Severely increased albuminuria in patients with type 2 diabetes mellitus is associated with increased subclinical atherosclerosis in femoral arteries with Na [18F]F activity as a proxy - The DETERMINE study.

BACKGROUND AND AIMS: Sodium [18F]fluoride (Na [18F]F) positron emission tomography imaging allows detailed visualization of early arterial micro-calcifications. This study aims to investigate atherosclerosis manifested by micro-calcification, macro-calcification, and aortic stiffness in patients with type 2 diabetes mellitus (T2DM) with and without albuminuria and severely decreased kidney function. METHODS: A cohort was stratified in four groups (N = 10 per group), based on KDIGO categories (G1-5 A1-3). G1-2A1 non-diabetic controls (median [IQR] estimated glomerular filtration rate (eGFR) in mL/min/1.73 m2 91 [81-104]), G1-2A1 with T2DM (eGFR 87 [84-93], and albumin-creatinin-ratio (ACR) in mg/mmol 0.35 [0.25-0.75]), G1-2A3 with T2DM (eGFR 85 [60-103], and ACR 74 [62-122], and G4A3 with T2DM (eGFR 19 [13-27] and ACR 131 [59-304]). RESULTS: Na [18F]F femoral artery grading score differed significantly in the groups with the highest Na [18F]F activity in A3 groups with T2DM (G1-2A3 with T2DM 228 [100-446] and G4A3 with T2DM 198 [113-578]) from the lowest groups of the G1-2A1 with T2DM (33 [0-93]) and in G1-2A1 non-diabetic controls (75 [0-200], p = 0.001). Aortic Na [18F]F activity and femoral artery computed tomography (CT)-assessed macro-calcification was increased in G4A3 with T2DM compared with G1-2A1 with T2DM (47.5 [33.8-73.8] vs. 17.5 [8.8-27.5] (p = 0.006) and 291 [170-511] vs. 12.2 [1.41-44.3] mg (p = 0.032), respectively). Carotid-femoral pulse wave velocity (PWV)-assessed aortic stiffness was significantly higher in both A3 groups with T2DM compared with G1-2A1 with T2DM (11.15 and 12.35 vs. 8.86 m/s, respectively (p = 0.009)). CONCLUSIONS: This study indicates that the presence of severely increased albuminuria in patients with T2DM is cross-sectionally associated with subclinical arterial disease in terms of micro-calcification and aortic stiffness. Additional decrease in kidney function was associated with advanced macro-calcifications.

[18F]FDG and [18F]NaF as PET markers of systemic atherosclerosis progression: A longitudinal descriptive imaging study in patients with type 2 diabetes mellitus.

BACKGROUND: While [18F]-fluordeoxyglucose ([18F]FDG) uptake is associated with arterial inflammation, [18F]-sodium fluoride ([18F]NaF) is a marker for arterial micro-calcification. We aimed to investigate the prospective correlation between both PET markers over time and whether they are prospectively ([18F]FDG) and retrospectively ([18F]NaF) related to progression of systemic arterial disease in a longitudinal study in patients with type 2 diabetes mellitus (T2DM). METHODS: Baseline [18F]FDG PET/Low Dose (LD) Computed Tomography (CT) scans of ten patients with early T2DM without cardiovascular history (70% men, median age 63 years) were compared with five-year follow-up [18F]NaF/LDCT scans. Systemic activity was expressed as mean target-to-background ratio (meanTBR) by dividing the maximal standardized uptake value (SUVmax) of ten arteries by SUVmean of the caval vein. CT-assessed macro-calcifications were scored visually and expressed as calcified plaque (CP) score. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (PWV). Five-year changes were expressed absolutely with delta (Δ) and relatively with %change. RESULTS: Baseline meanTBR[18F]FDG was strongly correlated with five-year follow-up meanTBR[18F]NaF (r = 0.709, P = .022). meanTBR[18F]NaF correlated positively with ΔCPscore, CPscore at baseline, and follow-up (r = 0.845, P = .002 and r = 0.855, P = .002, respectively), but not with %change in CPscore and PWV. CONCLUSION: This proof-of-concept study demonstrated that systemic arterial inflammation is an important pathogenetic factor in systemic arterial micro-calcification development.

Work ability and work functioning: measuring change in individuals recently returned to work.

PURPOSE: To assess: (1) whether work ability and work-functioning instruments can detect relevant changes in their respective parameters following a return to work (RTW) and (2) what proportion of those returning to work show changes in their work ability and work functioning. METHODS: A total of 1073 workers who returned to work after at least 2 weeks of sick leave were invited to fill out three questionnaires in the first 8 weeks after RTW. These consisted of an appraisal of general, physical, and mental/emotional work ability (scores 0-10) and a work-functioning questionnaire (scores 0-100). Minimal Important Change (MIC) was defined to determine the proportion of people, whose scores had changed at weeks 5 and 8 following RTW. The Smallest Detectable Change (SDC) was determined to put the MIC in perspective of measurement error. RESULTS: Of all participants, 235 were eligible for the analysis. All MIC values were below the SDC and thus not suitable for use. The SDC for work ability was 2.2 and 19.9 for work functioning. In the first 5 weeks after RTW, 10-15% showed a relevant, measurable improvement in work ability, and work functioning based on the SDC margins. CONCLUSIONS: Both instruments were unable to identify change after RTW adequately. We can conclude that 10-15% of individuals showed improvement in work ability and work functioning in the first 5 weeks after RTW when SDC is used.

Physiological stress response patterns during a blood donation.

BACKGROUND: Donating blood is associated with increased psychological stress. This study investigates whether a blood donation induces physiological stress and if response patterns differ by gender, donation experience and non-acute stress. STUDY DESIGN AND METHODS: In 372 donors, physiological stress [blood pressure, pulse rate, pulse rate variability (PRV)] was measured at seven moments during routine donation. PRV was assessed using time domain [root mean square of successive differences (RMSSD)] and frequency domain [high frequency (HF) and low frequency (LF) power] parameters. Non-acute stress was assessed by questionnaire. Shape and significance of time course patterns were assessed by fitting multilevel models for each stress measure and comparing men and women, first-time and experienced donors, and donors with high and low levels of non-acute stress. RESULTS: Significant response patterns were found for all stress measures, where levels of systolic blood pressure (F(1,1315) = 24·2, P < 0·001), RMSSD (F(1,1315) = 24·2, P < 0·001), LF (F(1,1627) = 14·1, P < 0·001) and HF (F(1,1624) = 34·0, P < 0·001) increased towards needle insertion and then decreased to values lower than when arriving at the donation centre. Diastolic blood pressure (F(1,1326) = 50·9, P < 0·001) increased and pulse rate (F(1,1393) = 507·4, P < 0·001) showed a U-shaped curve. Significant group effects were found, that is, higher systolic blood pressure/pulse rate in women; higher pulse rate in first-time donors; higher RMSSD at arrival and from screening until leaving in first-time donors; and higher LF and HF in first-time donors. CONCLUSION: This study shows an increase in physiological stress related to needle insertion, followed by a decrease when leaving the donation centre. Some group effects were also found.

Reproducibility of work ability and work functioning instruments.

Background: Work ability (WA) and work functioning (WF) instruments can be useful in occupational health practice. The reproducibility of both instruments is important to their relevance for daily practice. Clinimetrics concerns the methodological and statistical quality of instruments and their performance in practice. Aims: To assess the reproducibility of WA and WF instruments. Methods: Dutch workers completed a questionnaire containing WA questions and the WF questionnaire twice with a 7-day interval between. The questionnaire included an appraisal of current general, physical and mental/emotional WA (0-10) and the composite WF questionnaire of 49 items (0-100). We measured reproducibility, reliability and agreement by calculating the intraclass correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). Results: The answers of 104 respondents were available for analysis. General, physical and mental/emotional WA had ICC values of 0.52, 0.69 and 0.56, respectively. For WF, the ICC value was 0.85. For general WA, the SEM was 0.71. For physical and mental/emotional WA, the SEMs were 0.75 and 0.74, respectively. For general, physical and mental/emotional WA, the SDC was 1.98, 2.09 and 2.05 respectively. The SEM of the WF score was 4.78, and the SDC was 13.25. Conclusions: The WA questions showed moderate reliability, while the WF instrument showed good reliability. Occupational health professionals can use the SDCs of the instruments to monitor changes in WA and WF in workers over time.

Psychological and hormonal stress response patterns during a blood donation.

BACKGROUND AND OBJECTIVES: Donating blood has been associated with increased stress responses, with scarce evidence indicating that levels of psychological and hormonal stress are higher pre-donation than post-donation. We investigated whether a blood donation induces psychological and/or hormonal stress during the course of a blood donation, and whether responses differed between men and women, first-time and experienced donors and donors with high or low non-acute stress. MATERIALS AND METHODS: In 363 donors, psychological (donation-stress and arousal) and hormonal (cortisol) stress were measured by questionnaire and salivary sample at seven key moments during a routine donation. Non-acute stress was assessed by a questionnaire. Repeated measurement analyses were performed, using the last measurement (leaving the donation center) as reference value. RESULTS: Levels of donation-stress, arousal and cortisol were significantly higher during donation than when leaving the donation center. When compared with men, women reported higher levels of donation-stress and cortisol in the first part of the visit. When compared with first-time donors, experienced donors reported lower levels of donation-stress during the first part of the visit, and higher levels of arousal but less reactivity throughout the visit. When compared to donors high on non-acute stress, donors low on non-acute stress reported lower levels of donation-stress during the first part of the visit, and showed less cortisol reactivity throughout the visit. CONCLUSION: Donating blood influences psychological and hormonal stress response patterns. The response patterns differ between women and men, first-time and experienced donors and between donors high and low on non-acute stress.

Job-specific mandatory medical examinations for the police force.

BACKGROUND: Mandatory medical examinations (MMEs) of workers should be based on the health and safety requirements that are needed for effectively performing the relevant work. For police personnel in the Netherlands, no job-specific MME exists that takes the specific tasks and duties into account. AIMS: To provide the Dutch National Police with a knowledge base for job-specific MMEs for police personnel that will lead to equitable decisions from an occupational health perspective about who can perform police duties. METHODS: We used a stepwise mixed-methods approach in which we included interviews with employees and experts and a review of the national and international literature. We determined the job demands for the various police jobs, determined which were regarded as specific job demands and formulated the matching health requirements as specific as possible for each occupation. RESULTS: A total of 21 specific job demands were considered relevant in different police jobs. These included biomechanical, physiological, physical, emotional, psychological/cognitive and sensory job demands. We formulated both police-generic and job-specific health requirements based on the specific job demands. Two examples are presented: bike patrol and criminal investigation. CONCLUSIONS: Our study substantiated the need for job-specific MMEs for police personnel. We found specific job demands that differed substantially for various police jobs. The corresponding health requirements were partly police-generic, and partly job-specific.

The mediating role of recovery opportunities on future sickness absence from a gender- and age-sensitive perspective.

A lack of sufficient recovery during and after work may help to explain impaired health in the long run. We aimed to increase knowledge on the mediating role of recovery opportunities (RO) during and after work on future sickness absence from a gender- and age-sensitive perspective. We used data on RO from a Swedish national survey in 2011 and linked these to sickness absence (>14 days) two years later among the general working population (N = 7,649). Mediation of the relationship between gender and sickness absence by exposure to RO was studied through linear regression. We conducted separate analyses for RO during and after work and for three different age groups (16-29; 30-49; 50-64). The sample consisted of 3,563 men and 4,086 women. Sickness absence was higher among the women than among the men (11 days vs 5 days, p<0.001). Men reported statistically significantly more positive on their RO than women. RO during (ß 0.3-1.8) and after work (ß 0.4-0.6) mediated the relationship between gender and sickness absence. Mediation effects existed across age groups, with the strongest effects of RO during work found among the age group between 50 and 64 years of age (attenuation 36%). Our results indicate that gender inequality is also reflected in worse RO among women. This partially explains the increased risk of future sickness absence, particularly among those above 50 years of age. These findings show that RO during work deserve more attention in working life research.

Negative experiences and pre-donation blood pressure: the role of attitude and anxiety.

BACKGROUND/OBJECTIVES: Negative experiences (NEs) have been shown to result in an increased stress response, as indicated by blood pressure, at the subsequent donation. This response might be influenced by how the donor rates the donation in terms of importance and pleasantness [affective attitude (AA)/cognitive attitude (CA)] or by anxiety about donating blood. We investigated the effect of AA/CA/anxiety on the impact of NEs on pre-donation blood pressure (pd-BP) in the subsequent donation. MATERIALS/METHODS: pd-BP at visit 3 was compared between donors with and without a history of NEs during or after their first two visits (visit 1: medical check, visit 2: first donation). The effect of AA/CA/anxiety (measured 1 month prior to visit 1 on a 7-point scale) on visit 3 pd-BP was explored using linear regression and interaction analyses. Analyses were stratified for gender, age and pd-BP at visit 1, which were taken into account as confounders. RESULTS: In 1106 first-time blood donors (70% female), 632 donors (57% of total) indicated an NE at their first donation. Mean scores for AA/CA/anxiety were 5·2/6·5/2·2 (men without NE), 4·8/6·3/3·0 (men with NE), 5·2/6·6/2·6 (women without NE) and 4·8/6·6/3·2 (women with NE). No significant associations were found for NE and pd-BP at visit 3 after adjusting for confounding. Of 48 interaction effects, four were significant, but effects were small and inconsistent. CONCLUSION: In donors who had had negative experiences during their first donation, anxiety and attitude to donation did not influence their pre-donation blood pressure at their subsequent visit.

Relationships between work-related factors and musculoskeletal health with current and future work ability among male workers.

PURPOSE: The purpose was to increase job-specific knowledge about individual and work-related factors and their relationship with current and future work ability (WA). We studied cross-sectional relationships between mental demands, physical exertion during work, grip strength, musculoskeletal pain in the upper extremities and WA and the relationships between these variables and WA 11 years later. METHODS: We used a dataset of a prospective cohort study (1997-2008) among employees of an engineering plant (n = 157). The cohort was surveyed by means of tests and written questions on work demands, musculoskeletal health, WA score (WAS; 0-10), and mental and physical WA. Spearman correlation coefficients and logistic regression analysis were used. RESULTS: Among manual workers, we found weak correlations between grip strength and current and future physical WA. We did not find predictors for future poor WA among the manual workers. Among the office workers, we found that musculoskeletal pain was moderately and negatively related to current WAS and physical WA. More handgrip strength related to better future WAS and physical WA. Musculoskeletal pain (OR 1.67 p < 0.01) and lower handgrip strength (OR 0.91 p < 0.05) predicted future poor WA among office workers. CONCLUSIONS: Our results showed cross-sectional and longitudinal relationships between musculoskeletal health and work ability depending on occupation. However, the present implies that predicting work ability in the far future based on health surveillance data is rather difficult. Testing the musculoskeletal system (grip strength) and asking workers' about their musculoskeletal health seems relevant when monitoring work ability.

External Validation and Update of a Prediction Rule for the Duration of Sickness Absence Due to Common Mental Disorders.

Purpose The objective of the present study was to validate an existing prediction rule (including age, education, depressive/anxiety symptoms, and recovery expectations) for predictions of the duration of sickness absence due to common mental disorders (CMDs) and investigate the added value of work-related factors. Methods A prospective cohort study including 596 employees who reported sick with CMDs in the period from September 2013 to April 2014. Work-related factors were measured at baseline with the Questionnaire on the Experience and Evaluation of Work. During 1-year follow-up, sickness absence data were retrieved from an occupational health register. The outcome variables of the study were sickness absence (no = 0, yes = 1) at 3 and 6 months after reporting sick with CMDs. Discrimination between workers with and without sickness absence was investigated at 3 and 6 months with the area under the receiver operating characteristic curve (AUC). Results A total of 220 (37 %) employees agreed to participate and 211 (35 %) had complete data for analysis. Discrimination was poor with AUC = 0.69 and AUC = 0.55 at 3 and 6 months, respectively. When 'variety in work' was added as predictor variable, discrimination between employees with and without CMD sickness absence improved to AUC = 0.74 (at 3 months) and AUC = 0.62 (at 6 months). Conclusions The original prediction rule poorly predicted CMD sickness absence duration. After adding 'variety in work', the prediction rule discriminated between employees with and without CMD sickness absence 3 months after reporting sick. This new prediction rule remains to be validated in other populations.

Appraisal of work ability in relation to job-specific health requirements in ambulance workers.

PURPOSE: To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? METHOD: Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. RESULTS: Outcomes in 'raised alertness and judgment ability' (R 2 = 0.09), 'job-specific physical abilities' (R 2 = 0.10) and 'emotional peak load' (R 2 = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. CONCLUSIONS: Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.

Common mental disorders related to incidents and behaviour in physicians.

BACKGROUND: Common mental disorders (CMD-burnout, stress, depression and anxiety disorders) are prevalent in physicians. AIMS: To investigate the relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. METHODS: PubMed was searched for all articles published between 2003 and 2013 that study a relationship between CMD and medical incidents and/or unprofessional behaviour in hospital physicians. The strength of evidence was assessed through five levels of evidence. RESULTS: We included 15 studies. We found strong evidence for a significant association between burnout and the occurrence of medical incidents, based on two longitudinal and seven cross-sectional studies with a positive association [odds ratio (OR) 1.07-5.5]; one longitudinal study found a non-significant association (strong evidence). For the association between depression and medical incidents, four longitudinal studies and three cross-sectional studies found a significant positive association (strong evidence; OR 2.21-3.29). For the association between fatigue and medical incidents, one longitudinal study and one cross-sectional study showed a significant positive association, but one cross-sectional study showed a non-significant association (strong evidence; OR 1.37). For the association between sleepiness and medical incidents, one longitudinal study and two cross-sectional studies showed a significant positive association (strong evidence; OR 1.10-1.37). No significant association was found between burnout and unprofessional behaviour (inconsistent evidence). Nor was any evidence found for the association between unprofessional behaviour and depression, fatigue or sleepiness. CONCLUSIONS: CMD in hospital physicians were associated with the occurrence of self-reported medical incidents, but there was inconsistent evidence for unprofessional behaviour.

Improving fit to work assessments for rail safety workers by exploring work limitations.

PURPOSE: We aim to provide evidence for improving fit to work assessments for rail safety workers and raised the question whether adding an assessment of work limitations is useful. Therefore, we assessed differences in the proportions of perceived work limitations and reported health complaints and whether older age or having health complaints are risk factors for having work limitations. METHODS: Job requirements for rail safety workers are 'vigilance and clear judgment', 'good communication abilities', 'sufficient eye sight' and 'task-required physical abilities'. We invited 1000 workers to fill in a questionnaire about perceived work limitations and health problems related to their job requirements. Proportions of the two were compared by using the McNemar test. Associations were analyzed by using univariate logistic regression. RESULTS: Among 484 rail safety workers, we found statistically significant differences between the proportions of reported health complaints (2-26 %) and work limitations (10-32 %). No significant associations were found between older age and work limitations, except for workers in the age group 40-50 years regarding physical abilities. This was not found for the age group over 50 years. For each age category, workers reporting health complaints related to 'vigilance and clear judgment' and 'sufficient physical abilities' had a statistically significant increased risk for reporting work limitations as well (ORs 2.4-17.9). CONCLUSIONS: Our results indicate that fit to work assessments should include both health complaints and work limitations. Our results do not substantiate the assumption that workers over 40 years of age are at increased risk for work limitations in general.

Negative experiences and predonation blood pressure at the subsequent donation in blood donors.

BACKGROUND: Negative donation experiences, like being deferred or experiencing an adverse reaction, might upset blood donors, resulting in anticipatory stress responses such as elevated blood pressure at the subsequent visit. We therefore explored associations between blood donors' negative donation experiences and their blood pressure at the subsequent visit. STUDY DESIGN AND METHODS: Blood pressure of donors with no history of negative experiences in three consecutive donations was compared to the blood pressure of donors with a negative experience during the second of the three donations. Blood pressure (systolic and diastolic) measured prior to the third donation was compared between the two groups, using linear regression analyses. Two types of negative experiences (adverse reactions and deferral) were analysed, stratifying for donation type and sex, and adjusting for age and predonation blood pressure at baseline. RESULTS: In total, 248 118 (50% female) donors were included in the analyses. Eleven per cent (26 380 donors, 61% female) had experienced a negative experience. Fainting and dizziness were associated with significant (P < 0·05) increases in systolic blood pressure: in men, 3·0 mmHg (fainting) and 2·0 mmHg (dizziness); in women, 2·0 mmHg (fainting) and 1·4 mmHg (dizziness). Deferral was associated with significant (P < 0·05) increases in both systolic (men: 0·7 mmHg, women: 0·3 mmHg) and diastolic (men: 0·2 mmHg, women: 0·3 mmHg) blood pressure. CONCLUSION: Whole blood donations with negative experiences were associated with a statistically significant higher predonation blood pressure at the subsequent visit. This indicates that negative experiences might cause an anticipatory stress reaction in a subsequent donation.

Current and future healthcare needs of future hospital physicians.

BACKGROUND: Work-related health problems can impair the work ability of hospital physicians and pose a threat to patient safety. Understanding the health status and care needs of young hospital physicians is therefore essential to providing job-specific health services and ensuring good future quality of care. AIMS: To investigate the current health status of future hospital physicians and their current and future care needs and to explore their preferences regarding occupational health services. METHODS: We gathered data concerning worries about current health, current and future care needs and preferred ways of receiving feedback and interventions when using occupational health services from the 2013 wave of a cohort study of Dutch medical students (original population: n = 4961). We also calculated the relationship between current health status and future care needs. RESULTS: We obtained data from 647 future physicians. Irrespective of their stage of training, most (73%) had few worries about their current health. However, two-fifths felt in need of care for psychological (42%) or physical (40%) complaints. More than half (52%) anticipated future care needs by indicating they would consider using occupational health services when offered in the future. General health status was not significantly related to feeling in need of future care. Preferences regarding feedback on health results were to receive this by email (54%) or from an occupational physician (51%) and in their own teaching hospital (68%). CONCLUSIONS: Future hospital physicians expressed a need for current and future occupational healthcare, irrespective of current worries about health.

Development of hospital nurses' work ability over a 2 year period.

BACKGROUND: A new approach to the study of work ability is an individually oriented approach. This approach increases our understanding of how work ability develops over time among individuals with a different level of work ability. AIMS: To increase knowledge about individuals' work ability trajectories by studying hospital nurses' development of work ability over a 2 year period and factors associated with these trajectories. METHODS: We used a data set of a prospective cohort study of hospital nurses, which was surveyed for 2 years by means of three questionnaires on work characteristics, health and work ability. The outcome variable was the general work ability trajectory over the course of 2 years (favourable/unfavourable). The predictors were the individual, physical and mental work ability and health characteristics at baseline. A multivariate backwards stepwise logistic regression analysis was used. RESULTS: Of 572 nurses in the cohort, nearly one-third (31%, 179/572) showed an unfavourable general work ability trajectory. Low physical work ability (odds ratio (OR) 1.82; 95% confidence interval (95% CI) 1.12-2.95) and high level of fatigue (OR 1.52; 95% CI 0.97-2.40) at baseline were predictors for the unfavourable course of self-reported general work ability. CONCLUSIONS: A substantial proportion of this cohort of hospital nurses experienced a reduction in work ability over the course of 2 years. Baseline physical work ability and level of fatigue were related to this. The next step is to address these factors when counselling nurses and evaluate the effect of interventions aimed at improving physical work ability and reducing fatigue.

Mental and psychosocial health among current and former professional footballers.

BACKGROUND: In common with elite athletes from other sport disciplines, severe or recurrent injuries in professional footballers are considered to be major physical and psychosocial stressors, which may predispose to mental health problems during and after their career. AIMS: To determine the prevalence of mental health problems and psychosocial difficulties in current and former professional footballers, and to explore the association between psychosocial stressors and the health conditions studied. METHODS: Based on validated scales, a paper and electronic questionnaire was developed for current and former professional footballers and distributed by the World Footballers' Union (FIFPro) and players' unions in six countries. Prevalence was calculated and cross-sectional analyses were conducted. RESULTS: The response rate was 29% with 253 responses available for analysis. The prevalence of mental health complaints ranged from 5% (burnout) to 26% (anxiety/depression) in 149 current players and from 16% (burnout) to 39% (anxiety/depression) in 104 former footballers. The prevalence of psychosocial problems ranged from 3% (low self-esteem) to 26% (adverse nutrition behaviour) in current players and from 5% (low self-esteem) to 42% (adverse nutrition behaviour) in former footballers. In both current and former players, mental health problems were significantly associated with low social support (odds ratio [OR] = 1.1) and recent life events (OR = 1.4-1.6). In former players, previous surgery was significantly associated with smoking (OR = 1.9). CONCLUSIONS: The prevalence of mental health problems and/or psychosocial difficulties in current and former professional footballers was found to be high. The presence of mental health problems was associated with low social support and recent life events.

E-health to improve work functioning in employees with rheumatoid arthritis in rheumatology practice: a feasibility study.

OBJECTIVES: To evaluate the feasibility of an e-health intervention in rheumatology practice for employees with rheumatoid arthritis (RA) who experience problems with work functioning. METHOD: Twenty-three out of 90 patients with RA from a hospital rheumatology department, invited by letter, participated in a feasibility study. The 3-month internet e-health programme consisted of a self-management programme using a three-step problem-solving strategy: (step 1) analyse your work problems and opportunities; (step 3) identify solutions; and (step 3) work out a strategy (action plan). Support and personal feedback was provided by a rheumatology nurse. Patients completed assignments, received information, and actively worked on their goals. The main feasibility outcome included satisfaction with the programme. Other feasibility outcomes included usefulness, suitability, website use, and work functioning measured at baseline and/or 3 months using questionnaires, semi-structured interviews, and website data. RESULTS: In total, 95% of the participants were satisfied with the programme, and 96% thought the programme was useful for working RA patients and would recommend the programme to other working RA patients (91%). On the website, all patients at least partially completed the assignments in step 1 and 12 patients completed at least one assignment in step 3. Patients judged the website as well arranged with clear tasks. Patients worked on a range of (individual) goals, resolving work challenges using different strategies and actions. CONCLUSIONS: The e-health intervention is a feasible intervention for rheumatology practice justifying further effectiveness evaluation while allowing for further improvements in the selection of RA patients and shaping the intervention.

Outcomes of seafarer work fitness qualifications in the Netherlands.

BACKGROUND: Seafaring is a dangerous profession involving high fatality rates and little research has been done to identify conditions that may lead to failing the seafarer's medical qualification (SMQ). AIMS: To determine the proportion of seafarers failing to pass the SMQ in the Netherlands during 2012, to analyse the outcomes of the SMQ according to qualification, age, duties and requirements of additional evaluations and to describe the reasons for considering a seafarer unfit for duty. METHODS: A retrospective descriptive study of SMQs registered in the Netherlands Shipping Inspectorate database. RESULTS: Less than 1% (46 cases; 0.6%) of the 7617 final SMQ candidates were considered unfit for duty with 53% (24) of these being temporarily unfit. Four per cent (276) of cases were classified 'fit with restrictions' and 1% (66) 'fit by exemption' (FEx). Re-examination was required in 2% (122) of cases. A second opinion from a medical referee was sought in 4% of cases. The highest rate of FEx was found in older seafarers (aged over 55) due to restrictions in hearing and vision in the majority (59%) of cases. The leading causes of unfitness were other medical reasons, mainly associated with cardiovascular conditions and morbid obesity, in 52% of cases and visual impairment in 34%. CONCLUSIONS: The proportion of seafarers considered unfit in the SMQ carried out in the Netherlands in 2012 is relatively low. The proportion of FEx was higher in older groups, mainly due to hearing or visual impairments.