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Occupational Medicine Advance Access originally published online on February 23, 2006
Occupational Medicine 2006 56(3):191-198; doi:10.1093/occmed/kqj030
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© The Author 2006. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Occupational physicians: what are their questions in daily practice? An observation study

Frederieke Schaafsma1, Carel Hulshof1, Angela de Boer1, Ralph Hackmann2, Nannette Roest3 and Frank van Dijk1

1 Academic Medical Center, University of Amsterdam-Coronel Institute for Occupational and Environmental Health, PO Box 22700, Amsterdam 1100 DE, The Netherlands
2 Royal Netherlands Navy Occupational Health Service, PO Box 10.000, 1780 CA DenHelder, The Netherlands
3 ING Occupational Health and Safety Services, PO Box 1800, 1000 BV Amsterdam, The Netherlands

Correspondence to: Frederieke Schaafsma, Academic Medical Center, University of Amsterdam-Coronel Institute for Occupational and Environmental Health, PO Box 22700, Amsterdam 1100 DE, The Netherlands. e-mail: f.g.schaafsma{at}amc.uva.nl


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 
Background To enable occupational physicians (OPs) to make use of scientific information in the decision-making process, evidence-based occupational health practice is stimulated.

Aims To study the questions which arise in daily practice of OPs, and to evaluate the possible contribution of evidence-based medicine (EBM) strategies to answer these questions.

Methods Observation of 20 OPs during two consecutive half-day periods, followed by an interview to explore the topics that arose during the preceding period. The conscious or manifest and unconscious or latent questions by OPs were analysed, and the number of questions suitable for performing a search in scientific medical literature databases was assessed.

Results After 40 half-day periods, the OPs had asked 26 manifest questions and 348 latent questions; the latter were voiced during the interview. Of all the questions, 40% were clinical in nature and considered suitable for a literature search. The emphasis of these questions was on prognosis, susceptibility and diagnosis following individual consultations. A lack of time or ‘no necessity to look for an answer’ were the most important reasons for leaving the questions unanswered.

Conclusions OPs spontaneously formulated less than one question per working day. However, after an observation of their daily practice followed by an interview, many latent questions were formulated. A substantial number of these questions could be answered by EBM strategies. If OPs were encouraged more to improve the quality of their decision making, they might formulate more answerable questions and feel more inclined to search for answers.

Keywords      Evidence-based medicine; information demand; information need; occupational medicine; occupational physicians


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Conflicts of interest
 References
 
To encourage occupational physicians (OPs) to enhance their professional knowledge and competency, the introduction of evidence-based medicine (EBM) in their daily practice is desirable [1,2]. Evidence-based practice will enable OPs to use scientific information in the decision-making process whenever relevant but to achieve this we need to understand the barriers that exist. We therefore studied the questions asked by OPs in their current daily practice in the Netherlands, and their behaviour and motivation for finding answers.

OPs in the Netherlands strive to protect and improve the health of employees in relation to their work, acting mostly as an adviser. Tasks concerned with evaluating fitness for work or vocational rehabilitation take up most of their time and generate the greatest demands for information. For these tasks, OPs use several sources of information, including the patient/worker and the employer or company (e.g. medical and employee data), their own knowledge and experience in occupational health and the available literature on occupational health issues. The availability of sources and awareness of the presence and accessibility of this information will influence whether information is actually sought [3].

In an earlier survey, we asked OPs in the Netherlands about their most important information demands [4]. Their questions covered a broad range, although the majority involved medical topics. These questions should have been answerable using evidence-based information sources but we saw that actual access and use of these sources was very limited. OPs preferred to consult colleagues to answer their questions rather than consulting scientific databases or sources. In this respect, they did not differ from other medical doctors [5–9]. In addition, some specific contextual factors within the OP's speciality might influence this behaviour: the culture or organization of the working environment of the OP, the motivation and competence of the OP, and technical influences (e.g. access to the Internet) [10].

Different definitions for information demands and needs for physicians are in use [5,11,12]. In this study, we have distinguished information demand from information need. Information demand is the consciously recognized need or the questioning behaviour, which can be characterized by ‘manifest’ questions: questions that arise during the consultation hours of the OP, or directly thereafter. In addition, we defined information need as the unconscious or the unrecognized need, which can be characterized by ‘latent’ questions: questions that arise after the topic is brought to the attention by an observer. Observing doctors during their daily practice and feeding back to them elicits a substantial higher need for information [13–15]. Collecting both the manifest and the latent questions of OPs in daily practice will provide us with a better understanding of the opportunities and barriers for practising EBM.

Since ‘background’ questions demand more general knowledge about a topic, these questions might be effectively answered by consulting a textbook or other more general information sources. We therefore focused on the analysis of ‘foreground’ questions which require more specific knowledge about a topic [16] and which are suitable to being answered using an EBM approach.

We therefore set the following research questions: How many manifest and latent questions do OPs ask in daily practice and to what extent does this correspond with their own perception? What proportion of questions can certainly be answered using EBM strategies? What are the major topics of interest of these questions, and what is the influence of the daily activities of OPs? Finally, we will assess the attributed professional value to the formulated question and the intention of the OP to actually look for the answer.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Conflicts of interest
 References
 
Twenty experienced OPs were observed and interviewed by two of the authors (R.H., N.R.) during their daily work for two half-day periods. The majority [16] were volunteers recruited during a meeting on the evaluation of occupational health practice guidelines and the remainder were enlisted on the recommendation by colleagues of the authors.

The technique of observation and use of the interview forms were practised in a training setting and pilot tested during five daily periods in real practice. At the start of each observation, the aim of the study was explained to the participating OP. The OP was observed during most of his or her daily activities: individual consultations, medical examinations (pre-employment or periodic) and company meetings or meetings with colleagues of the Occupational Health Service (OHS). The company meetings were with the employer, staff or supervisors of the company. OP activities and the topics discussed in their context were observed and recorded. This report was used as a starting point for a semi-structured interview, held at the end of every half-day observation period. The OP was first asked if the preceding session had raised any questions. This addressed the manifest information demands. Then, in a search for so called ‘latent’ questions, the OPs were asked in detail about their potential information needs by elaborating different aspects of the recorded occupational health problems of the preceding session.

Age, gender and number of years working experience of the OP were noted during the interview as background variables. The OPs were asked to estimate their own questioning behaviour. The following interview addressed two items [17]. First, topics concerning the specific occupational health environment such as: work-related risk, causes and consequences were discussed. Second, medical issues such as prevention, diagnosis and intervention of the observed cases were discussed. To reflect on meetings with companies or with professional colleagues we chose a more general interview structure. All OP questions were written down literally and the OPs were then asked how important the question was in relation to their practice. Finally, the OPs were asked about their intention to search for information to answer the question.

First, the authors F.S. and C.H. independently assigned the unique questions formulated by the observed OPs on different subjects into categories corresponding with the topics mentioned previously. Second, they independently assessed which questions were considered suitable for seeking an answer by performing a search in medical databases. In case of a difference in opinion, a decision was made based on consensus.

Inclusion criteria for ‘suitability’ of questions were based on instructions by Sackett et al. [16]:

(i) Questions about medical knowledge and information, to be sought in medical scientific literature databases. No questions concerning lack of information in relation to the patient, situation, medical history or findings in particular.
(ii) Questions should be specifically formulated, so as to require a concrete answer. No ‘background’ questions.
(iii) Questions should be clearly formulated.
(iv) Questions should relate to the medical domain. No legal topics or social security topics.
Questions that did not meet the inclusion criteria were not analysed further. The proportions of ‘suitable’ and ‘unsuitable’ questions were described per category. The number and categories of questions in relation to the different activities of the OP and the topics discussed during these activities were also described. Finally, for each question, the attributed professional interest was analysed, as well as the motivations given whether or not they would seek an answer.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Conflicts of interest
 References
 
The average age of the 20 participating OPs (14 male, 6 female) was 43 years (±5.4 years), with 12 years (±4.5 years) experience as an OP. Prior to the interview, 50% of the OPs indicated requiring information about once a week, the other 50% once a month.

We attended 70 workers' consultations, 11 medical examinations, 13 meetings with company management and five meetings with professional colleagues. One half-day period per OP included between one and six consultations (or examinations) or one to two meetings. Nine meetings with employers had a focus on rehabilitation issues, the other four concerned issues on prevention and general company policy on occupational health. The workers' consultations concerned predominantly sickness absence (n = 59) while 11 had a preventive nature. One OP did not have any individual consultations or medical examinations and seven OPs did not have any meetings with management or colleagues during the observation period.

Table 1 gives information about the number of manifest and latent questions. On average, an OP posed 0.7 (range 0–2) manifest questions and 8.7 (range 4–28) latent questions after one half-day period. Individual consultations resulted in more questions than meetings.


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  		Table 1. Manifest and latent questions asked by the 20 participating OPs during two consecutive half-day periods

 
Tables 2 and 3 show the categories and numbers of questions asked and the numbers of questions considered suitable or unsuitable for an EBM approach. The distribution of categories of questions asked per OP was fairly equal. In the case of individual workers' consultations, questions on prognosis (n = 38), susceptibility (n = 29) and diagnosis (n = 28) were most prevalent (Table 2). After meetings, the emphasis was on effectiveness of OHS recommendations and interventions (n = 16) and occupational risk prevention by company management (n = 15) (Table 3).


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  		Table 2. Number and categories of questions asked by the participating OPs during two half-day periods (n = 20) of consultations with an employee

 

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  		Table 3. Number and categories of questions asked by the participating OPs during two half-day periods (n = 20) of meetings with an employer or with colleagues

 
A substantial number of questions (149 out of 374) met our criteria for ‘suitability’ for an EBM approach. On average, after a half-day period of consultations, 4.2 questions were considered suitable, most on susceptibility and prognosis. As a result of meetings, 2.7 questions were considered suitable, mostly general questions around the topics discussed or on prevalence and incidence numbers. Examples of questions are shown in Box 1.
Box 1. Examples of suitable questions (n = 149) asked by the participating OPs (n = 20)

Examples of suitable questions after workers' consultations Category of questions
Do lorry drivers with long sitting hours have a higher risk for developing anal fistulas? Work-related cause
Is the work of a postman a risk factor for a recurrence of inguinal hernia? Work-related consequence
What is the sickness absence rate as a result of upper airway infections for refuse collectors? Prevalence and incidence numbers
To what extent and when can someone, recovering from a whiplash in the lower extremity, be rehabilitated to his work as a mechanic in a brewery? Rehabilitation
Does the intervention of an OP have better results than the intervention of a psychologist for employees suffering with stress? Effectiveness of consultation hours by OP
Are there specific risk factors for developing different types of pelvic instability with pregnancy? Aetiology
Is there a relation between personality traits and the risk of burnout? Susceptibility
What groups of people should I check to prevent visual discomfort? Prevention
What are the diagnostic criteria for pregnancy-related pelvic joint pain? Diagnosis
Does physiotherapy have better results than rest for neck pain? Therapy
What are prognostic factors for a relapse of subtrochanteric bursitis? Prognosis
To what extent should an OP give advice on lifestyle with regard to a patient with obesity? ‘Other’
Examples of suitable questions after company meetings or meetings with colleagues
What is the best course of referral for people with psychological complaints? General
What are the occupational risks of a grocery check-out assistant? Work-related causes
To what extent can a welder return to his work after developing health complaints of welding fumes? Work-related consequences
What are the numbers of dermatological complaints within the branch of road transport, in particular for fork-lift truck drivers? Prevalence and incidence numbers
How do other breweries develop policies on worker health and environment? Branch of industry issues
What are the options for prevention of biological risk for the municipal sanitation service? Occupational risk prevention by company management
What interventions are effective for rehabilitation of employees recovering from mental stress complaints? Effectiveness of OHS recommendations and interventions
Are there research studies on the comparison of different types of risk inventory and evaluation of companies? ‘Other’

 

Many questions about diseases were considered not suitable for a literature search, especially questions on aetiology (21 out of 24) and diagnosis (21 out of 28), as they were too generally formulated or they could only be answered by the treating physician. In total, 225 questions did not meet our criteria. The majority (n = 110) were considered too generally formulated or not clear or not making sense. Furthermore, 98 questions should have been answered by other physicians, experts in occupational health or the asking OP himself. Finally, there were 17 questions on legislation and social security regulations. Examples of these questions are shown in Box 2.
Box 2. Examples of unsuitable questions (n = 225) asked by the participating OPs (n = 20)

Examples of unsuitable questions Reason for unsuitability
1) How do shoulder complaints originate? Question is too generally formulated for a literature search
2) General information on repetitive strain injury
1) If rehabilitation does not work out, I will need to know more Question is not clearly formulated or not making sense (e.g. only a part of a question)
2) It would be interesting to know more about this topic
I am curious about the results of the blood test Question should be answered by the treating physician
What machine has caused the accident and how could this happen? Question should be answered by the employer or employee
What is the exact content of his job and what are the circumstances? Question should be answered by the OP himself direct or by visiting the workplace environment
How is rehabilitation to another employer organized? Question should be answered by the OHS or by consulting an expert on work
What is the legal position of the employer in this situation? Question is about legislation or social security regulations

 

The medical topics discussed during the consultations were mainly mental health disorders such as stress and depression (n = 28) and musculoskeletal problems such as fractures and cumulative trauma disorders (n = 19). Various other physical problems were discussed only once or twice. A broad range of topics were discussed during the meetings with company management and/or colleagues. There were discussions, for example, about company policy on sickness absence, about the prevention of cumulative trauma disorders, about admissible physical load of specific tasks and the need for pre-employment examinations. We found no correlations between the discussed topics and type of questions posed.

After the formulation of manifest and latent questions, OPs were asked about their importance for their work. Manifest questions were considered either fairly important (75%) or very important (25%). Also, most latent questions were considered fairly important (62%) or very important (15%). Twenty-three per cent of these questions were primarily asked out of ‘personal interest’, especially questions on susceptibility and on prevalence and incidence rates.

The participating OPs claimed to search for an answer to 86% of the questions they considered very important, for 57% of the fairly important questions and for 51% of those asked out of personal interest. With regard to the manifest questions, 11 of the 12 OPs claimed that they would seek an answer. The intended methods were consulting a colleague directly or using a meeting with colleagues (three OPs), using textbooks (three OPs), exploring the Internet (three OPs) and consulting the treating specialist (two OPs). One OP said that he would not search for an answer because he did not know how to perform a literature search.

The incentive to search for an answer to latent questions depended on various factors. Taking all intended actions together, four OPs said that they would not search for an answer to any of the questions, four said that they would search for an answer for every question and the other 12 OPs would search dependent on the case and question. We could not find a correlation between the category of latent question and the intention to search. Seven OPs mentioned predominantly ‘no priority or necessity’ as a reason for not seeking an answer, five OPs mentioned primarily ‘no time’ as a reason, and three OPs mentioned mainly ‘not knowing where to look for an answer’ as a reason. Five OPs mentioned various reasons for not searching for an answer. The intended actions for seeking an answer were similar to those mentioned for the manifest questions.


   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Conflicts of interest
 References
 
After a half-day session observation, OPs posed 0.7 manifest questions on average. During the interview, OPs expressed on average another 8.7 latent questions, which is 12 times as many. Therefore, OPs underestimate their information demands since 50% of the OPs stated asking only one question per week prior to the interview. A substantial portion (40%) of all questions was considered suitable to be answered by a search in a medical database. Many questions on medical topics were too general in nature, reflecting a need for background information, or were not clearly formulated (n = 110). More questions were generated after a half-day period with individual workers' consultations or medical examinations (10.5) than after a half-day period with one or two meetings with company management or colleagues (7.0). The majority of suitable questions were dealing with issues of prognosis and susceptibility. The importance attributed to a question positively influenced the intention to search for an answer.

The results presented extend our knowledge on information demands and needs in occupational health care and stimulate discussion on possibilities of, and limits to, an evidence-based approach. By including latent questions in our study, we were able to broaden the scope of OP-information needs of which they are mostly unaware. After prompting the OP, many questions were voiced, demonstrating what OPs actually need to know in order to enhance the quality of their daily practice.

We chose a selected sample of 20 experienced OPs. Studying this sample can demonstrate particular opportunities for developing best practice in terms of making use of EBM strategies. However, the external validity of this study towards all present OPs in the Netherlands (n = 1913) and other countries is limited and might be biased in a positive direction. The presence of an outside observer may also have affected the OPs' questioning behaviour to some extent. Although it was made clear that there would be no ruling of any kind, we know that presence alone of observers can have an effect on behaviour under investigation (Hawthorne effect) [11,18,19].

The inclusion criteria for questions suitable for a literature search complied with the instructions by Sackett et al. [16] about formulating answerable questions. We considered background questions as being not suitable for this approach. However, some background questions can be answered by a search in a medical database. For example, narrative reviews can give an excellent overview on a specific medical topic and might provide an adequate answer to a background question. Therefore, the calculated proportion of suitable versus ‘not-suitable’ is a rather conservative approach.

The distribution of tasks performed by the OP was comparable with the tasks of OPs in general in the Netherlands [20]. This confirms our expectation that OPs in the Netherlands are more involved in sickness absence management than in activities related to prevention of (work-related) disorders. We expect a different distribution of tasks in other countries and realize that the results of this study would have been different if we had chosen to observe the OPs during more preventive activities.

Many questions were considered not suitable for a search in medical databases, reflecting a substantial need for background information and difficulties in formulating a complete question. We recognize four reasons for this need. Firstly, this finding is comparable to the questioning and answering behaviour of family doctors [21]. OPs, like family doctors, are general practioners and therefore they need to know the essentials of a broad range of topics. Secondly, due to the tasks of OPs and the focus on sickness absence management, there might be a limited need for OPs to have up-to-date medical knowledge, and a lesser level of knowledge on certain medical topics is then sufficient. This also explains the emphasis on prognosis questions and, in a broader sense, rehabilitation to work since this is the main focus of advice given by these OPs. Thirdly, the main focus of the commercial interests of managers of OHS might not be the improvement of professional medical quality. Finally, the OPs have no long-standing tradition, as is the case in many clinical settings, to discuss the medical content of their work on a regular basis with colleagues. If OPs were to have regular meetings in which their patients are discussed in a more structured way, as promoted by Sackett et al. [16], they would probably feel more need to expand their knowledge about a relevant topic.

These reasons may also explain why many questions asked were not considered ‘important’ enough to search for an answer. The lack of necessity was illustrated with the typical response that ‘There is no need, the patient will soon return to work’. Other barriers to searching for answers were ‘lack of time’ or ‘not knowing where to look’. This confirms that a lack of awareness of the potential contribution or value in the decision-making processes of research-based information sources could be a reason for not generating questions about research-based information [22]. We have indicated before that the existence of a good knowledge infrastructure would be helpful in stimulating OPs to retrieve information from scientific resources using the Internet [4].

The information demands and needs of OPs in daily practice are for a substantial part (40%) directly suitable to be answered using evidence-based strategies. The large number of latent questions confirms our belief that there is potential to use research-based information sources more often. Both the information demands and needs of OPs focused on medical or related topics, which can be answered directly using these sources [23–25]. However, further development of evidence-based practice will meet some serious barriers. An important reason being that present role and tasks of the OP in the Netherlands do not really stimulate the use of evidence-based information. We conclude that there is a need for more education on available information sources and on how to pose an answerable question. The knowledge infrastructure and ICT facilities should be improved in order to offer adequate support to professionals. Furthermore, we recommend that OPs organize regular meetings with colleagues to discuss occupational health topics in a structured way in order to stimulate a more fruitful and challenging questioning behaviour.
Key points
  • OPs ask about one question per working day of which a substantial part can be answered using the strategies of EBM.
  • OPs should be stimulated by their management and colleagues to enhance their decision-making quality.
  • Knowledge, infrastructure and ICT facilities should be improved in order to offer adequate support to occupational physicians.

 


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
References
 
None declared.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Conflicts of interest
 References
 

  1. Carter T. The application of the methods of evidence-based practice to occupational health. Occup Med (Lond) 2000;50:231–236.

  2. Franco G. The future of occupational health practice: reconciling customer expectation and evidence-based practice. Occup Med (Lond) 2001;51:482–484.

  3. Leckie GJ, Pettigrew KE, Sylvain C. Modeling the information seeking of professionals: a general model derived from research on engineers, health care professionals, and lawyers. Libr Q 1996;66:161–193.

  4. Schaafsma FG, Hulshof CTJ, Dijk van FJH, Verbeek JHAM. Information demands of occupational health physicians and their attitude towards evidence-based medicine. Scand J Work Environ Health 2004;30:327–330.[Medline]

  5. Barrie AR, Ward AM. Questioning behaviour in general practice: a pragmatic study. Br Med J 1997;315:1512–1515.[Abstract/Free Full Text]

  6. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med 1985;103:596–599.[ISI][Medline]

  7. Ely JW, Osheroff JA, Ebell MH et al. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. Br Med J 2002;324:710.[Abstract/Free Full Text]

  8. Smith R. What clinical information do doctors need? Br Med J 1996;313:1062–1068.[Free Full Text]

  9. Verhoeven AA, Boerma EJ, Meyboom-de Jong B. Use of information sources by family physicians: a literature survey. Bull Med Libr Assoc 1995;83:85–90.[ISI][Medline]

  10. Weggeman M. Management of Knowledge/Organisation and Control of Intensive Knowledge Organisations (Kennismanagement/Inrichting en besturing van kennisintensieve organisaties). Schiedam: Scriptum, 2001.

  11. Forsythe DE, Buchanan BG, Osheroff JA, Miller RA. Expanding the concept of medical information: an observational study of physicians' information needs. Comput Biomed Res 1992;25:181–200.[CrossRef][ISI][Medline]

  12. Osheroff JA, Forsythe DE, Buchanan BG, Bankowitz RA, Blumenfeld BH, Miller RA. Physicians' information needs: analysis of questions posed during clinical teaching. Ann Intern Med 1991;114:576–581.[ISI][Medline]

  13. Covell DG, Uman GC, Manning PR. Information needs in office practice: are they being met? Ann Intern Med 1985;103:596–599.[ISI][Medline]

  14. Gorman PN, Ash J, Wykoff L. Can primary care physicians' questions be answered using the medical journal literature? Bull Med Libr Assoc 1994;82:140–146.[ISI][Medline]

  15. Timpka T, Arborelius E. The GP's dilemmas: a study of knowledge need and use during health care consultations. Methods Inf Med 1990;29:23–29.[ISI][Medline]

  16. Sackett DL, Strauss SE, Richardson WS, Rosenberg W, Haynes RB. Evidence-based Medicine/How to Practice and Teach EBM. Edinburgh: Churchill Livingstone, 2004.

  17. Hoedeman R, Nauta AP, Bosbaan A. The transparent consultation (Het transparante spreekuur). Tijdschr Bedrijfsen Verzekeringsgeneeskd 2003;11:238–242.

  18. Franke RH, Kaul JD. The Hawthorne experiments: first statistical interpretation. Am Sociol Rev 1978;43:623–643.[CrossRef]

  19. Swinglehurst DA, Pierce M. Questioning in general practice—a tool for change. Br J Gen Pract 2000;50:747–750.[ISI][Medline]

  20. Smits PBA, Kroon PJ, Verbeek JHAM. Time spent by occupational health physicians (Tijdbesteding van bedrijfsartsen). Tijdschr Bedrijfsen Verzekeringsgeneeskd 1996;4:9–13.

  21. Ely JW, Osheroff JA, Ebell MH et al. Obstacles to answering doctors' questions about patient care with evidence: qualitative study. Br Med J 2002;324:710.[Abstract/Free Full Text]

  22. Forsetlund L, Bjorndal A. The potential for research-based information in public health: identifying unrecognised information needs. BMC Public Health 2001;1:1.[Medline]

  23. Verbeek JHAM, van Dijk FJ, Malmivaara A et al. Evidence-based medicine for occupational health. Scand J Work Environ Health 2002;28:197–204.[Medline]

  24. Monduzzi G, Franco G. Practising evidence-based occupational health in individual workers: how to deal with a latex allergy problem in a health care setting. Occup Med (Lond) 2005;55:3–6.

  25. Grandi P, Franco G. Practising evidence-based occupational health in workers' groups: how to prevent sickness absence caused by influenza. Occup Med (Lond) 2005;55:7–9.


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