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Objectives Undergraduate medical teaching in occupational health (OH) is a challenge in universities around the world. Case-based e-learning with an attractive clinical context could improve the attitude of medical students towards OH. The study question is whether case-based e-learning for medical students is more effective in improving knowledge, satisfaction and a positive attitude towards OH than non-case-based textbook learning. Methods Participants, 141 second year medical students, were randomised to either case-based e-learning or text-based learning. Outcome measures were knowledge, satisfaction and attitude towards OH, measured at baseline, directly after the intervention, after 1 week and at 3-month follow-up. Results Of the 141 participants, 130 (92%) completed the questionnaires at short-term follow-up and 41 (29%) at 3-month follow-up. At short-term follow-up, intervention and control groups did not show a significant difference in knowledge nor satisfaction but attitude towards OH was significantly more negative in the intervention group (F=4.041, p=0.047). At 3-month follow-up, there were no significant differences between intervention and control groups for knowledge, satisfaction and attitude. Conclusions We found a significant decrease in favourable attitude during the internship in the experimental group compared with the control group. There were no significant differences in knowledge or satisfaction between case-based e-learning and text-based learning. The attitude towards OH should be further investigated as an outcome of educational programmes. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate process and outcome of a multifaceted occupational health intervention programme on whole-body vibration (WBV) in forklift truck drivers. Methods: An experimental pretest/post-test control group study design. The authors trained occupational health services (OHS) in the experimental group in the use of the programme. OHS in the control group were asked to deliver care as usual. In total, 15 OHS, 32 OHS professionals, 26 companies, and 260 forklift drivers were involved. Post-test measurements were carried out one year after the start of the programme. Results: Baseline data before the start of the programme showed no difference between experimental and control group. Results of the outcome evaluation indicate a slight, although not statistically significant, reduction of WBY exposure in the experimental group (p=0.06). Process evaluation revealed a positive influence on company policy toward WBV, attitude and intended behaviour of forklift drivers, and a trend towards an increase in knowledge of OHS professionals and company managers. The number of observed control measures with a major impact (levelling of surface and reduction of speed) was rather low. In those cases where control measures had been taken, there was a significant reduction in WBV exposure. This limited effect of the programme might be caused by the short period of follow up and the dropout of participants. The feasibility and the usefulness of the programme within the OHS setting were rated good by the participants. Conclusions: This programme to decrease WBV exposure was partially effective. Significant effects on intermediate objectives were observed. More research on the effectiveness of intervention in the field of WBV is needed. [ABSTRACT FROM AUTHOR]

Background: As a result of low numbers and diversity in study type, occupational health intervention studies are not easy to locate in electronic literature databases. Aim: To develop a search strategy that facilitates finding occupational health intervention studies in Medline, both for researchers and practitioners. Methods: A gold standard of articles was created by going through two whole volumes of 19 biomedical journals, both occupational health specialty and non-occupational health journals. Criteria for occupational health intervention studies were: evaluating an intervention with an occupational health outcome and a study design with a control group. Each journal was searched independently by two of the authors. Search terms were developed by asking specialists and counting word frequencies in gold standard articles. Results: Out of 11 022 articles published we found 149 occupational health intervention studies. The most sensitive single terms were work*[tw] (sensitivity 71 %, specificity 88%) and effect*[tw] (sensitivity 75%, specificity 63%). The most sensitive string was (effect*[tw] OR control*[tw] OR evaluation*[tw] OR program*[tw]) AND (work*[tw] OR occupation*[tw] OR prevention*[tw] OR protect*[tw]) (sensitivity 89%, specificity 78%). The most specific single terms were "occupational health"[tw] (sensitivity 22%, specificity 98%) and effectiveness[tw] (sensitivity 22%, specificity 98%). The most specific string was (program[tw] OR "prevention and control"[sh]) AND (occupational[tw] OR worker*[tw]) (sensitivity 47%, specificity 98%). Conclusion: No single search terms are available that can locate occupational health intervention studies sufficiently. The authors' search strings have acceptable sensitivity and specificity to be used by researchers and practitioners respectively. Redefinition and elaboration of keywords in Medline could greatly facilitate the location of occupational health intervention studies. [ABSTRACT FROM AUTHOR]

Aims: To evaluate an occupational health intervention programme for workers at risk for early retirement. Methods: Between April 1997 and May 1998, 116 employees of a large company who were older than 50 years indicated that they would not be able to work up to their retirement. They were randomly assigned to an intervention (n = 61) or control group (n = 55). The intervention programme lasted six months and was executed by an occupational physician. Job position and number of sick leave days after two years were collected from the company's computer database. A questionnaire was sent to the employees at baseline, after six months, and after two years; it included the Work Ability Index, the Utrecht Burn Out Scale, and the Nottingham Health Profile measuring quality of life. Results: Fewer employees (11%) in the intervention group retired early than in the control group (28%). The total average number of sick leave days in two years was 82.3 for the intervention group and 107.8 for the control group. Six months after baseline, employees in the intervention group had better work ability, less burnout, and better quality of life than employees in the control group. Two years after randomisation no differences between the two groups were found. Conclusions: This occupational health intervention programme proved to be a promising intervention in the prevention of early retirement. [ABSTRACT FROM AUTHOR]

Aims: To study supervisory behaviour as a predictive factor for return to work of employees absent due to mental health problems; and to explore the association between conditional factors and supervisory behaviour. Methods: Eighty five supervisors of employees were interviewed by telephone. Questionnaires providing information on person related factors, depressive symptoms, and sickness absence were sent to the employees at baseline, three months, six months, and after one year. Three aspects of supervisory behaviour during the period of absence were measured: communication with the employee, promoting gradual return to work, and consulting of other professionals. Results: Better communication between supervisor and employee was associated with time to full return to work in non-depressed employees. For employees with a high level of depressive symptoms, this association could not be established. Consulting other professionals more often was associated with a longer duration of the sickness absence far both full and partial return to work. If sickness absence had financial consequences for the department, the supervisor was more likely to communicate frequently with the employee. Supervisors who were responsible for return to work in their organisation were more likely to communicate better and to consult more often with other professionals. Conclusion: Supervisors should communicate more frequently with employees during sickness absence as well as hold follow up meetings more often as this is associated with a faster return to work in those employees. [ABSTRACT FROM AUTHOR]

Presents information on a study that examined the psychometric properties of the Depression Anxiety Stress Scales in an occupational health care population. Methodology of the study; Results and discussion on the study.

Background: Rheumatic diseases are a major cause of permanent work disability. In the process of occupational rehabilitation several health professionals may have a role.Objective: To assess the quality and quantity of communication and cooperation between Dutch rheumatologists and occupational physicians.Methods: A postal survey among 187 Dutch rheumatologists.Results: 153/187 rheumatologists (82%) returned the questionnaire. They considered reducing pain and fatigue to be their major responsibility in the process of occupational rehabilitation, followed by improving work participation (68/153 (44%)) and quality of work (55/153 (36%)). Although 112/153 (73%) of the rheumatologists judged the communication and cooperation with occupational physicians as reasonable to good, 119/153 (78%) of them were willing to improve the collaboration. Perceived bottlenecks mentioned were a lack of clarity about the occupational physician's position and activities, and the absence of practice guidelines. The most important prerequisites for improvement were found to be guarantees about the occupational physician's professional independence and more clarity about the competence of the occupational physicians and how they used the information provided.Conclusion: Dutch rheumatologists are willing to improve cooperation and communication with occupational physicians. The perceived lack of clarity about their mutual tasks appears to be a major obstacle. Thus the development of a joint education programme and a guideline for occupational rehabilitation in rheumatic diseases may be appropriate first steps towards improvement. [ABSTRACT FROM AUTHOR]

Assesses consumer satisfaction with occupational health services (OHS). Changes in the organization of occupational health care; Review of publications about the concept of consumer satisfaction with health care; Evaluation on the quality of OHS.

Objectives: To investigate cooperation between occupational physicians (OPs) and general practitioners (GPs).Methods: Literature review; structured interviews; questionnaires sent to randomised samples of OPs (n = 232) and GPs (n = 243).Results: Actual cooperation is poor. However, more than 80% of both groups responded that they want to improve their cooperation, aiming at better quality of care. Obstacles identified by OPs include insufficient knowledge among GPs about occupational health services (OHSs) (57%) and their patients' working conditions (52%). OPs also consider that GPs suspect them of serving employers more than employees (44%) and of verifying reasons of absence, with information from GPs (34%). Responses from GPs confirm these two suspicions (48%, response 58%), adding obstacles like commercialisation of OHS, lack of financial incentives, etc. Both groups are unanimous about prerequisites for improvement, especially guaranteeing the professional autonomy of OPs (OPs 86%, GPs 76%).Conclusion: As a first step to overcome obstacles to cooperation, OPs must clarify their position to GP colleagues. Initiatives have been taken after presenting this study. [ABSTRACT FROM AUTHOR]

Objectives: To assess if the implementation of guidelines for occupational rehabilitation of patients with low back pain by means of process variables--a set of objective criteria for technical performance and continuity of care--led to a better outcome in clinical and return to work variables.Methods: The study group consisted of 59 patients with at least 10 days of sick leave because of low back pain. Univariate analyses as well as multiple logistic regression and Cox's regression analyses were performed to assess the relation between quality of care and outcome.Results: Process indicators for technical competence, continuity of care, and total performance were all significantly related to satisfaction of employees. Continuity of care and total performance were significantly related to working status at 3 months, and time to return to work. None of the process indicators was related to pain or disability after 3 months follow up. Satisfaction was not related to any of the other outcome variables. This indicates that if guidelines for occupational rehabilitation are met, outcome is better.Conclusion: Quality of the process of care was related to outcome. Interventions of occupational physicians need improvement in the areas of continuity of care and communication with treating physicians. The effectiveness of an improved intervention should be studied in a subsequent randomised clinical trial. [ABSTRACT FROM AUTHOR]

Objectives: To study the nature and extent of evaluation research in occupational health services (OHSs).Methods: Literature review of evaluation research in OHSs. On the basis of a conceptual model of OHS evaluation, empirical studies are categorised into aspects of input, process, output, outcome, and OHS core activities.Results: Many methods to evaluate OHSs or OHS activities exist, depending on the objective and object of evaluation. The amount of empirical studies on evaluation of OHSs or OHS activities that met the non-restrictive inclusion criteria, was remarkably limited. Most of the 52 studies were more descriptive than evaluative. The methodological quality of most studies was not high. A differentiated picture of the evidence of effectiveness of OHSs arises. Occupational health consultations and occupational rehabilitation are hardly studied despite much time spent on the consultation by occupational physicians in most countries. The lack of effectiveness and efficiency of the pre-employment examination should lead to its abandonment as a means of selection of personnel by OHSs. Periodic health monitoring or surveillance, and education on occupational health hazards can be carried out with reasonable process quality. Identification and evaluation of occupational health hazards by a workplace survey can be done with a high output quality, which, however, does not guarantee a favourable outcome.Conclusions: Although rigorous study designs are not always applicable or feasible in daily practice, much more effort should be directed at the scientific evaluation of OHSs and OHS instruments. To develop evidence-based occupational health care the quality of evaluation studies should be improved. In particular, process and outcome of consultation and rehabilitation activities of occupational physicians need to be studied more. [ABSTRACT FROM AUTHOR]

Objectives: To (a) describe differences in the outcome of cross sectional and longitudinal analysis on musculoskeletal complaints relative to age and work demands, and (b) to assess the entrance and drop out selection on musculoskeletal complaints among groups of employees relative to age and work demands.Methods: A study population was selected on the basis of questionnaire data from periodical occupational health surveys of almost 45,000 employees collected between 1982 and 1993. From all companies within this data base that participated twice in company wide surveys four years apart, male employees were selected, and stratified for age and work demands. There were several populations: follow up (participation in both surveys); drop out (participation only in the first survey); entrance (participation only at the second survey); and two cross sectional populations (all participants at each survey). Prevalences of back complaints and turnover rates were analysed.Results: Reported back complaints in the cross sectional analysis declined over the oldest age groups in heavy physical work versus a small increase in the longitudinal analysis. The age group 50-9 and back complaints were identified as predictors at the first survey for not participating at the second survey. Neither age nor work demands at the first survey indicated drop out among those employees with back complaints at the first survey. The effects of entrance selection on estimated prevalences were small.Conclusions: The results indicate that musculoskeletal disorders lead to selection out of work, affecting the validity of both cross sectional and longitudinal epidemiological studies. In future studies analyses of turnover figures on musculoskeletal complaints relative to work demands and age are recommended. [ABSTRACT FROM AUTHOR]

Objectives: To examine changes in musculoskeletal complaints over four years in groups of employees relative to age and work demands.Methods: Repeated questionnaire data of male employees in heavy physical work (exposed group, n = 7324) and mental work (control group, n = 4686), stratified for age (20-9, 30-9, 40-9, 50-9), were analysed. For each employee, data on the occurrence of musculoskeletal complaints from two surveys with a mean interval of around four years were available. Changes in prevalences over the follow up interval were analysed. Proportions of new, recovered, and chronic cases as well as those free of complaints at both surveys were studied.Results: For most complaints, there were significantly greater increases in prevalences in the exposed group compared with the control group over the follow up interval particularly within the group aged 40-9 for back, neck, and several sites of the upper and lower limbs. The 20-9 year age group also had significantly greater changes for several musculoskeletal complaints. Within the oldest age group (50-9) exposure to heavy physical work demands only affected changes in prevalences of neck and upper arm complaints. After four years in the cohort free of complaints at the start of the follow up the group aged 40-9 had the highest prevalence of complaints of the back, neck, and the upper and lower limbs.Conclusions: Middle aged and younger employees develop musculoskeletal complaints as a result of exposure to heavy physical work. In the oldest age group health related selection seems to mask the occupational health risks under study. To prevent the expected increase in musculoskeletal disorders and related work disability in our aging workforce, preventive measures should be taken at all stages of a working life. [ABSTRACT FROM AUTHOR]

Objectives: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands.Methods: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics.Results: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect".Conclusions: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands. [ABSTRACT FROM AUTHOR]

Objective and Methods: Health gain, prevention of health loss, and avoidance of financial risk all seem to be driving forces for the use of pre-employment medical assessment. An attempt is made to measure the effect of implementing the pre-employment medical assessment on these end points. The anticipated maximum preventive effect (preventive effectiveness) of selection by means of pre-employment medical assessments for work related risks and the potential for disablement in individual workers can be calculated or estimated. Necessary parameters include test validity characteristics and epidemiological data for both the adverse outcome to be prevented, and risk factors of concern.Results: The preventive effectiveness can be expressed as the effort (number of actions) needed to prevent one adverse event-for example, one case of occupational disease or one case of long term disablement. Actions include: a pre-employment health assessment, rejection of the candidate, individual precautions, adjustments of the job, and adjustments of the job environment. It seems that the preventive effectiveness of many actions can be low, implying that large numbers of actions are needed to prevent one adverse outcome.Discussion: The medical assessment should consist of no more questions and tests than are required relevant to the stated aim. Particularly, when the pre-employment medical assessment is used to reject candidates at risk, the use of tests should be carefully weighed. If the preventive effectiveness is considered to be too low, then the question or test should not be incorporated for selection purposes. The application of a so called "expert judgment" should be based on professional guidelines wherever possible and should be made clear. The benefit of reducing the incidence of a serious adverse event by one may outweigh the costs of rejecting many candidates.Conclusions: The concept of preventive effectiveness may help to reach evidence based occupational medicine, which starts at the pre-employment medical assessment. [ABSTRACT FROM AUTHOR]

Internationally, the debate on aims for occupational health policy is expanding its horizons. Included among the issues are not only concerns about safety for workers, but also for their progeny. Equality among the sexes is also assuming a prominent position. In several countries, existing and proposed legislation already considers these matters. In the course of this article it is argued that this legislation and its implementation are inadequate. There are several reasons for this. Firstly, what constitutes health risks for workers exposed to chemical substances is subject to different interpretations. This is further complicated when one includes risks to reproductive function and to the progeny: the reproductive risks of toxicity. The different interpretations of the concepts of safety and equality are also discussed. There are differences in regulations and in standards about whether or not safety factors should be used when knowledge is uncertain. The operation of reasonable measures with a generic or sex specific policy also differs. Secondly, the current occupational exposure limits are set too high. These aspects are considered and it is probable that the policy aims should be made more specific. An elaborated approach that includes the "precautionary principle" in safety standards is proposed. To advise employers in their role as managers of reproductive risks of toxicity, a recently developed system for occupational health and safety services is described. This system is based on two criteria: effectiveness and reasonableness of proposed measures. The effectiveness criterion includes the precautionary principle; the reasonableness criterion includes equal rights and opportunities for men and women. Finally, a supportive governmental policy that is consistent with the most recent international development is recommended. [ABSTRACT FROM AUTHOR]

Deals with fatigue and the progress in research contributions to occupational health. Risk factors for fatigue; Way to reduce the incidence and prevalence of fatigue; Efficacy of cognitive behavioral interventions in managing stress.

Editorial. Introduces a series of articles which deals with the concept and measurement of fatigue and related problems and disorders among workers.

Objectives: The postgraduate educational programme for occupational physicians on guidelines for work rehabilitation of patients with low back pain was evaluated as to what extent did knowledge of the guidelines increase, and did the workers improve their performance at work.Methods: An experimental group (n=25) attended an educational programme and a reference group did so (n=20) 6 months later. Knowledge and performance were assessed for both groups, before and after education of the experimental group. Knowledge was assessed for the reference group after education.Results: Knowledge increased significantly more in the experimental group. The reference group's score increased further after education. The experimental group's adjusted gain score for performance indicators was significantly positive. Analysis of covariance also showed a significant effect for the experimental group for increased performance score.Conclusions: The educational programme improved the quality of care because knowledge and performance of occupational physicians improved and complied better with practice guidelines. [ABSTRACT FROM AUTHOR]