Biomedical subjects

J H Verbeek

Publications and source records attributed to J H Verbeek.

At least 19 recordsLinked to original sources

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

Prognostic factors for duration of sick leave in patients sick listed with acute low back pain: a systematic review of the literature.

BACKGROUND: The percentages of patients with acute low back pain (LBP) that go on to a chronic state varies between studies from 2% to 34%. In some of these cases low back pain leads to great costs. AIMS: To evaluate the evidence for prognostic factors for return to work among workers sick listed with acute LBP. METHODS: Systematic literature search with a quality assessment of studies, assessment of levels of evidence for all factors, and pooling of effect sizes. RESULTS: Inclusion of studies in the review was restricted to inception cohort studies of workers with LBP on sick leave for less than six weeks, with the outcome measured in absolute terms, relative terms, survival curve, or duration of sick leave. Of the studies, 18 publications (14 cohorts) fulfilled all inclusion criteria. One low quality study, four moderate quality studies, and nine high quality studies were identified; 79 prognostic factors were studied and grouped in eight categories for which the evidence was assessed. CONCLUSIONS: Specific LBP, higher disability levels, older age, female gender, more social dysfunction and more social isolation, heavier work, and receiving higher compensation were identified as predictors for a longer duration of sick leave. A history of LBP, job satisfaction, educational level, marital status, number of dependants, smoking, working more than 8 hour shifts, occupation, and size of industry or company do not influence duration of sick leave due to LBP. Many different constructs were measured to identify psychosocial predictors of long term sick leave, which made it impossible to determine the role of these factors.

Acute Disease↗

PubMed2005

Patient satisfaction with occupational health physicians, development of a questionnaire.

AIMS: To develop a questionnaire that measures specific aspects of patient satisfaction with occupational health physicians. METHODS: General patient satisfaction questionnaires, a literature survey, and interviews with patients were used. An initial questionnaire was distributed among sick listed patients (n = 432) of occupational physicians (n = 90) from different occupational health services. To reduce items and to develop scales exploratory factor analysis and reliability analysis was used. A linear regression model was used to predict satisfaction ratings from the scales of the questionnaire. RESULTS: Questions about independence of the occupational physician were difficult to ask unambiguously. The factor analysis revealed five relevant factors which were named "being taken seriously as a patient", "attitude towards occupational health services", "trust and confidentiality", "expectations", and "comfort and access". All scales could be reduced to a maximum of five items without reducing the scale reliability too much. In the regression analysis, 71% of the variance of satisfaction ratings was explained by the first four scales and most by the first scale. "Comfort and access" did not contribute significantly to the model. CONCLUSIONS: A short questionnaire was developed to measure different aspects of patient satisfaction specific for occupational health. Whether the questionnaire can effectively lead to quality improvement in occupational health services should be investigated.

Adult↗

PubMed2001

Assessment of short-term physical loading of the back: is serum keratin sulfate an appropriate biomarker?

STUDY DESIGN: A prospective experimental study. OBJECTIVES: To investigate the potential of serum keratan sulfate (KS) as an indicator of biochemical changes in intervertebral discs induced by physical loading of the back. BACKGROUND: By providing objective information on exposure and effects at the tissue level, biomarkers may enable us to improve our understanding of the intermediate steps between exposure to physical loading and the occurrence of back disorders. Serum KS has been proposed as a potential biomarker of the molecular changes in intervertebral discs that occur because of physical loading and are a potential cause of back disorders. METHODS AND MEASURES: Thirty-two nonimpaired men volunteers with a mean age of 22.5+/-2.3 years participated in the experimental condition, a manual lifting task, as well as in the control condition, lying on the back. Serum KS levels were measured immediately before and after both conditions, as well as 24 hours and 1 week later. RESULTS: No significant changes in serum KS levels were found after exposure to physical loading (mean SD serum KS before, 287.4+/-83.9 ng/mL; immediately after, 279.5+/-65.5 ng/mL; 24 hours after, 266.6+/-71.9 ng/mL; and 1 week after, 268.9+/-79.3 ng/mL), and no significant changes were found after lying on the back for 8 hours (mean+/-SD serum KS before, 273.0+/-94.3 ng/mL; immediately after, 261.6+/-68.9 ng/mL; 24 hours after, 277.3+/-68.9 ng/mL; and 1 week after, 274.5+/-68.5 ng/mL). CONCLUSIONS: These results indicate that the serum KS level is not suitable as a biomarker of the effects of short-term physical loading of the back induced by a manual lifting task.

Adult↗

PubMed2001

Vocational rehabilitation of workers with back pain.

This paper concerns the concepts and practices currently in use in occupational health for the rehabilitation of workers with back pain. No conclusive evidence exists for an etiologic model for nonspecific back pain. A difference between acute and chronic back pain is backed up by evidence from the literature. Apart from having the patient stay active and return to ordinary activities as early as possible, there are no significant forms of intervention for acute back pain that effectively decrease the time off work. For chronic back pain multidisciplinary treatment in an occupational setting is effective in enhancing return to work. Clinical practice guidelines consist of diagnostic triage, the assessment of "red flags" for medical emergencies, and guidance in the appropriate application of diagnostic facilities. Occupational health guidelines concentrate on gradual return to work, psychosocial issues, and multidisciplinary rehabilitation facilities.

Back Pain↗

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↗

PubMed1999

Psychosocial factors at work and back pain: a prospective study in office workers.

A prospective one-year follow-up study was carried out among 189 civil servants of a municipal social service department. Its aim was to investigate whether psychosocial factors at work predict back pain prevalence at follow-up. The workers were questioned twice about personal characteristics, psychosocial factors at work, physical workload, back pain experience, and general health and well-being. Back pain was assessed as twelve month prevalence and pain intensity on a visual analogue scale (VAS). In a univariate analysis the variables: high job demands, confinement to the workplace, depression, psychological complaints, and general health complaints, were positively related to back pain prevalence at follow-up. In a multivariate analysis, however, none of the odds ratios for psychosocial stressors differed significantly from one another. Among the back pain variables, pain intensity on the VAS was the best predictor of back pain at follow-up. In a final multivariate logistic regression model none of the above-mentioned variables contributed significantly, except for initial back pain. Initial back pain with low intensity and high intensity significantly predicted the prevalence of back pain at follow-up with odds ratios of 3.0 (90% CI: 1.5-6.0) and 10.3 (90% CI: 4.1-25.5), respectively. In conclusion, the present study does not provide clear evidence that psychosocial factors at work predict back pain.

Adult↗

PubMed1998

Keratan sulfate as a potential biomarker of loading of the intervertebral disc.

STUDY DESIGN: A review of the literature. OBJECTIVE: To investigate the potential of serum levels of keratan sulfate as a biomarker of the effects of loading of the spine. SUMMARY OF BACKGROUND DATA: Exposure to mechanical loading of the spine causes changes in metabolism of intervertebral discs, eventually leading to accelerated disc degeneration. This process is characterized by the degradation of proteoglycans, which is reflected by an increase in the blood level of proteoglycan components. The serum level of keratan sulfate, an epitope present on these proteoglycan components, has been suggested as a marker of changes in metabolism of cartilaginous tissues. METHODS: A review of the literature on serum keratan sulfate levels in relation to degenerative changes in cartilaginous tissue. RESULTS: In a number of studies keratan sulfate in serum was reported to be related to degeneration of articular cartilage in patients with osteoarthritis. In addition, massive and rapid degradation of intervertebral discs was determined to result in a large rise in serum keratan sulfate levels. Whether degenerative changes of intervertebral discs induced by mechanical stress also cause a detectable increase in serum keratan sulfate should be subjected to further investigation. CONCLUSION: Quantification of keratan sulfate in serum offers a promising measure for the early effects of mechanical loading of the spine, but research is needed for validation.

Biomarkers↗

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

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

Vocational outcome of intervention for low-back pain.

Practical management guidelines for occupational health physicians are needed for the individual support of employees with low-back pain. In this study the level of evidence regarding the efficacy of intervention with vocational outcome parameters was assessed. In a systematic literature search, 40 randomized clinical trials on different types of intervention were retrieved. Their internal validity and statistical power criteria were assessed. The randomization procedure, blinding of patients, and sample size were problematic in most studies. For patients with acute low-back pain limited or moderate evidence was found for the efficacy of no bed rest, a short period of bed rest, and spinal manipulation. For chronic patients limited evidence was found for the efficacy of antidepressants. For the other types of intervention, studies with sufficient statistical power were lacking. Such studies are needed before more-detailed evidence-based guidelines can be formulated for occupational health care.

Absenteeism↗

PubMed1995

The Atlas of Health and Working Conditions by Occupation. 1. Occupational ranking lists and occupational profiles from periodical occupational health survey data.

In this article, we describe methods which have been applied in the compilation of the Atlas of Health and Working conditions by Occupation. First, we discuss the need for information systems to identify problems concerning working conditions and health. Such information systems have an exploratory purpose, being deployed to identify work risks in companies, groups of occupations and sectors of industry, and can also be a starting point for the generation of hypotheses on the causes of adverse health effects. In the Netherlands, occupational health services gather questionnaire data about work and health as part of periodical occupational health surveys. In the atlas, aggregated questionnaire data for 129 occupations with male employees and 19 occupations with female employees are presented. In this article, we explain the methodology used to compare occupations with regard to each item in the questionnaire. We then discuss applications of these occupational ranking lists. The cross-sectional nature of the data collection, various forms of selection and the limited size of some occupational populations have to be taken into account when interpreting the results. Occupational ranking lists can be applied in the allocation of resources and in the design of scientific research. The overviews for each occupation, presented in the second half of the atlas, provide an occupational profile of existing problems with respect to work and health. These profiles are used as basic information to develop a practical policy on working conditions and health.

Adult↗

PubMed1995

The Atlas of Health and Working Conditions by Occupation. 2. A comparison with the "Atlas of Health and Working Conditions in the Construction Industry".

The results of the general Atlas of Health and Working Conditions by Occupation were compared with the results of the Atlas of Health and Working Conditions in the Construction Industry. Both are based on questionnaire data from periodical occupational health surveys [POHSs]. The scores on most of the items showed considerable differences between the two atlases, partly due to differences in the regional origin of the data. Therefore, direct comparisons between the atlases are biased by regional differences. To study the reliability and the generalizability of the results of both atlases, similarities between the data files with respect to occupations in the construction industry were studied. Most of the items on working conditions, especially those with a widespread distribution, showed a close resemblance between the data files in terms of the relative position of an occupation compared to other occupations in the construction industry. The items on health showed less resemblance, except for the items on musculoskeletal complaints, which showed results similar to those of the work items. These results indicate the reliability and generalizability of the judgements based on both atlases outside the regions of origin, as far as items with a widespread distribution are concerned. Therefore, we recommend the aggregation of POHS data on a national scale, taking regional differences into account. In that way, a greater number of occupations will be described and the reliability of the results will be enhanced.

Adult↗

PubMed1994

Validity of a diary estimating exposure to tasks, activities, and postures of the trunk.

The validity of a diary that estimates exposure to tasks, activities, and postures of the trunk was determined by comparing these self-reported exposure data with observational data of a whole working day. Two populations were studied: 32 professional drivers and five nurses. The nurses and 16 drivers also filled out a shortened version of the diary during another working day. Both versions of the diary showed poor agreement with observations over the same period. However, for variables concerning activities and postures of the trunk agreement was improved by the shortening of the diary. It is concluded that in epidemiologic studies observational measurements of exposure cannot validly be replaced by diaries or similar self-reported exposure data, because the self-reports easily lead to misclassification.

Adult↗