Foreword to 5th International Conference on Whole Body Vibration Injuries held at Academic Medical Center, University of Amsterdam, The Netherlands, 5-7 June 2013

Foreword to 5th International Conference on Whole Body Vibration Injuries held at Academic Medical Center, University of Amsterdam, The Netherlands, 5-7 June 201

Prevalence of actinic keratosis and skin cancer in a population of Dutch outdoor workers

Background: Outdoor work is associated with high and chronic exposure to solar ultraviolet radiation which might lead to an increased risk of developing skin (pre)malignancies. Prevalence of actinic keratosis (AK), basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and cutaneous melanoma (cM) in Dutch outdoor workers (OW) has not previously been investigated. Objective: This study compares the prevalence of premalignant lesions and skin tumours in OW and matched controls (non-OW). Methods: In a population-based cohort study, prevalence of premalignant lesions and skin tumours was investigated in a group of OW (n = 841) and controls matched 1:1 by age, sex, skin colour and tendency for sunburn. Skin examinations were conducted by physicians and skin cancer history was derived from the nationwide Dutch Pathology Registry. Information on OW was obtained through interviews. Conditional logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for associations between OW and BCC, cSCC, cM and (number of) AK. Results: AK was found in 22.7% of OW and 22.9% of non-OW, BCC in 14% of OW and 15.7% of non-OW, cSCC in 4.9% of OW and 3.4% of non-OW, and cM in 1.9% of OW and 2% of non-OW. There was no significant association between OW and premalignant lesions and skin tumours, with exception for developing ≥4 AKs (OR 1.3 [95% CI 1.0–1.78]). Conclusions: This study reveals high prevalence of premalignant lesions and skin tumours in a Dutch population. No association between OW and the occurrence of premalignant lesions and skin tumours was found, however, multiple AKs were more prevalent in OW.</p

Prevalence of actinic keratosis and skin cancer in a population of Dutch outdoor workers

Background: Outdoor work is associated with high and chronic exposure to solar ultraviolet radiation which might lead to an increased risk of developing skin (pre)malignancies. Prevalence of actinic keratosis (AK), basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and cutaneous melanoma (cM) in Dutch outdoor workers (OW) has not previously been investigated. Objective: This study compares the prevalence of premalignant lesions and skin tumours in OW and matched controls (non-OW). Methods: In a population-based cohort study, prevalence of premalignant lesions and skin tumours was investigated in a group of OW (n = 841) and controls matched 1:1 by age, sex, skin colour and tendency for sunburn. Skin examinations were conducted by physicians and skin cancer history was derived from the nationwide Dutch Pathology Registry. Information on OW was obtained through interviews. Conditional logistic regression models were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for associations between OW and BCC, cSCC, cM and (number of) AK. Results: AK was found in 22.7% of OW and 22.9% of non-OW, BCC in 14% of OW and 15.7% of non-OW, cSCC in 4.9% of OW and 3.4% of non-OW, and cM in 1.9% of OW and 2% of non-OW. There was no significant association between OW and premalignant lesions and skin tumours, with exception for developing ≥4 AKs (OR 1.3 [95% CI 1.0–1.78]). Conclusions: This study reveals high prevalence of premalignant lesions and skin tumours in a Dutch population. No association between OW and the occurrence of premalignant lesions and skin tumours was found, however, multiple AKs were more prevalent in OW.</p

The multiple mediating effects of vision-specific factors and depression on the association between visual impairment severity and fatigue: a path analysis study

Background: Severe fatigue is a common symptom for people with visual impairment, with a detrimental effect on emotional functioning, cognition, work capacity and activities of daily living. A previous study found that depression was one of the most important determinants of fatigue, but less is known about disease-specific factors in this patient population. This study aimed to explore the association between visual impairment severity and fatigue in adults with low vision, both directly and indirectly, with vision-specific factors and depression as potential mediators. Methods: Cross-sectional data were collected from 220 Dutch low vision service patients by telephone interviews. Fatigue was defined as a latent variable by severity and impact on daily life. Potential mediators included vision-related symptoms, adaptation to vision loss and depression. Hypothesized structural equation models were constructed in Mplus to test (in)direct effects of visual impairment severity (mild/moderate, severe, blindness) on fatigue through above mentioned variables. Results: The final model explained 60% of fatigue variance and revealed a significant total effect of visual impairment severity on fatigue. Patients with severe visual impairment (reference group) had significantly higher fatigue symptoms compared to those with mild/moderate visual impairment (β = -0.50, 95% bias-corrected confidence interval [BC CI] [-0.86, -0.16]) and those with blindness (β = -0.44, 95% BC CI [-0.80, -0.07]). Eye strain & light disturbance, depression and vision-related mobility mediated the fatigue difference between the severe and mild/moderate visual impairment categories. The fatigue difference between the severe visual impairment and blindness categories was solely explained by eye strain & light disturbance. Moreover, depressive symptoms (β = 0.65, p < 0.001) and eye strain & light disturbance (β = 0.19, p = 0.023) were directly associated with fatigue independent of visual impairment severity. Conclusions: Our findings indicate an inverted-U shaped relationship between visual impairment severity and fatigue in patients with low vision. The complexity of this relationship is likely explained by the consequences of visual impairment, in particular by strained eyes and depressive mood, rather than by severity of the disability itself

Back disorders and occupational exposure to whole-body vibration

During the past five years, a number of epidemiological studies on occupational exposure to whole-body vibration have been carried out at the Coronel Laboratory. These studies include both retrospective follow-up studies on long-term sick leaves and disability pensioning among crane-operators (N = 1,084) and tractor drivers (N = 423) and questionnaire studies on the prevalence of back pain among tractor drivers (N = 455), helicopter pilots (N = 133) and lift-truck drivers (N = 233). Measurements (according to the ISO 2631 (1985)) were conducted to establish the accelation levels of the tractors, the helicopters and the lift-trucks. The prevalence of back pain, in most studies, was significantly higher among workers exposed to whole-body vibration compared to workers not exposed to whole-body vibration. Incidence rates of sick leave and disability pensioning due to back disorders, in particular intervertebral disc disorders, were in some studies higher in occupations that expose workers to whole-body vibration. The relationship between the received vibration dose and the prevalence of back pain as observed in these studies is explored

Training on involving cognitions and perceptions in the occupational health management and work disability assessment of workers: development and evaluation

Background: In order to improve work participation of workers with a chronic disease, it is important for occupational health professionals (OHPs) to focus on those factors that can influence work participation. Cognitions and perceptions, such as recovery expectations and self-efficacy, are examples of these factors that can influence work participation. However, no training program is available for OHPs on how to involve cognitions and perceptions during their practice. Therefore, the aim of this study was to develop a training program for OHPs on how to involve cognitions and perceptions in the occupational health management and work disability assessment of workers with a chronic disease. In addition, to evaluate the OHPs’ satisfaction with the training and the feasibility of the training and learned skills. Methods: The training program was developed using information from previously conducted studies regarding cognitions and perceptions in relation to work participation. Satisfaction with the training by OHPs was evaluated by means of a questionnaire. A smaller group of OHPs were interviewed three to six months after the training to evaluate the feasibility of the training and learned skills. Results: The 4.5-h training program consisted of four parts concerning: 1) cognitions and perceptions associated with work participation, 2) how to obtain information on them, 3) the course of the conversation on these factors, and 4) intervening on these factors. Eight training sessions were conducted with 57 OHPs, of whom 54 evaluated the training. Participants were very satisfied (score 8.5 on a scale from 1 to 10). The eleven interviewed participants were more aware of cognitions and perceptions during consultations and perceived the training to be feasible. However, not all participants had applied the acquired skills in their practice, partially because of a lack of time. Conclusions: OHPs are very satisfied with the training program and perceive it to be feasible. The training increases awareness of important cognitions and perceptions and may possibly help to increase work participation of workers with a chronic disease

The economic burden of visual impairment and comorbid fatigue: A cost-of-illness study (from a societal perspective)

PURPOSE. To investigate the burden of visual impairment and comorbid fatigue in terms of impact on daily life, by estimating societal costs (direct medical costs and indirect non–health care costs) accrued by these conditions. METHODS. This cost-of-illness study was performed from a societal perspective. Cross-sectional data of visually impaired adults and normally sighted adults were collected through structured telephone interviews and online surveys, respectively. Primary outcomes were fatigue severity (FAS), impact of fatigue on daily life (MFIS), and total societal costs. Cost differences between participants with and without vision loss, and between participants with and without fatigue, were examined by (adjusted) multivariate regression analyses, including bootstrapped confidence intervals. RESULTS. Severe fatigue (FAS ≥ 22) and high fatigue impact (MFIS ≥ 38) was present in 57% and 40% of participants with vision loss (n = 247), respectively, compared to 22% (adjusted odds ratio [OR] 4.6; 95% confidence interval [CI] [2.7, 7.6]) and 11% (adjusted OR 4.8; 95% CI [2.7, 8.7]) in those with normal sight (n = 233). A significant interaction was found between visual impairment and high fatigue impact for total societal costs (€449; 95% CI [33, 1017]). High fatigue impact was associated with significantly increased societal costs for participants with visual impairment (mean difference €461; 95% CI [126, 797]), but this effect was not observed for participants with normal sight (€12; 95% CI [ 527, 550]). CONCLUSIONS. Visual impairment is associated with an increased prevalence of high fatigue impact that largely determines the economic burden of visual impairment. The substantial costs of visual impairment and comorbid fatigue emphasize the need for patient-centered interventions aimed at decreasing its impact

Multidisciplinaire richtlijn prikkelbaredarmsyndroom.

The multidisciplinary guideline 'Diagnostics and treatment of irritable bowel syndrome (IBS)' provides the basis for a properly coordinated collaboration between the patient suffering from IBS and all healthcare providers involved in his or her treatment, such as the general practitioner, gastroenterologist, internist, occupational-health physician, dietitian and psychologist. The diagnosis 'IBS' is often made in accordance with diagnostic criteria, such as the Rome III criteria, but a somatic condition needs to be excluded first. If there are no indications for this, additional diagnostic tests are not necessary. Management of the condition consists primarily of advice on life-style plus non-pharmacological interventions, in addition to explaining the condition and providing information. Drug treatment is rarely indicated. If the IBS symptoms have a significant impact on quality of life and patients do not respond to the measures taken in accordance with this general policy, there are three options for psychotherapeutic treatment. When the symptoms result in absenteeism or other work-related problems, the doctor can advise the patient to contact the occupational-health physician and to search for specific solutions in consultation with the employer. When individual advice is required or if the patient's diet is not well-balanced, a referral to the dietitian will follow