Hypoxia impairs reaction time but not response accuracy in a visual choice reaction task.

We investigated the effect of hypoxia on the reaction time (RT) and response accuracy of pilots performing a visual choice reaction task that corresponded to the scanning of helmet mounted display (HMD) symbology. Eighteen male military pilots performed the task in a hypobaric chamber at two simulated altitudes (92 m and 4572 m) in a single-blinded repeated measures and counter-balanced design. The visual stimuli were displayed in low and high contrast and at a 30- and 50-degree field of view (FoV). We measured the pilots' RT and response accuracy. Using an eye tracker, we measured the pilot's glance time at each stimulus location. Finally, we collected subjective ratings of alertness. The results show that hypoxia increased the RT and glance time. Lowering the stimulus contrast and increasing the FoV further increased the RT, independent of hypoxia. These findings provide no evidence for hypoxia-induced changes in visual contrast sensitivity or visual field. Instead, hypoxia seemed to affect RT and glance time by reducing alertness. Despite the increased RT, the pilots maintained their accuracy on the visual task, suggesting that visual scanning of HMD symbology may be resistant to the effects of acute hypoxia.

Working conditions in women with multiple pregnancy-the impact on preterm birth and adherence to guidelines: a prospective cohort study.

BACKGROUND: Women with multiple pregnancies are at risk for maternal complications such as preterm birth. Hazardous working conditions, such as physically demanding work and long and irregular working hours, might increase the risk of preterm birth. OBJECTIVE: This study primarily aimed to determine whether certain working conditions up to 20 weeks of pregnancy increase the risk of preterm birth in multiple pregnancies. The secondary objective was to evaluate whether the working conditions of Dutch women with multiple pregnancy have been adjusted to the guidelines of the Netherlands Society of Occupational Medicine. STUDY DESIGN: We performed a prospective cohort study alongside the ProTWIN trial, a multicenter randomized controlled trial that assessed whether cervical pessaries could effectively prevent preterm birth. Women with paid work of >8 hours per week completed questionnaires concerning general health and working conditions between 16 and 20 weeks of pregnancy. Univariable and multivariable logistic regression analyses were performed to identify work-related factors associated with preterm birth (32-36 weeks' gestation) and very preterm birth (<32 weeks' gestation). We analyzed a subgroup of participants who worked for more than half of the week (>28 hours). We calculated the proportion of women who reported work-related factors not in accordance with guidelines. RESULTS: We studied 383 women, of whom 168 (44%) had been randomized to pessary, 142 (37%) to care as usual, and 73 (19%) did not participate in the randomized part of the study. After adjusting for confounding variables, working >28 hours was associated with very preterm birth (n=33; 78%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.1), and irregular working times were associated with preterm birth (n=26, 17%) (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.1) and very preterm birth (n=10; 24%) (adjusted odds ratio, 2.7; 95% confidence interval, 1.0-7.3). Within a subgroup of 213 participants working >28 hours per week, multivariable analysis showed that irregular working times (n=16; 20%) (adjusted odds ratio, 3.5; 95% confidence interval, 1.2-10.1) and no/little freedom in performance of tasks (n=23; 28%) (adjusted odds ratio, 3.0; 95% confidence interval, 1.3-7.3) were associated with preterm birth. Irregular working times (n=9; 27%) (adjusted odds ratio, 3.4; 95% confidence interval, 1.0-11.1), requiring physical strength (n=9; 27%) (adjusted odds ratio, 5.3; 95% confidence interval, 1.6-17.8), high physical workload (n=7; 21%) (adjusted odds ratio, 3.9; 95% confidence interval, 1.1-13.9), and no/little freedom in performing tasks (n=10; 30%) (adjusted odds ratio, 3.2; 95% confidence interval, 1.1-9.6) were associated with very preterm birth. Before 20 weeks of pregnancy, 224 (58.5%) women with multiple pregnancy continued to work under circumstances that were not in accordance with the guidelines. CONCLUSION: In our cohort study, nearly 60% of women with multiple pregnancy continued to work under circumstances not in accordance with the guidelines to avoid physical and job strain and long and irregular working hours. Irregular hours were associated with preterm and very preterm birth, and long hours were associated with preterm birth.

The role of general practitioners in the work guidance of cancer patients: views of general practitioners and occupational physicians.

PURPOSE: To explore views of general practitioners (GPs) and occupational physicians (OPs) on the role of GPs in work guidance of cancer patients. METHODS: Between 2016 and 2019, two focus groups with GPs (N = 17) and two focus groups with OPs (N = 10) were conducted. Focus group discussions were audiotaped and transcribed verbatim. Transcripts were analysed by data-driven analysis. RESULTS: GPs generally indicated that they inquire about patients' occupations but do not structurally document these. GPs described offering support and advice to patients regarding their work, while other GPs stated they do not interfere with their patients' work or return to work (RTW) process. In general, GPs stated that they do not aspire a professional role in the work guidance of patients, due to lack of expertise and not having sufficient knowledge in work regulations and legislation. In contrast, OPs anticipated a proactive role from GPs concerning work guidance in cancer patients, and they expected GPs to refer cancer patients to the OP, when required. Moreover, they emphasised the importance of communication between GPs and OPs about patients' work-related problems to achieve common goals. CONCLUSIONS: GPs can contribute to cancer patients' RTW process by supporting patients, giving advice and providing referral to other health professionals. Better cooperation between GPs and OPs may improve work guidance in cancer patients. IMPLICATIONS FOR CANCER SURVIVORS: When cancer patients with work-related issues get appropriate advice and support from GPs and referred in time to OPs, the RTW process and staying at work of cancer patients may be positively affected.

Assessor burden, inter-rater agreement and user experience of the RoB-SPEO tool for assessing risk of bias in studies estimating prevalence of exposure to occupational risk factors: An analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: As part of the development of the World Health Organization (WHO)/International Labour Organization (ILO) Joint Estimates of the Work-related Burden of Disease and Injury, WHO and ILO carried out several systematic reviews to determine the prevalence of exposure to selected occupational risk factors. Risk of bias assessment for individual studies is a critical step of a systematic review. No tool existed for assessing the risk of bias in prevalence studies of exposure to occupational risk factors, so WHO and ILO developed and pilot tested the RoB-SPEO tool for this purpose. Here, we investigate the assessor burden, inter-rater agreement, and user experience of this new instrument, based on the abovementioned WHO/ILO systematic reviews. METHODS: Twenty-seven individual experts applied RoB-SPEO to assess risk of bias. Four systematic reviews provided a total of 283 individual assessments, carried out for 137 studies. For each study, two or more assessors independently assessed risk of bias across the eight RoB-SPEO domains selecting one of RoB-SPEO's six ratings (i.e., "low", "probably low", "probably high", "high", "unclear" or "cannot be determined"). Assessors were asked to report time taken (i.e. indicator of assessor burden) to complete each assessment and describe their user experience. To gauge assessor burden, we calculated the median and inter-quartile range of times taken per individual risk of bias assessment. To assess inter-rater reliability, we calculated a raw measure of inter-rater agreement (Pi) for each RoB-SPEO domain, between Pi = 0.00, indicating no agreement and Pi = 1.00, indicating perfect agreement. As subgroup analyses, Pi was also disaggregated by systematic review, assessor experience with RoB-SPEO (≤10 assessments versus > 10 assessments), and assessment time (tertiles: ≤25 min versus 26-66 min versus ≥ 67 min). To describe user experience, we synthesised the assessors' comments and recommendations. RESULTS: Assessors reported a median of 40 min to complete one assessment (interquartile range 21-120 min). For all domains, raw inter-rater agreement ranged from 0.54 to 0.82. Agreement varied by systematic review and assessor experience with RoB-SPEO between domains, and increased with increasing assessment time. A small number of users recommended further development of instructions for selected RoB-SPEO domains, especially bias in selection of participants into the study (domain 1) and bias due to differences in numerator and denominator (domain 7). DISCUSSION: Overall, our results indicated good agreement across the eight domains of the RoB-SPEO tool. The median assessment time was comparable to that of other risk of bias tools, indicating comparable assessor burden. However, there was considerable variation in time taken to complete assessments. Additional time spent on assessments may improve inter-rater agreement. Further development of the RoB-SPEO tool could focus on refining instructions for selected RoB-SPEO domains and additional testing to assess agreement for different topic areas and with a wider range of assessors from different research backgrounds.

Usefulness and feasibility of comprehensive and less comprehensive vocational rehabilitation for patients with chronic musculoskeletal pain: perspectives from patients, professionals, and managers.

PURPOSE: To explore the usefulness and feasibility of a comprehensive vocational rehabilitation (C-VR) program and less comprehensive (LC-VR) program for workers on sick leave due to chronic musculoskeletal pain, from the perspective of patients, professionals, and managers. MATERIALS AND METHODS: Semi-structured interviews were held with patients, professionals, and managers. Using topic lists, participants were questioned about barriers to and facilitators of the usefulness and feasibility of C-VR and LC-VR. Thirty interviews were conducted with thirteen patients (n = 6 C-VR, n = 7 LC-VR), eight professionals, and nine managers. All interviews were transcribed verbatim. Data were analyzed by systematic text condensation using inductive thematic analysis. RESULTS: Three themes emerged for usefulness ("patient factors," "content," "dosage") and six themes emerged for feasibility ("satisfaction," "intention to continue use," "perceived appropriateness," "positive/negative effects on target participants," "factors affecting implementation ease or difficulty," "adaptations"). The patients reported that both programs were feasible and generally useful. The professionals preferred working with the C-VR, although they disliked the fixed and uniform character of the program. They also mentioned that this program is too extensive for some patients, and that the latter would probably benefit from the LC-VR program. Despite their positive intentions, the managers stated that due to the Dutch healthcare system, implementation of the LC-VR program would be financially unfeasible. CONCLUSIONS: The main conclusion of this study is that it is not useful to have one VR program for all patients with CMP and reduced work participation, and that flexible and tailored-based VR are warranted.Implications for rehabilitationBoth comprehensive and less comprehensive vocational rehabilitation are deemed useful for patients with chronic musculoskeletal pain and reduced work participation. Particular patient factors, for instance information uptake, discipline, willingness to change, duration of complaints, movement anxiety, obstructing thoughts, and willingness to return to work might guide the right program for the right patient.Both comprehensive and less comprehensive vocational rehabilitation are deemed feasible in practice. However, factors such as center logistic (schemes, rooms, professionals available) and country-specific healthcare insurance and sickness compensation systems should foster the implementation of less comprehensive programs.

How to facilitate guideline use? A bottom-up qualitative approach developing a training programme for professionals involved in work participation of people with a chronic disease.

BACKGROUND: A guideline for occupational health professionals (OHPs) is developed which provides them with knowledge and skills to optimize their guidance to people with a chronic disease. OBJECTIVE: Developing a training programme to acquire and apply knowledge and skills provided by the guideline, through a bottom-up approach. METHODS: First, OHPs training needs were explored using focus groups. Second, learning objectives were formulated by the researchers. Third, experts in the field of education were interviewed to explore relevant training activities. Fourth, researchers integrated all the results into a training programme. RESULTS: Based on the training needs identified, we formulated 17 learning objectives, e.g. being able to name influential factors and effective interventions, increase the individual client's role, and increase communication with a professionals to enhance work participation of people with a chronic disease. The training activities identified by experts for OHPs to acquire and apply knowledge and skills were: a case study, role play, discussion of best practices and interviewing stakeholders. These were all performed in plenary sessions or small groups. CONCLUSIONS: Training needs, -activities and learning objectives were integrated into a six-hour training programme. This bottom-up approach can serve as input for others developing training programmes to transfer knowledge and skills to OHPs.

Exposure to hypoxia impairs helicopter pilots' awareness of environment.

The purpose of the present study was to determine how hypoxia effects awareness of environment (AoE) in helicopter pilots operating at high altitude. Eight helicopter crews flew two operational flights in a flight simulator while breathing gas mixtures of 20.9% (equivalent to 0 m altitude) and 11.4% (equivalent to 4572 m or 15,000 ft altitude) oxygen in a single blinded, counterbalanced, repeated measures study. Each flight included five missions, during which environment items were introduced that the crews needed to be aware of, and respond to. In the 4572 m simulation, the crews missed overall 28 AoE items compared to 12 in the 0 m simulation (Z = -1.992; p = .046). In contrast, the crews' technical skills were not significantly effected by hypoxia. Remarkably, the majority of pilots did not notice they were hypoxic or recognise their hypoxia symptoms during the simulation flight at 4572 m. Practitioner summary We show that hypoxia has a detrimental effect on helicopter pilot's AoE and alertness. This can lead to an increased risk for flight safety. To mitigate this risk we recommend performing hypoxia training in a flight simulator, developing wearable systems for physiological monitoring of pilots and re-evaluating current altitude regulations. Abbreviations: ANOVA: Analysis of variance; AoE: awareness of environment; CSV: comma-separated values; HDU: helmet display unit; HR: heart rate; IQR: interquartile range; Mdn: median; NTS: non-technical skills; RNLAF: Royal Netherlands Air Force; PPM: parts per million; SpO2: oxygen saturation; SSS: Stanford sleepiness scale; TS: technical Skills.

Is the "Brainwork Intervention" effective in reducing sick leave for non-permanent workers with psychological problems? Results of a controlled clinical trial.

BACKGROUND: Both the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called "Brainwork" was developed. The aim of this study was to assess the effectiveness of the 'Brainwork Intervention' in reducing the duration of sick leave compared to usual care over a 12-month follow-up. METHODS: In a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed. RESULTS: All 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94-1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%. CONCLUSIONS: The Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol. TRIAL REGISTRATION: The Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013.

The effect of occupational exposure to ergonomic risk factors on osteoarthritis of hip or knee and selected other musculoskeletal diseases: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence). DATA SOURCES: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA. STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project. RESULTS: In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate. Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I2 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I2 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies. CONCLUSIONS: Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as "limited evidence of harmfulness" and the relationship between exposure to occupational ergonomic factors and OA also as "limited evidence of harmfulness". These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053 PROSPERO registration number: CRD42018102631.

Usability and consistency in findings of the work support needs assessment tool.

BACKGROUND: Structured work support needs assessment could facilitate professionals and increase assessment consistency. OBJECTIVES: Evaluating usability of the Work Support Needs Assessment Tool and test if professionals' (labour experts, coaches) findings become more consistent after a tool training. The tool includes a 21 item checklist for assessing work support needs of people with disabilities. METHODS: Usability was explored through 28 interviews with professionals. Consistency was evaluated in an experimental pre-post study design, in which thirty-nine other professionals assessed work support needs of standardized clients before and after a protocolized training. Quantitative content analysis was conducted. Consistency of findings between professionals covered three categories: type (client-focused coaching), focus (topics to be addressed) and duration of support. An increase in consistency was defined as a decrease in the total number of different sub-categories of findings in each category. RESULTS: Nineteen professionals indicated that the tool was useful, as they gained relevant information and insights. Regarding consistency, the number of findings differed pre- and post-training for type of support (8 vs 9) and focus of support (18 vs 15 and 18 vs 17). CONCLUSIONS: Participants had positive experiences with the tool. Increased consistency in findings of professionals after the training was not demonstrated with the current study design.

The prevalence of occupational exposure to ergonomic risk factors: A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic and human data suggests that occupational exposure to ergonomic (or physical) risk factors may cause osteoarthritis and other musculoskeletal diseases (excluding rheumatoid arthritis, gout, and back and neck pain). In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to physical ergonomic risk factors for estimating the number of disability-adjusted life years from these diseases that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to ergonomic risk factors for osteoarthritis and other musculoskeletal diseases. DATA SOURCES: We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. The exposure was defined as any occupational exposure to one or more of: force exertion, demanding posture, repetitive movement, hand-arm vibration, kneeling or squatting, lifting, and/or climbing. We included all study types with an estimate of the prevalence of occupational exposure to ergonomic risk factors. STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. RESULTS: Five studies (three cross-sectional studies and two cohort studies) met the inclusion criteria, comprising 150,895 participants (81,613 females) in 36 countries in two WHO regions (Africa, Europe). The exposure was generally assessed with questionnaire data about self-reported exposure. Estimates of the prevalence of occupational exposure to ergonomic risk factors are presented for all five included studies, disaggregated by country, sex, 5-year age group, industrial sector or occupational group where feasible. The pooled prevalence of any occupational exposure to ergonomic risk factors was 0.76 (95% confidence interval 0.69 to 0.84, 3 studies, 148,433 participants, 35 countries in the WHO Europe region, I2 100%, low quality of evidence). Subgroup analyses found no statistically significant differences in exposure by sex but differences by age group, occupation and country. No evidence was found for publication bias. We assessed this body evidence to be of low quality, based on serious concerns for risk of bias due to exposure assessment only being based on self-report and for indirectness due to evidence from two WHO regions only. CONCLUSIONS: Our systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent. The current body of evidence is, however, limited, especially by risk of bias and indirectness. Producing estimates for the burden of disease attributable to occupational exposure to ergonomic risk factors appears evidence-based, and the pooled effect estimates presented in this systematic review may perhaps be used as input data for the WHO/ILO Joint Estimates. Protocol identifier:https://doi.org/10.1016/j.envint.2018.09.053. PROSPERO registration number: CRD42018102631.

Vocational Rehabilitation with or without Work Module for Patients with Chronic Musculoskeletal Pain and Sick Leave from Work: Longitudinal Impact on Work Participation.

Purpose To study the longitudinal relationship between interdisciplinary vocational rehabilitation (VR) with and without additional work module on work participation of patients with chronic musculoskeletal pain and sick leave from work. Methods Retrospective longitudinal data retrieved from care as usual in seven VR centers in the Netherlands was used. The VR program without work module consisted of multi-component healthcare (physical exercise, cognitive behavioral therapy, education, relaxation). The other program with additional work module (VR+) included case management and a workplace visit. Generalized estimating equations using binary logistic was applied. The dependent variable was work participation (achieved/not achieved) on discharge and 6-months follow-up. Independent variables were type of intervention, return to work expectation, sick leave duration, working status, job strain, and job dissatisfaction. Results Data from N = 470 patients were analyzed, of which 26% received VR and 74% VR+. Both programs increased work participation at 6-months follow-up (VR 86%, VR+ 87%). The crude model showed a significant longitudinal relationship between type of intervention and work participation in favor of VR+ (OR 1.8, p = 0.01). The final model showed a non-significant relationship on discharge (OR 1.3, p = 0.51) and a significant relationship on 6-months follow-up in favor of VR+ (OR 1.7, p = 0.04). RTW expectation was a significant confounder in the final model on discharge and 6-months follow up (OR 3.1, p = 0.00). Conclusions Both programs led to increased work participation. The addition of a work module to the VR program lead to a significant increase in odds of work participation at 6-months follow-up.

Long-term employment status and quality of life after cancer: A longitudinal prospective cohort study from diagnosis up to and including 5 years post diagnosis.

BACKGROUND: Accumulating evidence suggests that cancer survivors are able to return to work. However, little is known about their work situation 5 years after diagnosis. OBJECTIVE: To explore fluctuations in employment status and its association with quality of life 2, 3, and 5 years after cancer diagnosis of 65 cancer survivors employed at diagnosis. METHODS: In association with a randomised controlled trial (RCT), questionnaires were administrated to eligible cancer survivors at diagnosis, 2, 3, and 5 years thereafter comprising of validated questionnaires related to work (i.e. Work Ability Index (WAI), cancer, and quality of life (QOL) (i.e. SF-36, VAS QOL). The RCT studied a hospital-based work support intervention in female breast and gynaecological cancer survivors who were treated with curative intent and had paid work at diagnosis. Descriptive statistics and longitudinal multi-level analysis were employed. RESULTS: Sixty-five of the 102 eligible cancer survivors participated, who were primarily diagnosed with breast cancer (63%). Two and 5 years after cancer diagnosis respectively 63 (97%) and 48 (81%) participants were employed. Reasons for not being employed after 5 years included receiving unemployment benefits (7%), voluntary unemployment (3%), receiving disability benefits (3%), and early retirement (3%). Longitudinal multi-level analysis showed that employed cancer survivors reported in general statistically significant better quality of life outcomes at 5 years follow-up compared to those not being employed. CONCLUSIONS: We found high employment rates and few fluctuations in employment status. The steepest decline in employment rate occurs after the first two years of diagnosis. Employed participants reported better quality of life outcomes. Survivorship care should therefore focus on the population at risk possibly within the first two years after diagnosis.

Availability of vocational rehabilitation services for people with acquired brain injury in Dutch rehabilitation institutions.

OBJECTIVE: To provide an overview of the availability of and process involved in vocational rehabilitation (VR) services for people with acquired brain injury (ABI) provided in Dutch rehabilitation institutions. METHODS: A survey on the availability and characteristics of the VR intervention process for people with ABI was conducted in all Dutch rehabilitation centers and rehabilitation departments of general and academic hospitals (n = 120). Different domains of the VR intervention process were included in the questionnaire, the number (and percentage) of respondents giving a certain answer within a domain was reported. RESULTS: Fifty-five institutions replied (response rate 46%). VR services for ABI were provided in 34 (62%) of these, of which 20 (59%) used a VR protocol. The main similarities found among different organizations providing VR services were the involvement of different disciplines, determination of the gap between job requirements and the patient's abilities, goal-setting for VR, involvement of external partners, timing, and source of funding. The main differences found concerned start and stop criteria, and coordination of the VR process. CONCLUSIONS: Currently, at least 30% of the Dutch rehabilitation institutions offer VR services for people with ABI; there is variation in processes.

Is a tailored work-related support intervention feasible in everyday clinical practice? The experience of healthcare professionals and patients with cancer.

BACKGROUND: Work is valued as an important feature in life, however patients diagnosed with cancer can experience work-related problems. We developed a work-related support intervention to support those in need. OBJECTIVE: The objective of this study was to evaluate the feasibility of the performed tailored GIRONA (Gastro Intestinal cancer patients Receiving Occupational support Near and After diagnosis) intervention and to describe the experiences of those receiving the work-related support and of those providing it. METHODS: An online questionnaire was used to survey the feasibility of the intervention of the support recipients (patients diagnosed with gastrointestinal cancer) and the support providers (healthcare professionals including: oncology nurses and oncological occupational physicians). Five themes were covered: acceptability, demand, implementation, practicality and integration of Bowen's feasibility model. RESULTS: Twenty-three patients, 14 oncology nurses and 4 oncological occupational physicians, shared their experiences about the tailored work-related support intervention. This intervention was generally perceived as positive and feasible by the participants. Some patients received work-related support despite not experiencing severe problems; others mentioned that they received no such support even though they did need it. Despite positive experiences, there are some barriers to tackle, such as length of consultation, timing of the initiation of work-related support and embedding the oncological occupational physician within the clinical setting. CONCLUSION: According to the healthcare professionals involved, GIRONA is feasible, however some practical barriers were mentioned. The intervention was perceived as positive by both patients and healthcare professionals, but the tailored component could be further improved to better support those in need of work-related support.

Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis.

OBJECTIVE: The objective was to conduct an update of a previously published review and meta-analysis on the association between work-related psychosocial risk factors and stress-related mental disorders (SRD). DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline, Embase and PsycINFO were searched for articles published between 2008 and 12 August 2019 and references of a systematic review performed for the period before 2008 were included. Primary prospective studies were included when outcome data were described in terms of SRD assessment or a dichotomous outcome, based on a validated questionnaire, and at least two levels of work-related exposure were reported (exposed vs less or non-exposed). We used GRADE to assess the evidence for the associations between risk factors and the onset of SRD. RESULTS: Seventeen studies met the inclusion criteria. In total, a population of 73 874 workers from Belgium, Denmark, England, Finland, Japan, the Netherlands and Sweden were included in the meta-analysis of 14 prospective cohort studies. This meta-analysis revealed moderate evidence for associations between SRD and effort reward imbalance (OR=1.9, 95% CI 1.70 to 2.15), high job demands (OR=1.6, 95% CI 1.41 to 1.72), organisational justice (ORs=1.6 to 1.7, CIs 1.44 to 1.86), social support (ORs=1.3 to 1.4, CIs 1.16 to 1.69), high emotional demands (OR=1.6, 95% CI 1.35 to 1.84) and decision authority (OR=1.3, CI 1.20 to 1.49). No significant or inconsistent associations were found for job insecurity, decision latitude, skill discretion and bullying. CONCLUSION: Moderate evidence was found that work-related psychosocial risk factors are associated with a higher risk of SRD. Effort-reward imbalance, low organisational justice and high job demands exhibited the largest increased risk of SRD, varying from 60% to 90%.

The Successful Return-To-Work Questionnaire for Cancer Survivors (I-RTW_CS): Development, Validity and Reproducibility.

BACKGROUND: Cancer survivors' perspectives on a successful return to work (RTW) may not be captured in the common measure of RTW, namely time until RTW. OBJECTIVE: The purpose of this study was therefore to develop an RTW outcome measure that reflects employed cancer survivors' perspectives, with items that could be influenced by an employer, i.e. the Successful Return-To-Work questionnaire for Cancer Survivors (I-RTW_CS), and to assess its construct validity and reproducibility. METHODS: First, three focus groups with cancer survivors (n = 14) were organized to generate issues that may constitute successful RTW. Second, a two-round Delphi study among 108 cancer survivors was conducted to select the most important issues. Construct validity of the I-RTW_CS was assessed using correlations with a single-item measure of successful RTW and the Quality of Working Life Questionnaire for Cancer Survivors (QWLQ-CS; n = 57). Reproducibility (test-retest reliability) was assessed using the intraclass correlation coefficient (ICC; n = 50). RESULTS: Forty-eight issues were generated, of which seven were included: 'enjoyment in work'; 'work without affecting health'; 'confidence of employer without assumptions about work ability'; 'open communication with employer'; 'feeling welcome at work'; 'good work-life balance'; and 'joint satisfaction with the situation (employer and cancer survivor)'. Correlations with single-item successful RTW and QWLQ-CS were 0.58 and 0.85, respectively. The reproducibility showed an ICC of 0.72. CONCLUSIONS: The I-RTW_CS provides an RTW outcome measure that includes cancer survivors' perspectives and weights its items on an individual basis, allowing a more meaningful evaluation of cancer survivors' RTW. This study provides preliminary evidence for its construct validity and reproducibility.

The MiLES intervention targeting employers to promote successful return to work of employees with cancer: design of a pilot randomised controlled trial.

BACKGROUND: Employers express a need for support to facilitate the return to work (RTW) process of employees with cancer. We have developed the MiLES intervention, an online toolbox targeting employers during the RTW of employees with cancer. To evaluate the MiLES intervention, we propose the design of a pilot randomised controlled trial (RCT). The aim of this pilot is to determine whether a future RCT to study the effectiveness of this intervention on successful RTW of employees with cancer is feasible. Secondary aims are to obtain preliminary results on the effectiveness of the intervention and to determine the sample size needed in a future definitive RCT. METHODS: A pilot RCT with a 6-month follow-up will be conducted. Using medical specialists at Dutch hospitals, we aim to enrol 90 participants diagnosed with cancer (<2 years earlier) aged 18-63 years who are in paid employment with an employer and who are currently sick-listed or partly sick-listed for <1 year. Participants randomised to the intervention group will be asked to inform their employer about the online toolbox supporting employers during the RTW process of employees with cancer. Participants in the control group will receive 'care as usual' from their employer. All measures will be assessed at the level of the employee using questionnaires at baseline and after 3 and 6 months of follow-up. The feasibility of a future RCT will be determined using criteria concerning method-related uncertainties and acceptability of the study protocol. The primary effect measure will be successful RTW (that is, RTW perceived as being successful by the cancer survivor themselves). This effect measure will be used to perform the sample size calculation for a future definitive RCT. DISCUSSION: The design is proposed to determine the feasibility to study the effectiveness of the MiLES intervention targeting employers on the successful RTW of employees diagnosed with cancer. This pilot RCT can increase the probability of a successful future definitive RCT on the effectiveness of the intervention and potentially obviate the need to carry out an unfeasible and resource-intensive study. TRIAL REGISTRATION: Dutch Trial Register (NTR): NL6758, NTR7627. Registered on 30 October 2018.