Ex Situ Left Ventricular Pressure-Volume Loop Analyses for Donor Hearts: Proof of Concept in an Ovine Experimental Model.

Ex situ heart perfusion (ESHP) has emerged as an important strategy to preserve donation after brain death (DBD) and donation after circulatory death (DCD) donor hearts. Clinically, both DBD and DCD hearts are successfully preserved using ESHP. Viability assessment is currently based on biochemical values, while a reliable method for graft function assessment in a physiologic working mode is unavailable. As functional assessment during ESHP has demonstrated the highest predictive value of outcome post-transplantation, this is an important area for improvement. In this study, a novel method for ex situ assessment of left ventricular function with pressure-volume loop analyses is evaluated. Ovine hearts were functionally evaluated during normothermic ESHP with the novel pressure-volume loop system. This system provides an afterload and adjustable preload to the left ventricle. By increasing the preload and measuring end-systolic elastance, the system could successfully assess the left ventricular function. End-systolic elastance at 60 min and 120 min was 2.8 ± 1.8 mmHg/mL and 2.7 ± 0.7 mmHg/mL, respectively. In this study we show a novel method for functional graft assessment with ex situ pressure-loop analyses during ESHP. When further validated, this method for pressure-volume assessments, could be used for better graft selection in both DBD and DCD donor hearts.

Gender differences in work modifications and changed job characteristics during the return-to-work process: a prospective cohort study.

OBJECTIVES: To describe gender differences in work modifications and changed job characteristics during return-to-work after sickness absence. METHODS: A 13 month prospective cohort study was performed among 119 employees (54 women and 65 men) who had reported sick for more than 1 month due to mental or musculoskeletal disorders. Men and women were of comparable ages and educational levels, worked in similar sectors, at corresponding functional levels, and were experiencing the same types of health disorders. They were interviewed bi-monthly. Work modifications and job characteristics were assessed at return-to-work. Job characteristics were also assessed upon the employee's inclusion in the study. RESULTS: Work modifications occurred in 77.4% of the return-to-work attempts (no gender differences); reduced working hours, reduced work pace, or task reassignments were most frequent. Compared to men, reduced hours and pace were more often used for women between 12 and 20 weeks of absence (P > 0.001 and 0.01 < P < 0.001 respectively) and reduced hours also during the whole period (0.01 < P < 0.001). Applying reduced hours related to type of disorder in men and applying different time-schedules in women. Upon return to work both women and men reported increased job autonomy and emotional demands (P < 0.001); women reported more job satisfaction (P < 0.001). CONCLUSIONS: Work modifications were widely applied during the return-to-work process and predominantly aimed at reduction of pressure at work. Women had a few more work modifications. The marginal gender differences may be due to male and female respondents having similar characteristics. Upon return to work some job characteristics improved.

A behavioral approach to RTW after sickness absence: the development of instruments for the assessment of motivational determinants, motivation and key actors' attitudes.

INTRODUCTION: On the basis of a motivational framework for return to work (RTW) after sickness absence, scales were developed to measure absentee attitudes towards RTW, perceived social norm with respect to RTW, RTW self-efficacy, RTW motivation, and the RTW attitudes of six types of key actors. METHODS: Both theory and 33 in-depth interviews with sickness absentees and occupational physicians produced 95 items. A sample of 119 absentees who had reported sick for more than one month completed these items. Absentees varied with respect to gender, age, educational level, and work sector. RESULTS: Factor analyses and reliability analyses yielded seventeen scales with sufficient reliability (Cronbach's alpha: 0.60-0.86). CONCLUSIONS: The new scales appear to be valid and promising for future research on RTW. Validation in larger samples is necessary and the predictive validity should to be tested.

[Shared decision-making: dilemmas in daily practice]. / Samen beslissen: dilemma's in de praktijk.

Shared decision-making is an essential - but often neglected - component of evidence-based medicine. In practice, doctors, nurses and patients encounter dilemmas which are understandable, but not insurmountable. We illustrate this by means of a complex decision concerning therapy in the advanced stage of Parkinson's disease. Evidence of effectiveness differs with each individual therapy, and, in practice, the experiences of neurologists also vary widely. In addition, the various treatment strategies all require a different sort of daily care, and have differing impacts on people's lives. It is time that we worked towards a realistic view of shared decision-making. Shared decision-making cannot be generalised to a 'one size fits all' strategy that we can choose to apply or not to apply at will. It should be a flexible instrument which, depending on the individual and the specific situation, can be put to use to deliver the best tailored care.

Work-family conflict as a risk factor for sickness absence.

OBJECTIVES: (1) To study both cross-sectional and prospective relationships between work-family conflict and sickness absence from work; (2) to explore the direction of the relationships between the different types of conflict (work-home interference and home-work interference) and sickness absence; and (3) to explore gender differences in the above relationships. METHODS: Data from the Maastricht Cohort Study were used with six months of follow up (5072 men and 1015 women at T6). Work-family conflict was measured with the Survey Work-Home Interference Nijmegen (SWING). Sickness absence was assessed objectively through individual record linkage with the company registers on sickness absence. RESULTS: In the cross-sectional analyses, high levels of work-family conflict, work-home interference, and home-work interference were all associated with a higher odds of being absent at the time of completing the questionnaire, after controlling for age and long term disease. Differences in average number of absent days between cases and non-cases of work-home interference were significant for men and most pronounced in women, where the average number of absent days over six months follow up was almost four days higher in women with high versus low-medium work-home interference. CONCLUSIONS: A clear relation between work-family conflict and sickness absence was shown. Additionally, the direction of work-family conflict was associated with a different sickness absence pattern. Sickness absence should be added to the list of adverse outcomes for employees struggling to combine their work and family life.

A new typology of work schedules: Evidence from a cross-sectional study among nurses working in residential elder care.

BACKGROUND: Work schedules contribute substantially to the health and well-being of nurses. Too broad typologies are used in research that do not meet the current variety in work schedules. OBJECTIVE: To develop a new typology for nurses' work schedules based on five requirements and to validate the typology. METHODS: This study is based on a questionnaire returned by 498 nurses (response 51%) including questions regarding nurses' work schedule, socio-demographic, and family characteristics and their appraisal of the work schedule. Frequencies of the different schedules were computed to determine the typology. To validate the typology, differences between the types were tested with ANOVAs, Chi2 and Kruskal-Wallis tests. RESULTS: Five main types can be distinguished based on predetermined requirements and frequencies, namely: (1) fixed early shift, (2) rotating two shift pattern without night shift, (3) rotating three shift pattern, (4) fixed and rotating two shift pattern including night shift, and (5) fixed normal day or afternoon shifts. Nurses in these types of work schedule differed significantly with respect to hours worked, days off between shifts, age, education, years in the job, commuting time, contribution to household income, satisfaction with work schedule and work schedule control. Especially nurses with type 3 schedules differed from other types. CONCLUSIONS: A typology of five main types of work schedules is proposed. Content validity of the typology is sufficient and the new typology seems useful for research on work-related aspects of nursing.

Difference in fitness for duty among soldiers on a mission: can these be explained by a difference in the preemployment assessment?

In 1998, the Royal Netherlands Army introduced a new examination system (abbreviated as BMEKL), which was based on the "workload-capability" model, to replace the old system (abbreviated as PULHEEMS), which focused on diagnosis and was based solely on the detection of diseases and infirmities. To discern differences under operational conditions between soldiers examined with one of the two medical examination systems, we performed a prospective cohort study. In the study, soldiers who had been declared fit for duty with one of the two medical assessment systems (randomized) and sent on a mission were monitored for 2 years. We used the two operational measures of availability and health care costs. In addition, the candidates were given a questionnaire twice per year during the study period. The study revealed that the soldiers assessed using the function-based BMEKL system displayed greater fitness for duty than did those assessed using the diagnosis-based PULHEEMS system. The BMEKL assessment system is a better predictor of the ability to function as a soldier in general, and with regard to deployment, health, and the locomotor apparatus specifically, than is the PULHEEMS system.

Crystalline retinopathy.

A 34-year-old woman had crystalline dystrophy of the retina associated with atrophy of the choriocapillaris and pigment epithelium, and pigment clumping in the fundus periphery. Consanguinity of her parents suggested an autosomal recessive inheritance pattern for this type of crystalline retinal dystrophy. The patient did not have corneal crystals. Her electroretinogram was normal, although her electro-oculogram was abnormal.

Associations between work stress, alcohol consumption and sickness absence.

AIMS: To test an interactional model on the associations between work stressors, perceived stress, alcohol consumption and sickness absence. DESIGN: Cross-sectional survey. SETTING: The study was part of a Worksite Health Project including an Employee Assistance Programme and a Health Promotion Programme in the Netherlands. PARTICIPANTS: Participants were blue-collar workers from two Municipal Garbage Collecting Departments and white-collar workers from a Pharmaceutical Company (N = 471). MEASUREMENTS: Measurements included socio-demographic characteristics (gender, age, education, marital status), work stressors, perceived stress, alcohol consumption and sickness absence. Type of work-site (blue- or white-collar) and smoking behaviour were used as covariates. FINDINGS: Regression analyses resulted in three major findings. First, in the presence of stress, abstinence increased the risk of sickness absence compared with moderate drinking. We failed to find a significant relationship between excessive drinking and sickness absence. Secondly, stress mediated the associations between stressor and alcohol consumption, and between stressor and sickness absence, although stressors also directly predicted sickness absence. CONCLUSIONS: The association between abstinence and sickness absence could reflect medical problems of abstainers or a lack of skills for coping with stress. The failure to find a significant detrimental effect of excessive drinking may have been due to use of a low threshold for excessive drinking and/or low power. Prospective studies are needed to gain insight in causal relationships between the variables concerned.

The incorporation of different demand concepts in the job demand-control model: effects on health care professionals.

This paper reports a study of 212 health care professionals that focuses on job characteristics as predictors of employee health. By means of covariance structure modelling (LISREL 8) we tested the interactive assumptions of the Karasek (1979) Job Demand-Control (JD-C) Model [Karasek, R.A., Jr., 1979. Job demands, job decision latitude, and mental strain: implications for job redesign. Administrative Science Quarterly, 24, 285-307.] using three different concepts of job demands (i.e. psychological job demands, physical demands and emotional demands) in combination with a more focused measure of decision latitude (i.e. job autonomy) to predict employee health (i.e. job satisfaction, job involvement, emotional exhaustion and psychosomatic health complaints). Controlling for gender and age, the results partly support the JD-C hypotheses by finding three out of twelve assumed interaction effects. More specifically, different outcome variables are predicted by different combinations of job autonomy with the three kinds of job demands, respectively. In conclusion, although we refute the central hypotheses of the JD-C model to a large extent, the current (interactive) findings are quite illuminating and will be discussed in the context of their theoretical and practical implications. Researchers as well as practitioners have to broaden their perspective on 'job demands' in health care work and need to focus on different kinds of job demands to capture the complexity of this work setting.

Are multiple roles a risk factor for myocardial infarction in women?

This study examined whether multiple social roles are associated with an increased risk for a first myocardial infarction in a sample of Dutch women and whether there is evidence in favour of either the scarcity or the enhancement hypothesis about multiple roles. Subjects were 79 patients with a first myocardial infarction (MI), and they were compared with 90 hospital controls. Logistic regression analyses showed that multiple social roles do not constitute a risk factor for a first myocardial infarction. Classic risk factors seem to be more important. Neither the scarcity nor the enhancement hypothesis was confirmed in connection with a first myocardial infarction. However, the findings do support the enhancement hypothesis with regard to general health. In conclusion, the results indicate that multiple social roles do not constitute a risk factor for a first myocardial infarction in women.

Effectiveness of a personalized Health Profile for blue-collar workers.

This article describes a study on the effectiveness of a Health Profile that was offered to blue-collar workers. The major goal of the Health Profile was to improve workers' awareness of own health behaviors and their intentions to change unhealthy behaviors. The Health Profile consisted of a booklet in A4-format in which tailored information was given on health behaviors. A pretest and posttest design (no control group) was used. The results showed a significant improvement of awareness of own health behaviors. Significant attitudinal changes were also achieved. There were no changes in social support and self-efficacy nor was there a change in the intention to change behaviors. These results suggest that a personalized Health Profile is a promising means to make workers aware of their personal risk behaviors.

Employment careers of young type I diabetic patients in The Netherlands.

The factors that influence the employment careers of diabetic patients aged 20 to 34 years were studied using a mail questionnaire. The study included all members of the Dutch diabetics association (Diabetes Vereniging Nederland) in that age group. A total of 5987 questionnaires were mailed; 4300 completed questionnaires were returned, giving a response rate of about 72%. The aim of the study was to provide a better insight into the problems type I diabetic patients face in the labor market: entry into the labor market, conditions at work, and (premature) exit from the labor market owing to health reasons. This study carefully distinguished between employability and employment. Results showed that having diabetes did not decrease the chances of entry into the labor market for the subjects, although some types of jobs are still unavailable for diabetic patients. There was no higher unemployment in the study population than in the general population. Although there were problems faced by patients in the work situation, they were generally limited to a small group.

Morbidity among unemployed and work-incapacitated men in The Netherlands.

As yet, the relationship between unemployment and physical health has not sufficiently been clarified. With a longitudinal approach a representative Dutch panel study and a study on a health center population were carried out. They involved work-incapacitated and unemployed men between 21 and 65 years of age. Men incapacitated for work were in poorer health than matched working men; the same was true in a three-year follow-up. Unemployed and working men were shown to be equally healthy. The physical health of the incapacitated men decreased with time but that of the unemployed men did not. This finding implies that unemployment per se does not lead to poorer health. Differences in social security systems seem to interfere with an international comparison of the consequences of unemployment on health. International research should distinguish more explicitly between those who are unemployed for economic reasons or incapacitated for work for medical reasons.

The role of production control in the development of burnout.

Burnout is an increasingly important problem in modern work organizations. Few studies, however, have explicitly applied an adequate theoretical understanding of the performance of modern organizations. This article aims to initiate both a discussion of this phenomenon and higher-quality research into the emergence of burnout based on an understanding of the economic-technological rationalization and control (management control) of production and service processes. In applying production control, both technical and bureaucratic, group and attitudinal control systems are increasingly integrated. This so-called systematic control strategy is one of the major causes of burnout. The cumulative effect of an increasing workload combined with reduced resources due to economic considerations and technocratic implementation of production control is assumed to be relevant to the development of burnout. The authors' propositions apply to service workers in human service organizations and to key workers in enterprises using flexible specialization combined with self-directed work groups.

Assessment, education and placement: an integrated approach to vocational rehabilitation.

Taking into account that a great number of people in the Netherlands are considered incapacitated for work, reintegration activities are becoming increasingly important. Thus far, no studies have been conducted in the Netherlands to investigate the long-term effectiveness of vocational rehabilitation programmes. This study assessed the long-term effectiveness of the programmes of three vocational rehabilitation centres. The centres relate their success to the proportion of trainees participating in the competitive labour market. The centres provide integrated programmes in certified occupational training and personal skills training. After five years, 80% of the trainees are working in the competitive labour market. In addition, their personal skills have improved. Within 4 to 7 years the decrease in social security costs of reintegrated employees will outweigh the total costs of the vocational training programme.

The Demand-Control-Support model as a predictor of return to work.

The present study investigated work-related determinants of return to work. Our hypothesis was based on the strain hypothesis of the Demand-Control-Support model, which postulates a relation between job demands, job control and support at work on the one hand, and the aetiology of health complaints on the other hand. High demands were hypothesized to obstruct return to work, whereas high control and high support were thought to have a positive effect on return to work. This hypothesis was tested in a population of employees who were sick-listed for 6-8 weeks. Return to work, as operationalized by the categories (i) not working; (ii) return to work with adjustments; and (iii) full return to work, was determined 4 months after the onset of the sick leave. The hypothesis was tested by logistic regression analyses. High job demands were the least predictive of full return to work. However, the likelihood of employees with high job demands returning to work with adjustments was higher than the likelihood of them not working. Therefore, job demands might also work as a pressure to return to work (compare this with Smulders and Nijhuis, 1999). Furthermore, high skill discretion in combination with high job demands predicted working with adjustments in comparison with not working. Finally, high supervisor support was the most predictive of return to work without adjustments, and the least predictive of not working.

[Insufficient protection against infection with HIV in general and orthopedic surgeons]. / Onvoldoende bescherming tegen besmetting met HIV bij algemene en orthopedische chirurgen.

In a study of the content of occupational health care for hospital workers we carried out a separate study to measure the professional protection used to prevent contamination with HIV or hepatitis B virus. Therefore we carried out a study among Dutch general and orthopaedic surgeons. A questionnaire was sent to a representative sample of this population. The conclusions are that the respondents are relatively poorly informed about HIV and (or) hepatitis risks. A relatively small part of the respondents used protecting instruments; 40 (operating rooms) and 83% (emergency departments) of the respondents did not use safety glasses. The availability of protecting instruments is higher in operating rooms than in emergency departments, but this availability does not imply use of these instruments. The information on occupational contamination risks, the individual safety measures and the quality of the safety glasses are subject to criticism.

Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: a randomized controlled trial.

OBJECTIVE: To evaluate the substitution of specialized rheumatology nurses for rheumatologists in diagnosing fibromyalgia (FM). METHODS: Referred patients with FM symptoms (n = 193) were randomized to a study group diagnosed by a specialized rheumatology nurse (SRN group, n = 97) or to a control group diagnosed by a rheumatologist (RMT group, n = 96). SRN patients were seen within 3 weeks by a nurse who took structured history and initiated routine laboratory tests. During a 5-minute supervision session, the rheumatologist was informed by the nurse about medical history, performed a brief physical examination, and confirmed or rejected the nurse's diagnosis. RMT patients were seen by a rheumatologist after a regular waiting period of 3 months. Outcome measures were initial agreement between the nurse and rheumatologist in the SRN group, final diagnosis after 12-24 months of followup, patient satisfaction, and diagnostic costs. RESULTS: The mean waiting time after randomization was 2.8 and 12.1 weeks in the SRN and RMT groups, respectively. Eight RMT patients cancelled their appointments because of the waiting time. Excellent agreement (kappa = 0.91) between rheumatologists and nurses was found. After 12-24 months of followup, none of the initial diagnoses were recalled in either group. SRN patients were significantly more satisfied than RMT patients. Mean diagnostic costs were lower in the SRN group (euro219) than in the RMT group (euro281) (95% uncertainty interval euro-103, euro-20). CONCLUSION: Substituting specialized nurses for rheumatologists in the diagnostic process of FM is a trustworthy and successful approach that saves waiting time, provides greater patient satisfaction, and is cost-effective.

Organizational characteristics as predictors of work disability: a prospective study among sick employees of for-profit and not-for-profit organizations.

INTRODUCTION: This article reports a prospective study that focused on the influence of organizational structure and organizational culture on the outcome of sickness absence, return to work or work disability. Former studies of determinants of work disability hardly have given attention to organizational characteristics and, if so, not following a appropriate prospective design. METHODS: The study population consisted of 455 employees of 45 for-profit and not-for-profit companies participating in the Maastricht Cohort Study on fatigue at work who were on sick leave for at least 6 weeks. Both independent variables which were type of company, size, centralization of decision making and organizational culture, and covariates, which were sex, age, educational level, fatigue, and chronic illness, were all measured before employees reported sick. The dependent variable outcome of the sickness absence, mainly return to work or work disability, was measured 15 months after reporting sick. RESULTS: Multilevel logistic regression analysis, with organizational characteristics as level 2 independent variables and demographic and health characteristics as covariates, suggested that the type of company (for-profit/private or not-for-profit/public) is predictive of the outcome of sickness absence (crude OR = 2.21; CI: 1.16-4.20), but this may be partially due to a higher proportion of fatigued and chronically ill employees in not-for-profit companies (adjusted OR = 2.09; CI: 0.93-4.37). Findings about the role of some other organizational characteristics, like organizational culture, were inconclusive. CONCLUSIONS: Organizational characteristics should next to health characteristics be included in the models of studies which aim at predicting which sick employees are at risk for work disability. To prevent work disability not-for-profit companies might be stimulated to more active return-to-work policy by charging them with the costs of it.