Cancer survivors and unemployment: a meta-analysis and meta-regression

CONTEXT

Nearly half of adult cancer survivors are younger than 65 years, but the association of cancer survivorship with employment status is unknown.

OBJECTIVE

To assess the association of cancer survivorship with unemployment compared with healthy controls.

DATA SOURCES

A systematic search of studies published between 1966 and June 2008 was conducted using MEDLINE, CINAHL, EMBASE, PsycINFO, and OSH-ROM databases.

STUDY SELECTION

Eligible studies included adult cancer survivors and a control group, and employment as an outcome.

DATA EXTRACTION

Pooled relative risks were calculated over all studies and according to cancer type. A Bayesian meta-regression analysis was performed to assess associations of unemployment with cancer type, country of origin, average age at diagnosis, and background unemployment rate.

RESULTS

Twenty-six articles describing 36 studies met the inclusion criteria. The analyses included 20,366 cancer survivors and 157,603 healthy control participants. Studies included 16 from the United States, 15 from Europe, and 5 from other countries. Overall, cancer survivors were more likely to be unemployed than healthy control participants (33.8% vs 15.2%; pooled relative risk [RR], 1.37; 95% confidence interval [CI], 1.21-1.55). Unemployment was higher in breast cancer survivors compared with control participants (35.6% vs 31.7%; pooled RR, 1.28; 95% CI, 1.11-1.49), as well as in survivors of gastrointestinal cancers (48.8% vs 33.4%; pooled RR, 1.44; 95% CI, 1.02-2.05), and cancers of the female reproductive organs (49.1% vs 38.3%; pooled RR, 1.28; 95% CI, 1.17-1.40). Unemployment rates were not higher for survivors of blood cancers compared with controls (30.6% vs 23.7%; pooled RR, 1.41; 95% CI, 0.95-2.09), prostate cancers (39.4% vs 27.1%; pooled RR, 1.11; 95% CI, 1.00-1.25), or testicular cancer (18.5% vs 18.1%; pooled RR, 0.94; 95% CI, 0.74-1.20). For survivors in the United States, the unemployment risk was 1.5 times higher compared with survivors in Europe (meta-RR, 1.48; 95% credibility interval, 1.15-1.95). After adjustment for diagnosis, age, and background unemployment rate, this risk disappeared (meta-RR, 1.24; 95% CI, 0.85-1.83).

CONCLUSION

Cancer survivorship is associated with unemployment.

Predicting the duration of sickness absence for patients with common mental disorders in occupational health care

OBJECTIVES

This study attempted to determine the factors that best predict the duration of absence from work among employees with common mental disorders.

METHODS

A cohort of 188 employees, of whom 102 were teachers, on sick leave with common mental disorders was followed for 1 year. Only information potentially available to the occupational physician during a first consultation was included in the predictive model. The predictive power of the variables was tested using Cox's regression analysis with a stepwise backward selection procedure. The hazard ratios (HR) from the final model were used to deduce a simple prediction rule. The resulting prognostic scores were then used to predict the probability of not returning to work after 3, 6, and 12 months. Calculating the area under the curve from the ROC (receiver operating characteristic) curve tested the discriminative ability of the prediction rule.

RESULTS

The final Cox's regression model produced the following four predictors of a longer time until return to work: age older than 50 years [HR 0.5, 95% confidence interval (95% CI) 0.3-0.8], expectation of duration absence longer than 3 months (HR 0.5, 95% CI 0.3-0.8), higher educational level (HR 0.5, 95% CI 0.3-0.8), and diagnosis depression or anxiety disorder (HR 0.7, 95% CI 0.4-0.9). The resulting prognostic score yielded areas under the curves ranging from 0.68 to 0.73, which represent acceptable discrimination of the rule.

CONCLUSIONS

A prediction rule based on four simple variables can be used by occupational physicians to identify unfavorable cases and to predict the duration of sickness absence.

Biodeterioration of medical-grade silicone rubber used for voice prostheses: a SEM study

Silicone voice prostheses used for rehabilitation of speech after total laryngectomy are inserted in an non-sterile habitat. Deposits on explanted Groningen Button voice prostheses revealed a biofilm, due to heavy colonization of the silicone surface by bacteria and yeasts. Furthermore, it was demonstrated by scanning electron microscopy on sectioned explants that the silicone material was deteriorated by filamentous and vegetative yeast cells. The different explants showed a variety of sharp-edged, discrete yeast colonies. The yeasts grew just under the silicone surface and up to 700 microns into the silicone material. Finally, nine different types of defects in the silicone material created by the yeasts are described. This deterioration of the silicone by yeasts seems to be the main reason for the failure and the frequent replacement of the prostheses. The mechanisms of silicone deterioration are still hypothetical.

Dutch practice guidelines for managing adjustment disorders in occupational and primary health care

Stress-related disorders, especially adjustment disorders, are widespread among working populations and are responsible for high costs in terms of suffering, sick leave, disability, and economic losses. Despite their high prevalence, there has been relatively little research on the effectiveness of treatments in an occupational health care setting. Guidelines for occupational physicians and general practitioners in relation to mental health problems were recently developed in The Netherlands and are discussed in this article. The guidelines provide a classification based on terms that are already used in the profession and are consistent with the diagnosis "adjustment disorder". They give recommendations for guidance and treatment on the basis of existing evidence, experience in adjacent fields, and consensus procedures. They are based on cognitive behavioral principles, mainly stress inoculation training and graded activity, and aim to enhance the problem-solving capacity of patients in relation to the work environment. The aim of this paper is to contribute to the exchange of and a discussion on methods and good practices in primary and occupational health care.

How can we help employees with chronic diseases to stay at work? A review of interventions aimed at job retention and based on an empowerment perspective

OBJECTIVES

A growing number of persons aged 16-65 is hampered by a chronic condition in performing job activities. Some of them quit the labour market prematurely. Vocational rehabilitation used to focus on (re)entering the labour market. Recently more attention is paid to interventions aimed at job retention. Some of these use an empowerment perspective. The objective of this study is to describe the characteristics, feasibility and effectiveness of such vocational rehabilitation interventions in order to decide which approaches are fruitful.

METHOD

The Medline, Embase, Cinahl and Psycinfo databases were systematically researched for studies published between 1988 and March 2004. Studies were included if they were experimental, included an intervention that aimed at job retention by means of solving work-related problems, used an empowerment perspective and concerned employees with one of the following chronic illnesses: diabetes mellitus, rheumatic diseases, hearing disorders, multiple sclerosis, inflammatory bowel disease, epilepsy, chronic kidney failure, COPD and asthma.

RESULTS

Nine studies were detected. The aims of the intervention programs were to improve psychosocial skills or implement work accommodations. They were structured as individual (6x) or group programmes (3x). They used methods like education (9x), assessment (7x), counselling (5x), training or role playing (5x). The most important outcome measures were employment status (5x), actions to arrange work accommodations (3x), and psychosocial measures like self-efficacy and social competence (3x). Employment status was claimed to be positively influenced in four out of five studies, obtaining work accommodations was successful in all three studies and psychological outcome measures improved in two out of three studies.

CONCLUSIONS

There is some evidence that vocational rehabilitation interventions that pay attention to training in requesting work accommodations and feelings of self-confidence or self-efficacy in dealing with work-related problems are effective. There is no evidence for greater effectiveness of group programs compared to individual programs. Attention has to be paid to feasibility aspects such as recruitment of participants and cooperation between medical professionals, occupational physicians, and vocational rehabilitation experts. Medical specialists and nursing specialists should pay more attention to work. Although many studies claim effectiveness, evidence for this was often weak due to short follow-up and the lack of control groups. More rigorous evaluation is needed.

What employees with rheumatoid arthritis, diabetes mellitus and hearing loss need to cope at work

OBJECTIVES

This study attempted to determine factors that help currently employed people with rheumatoid arthritis, diabetes mellitus or hearing loss to continue working.

METHODS

This was a qualitative study that used three concept-mapping sessions. Sixty-nine participants (rheumatoid arthritis 21, diabetes mellitus 23, and hearing loss 25) were recruited from the patient records of the rheumatology, diabetes, and audiology outpatients of the Academic Medical Center (AMC), Amsterdam, and referrals from occupational physicians and patient associations. An arthritis consultant, a diabetes consultant, and an audiologist screened the patients for the used illness inclusion criteria. A researcher screened the patients for the inclusion criteria of age and work.

RESULTS

The main factors enabling employees to continue working were ability to cope with the illness, support from management and colleagues, adequate work conditions, support of patient organizations and society, support of medical professionals and facilities, and benefits. The three groups of employees rated the priority of these factors differently. For the employees with rheumatoid arthritis, the support of management was the most important, followed by self-acceptance, self-efficacy, and professional advice on how to cope at work. For those with diabetes mellitus, self-acceptance, self-care, and support from management, colleagues and health professionals were the most important. For employees with hearing loss, being well informed about hearing equipment, reimbursement, and self-acceptance were the most important. A topic list was developed that can be used by health professionals as a guideline for exploring the work-related problems of patients with a chronic disease.

CONCLUSION

The results provide an understanding of the needs chronically ill employees have at work and the areas to which health professionals need to pay attention.

Effectiveness of e-learning in continuing medical education for occupational physicians

Background Within a clinical context e-learning is comparable to traditional approaches of continuing medical education (CME). However, the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians (OPs) has not been evaluated.

Aim To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs.

Methods Within the context of a postgraduate meeting for 74 OPs, a randomized controlled trial was conducted. Test assessments of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning.

Results In both groups, a significant gain in knowledge on mental health care was found (P < 0.05). However, there was no significant difference between the two educational approaches.

Conclusion The effect of e-learning on OPs' mental health care knowledge is comparable to a lecture-based approach. Therefore, e-learning can be beneficial for the CME of OPs.

Common prognostic factors of work disability among employees with a chronic somatic disease: a systematic review of cohort studies

OBJECTIVE

Based on prospective and retrospective disease cohort studies, the aim of this review was to determine common prognostic factors for work disability among employees with rheumatoid arthritis, asthma, chronic obstructive pulmonary disease, diabetes mellitus, and ischemic heart disease (IHD).

METHODS

A systematic literature search in Medline (1990-2008) and Embase (1990-2008) was carried out to identify relevant cohort studies using a well-defined list of inclusion and quality criteria.

RESULTS

We identified 43 relevant cohort studies with sufficient methodological quality (20 for rheumatoid arthritis, 3 for asthma and 20 for IHD). The common prognostic factors for work disability found in all the diseases were: perceived health complaints, limitation in daily physical activities caused by the disease (high versus low), heavy manual work, and female gender. The common positive prognostic factors for rheumatoid arthritis and IHD were age (high versus low) and sickness absence. The common negative factors for rheumatoid arthritis and IHD were education (high versus low) and ethnic origin (white versus non-white).

CONCLUSIONS

As many prognostic factors for work disability are similar for employees with various chronic diseases, it is possible to detect high risk groups. This information supports the development and implementation of a general disability management intervention for employees suffering from a chronic disease to overcome health-related limitations at work.

Cytokine gene polymorphisms and susceptibility to chronic irritant contact dermatitis

BACKGROUND

Cytokines play an important role in skin inflammation.

OBJECTIVES

We determined whether polymorphisms in cytokine genes contribute to the occurrence of occupational chronic irritant contact dermatitis (CICD).

METHODS

In a case-control study, 9 polymorphisms in the genes coding for interleukin (IL)-1 alpha, IL-1 beta, IL-8, IL-10, and tumour necrosis factor (TNF)-alpha were determined in 197 patients with CICD. 217 apprentices in vocational training for high-risk occupations for CICD served as controls.

RESULTS

For all polymorphisms, no differences in genotype distributions were found between patients and controls. However, in patients with self-reported low levels of wet work and irritant exposure, more TNFA -308 variant genotypes (G/A and A/A) were present compared with those exposed to higher levels or controls, which indicates a TNFA-induced increase of susceptibility. In patients with TNFA -308 variant genotypes, the prevalence of flexural eczema was higher (48% and 57%) compared with that in patients presented with wild-type genotype (30%). Regarding IL1A -889, prevalence of symptoms of dermatitis was lower in apprentices with T/T or C/T genotype (32% and 36%) compared with wild-type genotype (54%, C/C). This indicates a protective effect of these variant alleles in acquiring hand dermatitis.

CONCLUSIONS

This study provides evidence that some genetic variations alter susceptibility to (chronic) dermatitis. Knowledge of the impact of genetic differences on the risk of CICD is essential in predictive testing of individuals at risk.

Wet work and hand eczema in apprentice nurses; part I of a prospective cohort study

BACKGROUND /OBJECTIVES

Environmental exposure and personal susceptibility both contribute to the development of hand eczema. Here, we report an investigation on wet work exposure and its influence on the risk of developing hand eczema in apprentice nurses.

METHODS

A prospective cohort study was performed among 721 Dutch apprentice nurses. Participants recorded wet work exposure and symptoms of hand eczema using specially designed diary cards.

RESULTS

For 533 apprentice nurses, a follow-up time of 1-3 years was completed. Diary cards were supplied by 383 students. The 1-year period prevalence of hand eczema was 23% in the first year, 25% in the second year and 31% in the third year of follow-up. Eighty-one new cases of hand eczema developed, most of which occurred during the first year of follow-up. In approximately one-third of the participants, wet work exposure exceeded the national guidelines. Frequent hand washing during traineeships [odds ratio (OR) 1.5; 90% confidence interval (CI) 1.0-2.3], frequent hand washing at home (OR 2.3; 90% CI 1.5-3.7) and having a side job involving wet work (OR 1.6; 90% CI 1.0-2.4) were independent risk factors for hand eczema.

CONCLUSION

As a considerable number of apprentice nurses had already developed hand eczema during traineeships, more attention should be paid to skin protection in vocational education.

Filaggrin loss-of-function mutations and atopic dermatitis as risk factors for hand eczema in apprentice nurses: part II of a prospective cohort study

Background/objectives

Environmental exposure and personal susceptibility both contribute to the development of hand eczema. In this study, we investigated the effect of loss-of-function mutations in the filaggrin gene (FLG), atopic dermatitis and wet work exposure on the development of hand eczema in apprentice nurses.

Methods

Dutch apprentice nurses were genotyped for the four most common FLG mutations; atopic dermatitis and hand eczema history were assessed by questionnaire. Exposure and hand eczema during traineeships were assessed with diary cards.

Results

The prevalence of hand eczema during traineeships was higher among subjects with a history of hand eczema reported at inclusion. Hand washing during traineeships and at home increased the risk of hand eczema. After adjustment for the effects of exposure and FLG mutations, an odds ratio of 2.5 (90% confidence interval 1.7–3.7) was found for a history of atopic dermatitis. In this study, an increased risk of hand eczema conferred by FLG mutations could not be shown, but subjects with concomitant FLG mutations and atopic dermatitis showed the highest risk of hand eczema during traineeships.

Conclusion

A history of atopic dermatitis, a history of hand eczema and wet work exposure were the most important factors increasing the risk of hand eczema during traineeships.

Inflammatory variant of epidermolysis bullosa acquisita with IgG autoantibodies against type VII collagen and laminin alpha3

BACKGROUND

The inflammatory variant of epidermolysis bullosa acquisita (EBA) may clinically closely resemble bullous or cicatricial pemphigoid. Patients with inflammatory EBA have IgG autoantibodies against type VII collagen. Patients with anti-epiligrin cicatricial pemphigoid have IgG autoantibodies against laminin 5.

OBSERVATION

We describe a patient with inflammatory EBA exhibiting nonscarring oral and vaginal involvement. Indirect immunofluorescence using skin substrate lacking an epidermal basement membrane molecule, direct immunoelectron microscopy, immunoblot, and immunoprecipitation studies revealed the simultaneous presence of circulating IgG autoantibodies against type VII collagen and laminin alpha3. A final diagnosis of EBA was based on the sublamina densa level of blister formation.

CONCLUSION

This case illustrates the clinical and immunological overlap between EBA and anti-epiligrin cicatricial pemphigoid, a unique finding that may have developed as a consequence of epitope spreading.

Low-back and shoulder complaints among workers with pushing and pulling tasks

OBJECTIVES

Low-back and shoulder complaints were examined in relation to self-reported and objectively assessed exposure to work-related pushing and pulling.

METHODS

Workers from several companies (eg, nursing homes and flower auctions) with pushing and pulling tasks and, as reference, workers without physically demanding tasks were invited to participate. Altogether 829 workers initially received a questionnaire, of whom 459 responded both initially and after 1 year of follow-up. Initially, self-reported exposure to pushing and pulling was assessed by questionnaire. Furthermore, a representative sample of 131 workers was observed at work using TRAC (task recording and analysis on computer) to assess exposure to pushing and pulling objectively. For exposure to pushing and pulling, the workers were classified into a reference group and medium and high exposure groups. Initially and in the follow-up, the 12-month prevalence of low-back and shoulder complaints was assessed. Complaints reported in the follow-up were separately used as dependent variables to calculate prevalence rate ratios (PR) in a Cox's proportional hazard regression analysis.

RESULTS

The adjusted PR values were not significant for low-back complaints. For shoulder complaints, both the medium and high exposure groups showed significant adjusted PR values for self-reported exposure and observed duration of pushing and pulling when compared with the reference group (PR range 2.18-4.86). For the observed frequency of pushing and pulling, only the medium exposure group showed a significant PR, of 3.95.

CONCLUSIONS

The findings suggest a rather strong relationship between pushing and pulling and shoulder complaints. The evidence for a relationship between pushing and pulling and low-back complaints is limited.

On the cellular origin and development of atheromatous plaques. A light and electron microscopic study of combined X-ray and hypercholesterolemia-induced atheromatosis in the carotid artery of the rabbit

The cellular origin and development of radiation-induced atheromatous plaques in the carotid artery of the hypercholesterolemic rabbit have been studied morphologically from a few hours post-irradiation up to several weeks later. As early as 8 h following local X-irradiation (500 or 1,000 rad) mononuclear cells, presumably blood monocytes, enter the subendothelial space. The cells have disappeared again 10 days post-irradiation in normocholesterolemic animals. In irradiated hypercholesterolemic animals, however, the invading mononuclear cells transform into lipophages and become so-called foam cells, visible from the second day post-irradiation. The number of lipophages increases with time resulting in plaques of about 5-10 cell layers after 20 days. From 20 days post-irradiation onwards smooth muscle cells enter the plaque by migrating from the tunica media through the fenestrations of the lamina elastica interna. Smooth muscle cells are found to contain less lipid vacuoles than monocyte-derived lipophages. At 30 days post-irradiation the smooth muscle cells have formed parallel layers in the luminal side of the plaque encapsulating an inner core of foam cells and other material. The morphology of the plaque at 30 days post-irradiation is similar to that reported for advanced plaques developing in rabbits by mere cholesterol feeding over a relatively long period. In irradiated normocholesterolemic and in non-irradiated hypercholesterolemic rabbits plaques are not observed in the carotid arteries during the experimental period. The early involvement of blood monocytes has been separated from the later role of medial smooth muscle cells in radiation-induced plaque formation. The results suggest that the underlying process in this lesion may be understood in terms of a sterile inflammation, complicated by an immediate fatty degeneration and followed by repair phenomena. The combination of hypercholesterolemia and ionizing radiation may serve as a useful experimental model for further studies in various animal species on why and how plaques originate, develop or regress and how they could possibly be prevented. The relevance of the results to radiotherapy in humans is mentioned briefly.

Kinetics of cell spreading on protein precoated substrata: a study of interfacial aspects

In this paper, interfacial aspects of spreading and adhesion of human skin fibroblasts on solid substrata after protein precoating have been studied. Three solid substrata were used with different surface free energy (gamma s): Tissue Culture Polystyrene (TCPS) with gamma s = 70 erg.cm-2, Polyvinylfluoride (PVF) with gamma s = 56 erg.cm-2 and Fluoroethylenepropylene (FEP) copolymer with gamma s = 18 erg.cm-2. The substrata were precoated with fetal calf serum, bovine fibronectin or bovine serum albumin. Cell spreading was evaluated by means of light microscopy and scanning electron microscopy (SEM). Adhesion sites were studied by transmission electron microscopy (TEM). In general, spreading was lowest on FEP and highest on TCPS. Although protein precoating markedly increased cell spreading, the relative order in which the cells spread on the protein precoated substrata remained identical to that on the bare substrata. Analysis of the kinetics of spreading demonstrated that spreading was fastest on the high-energy substratum and slowest on the low-energy substratum. In the presence of all three types of protein precoating, the average distance between a cell and a substratum after spreading was smaller (20-50 nm) than without a coating (greater than 100 nm).

Coping and sickness absence

Objectives

The aim of this study is to examine the role of coping styles in sickness absence. In line with findings that contrast the reactive–passive focused strategies, problem-solving strategies are generally associated with positive results in terms of well-being and overall health outcomes; our hypothesis is that such strategies are positively related to a low frequency of sickness absence and with short lengths (total number of days absent) and durations (mean duration per spell).

Methods

Using a prospective design, employees’ (N = 3,628) responses on a self-report coping inventory are used to predict future registered sickness absence (i.e. frequency, length, duration, and median time before the onset of a new sick leave period).

Results and conclusions

In accordance with our hypothesis, and after adjustment for potential confounders, employees with an active problem-solving coping strategy are less likely to drop out because of sickness absence in terms of frequency, length (longer than 14 days), and duration (more than 7 days) of sickness absence. This positive effect is observed in the case of seeking social support only for the duration of sickness absence and in the case of palliative reaction only for the length and frequency of absence. In contrast, an avoidant coping style, representing a reactive–passive strategy, increases the likelihood of frequent absences significantly, as well as the length and duration of sickness absence. Expression of emotions, representing another reactive–passive strategy, has no effect on future sickness absenteeism. The median time before the onset of a new episode of absenteeism is significantly extended for active problem-solving and reduced for avoidance and for a palliative response.

The results of the present study support the notion that problem-solving coping and reactive–passive strategies are inextricably connected to frequency, duration, length and onset of sickness absence. Especially, active problem-solving decreases the chance of future sickness absence.

Return to work perceptions and actual return to work in workers with common mental disorders

INTRODUCTION

Return to work (RTW) perceptions have been found to predict actual RTW of workers with common mental disorders. This study aims to (1) assess the relative value of RTW self-efficacy (RTW-SE) and RTW expectation in predicting actual RTW and (2) explore the role of mental health symptoms, work characteristics and their interaction as determinants of these RTW perceptions at baseline and over time.

METHODS

Workers (N = 179) with common mental disorders were included at the start of their sick leave and followed-up at 3, 6, 9, and 12 months. RTW self-efficacy, RTW expectation, mental health and RTW were assessed by self-report. Kaplan-Meier survival analysis was used to test the predictive value of RTW-SE and RTW expectation against the actual RTW. Linear regression was used to study the associations of mental health symptoms, work characteristics and their interaction with RTW-SE at baseline. Mental health symptoms in relation to RTW-SE over the first 6 months were analyzed using Linear Mixed Models.

RESULTS

Compared to RTW expectation, differences in RTW-SE were more predictive of actual RTW. At baseline, lower fatigue, depressive symptoms, and work pace- and load were associated with higher RTW-SE. Decreasing levels of fatigue and depressive symptoms over time were associated with parallel improvements in RTW-SE. Workers with high work pace and workload at baseline showed lower levels of RTW-SE at all time points.

CONCLUSIONS

We recommend the use of the RTW-SE scale to detect workers with common mental disorders at risk of a late RTW. Work characteristics and changes in mental health symptoms were associated with RTW-SE over time.

Regeneration of the arterial wall in microporous, compliant, biodegradable vascular grafts after implantation into the rat abdominal aorta. Ultrastructural observations

The ultrastructure of a new type of vascular graft, prepared from a mixture of polyurethane (95 weight %) and poly-L-lactic acid (5 weight %), was examined six weeks after implantation into the abdominal aorta of rats. These microporous, compliant, biodegradable, vascular grafts function as temporary scaffolds for the regeneration of the arterial wall. Smooth muscle cells, covering the grafts, regenerated a neo-media underneath an almost completely regenerated endothelial layer (neo-intima). These smooth muscle cells varied in morphology from normal smooth muscle cells to myofibroblasts. They were surrounded by elastic laminae and collagen fibers. Macrophages, epithelioid cells, multinucleated giant cells, fibroblasts and capillaries were present in the disintegrating graft lattices. The epithelioid cells and multinucleated giant cells engulfed polymer particles of the disintegrating grafts. The regeneration of the endothelial and smooth muscle cells is similar to the natural response of arterial tissue upon injury. The presence of macrophages, epithelioid cells, multinucleated giant cells, fibroblasts and capillaries in the graft lattices resembles the natural response of tissue against foreign body implants. Both of these responses result in the formation of a neo-artery that possesses sufficient strength, compliance and thromboresistance to function as a small caliber arterial substitute.

Preventing work disability among employees with rheumatoid arthritis: What medical professionals can learn from the patients' perspective

OBJECTIVE

To compare the perspectives of employees with rheumatoid arthritis (RA) with those of medical professionals regarding what persons with RA need to prevent work disability.

METHODS

Concept mapping was conducted in a group session with 21 employees and by mail with 17 medical professionals. Each group was asked to formulate statements on what enables employees with RA to retain their jobs. Group members scored all statements for importance and clustered them into themes. Results were statistically aggregated at the group level.

RESULTS

The concept mapping with employees yielded 59 statements, which were clustered into 7 themes. The 4 most important themes were employer support; understanding and acceptance of illness by employees themselves; suitable working conditions; and support from colleagues, health professionals, and the patient's organization. The concept mapping with medical professionals yielded 65 statements, which were clustered into 8 themes. The 6 most important themes were well-informed professionals who cooperate effectively; employees' coping capacities and commitment to work; financial regulations at the workplace; adequate social security provisions, medication, and therapy; a positive attitude on the part of employers and colleagues; and suitable working conditions.

CONCLUSION

Factors that enable continued employment lie at different levels, including the psychosocial, practical, organizational, and social policy levels. Health professionals appear to underestimate factors that are important from the patient's perspective, especially support from employers. In discussing work with patients, health professionals need to address themes that are important from the patient's perspective.

The effect of a cognitive and a physical stress-reducing programme on psychological complaints

OBJECTIVES

To investigate the short-term and long-term effectiveness of two, brief, preventive, work stress management programmes. One programme was a cognition-focused programme, the other was a newly developed intervention in which physical exercise and relaxation were combined. It was hypothesised that the newly developed intervention would be more effective in reducing psychological complaints than the cognitive intervention. Both programmes consisted of four sessions in a period of 10 weeks.

METHODS

From a working population engaged in a periodic health check-up, employees above a minimum stress level (n=396) were invited to participate in a randomised comparative outcome study with pre-trial, post-trial and 6-month follow-up measures. After giving informed consent 130 participants entered the study (response rate 33%). Outcome measures consisted of three self-reported questionnaires on psychological complaints.

RESULTS

It was found that both interventions revealed a positive impact on psychological complaints, burnout and fatigue, both at short-term and at 6-month follow-up. No statistical interaction effects between the two interventions were found. Calculation of the clinical significance of the effects indicated that 50% of the employees with psychological complaints who participated in the physical intervention and 60% of the employees who participated in the cognitive intervention improved and returned to functioning within normal range both in the short term and in the long term at 6 months.

CONCLUSION

The data indicate that interventions were equally effective on psychological complaints, burnout and fatigue.

Review on the validity of self-report to assess work-related diseases

PURPOSE

Self-report is an efficient and accepted means of assessing population characteristics, risk factors, and diseases. Little is known on the validity of self-reported work-related illness as an indicator of the presence of a work-related disease. This study reviews the evidence on (1) the validity of workers' self-reported illness and (2) on the validity of workers' self-assessed work relatedness of an illness.

METHODS

A systematic literature search was conducted in four databases (Medline, Embase, PsycINFO and OSH-Update). Two reviewers independently performed the article selection and data extraction. The methodological quality of the studies was evaluated, levels of agreement and predictive values were rated against predefined criteria, and sources of heterogeneity were explored.

RESULTS

In 32 studies, workers' self-reports of health conditions were compared with the "reference standard" of expert opinion. We found that agreement was mainly low to moderate. Self-assessed work relatedness of a health condition was examined in only four studies, showing low-to-moderate agreement with expert assessment. The health condition, type of questionnaire, and the case definitions for both self-report and reference standards influence the results of validation studies.

CONCLUSIONS

Workers' self-reported illness may provide valuable information on the presence of disease, although the generalizability of the findings is limited primarily to musculoskeletal and skin disorders. For case finding in a population at risk, e.g., an active workers' health surveillance program, a sensitive symptom questionnaire with a follow-up by a medical examination may be the best choice. Evidence on the validity of self-assessed work relatedness of a health condition is scarce. Adding well-developed questions to a specific medical diagnosis exploring the relationship between symptoms and work may be a good strategy.

Cerebral impairment in chronic solvent-induced encephalopathy

OBJECTIVE

Worldwide, many workers experience occupational exposure to organic solvents, which may induce chronic solvent-induced encephalopathy (CSE). Disturbances within the frontostriatothalamic (FST) circuitry might explain the symptomatology of CSE. We tested the hypothesis of FST circuitry abnormalities in CSE, as well as associations with performance of psychomotor speed, attention, and solvent exposure. To detect preclinical, solvent-related effects, we also studied the FST circuitry in solvent-exposed, but asymptomatic workers.

METHODS

Ten CSE patients, 10 asymptomatic but solvent-exposed house painters (EC), and 11 nonexposed asymptomatic carpenters were included. Dopamine D(2) receptor (D2R) binding, central nervous system tissue metabolites, and fractional anisotropy were measured within the FST circuitry, using single-photon emission computed tomography, magnetic resonance spectroscopy, and diffusion tensor imaging. Performance of psychomotor speed and attention, and severity of solvent exposure were assessed.

RESULTS

Striatal D2R binding was reduced in CSE. In the solvent-exposed asymptomatic patients, striatal D2R binding and levels of N-acetylaspartate + N-acetylaspartyl-glutamate in frontal gray matter were reduced. In both exposed groups, a trend was seen for reduced choline in frontal gray matter. In CSE, the fractional anisotropy in the thalamus, caudate nucleus, and striatal D2R binding significantly predicted reduced performance of attention and psychomotor speed. In CSE, striatal D2R binding showed a negative correlation with solvent exposure.

INTERPRETATION

This is the first study in CSE showing pronounced disturbances within the FST circuitry that are related to the clinical findings and to exposure severity to solvents. The comparable, but milder, abnormalities within the FST circuitry in the exposed asymptomatic workers may imply a presymptomatic phase of CSE.

Vacuum cell seeding: a new method for the fast application of an evenly distributed cell layer on porous vascular grafts

The study was to develop a method to induce rapid endothelial coverage of vascular prostheses by cell seeding. The method uses vacuum pressure and is therefore called vacuum cell seeding. A special seeding device was constructed, in which grafts of different length and/or inner diameter could be positioned. Microporosity of the grafts was a prerequisite for this method. Two types of commercially available microporous grafts were tested. The ePTFE graft routinely used clinically needed pretreatment to enable the method, whilst a polyurethane-based graft could be seeded as received. Vacuum cell seeding applied cells from a suspension in culture medium within 10 min in an evenly distributed cell layer on to the luminal graft surface. The adhering cells immediately started flattening, thereby completely covering the luminal surface. It was concluded that the vacuum cell seeding method rapidly introduced a confluent layer of seeded cells on porous vascular grafts in a simple way, which in the clinical setting could easily be performed on the operating table.

In vitro and in vivo microbial adhesion and growth on argon plasma-treated silicone rubber voice prostheses

Patients who undergo a total laryngectomy usually receive a silicone rubber voice prosthesis for voice rehabilitation. Unfortunately, biofilm formation on the esophageal side of voice prostheses limits their lifetime to 3-4 mon on average. The effects of repeated argon plasma treatment of medical grade, hydrophobic silicone rubber on in vitro adhesion and growth of bacteria and yeasts isolated from voice prostheses, as well as in vivo biofilm formation are presented here. In vitro experiments demonstrated that initial microbial adhesion over a 4 h time span to plasma-treated, hydrophilized, silicone rubber was generally less than on original, hydrophobic silicone rubber, both in the absence and presence of a salivary conditioning film on the biomaterial. Growth studies over a time period of 14 d at 37 degrees C in a modified Robbins device, showed that fewer Candida cells adhered on plasma-treated, hydrophilized silicone rubber as compared to on original, hydrophobic silicone rubber. For the in vivo evaluation of biofilm formation on plasma-treated silicone rubber voice prostheses, seven laryngectomized patients received a partly hydrophilized "Groningen Button" voice prosthesis for a planned evaluation period of 4 wk. After removal of the voice prostheses, the border between the hydrophilized and the original, hydrophobic side of the prostheses was clearly visible. However, biofilm formation was, unexpectedly, less on the original, hydrophobic sides, although the microbial compositions of the biofilms on both sides were not significantly different. Summarizing, this study demonstrates that in vitro microbial adhesion and growth on silicone rubber can be reduced by plasma treatment, but in vivo biofilm formation on silicone rubber voice prostheses is oppositely enhanced by hydrophilizing the silicone rubber surface. Nevertheless, from the results of this study the important conclusion can be drawn that in vivo biofilm formation on voice prostheses is controlled by the hydrophobicity of the biomaterials surface used.

Using intervention mapping (IM) to develop a self-management programme for employees with a chronic disease in the Netherlands

Background

Employees with a chronic disease often encounter problems at work because of their chronic disease. The current paper describes the development of a self-management programme based on the Chronic Disease Self-Management programme (CDSMP) of Stanford University to help employees with a chronic somatic disease cope with these problems at work. The objective of this article is to present the systematic development and content of this programme.

Methods

The method of intervention mapping (Bartholomew 2006) was used to tailor the original CDSMP for employees with a chronic somatic disease. This paper describes the process of adjusting the CDSMP for this target group. A needs assessment has been carried out by a literature review and qualitative focus groups with employees with a chronic disease and involved health professionals. On the basis of the needs assessment, the relevant determinants of self-management behaviour at work have been identified for the target population and the objectives of the training have been formulated. Furthermore, techniques have been chosen to influence self-management and the determinants of behaviour and a programme plan has been developed.

Results

The intervention was designed to address general personal factors such as lifestyle, disease-related factors (for example coping with the disease) and work-related personal factors (such as self-efficacy at work). The course consists of six sessions of each two and a half hour and intents to increase the self management and empowerment of employees with a chronic somatic disease.

Conclusion

Intervention mapping has been found to be a useful tool for tailoring in a systematic way the original CDSMP for employees with a chronic somatic disease. It might be valuable to use IM for the development or adjusting of interventions in occupational health care.