
contact employees on sick leave. Early
support models require the training of
supervisors on how to support employees when they have difficulties in coping
with the demands of their work because
of MSDs or other medical problems.
Employers are also required to inform OHS as soon as the sickness absence
of an employee exceeds 30 days. The purpose of this is to add timely work-related
solutions to the medical management
of MSDs. Professional confidentiality
means that the employer is not entitled to
know the details of an employees medical condition. However, this is not even
needed, because the focus of the solutions
is to modify work so that the employee
can continue productively, despite health
problems.

Role of OHS
The longer the related work disability,
the less likely the employee is to return to work. The reasons for this may
be medical by nature at the beginning,
but are later more often related to other
reasons, i.e., social, work-related, and
systemic factors. Therefore, a law was
passed in Finland in 2012, that no sickness absence can exceed four months
without an adequate assessment by an
occupational health physician (OHP).
Every employer in Finland has to
organize OHS for all of their employees.
OHPs are familiar with the workplaces,
and therefore more competent than their
clinical colleagues to assess remaining
work ability (rather than work disability) and whether or not the workplace
can accommodate work. The Finnish
OHS system is a bridge-builder between
the health care system and workplaces.
General practitioner level curative care
in addition to prevention provides OHS
with the possibility to intervene in work
disability at an early stage.
The challenge remains, however, in
the value of an employee with disability
in the labour market. Without employers and co-workers good-will and motivation, employees with disabilities will
be excluded from workplaces, even if
they still have a great deal of potential
and motivation left.

Barents Newsletter on Occupational Health and Safety 2014;17:7374

References
1. Kaila-Kangas L, Ed. Musculoskeletal
disorders and diseases in Finland,
Results of the Health 2000 Survey. Publications of the National Public Health
Institute B 25/2007.
http://www.terveys2000.fi/julkaisut.
html 2007
2. Kelan sairausvakuutustilasto (Social Insurance Institution, sickness insurance
statistics) 2012, Sosiaaliturva 2013,
Official Statistics of Finland.
http://uudistuva.kela.fi/it/kelasto/kelasto.nsf/(WWWAllDocsById)/A57170CD
0ADB76FFC2257C1A002CF4F1/$file/
Kelan_sairausvakuutustilasto_2012.pdf
3. Martimo KP, Shiri R, Miranda H,
Ketola R, Varonen H, Viikari-Juntura E.
Effectiveness of an ergonomic intervention on productivity of workers with upper extremity disorders: A randomised
controlled trial. Scand J Work Environ
Health 2010;36(1):2533.
4. Haukka E, Kaila-Kangas L, Ojajrvi A,
Miranda H, Karppinen J, Viikari-Juntura E, Helivaara M, Leino-Arjas P. Pain
in multiple sites and sickness absence
trajectories: a prospective study among
Finns. Pain 2013;154(2):30612.
5. Miranda H, Kaila-Kangas L, Martimo
KP, Leino-Arjas P. The co-occurrence
of musculoskeletal and mental symptoms and its effect on perceived work
ability: time trends in Finland 19972009. Journal of Epidemiology and
Community Health 2011;65: A345
A346.
6. Tyaikakatsaus 2012 (Work Time
Survey). Confederation of Finnish
Industries (EK) http://ek.fi/wp-content/
uploads/Tyaikakatsaus-2012.pdf
7. Viikari-Juntura E, Kausto J, Shiri R,
Kaila-Kangas L, Takala EP, Karppinen
J, Miranda H, Luukkonen R, Martimo
KP. Return to work after early parttime sick leave due to musculoskeletal disorders: randomized controlled
study. Scand J Work Environ Health
2012;38(2):13443.

Contact information
Kari-Pekka Martimo, MD, PhD,
Specialist in OHS and Occupational
Medicine
Director, Effective Occupational
Health Services
Finnish Institute of Occupational
Health
Email: kari-pekka.martimo@ttl.fi


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Email: kari-pekka.martimo@ttl.fi

Have a look at the


electronic publications
by the Finnish Institute of
Occupational Health at
the website: www.ttl.fi/en
A Management Model
for Physical Risks in the
Care Work, 72 pages
Ache and Melancholy,
30 pages

Barents Newsletter on Occupational Health and Safety 2014;17:7577

77

Musculoskeletal
disorders

and return to work in Estonia


Mari Jrvelaid
Estonia

stonia is the smallest of the Baltic states, with 1 315 819 inhabitants (1.1.2014 by Statistics Estonia). Since 1990, the population has
decreased by over 200 000 as a result of
migration and natural negative growth.
(1) Altogether, the number of workingage inhabitants is 671 500. (http://www.
stat.ee/population viewed 11.10.14).
The traditionally higher impact of infant
and child mortality on life expectancy
has been replaced by the growing role
of mortality among the working aged.
The probability of dying between the
ages of 15 and 60 per 1000 population
has declined to 83% among men (301 in
1990 and 249 in 2008) and 79% among
females (107 in 1990 and 84 in 2008).
From the viewpoint of the quality of life,
it is increasingly important to take into
account not only fatal, but also non-fatal
health outcomes. (2)
According to a cross-sectional study,
18.5% of the Estonian population aged
2079 experience some limitations in
their daily activities due to chronic conditions that have developed earlier in the
life course. Altogether, the prevalence
of severe limitations was reported by
10.6% of the population.(3) In Estonia,
the healthy life expectancy is 53.7 years
for males and 56.7 years for females
(http://pub.stat.ee/px-web.2001/Dialog/
Saveshow.asp), which is less than we ourselves estimate.
In Estonia, similarly to Finland, musculoskeletal disorders, together with mental disorders, account for the majority of
permanent disability pensions (4). On 1
January 2014, a total of 411 141 people
received a monthly pension in Estonia;
0.5% more than in 2013. Among these,
22.9% (n=94 325) were not retired due to
old age, but due to work disability. The
primary causes of permanent incapacity
for work are musculoskeletal disorders

78

(25%); cardiovascular disorders (16%);


mental and behavioural disorders (15%);
injuries, poisoning and other external
causes (8%); and cancers (7%). However,
as regards the incidence of occupational
disorders, 68% of cases are musculoskeletal disorders (http://terviseamet.ee/
fileadmin/dok/Tervishoid/tootervis/toost_
pohjustatud_haigused_2012.pdf).
The figures for the incidence of musculoskeletal disorders during the period
19982012 reveal that the incidence of
musculoskeletal disorders per 100 000
population has doubled among both genders in Estonia.
As we know, musculoskeletal disorders are the main causes of temporary
and permanent work disability. So, the
incidence of musculoskeletal disorders

among the working-age population is a


sensitive index number for the quality of
their health. The data on musculoskeletal
disorders of 20- to 64-year-olds by gender
per 100 000 population show that their incidence is quite similar among both genders at the age of 25 to 34, but that later
on, with increasing age, musculoskeletal
disorders are a much more common problem for females.
There are different possible approaches to reducing disability due to
musculoskeletal disorders at work: prevention by reducing work-related risk
factors (primary prevention), prevention
of disability as a consequence of existing musculoskeletal disorders (secondary
prevention), and prevention of the exacerbation of disability (tertiary prevention).

25000

20000

15000
Males
10000

5000

Figure 1. Incidence of musculosceletal disorders per 100 000 population



by gender, 1998-2012

http://pxweb.tai.ee/esf/pxweb2008/Dialog/SaveShow.asp

Barents Newsletter on Occupational Health and Safety 2014;17:7879

Females

35000
30000
25000
20000

Males

15000

Females

10000
5000
0

2024

2534

3544

4554

5564

Figure 2. Incidence of musculosceletal and connective tissue disorders



in age-groups of 20-64-year-olds per 100 000 population by

gender in 2012 (Health Development Institute)

This means that the total sum depends


not only on the health care systems effort, but on the influence of many different factors, among them the accessibility
to occupational health services. The ILO
Convention on Promotional Framework
for Occupational Safety and Health, No
187 is not yet ratified by Estonia, we have
not yet been able to formulate, implement and periodically review a coherent
national policy on Occupational Safety,
Health and the Working Environment in
consultation with the most representative
organizations of employers and workers.
Trade union membership is as low as 7%
in Estonia; it is the goverment that makes
labour market policy, and social partners
do not have veto rights over changes in
the legislation. However, in general, there
is a well-organized system for the early
identification of occupational and workrelated diseases, and according to the risk
assessments of employers, all workers
with any health risk factors should have
a medical check-up at least once every
three years. About 50% of the working
population has undergone a check-up by
an occupational health physician. All occupational health services are provided
by private firms, and are not a part of the
health care services provided by the contracts with the Estonian Health Insurance
Fund. All services are paid by employers.
The physicians must be registrated in the
Health Board, the registry of which contains 101 occupational health physicians
(October 2011), but only about 50% of
these are currently working as occupational health physicians (detailed data are
available on the website of the Estonian
Health Board: www.terviseamet.ee).

References
1. Koppel A, Kahur K, Habicht T, Saar
P, Habicht J, van Ginneken E. Estonia:
Health system review. Health Systems
in Transition. 2008;10:1230.
2. Jrvelaid M. Inimene ja tervis.
Riigikogu Toimetised 2014;29
http://www.riigikogu.ee/rito/index.
php?id=16416
3. Altmets K, Puur A, Uuskla A, Saava
A, Sakkeus L, Katus K. Self-reported
activity limitations among the population aged 2079 in Estonia: a cross-sectional study. European Journal of Public
Health 2010;21:4955. doi:10.1093/
eurpub/ckp239
4. Martimo K-P. Musculoskeletal disorders, disability and work. Finnish Institute of Occupational Health. People and
Work Research Reports 89. Tampere
2010.

Contact information
Dr. Mari Jrvelaid, MD, Dr. Med Sci
Resident physician
University of Tartu, Faculty of
Medicine
North Estonia Medical Centre
Clinic of Psyciatry Paldiski mnt 52
Tallinn ESTONIA EE10614
Email:
mari.jarvelaid@regionaalhaigla.ee


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Workplace health
promotion should be
based on the needs of
the workplace
TOP 10 recommendations for
how to promote employees'
health and well-being at work
Anne Salmi1, Jaana Lerssi-Uskelin1, Leila Hopsu1,
Lsma Kozlova2, Svetlana Lakia2
Finland1 Latvia2

he Health education at workplace


survey: reality and needs projects
newly published TOP 10 recommendations emphasize the integration
of workplace health promotion (WHP)
into daily work life. (1,2,3) The recommendations stress the importance of
everybodys participation and the managements commitment. A balanced approach, in which activities should seek
to improve the quality and conditions

of work life, as well as focus on the behaviour of the individual worker, is also
essential. The TOP 10 recommendations
on how to promote employees health,
well-being and work ability is a checklist for companies. With the help of the
recommendations, companies are made
aware of the most important things to
consider, even if they are not normally
so active in WHP issues.
PHOTO numat-project

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. 79

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, EE10614
Email: mari.jarvelaid@
regionaalhaigla.ee

Barents Newsletter on Occupational Health and Safety 2014;17:8184

81

The recommendations include the


following themes:
1. WHP is based on the needs of the
workplace
2. Management is committed to and
motivated by WHP
3. Everybody has the opportunity to
participate in WHP
4. WHP activities are well-planned
5. WHP is planned on paper. Different
programmes are implemented for
these plans
6. The work environment and ways of
working promote health
7. Health-promoting materials are inspiring, clear and easily accessible to all
8. The workplace is an active member
of society. As well as following laws,
it also takes into account WHP-related recommendations, guidelines and
experts' opinions
9. WHP professionals are consulted
when needed
10. WHP is an integrated and integral
part of work and everyday activities.
The goal of this article, which is based
on the unpublished results of the Health

education at workplace survey: reality


and needs surveys, is to briefly study the
backgrounds of some of the themes and
the factors that have led to them spearheading the list.

Workplaces own leading themes


The Top 10 recommendations were
gathered from the Finnish, Latvian and
Lithuanian companies and employers of
the Health education at workplace survey: reality and needs project. (4) The
total number of project survey respondents was 363: Finland (n=103), Latvia
(n=124) and Lithuania (n=136). The
respondents were from the elderly care
and rehabilitation sectors. Scientific articles will be written on the basis of these
results.

WHP should be based on the needs


of the workplace
WHP activities should be based on an
analysis of the enterprises health requirements. The recommendations encourage companies to regularly organize
well-being at work surveys or interviews, including questions concerning

employees health, work ability and psychosocial issues at work; bullying; stress
levels, etc. Our survey results show that
occupational safety and illness prevention programmes are provided for 73.8%
(Finland), 63.7% (Latvia) and 33.1%
(Lithuania) of respondents. Well-being
also includes safety and ergonomics issues.
A health-promoting workplace also
takes into account individual needs concerning, for example, working hours or
ergonomics. In practice, this means having the option of varying your work
shifts to suit your life situation: for
example, parents of small children may
prefer different kinds of work shifts to
employees taking care of their elderly
relatives. It is clear that being able to
influence work shift planning promotes
a good balance between work life and
family life.
Individual needs can be hard to recognize and support. One way of determining these needs is to hold regular
performance appraisals and career discussions with employees. What about
the other, more general, needs how can
PHOTO BY susanna kemppainen

82

Barents Newsletter on Occupational Health and Safety 2014;17 :8184

companies turn the information provided


by the survey into actions and make the
most of the feedback they receive? This
requires planning, participation, integration, time, and co-operation.

Well-planned WHP activities are


effective
Through the WHP activities are wellplanned theme, companies can check
whether they dedicate enough time and resources to planning WHP activities. Does
management provide sufficient resources
(investing time, money) for carrying out
WHP activities in the organization? Is
WHP planned in a participatory way?
One tip offered by the list is the idea
of supervisors encouraging employees
to ask questions and express their own
thoughts at the workplace. The supportive, guiding role of the supervisor is
important for employees. Survey results
show that supervision of work is clear and continuous for 57.3% (Finland),
77.4% (Latvia) and 58.8% (Lithuania)
of respondents. The main responsibility for WHP is the supervisors, but the
whole work community can and should

participate. As regards responsibility for


WHP, 92.2% of respondents in Finland
answered that promoting ones health is
ones own responsibility, in comparison
with 67.7% in Latvia and 76.5% in Lithuania. Supervisors are in a good position to activate and encourage employees
to participate. An open, sharing and trusting atmosphere also creates well-being
and promotes health at the workplace.

Effectiveness requires co-operation


and participation
Employees tend to know the issues relating to their own work best. Thus it is
worthwhile involving them in planning the
companys safety, health and well-being
at work processes. Every member of the
work community should participate, take
action and have the opportunity to create
health-related initiatives at the workplace.
Survey results show that 73.8% (Finland),
60.5% (Latvia) and 44.9% (Lithuania) of
respondents can initiate changes regarding health at their workplace. Participation
creates communality.
For example, all employees might
not be aware of the OHS available. By

planning the companys modes of activity and health-promoting practices together, everybody has the chance to make a
personal contribution and to learn of the
decisions that have been made concerning the issue. As a result, the practices
are more likely to better suit and serve
the needs of the different professional
groups at the workplace. This leads to
effectiveness.
An open atmosphere is an important part of good quality co-operation.
It is also important to ensure that a new
employees induction training covers
themes such as workplace practices,
forms of communication and responsibility issues. Companies can establish
specific well-being at work groups or
programmes to promote changes in their
work culture. These practices bring both
continuity and power of regeneration to
WHP processes.

A health-promoting work environment is created together


Successful WHP leads to mutual understanding of how work is to be done, how
to foster ones own health, and how to act
PHOTO numat-project

Barents Newsletter on Occupational Health and Safety 2014;17:8184

83

at the workplace. WHP should be an integrated and integral part of work and everyday activities. Both its extent and goals
vary. The recommendations list provides
tips and guidance for planning strategic
company-wide WHP practices, but also
gives advice on how to take employees
personal health into account. The list
also serves as a method for starting the
conversation about how to increase welfare and work ability at the workplace.
In practice, employers encouragement
to foster employees own health (e.g.
to exercise or to eat healthily as part of
a healthy lifestyle or during working
hours) varies. The recommendations list
provides companies with strategic tips
and asks whether workplaces have sport
facilities, or a subsidized, healthy staff
canteen or shop for employees. A smokefree workplace is also recommended, as
well as a relaxation room for employees
use. Encouragement to follow a healthy
lifestyle can also be in the form of healthrelated guidance material, healthy nutrition programmes or health education
seminars. The companys needs form the
basis a health-promoting work environment is created together and is unique.
Companies can also promote employees health in simple ways: by providing shower facilities, storage facilities
for sports equipment and safe places to
park bicycles at the workplace. It pays
to encourage employees to exploit every
opportunity for exercise, by, for example, parking vehicles at a distance from
the door, thus increasing physical activity
during working time. The management
sets an important example. Managers and
entrepreneurs should also reflect on the
amount of sports they do themselves, and
whether or not they do enough to keep
themselves fit.
Nutrition plays an important role in
improving individuals healthy lifestyles. Consequently, a workplace that takes care of employees work fitness also
encourages and promotes healthy dietary
habits during working hours. A company can provide its employees with lunch
boxes, for example, in which they can
store their packed lunches.

The challenge of incorporating


the TOP 10 recommendations into
management practices

good induction training in work tasks, but


also things such as motivating employees
to live healthily. A great deal of work remains to be done in all of these areas.
The Top 10 recommendations on
how to promote employees health and
well-being at work are best executed
through collaboration between the different actors at workplaces. A country
comparison shows that those who initiate WHP activities vary: 70.9% (Finland),
50.0% (Latvia) and 24.3% (Lithuania) of
the answers show that employees initiate
the activities, followed by administration/employer 61.2% (Finland), 62.1%
(Latvia) and 52.9% (Lithuania). Health
and well-being at work will only improve and gain better results with the help of
well-functioning collaboration between
the above mentioned actors. Best of all,
WHP is a process and it is never too late
to get started.
The Health education at workplace survey: reality and needs 20132014 is a
Nordplus Adult-funded project. It has
produced recommendations on how to
promote employees health and well-being at work. The recommendations were
compiled from information in Finnish,
Latvian and Lithuanian workplaces. The
project itself was carried out by the Lithuanian Hygiene Institute, the Lithuanian
Occupational Health Center, the Lithuanian Positive Health Team, the Finnish
Institute of Occupational Health, and the
Latvian Riga Stradins Universitys Institute of Occupational Safety and Environmental Health.
Read about the TOP 10 recommendations on how to promote employees'
health and well-being at work:
www.ttl.fi/en/health/workplace_health_
promotion/Documents/Fact_sheet.pdf
A free printed copy of the TOP 10 recommendations can be ordered by email
from jaana.lerssi-uskelin@ttl.fi.
Workplace health promotion website
in English:
www.ttl.fi/en/health/workplace_health_
promotion

Small and medium-sized companies are


typical in the Baltic countries and in Finland. These companies often need to increase well-being at work investments,
which include occupational health services, occupational safety, personnel training,

84

Barents Newsletter on Occupational Health and Safety 2014;17:8184

References
1.

www.ttl.fi/en/health/workplace_health_
promotion/Documents/Fact_sheet.pdf
2. Lerssi-Uskelin J, Hopsu L, Salmi A.
What is Work Place Health Promotion
(WHP). African Newsletter on
Occupational Health and Safety 2014; 24
(2): 46. Electronic version available:
www.ttl.fi/en/publications/electronic_
journals/african_newsletter/Documents/
AfricanNewsletter2-2014.pdf
3. The Luxembourg Declaration on
Workplace Health Promotion in the
European Union. Electronic access:
http://sund-by-net.dk/sites/sund-by-net.dk/
files/Luxembourg_Declaration_0.pdf
4. Lerssi-Uskelin J, Hopsu L, Salmi A.
Challenging but rewarding international
project. African Newsletter on
Occupational Health and Safety 2014; 24
(2): 43 45. Electronic version available:
www.ttl.fi/en/publications/electronic_
journals/african_newsletter/Documents/
AfricanNewsletter2-2014.pdf

Contact information
Anne Salmi, Senior Specialist
Finnish Institute of Occupational
Health, Promotion of Work Ability
and Health, Finland
anne.salmi@ttl.fi
Jaana Lerssi-Uskelin,
Head of Development
Finnish Institute of Occupational
Health, Promotion of Work Ability
and Health, Finland
jaana.lerssi-uskelin@ttl.fi
Leila Hopsu, Senior Specialist
Finnish Institute of Occupational
Health, Physical Work Capacity,
Finland
leila.hopsu@ttl.fi
Lsma Kozlova, Researcher
Riga Stradin University, Institute of
Occupational Safety and Environmental Health, Latvia
lasma.kozlova@rsu.lv
Svetlana Lakia, Researcher and Public Health Specialist of Laboratory of
Hygiene and Occupational Diseases
Riga Stradin University, Institute of
Occupational Safety and Environmental Health, Latvia
svetlana.lakisa@rsu.lv




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OCCSET project
examines companies
attitudes to workers health
and well-being in Russia
Well-organized medical and occupational health services may create a
competitive edge that may encourage
employees to commit themselves to the
enterprise. The costs of workforce turnover are a challenge for many international enterprises operating in Russia.
The OCCSET project aims to study
and further develop workers health
and well-being in the St. Petersburg
area. By creating a template, the project
seeks ways with which service providers can tackle the challenges they face
when entering a new market area.
The first electronic questionnaire
to study the market was sent out in
April 2014 to 113 Finnish-based companies, of which 27 companies replied.
The thematic interviews carried out in
the summer of 2014 aimed to deepen

the knowledge regarding companies attitudes towards workers well-being and


to find ways in which to provide workers
with medical services, health promotion
and occupational health services.
The thematic interviews revealed
that Finnish-based companies closely
follow the requirements set in the legislation of the Russian Federation when it
comes to occupational safety and periodical medical examinations. The Compulsory Health Insurance is set and regulated by the Federation. Additionally, the
companies can improve their insurance
policies with the Voluntary Health Insurances. The Voluntary Health Insurance is provided by the private insurance
companies which are specialized in such
fields of activities. Majority of Finnish
based and other international companies

use such voluntary health insurances.


Positive workplace health promotion
measures, on the other hand, appear a
promising area for future strengthening.
The two-year project was launched at
the beginning of 2014 by the Saimaa University of Applied Sciences, the Lappeenranta University of Technology and the
Finnish Institute of Occupational Health.
The project is funded by Tekes the
Finnish Funding Agency for Innovation.
www.tekes.fi/en
*OCCSET=Occupational Health Care
Services Template
Additional information from research
manager Henri Karppinen,
email: henri.karppinen@saimia.fi

Barents Newsletter on Occupational Health and Safety 2014;17:89

89

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(email: henri.karppinen@saimia.fi).

Physiotherapists and
optometrists in occupational
health services

experts in workplace
health promotion
Leena Noronen, Juha Pllysaho, Elisa Mkinen
Finland

romoting occupational health and


maintaining ones work ability
demands versatile competence. In
the past, work ability has mainly been
understood as ones own qualification.
Today work ability is increasingly understood to be related to work community and to work. The understanding of
the concept of work ability as a balance
between work and personal qualities is
no longer accurate. It is no longer sufficient to direct actions solely towards the
individual; we must also understand todays continuously changing work life
and society.
Nowadays, tasks are increasingly
carried out in a mobile environment
independent of time and place. Online
working and the use of networks is a
central part of everyday life. Work is
quite often done together in a network,
although we still mainly sit alone in
front of our computers.
In our modern information society,
employees receive the majority of information through their visual system,
which causes eye strain and other visual
symptoms. General stress and a static
sitting position cause hazardous strain
to the musculoskeletal system. In order
to prevent these stress factors, versatile
professional competence in ergonomics, optometry and occupational physiotherapy is needed.

The rapid ageing of the labour force


has resulted in an increased need for support to maintain work ability. Musculoskeletal disorders and ageing eye problems (i.e. presbyopia) are closely related
to work ability. On the other hand, in our
information society, it is often young and
well-educated workers whose work ability suffers due to static stress. The static
sitting position has thus become one of
the major risk factors to general health.
At the same time, the perceptual system
and the brain are suffering from information overload.
Moreover, we must not forget traditional, physically heavy work that causes
strain to the musculoskeletal, cardiovascular and respiratory systems. Here, it is
crucial to recover from disadvantageous
work stress by the means of ergonomics
and physiotherapy.
Today, employees are increasingly
personally responsible for maintaining
their own work ability. For this, they
need help and support. However, the employer is responsible for providing a safe
and healthy work environment. The prerequisite for this is the need to continuously develop work, equipment, and the
work environment.
The goal of occupational health
services (OHS) is to promote the work
ability and occupational health of employees. This is carried out as multi-

professional co-operation between OHS


experts, employees and the employer.
Workplace health promotion and the
support of work ability are complex and
demanding tasks, which require diverse
knowledge and competence. Some of the
key experts used by occupational health
services are physiotherapists and occupational vision experts: optometrists.
These specialists can provide the expertise that is increasingly needed to support employees work ability in todays
rapidly changing work life.

Occupational health physiotherapists enhance work ability at


workplaces
Occupational health physiotherapists are
experts working within multidisciplinary
occupational health service teams. These
physiotherapists either work in the occupational health service units of companies, in private medical centres that
provide health care services to companies, or in the public occupational health
service units of municipal health centres.
They also operate in the private sector as
self-employed professionals and entrepreneurs. An important area is multidisciplinary co-operation with other experts
and professionals who develop and provide occupational well-being services.
According to the Act on Occupational Health Services (Occupational Health

Barents Newsletter on Occupational Health and Safety 2014;17 :9193

91

PHOTO BY Metropolia / Taavi Tihkan

92

Barents Newsletter on Occupational Health and Safety 2014;17:9193

Care Act 1383/2001), an occupational


health physiotherapist is an expert who
is both qualified as a physiotherapist and
has sufficient knowledge of occupational
health services. In practice, the education includes a degree in physiotherapy
as well as further education at a university of applied sciences or at the Finnish
Institute of Occupational Health. Occupational health physiotherapists expertise includes ergonomics and measures
directed at both individuals and groups.
They strive to promote employees physical work ability and functioning in their
own work environment, and also participate in the design of new work premises
and the purchasing of assistive devices.
Occupational health physiotherapists
provide guidance concerning musculoskeletal problems. They measure and
assess physical functional capacity, and
participate in multidisciplinary occupational health service activities and in
various rehabilitation processes.
The core competences of occupational health physiotherapists are in the
assessment of physical workload, applying ergonomics to balance physical
workload, the prevention of work-related
strain injuries and musculoskeletal disorders, and the promotion of well-being at
work. Their basic principle is to enhance
employees health in a comprehensive
manner, by utilizing the physiotherapists own fields of expertise.

Promoting a well-functioning work


environment
Occupational health physiotherapists assess the workload and ergonomic factors
related mainly to physical functioning.
Together with employees, they develop
solutions for improving the work environment. They take part in developing
and planning working conditions by
providing information regarding stress
factors to relevant parties, e.g. for workplace layout planning. They also take
part in the assessment and selection of
optimal furniture, tools and ergonomic
assistive devices. A well-functioning
work environment creates well-being for
the individual and for the work community.

Enhancing employee well-being


A healthy employee is the cornerstone
of a well-functioning workplace. Occupational health physiotherapists give
instructions either individually or in
groups for the promotion and maintenance of functioning and work ability,
based on individual assessment. They

guide employees to select optimal work


movements and postures, assistive devices and tools. They also assess individual needs for physiotherapy or rehabilitation and participate in the planning
and follow-up of rehabilitation.

Development of the work community generates well-being at work


Occupational health physiotherapists
participate in development projects in
the work community and plan and implement, together with employees, activities that maintain work ability. They
inform workplaces of stress factors,
and the close relationship between psychological and physical stress and their
manifestation. They also participate in
developing and implementing fitness
services in enterprises.

Optometrists are vision


experts and promoters
of work ability
The optometrist as a healthcare
professional
Optometrists are the primary health care
practitioners of the eye and visual system. They provide comprehensive eye
and vision care, which includes correcting the eyes optical imperfections,
and dispensing the optical corrections
needed. Optometrists may also detect/diagnose and manage diseases in the eye,
and they can provide rehabilitation for
conditions of the visual system.

Occupational optometry
Occupational optometry is the section of optometric practice that is concerned with the efficient and safe visual
functioning of an individual within the
work environment. It consists of more
than just the prevention of occupational
eye injuries, although this certainly is a
major element. It also includes vision
assessments of workers, taking into account their specific vision requirements
and the demands these requirements
place upon them.

Computer vision syndrome


As people today use computerized
devices every day, they often experience vision-related problems that result
from long periods of staring at visual
displays. Many individuals experience
eye discomfort that appears to increase
with the amount of computer use. These
symptoms may be caused by poor lighting, glare from the computer screen, im-

proper viewing distances, poor seating


posture, uncorrected vision problems or
a combination of these factors.
Many of the visual symptoms experienced by computer users are often
temporary and diminish after ceasing
computer work. However, some individuals may experience continued reduced
visual abilities, such as blurred distance
vision, even if they no longer work at a
computer. If nothing is done to address
the cause of a visual problem, the symptoms will continue to recur and perhaps
worsen, which may affect general work
ability.
Prevention or reduction of the above
mentioned vision problems associated
with computer work involves taking
steps to control lighting and the glare of
the computer screen, establishing proper
working distances and posture for computer viewing, and assuring that even
minor vision problems are properly corrected.

Workplace health promotion is a


co-operative process
In high-quality occupational health services, physiotherapists and optometrists
work in collaboration with other occupational health service professionals, occupational safety officials, employees, and
employers. In the Finnish health care
system, occupational health physicians,
nurses, psychologists, physiotherapists,
and optometrists are the core professionals and experts that form a multi-professional occupational health service team.
Through collaboration within this team,
it is possible to promote well-being at
workplaces and solve the often complex
problems that work life faces today.

Contact information
Leena Noronen,
MEd Senior Specialist
Juha Pllysaho,
OD PhD Senior Lecturer
Elisa Mkinen,
PhD Principal Lecturer
Helsinki Metropolia University of
Applied Sciences
P.O. Box 4000, 00079 Metropolia
Finland

Barents Newsletter on Occupational Health and Safety 2014;17:9193

93




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The 20th Annual Meeting of


the Baltic Sea Network discussed

training of occupational
health personnel
Mirkka Salmensaari
Finland
PHOTO BY Lina muleronkaite

The 20th Annual Meeting of the Baltic Sea Network was held in Vilnius in September 2014.
20- 2014 .

he 20th Annual Meeting of the


Baltic Sea Network on Occupational Health and Safety was held
in Vilnius, Lithuania, on 15-16 September 2014. The programme of the meeting was more diverse than usually, and a
short historical slide-show on the years
of co-operation was shown at the Jubilee
Dinner. The meeting was co-sponsored
by the Norwegian partners and it gathered 40 participants in the beautiful old
city of Vilnius.
The BSN countries reported on their
training systems for occupational health
personnel, including both basic training
and upgrading training. The training systems were commented on and discussed.
It emerged that in several countries,
the average age of trained occupational
health physicians is increasing.

New views for collaboration


Professor Jovanka Bislimovska from the
former Yugoslav Republic of Macedonia
was invited to join the BSN meeting on
the basis of earlier discussions on possible co-operation between the BSN and
the SEENWH (South East European
Network for Workers' Health).
The SEENWH was established in
2006 and its members include Albania, Bosnia and Herzegovina, Bulgaria,
Croatia, FYR Macedonia, Montenegro, Romania, Serbia, and Turkey. The
SEENWH aims at improving workers
health and well-being, and strengthening occupational health systems, policies and services. The main topics at the
annual meetings of the SEENWH so far
have been national strategies and action
plans, country profiles, Basic Occupa-

tional Health Services (BOHS), education and training, and the occupational
health of health care workers, and agricultural workers. Professor Bislimovska
commented on the strengths and current
weaknesses of the network:

Our strength is in our experts


knowledge and excellent professional
experience. Current weaknesses are the
lack of sustainable funding and poor dissemination opportunities.
Jos Verbeek from the Finnish Institute of Occupational Health introduced
the Cochrane Systematic Reviews at
the BSN meeting. Assistant Professor
Eda Merisalu (Estonia) and Professor
Jorma Rantanen (Finland) commented
on these. Norwegian specialists also
gave presentations on collaboration
between safety systems and occupa-

Barents Newsletter on Occupational Health and Safety 2014;17:9798

97

PHOTO BY Lina muleronkaite

The founders of the Baltic Sea Network received Service Awards at the 20th Jubilee Dinner. From the left: Remigijus Jankauskas,
Suvi Lehtinen, Bo Dahlner, Maija Eglite, Jorma Rantanen and Axel Wannag. Founders not present are Kaj Elgstrand, Hubert
Kahn and Boguslaw Baranski.
20-
. : ., . , . , . , . . .
. , .
PHOTO BY Lina muleronkaite

tional health systems from many perspectives.

Joint projects
The current situation of the joint projects
dealing with Reliable accident reporting systems and Healthy lifestyles were
also discussed in the meeting. The accident project has received funding for
the planning period, and is led by Latvia.
The Healthy Lifestyles project has been
planned by the Uppsala University and
will be further reconsidered by WHOEURO, to define how to proceed with
the project plan.

Pivi Mattila-Wiro (Finland) and Magnus Falk (Sweden) attended the BSN meeting
for the first time. The participants enjoyed the spectacular views over the old city of
Vilnius at the Jubilee Dinner.
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98

Barents Newsletter on Occupational Health and Safety 2014;17 :9798

Contact information
Mirkka Salmensaari
Finnish Institute of Occupational Health
E-mail: mirkka.salmensaari@ttl.fi

XX


PHOTO BY Lina muleronkaite


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E-mail:
mirkka.salmensaari@ttl.fi

Barents Newsletter on Occupational Health and Safety 2014;17 :99

99

Barents Newsletter in 2015

Editorial Board

The themes for the Newsletter


to be published in 2015 will be:

Valeri Chashchin, Prof.


Centre of Occupational Health, St. Petersburg,
Russian Federation

1/2015 Arctic work


2/2015 Training of OH personnel
3/2015 Networks of OH&S

Vladimir Masloboev, Dr. Sci. (Techn.)


Kola Science Centre, Russian Federation

All manuscripts addressing the above theme and


other topics in the field of occupational health and
safety are welcome. If you plan to submit a manuscript, kindly contact the Editorial Office in advance
(Email: suvi.lehtinen@ttl.fi). Readers may also
send proposals on potential authors and articles.
The Barents Newsletter does not publish original
scientific articles that have not been through the
peer-review process.

Juri Lupandin, Prof.


Petrozavodsk State University, Russian Federation
Evgeny R. Boyko, Prof.
Institute of Physiology, Ural Division Russian Academy
of Sciences Russian Federation
Anatoly Vinogradov, Ph.D,
Secretary General, Kola Science Centre,
Russian Federation
Randi Eidsmo Reinertsen, Research Director, Prof.
SINTEF Health Research, Norway
Hannu Rintamki, Research Professor
Finnish Institute of Occupational Health, Finland

2015
:
1/2015
2/2015
3/2015


, . ,
, (
: suvi.lehtinen@ttl.fi ).

.

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Collaborative organizations

Finnish Institute of Occupational Health
Institute of Sanitary-Epidemiologic Research,
Petrozavodsk
Institute of Physiology, Russian Academy of Sciences,
Archangelsk
Kola Science Centre, Russian Academy of Sciences
Kola Research Laboratory of Occupational Health
National Institute of Occupational Health,
Oslo, Norway
North-West Public Health Centre, St. Petersburg
St. Petersburg Scientific Research Institute of Labour
and Occupational Diseases
State University of Petrozavodsk
SINTEF Health Research, Norway
Norwegian University of Science and Technology,
Trondheim, Norway