Self-Rated Health among Older Adults: Longitudinal Analyses Examining Sex Differences across Different Birth Cohorts and Educational Levels.

INTRODUCTION: Given the known female disadvantage in physical and mental health, this study aimed to investigate sex differences in self-rated health (SRH) among older adults, considering the longitudinal course by age, birth cohort, and educational level. METHODS: Data from birth cohort 1911-1937 with baseline age 55-81 years (n = 3,107) and birth cohort 1938-1947 with baseline age 55-65 years (n = 1,002) from the Longitudinal Aging Study Amsterdam (LASA) were used. Mixed model analyses were used to examine sex differences in SRH (RAND General Health Perception Questionnaire [RAND-GHPQ], range 0-16) over the age course, testing for effect modification by the birth cohort and educational level (low, middle, high). RESULTS: For both sexes, a decline in SRH was seen with increasing age. Over the age course, there was no significant sex difference in SRH within the older (1911-1937) birth cohort (0.13 lower score on SRH for women compared to men, 95% CI: -0.35 to 0.09) and only a small sex difference in the more recent (1938-1947) birth cohort (0.35 lower score on SRH for women compared to men [95% CI: -0.69 to -0.02], p = 0.04). There was no significant cohort difference in the size of the sex difference (p = 0.279). Those with a higher level of education reported a higher SRH, but between educational levels, there was no significant difference in the size of the sex difference in SRH. DISCUSSION: In this study, no relevant sex difference in SRH over the age course was observed among older adults. Future research on SRH trajectories by sex during aging should take health-related, cognitive, psychosocial, and behavioral factors into account.

RESTART: a stepped-care approach to facilitate return to work for employees with psychological distress: design of a randomized controlled trial.

BACKGROUND: Common mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees' cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process. METHODS: RESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted. DISCUSSION: Early intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole. TRIAL REGISTRATION: ISRCTN: 90663076. Registered on 5 October 2023.

The longitudinal association between working from home and musculoskeletal pain during the COVID-19 pandemic.

OBJECTIVE: This study investigates the associations between working from home and the presence of MSP during the COVID-19 pandemic. Working from home often involves a lot of sedentary computer screen work and the home working environment might not be optimally equipped, which can lead to health problems, including musculoskeletal pain (MSP). METHODS: Longitudinal data from 16 questionnaire rounds of the Lifelines COVID-19 cohort during the first year of the COVID-19 pandemic (March 2020-February 2021) were used. In total, 40,702 Dutch workers were included. In every round, participants reported whether they worked on location, from home, or hybrid. Logistic Generalized Estimating Equations were used to study the association of work situation with the presence of MSP and the presence of severe MSP. RESULTS: Working from home was associated with higher risks of having MSP in the lower back (OR: 1.05, 95% CI 1.02-1.08), in the upper back (OR: 1.24, 95% CI 1.18-1.31), and in the neck, shoulder(s) and/or arm(s) (OR: 1.18, 95% CI 1.13-1.22). Hybrid working was associated with higher risks of having pain in the upper back (OR: 1.09, 95% CI 1.02-1.17) and in the neck, shoulder(s) and/or arm(s) (OR: 1.14, 95% CI 1.09-1.20). Both home and hybrid workers had higher risks of severe MSP in the different body areas. CONCLUSION: Home workers, and to a smaller extent hybrid workers, had higher risks of having MSP than location workers during the first year of the COVID-19 pandemic. The results indicate the importance of measures to prevent MSP in future policies involving working from home.

Barriers and facilitators for participation in workplace health promotion programs: results from peer-to-peer interviews among employees.

OBJECTIVE: Workplace health promotion programs (WHPPs) have shown to be effective in improving lifestyle behaviors of employees. Despite potential benefits for employees, participation rates are generally low. The aim of this study was to gain deeper insight into barriers and facilitators for participation in WHPPs prior to implementation according to employees. METHODS: Peer-to-peer interviewing, a method derived from citizen science, was used to actively involve employees in the data collection. Employees working in the cleaning-, ICT- and facility-sector were trained to interview their co-workers. Interviews were recorded and transcribed verbatim. Thematic analysis was performed using the Consolidated Framework for Implementation Research (CFIR), complemented with the constructs 'interpersonal factors' and 'intrapersonal factors' from the social ecological model. Data were coded deductively and inductively, and rated by two researchers independently. RESULTS: Fourteen peer-interviewers conducted 62 peer-to-peer interviews. Main barriers for participation in WHPPs were an unsupportive organizational culture where lifestyle is not a common topic and programs that are not tailored to their needs. Support from peers and supervisors were facilitators. The availability of organizational resources, such as facilities and financial compensation, support participation. CONCLUSIONS: To enhance participation of employees in WHPPs it is recommended to take into account the barriers and facilitators identified in this study. For instance, employees should be involved in the development and implementation of WHPPS by the employer and their needs and available resources should be taken into account. This may lead to more successful implementation and higher participation rates in future WHPPs.

Sex Differences in Cognitive Functioning with Aging in the Netherlands.

INTRODUCTION: Dementia prevalence in older women is higher than that in men. The purpose of the present study was to investigate whether there is a female disadvantage in cognitive functioning at adult age and/or whether a female disadvantage develops with age. METHODS: Data of 5,135 women and 4,756 men from the Longitudinal Aging Study Amsterdam (LASA) and the Doetinchem Cohort Study (DCS) were used. In the LASA, memory, processing speed, fluid intelligence, and global cognitive function were measured every 3-4 years since 1992 in persons aged 55+ years for up to 23 years. In the DCS, memory, processing speed, cognitive flexibility, and global cognitive function were measured every 5 years since 1995 in persons aged 45+ years for up to 20 years. Sex differences in cognitive aging were analyzed using linear mixed models and also examined by the 10-year birth cohort or level of education. RESULTS: Women had a better memory, processing speed, flexibility, and, in the DCS only, global cognitive function than men (p's < 0.01). However, women showed up to 10% faster decline in these cognitive domains, except for flexibility, where women showed 9% slower decline. In the LASA, women scored poorer on fluid intelligence (p < 0.01), but their decline was 10% slower than that in men. Female advantage was larger in later born cohorts; adjustment for the educational level increased the female advantage. CONCLUSION: Women have better memory and processing speed than men at middle age. This female advantage becomes smaller with aging and has increased in more recent birth cohorts.

Exploring the difference between men and women in physical functioning: How do sociodemographic, lifestyle- and health-related determinants contribute?

BACKGROUND: To explore whether differences between men and women in the sensitivity to (strength of the association) and/or in the exposure to determinants (prevalence) contribute to the difference in physical functioning, with women reporting more limitations. METHODS: Data of the Doetinchem Cohort Study was used (n = 5856, initial ages 26-70 years), with follow-up measurements every 5 years (up to 20). Physical functioning (subscale SF-36, range:0-100), sex (men or women) and a number of socio-demographic, lifestyle- and health-related determinants were assessed. Mixed-model multivariable analysis was used to investigate differences between men and women in sensitivity (interaction term with sex) and in exposure (change of the sex difference when adjusting) to determinants of physical functioning. RESULTS: The physical functioning score among women was 6.55 (95%CI:5.48,7.61) points lower than among men. In general, men and women had similar determinants, but pain was more strongly associated with physical functioning (higher sensitivity), and also more prevalent among women (higher exposure). The higher exposure to low educational level and not having a paid job also contributed to the lower physical functioning score among women. In contrast, current smoking, mental health problems and a low educational level were more strongly associated with a lower physical functioning score among men and lower physical activity and higher BMI were more prevalent among men. CONCLUSIONS: Although important for physical functioning among both men and women, our findings provide no indications for reducing the difference in physical functioning by promoting a healthy lifestyle but stress the importance of differences in pain, work and education.

A study protocol of the adaptation and evaluation by means of a cluster-RCT of an integrated workplace health promotion program based on a European good practice.

BACKGROUND: An integrated workplace health promotion program (WHPP) which targets multiple lifestyle factors at different levels (individual and organizational) is potentially more effective than a single component WHPP. The aim of this study is to describe the protocol of a study to tailor a European good practice of such an integral approach to the Dutch context and to evaluate its effectiveness and implementation. METHODS: This study consists of two components. First, the five steps of the Map of Adaptation Process (MAP) will be followed to tailor the Lombardy WHP to the Dutch context. Both the employers and employees will be actively involved in this process. Second, the effectiveness of the integrated Dutch WHPP will be evaluated in a clustered randomized controlled trial (C-RCT) with measurements at baseline, 6 months and 12 months. Clusters will be composed based on working locations or units - dependent on the organization's structure and randomization within each organization takes place after baseline measurements. Primary outcome will be a combined lifestyle score. Secondary outcomes will be the separate lifestyle behaviors targeted, stress, work-life balance, need for recovery, general health, and well-being. Simultaneously, a process evaluation will be conducted. The study population will consist of employees from multiple organizations in different industry sectors. Organizations in the intervention condition will receive the integrated Dutch WHPP during 12 months, consisting of an implementation plan and a catalogue with activities for multiple lifestyle themes on various domains: 1) screening and support; 2) information and education; 3) adjustments in the social, digital or physical environment; and 4) policy. DISCUSSION: The MAP approach provides an appropriate framework to systematically adapt an existing WHPP to the Dutch context, involving both employers and employees and retaining the core elements, i.e. the catalogue with evidence-based activities on multiple lifestyle themes and domains enabling an integrated approach. The following process and effect evaluation will contribute to further insight in the actual implementation and effectiveness of the integrated WHP approach. TRIAL REGISTRATION: NTR (trialregister.nl ), NL9526. Registered on 3 June 2021.

The sex difference in gait speed among older adults: how do sociodemographic, lifestyle, social and health determinants contribute?

BACKGROUND: This study explores whether a sex difference in sensitivity to (strength of the association) and/or in exposure to (prevalence) determinants of gait speed contributes to the observed lower gait speed among older women compared to men. METHODS: Data from the Longitudinal Aging Study Amsterdam (LASA) were used. In total 2407 men and women aged 55-81 years were included, with baseline measurements in 1992/2002 and follow-up measurements every 3-4 years for 15/25 years. Multivariable mixed model analysis was used to investigate sex differences in sensitivity (interaction term with sex) and in exposure to (change of the sex difference when adjusted) socio-demographic, lifestyle, social and health determinants of gait speed. RESULTS: Women had a 0.054 m/s (95 % CI: 0.076 - 0.033, adjusted for height and age) lower mean gait speed compared to men. In general, men and women had similar determinants of gait speed. However, higher BMI and lower physical activity were more strongly associated with lower gait speed in women compared to men (i.e. higher sensitivity). More often having a lower educational level, living alone and having more chronic diseases, pain and depressive symptoms among women compared to men also contributed to observed lower gait speed in women (i.e. higher exposure). In contrast, men more often being a smoker, having a lower physical activity and a smaller personal network size compared to women contributed to a lower gait speed among men (i.e. higher exposure). CONCLUSIONS: Both a higher sensitivity and higher exposure to determinants of gait speed among women compared to men contributes to the observed lower gait speed among older women. The identified (modifiable) contributing factors should be taken into account when developing prevention and/or treatment strategies aimed to enhance healthy physical aging. This might require a sex-specific approach in both research and clinical practice, which is currently often lacking.

The mediating role of unhealthy behavior in the relationship between shift work and perceived health.

BACKGROUND: Little is known about the relationship between shift work and perceived health, including potential underlying mechanisms such as unhealthy behaviors. The aim of this study was to investigate whether unhealthy behaviors mediate the relationship between shift work and perceived mental and physical health, taking into account potential differences by level of education. METHODS: Data from 1633 workers participating in the Doetinchem Cohort Study during 1995-2016 were used. Being engaged in shift work was determined at 1 year preceding the assessment of health behaviors. Mental and physical health were assessed after 5 years of follow-up by the 5-item Mental Health Inventory and the physical functioning scale of the 36-item Short Form Health Survey. Smoking, physical inactivity, alcohol consumption, and overweight were considered as potential mediators and education was treated as moderator. Moderated mediation analyses using generalized estimated equations were performed. RESULTS: Shift work was not statistically significantly related to either mental or physical health. Despite this, statistically significant mediation effects of smoking (Beta - 0.09; 95% Confidence Interval - 0.20 - -0.01, respectively B -0.09; 95%CI -0.21 - -0.01) and physical inactivity (B 0.11; 95%CI 0.03-0.23, respectively B 0.08; 95%CI 0.01-0.18) were found in the relationship between shift work and mental or physical health. Direct and indirect effects outweighed each other in the relationship between shift work and mental health, since the direction of these effects was opposite. The relationship between shift work, unhealthy behavior, and health was not different by educational level. CONCLUSION: Shift workers did not report lower mental or physical health than non-shift workers. Though mediation effects of unhealthy behavior were observed in the relationship between shift work and perceived health, these small effects had minor public health relevance.

Sex differences in mental health among older adults: investigating time trends and possible risk groups with regard to age, educational level and ethnicity.

OBJECTIVES: Older women report lower mental health compared to men, yet little is known about the nature of this sex difference. Therefore, this study investigates time trends and possible risk groups. METHOD: Data from the Doetinchem Cohort Study (DCS) and the Longitudinal Aging Study Amsterdam (LASA) were used. General mental health was assessed every 5 years, from 1995 to 1998 onwards (DCS, n = 1412, 20-year follow-up, baseline age 55-64 years). Depressive and anxiety symptoms were assessed for two birth cohorts, from 1992/1993 onwards (LASA cohort 1, n = 967, 24-year follow-up, age 55-65 years,) and 2002/2003 onwards (LASA cohort 2, n = 1002, 12-year follow-up, age 55-65 years) with follow-up measurements every 3-4 years. RESULTS: Mixed model analyses showed that older women had a worse general mental health (-6.95; -8.36 to 5.53; range 0-100, ∼10% lower), more depressive symptoms (2.09; 1.53-2.63; range 0-60, ∼30% more) and more anxiety symptoms (0.86; 0.54-1.18; range 0-11, ∼30% more) compared to men. These sex differences remained stable until the age of 75 years, where after they decreased due to an accelerated decline in mental health for men compared to women. Sex differences and their course by age were consistent over successive birth cohorts, educational levels and ethnic groups (Caucasian vs. Turkish/Moroccan). CONCLUSION: There is a consistent female disadvantage in mental health across different sociodemographic groups and over decennia (1992 vs. 2002) with no specific risk groups.

A four-domain approach of frailty explored in the Doetinchem Cohort Study.

BACKGROUND: Accumulation of problems in physical, psychological, cognitive, or social functioning is characteristic for frail individuals. Using a four-domain approach of frailty, this study explored how sociodemographic and lifestyle factors, life events and health are associated with frailty. METHODS: The study sample included 4019 men and women (aged 40-81 years) examined during the fifth round (2008-2012) of the Doetinchem Cohort Study. Four domains of frailty were considered: physical (≥4 of 8 criteria: unintentional weight loss, exhaustion, strength, perceived health, walking, balance, hearing and vision impairments), psychological (2 criteria: depressive symptoms, mental health), cognitive (<10th percentile on global cognitive functioning), and social frailty (≥2 of 3 criteria: loneliness, social support, social participation). Logistic regression was used to study the cross-sectional association of sociodemographic factors, lifestyle, life events and chronic diseases with frailty domains. RESULTS: About 17% of the population was frail on one or more domains. Overlap between the frailty domains was limited since 82% of the frail population was frail on one domain only. Low educated respondents were at higher risk of being psychologically and socially frail. Having multiple diseases was associated with a higher risk of being physically and psychologically frail. Being physically active was consistently associated with a lower risk of frailty on each of the four domains. Short or long sleep duration was associated with a higher risk of being physically, psychologically, and socially frail. CONCLUSIONS: Sociodemographic factors, lifestyle and multimorbidity contributed differently to the four frailty domains. It is important to consider multiple frailty domains since this helps to identify different groups of frail people, and as such to provide tailored care and support. Lifestyle factors including physical activity, smoking and sleep duration were associated with multiple domains of frailty.

Common trajectories of physical functioning in the Doetinchem Cohort Study.

PURPOSE: to describe common trajectories of physical functioning and their determinants among an adult cohort, followed over a period of 15 years. METHODS: the study sample consisted of 4,123 participants (initial ages 26-70 years) from the Doetinchem Cohort Study, who participated in three or four measurement cycles. Physical functioning was measured with the Dutch version of the SF-36. Using a group-based modelling strategy, trajectories of physical functioning were determined. Weighted multinomial logistic regression analyses were performed to identify socio-demographic, lifestyle and health characteristics that differentiate between the trajectories at baseline. RESULTS: five common physical functioning trajectories were distinguished, labelled as 'stable not limited' (27% of the population), 'stable slightly limited' (54%), 'slightly limited substantial deterioration' (7%), 'moderately limited gradual improvement' (9%) and 'stable severely limited' (3%). The characteristics that differentiate between the trajectories with limitations and the trajectory 'stable not limited' were being female, older, physically inactive, overweight or obese, having one or more chronic conditions, poor mental health and poor self-perceived health at baseline. Being younger, physically active, less obese, living with a partner and a good perceived health were characteristics of the trajectory 'moderately limited gradual improvement' compared with 'stable severely limited'. CONCLUSION: five common trajectories of physical functioning were distinguished in an adult cohort, with most individuals following a stable but slightly limited course of physical functioning. Some early risk indicators were found that in the future might be used to early identify those with limitations in physical functioning.

Workplace interventions to prevent work disability in workers on sick leave.

BACKGROUND: Work disability has serious consequences for individuals as well as society. It is possible to facilitate resumption of work by reducing barriers to return to work (RTW) and promoting collaboration with key stakeholders. This review was first published in 2009 and has now been updated to include studies published up to February 2015. OBJECTIVES: To determine the effectiveness of workplace interventions in preventing work disability among sick-listed workers, when compared to usual care or clinical interventions. SEARCH METHODS: We searched the Cochrane Work Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO databases on 2 February 2015. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of workplace interventions that aimed to improve RTW for disabled workers. We only included studies where RTW or conversely sickness absence was reported as a continuous outcome. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed risk of bias of the studies. We performed meta-analysis where possible, and we assessed the quality of evidence according to GRADE criteria. We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included 14 RCTs with 1897 workers. Eight studies included workers with musculoskeletal disorders, five workers with mental health problems, and one workers with cancer. We judged six studies to have low risk of bias for the outcome sickness absence.Workplace interventions significantly improved time until first RTW compared to usual care, moderate-quality evidence (hazard ratio (HR) 1.55, 95% confidence interval (CI) 1.20 to 2.01). Workplace interventions did not considerably reduce time to lasting RTW compared to usual care, very low-quality evidence (HR 1.07, 95% CI 0.72 to 1.57). The effect on cumulative duration of sickness absence showed a mean difference of -33.33 (95% CI -49.54 to -17.12), favouring the workplace intervention, high-quality evidence. One study assessed recurrences of sick leave, and favoured usual care, moderate-quality evidence (HR 0.42, 95% CI 0.21 to 0.82). Overall, the effectiveness of workplace interventions on work disability showed varying results.In subgroup analyses, we found that workplace interventions reduced time to first and lasting RTW among workers with musculoskeletal disorders more than usual care (HR 1.44, 95% CI 1.15 to 1.82 and HR 1.77, 95% CI 1.37 to 2.29, respectively; both moderate-quality evidence). In studies of workers with musculoskeletal disorders, pain also improved (standardised mean difference (SMD) -0.26, 95% CI -0.47 to -0.06), as well as functional status (SMD -0.33, 95% CI -0.58 to -0.08). In studies of workers with mental health problems, there was a significant improvement in time until first RTW (HR 2.64, 95% CI 1.41 to 4.95), but no considerable reduction in lasting RTW (HR 0.79, 95% CI 0.54 to 1.17). One study of workers with cancer did not find a considerable reduction in lasting RTW (HR 0.88, 95% CI 0.53 to 1.47).In another subgroup analysis, we did not find evidence that offering a workplace intervention in combination with a cognitive behavioural intervention (HR 1.93, 95% CI 1.27 to 2.93) is considerably more effective than offering a workplace intervention alone (HR 1.35, 95% CI 1.01 to 1.82, test for subgroup differences P = 0.17).Workplace interventions did not considerably reduce time until first RTW compared with a clinical intervention in workers with mental health problems in one study (HR 2.65, 95% CI 1.42 to 4.95, very low-quality evidence). AUTHORS' CONCLUSIONS: We found moderate-quality evidence that workplace interventions reduce time to first RTW, high-quality evidence that workplace interventions reduce cumulative duration of sickness absence, very low-quality evidence that workplace interventions reduce time to lasting RTW, and moderate-quality evidence that workplace interventions increase recurrences of sick leave. Overall, the effectiveness of workplace interventions on work disability showed varying results. Workplace interventions reduce time to RTW and improve pain and functional status in workers with musculoskeletal disorders. We found no evidence of a considerable effect of workplace interventions on time to RTW in workers with mental health problems or cancer.We found moderate-quality evidence to support workplace interventions for workers with musculoskeletal disorders. The quality of the evidence on the effectiveness of workplace interventions for workers with mental health problems and cancer is low, and results do not show an effect of workplace interventions for these workers. Future research should expand the range of health conditions evaluated with high-quality studies.

Generation shifts in smoking over 20 years in two Dutch population-based cohorts aged 20-100 years.

BACKGROUND: Younger and older generations may differ substantially in their lifetime smoking habits, which may result in generation-specific health challenges. We aimed to quantify generation shifts in smoking over a period of 25 years. METHODS: We used the Doetinchem Cohort Study (baseline 1987-1991; 7768 individuals; 20-60 years; follow-up 1993-2012) and the Longitudinal Aging Study Amsterdam (baseline 1992-1993; 3017 individuals; 55-85 years; follow-up 1995-2009). Generation shifts were studied between 10-year generations (age range: 20-100 years). Generation shifts were examined graphically and by using logistic random effect models for men and women. RESULTS: Among men, significant generation shifts in current smoking were found between two non-successive generations: for instance men in their 40s at baseline smoked much more than men in their 40s at follow-up (33.6% vs. 23.1%, p < 0.05). Among women, the most recently born generation showed a favourable significant generation shift in current smoking (-7.3%) and ever smoking (-10.1%). For all other generations, the prevalence of ever smoking among women was significantly higher in every more recently born generation, whereas no other generation shifts were observed for current smoking. The unfavourable generation shifts were mainly found among the lower educated. CONCLUSIONS: The future burden of disease due to smoking is expected to be reduced among men, but not yet among women. Educational differences in smoking-related health problems are expected to increase.

Multimorbidity of chronic diseases and health care utilization in general practice.

BACKGROUND: Multimorbidity is common among ageing populations and it affects the demand for health services. The objective of this study was to examine the relationship between multimorbidity (i.e. the number of diseases and specific combinations of diseases) and the use of general practice services in the Dutch population of 55 years and older. METHODS: Data on diagnosed chronic diseases, contacts (including face-to-face consultations, phone contacts, and home visits), drug prescription rates, and referral rates to specialised care were derived from the Netherlands Information Network of General Practice (LINH), limited to patients whose data were available from 2006 to 2008 (N=32,583). Multimorbidity was defined as having two or more out of 28 chronic diseases. Multilevel analyses adjusted for age, gender, and clustering of patients in general practices were used to assess the association between multimorbidity and service utilization in 2008. RESULTS: Patients diagnosed with multiple chronic diseases had on average 18.3 contacts (95% CI 16.8 19.9) per year. This was significantly higher than patients with one chronic disease (11.7 contacts (10.8 12.6)) or without any (6.1 contacts (5.6 6.6)). A higher number of chronic diseases was associated with more contacts, more prescriptions, and more referrals to specialized care. However, the number of contacts per disease decreased with an increasing number of diseases; patients with a single disease had between 9 to 17 contacts a year and patients with five or more diseases had 5 or 6 contacts per disease per year. Contact rates for specific combinations of diseases were lower than what would be expected on the basis of contact rates of the separate diseases. CONCLUSION: Multimorbidity is associated with increased health care utilization in general practice, yet the increase declines per additional disease. Still, with the expected rise in multimorbidity in the coming decades more extensive health resources are required.

The effect of an integrated workplace health promotion program on health behaviors targeted after 12 months: Results of a cluster randomized controlled trial.

INTRODUCTION: An integrated workplace health promotion program (WHPP) targeting multiple health behaviors by implementing activities at the individual and organizational level is potentially effective. The aim of this study was to evaluate the effect of implemented activities on targeted health behaviors. METHODS: Data from four organizations in a cluster randomized controlled trial, including 173 employees, were used. Linear multilevel analyses or generalized estimating equations were conducted to assess within- and between-condition differences for physical activity (PA) and nutrition. RESULTS: No between-condition differences were apparent for both health behaviors. Within the PA intervention condition, moderate PA increased and light PA decreased. Within the control condition the odds to consume more sugary drinks was lower. CONCLUSION: Implemented activities did not affect the targeted health behaviors, although moderate PA increased within the PA intervention condition. Small sample sizes and implementation of minimal, irregular activities may underly the absence of effect. Future research should address this.

Exploring Associations Between Device-Based Occupational Sedentary Behavior and Need for Recovery in White Collar Workers: A Compositional Data-Analysis.

Objectives: White collar workers spend an increasing amount of time in occupational sedentary behavior (OSB) and are thereby at risk for adverse health outcomes. Nevertheless, the association between OSB and the need for recovery (NFR), an important indicator of wellbeing, is unknown and therefore examined. Methods: Baseline data from a cluster randomized controlled trial was used. A subgroup of 89 white collar workers wore a triaxial accelerometer for 7 days. NFR was measured using the Questionnaire on the Experience and Evaluation of Work. Compositional data analysis was applied to determine the composition of different OSB bouts (short, medium and long) and occupational physical activity (OPA) (light, moderate and vigorous and standing). Linear regression analyses were performed to explore the associations between occupational compositions and NFR. Results: Relatively more time spent in long OSB bouts was associated with a lower NFR (ß: -11.30, 95% CI: -20.2 to -2.4). Short and medium OSB bouts and OPA were not associated with NFR. Conclusion: Associations between OSB bouts, OPA and NFR hinted at contrasting trends, suggesting the need to consider different bout lengths of OSB in future studies.

Anxiety among healthcare workers during the COVID-19 pandemic: a longitudinal study.

Background: During the COVID-19 pandemic, many healthcare workers faced extreme working conditions and were at higher risk of infection with the coronavirus. These circumstances may have led to mental health problems, such as anxiety, among healthcare workers. Most studies that examined anxiety among healthcare workers during the COVID-19 pandemic were cross-sectional and focused on the first months of the pandemic only. Therefore, this study aimed to investigate the longitudinal association between working in healthcare and anxiety during a long-term period (i.e., 18 months) of the COVID-19 pandemic. Methods: Data were used from online questionnaires of the Lifelines COVID-19 prospective cohort with 22 included time-points (March 2020-November 2021). In total, 2,750 healthcare workers and 9,335 non-healthcare workers were included. Anxiety was assessed with questions from the Mini-International Neuropsychiatric Interview, and an anxiety sum score (0-7) was calculated. Negative binomial generalized estimating equations (GEE), adjusted for demographic, work and health covariates, were used to examine the association between working in healthcare and anxiety. Results: Anxiety sum scores over time during the COVID-19 pandemic were similar for healthcare workers and non-healthcare workers. No differences between the anxiety sum scores of healthcare workers and non-healthcare workers were found [incidence rate ratio (IRR) = 0.97, 95% CI = 0.91-1.04]. Conclusion: This study did not find differences between healthcare workers and non-healthcare in perceived anxiety during the COVID-19 pandemic.

Mental health of healthcare workers during the first year of the COVID-19 pandemic in the Netherlands: a longitudinal study.

Purpose: In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this study is to examine to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic. Methods: We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 (N = 16,615; number of observations = 64,206). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses. Results: Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale, 95%-CI = 0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers. Conclusion: During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health.

A system science perspective on burn-out: development of an expert-based causal loop diagram.

Introduction: Burn-out leads to reduced worker well-being, long-term absenteeism, and high costs for employers and society. Determinants at different levels may affect burn-out in an interrelated and dynamic manner. The aim of the present study was to apply a broader systems perspective by exploring and visualizing the complex system of determinants at different levels (living conditions, working conditions, and societal developments) underlying the prevalence of burn-out in the Netherlands. Methods: During three group model building (GMB) sessions with in total eight experts on workers' mental health, a causal loop diagram (CLD) was developed and relevant feedback loops were identified. For the selection of determinants to be included in the CLD a recently published overview of determinants on burn-out at different levels was used. Experts could also add factors that were not listed in the overview. Results: The final CLD consists of 20 factors and depicts a central position of working conditions. Societal developments (e.g., access to mental health care, size of the working population, rougher social climate, etc.) were mostly located at the outside of the CLD and barely integrated in feedback loops. Several reinforcing feedback loops resulting in an increase of the prevalence of burn-out were identified in which the factors (very) high workload, imbalance between work and private life, and insufficient recovery time play an important role. Also, several balancing loops were found that visualize the crucial role of functional support from supervisors to prevent burn-out among workers. Discussion: Applying a broader systems perspective, including determinants at different levels, offers new insights into dynamic feedback loops that contribute to the prevalence of burn-out. Supervisors, amongst others, have a considerable impact on the system underlying the high prevalence of burn-out and may therefore contribute to its prevention. Even though societal developments were less integrated in feedback loops, they might be considered drivers of existing feedback loops. The results from this study confirm that determinants at various levels underly the prevalence of burn-out. To be able to address the diversity of determinants underlying a high prevalence of burn-out, a complex system approach can be helpful.