[The Employment Perspective in the Health Care Sector - Until What Age do Older Employees Want to, Can and Plan to Work?] / Die Erwerbsperspektive in Berufen des Gesundheitsdienstes ­ Wie lange wollen, können und planen ältere Erwerbstätige (zu) arbeiten?

OBJECTIVE: The aim of the study was to compare the employment perspective of older employees in different occupations in the health care sector. A distinction is made between three aspects of the employment perspective: until what age older employees want to, can and plan to work. METHODS: The data are based on the second (2014) and third (2018) wave of the representative lidA study, which surveyed employees born in 1959 and 1965, at intervals of 3 to 4 years since 2011. In descriptive cross-sectional and longitudinal analyses, five occupational groups of the health care sector were compared to further selected occupational groups (NSample=2.580). RESULTS: The occupational groups examined differed significantly in terms of their employment perspective. Employees in care professions stood out as, on average, they wanted to leave working life early, but most importantly, they could not work for as long as they had planned to. Longitudinal analyses indicated that the employment perspective shifted to higher age as the individuals approached the legal retirement age. CONCLUSIONS: Care professions are risk groups with regard to employment at higher working age and require special attention in health care organisations. The results also document substantial variability of employment perspective in individual employees over time. This finding has implications regarding opportunities for human resource management.

Leaving and staying with the employer-Changes in work, health, and work ability among older workers.

OBJECTIVE: The aim of this prospective study was to examine employer changes among older workers and to relate them to psychosocial work factors, health, and work ability. Four groups of employees as elaborated by Hom et al. (2012) were distinguished: Enthusiastic leavers (EL), reluctant leavers (RL), enthusiastic stayers (ES), and reluctant stayers (RS). METHODS: Repeated Measures ANOVA analyses were based on data from the second and third waves (2014, 2018) of the German lidA Cohort Study, a representative study of employees born in 1959 or 1965. RESULTS: The largest proportion of participants was ES (73.3%), 13.2% stayed with their employer although they would have preferred to leave (RS). 7.1% changed employer between 2014 and 2018 voluntarily (EL), 6.4% involuntarily (RL). Analyses confirmed that the four groups already differed in 2014 in terms of health, work ability, and psychosocial work factors and that these outcomes change in different characteristic patterns over time. Most outcomes improved substantially following the change among EL. RS already reported poor outcomes in 2014 and exhibited a further deterioration while staying at the undesired workplace. CONCLUSION: Our findings indicate that an employer change is followed by improvements of work, health, and work ability. We conclude that an inclusive labor market policy for older workers allowing for high job mobility may have the potential to contribute to considerable improvements of workers' individual working conditions, health, and work ability, thereby increasing the work participation. Also, the considerable group of RL requires increased political and scientific attention.

The moderating role of psychosocial working conditions on the long-term relationship between depressive symptoms and work ability among employees from the Baby Boom generation.

OBJECTIVE: Mental disorders have been identified as a leading cause for reduced work ability in industrialized countries. Identification of workplace factors that can increase the work ability of employees with depressive symptoms from the Baby Boom generation is, therefore, highly relevant. This study thus aims to investigate whether changes in psychosocial working conditions can moderate the negative association between depressive symptoms and work ability. METHODS: Two waves with a 3-year time lag of the German lidA cohort study with 3609 participants born in 1959 and 1965 (aged 46 and 52 years at first wave) were analyzed. Self-report data about depressive symptoms at baseline and changes of working conditions from baseline to follow-up were used to calculate main and interaction effects on perceived work ability at follow-up. These analyses were controlled for baseline work ability and working conditions. RESULTS: Depressive symptoms were predictive for an unfavorable course of work ability from baseline to follow-up (B = - 0.173, 95% CI = - 0.219 to - 0.128). However, no interaction effect between depressive symptoms and psychosocial working conditions was found. Instead, independent from the level of depressive symptoms, a decrease in quantitative demands (B = - 0.279, 95% CI = - 0.326 to - 0.232) and increases in leadership quality (B = 0.242, 95% CI = 0.192-0.292) and development opportunities (B = 0.177, 95% CI = 0.127-0.277) were related to a more favorable course of work ability. Only small effects were found for social support (B = 0.057, 95% CI = 0.008-0.106) and job control (B = 0.043, 95% CI = - 0.005-0.091). CONCLUSIONS: The results indicate that the lagged and negative effect of depressive symptoms on work ability was not moderated by changes in psychosocial working conditions. However, the promotion of favorable working conditions may contribute to a positive development of work ability among employees from the Baby Boom generation independently from the level of depressive symptoms.

The social and health implications of digital work intensification. Associations between exposure to information and communication technologies, health and work ability in different socio-economic strata.

PURPOSE: Older employees are often thought to be vulnerable to negative effects of information and communication technology (ICT). Our study aims to examine associations between work-related ICT exposure (i.e. ICT use or digital work intensification), physical health, mental health and work ability (WA). We examine whether these associations are modified by socio-economic position (SEP). METHODS: We analysed cross-sectional data from 3180 participants (born in 1959 and 1965) in wave 3 of the representative German lidA cohort study. We performed hierarchical multiple regression to assess the distinct associations of ICT use and digital work intensification with mental and physical health and WA. We stratified analyses by SEP and controlled for age, sex, and digital affinity. RESULTS: 92% of participants reported ICT use at work. Almost 20% reported high levels of digital work intensification, while a similar proportion did not experience digital work intensification. In bivariate analyses, ICT use by itself was not significantly associated with mental health or WA in the total sample or when stratified. Digital work intensification displayed negative associations with mental health and WA. In hierarchical multiple regressions, digital work intensification showed consistently negative associations with mental health and work ability of similar strength across SEP. CONCLUSION: Our results suggest that ICT use, per se, does not negatively impact older workers. Digital work intensification may be associated with worse mental health and work ability. Research on health and social implications of work-related ICT should differentiate patterns of ICT exposure and assess modifications by SEP to better gauge the ambiguous effects of ICT.

[Utilization of Medical Rehabilitation and Access Barriers for Persons with a Migrant Background - Results of the lidA Cohort Study]. / Inanspruchnahme medizinischer Rehabilitation und Zugangsbarrieren bei Personen mit Migrationshintergrund ­ Ergebnisse der lidA-Kohortenstudie.

INTRODUCTION: Rehabilitation services are considerably less used by persons with a migration background of working age in Germany than by persons without migration background. One reason could be access barriers. They can arise both from the structures of the health/rehabilitation system as well as from influences of the personal environment, e. g. financial burdens incurred through the use of rehabilitation or cultural expectations. In addition to the migration status, other factors such as country of origin, reasons for immigration, length of stay as well as the religious affiliation and social status could influence the utilization of medical rehabilitation. It was examined to what extent differences in utilisation are due to the migration background and to migration-independent personal barriers to access. METHODS: The lidA-study is a nationwide, representative prospective cohort study among employees with insurable employment born in 1959 and 1965 with a focus on work, age, health and employment. Data from the first (2011) and the second wave (2014) were combined for the analyses. In addition to bivariate analyses to describe the sample according to migration status, logistic regression analyses were carried out to estimate the odds ratios for the influence of migration background or nationality and other factors on the use of a medical rehabilitation measure. RESULTS: The chance of receiving medical rehabilitation is increased for migrants of the 1st generation (odds ratio (OR) 1.56, 95% confidence interval (CI): 1.09-2.25). If predominantly or exclusively no German is spoken at home, this could be associated with a comparatively much lower chance of utilisation (OR: 0.56, 95% CI: 0.28-1.15). Because only nationality is often available in routine data to determine the status of migration, another model only considers migrants and 2nd generation nationals and examines the influence of nationality on utilisation. A foreign nationality was not associated with a higher utilisation (OR: 1.07, 95% CI: 0.55-2.08). DISCUSSION: Results of previous studies on the use of medical rehabilitation for people with a migration background are inconsistent. This could be due to different examined population groups, different indications for rehabilitation, a temporal change in utilisation and the various study designs as well as data sources. We found a higher use of medical rehabilitation services by persons with a migrant background (1st generation) compared to non-migrant persons. One reason could be our more precise definition of the migration background compared to analyses of routine data. If predominantly or exclusively another language than German is spoken at home, the utilisation tends to be lower. The finding coincides with a lack of German language skills described as an access barrier in the literature.

Work profiles of older employees in Germany-results from the lidA-cohort study.

BACKGROUND: This study investigates whether a typology of work exposure can be established among older workers in Germany. Work exposure comprises physical work, working time quality, work intensity, skills & discretion, social environment, leadership, continued education, earnings and work prospects. METHODS: Latent profile analysis was conducted on a representative sample of the socially insured workforce in Germany born in 1959 or 1965 (N = 6277). Seven year-prospective associations between the typology and work-related outcomes (physical and mental health, work ability and work-privacy-conflict) were investigated to establish the distinctness of the profiles. RESULTS: Five profiles were identified: "Poor Quality" (19%), "Relaxed Manuals" (30%), "Strained non-Manuals" (16%), "Smooth Running" (33%) and "High Flying" (3%). These profiles exhibited diverging patterns of association with the selected outcomes, thus representing qualitatively distinct subgroups of older workers in Germany. CONCLUSIONS: We conclude that a typological approach may broaden the understanding of the ageing work force and the complex interplay of the overall work situation with outcomes of high individual and social relevance such as health, work ability and employment. The five work profiles identified in this study may constitute crucial clusters needed to reliably mirror today's over-all work exposure patterns in the older work force in Germany. They may allow for the comprehensible monitoring of quality of work and personal life among the older work force during their last working years and their transition to retirement in current times of extending working lives.

Utilisation of rehabilitation services for non-migrant and migrant groups of higher working age in Germany - results of the lidA cohort study.

BACKGROUND: An ageing and a shrinking labour force implies that the prevention of a premature exit from work due to poor health will become more relevant in the future. Medical rehabilitation is a health service that aims at active participation in working life. The provision of this service will be relevant for an increasing part of the ageing labour force, namely, employees with a migrant background and their different subgroups. Thus, this study examines whether first- and second-generation employees with migrant background differ from non-migrants in their utilisation of rehabilitation services and whether within the subsample of migrant employees, those persons with foreign nationality differ from those with German nationality. METHODS: Socially insured employees born in 1959 or 1965 were surveyed nationwide in 2011 as part of the lidA cohort study (n=6303). Survey data of the first study wave were used to identify the dependent variable of the utilisation of rehabilitation (in- and outpatient), the independent variable of migrant status and the covariates of sociodemographic, work- and non-work-related factors. Applying bivariate statistics with tests of independence and block-wise logistic regressions, differences between the groups were investigated. Additionally, average marginal effects were computed to directly compare the adjusted models. RESULTS: The study showed that first-generation migrants had a significantly lower likelihood of utilising outpatient rehabilitation than non-migrants (fully adj. OR 0.42, 95% CI 0.22-0.82) and that average marginal effects indicated higher differences in the full model than in the null model. No significant differences were found between the first- or second-generation migrants and non-migrants when comparing the utilisation of inpatient rehabilitation or any rehabilitation or when analysing German and foreign employees with migrant background (n=1148). CONCLUSIONS: Significant differences in the utilisation of outpatient rehabilitation between first-generation migrants and non-migrants were found, which could not be explained by sociodemographic, work- and non-work-related factors. Thus, further factors might play a role. The second-generation migrants resemble the non-migrants rather than their parent generation (first-generation migrants). This detailed investigation shows the heterogeneity in the utilisation of health services such as medical rehabilitation, which is why service sensitive to diversity should be considered.

[Vertical and horizontal social inequality and motivation for early retirement]. / Vertikale und horizontale soziale Ungleichheit und Motivation zum vorzeitigen Erwerbsausstieg.

BACKGROUND: Over the course of the demographic transition with an aging and shrinking work force, work participation of older employees becomes more and more important. Earlier investigations found social groups to be different in work-related and individual aspects, which were shown to be associated with motivation for early retirement. OBJECTIVE: The aim of the study was to investigate the differences between older employees from distinct social groups in the motivation and determinants for early retirement. MATERIAL AND METHODS: Within the framework of the prospective lidA cohort study ( www.lida-studie.de ) socially insured employees born in 1959 and 1965 were asked about work, health and work participation. Based on data from the 3961 participants who were employed at the time of both study waves (2011, 2014), associations between variables of horizontal (gender, migration background) and vertical (education) social inequality and motivation for early retirement were analyzed with multiple logistic regression and interaction analysis. RESULTS: There was an educational gradient regarding the motivation to retire in the expected direction. The wish to retire before the age of 65 years was less common in male than in female older employees. Employees with a lower level of education and with a first generation migration background wished to retire early significantly less frequently than those without a migration background. Besides the interaction between migration background and education there were no further significant moderating effects of work-related or non-work-related variables on the association of social variables and the wish to retire early. CONCLUSION: According to the results there are differences between social groups of older employees in the motivation to retire early. The reasons and the final realization still have to be investigated. As a result, consequences for companies and politics with respect to the preservation of the work force can arise.

The association of health and voluntary early retirement pension and the modifying effect of quality of supervision: Results from a Danish register-based follow-up study.

OBJECTIVES: The aims of this article are to (1) determine whether and to what extent general perceived health and quality of supervision predict voluntary early retirement pension (VERP) and (2) assess whether quality of supervision modifies the association between general perceived health and VERP. METHODS: Employees aged 49-64 years who participated in the Danish Work Environment Cohort Study in 2000 were selected. Their questionnaire data about health and work were linked to register data on social transfer payments, among others VERP, from 2001 to 2012 in the Danish Register for Evaluation of Marginalization ( N=1167). Cox proportional hazards analyses were performed to identify the prospective association of general perceived health and quality of supervision on VERP. Relative excess risks due to interaction (RERIs) were calculated to assess whether quality of supervision modified the association between health and VERP. RESULTS: Employees with poor health at baseline had an increased risk of VERP during follow-up (hazard ratio [HR]=1.23; 95% confidence interval [CI] 1.02-1.49). Quality of supervision at baseline was not associated to VERP during follow-up (HR=1.04; 95% CI 0.90-1.21). There was no statistically significant interaction of poor health and poor quality of supervision with regard to risk of VERP (RERI=-0.33; 95% CI -1.79 to 1.14). CONCLUSIONS: This study did not support the notion that quality of supervision buffers the association between poor health and VERP. Future research is needed to determine whether other aspects of supervision, for example supervisors' opportunities to effectuate workplace adjustments, may modify the association of poor health and VERP.

The satisfaction with the quality of dementia care and the health, burnout and work ability of nurses: a longitudinal analysis of 50 German nursing homes.

BACKGROUND: The increasing prevalence of residents with dementia in Nursing Homes (NH) leads to a demanding work with high physical and psychological workloads. This study focuses on NH nurses and their satisfaction with quality of care for residents with dementia (SQCD) and its impact on nurses' general health, burnout and work ability. METHOD: Two-wave (2007/2009) self-report questionnaire data of 305 nurses (RNs and nurses' aides) from 50 German NHs. RESULTS: 58.6% (2007) and 64.9% (2009) of the respondents reported satisfaction with the quality of care of the dementia residents. However, when dissatisfied, this was perceived as substantial work stressor and was adversely associated with nurses' individual resource outcomes. Those nurses who between 2007 and 2009 had become dissatisfied or were dissatisfied at both measurements showed the most adverse scorings for burnout, general health and work ability. DISCUSSION: The findings imply that in NHs, SQCD may be a relevant work factor with substantial impact on nurses' core resources.

Influence of work-related characteristics and work ability on changing employer or leaving the profession among nursing staff.

AIM: To investigate how work-related characteristics and work ability influence nursing staff decisions to change employer or leave the profession. BACKGROUND: Previous cross-sectional studies have indicated that decreased work ability and unfavourable work-related characteristics are important determinants for the intention to leave the profession among nursing staff. METHODS: A 1-year longitudinal study, using data from the European Nurses' Early Exit Study. The study population consisted of 9927 (66%) members of the eligible nursing staff of which 345 left their current employer. Work-related characteristics, work ability and employment status were assessed by questionnaires. RESULTS: Nursing staff with a low work ability were more likely to either change employer or leave the profession. Among nursing staff with a low work ability the risk of changing employer increased significantly with unfavourable work-related characteristics. However, among nursing staff with a good work ability the risk of changing employer barely changed with unfavourable work-related characteristics. CONCLUSION: The negative effects of decreased work ability on changing employer and leaving the profession are partly counterbalanced by favourable psychological and physical work-related characteristics. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should implement strategies that focus on promoting the work ability of nursing staff in combination with improving work-related characteristics in order to prevent unnecessary changes of employment.

[Satisfaction with the quality of care in nursing homes--the nurses' perspective]. / Zufriedenheit mit der Qualität der Pflege in stationären Altenpflegeeinrichtungen aus Sicht der Pflegenden.

BACKGROUND: In Germany, the number of residents in Nursing Homes (NH) has increased in recent years, residents become older, increasingly multimorbid and suffer more from dementia. In parallel demands concerning the quality of care in NH have increased. The vivid poltical and public debate about quality of care, however, widely disregards the perception of nurses. The aim of this study is to investigate the nurses' satisfaction with the quality of care in their NH and potential psychological consequences. METHODS: Secondary questionnaire data from 1489 nurses in 88 NH of the German 3Q-study (www.3q-studie.de) were used from the 2011 investigation. Questions regarding satisfaction enquire satsifaction in five nursing work domains. Descriptive analyses as well Chi2-tests were performed. RESULTS: The majority of nurses were satisfied in the subdomain "overall quality of care" and "physical care" (80% each). 67% were satisfied with "the quality of care for residents with dementia" and 64% with "end-of-life care". Only 56% of the nurses were satisfied with "mental care". If nurses were unsatisfied with the quality of care, this was mostly perceived as a psychological stressor. Subgroup analysis showed a pattern for four of the five domains: dissatisfied nurses were older, better qualified, worked more than 25 hours per week and worked in larger NH. No such pattern was found for "quality of care for residents with dementia". CONCLUSIONS: Nurses' satisfaction with the quality of care has shown to be a relevant work factor and potential stressor deserving more scientific and clinical attention. For NH it could constitute a core indicator for internal quality management as well as for human resource management. Research in work, health and economy in NH should also consider this factor.

Associations between precarious employment trajectories and mental health among older workers in Germany: Vertical and horizontal inequalities.

OBJECTIVE: The aim of the study was to investigate the longitudinal association between multi-dimensionally measured precarious employment (PE) trajectories and mental health among older employees in Germany. METHODS: Current data from the German lidA study was used, including panel cases, who participated in all four survey waves (2011, 2014, 2018, 2022). The study comprised 1636 subjects, aged 46 and 52 years at baseline. Group-based trajectory modelling was used to model PE trajectories based on a score combining multiple items from the dimensions employment insecurity and income inadequacy. The association between PE trajectories (2011-2022) and mental health (2022) was tested using weighted logistic regression. RESULTS: We identified a PE trajectory with upward movement that best described 13.6% of the study sample. Representation in this group was socially unequally distributed with noticeably larger shares of female, lower-educated and lower-skilled workers in PE. Women following this trajectory had increased odds [odds ratio (OR) 1.68-1.82] of reporting poor mental health in 2022 compared to their counterparts in constant non-PE. This was not the case for men (OR 0.37-0.51). CONCLUSIONS: Our findings highlight horizontal and vertical inequalities with respect to exposure to and consequences of PE. Future labor market reforms should improve protection of women, who will likely be disadvantaged by accumulating employment-related mental health risks over the course of their lives.

Effects of requested, forced and denied shift schedule change on work ability and health of nurses in Europe -results from the European NEXT-Study.

BACKGROUND: Previous cross-sectional findings from the European Nurses Early Exit Study (NEXT) show that nurses who were dissatisfied with their work schedule tended to consider leaving the nursing profession. Mediating factors in this decision process may be caused by self-perceived poor work ability and/or health. The aim of this paper is to investigate changes in work ability and general health among nurses in relation to requested, forced and denied change of shift schedule. METHODS: Longitudinal data from the NEXT Study was used. In total 11,102 nurses from Belgium, Germany, Finland, the Netherlands, Poland, Slovakia, France and Italy completed both the 'basic questionnaire' (t1) and the '12 month follow-up questionnaire' (t2). To examine the time-effect (repeated measures) and the group-effect of five defined groups of nurses on the Work Ability Index (WAI) and general health (SF36), an adjusted 2-way analysis of covariance (ANCOVA) was performed. RESULTS: The nurses who wanted to, but could not change their shifts during the 12 month follow-up had the lowest initial and follow-up scores for WAI (t1: 37.6, t2: 36.6, p <0.001), lowest general health (t1: 63.9, t2: 59.2, p <0.001) and showed the highest decrease in both outcomes. Shift pattern change in line with the nurses' wishes was associated with improved work ability and to a lesser comparatively low extent with increased decline in health scores. A forced change of shift against the nurses' will was significantly associated with a deteriorating work ability and health. CONCLUSIONS: The findings would suggest that nurses' desire to change their shift patterns may be an indicator for perceived low work ability and/or low health. The results also indicate that fulfilling nurses' wishes with respect to their shift work pattern may improve their personal resources such as work ability and - to somewhat lesser extent - health. Disregarding nurses' preferences, however, bears the risk for further resource deterioration. The findings imply that shift schedule organization may constitute a valuable preventive tool to promote nurses' work ability and - to lesser extent - their perceived health, not least in aging nursing work forces.

Psychosocial work environment and intention to leave the nursing profession: a cross-national prospective study of eight countries.

Many countries throughout the world are facing a serious nursing shortage, and retention of nurses also is a challenge. The aim of this study was to compare the predictive contribution of a broad spectrum of psychosocial work factors, including job strain, effort-reward imbalance, and alternative employment opportunity, to the probability of intention to leave the nursing profession. A total of 7,990 registered female nurses working in hospitals in eight countries (Germany, Italy, France, The Netherlands, Belgium, Poland, Slovakia, and China) were included in the one-year prospective study. A standardized questionnaire on job strain, effort-reward imbalance, employment opportunity, and intention to leave the nursing profession was used in the survey. Multilevel logistic regression modeling was used to analyze the data. Results showed that an imbalance between high effort and low reward (in particular, poor promotion prospects) and good employment opportunity at baseline were independently associated with a new intention to leave the nursing profession at follow-up. However, job strain appeared to have relatively less explanatory power. Findings suggest that interventions to improve the psychosocial work environment, especially the reciprocity experienced between effort and reward, may be effective in improving retention of nurses and tackling the international nursing shortage.

[Exposure to aggressive patient behaviour and its' association with the nurses' "work ability" in Germany]. / Konfrontation mit aggressiven Klienten-- Auswirkungen auf die Arbeitsfähigkeit von Pflegekräften in Deutschland.

BACKGROUND: Aggressive behavior and violence in patients, residents or clients are growing challenges in nursing. Aggressive behavior can have both, physical and psychological consequences for nurses and can lead to a reduced performance at work, demotivation, sickness absence and the premature exit from the nursing profession. To develop purposive strategies and to deal with aggressive behavior and health promotion programs, it is crucial to know more about the prevalence of aggressive behavior from patients and the effect on the work ability of nurses in different types of institutions. METHOD: Data of 1735 German nurses was derived from the European NEXT-Study. Description and analysis of variance for each working area (hospital ward, Intensive Care Unit, psychiatric ward, nursing home and home care) were conducted. The work ability was measured with the Work Ability Index (WAI). The aggressive behavior was measured by one item developed by the NEXT Study Group. Linear regression models were applied to analyze the effect of aggressive behavior on the work ability of nurses in a comparison of the five different working areas. RESULTS: A total of 84.9 percent of the nurses were "sometimes" or "often/always" confronted with aggressive behavior from patients. In the comparison of the five working areas, nurses were exposed to different levels of aggressive behavior, while differences in the work ability of nurses were also observed. It was found that aggressive behavior from patients was associated with reduced work ability in nurses working in hospital wards, nursing homes and home care, but not nurses working in ICUs and psychiatric wards. CONCLUSIONS: The findings indicate that many nurses in Germany are exposed to aggressive behavior from patients, which has negative effect on the nurses' work ability. However, it is assumed that strategies to deal with aggressive behavior could play a buffer role between aggressive behavior and work ability of nurses, highlighting one possibility of intervention in future.

The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study.

OBJECTIVES: The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data. METHODS: Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status. RESULTS: Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models. CONCLUSIONS: To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite.

Chronic disease outcome metadata from German observational studies - public availability and FAIR principles.

Metadata from epidemiological studies, including chronic disease outcome metadata (CDOM), are important to be findable to allow interpretability and reusability. We propose a comprehensive metadata schema and used it to assess public availability and findability of CDOM from German population-based observational studies participating in the consortium National Research Data Infrastructure for Personal Health Data (NFDI4Health). Additionally, principal investigators from the included studies completed a checklist evaluating consistency with FAIR principles (Findability, Accessibility, Interoperability, Reusability) within their studies. Overall, six of sixteen studies had complete publicly available CDOM. The most frequent CDOM source was scientific publications and the most frequently missing metadata were availability of codes of the International Classification of Diseases, Tenth Revision (ICD-10). Principal investigators' main perceived barriers for consistency with FAIR principles were limited human and financial resources. Our results reveal that CDOM from German population-based studies have incomplete availability and limited findability. There is a need to make CDOM publicly available in searchable platforms or metadata catalogues to improve their FAIRness, which requires human and financial resources.

Perceived work ability and turnover intentions: a prospective study among Belgian healthcare workers.

AIM: To report a study exploring prospective relations between nurses' perceived work ability and three forms of turnover intentions, respectively, intent to leave the ward, organization and profession. BACKGROUND: Turnover of nursing staff is a major challenge for healthcare settings and for healthcare in general, urging the need to improve retention. DESIGN: Survey. METHODS: Based on the longitudinal data of the Belgian sample from the European Nurses' Early Exit study, a total of 1531 healthcare workers who remained in their job, completed in 2003 and 1 year later a self-administered questionnaire including the Work Ability Index to assess work ability. Multiple logistic regression analysis was performed adjusting for possible confounding variables. RESULTS: In a population with low intent to leave at baseline prospective analyses showed that a poor work ability at baseline increased the risk of high intent to leave the ward and high intent to leave the organization, 1 year later. A substantial deterioration in work ability was a risk factor for developing high turnover intentions 1 year later. Social support had no effect on the relation between work ability and all three types of intent to leave but the relation between work ability and intent to leave the ward was borderline significantly moderated by good interpersonal relations. CONCLUSIONS: Poor work ability was a risk factor for developing turnover intentions. Maintaining good work ability and improving poor work ability becomes increasingly important to retain nurses.