M. H. W. Frings-Dresen

Effectiveness of measures and implementation strategies in reducing physical work demands due to manual handling at work

OBJECTIVES The purpose of this study was to determine whether workplace smoking policy was associated with respiratory health effects among food and beverage servers. METHODS Data were obtained from a postal survey of hospitality workers. The participation rate for the questionnaire was 73.9% of those contacted. Current smokers were excluded from the analysis. Adjustment for differences between groups in age, gender, ex-smoker versus never smoker status, home exposure environmental tobacco smoke, childhood asthma, mail versus telephone questionnaire, and hours worked per week was done using logistic regression. A subset of 88 nonsmokers underwent laboratory evaluation, including spirometry and hair nicotine analysis. RESULTS The prevalence of irritant and respiratory symptoms among 383 nonsmokers was consistently higher among the participants from premises where smoking was permitted without restrictions on the workplace. In comparison with those from facilities where smoking was prohibited, the highest adjusted odds ratios (OR) were for chronic phlegm for those working where smoking was permitted (OR 8.5 95% confidence interval (95% CI) 2.4-30.0] or where there were partial smoking restrictions (OR 5.7 95% CI 1.7-19.4). Lung function was not reduced apart from the ratio between forced expiratory volume in 1 second and forced vital capacity, which was lower for workers from facilities where smoking was permitted. Hair nicotine levels were lowest for workers from facilities where smoking was prohibited. CONCLUSIONS The results suggest that occupational exposure to environmental tobacco smoke, determined through smoking policies, can adversely affect the respiratory health of nonsmokers who work in the food and beverage service industry.

The effect of individual counselling and education on work ability and disability pension: a prospective intervention study in the construction industry

Objectives: To investigate the effectiveness of a counselling and education programme on work ability and work disability pension for employees in the construction industry. Methods: Employees with a high disability risk of 38% or more in the following four years were included. Employees in the intervention group were either selected by an occupational physician or enrolled themselves. They received an assessment and individual programme focused on optimising work functioning, while the control group received care-as-usual. Data on work ability measured with the Work Ability Index (WAI) and work disability pensions were collected at baseline during a periodic occupational health examination and at 9, 18 and 26 months after the start of the intervention using a questionnaire. Results: Most employees in both the intervention (n = 83) and control group (n = 209) were carpenters (43% and 37%) and bricklayers (7% and 15%). In the intervention group, 42% successfully completed the programme. Work ability in the intervention group was lower at baseline but showed an increase over time while work ability of the control group remained the same. The work ability in the intervention group improved slightly more (p = 0.09). No statistically significant differences in percentages of employees receiving a disability pension between the intervention and control group were found at 9 or 18 months and no differences in the age-adjusted percentages of employees receiving a disability pension were found between the groups at any measurement. Conclusions: The programme was slightly effective in improving the work ability but not in reducing work disability pensions. A more comprehensive multidisciplinary intervention programme might be necessary.

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.1 We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, NIOSHTIC-2, CISDOC and HSELINE up to February 2011. We intended to include randomised controlled trials, controlled before and …

World at work: bricklayers and bricklayers' assistants

Spotlight on the construction industry For ages people have been building shelters and houses using bricks and blocks bound together by mortar. As a result, the trade of bricklayer gradually evolved into what it is today. However, working methods, materials, tools, equipment, and workplaces may vary between workers, construction projects,1 and countries, leading to differences in health and safety risks. In the Netherlands, codes of practice are developed for various professions in the construction industry aimed at reducing health and safety risks. These codes are based on consensus between health and safety experts, employers, and employee organisations. Recently, such a code of practice was developed for bricklayers.2 The facts presented here are based on that document or other sources as research studies, expert opinions, questionnaires, and interviews conducted with employers and employees. The risk assessments are compared with international standards and scientific literature. The aim of this paper is to give an overview of the tasks, health and safety risks, and control measures to reduce or eliminate hazards of the job and in the workplaces of bricklayers and their assistants. Bricklayers are engaged in building and renovating houses, offices, and industrial complexes using bricks, blocks, and mortar. Each day the Dutch bricklayer handles some 800–1100 bricks or an average of 165–220 blocks.3,4 The bricks and blocks are delivered to the construction sites by truck, in packages or in bulk. The bricklayers’ assistant is responsible for the preparation and the transportation of materials and equipment to the actual workplaces. The bricklayer builds the walls by adding mortar and placing the bricks (one handed) or blocks (two handed) in their correct position. In general, one assistant works for two to five bricklayers. Over the years, bricklaying, transporting materials and equipment, and block laying have developed into three specialised …

Perceived employer-related barriers and facilitators for work participation of cancer survivors: A systematic review of employers' and survivors' perspectives

To identify employer‐related barriers and facilitators for work participation of cancer survivors from the perspective of both employers and cancer survivors, and to synthesise these perceived barriers and facilitators to understand their perceived consequences.

Employment status and work-related problems of gastrointestinal cancer patients at diagnosis: a cross-sectional study

Objective To assess the employment status of patients with gastrointestinal cancer at diagnosis and to examine work-related problems of employed patients. Design New, consecutive patients were included at the Gastrointestinal Oncology Center Amsterdam, a one-stop, rapid access diagnostic assessment centre. Patients were interviewed on their employment status by a nurse. If (self-) employed, patients were asked to self-report on work-related problems, perceived distress (0–10), cancer-related problems, fatigue (MFI-20, range 4–20) and work ability (three WAI questions, range 0–10). Results Of all 333 included new consecutive patients (age range 32–89 years), 95 patients (28%) were (self-) employed at time of diagnosis, 179 (54%) were pensioners, and 59 were not working (18%). For the assessment of work-related problems, 45 (47%) of these 95 employed patients with cancer participated. Their mean age was 56 years, and patients had oesophageal/stomach (49%), colorectal (18%) or hepatic/pancreatic/biliary cancer (33%). Half of the employed patients (49%) were still at work, while 51% were on sick leave. The main reasons for sick leave were stress (35%), (scheduled) operation (26%), fatigue (17%) and pain (13%). Most patients on sick leave (70%) had no contact with their own occupational physician, although the majority (67%) would like to continue to work. Work-related problems were experienced by 73% of working patients. The mean work ability was 5.4, the mean general fatigue score was 11.5, and the mean distress score was 4.7. Employed patients on sick leave reported a lower work ability, more fatigue and higher distress but no more cancer-related problems compared with those still working. Conclusion A quarter of all patients with gastrointestinal cancer seen at an oncological centre are employed at time of diagnosis, and of these employed patients, 73% experience work-related problems. During diagnosis and treatment, information and support on work-related issues should be offered to patients with cancer as an essential part of high-quality oncological care.

Determinants of return to work 12 months after total hip and knee arthroplasty

Introduction A substantial number of patients undergoing total hip or knee arthroplasty (THA or TKA) do not or only partially return to work. This study aimed to identify differences in determinants of return to work in THA and TKA. Methods We conducted a prospective, observational study of working patients aged <65 years undergoing THA or TKA for osteoarthritis. The primary outcome was full versus partial or no return to work 12 months postoperatively. Factors analysed included preoperative sociodemographic and work characteristics, alongside the Hip Disability and Osteoarthritis Outcome Score (HOOS)/Knee Injury and Osteoarthritis Outcome Score (KOOS), and Oxford Hip and Knee Scores. Results Of 67 THA and 56 TKA patients, 9 (13%) and 10 (19%), respectively, returned partially and 5 (7%) and 6 (11%), respectively, did not return to work 1 year postoperatively. Preoperative factors associated with partial or no return to work in THA patients were self-employment, absence from work and a better HOOS Activities of Daily Living (ADL) subscale score, whereas only work absence was relevant in TKA patients. Type of surgery modified the impact of ADL scores on return to work. Conclusions In both THA and TKA, absence from work affected return to work, whereas self-employment and better preoperative ADL subscale scores were also associated in THA patients. The impact of ADL scores on return to work was modified by type of surgery. These results suggest that strategies aiming to influence modifiable factors should consider THA and TKA separately.

Terugkeer naar werk na behandeling voor kanker: ervaringen van patiënten en leidinggevenden

SamenvattingDoel van dit onderzoek is om inzicht te krijgen in ervaringen van patiënten en leidinggevenden met de terugkeer naar werk na diagnose en behandeling bij kankerpatiënten. Er zijn drie focusgroepen gevormd: één focusgroep met zeven kankerpatiënten en twee focusgroepen met elk drie leidinggevenden. De gemiddelde leeftijd van de patiënten was 51 jaar en van de leidinggevenden 49 jaar. De belangrijkste themas voor de patiënten waren: contact met collegas en leidinggevende, kennis en advies van de bedrijfsarts, adviezen van andere artsen, en kennis over de late gevolgen van kanker. Voor de leidinggevenden waren de belangrijkste themas: de rol van de leidinggevende zelf en de bedrijfsarts in het werkhervattingproces, werkhervatting en werkaanpassingen, en communicatie met alle betrokken partijen. Werkende kankerpatiënten ondervonden in het algemeen steun van collegas en leidinggevenden. Echter, de beperkte communicatie tussen patiënten, leidinggevenden, bedrijfsartsen, verzekeringsartsen, huisartsen en specialisten werd als een belangrijk knelpunt ervaren in het werkhervattingsproces.

Perceived barriers and facilitators in the assessment of occupational diseases

Background Information is collected worldwide on the diagnosis and assessment of occupational diseases (ODs) by occupational physicians (OPs). However, information on perceived facilitators and barriers to assessment is scarce. Aims To evaluate the perceived barriers and facilitators in the assessment of ODs by OPs. Methods We conducted a qualitative study, using interviews and focus groups. We held 12 interviews and two focus groups with Dutch OPs, to identify barriers and facilitators in the assessment of ODs. Results Case definition, exposure assessment, attribution to work, guidelines and decision tools, external expertise, individual motivation and consequences were identified as themes. Barriers and facilitators were mainly reported regarding assessing work attribution, e.g. how to assess multifactorial causes or the need for training, and individual motivation such as the perceived lack of usefulness or the need for monitoring suspected OD cases. Within the theme of consequences, only barriers to the assessment of ODs were reported, including the liability of employers. Conclusions Perceived facilitators in the assessment of ODs were practical assessment tools, multifaceted education, ability to assess work exposures and professional independence. Perceived barriers were lack of usefulness, lack of urgency, complexity of assessment and concerns about liability issues.

1652d Preventive occupational health interventions: some workplace examples

Three examples of evaluating Dutch workplace interventions will be presented. This is input for discussing the essential elements in evaluations of interventions at workplaces on outcomes for work-related diseases or injuries. Needle stick injuries (NSIs) are frequently reported as occupational injuries among health care workers. The objective of a cluster randomised trial was to evaluate whether the number of NSIs decreased among health care workers at risk (n=796) after introduction of injection needles with safety devices in combination with an interactive workshop in an academic hospital. This combined intervention led to the highest reduction in the number of self–reported NSIs compared to a workshop alone or no intervention. Low back complaints are frequently reported as work–related diseases among bricklayers. The objective of a within–subject controlled intervention study was to evaluate whether work related risk factors and discomfort of the low back decreased among bricklayers (n=10) after introducing a scaffolding console to adjust the working height of the storage of materials in a construction company. Working with a scaffolding console resulted in a significant reduction of the frequency and duration of trunk flexion 79% and 52% respectively, and as well as discomfort of the lower back compared with bricks set out on the ground floor. Occupational risks affect the health of construction workers. The objective of a non–randomised controlled trial was to evaluate whether a job–specific workers’ health surveillance improved the preventive actions of construction workers (n=374) following occupational physicians recommendations. In total 73% of the workers undertook job–specific actions versus 59% in the control group, while occupational physicians provided more job–specific recommendations in the intervention group. Risk assessment, context related interventions and compliance to interventions are essential elements before and alongside the evaluation of real world preventive interventions.