Effectiveness of an ergonomic intervention on the productivity of workers with upper-extremity disorders--a randomized controlled trial.

Objectives: The aim of this study was to investigate the effectiveness of an ergonomic intervention on productivity loss at work caused by upper-extremity disorders (UED).

Methods: Workers with medically verified UED were invited to participate. The intervention consisted of a physician contacting the worker's supervisor and an occupational physiotherapist conducting an ergonomic assessment at the worksite.

Self-reported productivity loss among workers with upper extremity disorders.

Objective: Upper extremity disorders (UED) are prevalent in working populations. This study investigates the prevalence, magnitude, and associated factors of on-the-job productivity loss among workers with UED.

Methods: Workers with incipient upper extremity symptoms were invited to participate in our study after the disorder was verified by a physician and no immediate sick leave was required.

What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians.

Objectives: To identify potential barriers and facilitators to implementing computerized decision support systems (CDSSs) in health care as perceived by clinicians.

Methods: We carried out a qualitative focus group study with primary and secondary health care settings in six areas of Finland. A total of 39 interviewed physicians, of whom 22 practised in primary care and 17 in secondary care.

Antibiotics for acute maxillary sinusitis.

Background: Expert opinions vary on the appropriate role of antibiotics for sinusitis, one of the most commonly diagnosed conditions among adults in ambulatory care.

Objectives: We examined whether antibiotics are effective in treating acute sinusitis, and if so, which antibiotic classes are the most effective.

Search Strategy: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, Issue 3); MEDLINE (1950 to May 2007) and EMBASE (1974 to June 2007).

Antibiotics for adults with clinically diagnosed acute rhinosinusitis: a meta-analysis of individual patient data.

Background: Primary-care physicians continue to overprescribe antibiotics for acute rhinosinusitis because distinction between viral and bacterial sinus infection is difficult. We undertook a meta-analysis of randomised trials based on individual patients' data to assess whether common signs and symptoms can be used to identify a subgroup of patients who benefit from antibiotics.

Methods: We identified suitable trials--in which adult patients with rhinosinusitis-like complaints were randomly assigned to treatment with an antibiotic or a placebo--by searching the Cochrane Central Register of Controlled Trials, Medline, and Embase, and reference lists of reports describing such trials.

Return-to-work policies in Finnish occupational health services.

Aim: To describe return-to-work services for employees on sick leave offered by Finnish occupational health services (OHS).

Methods: Finnish OHS are surveyed every 3 years. Respondents are asked if they offer services to facilitate return to work (RTW), and if so, to describe them.

Recommended and prescribed symptomatic treatment for acute maxillary sinusitis in Finnish primary care.

We studied the use of symptomatic medication in the treatment of acute maxillary sinusitis (AMS) in primary care and whether this use is in accordance with national guidelines. The data was collected annually in the Antimicrobial Treatment Strategies (MIKSTRA) Program in 30 primary health care centres throughout Finland during one week in November in the years from 1998 to 2002. Physicians and nurses collected the data about the diagnoses, prescription-only medicines and over the counter medicines prescribed or recommended for all patients with an infection during the study weeks.

Risk factors of atherosclerosis and shoulder pain--is there an association? A systematic review.

Background: Shoulder pain is prevalent and a common cause of disability at work and daily activities. Some studies suggest an association between risk factors of atherosclerosis and shoulder pain and disorders.

Aim: To assess associations between risk factors of atherosclerosis and shoulder pain or disorders and to discuss possible pathophysiological pathways for found associations.

Factors associated with self-assessed work ability.

Background: Symptoms and health problems caused or aggravated by work are common. In order to study perceived work ability and associated factors, including those related to work, a closer analysis was undertaken in an occupational health setting.

Aims: This study aimed to analyse self-assessed work ability and its determinants in employees seeking medical advice, with special emphasis on work-related factors.

Cardiovascular and lifestyle risk factors in lumbar radicular pain or clinically defined sciatica: a systematic review.

Lumbar radicular pain is a fairly common health problem, yet its risk factors are far from clear. There are no published systematic reviews on associations between cardiovascular or lifestyle risk factors and lumbar radicular pain or sciatica. The aim of this systematic literature review was to assess associations between these risk factors and lumbar radicular pain or sciatica.

The association between carotid intima-media thickness and sciatica.

Objective: Both clinical and epidemiologic studies have shown an association between atherosclerotic changes in the aorta or lumbar arteries and lumbar disc degeneration. However, the association between atherosclerosis and sciatica remains unknown. The aim of this study was to investigate the association between carotid intima-media thickness and sciatica.

Hand dominance in upper extremity musculoskeletal disorders.

Objective: To investigate the role of hand dominance in common upper extremity musculoskeletal disorders (UEMSD) in a population study.

Methods: The target population consisted of a representative sample of people aged 30 years or older residing in Finland during 2000-2001. Of the 7977 eligible subjects, 6254 (78.

Implementing guidelines on acute maxillary sinusitis in general practice--a randomized controlled trial.

Background: Management of acute maxillary sinusitis (AMS) is not optimal; antibiotics are often prescribed for viral sinusitis, which leads to many problems including those with antimicrobial resistance. Guidelines have been proposed as a means to change the professional practices.

Objective: Our aim was to study whether a nationwide guidelines implementation programme has an effect on the management of AMS in primary care.

Cost-effectiveness of implementing national guidelines in the treatment of acute otitis media in children.

Objectives: Acute otitis media (AOM) is one of the most common diseases of childhood, representing a major disease burden on the society. New evidence-based guidelines for AOM, focusing on children under 7 years of age, were introduced in Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of implementing those guidelines in Finland.

Prevalence and determinants of lateral and medial epicondylitis: a population study.

Epicondylitis is a common disorder of the arm, yet the role of individual- and work-related factors has not been addressed in a population study. The aims of this study were to estimate the prevalence of lateral and medial epicondylitis and to investigate their risk factors. The target population of this study comprised a representative sample of people aged 30-64 years residing in Finland during 2000-2001.

Management of pain in acute otitis media in Finnish primary care.

Most treatment recommendations for acute otitis media favour active use of pain relief medication. These data comprised 3059 Finnish primary care acute otitis media patients. We found that 10.

The Antimicrobial Treatment Strategies (MIKSTRA) program: a 5-year follow-up of infection-specific antibiotic use in primary health care and the effect of implementation of treatment guidelines.

Background: A national 5-year follow-up study of infection-specific antibiotic use in primary care was conducted to see if prescribing practices change after implementing new treatment guidelines.

Methods: The data were collected during 1 week of November each year from 1998 to 2002 from 30 health care centers that covered a total population of 819,777 persons and in 2002 from 20 control health care centers that covered a population of 545,098 persons. National guidelines for 6 major infections (otitis media, sinusitis, throat infection, acute bronchitis, urinary tract infection, and bacterial skin infection) were published in 1999-2000.

Prescription rates and diagnostic patterns are stable: a comparison of high-, medium- and low-prescribing primary care physicians treating community-acquired respiratory tract infections.

The objective was to study prescription practices of primary care physicians in prescribing antibiotics for community-acquired respiratory tract infections. Design was time series analysis and cross-sectional survey. The setting was 30 community primary health care centres.

Electronic primary care guidelines with links to Cochrane reviews--EBM Guidelines.

In Finland, guidelines have been used in primary care since the late 1980s to bridge the gap between research evidence and practice. From the very beginning, the electronic format has been the primary source for EBM Guidelines (EBMG). Although also published on CD and in print, the guidelines are currently mostly used via the Internet.

Acute sinusitis: Finnish clinical practice guidelines.

These clinical practice guidelines aim at providing assistance mainly to primary health care physicians for the diagnosis and management of acute sinusitis. Despite the huge impact of upper respiratory infections, criteria for diagnoses are often vague, and physicians are often uncertain of their diagnoses. This is not surprising, as the sole definition of acute sinusitis is somewhat confusing, not to mention the existing discrepancies between treatments, even among specialists.

Management of acute maxillary sinusitis in Finnish primary care. Results from the nationwide MIKSTRA study.

Objectives: To study the management of acute maxillary sinusitis (AMS) in Finnish primary care and to compare it both to recommendations in national guidelines and to the management of other upper respiratory tract infections (URTI).

Design: A cross-sectional multi-centre epidemiological survey.

Setting: Thirty primary care health centres in Finland.

Grading quality of evidence and strength of recommendations.

Users of clinical practice guidelines and other recommendations need to know how much confidence they can place in the recommendations. Systematic and explicit methods of making judgments can reduce errors and improve communication. We have developed a system for grading the quality of evidence and the strength of recommendations that can be applied across a wide range of interventions and contexts.