Online reporting and assessing new occupational health risks in SIGNAAL.

BACKGROUND: Changes in work and working conditions continuously give rise to new work-related health risks. Without sufficient knowledge of these, opportunities for prevention and intervention may be missed. AIMS: To develop, implement and evaluate an online tool called SIGNAAL for reporting and assessment of new work-related health risks by occupational health physicians and experts in the Netherlands and Belgium. METHODS: Development and implementation of SIGNAAL to allow both easy and sufficient detailed reporting by occupational health physicians and structured and transparent assessment by occupational health experts. A new work-related health risk is defined as a work-related disease due to specific exposure in a specific work setting not described in the literature before. RESULTS: The online reporting and assessment tool proved to be a feasible means of reporting possible new combinations of health problems and exposures in the work situation. Eleven of the 15 cases reported until October 2014 were fully assessed: one was an entirely new work-related disease, four were known but uncommon work-related diseases, five were known but new in the reported work situation and one was a well-known work-related disease. CONCLUSIONS: An online reporting system used in an occupational health setting can provide insight into new work-related health risks by creating a structured way to gather, report and assess new combinations of health problems and exposure in the workplace.

Negative impact of occupational exposure on surgical outcome in patients with rhinosinusitis.

BACKGROUND: Chronic rhinosinusitis (CRS) is a frequent condition that is treated by functional endoscopic sinus surgery (FESS) when medical treatment fails. Endogenous as well as exogenous factors may be responsible for persisting symptoms after FESS. The role of occupational exposures on success of FESS has never been investigated. METHODS: In this case-control study, we tested the hypothesis that the outcome of FESS procedures is related to exposures at work. Questionnaires were sent to 890 patients who had undergone one or more FESS procedures and to 182 controls. Three independent experts assessed blindly the reported work exposures to inhaled agents. The relationship between exposure and the number of FESS procedures was analyzed. RESULTS: Relevant occupational exposure was reported by 25% of all responding patients undergoing FESS (n = 467) and 12% of controls (n = 69). The prevalence of occupational exposures increased linearly with the number of FESS procedures from 21% in those who had one FESS to 44% in those who had four or more FESS (χ(2)  = 12.74, P < 0.001). Logistic regression analysis with adjustments for potential confounders, including smoking, atopy, and asthma, confirmed that the odds ratio (OR) for reporting occupational exposures was significantly higher in those needing more than one FESS (OR = 1.64) or more than two FESS (OR = 1.97). These results were mainly driven by exposure to low molecular weight agents. CONCLUSION: Exposure at work appears to be a risk factor for the occurrence of CRS and for its recurrence or persistence, as evidenced by the need for revision surgery.

Plating of femoral shaft fractures. A review of 15 cases.

The objective of this study was to define the role, indications and outcome of plating in femur shaft fractures. All femoral shaft fractures admitted and treated by the authors during a 2-year period were analysed. The authors personally treated a total of 135 femur fractures. Of these 135 fractures, 15 (11%) were treated with primary plating. The femoral fractures were classified as grade I (n = 4), grade III (n = 3), grade IV (n = 4), grade V (n = 3), and grade VII (n = 1) (OTA classification). Three patients sustained open fractures (one grade I and two grade II, Gustilo and Anderson classification). Pelvic (6) or ipsilateral lower extremity injuries (4) occurred in 10 of the 15 patients. A total of 23 body areas were injured, most commonly the chest (n = 10), abdomen (n = 5), head (n = 6) and blood vessels (n = 3). There were no infections reported. Two implant failures were noted. Femur plating is a useful technique in polytrauma patients for specific indications where intramedullary nailing (IMN) may be contra-indicated or technically not feasible. Although the postoperative morbidity (ARDS, death) in our study seems to be lower after plating than after intramedullary nailing, the rate of complications of fracture healing (30%) is significantly greater with femur plating than with intramedullary nailing (12%).