The Dutch Multidisciplinary Occupational Health Guideline to Enhance Work Participation Among Low Back Pain and Lumbosacral Radicular Syndrome Patients.

Purpose Based on current scientific evidence and best practice, the first Dutch multidisciplinary practice guideline for occupational health professionals was developed to stimulate prevention and enhance work participation in patients with low back pain (LBP) and lumbosacral radicular syndrome (LRS). Methods A multidisciplinary working group with health care professionals, a patient representative and researchers developed the recommendations after systematic review of evidence about (1) Risk factors, (2) Prevention, (3) Prognostic factors and (4) Interventions. Certainty of the evidence was rated with GRADE and the Evidence to Decision (EtD) framework was used to formulate recommendations. High or moderate certainty resulted in a recommendation "to advise", low to very low in a recommendation "to consider", unless other factors in the framework decided differently. Results An inventory of risk factors should be considered and an assessment of prognostic factors is advised. For prevention, physical exercises and education are advised, besides application of the evidence-based practical guidelines "lifting" and "whole body vibration". The stepped-care approach to enhance work participation starts with the advice to stay active, facilitated by informing the worker, reducing workload, an action plan and a time-contingent increase of work participation for a defined amount of hours and tasks. If work participation has not improved within 6 weeks, additional treatments should be considered based on the present risk and prognostic factors: (1) physiotherapy or exercise therapy; (2) an intensive workplace-oriented program; or (3) cognitive behavioural therapy. After 12 weeks, multi-disciplinary (occupational) rehabilitation therapy need to be considered. Conclusions Based on systematic reviews and expert consensus, the good practice recommendations in this guideline focus on enhancing work participation among workers with LBP and LRS using a stepped-care approach to complement existing guidelines focusing on recovery and daily functioning.

Results of 10 years of monitoring nitrogen in the sandy regions in The Netherlands.

The effect of policy measures on agriculture and water quality with respect to nitrogen have been monitored on farms in the sandy regions since the early 1990s. Nitrogen surplus on dairy farms decreased by 100 kg/ha (30%) in the 1991-1999 period due to demonstration projects and the implementation of MINAS, limiting farm gate balance surplus. Nitrogen surplus on arable farms has slightly decreased (30 kg/ha, i.e. 20%), probably because MINAS became mandatory for arable farms from 2001 onwards. About 25% of the farm-gate balance N surplus leached as nitrate into the upper metre of the groundwater. The NO3-N concentration decreased in the 1992-2001 period, but the decrease was larger for dairy farms (16 mg/l, 46%) than for arable farms (7.7 mg/l, 30%). Of the decrease in NO3-N concentration on dairy farms, 23% is caused by a decrease in N surplus, and 27% by environmental factors, such as a higher precipitation surplus, more wet soils and more peat soils in the second part of the monitoring period. However, unknown factors are responsible for 50% of the decrease.

Economic and environmental effects of the manure policy in The Netherlands: synthesis of integrated ex-post and ex-ante evaluation.

This paper summarises the results of both an ex-post evaluation of the Dutch Mineral Accounting System (MINAS) and an ex-ante evaluation of the effect of different levy-free surplus values. The MINAS system has been introduced in 1998 in order to reduce nitrate and phosphate leaching from agricultural soils. MINAS resulted in a reduction of the N surplus on dairy farms of approximately 50 kg ha(-1) to limited or no costs to the farms involved. MINAS resulted in higher costs for manure removal for intensive livestock farmers. Though emissions of N and P have decreased significantly during the last five years effects of this reduction in environmental quality cannot be observed, except for a small decrease in nitrate concentration of the upper groundwater. The ex-ante evaluation of different variants for possible future levy-free surplus levels indicated that under the lowest variant, the nitrate concentration in groundwater will exceed 50 mg per litre on 14% of the area. The environmental effect of the different variants for P were not distinguished. The lowering of the levy-free surplus for P will have a drastic effect on the intensive livestock farms. The incorporation of fertiliser P under the MINAS system would be a cheap option to reduce the P surplus.

Monitoring nitrogen leaching for the evaluation of the Dutch minerals policy for agriculture in clay regions.

This paper presents the results of the Dutch monitoring program for agriculture in the clay regions for the period 1996-2000 and evaluates the monitoring strategy. A wide range of farms (25 to 85%) had a NO3--N concentration in tile drainwater higher than the EU standard of 11.3 mg/l. The low figure is related to wet winters; the high, to dry winters. Arable farms are more prone to NO3- leaching than dairy farms. On arable farms, about 25% of the N surplus leached to groundwater and tile drainwater, on dairy farms this was about 15%. N in tile drainwater has shown to be the best indicator for monitoring the effects of farming practice changes in the clay regions. The average NO3--N concentration in tile drainwater was 18.8 and 3.2 mg/l in borehole water on farms where both were monitored. It is known that N use has a relationship with NO3- in tile drainwater and not with NH4+ and organic N. The presented results indicate that crop rotation and precipitation strongly influence NO3- concentration in tile drainwater.