Assessment of diagnoses and other final conclusions
Final diagnoses were based on self-reports on the basic questionnaire, medications, interviews on symptoms, disease-specific interviews, copies of doctor’s certificates and medical records that the examinees had, and the clinical examination of a field physician including anamnesis, standardized physical status, field physician’s assessments of diagnoses, and conclusions on work capacity, functional performance and need for care. A field physician carried out a standardized examination for screening-positive subjects only (Aromaa et al. 1985, Sievers et al. 1985, Heliövaara et al. 1993a). A random sample of participants (altogether 640) was examined by a physician independently of screening results to evaluate the sensitivity of the screening.
Musculoskeletal diseases: The final assessments were almost entirely based on the field physician’s examination, which included also standardized classifications of physical status (MS061). The most important diagnoses comprised polyarthritis (rheumatoid arthritis as a specific subcategory), osteoarthritis of each hip and knee joint, chronic neck syndrome, chronic low-back syndrome (subcategories of herniated lumbar disc and sciatica), shoulder joint disease, and foot deformity (subcategories of hallux valgus and pes planus). The physician classified each diagnosis as either probable or definite and evaluated the need and adequacy of care/control and need of new measures.
MS061 Musculoskeletal diseases: physician’s examination
Cardiovascular and respiratory diseases: The final assessments were inferred after the field examinations. A special doctor of internal medicine preset diagnostic criteria and assessed the diagnosis on the basis of the clinical examination of field physician, chest x-ray examination, resting ECG, blood pressures, and linked register data on work disability pensions and specially reimbursed medications (MS018). He classified the existence of 15 different cardiovascular and 5 different respiratory diseases. For every disease, he also evaluated the need and adequacy of care/control and need of new measures. The most important diagnoses were myocardial infarction, angina pectoris, arterial hypertension, heart failure, cor pulmonale, cardiac arrhythmia, arteriosclerosis of lower limb (intermittent claudication), cerebrovascular disease and asthma.
MS018 Cardiovascular and respiratory diseases: physician’s examination
Somatic diseases, other: Diabetes, hyperlipidaemia, anemia, bacteriuria and renal failure were diagnosed according to standard criteria on the basis of serological determinations and field physician’s clinical examination (MS060). Other diagnoses recorded in the clinical examination were mainly based on the field physician’s assessments. Additional information on other diseases is also available from the health interview and the basic questionnaire. Field physicians coded the self-reports of participants after the field examinations using the International Classification of Diseases (ICD 8).
The final conclusions and classifications of ability to move, function of upper limbs, physical performance, working capacity, general functional capacity, summary assessment of diseases causing functional limitations (ICD 8 codes), and overall assessments of need and adequacy of care were mainly based on the clinical examination of field physician.
Mental disorder: The diagnostic conclusions were made after the field examination when a psychiatrist defined the criteria and made the diagnoses using the PSE-interview, the medical examination, the retrospective registry follow-up information, and epicrises and physician statements copied during different stages of the field examination (MS077). Especially the following conditions were taken into account: dementia, psychosis, depressive disorder, anxiety disorder, personal disorder, substance abuse and mental retardation.
