Work ability assessment in prolonged depressive illness.

BACKGROUND: Major depressive disorder (MDD) is a complex disease and therefore the assessment of work ability in patients with MDD is complicated. A checklist has been developed to support such assessment. AIMS: To assess the mean score and variation of work ability assessments undertaken by Dutch insurance physicians (IPs) in five real case history vignettes of MDD patients on long-term sick leave, with and without the aid of a checklist. METHODS: In a post-test-only randomized experiment, 25 IPs assessed work ability for five cases on a scale of 0-100 without the use of the checklist, while 21 IPs used the checklist. Differences between groups in mean and absolute variation of work ability were tested with independent t-tests. Intraclass correlation (ICC) analysis was used to determine inter-rater reliability. RESULTS: When using the checklist, the mean work ability score of all vignettes was 3-12 points higher than without its use. There was no difference in the variation in work ability scores per vignette and between groups. ICC was 0.64 for both groups. CONCLUSIONS: The use of the checklist increased the mean score of work ability but had no effect on the variation in scores between assessors. The inter-rater reliability was moderate, independent of the use of the checklist.

[Serious and sometimes fatal consequences of high-altitude pulmonary oedema]. / Ernstige en soms fatale gevolgen van hoogtelongoedeem.

Three women aged 25, 34 and 22 years respectively, experienced high-altitude pulmonary oedema during a climbing holiday. The first patient presented with complaints arising from a fast ascent to high altitude and was treated with acetazolamide and rapid descent. She recovered without any complications. The second patient developed symptoms during the night, which were not recognised as high-altitude pulmonary oedema. The next morning she died while being transported down on a stretcher without having received any medication or oxygen. The third case was not a specific presentation of high-altitude pulmonary oedema but autopsy revealed pulmonary oedema. This woman had already been higher up on the mountain before she developed complications. The cases illustrate the seriousness of this avoidable form of high altitude illness. The current Dutch national guidelines advise against the use of medication by lay people. A revision is warranted: travellers to high altitude should be encouraged to carry acetazolamide, nifedipine and corticosteroids on the trip. Travel guides ought to be trained to use these drugs. In addition climbing travellers should be encouraged to adopt appropriate preventive behaviour and to start descending as soon as signs of high-altitude pulmonary oedema develop.

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.

[Preconditions for a stay in high altitude areas in the case of existing health problems]. / Randvoorwaarden aan een verblijf op grote hoogte bij bestaande gezondheidsproblemen.

Various symptoms can arise during a stay in high altitude areas (above 2500 m), such as tissue hypoxia and in particular pulmonary and brain oedema. Patients with existing health problems can expect to develop more complaints or more severe complaints at an earlier stage. For a number of these patients a stay in high altitude areas should be advised against or should only take place if certain measures are taken. The advising physician should have knowledge about the reactions of the human body on hypoxy, and about (derailments of) the acclimatisation proces in high altitude areas. Every patient with a disease that can interfere with hypoxia should be assessed on an individual basis. The most important absolute and relative contraindications are cardiac and pulmonary conditions, haemoglobin abnormalities, diabetes mellitus, hypertension, epilepsy, severe obesity, kidney diseases and pregnancy. In the case of an existing health problem, a stay in high altitude should only be considered if medical care can be quickly and adequately provided on the spot.

[Repetitive strain injury (RSI); a report from the Health Council of the Netherlands]. / RSI; een rapport van de Gezondheidsraad.

The Health Council of the Netherlands has published its advisory report on Repetitive Strain Injury (RSI). The report provides clear information on the state of this syndrome, including the definition of the problem, the epidemiology, various hypothetical pathophysiological mechanisms, occupational and personal risk factors, and possible methods of treatment. The council states that with regard to the last aspect, too few data are available to draw any conclusion as to the most promising therapy. Nevertheless, patients should get consistent advice from their GP or company doctor. The council emphasises that encouraging physical exercise and eliminating any possible causative strain should be part of an integrated approach, embracing work-related psychosocial and personal issues. Of particular interest is the council's advice to prevent RSI by improving the physical condition and by selective training of muscle function. The report recommends that more research be carried out in order to provide insight into the effectiveness of the treatment of RSI.

Comparison of data on occupational health service systems in Austria, Finland, Germany, The Netherlands, Norway and Sweden.

Comparative data on the occupational health systems in different countries are lacking to a very great extent. This is illustrated here with the data from six European countries of participants of the workshop. On the basis of available data and various developments in the countries and the EC, it is concluded that in some countries the coverage of the working population will diminish, while in others it will increase. The need for international comparative research is discussed in the light of the recent EC ruling saying some form of occupational health service should be available for all EC workers. It is concluded that monitoring research is feasible taking the experience in national studies into account.