Dick Spreeuwers

Workplace interventions for treatment of occupational asthma

BACKGROUNDnThe impact of workplace interventions on the outcome of occupational asthma is not well-understood.nnnOBJECTIVESnTo evaluate the effectiveness of workplace interventions on the outcome of occupational asthma.nnnSEARCH STRATEGYnWe searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011.nnnSELECTION CRITERIAnRandomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma.nnnDATA COLLECTION AND ANALYSISnTwo authors independently assessed study eligibility and trial quality, and extracted data.nnnMAIN RESULTSnWe included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low.nnnAUTHORS CONCLUSIONSnThere is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.

Annual incidence of occupational diseases in economic sectors in The Netherlands

Objective To report the annual incidence of occupational diseases (ODs) in economic sectors in The Netherlands. Methods In a 5-year prospective cohort study (2009–2013), occupational physicians were asked to participate in a sentinel surveillance system for OD notification. The inclusion criteria for participation were (1) covering a population of employees, (2) reporting the economic sectors and the size of their employee population and (3) willingness to report all diagnosed ODs. In this study, an OD was defined as a disease with a specific clinical diagnosis that was predominantly caused by work-related factors. The economic sectors (n=21) were defined according the NACE (Nomenclature des Activités Économiques dans la Communauté Européenne) classification. Results In a total working population of 514u2008590 employees, 1782 ODs were reported over 12u2005months in 2009. The estimated annual incidence for any OD was 346 (95% CI 330 to 362) per 100u2008000 worker-years. Of all the ODs, mental diseases were reported most frequently (41%), followed by musculoskeletal (39%), hearing (11%), infectious (4%), skin (3%), neurological (2%) and respiratory (2%) diseases. The four economic sectors with the highest annual incidences per 100u2008000 workers were construction (1127; 95% CI 1002 to 1253), mining and quarrying (888; 95% CI 110 to 1667), water and waste processing (832; 95% CI 518 to 1146) and transport and storage (608; 95% CI 526 to 690). Conclusion ODs are reported in all economic sectors in The Netherlands. Up to 91% of all ODs are mental, musculoskeletal and hearing diseases. Efforts to increase the effective assessment of ODs and compliance in reporting activities enhance the usability of incidence figures for the government, employers and workers.

Review on the validity of self-report to assess work-related diseases

PurposeSelf-report is an efficient and accepted means of assessing population characteristics, risk factors, and diseases. Little is known on the validity of self-reported work-related illness as an indicator of the presence of a work-related disease. This study reviews the evidence on (1) the validity of workers’ self-reported illness and (2) on the validity of workers’ self-assessed work relatedness of an illness.MethodsA systematic literature search was conducted in four databases (Medline, Embase, PsycINFO and OSH-Update). Two reviewers independently performed the article selection and data extraction. The methodological quality of the studies was evaluated, levels of agreement and predictive values were rated against predefined criteria, and sources of heterogeneity were explored.ResultsIn 32 studies, workers’ self-reports of health conditions were compared with the reference standard of expert opinion. We found that agreement was mainly low to moderate. Self-assessed work relatedness of a health condition was examined in only four studies, showing low-to-moderate agreement with expert assessment. The health condition, type of questionnaire, and the case definitions for both self-report and reference standards influence the results of validation studies.ConclusionsWorkers’ self-reported illness may provide valuable information on the presence of disease, although the generalizability of the findings is limited primarily to musculoskeletal and skin disorders. For case finding in a population at risk, e.g., an active workers’ health surveillance program, a sensitive symptom questionnaire with a follow-up by a medical examination may be the best choice. Evidence on the validity of self-assessed work relatedness of a health condition is scarce. Adding well-developed questions to a specific medical diagnosis exploring the relationship between symptoms and work may be a good strategy.

Workplace interventions for treatment of occupational asthma: a Cochrane systematic review

Occupational asthma is the most frequently reported work-related respiratory disease in many countries. It is defined as asthma that is caused by a specific workplace exposure to certain substances and not to factors outside the workplace. In a recent review, the population attributable risk for adult onset asthma being caused by occupational exposures was 17.6%. Occupational asthma can lead to decreased quality of life, sickness absence and increased costs for the patient, the employer and society. Common causes of occupational asthma include exposure to high molecular weight (HMW) agents such as wheat, latex and animal proteins, or to low molecular weight (LMW) agents such as di-isocyanates, acid anhydrides, platinum salts and plicatic acid. There are no systematic reviews of controlled studies of workplace interventions for occupational asthma. Therefore, we conducted a Cochrane systematic review to evaluate the effectiveness of workplace interventions on the outcome of occupational asthma.1nnWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, NIOSHTIC-2, CISDOC and HSELINE up to February 2011.nnWe intended to include randomised controlled trials, controlled before and …

Sentinel Surveillance of Occupational Diseases: A Quality Improvement Project

BACKGROUNDnOccupational diseases are generally underreported. The aim of this study was to evaluate whether a sentinel surveillance project comprising motivated and guided occupational physicians would provide higher quality information than a national registry for a policy to prevent occupational diseases.nnnMETHODSnA group of 45 occupational physicians participated in a sentinel surveillance project for two years. All other occupational physicians (N = 1,729) in the national registry were the reference group. We compared the number of notifications per occupational physician, the proportion of incorrect notifications, and the overall reported incidence of occupational diseases.nnnRESULTSnThe median number of notifications per occupational physician during the project was 13.0 (IQR, 4.5-31.5) in the sentinel group versus 1.0 (IQR, 0.0-5.0) in the reference group (P < 0.001). The proportion of incorrect notifications was 3.3% in the sentinel group and 8.9% in the reference group (P < 0.001). The overall reported occupational disease incidence was 7 times higher (RR = 6.9, 95% CI: 6.5-7.4) in the sentinel group (466 notifications per 100,000 employee years) than in the reference group (67 notifications per 100,000 employee years).nnnCONCLUSIONSnA sentinel surveillance group comprising motivated and guided occupational physicians reported a substantially higher occupational disease incidence and a lower proportion of incorrect notifications than a national registry.

Interventions to increase the reporting of occupational diseases by physicians

BACKGROUNDnUnder-reporting of occupational diseases is an important issue worldwide. The collection of reliable data is essential for public health officials to plan intervention programmes to prevent occupational diseases. Little is known about the effects of interventions for increasing the reporting of occupational diseases.nnnOBJECTIVESnTo evaluate the effects of interventions aimed at increasing the reporting of occupational diseases by physicians.nnnSEARCH METHODSnWe searched the Cochrane Occupational Safety and Health Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PubMed), EMBASE, OSH UPDATE, Database of Abstracts of Reviews of Effects (DARE), OpenSIGLE, and Health Evidence until January 2015.We also checked reference lists of relevant articles and contacted study authors to identify additional published, unpublished, and ongoing studies.nnnSELECTION CRITERIAnWe included randomised controlled trials (RCTs), cluster-RCTs (cRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) of the effects of increasing the reporting of occupational diseases by physicians. The primary outcome was the reporting of occupational diseases measured as the number of physicians reporting or as the rate of reporting occupational diseases.nnnDATA COLLECTION AND ANALYSISnPairs of authors independently assessed study eligibility and risk of bias and extracted data. We expressed intervention effects as risk ratios or rate ratios. We combined the results of similar studies in a meta-analysis. We assessed the overall quality of evidence for each combination of intervention and outcome using the GRADE approach.nnnMAIN RESULTSnWe included seven RCTs and five CBA studies. Six studies evaluated the effectiveness of educational materials alone, one study evaluated educational meetings, four studies evaluated a combination of the two, and one study evaluated a multifaceted educational campaign for increasing the reporting of occupational diseases by physicians. We judged all the included studies to have a high risk of bias.We did not find any studies evaluating the effectiveness of Internet-based interventions or interventions on procedures or techniques of reporting, or the use of financial incentives. Moreover, we did not find any studies evaluating large-scale interventions like the introduction of new laws, existing or new specific disease registries, newly established occupational health services, or surveillance systems. Educational materialsWe found moderate-quality evidence that the use of educational materials did not considerably increase the number of physicians reporting occupational diseases compared to no intervention (risk ratio of 1.11, 95% confidence interval (CI) 0.74 to 1.67). We also found moderate-quality evidence showing that sending a reminder message of a legal obligation to report increased the number of physicians reporting occupational diseases (risk ratio of 1.32, 95% CI 1.05 to 1.66) when compared to a reminder message about the benefits of reporting.We found low-quality evidence that the use of educational materials did not considerably increase the rate of reporting when compared to no intervention. Educational materials plus meetingsWe found moderate-quality evidence that the use of educational materials combined with meetings did not considerably increase the number of physicians reporting when compared to no intervention (risk ratio of 1.22, 95% CI 0.83 to 1.81).We found low-quality evidence that educational materials plus meetings did not considerably increase the rate of reporting when compared to no intervention (rate ratio of 0.77, 95% CI 0.42 to 1.41). Educational meetingsWe found very low-quality evidence showing that educational meetings increased the number of physicians reporting occupational diseases (risk ratio at baseline: 0.82, 95% CI 0.47 to 1.41 and at follow-up: 1.74, 95% CI 1.11 to 2.74) when compared to no intervention.We found very low-quality evidence that educational meetings did not considerably increase the rate of reporting occupational diseases when compared to no intervention (rate ratio at baseline: 1.57, 95% CI 1.22 to 2.02 and at follow-up: 1.92, 95% CI 1.48 to 2.47). Educational campaignWe found very low-quality evidence showing that the use of an educational campaign increased the number of physicians reporting occupational diseases when compared to no intervention (risk ratio at baseline: 0.53, 95% CI 0.19 to 1.50 and at follow-up: 11.59, 95% CI 5.97 to 22.49).nnnAUTHORS CONCLUSIONSnWe found 12 studies to include in this review. They provide evidence ranging from very low to moderate quality showing that educational materials, educational meetings, or a combination of the two do not considerably increase the reporting of occupational diseases. The use of a reminder message on the legal obligation to report might provide some positive results. We need high-quality RCTs to corroborate these findings.Future studies should investigate the effects of large-scale interventions like legislation, existing or new disease-specific registries, newly established occupational health services, or surveillance systems. When randomisation or the identification of a control group is impractical, these large-scale interventions should be evaluated using an interrupted time-series design.We also need studies assessing online reporting and interventions aimed at simplifying procedures or techniques of reporting and the use of financial incentives.

The effectiveness of an educational programme on occupational disease reporting

BACKGROUNDnOccupational diseases are under reported. Targeted education of occupational physicians (OPs) may improve their rate of reporting occupational diseases.nnnAIMnTo study the effectiveness of an active multifaceted workshop aimed at improving OPs reporting of occupational diseases.nnnMETHODSnWe undertook a comparative study with 112 OPs in the intervention group and 571 OPs as comparisons. The intervention was a 1-day workshop. Measurements of occupational disease reporting activity in both groups in 6-month periods before and after the intervention were collected via the national registration system. Measurements of OPs knowledge, self-efficacy and satisfaction were made in the intervention group. Differences between the groups and predictive factors for reporting were subsequently analysed statistically.nnnRESULTSnThe percentage of reporting OPs after the intervention was significantly higher in the intervention group compared to the comparison group at 19 versus 11% (P < 0.01). No differences were found in the average number of reported occupational diseases per reporting physician after the intervention: 3.7 (SD 5.37) versus 3.4 (SD 4.56) (not significant). The self-efficacy score was a predictive factor for reporting occupational diseases (P < 0.05). Measurements of knowledge and self-efficacy increased significantly (both parameters P < 0.001) and remained after half a year. Satisfaction was high (7.85 of 10).nnnCONCLUSIONSnAn active, multifaceted workshop on occupational diseases is effective in increasing the number of physicians reporting occupational diseases. Self-efficacy measures are a predictive factor for such reporting.

Diagnosing and reporting of occupational diseases: a quality improvement study

AIMnTo assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder.nnnMETHODSnPerformance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were sent to all occupational physicians recorded on the Netherlands Centre for Occupational Diseases database. The performance of responding occupational physicians was then assessed by separate scores per performance indicator and by a total quality score.nnnRESULTSnTwenty-three questionnaires on noise-induced occupational hearing loss and 125 questionnaires on occupational adjustment disorder were available for analysis. The mean quality score for diagnosing and reporting was 6.0 (SD: 1.4) for noise-induced occupational hearing loss and 7.9 (SD: 1.5) for occupational adjustment disorder on a scale of 0-10. For noise-induced occupational hearing loss, there was a need for quality improvement of the aspects of medical history, audiometric measurement, clinical diagnosis of the disease and reporting. For occupational adjustment disorder, the assessment of other non-occupational causes needed improvement.nnnCONCLUSIONSnThe quality of diagnosing and reporting could be improved for noise-induced occupational hearing loss and occupational adjustment disorders. Information, education and practical tools are proposed for quality improvements.

Information and feedback to improve occupational physicians’ reporting of occupational diseases: a randomised controlled trial

PurposeTo assess the effectiveness of supplying occupational physicians (OPs) with targeted and stage-matched information or with feedback on reporting occupational diseases to the national registry in the Netherlands.MethodsIn a randomized controlled design, 1076 OPs were divided into three groups based on previous reporting behaviour: precontemplators not considering reporting, contemplators considering reporting and actioners reporting occupational diseases. Precontemplators and contemplators were randomly assigned to receive stage-matched, stage-mismatched or general information. Actioners were randomly assigned to receive personalized or standardized feedback upon notification. Outcome measures were the number of OPs reporting and the number of reported occupational diseases in a 180-day period before and after the intervention.ResultsPrecontemplators were significantly more male and self-employed compared to contemplators and actioners. There was no significant effect of stage-matched information versus stage-mismatched or general information on the percentage of reporting OPs and on the mean number of notifications in each group. Receiving any information affected reporting more in contemplators than in precontemplators. The mean number of notifications in actioners increased more after personalized feedback than after standardized feedback, but the difference was not significant.ConclusionsThis study supports the concept that contemplators are more susceptible to receiving information but could not confirm an effect of stage-matching this information on reporting occupational diseases to the national registry.

Work-related upper extremity disorders: one-year follow-up in an occupational diseases registry.

PurposeTo study the course and consequences of work-related upper extremity disorders in the registry of the Netherlands Centre for Occupational Diseases (NCvB).MethodsA follow-up study was performed in a sample of consecutive cases of work-related upper extremity disorders notified to the NCvB. Perceived severity was measured with VAS (0-100), quality of life with VAS (0-100) and SF-36, functional impairment with DASH and sickness absence with a questionnaire. Measurements took place directly after notification (T0) and after 3, 6 and 12xa0months (T1-T3). A linear mixed model was used to compare scores over time.ResultsAverage age of the 48 consecutive patients (89% response) was 42xa0years; 48% were men. Perceived severity, functional impairment and sickness absence decreased statistically significant during the follow-up period, and quality of life scores improved. Patients older than 45xa0years scored worse on perceived severity of the disease, functional impairment and quality of life than did younger patients.ConclusionsThe role of registries of occupational diseases for preventive policy can be extended by creating longitudinal data in sample projects. In the sample from our registry, work-related upper extremity disorders had a favourable course.