A trial of a job-specific workers' health surveillance program for construction workers: study protocol

<p>Abstract</p> <p>Background</p> <p>Dutch construction workers are offered periodic health examinations. This care can be improved by tailoring this workers health surveillance (WHS) to the demands of the job and adjust the preventive actions to the specific health risks of a worker in a particular job. To improve the quality of the WHS for construction workers and stimulate relevant job-specific preventive actions by the occupational physician, we have developed a job-specific WHS. The job-specific WHS consists of modules assessing both physical and psychological requirements. The selected measurement instruments chosen, are based on their appropriateness to measure the workers' capacity and health requirements. They include a questionnaire and biometrical tests, and physical performance tests that measure physical functional capabilities. Furthermore, our job-specific WHS provides occupational physicians with a protocol to increase the worker-behavioural effectiveness of their counselling and to stimulate job-specific preventive actions. The objective of this paper is to describe and clarify our study to evaluate the behavioural effects of this job-specific WHS on workers and occupational physicians.</p> <p>Methods/Design</p> <p>The ongoing study of bricklayers and supervisors is a nonrandomised trial to compare the outcome of an intervention (job-specific WHS) group (n = 206) with that of a control (WHS) group (n = 206). The study includes a three-month follow-up. The primary outcome measure is the proportion of participants who have undertaken one or more of the preventive actions advised by their occupational physician in the three months after attending the WHS. A process evaluation will be carried out to determine context, reach, dose delivered, dose received, fidelity, and satisfaction. The present study is in accordance with the TREND Statement.</p> <p>Discussion</p> <p>This study will allow an evaluation of the behaviour of both the workers and occupational physician regarding the preventive actions undertaken by them within the scope of a job-specific WHS.</p> <p>Trial registration</p> <p><a href="http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3012">NTR3012</a></p

A screening programme on chronic solvent-induced encephalopathy among Dutch painters

Background: Long-term exposure to organic solvents may lead to chronic solvent induced encephalopathy (CSE) in painters. In combination with reduction of exposure, a workers' health surveillance programme was developed, resulting in a three-stage CSE screening procedure for early neurobehavioural changes possibly predicting chronic health effects. The screening consists of a questionnaire (Neurosymptom Screening Checklist 60, NSC-60), computerised neurobehavioural functioning testing (Neurobehavioural Evaluation System; NES2) and multidisciplinary differential diagnostic evaluation by experts (called 'Solvent Team'). Results from the screening were compared with the results of the 'care as usual' (CAU), in which symptomatic patients were referred directly to the Solvent Team by occupational physicians, general practitioners or medical specialists. Parallel to the screening programme, a legal ban on indoor use of solvent-based paints resulted in lower exposure to solvents. Objective: To investigate the usefulness of the NSC-60 questionnaire as a screening tool for CSE among painters and to investigate the course of the number of CSE cases over the years as a potential consequence of improved prevention and control. Results: From 1998 to 2004, more than 40,000 painters were invited to participate in a health surveillance programme including a periodical occupational health examination (PHE) and 50% did participate. Four percent (N = 794) of these had a positive score on the NSC-60. The Solvent Team assessed 101 of these for CSE, which resulted in 27 CSE cases diagnosed. CAU during the same period of the surveillance (1998-2004) yielded 619 painters and 75 of these had the diagnosis CSE. After 2002 the number of CSE diagnosed cases dropped considerably and in 2004 only one case of CSE could be diagnosed. The substantially lower prevalence of CSE diagnosed cases in painters after 2002 might partly be explained as a result of a successful participation in the screening procedure of most prevalent CSE cases during the years 1998-2002. A second reason for the reduction of new diagnosed cases of CSE can be the effectiveness of the ban on indoor use of solvent-based paints resulting in lower exposure levels at work. Conclusion: The screening procedure is useful to screen for CSE among people taking part in the PHE programme. Control of CSE can be achieved by an integrated preventive approach with reduction of exposure and screening on early health effects. (C) 2012 Elsevier Inc. All rights reserve

Development of a decision model to identify workers at risk of long-term disability in the construction industry

Objective This study presents a decision model that predicts long-term disability among construction workers. Methods Risk factors were identified in two cohort studies among construction workers and evaluated in validation samples of smaller cohort studies among Dutch construction workers. The risk estimates (odds ratios) were used in a logistic regression model to calculate the probability of long-term disability in the next 4 years for a particular construction worker, subject to a specific combination of risk factors. The a priori probability was set equal to the overall long-term disability risk among the youngest construction workers ( = 3 months had an odds ratio of 2.0, and severe musculoskeletal complaints had an odds ratio of 3.0. Since the number of construction workers older than 55 years was rather small and heavily biased by a healthy worker effect, it was decided to limit the applicability of the decision model to workers aged 20-55 years. The decision model used four risk factors and predicted a 40-fold difference in disability risk between construction workers with all four risk factors present (0.79) and those without any risk factor (0.02). Conclusions The decision model presented the combined effect of different risk factors on the risk of an individual worker becoming disabled within 4 years. Evaluation studies will need to demonstrate whether the application of this decision model is helpful in identifying workers at risk for long-term disability and will facilitate appropriate intervention at the individual leve

Prognostic value of self-reported work ability and performance-based lifting tests for sustainable return to work among construction workers

This study aims to evaluate whether performance-based tests have additional prognostic value over self-reported work ability for sustainable return to work (RTW) in physically demanding work. A one-year prospective cohort study was performed among 72 construction workers on sick leave for six weeks due to musculoskeletal disorders. The Work Ability Index (WAI) question regarding "current work ability" was used. Three dynamic lifting tests were used from a Functional Capacity Evaluation (FCE). Sustainable RTW was the number of days on sick leave until the first day of returning fully to work for a period of ≥4 weeks. Regression models were built to calculate the prognostic values. Self-reported work ability alone predicted sustainable RTW (R=0.31, R (2)=0.09, P=0.009). In combination with one lifting test, the explained variance (R (2)) increased to 0.16 (P=0.001). Combining self-reported work ability and a lifting test nearly doubled the explained variance for sustainable RTW in physically demanding work, although the strength remained modes

Design of a RCT evaluating the (cost-) effectiveness of a lifestyle intervention for male construction workers at risk for cardiovascular disease: the Health under Construction study

<p>Abstract</p> <p>Background</p> <p>Of all workers in Dutch construction industry, 20% has an elevated risk of cardiovascular disease (CVD). A major risk factor for CVD risk is an unhealthy lifestyle. The aim of our study is to design a lifestyle intervention for construction workers with an elevated CVD risk, and to evaluate its (cost-) effectiveness.</p> <p>Methods/Design</p> <p>In a RCT, 692 participants will be randomised to either the control or the intervention group. The control group will receive usual care. For the intervention group, a lifestyle intervention has been designed based on interviews and current literature. The intervention will last 6 months and will comprise 3 face-to-face and 4 telephone contacts, consisting of individual counselling aimed at increasing daily physical activity (PA) and improving dietary behaviour, and/or smoking cessation. Counselling will take place at the Occupational Health Service (OHS), and will be done according to motivational interviewing (MI). Additional written information about healthy lifestyle will also be provided to those in the intervention group. At baseline, after 6 and after 12 months, measurements will take place. Primary outcome variables will be the lifestyle behaviours of concern, i.e. daily PA, dietary intake, and smoking status. Secondary outcome variables will be body mass index (BMI), systolic and diastolic blood pressure, total and HDL blood cholesterol, Hba1c and cardio-respiratory fitness (CRF). Sickness absenteeism and cost-effectiveness will be assessed as well. Multilevel analysis will be performed to compare all outcome measures between the intervention group and the control group.</p> <p>Discussion</p> <p>By improving lifestyle, CVD risk may be lowered, yielding benefits for both employee and employer. If proven effective, this lifestyle intervention will be implemented on a larger scale within the Occupational Health Services in construction industry.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN60545588</p