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Anttila S.,Finnish Institute of Occupational Health
Archives of Pathology and Laboratory Medicine | Year: 2012

Context.-Diagnosing epithelioid serosal lesions remains a challenge because numerous different processes-primary or secondary, benign or malignant-occur in body cavities, some of which are very rare. Objectives.-To review the newest literature and to describe the morphologic criteria and immunohistochemical markers that are useful for distinguishing epithelioid serosal lesions. Data Sources.-Previously published literature concentrating on the newest research findings. Earlier reviews are principally referred to for established diagnostic criteria. Conclusions.-Immunohistochemistry with a panel of antibodies has made the diagnosis of epithelioid serosal lesions very reliable. When deciding on antibodies used in differential diagnosis, it is important to consider tumor location, clinical and radiologic information, and morphologic features. Immunohistochemistry is less useful in the differential diagnosis of benign versus malignant mesothelial lesions. The diagnosis of benign versusmalignantmesothelial proliferations still relies on the histologic criteria of invasion.

Mischke C.,Finnish Institute of Occupational Health
The Cochrane database of systematic reviews | Year: 2013

There is uncertainty as to whether and what extent occupational safety and health regulation and legislation enforcement activities, such as inspections, are effective and efficient to improve workers' health and safety. We use the term regulation to refer both to regulation and legislation. To assess the effects of occupational safety and health regulation enforcement tools for preventing occupational diseases and injuries. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE (embase.com), CINAHL (EBSCO), PsycINFO (Ovid), OSH update, HeinOnline, Westlaw International, EconLit and Scopus from the inception of each database until January 2013. We also checked reference lists of included articles and contacted study authors to identify additional published, unpublished and ongoing studies. We included randomised controlled trials (RCTs), controlled before-after studies (CBAs), interrupted time series (ITS) and econometric panel studies of firms or workplaces evaluating inspections, warnings or orders, citations or fines, prosecution or firm closure by governmental representatives and if the outcomes were injuries, diseases or exposures.In addition, we included qualitative studies of workers' or employers' attitudes or beliefs towards enforcement tools. Pairs of authors independently extracted data on the main characteristics, the risk of bias and the effects of the interventions. We expressed intervention effects as risk ratios (RR) or mean differences (MD). We recalculated other effect measures into RRs or MDs. We combined the results of similar studies in a meta-analysis. We located 23 studies: two RCTs with 1414 workplaces, two CBAs with 9903 workplaces, one ITS with six outcome measurements, 12 panel studies and six qualitative studies with 310 participants. Studies evaluated the effects of inspections in general and the effects of their consequences, such as penalties. Studies on the effects of prosecution, warnings or closure were not available or were of such quality that we could not include their results. The effect was measured on injury rates, on exposure to physical workload and on compliance with regulation, with a follow-up varying from one to four years. All studies had serious limitations and therefore the quality of the evidence was low to very low. The injury rates in the control groups varied across studies from 1 to 23 injuries per 100 person-years and compliance rates varied from 40% to 75% being compliant.The effects of inspections were inconsistent in seven studies: injury rates decreased or stayed at a similar level compared to no intervention at short and medium-term follow-up. In studies that found a decrease the effect was small with a 10% decrease of the injury rate. At long-term follow-up, in one study there was a significant decrease of 23% (95% confidence interval 8% to 23%) in injury rates and in another study a substantial decrease in accident rates, both compared to no intervention.First inspections, follow-up inspections, complaint and accident inspections resulted in higher compliance rates compared to the average effect of any other type of inspections.In small firms, inspections with citations or with more penalties could result in fewer injuries or more compliance in the short term but not in the medium term.Longer inspections and more frequent inspections probably do not result in more compliance.In two studies, there was no adverse effect of inspections on firm survival, employment or sales.Qualitative studies show that there is support for enforcement among workers. However, workers doubt if the inspections are effective because inspections are rare and violations can be temporarily fixed to mislead inspectors. There is evidence that inspections decrease injuries in the long term but not in the short term. The magnitude of the effect is uncertain. There are no studies that used chemical or physical exposures as outcome. Specific, focused inspections could have larger effects than inspections in general. The effect of fines and penalties is uncertain. The quality of the evidence is low to very low and therefore these conclusions are tentative and can be easily changed by better future studies. There is an urgent need for better designed evaluations, such as pragmatic randomised trials, to establish the effects of existing and novel enforcement methods, especially on exposure and disorders.

Shiri R.,Finnish Institute of Occupational Health
Muscle and Nerve | Year: 2014

This study aimed to assess the magnitude of the association between hypothyroidism and carpal tunnel syndrome (CTS). Eighteen studies were included in a random-effects meta-analysis. A meta-analysis of the studies that did not control their estimates for any confounder showed an association between a thyroid disease (hypo- or hyperthyroidism) and CTS (N=9,573, effect size [ES]=1.32 (95% confidence interval [CI], 1.04-1.68) and between hypothyroidism and CTS (N=64,531, ES=2.15 [95% CI, 1.64-2.83]). When a meta-analysis limited to the studies that controlled their estimates for some potential confounders, the association between a thyroid disease and CTS disappeared (N=4,799, ES=1.17 [95% CI, 0.71-1.92], I2=0%), and the effect size for hypothyroidism largely attenuated (N=71,133, ES=1.44 [95% CI, 1.27-1.63], I2=0%). Moreover, there was evidence of publication bias. This meta-analysis found only a modest association between hypothyroidism and CTS. Confounding and publication bias may still account for part of the remaining excess risk. © 2014 Wiley Periodicals, Inc.

Hakanen J.J.,Finnish Institute of Occupational Health | Schaufeli W.B.,University Utrecht
Journal of Affective Disorders | Year: 2012

Background: Burnout and work engagement have been viewed as opposite, yet distinct states of employee well-being. We investigated whether work-related indicators of well-being (i.e. burnout and work engagement) spill-over and generalize to context-free well-being (i.e. depressive symptoms and life satisfaction). More specifically, we examined the causal direction: does burnout/work engagement lead to depressive symptoms/life satisfaction, or the other way around? Methods: Three surveys were conducted. In 2003, 71% of all Finnish dentists were surveyed (n = 3255), and the response rate of the 3-year follow-up was 84% (n = 2555). The second follow-up was conducted four years later with a response rate of 86% (n = 1964). Structural equation modeling was used to investigate the cross-lagged associations between the study variables across time. Results: Burnout predicted depressive symptoms and life dissatisfaction from T1 to T2 and from T2 to T3. Conversely, work engagement had a negative effect on depressive symptoms and a positive effect on life satisfaction, both from T1 to T2 and from T2 to T3, even after adjusting for the impact of burnout at every occasion. Limitations: The study was conducted among one occupational group, which limits its generalizability. Conclusions: Work-related well-being predicts general wellbeing in the long-term. For example, burnout predicts depressive symptoms and not vice versa. In addition, burnout and work engagement are not direct opposites. Instead, both have unique, incremental impacts on life satisfaction and depressive symptoms. © 2012 Elsevier B.V.

Sauni R.,Finnish Institute of Occupational Health
Cochrane database of systematic reviews (Online) | Year: 2011

Dampness and mould in buildings have been associated with adverse respiratory symptoms, asthma and respiratory infections of inhabitants. Moisture damage is a very common problem in private houses, workplaces and public buildings such as schools. To determine the effectiveness of remediating buildings damaged by dampness and mould in order to reduce or prevent respiratory tract symptoms, infections and symptoms of asthma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1951 to June week 1, 2011), EMBASE (1974 to June 2011), CINAHL (1982 to June 2011), Science Citation Index (1973 to June 2011), Biosis Previews (1989 to June 2011), NIOSHTIC (1930 to November 2010) and CISDOC (1974 to November 2010). Randomised controlled trials (RCTs), cluster-RCTs (cRCTs), interrupted time series studies and controlled before-after (CBA) studies of the effects of remediating dampness and mould in a building on respiratory symptoms, infections and asthma. Two authors independently extracted data and assessed the risk of bias in the included studies. We included eight studies (6538 participants); two RCTs (294 participants), one cRCT (4407 participants) and five CBA studies (1837 participants). The interventions varied from thorough renovation to cleaning only. We found moderate-quality evidence in adults that repairing houses decreased asthma-related symptoms (among others, wheezing (odds ratio (OR) 0.64; 95% confidence interval (CI) 0.55 to 0.75) and respiratory infections (among others, rhinitis (OR 0.57; 95% CI 0.49 to 0.66)). For children, we found moderate-quality evidence that the number of acute care visits (among others mean difference (MD) -0.45; 95% CI -0.76 to -0.14)) decreased in the group receiving thorough remediation.One CBA study showed very low-quality evidence that after repairing a mould-damaged office building, asthma-related and other respiratory symptoms decreased. For children and staff in schools, there was very low-quality evidence that asthma-related and other respiratory symptoms in mould-damaged schools were similar to those of children and staff in non-damaged schools, both before and after intervention. For children, respiratory infections might have decreased after the intervention. We found moderate to very low-quality evidence that repairing mould-damaged houses and offices decreases asthma-related symptoms and respiratory infections compared to no intervention in adults. There is very low-quality evidence that although repairing schools did not significantly change respiratory symptoms in staff or children, pupils' visits to physicians due to a common cold were less frequent after remediation of the school. Better research, preferably with a cRCT design and with more validated outcome measures, is needed.

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