Improving opportunities for walking and biking seems to increase physical activity cost-effectively. However, it is necessary to be careful in generalizing the results because of the small number of studies. This review provides important information for decision makers.

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Objectives-To find answers in the literature to the questions if, why, and how consumer satisfaction with occupational health services (OHSs) should be measured. Methods-Publications about the concept of consumer satisfaction with health care and surveys of consumer satisfaction with occupational health care were reviewed. Results-For care providers, surveys of consumer satisfaction can be useful to improve quality or as indicators of noncompliant behaviour among patients. For clients, satisfaction surveys can be helpful for choosing between healthcare providers. Satisfaction is made up of an aVective component of evaluation and a cognitive component of expectations. Also, in occupational health care, patient satisfaction is measured by dimensions such as the humanness and competence of the care provider similar to health care in general. However, there are dimensions that are specific to occupational health-such as the perceived independence of the physician, unclear reasons for visiting an OHS, and the perceived extent of knowledge of OHS professionals about the patient's working conditions. Dimensions of client satisfaction are mostly similar to patient satisfaction but include more businesslike aspects. They are diVerent for the two groups of client, employers and employees. To measure consumer satisfaction in occupational healthcare specific questionnaires must be constructed. To achieve the highest possible reader satisfaction guidelines are provided for construction of a questionnaire. Conclusions-Consumer satisfaction is a complex theoretical concept, but it is relatively easy to measure in practice and can be a valuable tool for quality improvement. Consumers' evaluations of occupational health services will become increasingly important due to changes in the organisation of occupational health care. Occupational healthcare providers are encouraged to measure the consumer satisfaction of their services. (Occup Environ Med 2001;58:272-278)

Background: Commonly recognized childhood conduct problems often lead to costly problems in adulthood. This study aimed to evaluate the long-term cumulative cost of childhood conduct problems until the age of 30. The costs included inpatient care, nervous system medicine purchases, and criminal offences. Methods: The study used population-based nationwide 1981 birth cohort data. Families and teachers assessed the conduct problems of the eight-year-olds based on Rutter questionnaires. We grouped 5,011 children into low-level of conduct problems (52%), intermediate-level of conduct problems (37%), and high-level of conduct problems (11%) groups, based on combined conduct symptoms scores. The analysis included the cohort data with the Care Register for Health Care, the Drug Prescription Register, and the Finnish Police Register. The cost valuation of service use applied national unit costs in 2016 prices. We used Wilcoxon rank-sum test to test the differences between groups and gender. Results: During 1989-2011, average cumulative costs of the high-level (€44,348, p < .001) and the intermediate-level (€19,405, p < .001) of conduct problems groups were higher than the low-level of conduct problems group's (€10,547) costs. In all three groups, the boys' costs were higher than girls' costs. Conclusions: The costs associated with conduct problems in childhood are substantial, showing a clear need for cost-effective interventions. Implementation decisions of interventions benefit from long-term cost-effectiveness modelling studies. Costing studies, like this, provide cost and cost offset information for modelling studies.

Self-certification versus physician certification of sick leave for reducing sickness absence and associated costs.