Biomedical subjects

F J van Dijk

Publications and source records attributed to F J van Dijk.

At least 19 recordsLinked to original sources

PubMed2001

Dutch Musculoskeletal Questionnaire: description and basic qualities.

A questionnaire ('Dutch Musculoskeletal Questionnaire', DMQ) for the analysis of musculoskeletal workload and associated potential hazardous working conditions as well as musculoskeletal symptoms in worker populations is described and its qualities are explored using a database of 1575 workers in various occupations who completed the questionnaire. The 63 questions on musculoskeletal workload and associated potentially hazardous working conditions can be categorized into seven indices (force, dynamic and static load, repetitive load, climatic factors, vibration and ergonomic environmental factors). Together with four separate questions on standing, sitting, walking and uncomfortable postures, the indices constitute a brief overview of the main findings on musculoskeletal workload and associated potentially hazardous working conditions. Homogeneity of the indices is satisfactory. The divergent validity of the indices is fair when compared with an index of psychosocial working conditions and discomfort during exposure to physical loads. Worker groups with contrasting musculoskeletal loads can be differentiated on the basis of the indices and other factors. With respect to the concurrent validity, it appears that most indices and factors show significant associations with low back and/or neck-shoulder symptoms. This questionnaire can be used as a simple and quick inventory for occupational health services to identify worker groups in which a more thorough ergonomic analysis is indicated.

Adult↗

PubMed2001

Factors affecting FEV1 in workers with potroom asthma after their removal from exposure.

OBJECTIVE: In this study the relationship has been studied between exposure time and potential prognostic factors and FEV1 percent predicted (FEV1-% pred) in workers with potroom asthma, after their transfer from exposure to exposure-free departments. METHODS: Between 1970 and 1990 in a Dutch aluminium-production plant, 179 workers had been diagnosed as having potroom asthma. We carried out a follow-up study (n = 122) in the population still present at the factory 5 years after their relocation to an exposure-free department. In this study population, we examined the relationship between FEV1-% pred at follow-up, and exposure time: the time interval between start of exposure and diagnosis. To correct for confounding factors, we included age, pre-employment FEV1-% pred, allergy, medical treatment, and smoking in the analysis. RESULTS: The mean FEV1-% pred at follow-up was within the normal range (90.3, SD 13.5). Long exposure time was significantly associated with a low FEV1-% pred at follow-up (P = 0.0046). Adjustment was necessary for pre-employment FEV1-% pred and current smoking as confounding factors. CONCLUSION: Long duration of exposure is a factor affecting FEV1 in workers with potroom asthma. The results of this study give support for additional preventive measures to be taken, such as early recognition of work-related respiratory complaints and repeated education.

Aluminum↗

PubMed2001

The benefits of interventions for work-related stress.

OBJECTIVES: This quantitative meta-analysis sought to determine the effectiveness of occupational stress-reducing interventions and the populations for which such interventions are most beneficial. METHODS: Forty-eight experimental studies (n = 3736) were included in the analysis. Four intervention types were distinguished: cognitive-behavioral interventions, relaxation techniques, multimodal programs, and organization-focused interventions. RESULTS: A small but significant overall effect was found. A moderate effect was found for cognitive-behavioral interventions and multimodal interventions, and a small effect was found for relaxation techniques. The effect size for organization-focused interventions was nonsignificant. Effects were most pronounced on the following outcome categories: complaints, psychologic resources and responses, and perceived quality of work life. CONCLUSIONS: Stress management interventions are effective. Cognitive-behavioral interventions are more effective than the other intervention types.

Behavior Therapy↗

PubMed2000

Questionnaire surveys on health and working conditions: development of an instrument for risk assessment in companies.

Periodic Occupational Health Surveys (POHS) are frequently used by occupational health and safety services in the Netherlands as a risk assessment instrument. These surveys include a questionnaire on work and health. Systematic attention is paid in this questionnaire to a broad range of working conditions and health complaints. In this article a method is presented to identify and evaluate work risks and health problems in groups of workers. Working conditions and health in any given company or department are assessed by comparing questionnaire data from its worker populations with data from one or more reference populations. Significant differences are interpreted as signals for both adverse working conditions and health problems. Considerations and choices with regard to the technical, operational and strategic quality of the method are elucidated. Probabilities of alpha- and beta-errors, choice of significance levels, and selection of reference populations are dealt with. Finally, a way of presentation of the results is shown. The method is considered to be part of a broader approach toward risk assessment. We recommend the combined use of questionnaire results and other available information, such as workplace surveys and sickness absence data. Questionnaires about work and health can be seen as one step in a multi-phase design: like in many diagnostic processes, the latter phases can enhance the precision of previous results. Recommendations are made for validating and evaluating this instrument.

Humans↗

PubMed2000

The relationship between leisure time, physical activities and musculoskeletal symptoms and disability in worker populations.

OBJECTIVES: To assess the association between leisure time physical activity and musculoskeletal morbidity, as well as possible interactions with physical activity at work. METHODS: A literature search was performed to collect all studies on musculoskeletal disorders in which physical activity was involved as a variable. Next, an analysis was made of questionnaire data on a group of 2,030 workers in various occupations, on self-reported physical activity in leisure time and at work, musculoskeletal symptoms (from low back, neck-shoulder and lower extremity) and sick leave due to these symptoms. A logistic regression analysis was carried out to estimate the association between musculoskeletal morbidity and four physical-activity indices (participation in sports and sedentary activities, active life style, sedentary life style), adjusted for age, gender, education and work load. Interaction of leisure activities with age and work load was tested too. RESULTS: Available literature data (39 studies) showed inconsistent results. Most studies did not show any effects. Some studies indicated favourable effects of physical activity, both on low back and neck pain. Participation in some vigorous sports seemed associated with unfavourable effects. The empirical data showed no association between participation in sports and/or other physical activities in leisure time and musculoskeletal symptoms. Sedentary activity in leisure time was associated with higher prevalence rates of low back symptoms and sick leave due to low back symptoms. CONCLUSIONS: Stimulation of leisure time physical activity may constitute one of the means of reducing musculoskeletal morbidity in the working population, in particular in sedentary workers.

Adult↗

PubMed2000

Evaluation of a postgraduate educational programme for occupational physicians on work rehabilitation guidelines for patients with low back pain.

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.

Clinical Competence↗

PubMed1999

Recent changes in occupational medicine in The Netherlands.

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.

Absenteeism↗

PubMed1999

Evaluation research in occupational health services: general principles and a systematic review of empirical studies.

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.

Evaluation Studies as Topic↗

PubMed1999

Relation between indicators for quality of occupational rehabilitation of employees with low back pain.

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.

Adult↗

PubMed1999

Prognostic factors for chronic disability from acute low-back pain in occupational health care.

OBJECTIVES: This study attempted to determine the prognostic indicators of low-back pain in an occupational health setting. METHODS: The identification of prognostic factors of (i) functional disability after 3 months' follow-up, (ii) functional disability after 12 months' follow-up, and (iii) time to return to work among 120 workers who reported to an occupational health unit and were off work with low-back pain for at least 10 days. Crude and adjusted odds ratios and hazard ratios with 95% confidence intervals were estimated for the 3 outcome measures. RESULTS: Factors related to a longer time to return to work were radiating pain, high functional disability at the beginning of the study, problems in relations with colleagues, and high work tempo and work quantity. High functional disability at the beginning of the study and a high avoidance coping style predicted functional disability at 3 months. Functional disability at 12 months was more accurately predicted by work-related and psychosocial factors. CONCLUSIONS: Especially radiating pain and functional disability predict a long duration of low-back pain in occupational health practice. Occupational physicians should also note work-related and psychosocial characteristics.

Acute Disease↗

PubMed1998

Pushing and pulling in relation to musculoskeletal disorders: a review of risk factors.

The objective was to review the literature on risk factors for musculoskeletal disorders related to pushing and pulling. The risk factors have been described and evaluated from four perspectives: epidemiology, psychophysics, physiology, and biomechanics. Epidemiological studies have shown, based on cross-sectional data, that pushing and pulling is associated with low back pain. Evidence with respect to complaints of other parts of the musculoskeletal system is lacking. Risk factors have been found to influence the maximum (acceptable) push or pull forces as well as the physiological and mechanical strain on the human body. The risk factors have been divided into: (a) work situation, such as distance, frequency, handle height, and cart weight, (b) actual working method and posture/movement/exerted forces, such as foot distance and velocity, and (c) worker's characteristics, such as body weight. Longitudinal epidemiological studies are needed to relate pushing and pulling to musculoskeletal disorders.

Arm Injuries↗

PubMed1998

Development and evaluation of a quality assessment instrument for occupational physicians.

OBJECTIVES: To develop and apply a method for assessing the quality of the process of occupational health care for individual patients. METHODS: The scientific literature was studied to develop a method to assess the quality of the process of occupational rehabilitation for workers with low back pain. The method was applied to health care and university workers with low back pain who were rehabilitated by their occupational physicians. RESULTS: Assessment of quality of care is regarded as a four step approach. Firstly, guidelines should be developed and implemented. Secondly, indicators for quality and criteria to demarcate good and deviant quality were derived from the guidelines. Thirdly, a method for data collection was chosen. Finally, quality was scored. For occupational rehabilitation, there was some deviance from the guidelines for most cases, especially in continuity of care with a deviant rate of 47%. Other indicators deviated from 1.4%-17.4%. Occupational physicians agreed on the relevance of the indicators and criteria, but for three indicators they evaluated the criteria as too rigid. They did not agree with their own performance scores in 66% of the deviant cases. CONCLUSION: Assessing the quality of the process of occupational health care with this method is an asset to present methods, but more specific criteria are needed for a more sensitive assessment.

Clinical Competence↗

PubMed1997

Musculoskeletal complaints in The Netherlands in relation to age, gender and physically demanding work.

OBJECTIVES: This cross-sectional study was performed in order to elucidate the relationship of musculoskeletal complaints with age, gender and physically demanding work in the Netherlands. METHODS: Questionnaire data of male (n = 36756) and female (n = 7730) employees, gathered as part of periodical occupational health surveys among active workers in the Netherlands, were stratified for age, gender, and type of work demands. For each stratified group prevalence rates (PR) were calculated for complaints of the back, neck, upper and lower extremities. Moreover, prevalence rate differences (PRD) were estimated as an absolute effect measure of exposure to various types of physical work demands, with active employees in mentally demanding work acting as a reference population. RESULTS: Musculoskeletal complaints among workers in physically demanding occupations were found to increase with age for both sexes. For several complaints, substantially higher rates were reported for women than for men, with a relatively high number of complaints observed among the older female workers (around 40% for complaints of back, upper and lower extremities). Significant PRDs were present in particular for employees in heavy physically demanding occupations and in jobs with mixed mental and physical work demands. CONCLUSIONS: With the ageing of the workforce in mind, these findings stress the need for implementation of preventive measures. Special attention towards the susceptible group of female employees, the elderly age groups in particular, seems justified. In order to clarify the combined effects of age and physical work demands on musculoskeletal complaints, additional studies are required.

Adolescent↗

PubMed1997

An audit of occupational health care for employees with low-back pain.

Guidelines for occupational rehabilitation of workers with low-back pain were developed as part of a larger study. We have formulated criteria for good practice of occupational rehabilitation on the basis of these guidelines. To assess the quality of occupational rehabilitation in the Netherlands, these criteria were subsequently used in an audit of medical records. The number of patients who received care consistent with the guidelines was compared to the number of patients eligible to receive that kind of care (performance rate). Six performance rates were calculated from the medical files of 40 workers with 48 new episodes of low-back pain. Two performance rates proved to be below 25% and two almost 50%. The highest performance rate, that for curative policy was 90%. These results are discussed in the light of the reliability of the original data. We recommend construction of guidelines as well as reliable registration of the occupational rehabilitation process to increase the possibilities of auditing and to raise the quality of occupational health care.

Absenteeism↗

PubMed1997

Repeated survey on changes in musculoskeletal complaints relative to age and work demands.

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.

Adult↗

PubMed1997

Priorities in occupational health research: a Delphi study in The Netherlands.

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.

Delphi Technique↗

PubMed1997

Occupational classification according to work demands: an evaluation study.

The use of job title as crude exposure measure in epidemiological studies is often inevitable when the available exposure data is scarce. In this study, an existing classification scheme of all job titles in the Netherlands into six categories of physical and mental work demands, constructed by expert judgement, was evaluated. Furthermore, a revision of this classification scheme for a research project on the relation between age, physical work demands, and musculoskeletal complaints was proposed and evaluated as well. For the evaluation, self-reported work demands, derived from questionnaire data of 38,921 employees and quantified by a scale of physical work demands and mental work demands, were used. Based on comparison of the mean scale scores of the several categories of work demands at group level, both classification schemes showed construct validity. Notwithstanding several limitations, the use of the presented classification schemes in epidemiological studies seems particularly challenging and rewarding when analysing data at group level from large and heterogeneous occupational populations. These kind of exploratory studies may generate new hypothesis on the basic patterns concerning work-related disorders, and can also be informative from a policy making perspective.

Adolescent↗

PubMed1996

Identification of high-risk groups among maintenance workers in a steel company with respect to musculoskeletal symptoms and workload.

To determine priorities for ergonomic improvements in five maintenance departments of a steel company, a study was carried out to identify groups with a high prevalence of musculoskeletal problems or a high exposure to unfavourable musculoskeletal workload. All workers were asked to complete a standardized questionnaire on musculoskeletal symptoms and musculoskeletal workload. Response rate in the five departments varied between 60 and 80% (n = 436). Symptoms of low back and neck-shoulder (12-month prevalence rates of 53% and 36%, respectively) were most common, but not higher in comparison with a reference group of 396 non-sedentary workers. Self-reported exposure rates to physical and psychosocial loads as well as poor climatic conditions were comparable with the reference group; only exposure to vibration was higher. Significant differences were seen between the five departments as well as between task groups with the departments. Several task groups with relatively high symptom rates and high exposure levels could be identified. It is concluded that a questionnaire survey can constitute a valuable contribution to the selection of high-risk task groups that need ergonomic intervention.

Adult↗