Ineffective disability management by doctors is an obstacle for return-to-work: a cohort study on low back pain patients sicklisted for 3-4 months.

AIMS: To determine obstacles for return-to-work in disability management of low back pain patients sicklisted for 3-4 months. METHODS: A cohort of 467 low back pain patients sicklisted for 3-4 months was recruited. A questionnaire was sent to their occupational physicians (OPs) concerning the medical management, obstacles to return-to-work, and the communication with treating physicians. RESULTS: The OPs of 300 of 467 patients participated in this study. In many cases OPs regarded the clinical waiting period (43%), duration of treatment (41%), and view (25%) of the treating physicians as obstacles for return-to-work. Psychosocial obstacles for return-to-work such as mental blocks, a lack of job motivation, personal problems, and conflicts at work were all mentioned much less frequently by OPs. In only 19% of the patients was there communication between OP and treating physician. Communication almost always entailed an exchange of information, and less frequently an attempt to harmonise the management policy. Surprisingly communication was also limited, when OPs felt that the waiting period (32%), duration of treatment (30%), and view (28%) of treating physicians inhibited return-to-work. Communication was significantly associated with the following obstacles for return-to-work: passivity with regard to return-to-work and clinical waiting period; adjusted odds ratios were 3.35 and 2.23, respectively. CONCLUSIONS: Medical management of treating physicians is often an obstacle for return to work regarding low back pain patients sicklisted for 3-4 months, in the opinion of OPs. Nevertheless communication between OPs and the treating physicians in disability management of these patients is limited. More attention to prevention of absenteeism and bilateral communication is needed in medical courses.

[Little communication between company doctors and private physicians with respect to hindrances to return to work after prolonged absence from work because of low back pain]. / Weinig communicatie tussen bedrijfsarts en curatieve sector over belemmeringen voor werkhervatting na langdurige arbeidsongeschiktheid wegens lage rugklachten.

OBJECTIVE: To determine occurrence and reasons of contact between company doctors and treating physicians with respect to patients absent with low back pain for three months. DESIGN: Prospective cohort study. METHOD: A cohort of employees who were absent for 3 months with back pain were selected according to defined criteria. A questionnaire about medical status and communication with treating physicians was sent to their company doctors. RESULTS: The company doctors of 300 of 467 employees participated. In 19% of the employees the company doctor contacted the curative sector (56 contacts had taken place, 14 were planned). The contact consisted almost always of exchange of information and less frequently of co-operation towards a mutual policy. In almost 50% of the cases the company doctors regarded the clinical waiting period, length of treatment and opinion of the curative sector as disincentives to return to work. Psychosocial factors such as psychological problems, work-related motivation, private problems and a conflict between employer and employee all were mentioned less frequently. Although contacts were slightly more frequent when psychosocial factors, treatment or opinion of the curative sector inhibited return to work, only disincentives such as work-related motivation, motivation to return to work and the waiting period were significantly associated with the contact frequency. CONCLUSION: The communication rate between company doctors and the curative sector in employees long absent with back pain is low. Communication consists of exchange of information rather than co-operation towards a mutual policy. Although according to many company doctors the curative sector plays an inhibitive role in return to work, they do not communicate accordingly.

Systolic blood pressure and cardiovascular mortality among 13,740 Dutch women.

Prospective data of cardiovascular mortality in relation to the systolic blood pressure of women are scarce, especially when combined with other risk factors. The association between systolic blood pressure and cardiovascular mortality was therefore studied in a 10-year follow-up of a population of 13,740 Dutch women, born between 1911 and 1925 who participated in a population-based breast cancer screening project (the DOM Project). Age-adjusted mortality rates over the 10-year follow-up period suggest a J-shaped pattern of cardiovascular mortality according to level of systolic blood pressure. Age-adjusted total cardiovascular, coronary, and cerebrovascular mortality rate ratios were significantly greater than 1.0 among women with elevated systolic blood pressure. Within categories of other risk factors (obesity index, diabetes mellitus, current smoking, and use of antihypertensive medicines) the age-adjusted cardiovascular rate ratios did not show confounding by any of these variables. A very high increase in cardiovascular mortality was observed among hypertensive diabetic women. This study shows that elevated systolic blood pressure is associated with increased rates of cardiovascular mortality for women in this age group.

Development and relative validity of a food frequency questionnaire for the estimation of intake of retinol and beta-carotene.

The aim of this study was to develop and validate a semiquantitative food frequency questionnaire to classify individuals according to their intakes of retinol and beta-carotene. Food items for the questionnaire were selected both on the basis of their contribution to total population intake of retinol and beta-carotene and on the proportion of between-person variation explained, which was as calculated from data of two study populations in the Netherlands. Thus, 15 products containing retinol and 15 products containing beta-carotene were selected. These contributed over 90% to the total intake and explained 99% of the variation of retinol and beta-carotene, respectively. The questionnaire was validated against a dietary history in a population of 82 women (aged 30-49 years). The time elapsed between the two interviews was (on average) 25 days. Spearman rank-order correlation coefficients comparing the questionnaire with the dietary history were 0.54, 0.59, and 0.64 for retinol, beta-carotene, and total vitamin A, respectively. The proportion of exact agreement in the two extreme categories of vitamin A intake, based on quintiles, was 56%. The corresponding gross misclassification (from 1 extreme category into the opposite) was 3%. These data indicate that a very short questionnaire can classify subjects into categories according to their vitamin A intake.

Food consumption of children with and without xerophthalmia in rural Tanzania.

Food intake of 26 children (4-9 years old) of whom nine had xerophthalmic eye lesions (Bitot's spots), was recorded over a period of four days. The principal staple foods were maize and sweet potatoes, while sorghum and cassava were also used as staple foods. The intake of energy was rather low partly due to the bulkiness of the diet. Protein intake was above the recommended intake but mainly derived from vegetable sources. The intake of retinol, beta-carotene, folic acid and iron was low in all children especially those with xerophthalmia. Dried green leafy vegetables contributed about 20% of the total beta-carotene intake during the period that the survey was carried out.