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.

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.

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.

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.

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.

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.

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.

Determinants of fat and fiber consumption in American rural energy workers.

BACKGROUND: The objective of this study was to gain insight into the determinants of dietary fat and fiber consumption in American rural energy workers. Main determinants in this study were knowledge, efficacy expectations, and outcome expectations. The determinants will be ordered in a model, assuming that efficacy and outcome expectations predict intention. METHODS: The study consisted of a cross-sectional survey. The questionnaires on food behavior and the determinants of fat and fiber consumption were administered to the subjects at the same time. Models of determinants of fat and fiber consumption were derived from the correlation and regression analyses. RESULTS: There were 211 questionnaires analyzed. The scales were shown to be valid and reliable. In the models of determinants of fat and fiber consumption the following determinants were generated: gender, education, knowledge, interest, efficacy expectations, outcome expectations, and intention. In this study efficacy expectations were important to determine fat and fiber consumption. CONCLUSIONS: Efficacy expectations can be considered an important variable of an intervention program aiming at the decrease of fat consumption and at the increase of fiber consumption in rural energy workers.

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.

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.

[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.

Male and female nurses in intensive-care wards in The Netherlands.

This article presents the results of a national survey among intensive-care nurses, establishing whether male nurses and female nurses can be distinguished with respect to issues such as professionalization, career orientation and their preference for technical departments. The study showed that there is an over-representation of men in technical wards. At IC/CC-units the percentage of male nurses is twice as large as in the hospital as a whole (IC/CCU included). The distribution of labour among male and female nurses is taking place according to traditional sex-specific role patterns. Male nurses are more oriented towards professionalization than female nurses. Male IC-nurses see their jobs more in a medical perspective and they also show a higher frequency in the performance of medically reserved activities. Male IC-nurses seem to be particularly directed at upgrading their own profession. The differences between male and female nurses can also be explained by culturally determined differences between men and women regarding their own career perspective and career development, as well as by internal staff policy.