Coronel Institute of Occupational Health

Amsterdam, Netherlands

Coronel Institute of Occupational Health

Amsterdam, Netherlands

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Mehnert A.,University of Leipzig | Mehnert A.,University of Hamburg | De Boer A.,Coronel Institute of Occupational Health | Feuerstein M.,Uniformed Services University of the Health Sciences
Cancer | Year: 2013

There is a considerable body of evidence about the adverse effects of cancer and cancer treatments on employment, work ability, work performance, and work satisfaction among cancer survivors. There is also a growing consensus that cancer survivorship research needs to address the large variety of short-term and long-term work-related problems and that programs to support return to work and employment should be developed and integrated into the follow-up survivorship care of cancer patients. Cancer survivorship and employment can be considered from the perspective of the cancer survivor, the caregiver and the family, the employer and coworkers, the health care providers, and the community or society - elements that comprise many similarities but also differences between Europe and the Unites States and that may affect employment and return to work among cancer survivors in different ways. Previous research has specifically addressed the likelihood and timeliness of work return, including factors that promote and hinder return to work and work performance, and intervention studies and programs that focus on psychological, physical, pharmacologic, or multidisciplinary approaches to work. The area of work disability has emerged as an international field with research from areas throughout the globe. In this article, the authors provide an overview of the current state of scientific research in these areas and further provide a cancer survivorship and work model that integrates significant individual cancer-related, treatment-related, and work-related factors and outcomes. The report concludes with a discussion of European and American contributions and possible future directions for the enhancement of current efforts. © 2013 American Cancer Society.


Thyssen J.P.,Copenhagen University | Kezic S.,Coronel Institute of Occupational Health
Journal of Allergy and Clinical Immunology | Year: 2014

The epidermis protects human subjects from exogenous stressors and helps to maintain internal fluid and electrolyte homeostasis. Filaggrin is a crucial epidermal protein that is important for the formation of the corneocyte, as well as the generation of its intracellular metabolites, which contribute to stratum corneum hydration and pH. The levels of filaggrin and its degradation products are influenced not only by the filaggrin genotype but also by inflammation and exogenous stressors. Pertinently, filaggrin deficiency is observed in patients with atopic dermatitis regardless of filaggrin mutation status, suggesting that the absence of filaggrin is a key factor in the pathogenesis of this skin condition. In this article we review the various causes of low filaggrin levels, centralizing the functional and morphologic role of a deficiency in filaggrin, its metabolites, or both in the etiopathogenesis of atopic dermatitis. © 2014 American Academy of Allergy, Asthma and Immunology.


de Groene G.J.,Coronel Institute of Occupational Health
Cochrane database of systematic reviews (Online) | Year: 2011

The impact of workplace interventions on the outcome of occupational asthma is not well-understood. To evaluate the effectiveness of workplace interventions on the outcome of occupational asthma. We searched the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; EMBASE; NIOSHTIC-2; CISDOC and HSELINE up to February 2011. Randomised controlled trials, controlled before and after studies and interrupted time series of workplace interventions for occupational asthma. Two authors independently assessed study eligibility and trial quality, and extracted data. We included 21 controlled before and after studies with 1447 participants that reported on 29 comparisons.In 15 studies, removal from exposure was compared with continued exposure. Removal increased the likelihood of reporting absence of symptoms (risk ratio (RR) 21.42, 95% confidence interval (CI) 7.20 to 63.77), improved forced expiratory volume (FEV1 %) (mean difference (MD) 5.52 percentage points, 95% CI 2.99 to 8.06) and decreased non-specific bronchial hyper-reactivity (standardised mean difference (SMD) 0.67, 95% CI 0.13 to 1.21).In six studies, reduction of exposure was compared with continued exposure. Reduction increased the likelihood of reporting absence of symptoms (RR 5.35, 95% CI 1.40 to 20.48) but did not affect FEV1 % (MD 1.18 percentage points, 95% CI -2.96 to 5.32).In eight studies, removal from exposure was compared with reduction of exposure. Removal increased the likelihood of reporting absence of symptoms (RR 39.16, 95% CI 7.21 to 212.83) but did not affect FEV1 % (MD 1.16 percentage points, 95% CI -7.51 to 9.84).Two studies reported that the risk of unemployment after removal from exposure was increased compared with reduction of exposure (RR 14.3, 95% CI 2.06 to 99.16). Three studies reported loss of income of about 25% after removal from exposure.Overall the quality of the evidence was very low. There is very low-quality evidence that removal from exposure improves asthma symptoms and lung function compared with continued exposure.Reducing exposure also improves symptoms, but seems not as effective as complete removal.However, removal from exposure is associated with an increased risk of unemployment, whereas reduction of exposure is not. The clinical benefit of removal from exposure or exposure reduction should be balanced against the increased risk of unemployment. We need better studies to identify which interventions intended to reduce exposure give most benefit.


van der Molen H.F.,Coronel Institute of Occupational Health
Cochrane database of systematic reviews (Online) | Year: 2012

Construction workers are frequently exposed to various types of injury-inducing hazards. A number of injury prevention interventions have been proposed, yet their effectiveness is uncertain. To assess the effects of interventions to prevent injuries in construction workers. We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, PsycINFO, OSH-ROM (including NIOSHTIC and HSELINE), Scopus, Web of Science and EI Compendex to September 2011. The searches were not restricted by language or publication status. The reference lists of relevant papers and reviews were also searched. Randomised controlled trials, controlled before-after (CBA) studies and interrupted time series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. Two review authors independently selected studies, extracted data and assessed study quality. For ITS, we re-analysed the studies and used an initial effect, measured as the change in injury-rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. Thirteen studies, 12 ITS and one CBA study met the inclusion criteria. The ITS evaluated the effects of the introduction or change of regulations (N = 7), a safety campaign (N = 2), a drug-free workplace programme (N = 1), a training programme (N = 1), and safety inspections (N = 1) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance.The overall risk of bias among the included studies was high as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome.The regulatory interventions at national or branch level showed a small but significant initial and sustained increase in fatal (effect sizes of 0.79; 95% confidence interval (CI) 0.00 to 1.58) and non-fatal injuries (effect size 0.23; 95% CI 0.03 to 0.43).The safety campaign intervention resulted in a decrease in injuries at the company level but an increase at the regional level. Training interventions, inspections or the introduction of occupational health services did not result in a significant reduction of non-fatal injuries in single studies.A multifaceted drug-free workplace programme at the company level reduced non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years per year (95% CI -3.5 to -0.5). The vast majority of technical, human and organisational interventions that are recommended by standard texts of safety, consultants and safety courses have not been adequately evaluated. There is no evidence that introducing regulations for reducing fatal and non-fatal injuries are effective as such. There is neither evidence that regionally oriented safety campaigns, training, inspections nor the introduction of occupational health services are effective at reducing non-fatal injuries in construction companies. There is low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign and a multifaceted drug workplace programme can reduce non-fatal injuries among construction workers. Additional strategies are needed to increase the compliance of employers and workers to the safety measures that are prescribed by regulation. Continuing company-oriented interventions among management and construction workers, such as a targeted safety campaign or a drug-free workplace programme, seem to have an effect in reducing injuries in the longer term.


De Boer A.G.E.M.,Coronel Institute of Occupational Health
Journal of Occupational Rehabilitation | Year: 2014

Purpose The number of cancer survivors is rapidly growing due to improved treatment and ageing population. Almost half of cancer patients will experience a cancer diagnosis during working age when career and work-related issues play an important role. Many cancer survivors are at risk for unemployment which greatly affects their quality of life and financial situation. Research on cancer and work is therefore of great importance but scattered over Europe and lacking appropriate dissemination. Moreover, interventions supporting employment of cancer survivors are urgently required but scarcely developed. Methods The European Cancer and Work Network (CANWON) aims to combine knowledge on: (1) prognostic factors of unemployment in cancer survivors including gender- and country-specific differences; (2) work-related costs of survivorship for both patients and society; (3) the role of employers; and (4) development and evaluation of innovative, interdisciplinary interventions which effectively support employment. Furthermore, it aims at disseminating research knowledge and best practice worldwide. Results CANWON currently unites 23 teams from 15 countries across different stakeholders and research areas. The expected benefits are rapid exchange of research knowledge, standardised methods and techniques, innovative interventions, future guidelines on cancer and work and the improvement of quality of life of cancer patients. Conclusions Understanding prognostic factors, work-related costs, role of the employer and innovative interventions in relation to work in cancer survivors might progress the understanding of other patients with long-term conditions therefore the knowledge resulting from CANWON will benefit a wide range of patient groups. © 2013 Springer Science+Business Media New York.


Kuijt M.T.K.,Coronel Institute of Occupational Health | Inklaar H.,Dutch Association for Sports Medicine | Gouttebarge V.,Coronel Institute of Occupational Health | Frings-Dresen M.H.W.,Coronel Institute of Occupational Health
Journal of Science and Medicine in Sport | Year: 2012

Objectives: To investigate the prevalence of knee and/or ankle osteoarthritis in former elite soccer player. Design: Systematic review. Methods: Medline, Embase and SPORTDiscus (2000 to January 2012) were used. To be included, studies were required to be a primary study, written in English, Dutch, French or German, former elite soccer players had to be the study population, and presenting knee or ankle OA had to be the outcome measure. Results: The search strategy resulted in four studies. Two studies, evaluated as having a high methodological quality, found a prevalence rate of knee OA between 60 and 80%. Both studies used radiographic examination as their measurement instrument to diagnose OA; the presence of ankle OA was not determined. The other two studies, evaluated as having a moderate methodological quality, found a prevalence rate of knee OA between 40 and 46% and a prevalence rate of ankle OA between 12 and 17%. These studies used a questionnaire as their measurement instrument wherein players were asked if they had ever been diagnosed with OA by a medical specialist. Conclusions: The prevalence of knee and ankle OA in former elite soccer players can be considered high compared to the general population and to other occupations. To identify players at risk for OA, a health surveillance program should be implemented in elite soccer as a preventive measure. Further research should be conducted to determine if the risk of developing OA varies among different subgroups of elite soccer players and what the consequences of this high OA prevalence are. © 2012 Sports Medicine Australia.


van der Veer T.,Coronel Institute of Occupational Health | Frings-Dresen M.H.W.,Coronel Institute of Occupational Health | Sluiter J.K.,Coronel Institute of Occupational Health
PLoS ONE | Year: 2011

Purpose: There is a growing awareness of the potent ways in which the wellbeing of physicians impacts the health of their patients. The purpose of this study was to investigate the health behaviors, care needs and attitudes towards self-prescription of Dutch medical students, and any differences between junior preclinical and senior clinically active students. Methods: All students (n = 2695) of a major Dutch medical school were invited for an online survey. Physical activity, eating habits, alcohol consumption, smoking, Body Mass Index, substance use and amount of sleep per night were inquired, as well as their need for different forms of care and their attitude towards self-prescription. Results: Data of 902 students were used. Physical activity levels (90% sufficient) and smoking prevalence (94% non-smokers) were satisfying. Healthy eating habits (51% insufficient) and alcohol consumption (46% excessive) were worrying. Body Mass Indexes were acceptable (20% unhealthy). We found no significant differences in health behaviors between preclinical and clinically active students. Care needs were significantly lower among clinically active students. (p<0.05) Student acceptance of self-prescription was significantly higher among clinically active students. (p<0.001) Conclusions: Unhealthy behaviors are prevalent among medical students, but are no more prevalent during the clinical study phase. The need for specific forms of care appears lower with study progression. This could be worrying as the acceptance of self-care and self-prescription is higher among senior clinical students. Medical faculties need to address students' unhealthy behaviors and meet their care needs for the benefit of both the future physicians as well as their patients. © 2011 van der Veer et al.


Gouttebarge V.,Coronel Institute of Occupational Health | Inklaar H.,Dutch Association for Sports Medicine | Frings-Dresen M.H.W.,Coronel Institute of Occupational Health
Journal of Sports Medicine and Physical Fitness | Year: 2014

Background. The aim of the present study was to assess whether previous injury is a risk determinant for knee and ankle osteoarthritis (OA) in former professional football players and to explore OA-related activity and work limitations. Methods. To retrieve the relevant recent literature, the Medline, Embase and Sportdiscus databases were systematically searched for studies published from January 2000 to May 2012. Included studies must be primary studies that are written in English, Dutch, French or German and involve former professional football players; injury had to be studied as an independent variable; and knee/ankle OA, work participation or limited activities had to be described as an outcome. The data from included studies were extracted using a standardised extraction form, and the methodological quality was assessed. Results. No studies were retrieved about injury as a risk determinant for knee/ankle OA in former professional football players. Four studies about OA-related activity and work limitations were included (three of high and one of moderate methodological quality). Up to 17% of former professional football players with knee/ankle OA reported suffering from joint pain and discomfort during activities such as squatting, walking and climbing stairs. Former professional football players with knee/ankle OA reported that their conditions were very painful, chronically painful and affected their daily lives, while 28% reported work-related limitations. Conclusion. Knee and ankle OA in former professional football players causes joint pain and discomfort that has negative consequences for daily life and work activities. An OA health examination programs should be developed to empower the sustainable health and functioning of professional football players.


Gouttebarge V.,Coronel Institute of Occupational Health | Sluiter J.K.,Coronel Institute of Occupational Health
Occupational Medicine | Year: 2014

Background: During their career, professional football players undergo periodic medical examinations intended to screen and monitor their fitness and health. In the Netherlands, information about the content of these examinations is lacking and it is not known whether they comply with current Dutch occupational medicine guidelines. Aims: To explore the content of medical examinations undertaken in Dutch professional football clubs, and assess whether they comply with current Dutch occupational medicine guidelines. Methods: An observational study conducted among physicians working for all clubs in the Dutch first- and second-tier professional football leagues, using an electronic questionnaire. Results: Cardiovascular assessment based on different instruments was used in all clubs and respiratory assessment based on different instruments was used in most (87%). Other assessments such as mental health (7%), neurological (27%) or urinary (22%) assessments were only undertaken in some clubs. Seven out of the 26 clubs met some of the relevant aspects of current Dutch occupational medicine guidelines. Conclusions: The medical examinations currently undertaken in Dutch professional football clubs are diverse in nature and not consistent from one club to another. Only a limited number of clubs meet Dutch guidelines for periodic medical examinations of workers. © The Author 2013. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.


de Boer A.G.,Coronel Institute of Occupational Health
Cochrane database of systematic reviews (Online) | Year: 2011

Cancer survivors are 1.4 times more likely to be unemployed than healthy people. It is therefore important to provide cancer patients with programmes to support the return-to-work process. To evaluate the effectiveness of interventions aimed at enhancing return-to-work in cancer patients. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, in The Cochrane Library Issue 2, 2010), MEDLINE, EMBASE, CINAHL, OSH-ROM, PsycINFO, DARE, ClinicalTrials.gov, Trialregister.nl and Controlled-trials.com to February 2010, reference lists of included articles and selected reviews, and contacted authors of relevant articles. Randomised controlled trials (RCTs) and controlled before-after studies (CBAs) of the effectiveness of psychological, vocational, physical, medical or multidisciplinary interventions enhancing return-to-work in cancer patients. The primary outcome was return-to-work measured as either return-to-work rate or sick leave duration. Secondary outcome was quality of life. Two authors independently selected trials, assessed the risk of bias and extracted data. We pooled studies with sufficient data, judged to be clinically homogeneous in different comparisons. We assessed the overall quality of the evidence for each comparison using the GRADE approach. Fourteen articles reporting 14 RCTs and 4 CBAs were included. These studies involved a total of 1652 participants. Results indicated low quality evidence of similar return-to-work rates for psychological interventions compared to care as usual (odds ratio (OR) = 2.32, 95% confidence interval (CI) 0.94 to 5.71). No vocational interventions were retrieved. Very low evidence suggested that physical training was not more effective than care as usual on improving return-to-work (OR = 1.20, 95% CI 0.32 to 4.54). Eight RCTs on medical interventions showed low quality evidence that functioning conserving approaches had similar return-to-work rates as more radical treatments (OR = 1.53, 95% CI 0.95 to 2.45). Moderate quality evidence showed multidisciplinary interventions involving physical, psychological and vocational components led to higher return-to-work rates than care as usual (OR = 1.87, 95% CI 1.07 to 3.27). No differences in the effect of psychological, physical, medical or multidisciplinary interventions compared to care as usual were found on quality of life outcomes. Moderate quality evidence showed that employed patients with cancer experience return-to-work benefits from multidisciplinary interventions compared to care as usual. More high quality RCTs aimed at enhancing return-to-work in cancer patients are needed.

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