Work-related upper extremity disorders: one-year follow-up in an occupational diseases registry.

PURPOSE: To study the course and consequences of work-related upper extremity disorders in the registry of the Netherlands Centre for Occupational Diseases (NCvB). METHODS: A follow-up study was performed in a sample of consecutive cases of work-related upper extremity disorders notified to the NCvB. Perceived severity was measured with VAS (0-100), quality of life with VAS (0-100) and SF-36, functional impairment with DASH and sickness absence with a questionnaire. Measurements took place directly after notification (T0) and after 3, 6 and 12 months (T1-T3). A linear mixed model was used to compare scores over time. RESULTS: Average age of the 48 consecutive patients (89% response) was 42 years; 48% were men. Perceived severity, functional impairment and sickness absence decreased statistically significant during the follow-up period, and quality of life scores improved. Patients older than 45 years scored worse on perceived severity of the disease, functional impairment and quality of life than did younger patients. CONCLUSIONS: The role of registries of occupational diseases for preventive policy can be extended by creating longitudinal data in sample projects. In the sample from our registry, work-related upper extremity disorders had a favourable course.

Evaluation of occupational disease surveillance in six EU countries.

BACKGROUND: Registries of occupational diseases in various European countries differ considerably in criteria for notification and recognition, statistical data provided and the legal and social security context. Therefore, figures on occupational diseases are not comparable between countries and are often regarded as not reliable even within a country. Still, registries of occupational diseases are an important source for policy on occupational safety and health. AIMS: To evaluate registries of occupational diseases in European (EU) countries for their ability to provide appropriate information for preventive policy. METHODS: Contact persons of national registries for occupational diseases in six countries were sent a questionnaire on the objectives of their registry and on the quality of monitoring time trends and alerting to new risks. An auditor then visited each contact person, discussed the completed questionnaire and sent a draft audit report to the contact person for verification. Two reviewers then established a quality score based on the verified audit report. The results of the audit were sent to each contact person, who was asked to evaluate the usefulness of the audit instrument for future quality improvement of the registry. RESULTS: The objectives of the registries assessed in the six countries were compensation, provision of statistics, prevention and research. The average quality was rated 3.2 (SD 2.2) out of 10 for monitoring occupational diseases and 5.3 (SD 1.4) out of 10 for alerting to new risks. The main reasons for the low scores were inadequate education and training of physicians and poor participation of notifying physicians. Three of the six contact persons (50%) agreed that the audit could actually contribute to future quality improvement of the registry in relation to prevention. CONCLUSIONS: Registries in EU countries do not adequately monitor existing occupational diseases or adequately alert to newly occurring occupational diseases. There is an urgent need to improve the education and participation of notifying physicians.

Sentinel surveillance of occupational diseases: a quality improvement project.

BACKGROUND: Occupational diseases are generally underreported. The aim of this study was to evaluate whether a sentinel surveillance project comprising motivated and guided occupational physicians would provide higher quality information than a national registry for a policy to prevent occupational diseases. METHODS: A group of 45 occupational physicians participated in a sentinel surveillance project for two years. All other occupational physicians (N = 1,729) in the national registry were the reference group. We compared the number of notifications per occupational physician, the proportion of incorrect notifications, and the overall reported incidence of occupational diseases. RESULTS: The median number of notifications per occupational physician during the project was 13.0 (IQR, 4.5-31.5) in the sentinel group versus 1.0 (IQR, 0.0-5.0) in the reference group (P < 0.001). The proportion of incorrect notifications was 3.3% in the sentinel group and 8.9% in the reference group (P < 0.001). The overall reported occupational disease incidence was 7 times higher (RR = 6.9, 95% CI: 6.5-7.4) in the sentinel group (466 notifications per 100,000 employee years) than in the reference group (67 notifications per 100,000 employee years). CONCLUSIONS: A sentinel surveillance group comprising motivated and guided occupational physicians reported a substantially higher occupational disease incidence and a lower proportion of incorrect notifications than a national registry.

The effectiveness of an educational programme on occupational disease reporting.

BACKGROUND: Occupational diseases are under reported. Targeted education of occupational physicians (OPs) may improve their rate of reporting occupational diseases. AIM: To study the effectiveness of an active multifaceted workshop aimed at improving OPs' reporting of occupational diseases. METHODS: We undertook a comparative study with 112 OPs in the intervention group and 571 OPs as comparisons. The intervention was a 1-day workshop. Measurements of occupational disease reporting activity in both groups in 6-month periods before and after the intervention were collected via the national registration system. Measurements of OPs' knowledge, self-efficacy and satisfaction were made in the intervention group. Differences between the groups and predictive factors for reporting were subsequently analysed statistically. RESULTS: The percentage of reporting OPs after the intervention was significantly higher in the intervention group compared to the comparison group at 19 versus 11% (P < 0.01). No differences were found in the average number of reported occupational diseases per reporting physician after the intervention: 3.7 (SD 5.37) versus 3.4 (SD 4.56) (not significant). The self-efficacy score was a predictive factor for reporting occupational diseases (P < 0.05). Measurements of knowledge and self-efficacy increased significantly (both parameters P < 0.001) and remained after half a year. Satisfaction was high (7.85 of 10). CONCLUSIONS: An active, multifaceted workshop on occupational diseases is effective in increasing the number of physicians reporting occupational diseases. Self-efficacy measures are a predictive factor for such reporting.

Diagnosing and reporting of occupational diseases: a quality improvement study.

AIM: To assess the need for quality improvement of diagnosing and reporting of noise-induced occupational hearing loss and occupational adjustment disorder. METHODS: Performance indicators and criteria for the quality of diagnosing and reporting were developed. Self-assessment questionnaires were sent to all occupational physicians recorded on the Netherlands Centre for Occupational Diseases database. The performance of responding occupational physicians was then assessed by separate scores per performance indicator and by a total quality score. RESULTS: Twenty-three questionnaires on noise-induced occupational hearing loss and 125 questionnaires on occupational adjustment disorder were available for analysis. The mean quality score for diagnosing and reporting was 6.0 (SD: 1.4) for noise-induced occupational hearing loss and 7.9 (SD: 1.5) for occupational adjustment disorder on a scale of 0-10. For noise-induced occupational hearing loss, there was a need for quality improvement of the aspects of medical history, audiometric measurement, clinical diagnosis of the disease and reporting. For occupational adjustment disorder, the assessment of other non-occupational causes needed improvement. CONCLUSIONS: The quality of diagnosing and reporting could be improved for noise-induced occupational hearing loss and occupational adjustment disorders. Information, education and practical tools are proposed for quality improvements.