Questionnaires and interviews
Education: The length and level of basic education and occupational training were recorded in the health interview (MS124). Afterwards, educational level was assessed based on the answers using pre-defined criteria (Method folder 3.8-3.9).
Occupation: The occupation was asked as well in the health interview (MS124) as in the basic questionnaire (MS011). The titles were coded using the Nordic Classification of Occupations (Pohjoismainen ammattiluokittelu 1963). Possible inconsistencies between the codes were checked and corrections were made after the field examination stage. In this work the original forms and their marginal comments were used. Current occupation and the most recent occupation classification were made.
Nature of occupation: The physical strenuousness of current work, physical and mental stress factors in current occupation and in the most long-lasting occupation during the career, and exercise when commuting to and from work were inquired in the basic questionnaire (MS011).
Other sociodemographic factors: Family size and structure, marital status, participant’s position in family, family income, type of possible pensions, family head’s occupation, and total and field area of farmer’s farms. The information was mainly received from the health interview (MS 124) and partly from the basic questionnaire (MS011).
Smoking: Former and current smoking was enquired in the health interview (MS124). A combination variable (Method folder 3.10) was created after the field examination. A lifelong exposure (”pack-years”) can be estimated only for individuals smoking at the time for the baseline. Serum cotinine and thiocyanate were determined several years after the field examination from the stored frozen serum samples of all participants.
Alcohol consumption: The information was received from the basic questionnaire (MS011). The average weekly alcohol intake during the last three months from beer, wine and hard liquors was estimated separately and after that combined to the total intake of alcohol (Method folder 3.11).
Exercise: Information about exercise was inquired in the Basic health questionnaire (MS011) and in the Physical activity questionnaire (MS112). Energy consumption was evaluated (Method folder 3.15).
MS112 Physical activity questionnaire
Life-change questionnaire. Information about life-changes at work, in living, in family, in economy etc. was collected with questionnaire MS064.
MS064 Life-change questionnaire
Use of health services and need for treatment: In the health interview the number of and reasons for visiting a physician during the past 2 weeks and 12 months were enquired. The corresponding information was enquired about public health nurse and dentist visits. The interviewer also evaluated whether the participant received enough treatment and rehabilitation. The field physician evaluated the need and sufficiency of treatment due to different chronic diseases in a clinical examination.
Medication: Information concerning the medication used during the past 3 months was obtained from the recipes, health interview, and basic questionnaire. The names of the medicines were coded after the field examination so that each brand name had a specific code. In case the exact name of the medicine was not available a code as exact as possible (e.g. contraceptive pill, cough medicine) was given using a separate classification. The codes were grouped by purpose of use and pharmacological category (Method folder 3.14).
Work ability, functional capacity and functional limitations due to chronic diseases: The data were obtained from several sources: health interview, basic questionnaire, disease specific additional interviews, measurements of muscle strength, joint function examination and clinical examination of the field physician (Aromaa et al. 1989b, Mäkelä et al. 1993).
In the health interview, the restriction of working capacity due to diseases or injuries, limitations of usual daily activities and handicaps were inquired for.
In the basic questionnaire, work ability was inquired and the examinees were asked to record their diseases causing work disability. After the field investigation a physician coded the diseases using three digits of the International Classification of Diseases (ICD 8). Those who were employed were asked how well they managed their present job, whether they had been obliged at some time to change occupation, job or duties because disease or disability, the number of days on sick leave during the past 12 months, and causes for those disabilities.
The basic questionnaire also comprised questions on capacity for recreation and tasks other than those connected with the job. A part of these questions with four self-rated categories (without difficulty; with some difficulty; with great difficulty; cannot do it at all) was adapted from previous surveys focusing on Activities of Daily Living (ADL). Those activities comprised climbing stairs, walking half a kilometer, running 100 and 500 meters, heavy cleaning work, writing, dressing and undressing, retaining and remembering everyday matters, concentrating on affairs and carrying out difficult tasks, travelling by train, bus or tram, and managing affairs together with others or explaining matters to strangers.
Chronic diseases and their treatment: Information was obtained from several sources: health interview, basic questionnaire, disease specific sdditional interviews, clinical examination of a field physician, and the national register of specially reimbursed drugs (Heliövaara et al. 1993b).
In the health interview, chronic diseases were inquired (Method folder 3.13). After the field investigation a physician coded the diseases using three digits of the International Classification of Diseases (ICD 8).
In the basic questionnaire there was a list of 28 diseases and disorders. The examinee was asked whether a physician had ever diagnosed each of them. The list comprised e.g. pulmonary tuberculosis, asthma, coronary heart disease, cardiac failure, arterial hypertension, cerebral stroke, arteriosclerosis of lower limbs (intermittent claudication), varicose veins of lower limbs, osteoarthritis, permanent traumatic injury, diabetes and anaemia. For each diagnosis, further questions regarded previous hospitalization for it, doctor’s current control/care, and previous and present medication for it. The examinee was also asked to record all the previous hospitalizations, operations and their causes. After the field investigation a physician coded the diseases using three digits of the International Classification of Diseases (ICD 8).
Dental care and status of teeth: In the health interview a public health nurse asked about
- visits to dentist (distance to the closest dentist, number of visits during the past 12 months, reason for the last visit, operations by the dentist, and costs of the dentist and dental technician.
- dental health (condition of teeth, toothache, other complaint, the number of missing teeth, removable dentures, self-rated need for fillings, teeth removals and dentures, and ability to chew hard food).
- habits and tools for cleaning teeth (e.g. brushing frequency).
Friendship and family relationships questionnaire: Obtained information on the participants’s closest relationships and on how they experience these relationships (Lehtinen et al. 1985). A form including ten questions was given to the participant when he/she arrived to the health examination, to be filled in during it. If needed, a health nurse completed missing answers by interview (MS016).
MS016 Friendship and family relationships questionnaire
Food questionnaire: The participants completed a food questionnaire (MS053) in connection with the basic questionnaire. The questionnaire included questions on the usage of staple foods from the groups milk products, grain products, meat and fish products, potato and root vegetable, vegetables, fruits and berries, and beverages (including coffee and tea consumption) and sweets during the day preceding the field examination (“what did you eat yesterday?”) at the different meals of the day. Based on the answers a “healthy diet index” was created (Seppänen and Karinpää 1986) (Method folder 3.26).
The health interview (MS124) also included a short series of questions on daily consumption of bread, milk, coffee and tea.
Use of mineral salt: The information was received from form MS110.
Hobby activity was included in the basic questionnaire. The participant was enquired on how often he/she performed eight hobby types (e.g. club- or union activity; study; visiting a restaurant, bar or performing dancing for relaxation).
A-type personality questionnaire (Jenkins Activity Survey, JAS) was mailed to the participants under 65 years of age after the health examination. Based on the questionnaire the so called A-type behavior score was calculated (MS012, Jenkins et al. 1967 ja 1971) (Method folder 3.27).
Psychiatric symptoms questionnaire (MS019) was posted to the invited individuals beforehand and they returned it when they arrived to the basic health examination. The questionnaire consisted of four sub-scales:
- General Health Questionnaire (GHQ 36) includes questions concerning recent changes within the following areas: general health, sleeping disorder, factors related to work ability and functional capacity, readiness for relations, mild stress symptoms, self-esteem disturbances, and depressive and anxiety symptoms (Goldberg 1972).
- Symptom Check List (SCL-90), the somatization domain of the psychiatric symptoms measure, which mainly includes sensations due to imbalance in the vegetative system such as different pain, weakness and dizziness, shortness of breath, and hot and cold waves (Derogatis et al. 1974) (Method folder 3.36).
- Whiteley-index measures hypochondria i.e. a disturbance with the central characteristic of concerned observation of one’s own bodily function and unrealistic interpretation of general physical symptoms and sensations as deviant. The index consists of three domains: pronounced observation of bodily functions, fear or anxiety due to diseases or disease risk, convinced of the presence of some serious disease (Pilowsky 1967).
- A domain consisting of direct questions on perceived mental disorder (duration, and influence on work ability and functional capacity), need for psychiatric treatment and use of mental services (visits to a mental health office, to a psychiatrist’s private practice, to another physician’s private practice, and to a psychologist’s private practice).
MS019 Symptom questionnaire; mental health
Interview on musculoskeletal symptoms was focused on various complaints, their occurrence ever and during the past month, duration, quality, severity and impact on functional ability (MS015). The most important symptoms were pains in lower back, neck, shoulder joints, and other peripheral joints, foot deformities, and walking difficulty due to hip and knee complaints (Sievers et al. 1985, Heliövaara et al. 1993).
MS015 Interview on musculoskeletal symptoms
Coronary and respiratory symptom interview (MS010) included dyspnoea-, chest pain-, and claudication- symptoms and cough- and sputum- symptoms indicating respiratory organ disease (Rose and Blackburn 1968, MCR Committee 1965, Fletcher et al. 1976).
MS010 Cardiovascular diseases and respiratory tract symptoms interview
Additional diabetes interview was performed at the basic health examination in individuals who in the basic questionnaire reported suffering from diabetes diagnosed by a physician (MS050).
MS050 Diabetes: additional interview
Additional asthma interview was completed in the basic health examination for individuals who in the basic questionnaire reported that they suffered from asthma diagnosed by a physician (MS052).
MS052 Asthma: additional interview
Additional cardiovascular diseases interview was performed in the basic examination in individuals who reported in the basic questionnaire that a physician had diagnosed organic heart defect, stroke, lower limb artery disease, hypertension or digitalis- or nitrate- medication (MS051) (Method folder 3.16-3.20).
MS051 Cardiovascular diseases: additional interview
Digitalis interview was carried out at the basic health examination in the individuals using digitalis medication (Impivaara 1986) (MS017).
MS017 Digitalis interview
MS114 Digitalis dose form
Additional musculoskeletal disease treatment and disability interview was performed in the clinical examination in musculoskeletal disease positive individuals and for a 5 % random sample (MS065).
MS065 Musculoskeletal diseases: additional interview
Present State Examination (PSE): A public health nurse specialized in psychiatry and trained for the task, performed an interview for the evaluation of mental health disturbance diagnose for all participants who were screening positive at the baseline health examination (MS056, Wing et al. 1967, Wing et al. 1974) (Method folder 3.34). Part of the PSE-interviews was carried out in the basic examination, part during the clinical examination.
