Crystal IS on the move

Introduction: Whether pediatric patients with differentiated thyroid carcinoma (DTC) are at risk of developing treatment-related adverse effects on cardiac function is unknown. We therefore studied in long-term survivors of pediatric DTC the prevalence of cardiac dysfunction and atrial fibrillation in relation to treatment variables, and the association between cardiac dysfunction and plasma biomarkers. Methods: In this nationwide prospective multicenter study, cardiac assessments were performed in 66 adult survivors of pediatric DTC (age at diagnosis 18 years and follow-up 5 years after diagnosis) treated in the Netherlands between 1970 and 2009. Assessment included echocardiography, plasma biomarkers (N-terminal pro-brain natriuretic peptide, high-sensitive troponin-T, galectin-3), and 24-hour Holter electrocardiography. Echocardiographic measurements were compared with retrospective data of 66 sex- and age-matched unaffected Dutch controls. Diastolic dysfunction was defined as an early diastolic septal and/or lateral tissue velocity (e) less than 2 SD of mean age-adjusted reference data. Results: The survivors (86.4% women) had at DTC diagnosis a median age of 16 years. Median follow-up was 17 years. Left ventricular ejection fraction <50% was found in one survivor, and median global longitudinal systolic strain was near normal. Diastolic dysfunction was present in 14 asymptomatic survivors (21.2%). Overall, diastolic function of survivors was lower compared with controls (emean 14.5 versus 15.8cm/s, P=0.006). Older attained age and higher waist circumference were associated with decreased diastolic function, whereas thyrotropin levels and cumulative administered radioiodine dose were not. In survivors, biomarkers were not associated with diastolic dysfunction; atrial fibrillation was not observed. Conclusion: While systolic function is unaffected, diastolic dysfunction is frequently observed in asymptomatic long-term survivors of pediatric DTC, which may suggest early cardiac agin

Impact of patient characteristics, education and knowledge on emergency room visits in patients with asthma and COPD: a descriptive and correlative study

<p>Abstract</p> <p>Background</p> <p>Asthma and COPD are major health problems and an extensive burden for the patient and the health care system. Patient education has been recommended, but the influence on knowledge and health outcomes is not fully examined. Our aims were to compare patient characteristics, education and knowledge in patients who had an emergency room (ER) visit, to explore factors related to disease knowledge, and to investigate patient characteristics, patient education and knowledge in relation to further ER visits over a 12 month period.</p> <p>Methods</p> <p>Eighty-four patients with asthma and 52 with COPD, who had had an ER visit, were included. They were interviewed by telephone 4 to 6 weeks after the ER visit and followed for a year.</p> <p>Results</p> <p>Patients with COPD were older, more sedentary, had had more ER visits the previous year, and had more co morbidity than patients with asthma. About 80% of the patients had received information from health professionals or participated in education/rehabilitation, but a minority (< 20%) reported that their knowledge about how to handle the disease was good. Patients with "good knowledge" were younger, were more likely to have asthma diagnose, and had a higher educational background (p < 0.05). Sixty-seven percent of the patients with COPD had repeated ER visits during the following year versus 42% in asthma (p < 0.05) (adjusted HRR: 1.73 (1.03-2.90)). Patients who had had ER visits the year before inclusion had a higher risk of ER visits the following year (adjusted HRR: 3.83 (1.99-7.38)). There were no significant differences regarding patient education and knowledge between the group with and without further ER visits after adjusting for sex, diagnose, age, and educational background.</p> <p>Conclusion</p> <p>Patients with asthma had a better self reported knowledge of disease management and were less likely to have new exacerbations than patients with COPD. Reported level of knowledge was, however, in it self not a predictor of exacerbations. This indicates that information is not sufficient to reduce the burden of disease. Patient education focused on self-management and behavioral change should be emphasized.</p

Reduced work-related stress in the hotel and restaurant sector

Work-related stress in the hotel and restaurant sector in the Netherlands declined by 13.2% in the four-year period between 2000 and 2004, partly due to a tripartite voluntary covenant on reducing work-related stress. The parties involved were the employer organisations and trade unions active in the sector, as well as the Ministry of Social Affairs and Employment. When the covenant period ended in 2004, the Ministry withdrew its immediate involvement, and the social partners continued with a new and promising way of working together

Rising numbers of temporary employees and independent contractors

The use of temporary employment contracts is a well-used labour market strategy in the Netherlands. Employers use them to explore the suitability of employees and temporary employees are often entrants to the labour market. In some sectors, organisations prefer to hire independent contractors who are generally highly motivated. Numbers of independent contractors and those on temporary contracts has been increasing since 1983, in absolute as well as relative terms

Ongevallenregistratie in bedrijf : over de melding, registratie en analyse van arbeidsongevallen

Het nauwkeurig melden en registreren van arbeidsongevallen, zowel op landelijk als op bedrijfstak- en bedrijfsniveau, is belangrijk om inzicht in het probleem te krijgen en voor het voeren van een verantwoord veiligheidsbeleid op alle niveaus. Dit boekje besteedt aandacht aan het melden, registreren en analyseren van arbeidsongevallen. Allereerst wordt in dit kader ingegaan op de wettelijke verplichtingen. Vervolgens wordt stilgestaan bij de beschikbare informatiebronnen, zoals de Statistiek der Bedrijfsongevallen, en bij de achtergronden, oorzaken en gevolgen van bedrijfsongevallen. Ook wordt aandacht geschonken aan de plaats van ongevallenregistratie in het bedrijfsveiligheidsbeleid. Voorts wordt de berekening en interpretatie van ongevalscijfers bekeken. Tenslotte wordt een hoofdstuk gewijd aan concrete ongevalsanalyse aan de hand van bestaande ongevalscijfers, afkomstig uit onderzoek van het NIA, de periode 1990 tot en met 1994

Working time

Working time concerns the hours of the day and the days of the week that work takes place. Most people have standard working hours between 0800 and 1800 on week days. But work also takes place at non-standard hours in the evening, at night and on weekends. Non-standard working times constitute an important part of the economy and society. Work at non-standard hours may have negative effects on the health and well-being of workers because of tiredness and problems of combining work and private life

Interventions to prevent and manage psychosocial risks and work-related stress

Prevention is the cornerstone of the European approach to managing occupational safety and health. Prevention means anticipating and analysing the various aspects of work to identify short and long term risks, and then taking action to eliminate or mitigate those risks; that is identifying and addressing the source of the problem. The actions taken to eliminate or mitigate risks are referred to as interventions. This article presents the different levels of interventions that can be applied to manage psychosocial risks and work-related stress. It also describes the process of psychosocial risk management which outlines best practice on how to design, implement and evaluate interventions. The article primarily focuses on prevention, rather than on an extensive discussion on treatment or rehabilitation