The objective of the present study is to compare the QL of a wide range of chronic disease patients. Secondary analysis of eight existing data sets, including over 15,000 patients, was performed. The studies were conducted between 1993 and 1996 and included population-based samples, referred samples, consecutive samples, and/or consecutive samples. The SF-36 or SF-24 were employed as generic QL instruments. Patients who were older, female, had a low level of education, were not living with a partner, and had at least one comorbid condition, in general, reported the poorest level of QL. On the basis of rank ordering across the QL dimensions, three broad categories could be distinguished. Urogenital conditions, hearing impairments, psychiatric disorders, and dermatologic conditions were found to result in relatively favorable functioning. A group of disease clusters assuming an intermediate position encompassed cardiovascular conditions, cancer, endocrinologic conditions, visual impairments, and chronic respiratory diseases. Gastrointestinal conditions, cerebrovascular/neurologic conditions, renal diseases, and musculoskeletal conditions led to the most adverse sequelae. This categorization reflects the combined result of the diseases and comorbid conditions. If these results are replicated and validated in future studies, they can be considered in addition to information on the prevalence of the diseases, potential benefits of care, and current disease-specific expenditures. This combined information will help to better plan and allocate resources for research, training, and health care.

The present study analyses the actual occupational situation, vocational handicaps and past labour career of a group of about 1000 Dutch patients suffering from a neuromuscular disorder (NMD). On the basis of the likelihood of a substantial employment history and sufficient numbers of patients, four types of NMD were selected: dystrophia myotonica (DM), hereditary motor and sensory neuropathy (HMSN), spinal muscular atrophy (SMA) and myasthenia gravis (MG). Results show that a labour career is in reach of most NMD patients, even for those with severe limitations. It is concluded that physical limitations seem not to be decisive in that respect. The loss of the quality of communication, the loss of mental abilities and the effect of the diseases on the facial expression, as with some DM patients, are also important for chances on the labour market. Though the labour participation of NMD patients tends to decrease after the age of 34, the availability of work 4 adaptations makes it possible to prolong the labour career. Analysis of the actual work situation of NMD patients shows that both disorder-related limitations and work characteristics play an important role in the amount of physical work problems encountered. It is argued that physical labour has to be regarded as generally unsuitable for NMD patients. This has implications for the sort and level of education to be attained by NMD patients. Career counselling as a focus point for the choice of an educational programme may improve labour market opportunities as well as quality of employment of NMD patients. Allowing for and accepting the possible effects of the disorder in the work situation are considered to be important in respect to labour participation and work satisfaction of workers with NMD. Reducing time pressure demands and increasing the freedom to organize one's work, are measures to be given especial consideration. Perspectives professionneiles et troubles neuromusculairesLa présente étude, analyse la situation professionnelle actuelle, le désavantage d'occupation et la carrière professionnelle antérieure d'un groupe d'environ 1000 patients néerlandais souffrant tle « difficultés neuromusculaires » désignées sous le sigle «NMD ». Partant de la probabilité d 'un passé professionnel riche et d'un nombre suffisant de patients on a sélectionné quatre types de patients souffrant de troubles neuromusculaires:dystrophie myotonique, pathologies neurologiques morrices et sensorielles héréditaires, atrophie musculaire d'origine spinale, myasthénie gravis. Les résultats montrent qu'une carrière professionnelle est à portée de la plupart des patients NMD, meine de ceux qui ont des limitations sévères. On en déduit que les limitations physiques ne semblent pas représenter un facteur décisif par rapport à cette question. La perte de la qualité de communication, la perte des habiletés cognitives et les conséquences de la maladie sur l'expression faciale comme ccla se produit chez certains patients DM, ont également leur importance pour ce qui concerne les cha...

Work(place) adjustments can help restore the work capacity of persons with a chronic disease. This study aims to quantify the presence of work adjustments among chronically ill workers in the Netherlands, and to investigate the extent to which the presence of work adjustments are related to the experience of work-interfering problems, disease characteristics or work characteristics. Data for this study are derived from the Dutch Panel of Patients with Chronic Diseases. The results discussed here relate to data collected in 1999 from a representative sample of 556 working people with various chronic somatic diseases. Of the work-interfering problems, the ones related to physical disabilities, concentration or memory deficits and transportation emerged as the most important factors related to the presence of either immaterial (i.e. not material) or material work adjustments. In addition, higher age and lower educational level were associated with a higher probability of immaterial adjustments; pain, attack frequency and physical demands of the job were important predictors of material work adjustments.

A secondary analysis was performed on a large scale cross-sectional survey (n = 12500) by the European Foundation for the Improvement of Living and Working Conditions. The analysis investigates (1) 'strain', i.e. whether or not employees in 12 European Union (EU) member states considered their health or safety to be a t risk because of their work in relation to psychological demands, job control and social support, (2) the unique contribution of (a combination o f ) these job characteristics in explaining differences in health and safety risk (HSR), (3) the explanatory value of these job characteristics in comparison to physical job demands, and (4) the relative strength of these determinants in each of the 12 EU niember states. Results show that (1) psychological demands, job control and social support are all related to a perceived health and safety risk in the work situation;(2) each of these characteristics has an unique contribution; (3) physical demands, when added to the model, are by far the most influential determinant; and (4) in a cross-national comparison, physical demands are found to be the most influential determinant of HSR in all EU member states. The importance of this study is its large scale and European charactrr. An important limitation, however, relates to thc operationalization of the dependent variable. It is concluded that high psychological demands per se constitute a risk of illness and injury from work. The larger number of European employees who consider their health or safety to be at risk because of their work, underlines the necessity of monitoring risk factors and risk groups and of prevention, and also of adequate legislation

For many people it is impossible to imagine working life today without a computer. What the increase of the use of computers means for the quality of the work, is still under discussion. The object of this study is to show the recent developments (1992 ± 2000) in the use of computers among the working population in the European Union and its impact on the quality of working life. The data used for these analyses were collected on a ®ve-year basis by means of a questionnaire. Results show that the use of computers has increased between 1992 and 2000. The increase in computer use is almost completely the result of developments within white-collar occupations. In general, the use of a computer results in more quali®ed work and less physical strain. However, those who work with a computer permanently, clearly show more signs of physical and mental strain than those who use the computer only part of the time. This could mean that adding other tasks than computer tasks could improve the working conditions of those using the computer permanently. These results suggest that the increase of the use of computers will further improve the quality of work except when one neglects the dangers connected with a permanent use of computers.

In 1989 a questionnaire was administered to approximately 3,000 persons employed in the automation sector in the Netherlands. The aim of this enquiry was to make an inventory of possible stressful aspects in the career and working conditions of automation personnel. Using multiple correspondence analysis, risk factors and occupations at risk were identified. It appears that middle-management occupations are at risk concerning stress; occupations in lower management and teachering seem to be at risk concerning career prospects.

The Work and Handicap Questionnaire (WHQ) was developed to improve the vocational perspectives of patients with a chronic disorder. The WHQ differs from similar instruments in its explicit linkage between disabilities in daily life and job demands. This is an important feature, which allows for the development of specific strategies to counter work problems of people with a chronic disorder. The WHQ makes an inventory of possibly harmful working conditions and of possible strategies to counter health-related work problems by means of the work adjustments. Results of the application of the WHQ are shown for three patient groups (neuromuscular disorders, multiple sclerosis and asthma) and a group of colleagues with no chronic disorder. Results show similarities and differences between labour conditions and labour experiences between the three patient groups. It also shows differences and similarities between those working with a chronic disorder and those without such a disorder. Acceptance of the consequences of a chronic disorder for the job performance and a focus on health-related work problems would prolong career opportunities for workers with a chronic disorder. The use of the Work and Handicap Questionnaire will hopefully further these aims in determining health-related work problems and offer solutions by means of adequate work adjustment.

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