High-speed AFM reveals the dynamics of single biomolecules at the nanometer scale.

Atomic force microscopy allows visualization of biomolecules with nanometer resolution under physiological conditions. Recent advances have improved the time resolution of the technique from minutes to tens of milliseconds, meaning that it is now possible to watch single biomolecules in action in real time. Here, we review this development.

Effectiveness of a dynamic seat cushion on recovery and recurrence of neck and low back pain in office workers: a secondary analysis of a randomized controlled trial.

BACKGROUND: Neck and low back pain are prevalent issues among office workers due to prolonged sitting, necessitating effective interventions. Dynamic seat cushion, designed to promote postural shifts, have emerged as promising solutions to address this concern. This study aims to evaluate the effectiveness of a dynamic seat cushion on recovery and recurrence of neck and/or low back pain in office workers. METHODS: This study used 6-month follow-up data of a randomized controlled trial, involving 66 office workers who reported neck and/or low back pain during the trial. At baseline, participants were cluster-randomized into an intervention group, which received a dynamic seat cushion designed to encourage postural shifts, or a control group, which received a placebo seat pad. Health outcomes included recovery duration and recurrence of pain. Analyses utilized log rank test and Cox proportional hazard models. RESULTS: The recovery rate from neck and/or low back pain was 100% for the intervention group, and 86% for the control group. The median recovery duration of participants who reported pain during the 6-month period was 1 month in the intervention group and 3 months in the control group. The intervention group had a higher probability of recovery compared to the control group (HRadj 4.35, 95% CI 1.87-10.11; p < 0.01). The recurrence rate of neck and low back pain was 27% in the intervention group, which was 75% in the control group. The Hazard Ratio, after adjustment, for the intervention group compared to the control group was 0.50 (95% CI = 0.11-2.12). CONCLUSIONS: A dynamic seat cushion that encourages postural shifts shortened recovery duration of neck and low back pain among office workers. Due to small numbers, a potentially relevant reduction in the recurrence of neck and low back pain could not be statistically confirmed. A power analysis was not conducted for this secondary analysis, and future studies should be designed with adequate sample sizes to explore the recurrence of pain with greater statistical power. TRIAL REGISTRATION: This trial is retrospectively registered under the Thai Clinical Trials Registry: TCTR20230623002 (23/06/2023).

Associations of occupational and leisure-time physical activity with all-cause mortality: an individual participant data meta-analysis.

OBJECTIVE: Health effects of different physical activity domains (ie, during leisure time, work and transport) are generally considered positive. Using Active Worker consortium data, we assessed independent associations of occupational and leisure-time physical activity (OPA and LTPA) with all-cause mortality. DESIGN: Two-stage individual participant data meta-analysis. DATA SOURCE: Published and unpublished cohort study data. ELIGIBILITY CRITERIA: Working participants aged 18-65 years. METHODS: After data harmonisation, we assessed associations of OPA and LTPA with all-cause mortality. In stage 1, we analysed data from each study separately using Cox survival regression, and in stage 2, we pooled individual study findings with random-effects modelling. RESULTS: In 22 studies with up to 590 497 participants from 11 countries, during a mean follow-up of 23.1 (SD: 6.8) years, 99 743 (16%) participants died. Adjusted for LTPA, body mass index, age, smoking and education level, summary (ie, stage 2) hazard ration (HRs) and 95% confidence interval (95% CI) for low, moderate and high OPA among men (n=2 96 134) were 1.01 (0.99 to 1.03), 1.05 (1.01 to 1.10) and 1.12 (1.03 to 1.23), respectively. For women (n=2 94 364), HRs (95% CI) were 0.98 (0.92 to 1.04), 0.96 (0.92 to 1.00) and 0.97 (0.86 to 1.10), respectively. In contrast, higher levels of LTPA were inversely associated with mortality for both genders. For example, for women HR for low, moderate and high compared with sedentary LTPA were 0.85 (0.81 to 0.89), 0.78 (0.74 to 0.81) and 0.75 (0.65 to 0.88), respectively. Effects were attenuated when adjusting for income (although data on income were available from only 9 and 6 studies, for men and women, respectively). CONCLUSION: Our findings indicate that OPA may not result in the same beneficial health effects as LTPA.

Psychosocial work factors affecting mental health of young workers: a systematic review.

OBJECTIVE: For the general working population, robust evidence exists for associations between psychosocial work exposures and mental health. As this relationship is less clear for young workers, this systematic review aims at providing an overview of the evidence concerning psychosocial work factors affecting mental health of young workers. METHODS: The electronic databases used were PubMed, Web of Science, and PsycINFO and were last searched in October 2021. The eligible outcomes included depression-, stress-, burnout- and anxiety-related complaints, and fatigue, excluding clinical diagnoses and suicide-related outcomes. Only studies with workers aged 35 years or younger were included, which reported at least one association between a psychosocial work factor as exposure and a mental health complaint as outcome. Studies had to be in English, German or Dutch. Risk of bias was assessed using an instrument from the National Heart, Lung, and Blood Institute. Data synthesis was conducted using GRADE. RESULTS: In total 17 studies were included in this systematic review, including data from 35,600 young workers in total. Across these studies 86 exposure-outcome associations were reported. Nine exposure-outcome associations could be synthesised. The application of the GRADE framework led to one "low" assessment for the association between psychosocial job quality and mental health. The certainty of evidence for the other eight associations in the synthesis was very low. CONCLUSIONS: The current systematic review disclosed a high degree of uncertainty of the evidence due to conceptually fuzzy outcomes and exposures as well as large heterogeneity between studies.

Effects of a comprehensive lifestyle intervention on cardiovascular health: the TANSNIP-PESA trial.

AIMS: To investigate the effectiveness of a 3-year worksite lifestyle intervention on cardiovascular metrics and to study whether outcomes are influenced by baseline subclinical atherosclerosis (SA) by non-invasive imaging. METHODS AND RESULTS: A randomized controlled trial was performed to compare a lifestyle intervention with standard of care in asymptomatic middle-aged subjects, stratified by SA. The intervention consisted of nine motivational interviews during the first year, followed by three further sessions between Years 1 and 3. The primary outcome was the change in a pre-specified adaptation of the Fuster-BEWAT score (Blood pressure, Exercise, Weight, Alimentation, and Tobacco) between baseline and follow-up Years 1-3. A total of 1020 participants (mean age 50 ± 4 years) were enrolled, of whom 510 were randomly assigned to the intervention and 510 to the control group. The baseline adapted Fuster-BEWAT score was 16.2 ± 3.7 points in the intervention group and 16.5 ± 3.5 points in the control group. At Year 1, the score improved significantly in intervention participants compared with controls [estimate 0.83 (95% CI 0.52-1.15) points]. However, intervention effectiveness decreased to non-significant levels at Year 3 [0.24 (95% CI -0.10 to 0.59) points]. Over the 3-year period, the intervention was effective in participants having low baseline SA [0.61 (95% CI 0.30-0.93) points] but not in those with high baseline SA [0.19 (95% CI -0.26 to 0.64) points]. CONCLUSION: In middle-aged asymptomatic adults, a lifestyle intervention was associated with a significant improvement in cardiovascular health and behavioural metrics. The effect attenuated after 1 year as the intensity of the intervention was reduced. TRIAL REGISTRATION: ClinicalTrials.gov (NCT02561065).

Filtering and Imaging of Frequency-Degenerate Spin Waves Using Nanopositioning of a Single-Spin Sensor.

Nitrogen-vacancy (NV) magnetometry is a new technique for imaging spin waves in magnetic materials. It detects spin waves by their microwave magnetic stray fields, which decay evanescently on the scale of the spin-wavelength. Here, we use nanoscale control of a single-NV sensor as a wavelength filter to characterize frequency-degenerate spin waves excited by a microstrip in a thin-film magnetic insulator. With the NV probe in contact with the magnet, we observe an incoherent mixture of thermal and microwave-driven spin waves. By retracting the tip, we progressively suppress the small-wavelength modes until a single coherent mode emerges from the mixture. In-contact scans at low drive power surprisingly show occupation of the entire isofrequency contour of the two-dimensional spin-wave dispersion despite our one-dimensional microstrip geometry. Our distance-tunable filter sheds light on the spin-wave band occupation under microwave excitation and opens opportunities for imaging magnon condensates and other coherent spin-wave modes.

Can the Borg CR-10 scale for neck and low back discomfort predict future neck and low back pain among high-risk office workers?

PURPOSE: Perceived discomfort could indicate an early sign of pain, for example, as a result of a biomechanical load on the musculoskeletal system. Assessing discomfort can, therefore, help to identify workers at increased risk of musculoskeletal disorders for targeted intervention development. We aimed: (1) to identify the optimal cut-off value of neck and low back discomfort among office workers and (2) to evaluate its predictive validity with future neck and low back pain, respectively. METHODS: At baseline healthy participants (n = 100) completed questionnaires, including the Borg CR-10 discomfort scale (on a 0-10 scale), and were followed for six months, during which musculoskeletal pain was assessed monthly. Logistic regression analyses were performed to assess the associations of baseline discomfort with the onset of future neck or low back pain. Sensitivity, specificity, and the area under the receiver operating characteristics curve were estimated to identify the optimal discomfort cut-off value predicting future pain. RESULTS: Borg CR-10 scores ≥ 3.5 for perceived neck and low back discomfort had acceptable sensitivity and specificity to predict future neck and low back pain, respectively. Perceived discomfort at baseline as a dichotomous measure (using the ≥ 3.5 cut-off) was a statistically significant predictor of future neck pain (OR = 10.33) and low back pain (OR = 11.81). CONCLUSION: We identified the optimal cut-off value of the Borg CR-10 discomfort scale to identify office workers at increased risk of developing neck and low back pain. These findings might benefit ergonomists, primary health care providers, and occupational health researchers in developing targeted interventions.

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 process evaluation of a citizen science approach to design and implement workplace health promotion programs.

BACKGROUND: Many workplace health promotion programs (WHPPs) do not reach blue-collar workers. To enhance the fit and reach, a Citizen Science (CS) approach was applied to co-create and implement WHPPs. This study aims to evaluate i) the process of this CS approach and ii) the resulting WHPPs. METHODS: The study was performed in two companies: a construction company and a container terminal company. Data were collected by questionnaires, interviews and logbooks. Using the framework of Nielsen and Randall, process measures were categorized in the intervention, context and mental models. Interviews were transcribed and thematically coded using MaxQDA software. RESULTS: The involvement in the CS approach and co-creating the WHPPs was positively experienced. Information provision, sustained engagement over time and alignment with the workplace's culture resulted in barriers in the CS process. As to the resulting WHPPs, involvement and interaction during the intervention sessions were particularly experienced in small groups. The reach was affected by the unfavorable planning off the WHPPs and external events of re-originations and the covid-19 pandemic. DISCUSSION: Continuous information provision and engagement over time, better alignment with the workplace's culture and favorable planning are considered to be important factors for facilitating involvement, reach and satisfaction of the workers in a Citizen science approach to design and implement a WHPP. Further studies continuously monitoring the process of WHPPs using the CS approach could be helpful to anticipate on external factors and increase the adaptability. CONCLUSIONS: Workers were satisfied with the involvement in WHPPs. Organizational and social cultural factors were barriers for the CS approach and its reach. Involvement and interaction in WHPPs were particularly experienced in small grouped sessions. Consequently, contextual and personal factors need be considered in the design and implementation of WHPPs with CS approach among blue-collar workers.

Barriers and facilitators influencing the implementation of the occupational health intervention 'Dynamic Work': a qualitative study.

BACKGROUND: Sedentary behavior is associated with an increased risk of morbidity and mortality. To reduce occupational sitting time of office workers, the multi-component intervention 'Dynamic Work' was implemented in a Dutch insurance company. Although the results showed no significant reductions in sitting time, associations were found between higher levels of implementation and reductions in sitting time. Building upon these findings, this qualitative study aimed to identify barriers and facilitators from an organizational perspective for the implementation of Dynamic Work. In addition, we explored differences in barriers and facilitators between departments with a low, middle and high level of implementation. METHODS: In total, eighteen semi-structured interviews were conducted with two Dynamic Work coordinators, three occupational physiotherapists who delivered the intervention, and thirteen department managers. All participants were purposively sampled. The data was coded in Atlas.ti and a thematic analysis was performed guided by The Integrated Checklist of Determinants (TICD). RESULTS: Implementation factors were related to the organization; working culture and financial support facilitated implementation. Factors related to the implementing department mainly hindered implementation, i.e. lack of information at start of the project, late delivery of Dynamic Work equipment, large group sizes, employee's workload and work tasks, and an ongoing reorganization. The facilitating role of managers was experienced as both enabling and hindering. The pre-existing familiarity of the occupational physiotherapists with the departments and alignment amongst the three implementers facilitated implementation. Yet, the non-obligatory nature of the intervention as well as limited availability and technical problems of equipment did not support implementation. CONCLUSIONS: Various barriers and facilitators influenced the implementation of the Dynamic Work intervention, where the key role of the department manager, late delivery of dynamic work equipment and groups sizes varied between low and high implementing departments. These results can contribute to developing and improving implementation strategies in order to increase the effectiveness of future occupational health interventions. TRIAL REGISTRATION: The study protocol was registered on April 14, 2017 in the ClinicalTrials.gov Protocol Registration and Results System under registration number NCT03115645 .

Caregiver's burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers.

BACKGROUND: Growing numbers of people with advanced illnesses who wish to die at home, a concurrent decline in the accessibility of professional home care, and policies aiming at prolonging work participation are increasing the reliance on family caregivers. This study aimed to describe trajectories in burden of working family caregivers who care for patients with a life-threatening illness, and identify factors in work and care that are related to changes in burden over time. METHODS: Semi-structured interviews were held in one to four rounds between July 2018 and November 2020 with 17 working family caregivers of patients with a life-threatening illness living at home. Transcripts were analysed as a single unit to create timelines per participant. Next, individual burden trajectories were created and grouped based on the course of burden over time. Factors related to changes in burden were analysed, as well as similarities and differences between the groups. RESULTS: It was common for family caregivers who combine work and end-of-life care to experience a burden. Two trajectories of caregiver burden were identified; caregivers with a persistent level of burden and caregivers with an increasing burden over time. Family caregivers with a persistent level of burden seemed to be at risk for burnout throughout the illness trajectory, but were often able to cope with the situation by making arrangements in care or work. Caregivers with an increasing burden were unable to make sufficient adjustments, which often resulted in burnout symptoms and sick leave. In both groups, burden was mostly related to aspects of the care situation. The emotional burden, a decreasing burden after death and a different view on the trajectory in hindsight proved to be important overarching themes. CONCLUSIONS: Providing care to a loved one nearing the end of life is often emotionally burdensome and intensive. To facilitate the combination of paid work and family care, and reduce the risk of burnout, more support is needed from employers and healthcare professionals during the illness trajectory and after death. Bereaved family caregivers also warrant more attention from their supervisors and occupational physicians in order to facilitate their return to work.

Directional Excitation of a High-Density Magnon Gas Using Coherently Driven Spin Waves.

Controlling magnon densities in magnetic materials enables driving spin transport in magnonic devices. We demonstrate the creation of large, out-of-equilibrium magnon densities in a thin-film magnetic insulator via microwave excitation of coherent spin waves and subsequent multimagnon scattering. We image both the coherent spin waves and the resulting incoherent magnon gas using scanning-probe magnetometry based on electron spins in diamond. We find that the gas extends unidirectionally over hundreds of micrometers from the excitation stripline. Surprisingly, the gas density far exceeds that expected for a boson system following a Bose-Einstein distribution with a maximum value of the chemical potential. We characterize the momentum distribution of the gas by measuring the nanoscale spatial decay of the magnetic stray fields. Our results show that driving coherent spin waves leads to a strong out-of-equilibrium occupation of the spin-wave band, opening new possibilities for controlling spin transport and magnetic dynamics in target directions.

Cancer survivors' experiences with conversations about work-related issues in the hospital setting.

OBJECTIVE: Early access to work-related psychosocial cancer care can contribute to return to work of cancer survivors. We aimed to explore: (a) the extent to which hospital healthcare professionals conduct conversations about work-related issues with cancer survivors, (b) whether cancer survivors experience these conversations as helpful, and (c) the possible financial implications for cancer survivors of (not) discussing their work early on. METHODS: The Dutch Federation of Cancer Patient Organizations developed and conducted a cross-sectional online survey, consisting of 27 items, among cancer survivors in the Netherlands. RESULTS: In total, 3500 survivors participated in this study (71% female; mean age (SD) 56 (11) years). Thirty-two percent reported to have had a conversation about work-related issues with a healthcare professional in the hospital. Fifty-four percent indicated that this conversation had been helpful to them. Conversations about work-related issues took place more frequently with male cancer survivors, those aged 55 years or below, those diagnosed with gynecological, prostate, breast, and hematological or lymphatic cancer, those diagnosed ≤2 years ago, or those who received their last treatment ≤2 years ago. There was no statistically significant association between the occurrence of conversations about work-related issues and experiencing the financial consequences of cancer and/or its treatment as burdensome. CONCLUSIONS: Although conversations about work-related issues are generally experienced as helpful by cancer survivors, early access to work-related psychosocial cancer care in the hospital setting is not yet systematically offered.

Work-related physical and psychosocial risk factors cluster with obesity, smoking and physical inactivity.

OBJECTIVE: This study investigated associations between the co-existence of multiple types of work-related psychosocial and physical risk factors, and (1) obesity; (2) smoking; and (3) leisure-time physical inactivity. It also aimed to identify sociodemographic characteristics related to clustering of work-related risk factors and lifestyle factors. METHODS: Cross-sectional data on work-related risk factors (e.g., decision authority and repetitive movements) and lifestyle was measured using a standardized questionnaire among 52,563 Dutch workers in health care, services, manufacturing and public sector. Multiple-adjusted logistic regression models assessed associations between the co-existence of multiple types of psychosocial and physical risk factors and lifestyle factors. Additionally, logistic regression models related age, gender and educational level to clustering of risk factors and lifestyle factors. RESULTS: The co-existence of multiple types of work-related psychosocial risk factors was associated with higher odds of smoking and being physically inactive. For example, workers exposed to three psychosocial risk factors had a 1.55 times higher odds of being physically inactive (95%CI: 1.42-1.70) compared to unexposed workers. A higher number of physical risk factors was also significantly associated with higher odds of smoking and obesity. The co-existence of multiple types of physical risk factors was not associated with higher odds of physical inactivity. Clustering of work-related risk factors and at least one unhealthy lifestyle factor occurred in particular among workers with low educational level. CONCLUSIONS: Results imply that interventions are needed that focus on workers with a low educational level and address work-related physical and psychosocial risk factors as well as lifestyle.

Supporting participation in paid work of cancer survivors and their partners in the Netherlands: protocol of the SusTained Employability in cancer Patients and their partnerS (STEPS) multi-centre randomized controlled trial and cohort study.

BACKGROUND: Many cancer survivors experience physical and/or psychosocial problems affecting return to work (RTW) and work retention. Current interventions on RTW lack evidence regarding effectiveness, while interventions for work retention are missing. Partners of cancer survivors may also experience work- and health-related outcomes; yet, these consequences are not well understood. Here, the protocol of the STEPS study is described. The study aims are to: 1) evaluate the (cost-)effectiveness of a rehabilitation program for RTW and work retention in cancer survivors, and 2) assess health- and work-related outcomes among cancer survivors' partners. METHODS: In a multicentre Randomized Controlled Trial (RCT), 236 working-age cancer survivors with an employment contract will be randomly allocated to a usual care group or an intervention group receiving a multidisciplinary rehabilitation program, combining occupational therapy facilitating work retention (e.g., energy management and self-efficacy training) and reintegration consultation addressing work-related issues (e.g., RTW planning and discussing workplace or task modifications with the supervisor). Alongside the RCT, a prospective cohort study will be conducted among cancer survivors' partners (n = 267). Participants in the RCT and cohort study will be asked to complete questionnaires at baseline, and after six and 12 months, assessing work- and health-related outcomes. Generalized estimating equations will be used to assess intervention's effectiveness, compared to usual care, regarding primary (i.e., working hours per week) and secondary outcomes. Also economic and process evaluations will be performed. For the cohort study, logistic or linear regression modelling will be applied assessing work- and health-related outcomes (primary outcome: working hours) of cancer survivors' partners, and what factors predict these outcomes. RESULTS: The study is planned to start in September 2021; results are expected in 2023. CONCLUSION: Compared to usual care, the STEPS intervention is hypothesized to be (cost-)effective and the intervention could be a valuable addition to standard care helping cancer survivors to sustain employment. Further, it is expected that living with a cancer survivor has a substantial impact on work and health of partners, while specific groups of partners that are at particular risk for this impact are likely to be identified. TRIAL REGISTRATION: Dutch Trial Register ( NTR;NL9094 ; 15-12-2020).

Associations of sustained smoking and smoking cessation with work-related outcomes: a longitudinal analysis.

PURPOSE: The aim of this study was to assess the association between sustained smoking and quitting with work-related outcomes among older workers. METHODS: We categorized a sample of older employees into non-smokers, sustained smokers and quitters. Multivariable regression models were used to test longitudinal associations of sustained smoking and smoking cessation with sickness absence, productivity loss and work ability. RESULTS: We included 3612 non-smokers, 673 sustained smokers and 246 quitters. Comparing sustained smokers to non-smokers, we found higher (but not statistically significant) sickness absence for sustained smokers [1.01, 95% confidence interval (CI) - 0.16-2.17]. We did not find differences in productivity loss (OR 0.82, 95% CI 0.60-1.13) and work ability (0.05, 95% CI -0.05-0.15). For employees with a relatively high physical health at baseline, comparing quitters to sustained smokers, we found higher (but not statistically significant) productivity loss for quitters (OR 2.23, 95% CI 0.94-5.31), and no difference in sickness absence (0.10, 95% CI - 2.67-2.87), and work ability (- 0.10, 95% CI -  0.36-0.16). For employees with a relatively low physical health at baseline, comparing quitters to sustained smokers, we found a statistically significant lower work ability (- 0.31, 95% CI - 0.57-0.05), and no difference in sickness absence (2.53, 95% CI - 1.29-6.34) and productivity loss (OR 1.26, 95% CI 0.66-2.39). CONCLUSIONS: We found no evidence that sustained smokers have less favorable work-related outcomes than non-smokers or that quitters have more favorable work-related outcomes than sustained smokers. The benefits of smoking cessation for employers might take a longer time to develop.

Cross-cultural translation and adaptation of the Readiness for Return To Work questionnaire for Dutch cancer survivors.

OBJECTIVE: Effective interventions supporting cancer survivors in work participation are lacking, possibly due to the poor fit between interventions and cancer survivors' needs. The 'Readiness for Return To Work' (RRTW) questionnaire could facilitate intervention development tailored to cancer survivors' needs. We performed a cross-cultural translation and adaptation of this questionnaire into Dutch and pre-tested its psychometric properties among cancer survivors. METHODS: Questionnaire translation and adaptation were conducted using a systematic approach of: forward translation, synthesis, backward translation, consolidation of translations with an expert committee, and pre-testing. Pre-testing consisted of interviewing 40 cancer survivors, who completed the questionnaire. RESULTS: The translated and adapted RRTW questionnaire showed reasonable psychometric properties, that is high item-to-stage correlations and internal consistency for all RRTW stages, except for the prepared for action - self-evaluative stage. CONCLUSIONS: The translated and adapted RRTW questionnaire may be useful for tailoring interventions to support cancer survivors in returning to and maintaining at work. However, some items showed poor psychometric properties and several factors, important for work participation, are not captured, for example personal, disease-, treatment- and/or work-related characteristics. We recommend to further test the RRTW questionnaire and to use it in combination with additional measurement instruments when developing tailored work participation interventions.

Reliability, validity and responsiveness of the Dutch version of the AOSpine PROST (Patient Reported Outcome Spine Trauma).

PURPOSE: To validate the Dutch version of AOSpine PROST (Patient Reported Outcome Spine Trauma). METHODS: Patients were recruited from two level-1 trauma centers from the Netherlands. Next to the AOSpine PROST, patients also filled out SF-36 for concurrent validity. Descriptive statistics were used to analyze the characteristics. Content validity was assessed by evaluating the number of inapplicable or missing questions. Also floor and ceiling effects were analyzed. Internal consistency was assessed by calculating Cronbach's α and item-total correlation coefficients (itcc). Spearman correlation tests were performed within AOSpine PROST items and in correlation with SF-36. Test-retest reliability was analyzed using Intraclass Correlation Coefficients (ICC). Responsiveness was assessed by calculating effect sizes (ES) and standardized response mean (SRM). Factor analysis was performed to explore any dimensions within AOSpine PROST. RESULTS: Out of 179 enrolled patients, 163 (91.1%) were included. Good results were obtained for content validity. No floor or ceiling effects were seen. Internal consistency was excellent (Cronbach's α = 0.96, itcc 0.50-0.86), with also good Spearman correlations (0.25-0.79). Compared to SF-36, the strongest correlation was seen for physical functioning (0.79; p < .001). Also test-retest reliability was excellent (ICC = 0.92). Concerning responsiveness analysis, very good results were seen with ES = 1.81 and SRM = 2.03 (p < 0.001). Factor analysis revealed two possible dimensions (Eigenvalues > 1), explaining 65.4% of variance. CONCLUSIONS: Very satisfactory results were obtained for reliability, validity and responsiveness of the Dutch version of AOSpine PROST. Treating surgeons are encouraged to use this novel and validated tool in clinical setting and research to contribute to evidence-based and patient-centered care.

Combining paid work and family care for a patient at the end of life at home: insights from a qualitative study among caregivers in the Netherlands.

BACKGROUND: Population ageing, an emphasis on home-based care of palliative patients and policies aimed at prolonging participation in the labour market are placing a growing demand on working family caregivers. This study aimed to provide insight into experiences with combining paid work and family care for patients at the end of life, factors facilitating and hindering this combination, and support needs. METHOD: Semi-structured interviews were held between July 2018 and July 2019 with 18 working family caregivers of patients with a life-threatening illness who were living at home. Transcripts were analysed following the principles of thematic analysis. RESULTS: Some family caregivers could combine paid work and family care successfully, while this combination was burdensome for others. Family caregivers generally experienced a similar process in which four domains - caregiver characteristics, the care situation, the work situation and the context - influenced their experiences, feelings and needs regarding either the combination of paid work and care or the care situation in itself. In turn, experiences, feelings and needs sometimes affected health and wellbeing, or prompted caregivers to take actions or strategies to improve the situation. Changes in health and wellbeing could affect the situation in the four domains. Good health, flexibility and support at work, support from healthcare professionals and sharing care tasks were important in helping balance work and care responsibilities. Some caregivers felt 'sandwiched' between work and care and reported physical or mental health complaints. CONCLUSIONS: Experiences with combining paid work and family care at the end of life are diverse and depend on several factors. If too many factors are out of balance, family caregivers experience stress and this impacts their health and wellbeing. Family caregivers could be better supported in this by healthcare professionals, employers and local authorities.

RNA-Sequencing Highlights Inflammation and Impaired Integrity of the Vascular Wall in Brain Arteriovenous Malformations.

Background and Purpose- Interventional treatment of unruptured brain arteriovenous malformations (BAVMs) has become increasingly controversial. Because medical therapy is still lacking, we aimed to obtain insight into the disease mechanisms implicated in BAVMs and to identify potential targets for medical treatment to prevent rupture of a BAVM. Methods- We used next-generation RNA sequencing to identify differential expression on a transcriptome-wide level comparing tissue samples of 12 BAVMs to 16 intracranial control arteries. We identified differentially expressed genes by negative binominal generalized log-linear regression (false discovery rate corrected P<0.05). We selected 10 genes for validation using droplet digital polymerase chain reaction. We performed functional pathway analysis accounting for potential gene-length bias, to establish enhancement of biological pathways involved in BAVMs. We further assessed which Gene Ontology terms were enriched. Results- We found 736 upregulated genes in BAVMs including genes implicated in the cytoskeletal machinery and cell-migration and genes encoding for inflammatory cytokines and secretory products of neutrophils and macrophages. Furthermore, we found 498 genes downregulated including genes implicated in extracellular matrix composition, the binary angiopoietin-TIE system, and TGF (transforming growth factor)-ß signaling. We confirmed the differential expression of top 10 ranked genes. Functional pathway analysis showed enrichment of the protein digestion and absorption pathway (false discovery rate-adjusted P=1.70×10-2). We identified 47 enriched Gene Ontology terms (false discovery rate-adjusted P<0.05) implicated in cytoskeleton network, cell-migration, endoplasmic reticulum, transmembrane transport, and extracellular matrix composition. Conclusions- Our genome-wide RNA-sequencing study points to involvement of inflammatory mediators, loss of cerebrovascular quiescence, and impaired integrity of the vascular wall in the pathophysiology of BAVMs. Our study may lend support to potential receptivity of BAVMs to medical therapeutics, including those promoting vessel maturation, and anti-inflammatory and immune-modifying drugs.