Long-term effects of an occupational health guideline on employees' body weight-related outcomes, cardiovascular disease risk factors, and quality of life: results from a randomized controlled trial.

OBJECTIVE: This study aims to evaluate the effectiveness of a draft occupational health guideline, aimed at preventing weight gain, on employees' body weight-related outcomes, cardiovascular disease (CVD) risk factors, and quality of life. METHODS: In a cluster randomized controlled trial including 16 occupational physicians (OP) and 523 employees, guideline-based care was compared to usual care by OP between 2009-2011 in the Netherlands. Guideline-based care consisted of (i) providing advice to employers on how to assess and intervene on the obesogenic work environment, (ii) conducting five face-to-face behavioral change counseling sessions with employees to improve their lifestyles, and (iii) evaluating the outcome and maintaining sections i and ii. Data were collected at baseline and 6, 12, and 18-months follow-up. To evaluate the effects of the intervention, multilevel analyses were performed. RESULTS: No significant differences were found between the intervention and control group on waist circumference [ß 1.2 cm, 95% confidence interval (95% CI) -0.6-2.9], body weight (ß 0.3 kg, 95% CI -1.0-1.6), body mass index (ß 0.1 kg/m (2), 95% CI -0.3-0.5), systolic blood pressure (ß 1.7 mmHG, 95% CI -2.4-5.8), diastolic blood pressure (ß 0.3 mmHG, 95% CI -1.0-0.6), cholesterol (ß 0 mmol/l, 95% CI -0.2-0.2), or quality of life indicators after 18-months follow-up. Stratified analyses showed an increase in waist circumference among men (ß 2.5 cm, 95% CI 0.5-4.5) and obese intervention participants (ß 2.7 cm, 95% CI 0.6-4.7) compared to control participants. CONCLUSION: The draft occupational health guideline was not more effective than usual care. Therefore, the guideline in its current form cannot be recommended for implementation.

Barriers and facilitators to implementation of an occupational health guideline aimed at preventing weight gain among employees in the Netherlands.

OBJECTIVE: To assess barriers and facilitators to implementation of an occupational health guideline aimed at preventing weight gain. METHODS: Barriers and facilitators to implementation were assessed among 14 occupational physicians (OPs) and employers and analyzed following a systematic approach using Atlas.ti. RESULTS: Barriers and facilitators mentioned by OPs and employers were related to the sociopolitical context, organization, OP, and guideline. Recommendations include the formation of a linkage group, collaboration with other experts, formation of peer support groups, and communicating benefits of investments, expectations, and ethical considerations. Results of this study recommend incorporating these barriers and facilitators in the guideline, including strategies about how to overcome barriers and stimulate facilitators. CONCLUSIONS: The identified barriers and facilitators can be used to increase the chance of successful implementation of the final guideline into occupational health practices throughout the Netherlands.

Registration of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao.

OBJECTIVE: To estimate the incidence of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao and to identify some next steps in the prevention process. METHODS: All of the three countries' 18 occupational health specialists were asked to participate; 100% agreed to report all work-related diseases, injuries, and complaints in 2004-2008. A standard online notification form was used to register cases in a database maintained by the Netherlands Center for Occupational Diseases (NCOD). The public health service of Curaçao analyzed the data and presented the results to the participating physicians during educational and feedback meetings. RESULTS: During the study period, 1 519 cases were reported: 720 (47.0%) work-related diseases; 515 (34.0%) injuries; and 284 (19.0%) complaints. The mean patient age was 42.4 years (range 16-70 years); 924 (60.8%) were males and 571 (37.6%), females. Most frequently reported were musculoskeletal diseases, injuries, and complaints; mental health disorders; and skin injuries. Analysis showed incidence rates of work-related diseases, injuries, and complaints in Aruba to be 157 new cases per 100 000 employee years; in Bonaire, 53/100 000; and in Curaçao, 437/100 000. CONCLUSIONS: These results suggest that labor protection laws need improvement and that preventive action should be fostered. Further study is needed on working conditions, preventive policy, and the quality of occupational health and safety practices in Aruba, Bonaire, and Curaçao. Funding is imperative for collecting and publishing accurate data, which will keep this problem on the social-political agenda.

The application of an occupational health guideline reduces sedentary behaviour and increases fruit intake at work: results from an RCT.

OBJECTIVE: To evaluate the effectiveness of a draft occupational health practice guideline aimed at preventing weight gain on employees' physical activity, sedentary behaviour and dietary behaviour and on body weight-related outcomes. METHODS: A randomised controlled trial was performed comparing guideline-based care to usual care among 16 occupational physicians and 523 employees in the Netherlands between 2009 and 2011. Occupational physicians in the intervention group followed the draft guideline by providing advice to employers on how to assess and intervene on the obesogenic work environment and conducted five face-to-face behavioural change counselling sessions with employees to improve their lifestyle. Data of employees were collected by questionnaire and physical measurements at baseline and 6-months follow-up. Linear and logistic regression analyses were performed to determine effects. RESULTS: The intervention showed significant effects on sedentary behaviour at work (ß -28 min/day, 95% CI -2 to -54) and on fruit intake (ß 2.1 pieces/week; 95% CI 0.6 to 3.6). No significant intervention effects were found for physical activity, sedentary behaviour in leisure time or during weekend days, snack intake and body weight-related outcomes. CONCLUSION: Guideline-based care resulted in a more favourable sedentary behaviour at work and increased fruit intake but did not improve employees' physical activity, snack intake or body weight-related outcomes. Trial registration number ISRCTN/73545254 and NTR/1190.

Registration of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao / Registro de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao

OBJECTIVE: To estimate the incidence of work-related diseases, injuries, and complaints in Aruba, Bonaire, and Curaçao and to identify some next steps in the prevention process. METHODS: All of the three countries' 18 occupational health specialists were asked to participate; 100 percent agreed to report all work-related diseases, injuries, and complaints in 2004-2008. A standard online notification form was used to register cases in a database maintained by the Netherlands Center for Occupational Diseases (NCOD). The public health service of Curaçao analyzed the data and presented the results to the participating physicians during educational and feedback meetings. RESULTS: During the study period, 1 519 cases were reported: 720 (47.0 percent) work-related diseases; 515 (34.0 percent) injuries; and 284 (19.0 percent) complaints. The mean patient age was 42.4 years (range 16-70 years); 924 (60.8 percent) were males and 571 (37.6 percent), females. Most frequently reported were musculoskeletal diseases, injuries, and complaints; mental health disorders; and skin injuries. Analysis showed incidence rates of work-related diseases, injuries, and complaints in Aruba to be 157 new cases per 100 000 employee years; in Bonaire, 53/100 000; and in Curaçao, 437/100 000. CONCLUSIONS: These results suggest that labor protection laws need improvement and that preventive action should be fostered. Further study is needed on working conditions, preventive policy, and the quality of occupational health and safety practices in Aruba, Bonaire, and Curaçao. Funding is imperative for collecting and publishing accurate data, which will keep this problem on the social-political agenda.

OBJETIVO: Calcular la incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo en Aruba, Bonaire y Curazao e identificar los pasos siguientes en el proceso de prevención. MÉTODOS: Se invitó a participar a los 18 especialistas en salud ocupacional de los tres países; todos aceptaron notificar todas las enfermedades, lesiones y síntomas relacionados con el trabajo entre el 2004 y el 2008. Se usó un formulario estándar de notificación en línea para registrar los casos en una base de datos mantenida por el Centro para las Enfermedades Ocupacionales de los Países Bajos. El servicio de salud pública de Curazao analizó los datos y presentó los resultados a los médicos participantes durante las reuniones educativas y de retroalimentación. RESULTADOS: Durante el período del estudio se notificaron 1 519 casos relacionados con el trabajo: 720 (47,0 por ciento) enfermedades, 515 (34,0 por ciento) lesiones y 284 (19,0 por ciento) síntomas. La edad promedio de los pacientes fue 42,4 años (recorrido, 16-70 años); 924 (60,8 por ciento) eran varones y 571 (37,6 por ciento), mujeres. Se notificaron con mayor frecuencia las enfermedades, lesiones y síntomas musculoesqueléticos; los trastornos mentales; y las lesiones cutáneas. El análisis mostró tasas de incidencia de enfermedades, lesiones y síntomas relacionados con el trabajo de 157 nuevos casos por 100 000 empleados por año en Aruba, 53/100 000 en Bonaire y 437/100 000 en Curazao. CONCLUSIONES: Estos resultados indican que las leyes de protección laboral deben mejorarse y que deben promoverse las medidas preventivas. Es necesario llevar a cabo otros estudios sobre las condiciones de trabajo, los planes de prevención y la calidad de la salud ocupacional y las prácticas de seguridad en Aruba, Bonaire y Curazao. Se requiere financiamiento para recopilar y publicar datos exactos, a fin de mantener este problema en la agenda política y social.

[Interdisciplinary cooperation in occupational health: ethical friction]. / Interdisciplinair werken bij arbeid en gezondheid: ethische fricties.

OBJECTIVE: To investigate which ethical considerations play a role in the assessment of absenteeism due to sickness and of disability, and how these are dealt with. DESIGN: Qualitative, exploratory study. METHOD: We conducted interviews with 32 individual professional practitioners: 8 occupational health physicians, 8 insurance company physicians, 8 general practitioners, and 8 psychologists, with the aid of a semi-structured questionnaire. During the interview we differentiated between 4 clusters of questions referring to the ethical, legal, interdisciplinary, and professional context, respectively. The study revealed only the spectrum of ethical considerations that played a role, and not the representativeness. For this reason the results did not allow for quantitative conclusions. RESULTS: Differences in the manner of thinking and behaving between health-care providers stem from differences in ethical considerations and in background beliefs. These differences hinder effective cooperation within the occupational health sector. CONCLUSION: To improve professional performance and to achieve more responsible decision-making those involved need to be aware of their ethical considerations and background beliefs and to make them explicit, possibly with the aid of a checklist.

Activities of occupational physicians for occupational health services in small-scale enterprises in Japan and in the Netherlands.

OBJECTIVES: Occupational health service (OHS) for small-scale enterprises (SSEs) is still limited in many countries. Both Japan and the Netherlands have universal OHS systems for all employees. The objective of this survey was to examine the activities of occupational physicians (OPs) in the two countries for SSEs and to investigate their proposals for the improvement of service. METHODS: Questionnaires on types and sizes of the industries they serve, allocation of service hours (current and desired), sources of information for occupational health activities etc. were mailed in 2006 to 461 and 335 Japanese and Dutch OPs, respectively, who have served in small- and medium-scale enterprises. In practice, 107 Japanese (23%) and 106 Dutch physicians (32%) replied, respectively. RESULTS AND CONCLUSIONS: Total service time per month was longer for OPs in the Netherlands than OPs in Japan. Japanese OPs spent more hours for health and safety meetings, worksite rounds, and prevention of overwork-induced ill health (14-16% each). Dutch OPs used much more hours for the guidance of absent workers (48%). Thus, service conditions were not the same for OPs in the two countries. Nevertheless, both groups of OPs unanimously considered that employers are the key persons for the improvement of OHS especially in SSEs and their education is important for better OHS. The conclusions should be taken as preliminary, however, due to study limitations including low response rates in both groups of physicians.

Design of the Balance@Work project: systematic development, evaluation and implementation of an occupational health guideline aimed at the prevention of weight gain among employees.

BACKGROUND: Occupational health professionals may play an important role in preventive health promotion activities for employees. However, due to a lack of knowledge and evidence- and practice based methods and strategies, interventions are hardly being implemented by occupational physicians to date. The aim of the Balance@Work project is to develop, evaluate, and implement an occupational health guideline aimed at the prevention of weight gain among employees. METHODS: Following the guideline development protocol of the Netherlands Society of Occupational Medicine and the Intervention Mapping protocol, the guideline was developed based on literature, interviews with relevant stakeholders, and consensus among an expert group. The guideline consists of an individual and an environmental component. The individual component includes recommendations for occupational physicians on how to promote physical activity and healthy dietary behavior based on principles of motivational interviewing. The environmental component contains an obesogenic environment assessment tool. The guideline is evaluated in a randomised controlled trial among 20 occupational physicians. Occupational physicians in the intervention group apply the guideline to eligible workers during 6 months. Occupational physicians in the control group provide care as usual. Measurements take place at baseline and 6, 12, and 18 months thereafter. Primary outcome measures include waist circumference, daily physical activity and dietary behavior. Secondary outcome measures include sedentary behavior, determinants of behavior change, body weight and body mass index, cardiovascular disease risk profile, and quality of life. Additionally, productivity, absenteeism, and cost-effectiveness are assessed. DISCUSSION: Improving workers' daily physical activity and dietary behavior may prevent weight gain and subsequently improve workers' health, increase productivity, and reduce absenteeism. After an effect- and process evaluation the guideline will be adjusted and, after authorisation, published. Together with several implementation aids, the published guideline will be disseminated broadly by the Netherlands Society of Occupational Medicine. TRIAL REGISTRATION: ISRCTN73545254/NTR1190.

Certification and quality assurance in Dutch occupational health services.

Since 1994, each Dutch enterprise has to be affiliated to an independent occupational health service (OHS), recognized by the government. In addition, each enterprise has to be supported by this occupational health service in its activities for the improvement of working conditions, and in the guidance of employees absent from work. From 1994 to 1998, the government was carrying out the certification and recognition of occupational health services. Since 1998 the certification has been carried out by private certifying institutions, in general consultancy bureaus that also provide ISO certification. In the Netherlands, the supervision of the quality of occupational safety and health care is twofold. Firstly, the Labor Inspectorate is checking if the enterprises keep to the rules. For example, each enterprise should have a risk assessment report at its disposal. The latter should be approved by the OHS. If an enterprise does not meet these rules, a penalty may be imposed. In practice, this happens rather seldom. Secondly, each OHS unit should be recognized by the Ministry of Social Affairs and Employment. The recognition takes place if the private certifying institution has assessed that the OHS meet a large number of requirements laid down in the "Guideline for the Certification of Occupational Health Services". This Guideline consists of 50 conditions and about 200 verification points. The requirements deal with the internal organzation and the output. By order of the Dutch government the IVA, a Dutch institute for social research, has recently investigated if this certification leads to a sufficient guarantee for appropriate occupational safety and health care. By means of a large number of discussions and workshops, the IVA has investigated how OHS, employees, employers, insurance companies and others judge the quality management. In this study, the current method of certification turned out to produce insufficient incentives for quality improvement. None of the involved parties turned out to be satisfied with the current system. The fundamental problem of this certification system can be summarized as follows. The requirements prescribe a quality management system in conformity with ISO, but they also contain a lot of organization rules, much more than ISO. It is this degree of specification that, if practiced slavishly, leads to an output that is not able to satisfy the needs and demands of employers, employees and government. There are no rules with regard to this output, but only to the process, e.g. the way an advice has been brought about. In this paper, we show how the current certification system is working, how this system has been evaluated, and what criticisms have been uttered. We also indicate how we might achieve a real improvement of quality management in prescribing much less details about the OHS internal organization, and in demanding employers and employees to make clear agreements about the desired OHS output and to monitor carefully if the agreed output quality has been achieved.