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One objective of the Dutch Organisation for Scientific Research (NWO) Research Programme on Fatigue at Work was to obtain more knowledge about the occurrence and course of fatigue, risk factors, [...]

Abstract:  In some respects, the Dutch seem to be forerunners in Europe. Occupational health care for all workers can be considered as a substantial progress. Nonetheless, The Netherlands has taken the lead in Europe regarding high work pressure, sickness absence and disability for work. The resulting focus on sickness absence management in many companies is associated with changes in the tasks and position of the occupational physician. Quality of occupational health care is not always as high as it should be, partly as a result of the commercial approach occupational health services have to adopt nowadays. However, the post-academic education programme, with special attention for training of skills, is increasingly adapted to occupational physicians working in a commercial environment. Moreover, a basis has been laid for a better infrastructure and occupational physicians show an increase in professional enthusiasm. Furthermore, co-operation between different professionals has become increasingly common, resulting in a more comprehensive support for companies. Efforts are being made for better co-operation with general practitioners and medical specialists. Finally, the priorities for future research have been clearly outlined by a programming study. Experts are in demand for studies regarding implementation and evaluation of interventions, especially cost-benefit analysis. Furthermore, work stress and musculoskeletal disorders remain on the research agenda.

Due to political priorities and benefit arrangements, prevention of work incapacity has played a minor role in employers' policies in the Netherlands. However, the comparatively high sickness absence rates and large numbers of disability benefit recipients in the Netherlands have fostered preventive policies and measures regarding unfavourable working conditions. Corresponding to recent changes in legislation, the role of occupational health and safety services will substantially increase in the coming years. Part of the new orientation will be a multi-disciplinary staff structure and more attention to tailor-made services and effectiveness. There is much debate about the precise role for occupational physicians in the control of sickness absenteeism in companies. This paper presents several instruments which are now being applied or which are still in a developmental stage. The issues of prevention of sickness absence and monitoring of long-term sick employees will remain a substantial part of the responsibilities of occupational health and safety services.

Interest in the quality of instruments for occupational health services is growing as a result of European legislation on preventive services stressing, for example, risk identification and assessment. The quality of the services can be enhanced when the quality of the applied instruments can be judged and improved. To judge quality aspects of instruments, a basic draft scheme and criteria are presented. A first category of criteria covers measurement objective and study design and comprises for example sample strategy and data aggregation level. Technical quality aspects are validity, reliability, standardization and precision. Acceptability of an instrument by employees, employers and professionals belongs to the process quality. At last, strategic quality or presumed utility has to be assessed. As an illustration four instruments have been judged: periodic occupational health surveys, pre-employment medicals, the company audit on work and health, and specific working conditions assessment instruments. Finally the presented basic scheme and criteria are brought into discussion.

Among personnel of the city of Amsterdam the incidence of disability as a result of musculoskeletal problems amounts to 15 per 1000 person-years in the refuse collecting department. A disability prevention programme in accordance with literature was started to decrease this high incidence of disability. In the process-evaluation after 2 years from the start of the project it turned out that only three of the ten preventive measures advocated were realized. These meagre results were explained by strategic factors such as lack of motivation among management and the fact that policy on worker health protection was isolated from the overall company policy. Recommendations for future evaluation research are given.

The outline of a study in occupational health services (OHS) on the prevention and control of effects of whole-body vibration is described and preliminary results are presented here. The study comprises an inventory of current activities of occupational health services in vibration-related issues, the development of a specific OHS-programme and evaluation of this programme, mainly on process level. Results of the inventory, a questionnaire survey in occupational health services (n = 112, response 67%), show that the impact of OHS in prevention and control of adverse health effects is small. The development and evaluation of a specific OHS-programme may be useful in setting up a preventive approach. Some methodologic problems are discussed also.

The results of the general Atlas of Health and Working Conditions by Occupation were compared with the results of the Atlas of Health and Working Conditions in the Construction Industry. Both are based on questionnaire data from periodical occupational health surveys [POHSs]. The scores on most of the items showed considerable differences between the two atlases, partly due to differences in the regional origin of the data. Therefore, direct comparisons between the atlases are biased by regional differences. To study the reliability and the generalizability of the results of both atlases, similarities between the data files with respect to occupations in the construction industry were studied. Most of the items on working conditions, especially those with a widespread distribution, showed a close resemblance between the data files in terms of the relative position of an occupation compared to other occupations in the construction industry. The items on health showed less resemblance, except for the items on musculoskeletal complaints, which showed results similar to those of the work items. These results indicate the reliability and generalizability of the judgements based on both atlases outside the regions of origin, as far as items with a widespread distribution are concerned. Therefore, we recommend the aggregation of POHS data on a national scale, taking regional differences into account. In that way, a greater number of occupations will be described and the reliability of the results will be enhanced.

GEOLOGICAL and palaeomagnetic evidence indicates that after the Permian the Corso–Sardinian plate rotated counterclockwise with respect to stable (extra-Alpine) Europe1–6. Palaeomagnetic directions from Late Oligocene/Early Miocene rocks can be interpreted as indications for a Late Tertiary rotation5,7. Here we present additional palaeomagnetic data from volcanic rocks and tuffites of Tertiary age, collected near the village of Castelsardo on the northern coast of Sardinia (Fig. 1).