Effect evaluation of a self-management program for dutch workers with a chronic somatic disease: a randomized controlled trial.

PURPOSE: The objective of this study is to investigate the effect of a Self-Management Program for workers with a chronic disease. This program is based on the Chronic Disease Self-Management Program of Stanford University, modified for workers with a chronic somatic disease. METHODS: In a randomized controlled trial, the effectiveness of a Self-Management Program was evaluated. Participants were randomly assigned to the experimental group (n = 57) and the control group (n = 47). The experimental group received an intervention, the control group received care as usual. Primary outcome measures were self-efficacy at work and the attitude towards self-management at work. Secondary outcomes were the SF-12 health survey questionnaire, job satisfaction and intention to change job. The results were measured at baseline, after the intervention and 8 months after the intervention. RESULTS: The attitude towards self-management at work (enjoyment) improved after 8 months for the intervention group (p = 0.030). No other outcome variable differed significantly. As an interaction effect, it was found that low educated workers developed a better physical health quality (SF-12) in the intervention group compared with the control group. The attitude towards self-management at work (importance) improved in the intervention group for older and female workers and the attitude toward enjoying self-management at work improved for female workers only. CONCLUSION: The results show that low educated workers, older workers and women benefit significantly more from the training than higher educated workers, younger workers and men.

"My lung disease won't go away, it's there to stay": profiles of adaptation to functional limitations in workers with asthma and COPD.

PURPOSE: Earlier research has shown that adaptation (i.e., the way in which employees cope with limitations resulting from their disease) is associated with sick leave. Our aim was to investigate signs of adequate or inadequate adaptation in employees with asthma and COPD. METHODS: A Q-methodological study was carried out among 34 workers with asthma or COPD. RESULTS: Four adaptation profiles were distinguished: the eager, the adjusted, the cautious, and the worried workers. The adaptation profiles provide insight into the different ways in which workers with asthma and COPD cope with their illness at work. CONCLUSIONS: The adaptation profiles serve as a starting point for the design of appropriate (occupational) care. The eager workers experience little difficulties at work; the cautious workers may need assistance in learning how to accept their disease; the worried workers need reassurance, and may need reactivation; the adjusted workers deserve extra attention, and, when necessary, advice on how to live with their asthma or COPD.

Longitudinal changes in bronchial responsiveness associated with swine confinement dust exposure.

STUDY OBJECTIVES: Acute exposure to the air in swine confinement units causes bronchial hyperresponsiveness and inflammation of the airways. This study was performed to assess the longitudinal development of bronchial responsiveness in pig farmers and to establish exposure-response relationships. METHODS: A cohort of 171 pig farmers was followed over a 3-year period. Bronchial responsiveness was assessed by a histamine provocation test. Long-term average exposure to inhalable dust and endotoxin was determined by personal monitoring in summer and winter, using data on farm characteristics and activities. Time-weighted average (TWA) personal exposure to ammonia was measured. Data on farm characteristics were gathered in the same period. RESULTS: Mean increase in responsiveness was 2.52 doubling concentrations of histamine for a 10% decrease in FEV(1) and 1.36 doubling concentrations for a 20% decrease in FEV(1). Long-term average exposure to dust was 2.63 mg/m(3) and to endotoxin was 105 ng/m(3). TWA exposure to ammonia was 1.60 mg/m(3). After adjusting for age and smoking behavior, long-term average exposure to inhalable dust was associated with increases in bronchial responsiveness expressed as steps for provocative concentration causing 10% fall in FEV(1). TWA exposure to ammonia, use of wood shavings as bedding, and automated dry feeding were associated with increases in responsiveness expressed as steps for provocative concentration causing a 20% fall in FEV(1). CONCLUSIONS: Exposure to dust and ammonia in pig farms contributes to chronic inflammation of the airways and should be reduced.

Repeatability of self-reported data on occupational exposure to particular compounds.

The repeatability of self-reported occupational exposure to eight particular compounds was investigated in 209 males aged 49-87 years. The subjects completed an initial mailed questionnaire and were interviewed by telephone 3-5 weeks later. The study was carried out as part of a case-referent study on the relation between occupation and prostate cancer. The repeatability of answers was found to be better in the case of some agents than in that of others: kappas calculated as a measure of concordance range from 0.36 to 0.70. No substantial influence was found to be exercised by age or socioeconomic status, or by case or referent status. Although the repeatability observed was not flawless, it was concluded that self-reported exposure data would appear to be a sound basis for epidemiological studies on the aetiology of disease, whenever objective information on occupational exposure is not available.

Longitudinal changes in lung function associated with aspects of swine-confinement exposure.

Several aspects of swine-confinement farming appear to be leading to adverse respiratory effects. This study was set up in a longitudinal design to study the association between certain characteristics of farms or the way they are run and a decline in lung function. A cohort of 171 pig farmers was observed for 3 years. Lung function was measured. Exposure to farm characteristics was determined at the start of the observation period, using data from standardized farm surveys and from diaries kept by the participants. Mean decline in lung function was 73 mL/year for forced expiratory volume in 1 second (FEV1) and 55 mL/year for forced vital capacity (FVC). A longitudinal decline in FEV1 was significantly associated with the use of quaternary ammonium compounds as disinfectants (an additional 43 mL/year) and also with the use of an automated dry feeding system (an additional 28 mL/year). The association with the use of wood shavings as bedding material was not statistically significant. The impact of these characteristics in a longitudinal study provides stronger evidence for causal inference than that shown in previous cross-sectional designs. This may be useful in promoting preventive measures.

A simple method to evaluate the reliability of OWAS observations.

Slides showing nurses in different working postures were used to determine the reliability of OWAS observations. Each slide could be looked at for 3 seconds, while a new slide was shown every 30 seconds to resemble the normal practice of observation. Two observers twice scored a series of slides, some of them being identical at both viewings. To reduce effects of recall there was a time interval of 4 weeks or more between the two viewings and the slides were in a different order the second time. Different series were used to evaluate inter- and intra-observer reliability. The OWAS scores of corresponding slides were compared. In almost all comparisons percentages of agreement over 85% and kappa's over 0.6 were found, which is considered as good agreement. The procedure described seems to be a useful and simple technique to determine such reliability.

[Illness due to work or to an overactive thyroid?]. / Ziek door het werk of een te hard werkende schildklier?

An incapacity to work brought about by stress was diagnosed in two women aged 40 and 38. They were both in conflict situations at work and had psychological problems. They stopped working but remained tired and irritable. After being unfit for work for more than a year they were diagnosed with hyperthyroidism which was treated appropriately. They both recovered and resumed work. Hyperthyroidism can impair physical and mental functioning. Presenting symptoms may be confusing, specifically if work-related factors appear to be the obvious implication. In The Netherlands, employees who become ill, consult their general practitioner or a medical specialist, who are concerned with diagnosis and treatment. They also report to their employer's occupational-health department, where the physician focuses on work-related factors that may impair health and on assessment of disability. Communication between all parties should be optimal.

Fatigue, emotional exhaustion and perceived health complaints associated with work-related characteristics in employees with and without chronic diseases.

OBJECTIVES: Ageing of the Dutch working force and increasingly more stringent restrictions regarding early retirement and disability benefits are leading to higher numbers of workers with ill health. Until now, only a few studies have explored how employees with ill health perceive their work. This study investigated possible differences in scores on fatigue, emotional exhaustion, perceived health complaints and various work-related characteristics between chronically ill (CIWs) and non-chronically ill workers (NCIWs), as well as differences in associations between work- and health-related characteristics. METHODS: A questionnaire was sent to all employees of a Dutch university to collect data on perceived work-related and health-related characteristics (response 49.1%). Differences in various scores were analysed using chi (2)-tests and the general linear model. Associations between the work- and the health-related characteristics were determined by multiple linear regression analyses in the CIWs (n = 444) and NCIWs (n = 1,347) separately. Interaction terms were included to detect differences between the two groups. RESULTS: The results indicated that the CIWs had less favourable scores on the three health-related characteristics. Also, the CIWs scored less favourably than the NCIWs on almost all the work-related characteristics. In the two groups, negative work-related aspects, such as higher work pressure, contributed most to explaining the variance in the health-related characteristics. However, in the CIWs, fatigue was not explained by the work-related aspects as much as in the NCIWs. In the CIWs, the association between unpleasant treatment and the health-related characteristics was stronger than in the NCIWs, but there were indications that autonomy, possibilities for learning and social support from superiors also played an important role. CONCLUSIONS: CIWs perceived more fatigue, emotional exhaustion and health complaints than NCIWs. There were different patterns of associations between work- and health-related characteristics in the NCIWs and CIWs. Future studies on associations between work-related characteristics and health should take the presence of chronic disease into account.

Health-related and work-related aspects associated with sick leave: a comparison of chronically ill and non-chronically ill workers.

OBJECTIVES: Our aims were to study to what extent chronically ill workers (CIWs) take more sick leave than non-chronically ill workers (NCIWs) and to explore which health-related and work-related aspects are associated with the sick leave patterns of the two groups. METHODS: A questionnaire on work, health and sick leave was sent to all employees of a university in The Netherlands (response: 49.1%). Analyses were conducted for 444 CIWs and 1,347 NCIWs. Odds ratios (ORs) were calculated to quantify the contribution of being chronically ill to sick leave in general, frequent sick leave, prolonged sick leave, and present sick leave. The contributions of health-related and work-related aspects to sick leave were investigated by multiple logistic regression analyses for both CIWs and NCIWs separately. RESULTS: CIWs showed significantly increased ORs for general, frequent, prolonged and present sick leave when compared with NCIWs. Fatigue, emotional exhaustion and perceived health complaints showed stronger associations with sick leave for both CIWs and NCIWs than various work-related aspects. Workers of 46 years of age and older showed less sick leave than workers under the age of 36. Male respondents and scientific personnel showed less frequent sick leave than the other respondents, and so did respondents working more than 40 h a week, compared with part-timers. The final regression models explained 8%-16% of the variance in sick leave. CONCLUSIONS: CIWs take two to three times more and longer sick leave than NCIWs. Health-related aspects are more strongly associated with sick leave than work-related aspects for both CIWs and NCIWs. Sick leave patterns were, nevertheless, only partly explained by health-related and work-related aspects. In any case, future studies of sick leave should certainly take the presence of chronic disease into account as an important determinant of sick leave.

Metal workers and repairmen at risk for prostate cancer: a review.

BACKGROUND: The objective is to summarize the results of studies of prostate cancer risk among metal workers, mechanics, and repairmen in order to evaluate the magnitude of risk and to investigate the role of specific work-related hazards in the development of this disease. METHODS: Review of literature. RESULTS: In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among metal workers and repairmen. It is as yet unclear, however, whether this excess risk is caused by particular occupational exposures or by risk factors in personal life style (e.g., dietary habits). Hardest evidence is found of a relationship to exist between the use of cutting oils or other metal-work liquids and prostate cancer risk. CONCLUSIONS: It would appear that metal workers, mechanics, and repairmen run a slightly elevated risk of prostate cancer. However, the actual risk factors are still unknown.

Farmers at risk for prostate cancer.

OBJECTIVE: To summarize the literature on the risk of prostate cancer among farmers and farm workers, to evaluate the magnitude of the risk and to determine the presence of risk factors peculiar to agricultural work. METHODS: Recent literature was searched and reviewed, selecting only case-control studies in which both positive and negative odds ratios were presented for several occupations, while only cohort studies and death-certificate studies were selected which presented risk estimates for several cancer sites, elevated as well as decreased. RESULTS: In most of the studies reviewed, a slight excess risk of prostate cancer incidence or mortality was observed among farmers. It is as yet unclear whether this excess risk is caused by particular occupational exposures or by risk factors in their personal lifestyle (e.g. dietary habits). Evidence was found for a relationship between the use of pesticides and of other agricultural chemicals and the risk of prostate cancer. CONCLUSION: Farmers probably have a slightly elevated risk of contracting prostate cancer. However, the actual risk factors are still a matter of conjecture.

[Chondroma of the larynx--case report and differential diagnosis in CT]. / Chondrom des Larynx--Falldarstellung und Differentialdiagnose in der CT.

The characteristic features of chondroma and chondrosarcoma of the larynx (less than 1% of laryngeal tumors) are discussed in a case report. Laryngoscopy (rounded, smooth tumor, covered by normal mucous membrane) and HR-CT of the larynx (swelling of the cartilages, calcifications in 80% of cases) give a characteristic view of the tumor, so that, by synopsis of both, a definite diagnostic statement concerning the kind of tumor is possible. However, carcinoma of the larynx with invasion of the cartilage, laryngeal manifestation of multiple chondromatosis and calcification after severe trauma have to be differentiated from cartilaginous tumors of the larynx. The adequate therapy of chondroma and low-grade chondrosarcoma consists of partial laryngectomy and reconstruction of the air passages. High-grade chondrosarcoma should be treated with radical laryngectomy.

Reproductive hazards related to perchloroethylene. A review.

The literature of perchloroethylene (PER) was scrutinized to find answers to the following questions: (1) is an effect of PER on reproduction to be expected, and (2) if so, has such an effect actually been shown in animal experiments and/or in epidemiological studies? From this review it can be concluded that the first question should be answered in the affirmative, considering the various mechanisms capable of leading to defects in the reproductive processes and the information about how PER can interact (and in fact does interact) with these mechanisms. The few studies in which the effects of PER exposure on reproductive outcome have been studied are, however, not very conclusive. Some suggest an effect, others do not. In view of the incompleteness of the experimental results and the methodological shortcomings especially of the epidemiological studies, there is a need for a suitably designed epidemiological investigation on the reproductive consequences of exposure to PER. In order to avoid the methodological problems of the above-mentioned studies, the design should be a prospective one.