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Biomedical subjects

A P Nauta

Publications and source records attributed to A P Nauta.

6 recordsLinked to original sources
PubMed2006

Prognostic indicators for non-recovery of non-traumatic complaints at arm, neck and shoulder in general practice--6 months follow-up.

OBJECTIVES: To identify predictors of non-recovery in non-traumatic complaints at the arm, neck and shoulder in general practice 6 months after the first consultation. METHODS: A prospective cohort study was set in 21 Dutch general practices. Consulters with a first or new episode of non-traumatic arm, neck or shoulder complaints and age 18 through 64 yrs entered the cohort. Complaint, patient, physical, psychosocial and work characteristics were investigated as possible predictors of non-recovery at 6 months using multiple logistic regression analyses (backward Wald). RESULTS: At 6 months, 46% of the total population (n = 612) and 42% of the working subpopulation (n = 473) still reported complaints. Complaint characteristics (long duration of the complaint before consultation, recurrent complaint, musculoskeletal comorbidity and complaint mainly located at wrist or hand) were most predictive of non-recovery followed by psychosocial characteristics (more somatization and experiencing less social support). Having a specific diagnosis was associated with recovery. In the working subpopulation, the same variables were predictors of non-recovery. Additionally, low supervisory support was associated with non-recovery. The models correctly classified 72-75% of the patients (explained variance 0.27-0.28). CONCLUSIONS: Besides questions on complaint characteristics, information on somatization and support can help a general practitioner to recognize patients at risk of persistent complaints.

Adolescent↗
PubMed2005

[Limited change in the quality of the social medical guidance and in the satisfaction of sick-listed patients, after collaborative projects between general practitioners and occupational physicians].

OBJECTIVE: To evaluate whether regional projects for collaboration between general practitioners (GPs) and occupational physicians (OPs) improved the quality of their social medical guidance (SMG) and the satisfaction of their patients. DESIGN: Evaluation study with before and after measurements with respect to the same GPs and OPs. METHOD: Structured interviews were conducted with 58 GPs and 83 OPs regarding the SMG of their sick-listed patients. Before the project, the SMG of 1109 sick-listed patients was assessed and after the project, 1 or 1.5 years later, the SMG of 1121 sick-listed patients. These patients were sent a questionnaire by means of which their satisfaction could be assessed. RESULTS: After the projects, the quality ofthe diagnosis by the OPs was improved and they also more often adhered to the official guidelines of the KNMG (Royal Netherlands Medical Association) when contacting the GP about a patient. The GPs more often contacted the OP if they needed more information about a patient after reaching a diagnosis. Nevertheless, in half to three-quarters of the patients for whom contact between GPs and OPs was indicated, this contact did not take place. There was no significant increase in patient satisfaction. Before the projects, patients gave their GP a grade of 8.2 on a 10-point scale and after the projects this was 8.5; the OPs were given a grade of 7.5 both times. Further analysis showed that there was no significant relation between the quality ofthe SMG and the patient's satisfaction with the doctor. CONCLUSION: Although there was some improvement in the quality of the SMG, there was still insufficient cooperation between GPs and OPs compared to the guidelines. An increase in patient satisfaction was not demonstrated.

Adolescent↗
PubMed2005

In a controlled trial training general practitioners and occupational physicians to collaborate did not influence sickleave of patients with low back pain.

OBJECTIVE: The objective of this study was to determine the effectiveness of a training to increase collaboration between general practitioners and occupational health physicians in the treatment of patients with low back pain (LBP) because more collaboration might improve a patient's recovery and shorten sick leave. METHODS: In a controlled trial, the intervention in one region was compared with usual care in a control region. Participating physicians enrolled patients with LBP on sick leave for 3-12 weeks. Patients filled out three questionnaires: at inclusion, at 3 months, and at 6 months. Information on sick leave was gathered from occupational health services. All analyses were performed on an intention-to-treat basis. RESULTS: Fifty-six patients with LBP were enrolled in each region. There was little collaboration between physicians during the project. Patients in the intervention region returned to work significantly later (P=.005) but were significantly more satisfied with their occupational health physician (P=.01). No differences were found between the intervention and control patients for pain, disability, quality of life, and medical consumption. CONCLUSION: Our study does not show a positive effect of the training to increase collaboration between general practitioners and occupational health physicians. The training may not have improved collaboration enough to influence the prognosis of LBP.

Adult↗
PubMed2001

Factors predicting trust between GPs and OPs.

PURPOSE: To study possible differences in trust between general practitioners (GPs) and occupational physicians (OPs) and the explanatory factors for trust. Insight into the factors predicting trust can improve programmes for stimulating the co-operation of GPs and OPs. THEORY: On the basis of theories of trust and of social identity theory we expected, (1) in both professions a higher level of knowledge-based trust than of identification-based trust, (2) a relationship between higher levels of identification-based trust and higher frequency of contact, (3) OPs to have a higher level of identification-based trust than GPs. We hypothesised (4) that OPs perceiving an equal status have higher levels of trust and (5) GPs perceiving a higher status have lower levels of trust. METHODS: A mail survey sent to 2297 doctors (1728 GPs and 569 OPs) of which we used 547 questionnaires. RESULTS: Hypotheses 1 and 2 were supported. Hypothesis 3 was not supported. Hypotheses 4 and 5 were supported for knowledge-based trust. On the basis of these findings it is possible that co-operation between the two groups is still in its early stages. CONCLUSIONS: Programmes to improve the co-operation of GPs and OPs should focus on equalising status and stimulating contacts to build (identification-based) trust.

Journal Article↗
PubMed1991

Lyme borreliosis in Dutch forestry workers.

Serum samples from 127 Dutch forestry workers and 127 matched controls were tested for antibodies against Borrelia burgdorferi in an indirect immunofluorescence assay (IFA). Those of the forestry workers were also tested by Western blotting. The forestry workers were examined clinically for evidence of Lyme borreliosis without the examiner or the workers knowing the results of the laboratory tests. Seroprevalence of B. burgdorferi antibodies among forestry workers (25/127) was significantly higher than among controls matched for age and place of residence (8/127), odds ratio 3.7 (95% CI 1.5-9.7). Of the 25 sera of forestry workers positive in the IFA, 23 reacted with at least five bacterial polypeptides in the Western blot test. According to adapted CDC criteria, seven forestry workers (6%) were classified as being a case of Lyme borreliosis. In only one of them had the diagnosis been made before this investigation. Five persons had a history of erythema migrans, one of arthritis, and one of persistent infection. We conclude that Lyme borreliosis is an occupational disease among forestry workers in the Netherlands, with a three-fold higher seroprevalence than among matched controls. The disease, often not diagnosed among this high-risk group, warrants more attention to achieve early recognition and to prevent late complications.

Adult↗