Current research

Development and prevention of occupational diseases

PI: Prof. dr Monique H.W. Frings-DresenOccupational disorders and diseases constitute an extensive medical, economic, social and political problem. They result in limitations to the performance of everyday activities and tasks, and to sick leave, occupational disability and loss of productivity.

The focus in this line of research is on gathering knowledge regarding occupational factors that cause occupational diseases, on the one hand, and on impediments encountered by people with (chronic) diseases (rheumatoid arthritis, chronic fatigue, cancer, cardiovascular disease, acquired brain injuries, musculoskeletal disorders and post-polio patients) to remaining in work, on the other. Some of the research projects in this line concern the effectiveness of reintegration activities, and others the effectiveness of preventive measures.

Research is also carried out looking at the quality of insurance medical practice, including the factors that perpetuate occupational disability after two years of sick leave, the effectiveness of interventions for the sick unemployed with depressive disorders, and the assessment by insurance physicians of work ability in young people with disabilities. The clinimetric quality of instruments plays an important role in this respect.

Research is conducted in collaboration with the curative sector to determine whether maintaining and returning to work can boost recovery. Co-operation exists with the Gastrointestinal Oncology Center Amsterdam (GIOCA) in the AMC to incorporate returning to work in the multidisciplinary treatment plan. Eleven PhD projects are being conducted in this line of research.

The research is financed primarily by contract funding (UWV, Stichting Instituut GAK, A&O Fonds), while other projects are funded by industries (e.g. transport, construction, fire-fighters, ambulance, household waste collection) and the government (Ministries of Social Affairs and Employment (SZW), Health, Welfare and Sport (VWS) and the Interior and Kingdom Relations (BZK).

A collaborative project has been launched with researchers from Temple University, Philadelphia, USA to study RSI, and research on work capacity and ageing is being conducted in collaboration with Harvard Medical School/ Harvard School of Public Health, Boston, USA.

Individual susceptibility to occupational skin disorders

PI: Dr Sanja Kezic

Research focuses on individual susceptibility to occupational diseases, with particular attention for contact eczema. Genetic factors play a key role here. Apart from etiological issues, attention is also paid to the therapeutic and prognostic component of this disease. To answer our research questions, both case-control and prospective cohort studies are conducted among patients with chronic contact eczema (in collaboration with the Dermatology Department of the University of Osnabruck) and among student nurses, respectively. In addition, this research involves developing methods to quantify the exposure to ‘wet work’ as well as researching the ethical aspects of genetic screening.

The role that the skin barrier plays in the development of atopic eczema (AE) is an important aspect of this line of research. Atopic eczema is one of the main risk factors for developing occupational contact eczema. This research focuses on the functional significance of the polymorphisms in genes that are responsible for producing an effective skin barrier. A number of important parameters for skin barrier function, such as the permeability of the epidermis, skin irritability and the amount of ‘natural moisturizing factor’, are being studied in relation to a particular genetic factor.

Workers’ Health Surveillance: work ability and recovery

This research line contributes to knowledge about:

• the assessment of work ability when having acute or chronic health problems.
• the prognoses for job-specific recovery following health problems.
• medical examinations for high-demand-job-populations: development, implementation and evaluation.

Current funding position:
Funding is currently coming from ZONMW, Stichting Instituut GAK, several sectors (construction industry, ambulance sector, firefighting sector). In addition, external companies like UWV, ministry of Defence, Rehabilitation Center Heliomare, and several occupational health services provide human capital for research projects.

Current PhD students:

• Nine currently active PhD students will finish up to 2014.
• In 2011, Margot Joosen defended her thesis in February: the evaluation of vocational rehabilitation services for workers with chronic fatigue was studied and found to be positive with respect to physiological and fatigue status, work status, and quality of life.

Connection with the department’s mission statement and ambitions:
Outcomes of the studies in this PI-line help to reach towards three of the five department’s set aims for the coming five years, namely to:

1. provide occupational health professionals, employers, employees and governmental agencies with evidence based knowledge for practice by translating knowledge from individual projects and spread this knowledge by means of implementation projects and through the information canals of the KMKA (Expertise Center for medical examinations in workers).
2. develop, implement and evaluate evidence based medical examinations and care for workers.
3. develop and evaluate better diagnostics and interventions to prevent work-disability: by developing and evaluating new instruments that mirror and predict work functioning.

Examples of research projects:

• develop and implement new workers’ health surveillance for medical specialists and medical residents.
• implement and evaluate worker’s health surveillance for ambulance workers.
• develop a new work-functioning instrument to screen nurses with common mental health complaints.
• evaluate the effectiveness of two workers health surveillance strategies (e-mental health interventions vs. occupational physician visits).
• evaluate the use of instruments for occupational health services.
• implement new developed instruments for insurance physicians to better predict work-ability.
• study an intervention of helmet-fit in helicopter crew to decrease neck load.
• develop and evaluate an e-health intervention for solving work-related problems for rheumatoid arthritis patients.

New initiatives

• In 2010, a four-years cohort study on the study- and work-related health of all medical students has been started at the University of Amsterdam and was elaborated to two other academic hospitals.
• A large 3-arm RCT was started in 2011 to study the effectiveness of two strategies for workers’ health surveillance.
• Starting from January 2011 both the Ambulance sector and the Firefighting sector officially launched the national use and implementation of pre-employment medical examinations and workers’ health surveillance that were developed at the AMC.