Comparison between myocardial function assessed by echocardiography during hospitalization for COVID-19 and at 4 months follow-up.

In patients hospitalized for corona virus infectious disease 19 (COVID-19) it is currently unknown whether myocardial function changes after recovery and whether this is related to elevated cardiac biomarkers. In this single center, prospective cohort study we consecutively enrolled hospitalized COVID-19 patients between 1 April and 12 May 2020. All patients underwent transthoracic echocardiography (TTE) evaluation during hospitalization and at a median of 131 days (IQR; 116-136) follow-up. Of the 51 patients included at baseline, 40 (age: 62 years (IQR; 54-68), 78% male) were available for follow-up TTE. At baseline, 68% of the patients had a normal TTE, regarding left ventricular (LV) and right ventricular (RV) volumes and function, compared to 83% at follow-up (p = 0.07). Median LV ejection fraction (60% vs. 58%, p = 0.54) and tricuspid annular plane systolic excursion (23 vs 22 mm, p = 0.18) were comparable between hospitalization and follow-up, but a significantly lower RV diameter (39 vs. 34 mm, p = 0.002) and trend towards better global longitudinal strain (GLS) (- 18.5% vs - 19.1%, p = 0.07) was found at follow-up. Subgroup analysis showed no relation between patients with and without elevated TroponinT and/or NT-proBNP during hospitalization and myocardial function at follow-up. Although there were no significant differences in individual myocardial function parameters at 4 months follow-up compared to hospitalisation for COVID-19, there was an overall trend towards normalization in myocardial function, predominantly due to a higher rate of normal GLS at follow-up.

The influence of residential distance on time to treatment in ST-elevation myocardial infarction patients.

AIMS: To evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: STEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI 'spoke' centre ('spoke' patients) and 2725 patients (66 %) were referred via field triage in the ambulance (ambulance patients). RESULTS: A longer residential distance increased median total ischaemic time in 'spoke' patients (0-30 km: 228 min, >30-60 km: 235 min, >60-90 km: 264 min, p < 0.001), however not in ambulance patients (0-30 km: 179 min, >30-60 km: 175 min, >60-90 km: 186 min, p = 0.225). After multivariable linear regression analysis, in 'spoke' patients residential distance of >30-60 km compared with 0-30 km was not independently associated with ischaemic time; however, a residential distance of >60-90 km (exp (B) = 1.11, 95 % CI 1.01-1.12) compared with 0-30 km was independently related with ischaemic time. In ambulance patients, residential distance of >30-60 and >60-90 km compared with 0-30 km was not independently associated with ischaemic time. CONCLUSION: A longer distance from the patient's residence to a PCI centre was associated with a small but significant increase in time to treatment in 'spoke' patients, however not in ambulance patients. Therefore, referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances (up to 90 km).

Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction.

Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial patency of the infarct related vessel (IRV) and/or clinical outcome compared to in-hospital initiation of HD clopidogrel. From 2001 until 2009 all consecutive ST-Segment Elevation Myocardial Infarction (STEMI) patients who underwent pre-hospital diagnosis and therapy in the ambulance were prospectively included in our single-centre cohort study. We compared initial patency of the IRV and clinical outcome in patients treated from 2001 until June 2006 (in-hospital HD clopidogrel) with patients treated from July 2006 until 2009 (ambulance HD clopidogrel). A total of 2,475 patients with STEMI were registered; of these 1,110 (44.8%) received in-hospital HD clopidogrel and 1,365 (55.2%) received ambulance HD clopidogrel. Ambulance HD clopidogrel was not independently associated with initial patency (TIMI-2/3-flow pre-PCI (odds ratio: 1.18, 95% confidence interval [CI] 0.96-1.44); however, it was associated with fewer recurrent myocardial infarctions at 30 days (hazard ratio [HR]: 0.45, 95% CI 0.22-0.93) and at one year (HR: 0.45, 95% CI 0.25-0.80). No difference in TIMI 2/3 flow post-PCI, major bleeding, mortality, MACE - and the combination of mortality and recurrent myocardial infarction at 30-days and at one year was present between the two groups. In conclusion, early in-ambulance as compared to in-hospital initiation of HD clopidogrel in STEMI patients did not improve initial patency of the IRV or clinical outcome, except for a reduction of recurrent myocardial infarction. Therefore, early administration of HD clopidogrel seems to have net clinical benefit for these patients.

What bothers the sick-listed employee with severe MUPS?

AIMS: The aim of this study was to explore what employees with severe medically unexplained physical symptoms (MUPS) experience as causes of distress with regard to employees with mild or no MUPS. METHODS: This study is an additional analysis of a cross-sectional study in which 486 sick-listed employees, were assessed with Patient Health Questionnaire (PHQ)-15 for self-rated levels of MUPS. A cut-off score of 15 (≥15) was used to categorise employees with severe MUPS. Distress was qualitatively categorised with the answers on the open question in the PHQ-15 "if you experience distress at this moment, what are you distressed about?" RESULTS: Sick-listed employees with severe MUPS were most distressed by their medical, mental, and financial problems. Employees with mild or no MUPS by their medical, work-related, and return to work-related problems. Employees with severe MUPS had more often distress by their mental and financial problems, compared to the employees with mild and no MUPS, who had more often no problems. CONCLUSIONS: There are differences in the causes of distress in sick-listed employees with severe MUPS compared to those with mild or no MUPS. Exploring these causes create possibilities for the physician to improve the quality of explanations and reassurance to the employee and to remove barriers for the return to work process.

Sickness absence due to mental health disorders--a societal perspective.

BACKGROUND: Sickness absence (SA) is affected by societal factors. Increasing socioeconomic stress may cause or worsen mental health disorders, which are among the most frequent causes of SA. Employees may also be more cautious about being absent, for example in times of poor economy. AIMS: To monitor the incidence of SA due to mental health disorders in the Netherlands from 2001 to 2010. METHODS: Descriptive observational study of long-term (> 3 weeks) SA available from an occupational health service register. The incidence of both total and mental health long-term SA in each year was calculated and evaluated alongside the changes in SA compensation policies, gross national product and national unemployment statistics. The incidence of mental health SA was stratified based on the economic (agricultural, industrial, private, public) sector. RESULTS: The incidence of both total and mental health SA decreased gradually since 2004, and fell during the economic recession in 2009 in all economic sectors, particularly the agricultural and industrial sectors. The incidence of mental health SA increased with preliminary economic recovery in 2010 in the private and public sectors, but not in the agricultural and industrial sectors. CONCLUSIONS: Long-term SA due to mental health disorders has decreased since 2004, but further studies across countries are required to confirm and explain this trend.

Employees sick-listed with mental disorders: who returns to work and when?

PURPOSE: To investigate return to work (RTW) in employees sick-listed with mental disorders classified according to the International Classification of Diseases (ICD). METHODS: Sickness absences (SA) medically certified as emotional disturbance (ICD-10 R45) or mental and behavioral disorders (ICD-10 F00-F99) were retrieved from an occupational health service register. RTW was associated with age, gender, and socioeconomic position (SEP) by parametric survival analysis. RESULTS: Emotional, neurotic, somatoform, stress-related, and mood disorders encompassed 94 % of all mental SA. Employees with emotional disturbance had the highest RTW rates: after 1 year 95 % had resumed work and after 2 years 98 % compared to 89 and 96 % of employees with neurotic, somatoform and stress-related disorders, and 70 and 86 % of employees with mood disorders. The probability of RTW decreased after 1 month of SA due to emotional disturbance, 2 months of SA with neurotic, somatoform and stress-related disorders, and 3 months of SA with mood disorders. Women resumed their work later than men. Young employees presenting with emotional disturbance, neurotic, somatoform, and stress-related disorders had earlier RTW than older employees and low-SEP employees had earlier RTW than high-SEP employees. CONCLUSIONS: RTW rates and probabilities differed across categories of mental disorders. Age and SEP were associated with RTW of employees with emotional, neurotic, somatoform, and stress-related disorders, but not with RTW of employees experiencing mood disorders. To maximize the likelihood of RTW, a focus on RTW is important in the first months after reporting sick with mental disorders.

Return to work after cancer diagnosed in 2002, 2005 and 2008.

INTRODUCTION: Improvements in diagnosis and treatment of cancer have increased cancer survival. This study investigated the trends in return to work (RTW) after cancer. METHODS: All employees absent from work due to cancer diagnosed in 2002 (N = 1209), 2005 (N = 1522), and 2008 (N = 1556) were selected from an occupational health service register. Partial RTW was defined as resuming work with 50% of earnings and full RTW as resuming work with 100% of earnings. The percentages of partial and full RTW were determined 2 years after reporting sick and compared with percentages of partial and full RTW after cardiovascular disorders. The time to partial and full RTW after cancer in 2005 and 2008 was compared with the time to RTW in 2002. RESULTS: Partial RTW decreased from 85% 2 years after cancer diagnosis in 2002 to 80% in 2005 and 69% in 2008. Full RTW decreased from 80% 2 years after cancer diagnosis in 2002 to 74% in 2005 and 60% in 2008. RTW after cardiovascular disorders showed similar changes. The time to partial RTW in 2008 was longer than in 2002 after gastrointestinal cancer and lung cancer. The time to full RTW in 2008 was longer than in 2002 after breast cancer, gastrointestinal cancer and lung cancer. CONCLUSIONS: In the past decade, the percentages of employees who resumed work after cancer have decreased in The Netherlands, while the time to RTW increased. Possible explanations include changes in disability policy, economic decline, and resulting decreases in work latitude and workplace accommodations.

Trends in return to work of breast cancer survivors.

Most women interrupt their work activities during the treatment of cancer. This study investigated return to work (RTW) after treatment of breast cancer in the period from January 2002 to December 2008. ArboNed Occupational Health Service records the sickness absence and RTW data of more than one million workers of whom approximately 40% are women. Incident cases of sickness absence due to breast cancer (ICD-10 code C50) were selected from the ArboNed register. Proportions of partial RTW, with 50% of the earnings before sickness absence, and full RTW were determined 1 year after diagnosis. Trends in partial RTW and full RTW were examined by Chi-square trend analysis. The time to partial RTW and full RTW was analysed by Cox regression and stratified by age (<40 years, 40-50 years and >50 years). The proportion of partial RTW was stable around 70% from 2002 to 2008. The proportion of full RTW decreased from 52% in 2002 to 43% in 2008 and showed a linear decline in women of all ages. The time to partial RTW and full RTW in the years 2003-2008 did not change significantly compared with 2002. In the Netherlands, the proportion of employed women who fully resumed working after breast cancer within 1 year of diagnosis has decreased since 2002. These results warrant more epidemiological research to examine the trends in RTW of breast cancer survivors across countries.

The history of registered sickness absence predicts future sickness absence.

BACKGROUND: The history of sickness absence has been found to predict future sickness absence. AIMS: To establish the review period of historical sickness absence data that is needed to predict future sickness absence. METHODS: The individual number of days and episodes of sickness absence were ascertained for 762 hospital employees from 2004 to 2008 inclusive. Past sickness absence was included stepwise in ordinal regression models. The explained variance of the ordinal regression models reflected the extent to which future sickness absence could be predicted and was expressed in percentages calculated as Nagelkerke's pseudo R(2) × 100%. RESULTS: A total of 551 employees (72%) had complete data and were eligible for regression analysis. Days of sickness absence in the past year predicted up to 15% of future days of sickness absence. Adding the sickness absence data of the past 2 or 3 years did not further increase the predictability of days of sickness absence. Episodes of sickness absence in the past year predicted up to 25% of future episodes of sickness absence. The predictability of episodes of sickness absence increased to 30% when the past 2 years of sickness absence were included in the regression model, but did not further increase when sickness absence of the past 3 years was included. CONCLUSIONS: Employees who are more likely to have an above average sickness absence can be identified from their history of sickness absence in the past 2 years.

Resuming work after cancer: a prospective study of occupational register data.

INTRODUCTION: Long-term employment rates have been studied in cancer survivors, but little is known about the return to work of cancer patients. This study investigated return to work (RTW) within 2 years after the diagnosis of different types of cancer. METHODS: This prospective study investigated the associations of demographics (age, gender, socioeconomic status, and residential region) and occupational factors (occupation, duration of employment, and company size) of employees absent from work due to cancer with the time to partial RTW, defined as working at least 50% of the earnings before sickness absence. Likewise, the associations of demographics and occupational factors with full RTW at equal earnings as before sickness absence were investigated. RESULTS: The cohort included 5,234 employees who had been absent from work due to cancer between January 2004 and December 2006. The time to partial RTW was shortest among employees with skin cancer (median 55 days) and longest among employees with lung cancer (median 377 days). There were no significant associations between RTW and demographics. With regard to the occupational factors, employees in high occupational classes started working earlier than those in low occupational classes, but the time to full RTW did not differ significantly across occupational classes. Employees working in large companies returned to work earlier than those working in small companies. CONCLUSION: RTW after different types of cancer depended on occupational factors rather than demographics.

Return to work following sickness absence due to infectious mononucleosis.

BACKGROUND: Epstein-Barr virus infectious mononucleosis among adults is notorious because of the prolonged incapacitating fatigue it causes. AIMS: To investigate the duration of sickness absence and return to work following infectious mononucleosis. METHODS: Episodes of sickness absence due to infectious mononucleosis were selected from an occupational health services register. The duration of sickness absence and return to work was assessed with Kaplan-Meier survival analysis. RESULTS: Two thousand one hundred and thirty-seven episodes of absence due to infectious mononucleosis had a median duration of 91 days. Young employees (aged 15-24 years) had the highest return to work rates. Women had longer sickness absence than men. Employees working in small companies were absent longer than employees in large companies. CONCLUSIONS: Occupational physicians should advise gradual return to work, starting 4 weeks after the onset of the illness, in order to prevent physical deconditioning and prolonged illness.

Recurrence of medically certified sickness absence according to diagnosis: a sickness absence register study.

INTRODUCTION: Sickness absence is a major public health problem. Research on sickness absence focuses on interventions aimed at expediting return to work. However, we need to know more about sustaining employees at work after return to work. Therefore, this study investigated the recurrence of sickness absence according to diagnosis. METHODS: We analyzed the registered sickness absence data of 137,172 employees working for the Dutch Post and Telecom. Episodes of sickness absence were medically certified, according to the ICD-10 classification of diseases, by an occupational physician. The incidence density (ID) and recurrence density (RD) of medically certified absences were calculated per 1,000 person-years in each ICD-10 category. RESULTS: Sickness absence due to musculoskeletal disorders had the highest recurrence (RD = 118.7 per 1,000 person-years), followed by recurrence of sickness absence due to mental disorders (RD = 80.4 per 1,000 person-years). The median time to recurrent sickness absence due to musculoskeletal disorders was 409 days after the index episode. Recurrences of sickness absence due to musculoskeletal disorders accounted for 37% of the total number of recurrent sickness absence days. For recurrences of sickness absence due to mental disorders this was 328 days and 21%, respectively. Unskilled employees with a short duration (<5 years) of employment had a higher risk of recurrent sickness absence. CONCLUSIONS: Interventions to expedite return to work of employees sick-listed due to musculoskeletal or mental disorders should also aim at reducing recurrence of sickness absence in order to sustain employees at work.

Occupational rewards relate to sickness absence frequency but not duration.

Work stress is an important problem that shifted sickness absence research to the psychosocial work environment at the expense of physical or chemical hazards. Most studies investigated the psychosocial work environment using the Demand-Control model. However, this model does not consider coping styles which are important in absenteeism. The Effort-Reward Imbalance model takes coping into account. Little is known about occupational rewards and their relationship with sickness absence. This study investigated the relations between occupational rewards and the frequency and duration of sickness absence among 366 workers. The data of 326 employees (89%) were suitable for statistical analysis. Rewards in terms of job esteem (OR = 0.64; 95% CI = 0.47-0.87) and job perspectives (OR = 0.59; 95% CI = 0.57-0.84) were negatively related to the absence frequency in men. Satisfaction with income (OR = 0.53; 95% CI = 0.35-0.81) was negatively related to the absence frequency in women. Occupational rewards were not associated with the mean duration of absence episodes. The associations we found warrant more attention for occupational rewards in sickness absence research.

Marked reduction of early stent thrombosis with pre-hospital initiation of high-dose Tirofiban in ST-segment elevation myocardial infarction.

BACKGROUND: No randomized comparisons are yet available evaluating the effect of pre-hospital high dose tirofiban on the incidence of early stent thrombosis after primary percutaneous coronary intervention (PCI). OBJECTIVES: The aim of this analysis was to evaluate whether routine pre-hospital administration of high-dose tirofiban in ST-segment elevation myocardial infarction (STEMI) decreases the incidence of early stent thrombosis after primary PCI. PATIENTS/METHODS: The Ongoing Tirofiban in Myocardial Evaluation (On-TIME) 2 trial was a prospective multicenter study of consecutive STEMI patients referred for primary PCI in which patients were randomized to pre-hospital no high-dose tirofiban/placebo. We examined the incidence of Academic Research Consortium definite and probable early stent thrombosis and determined predictors and outcome of early stent thrombosis. RESULTS: Primary PCI was performed in 1203 out of 1398 patients (86.1%). In 1073 patients (89.2%) a coronary stent was placed. Early stent thrombosis occurred in 39 patients (3.6%). Pre-hospital initiation of high-dose tirofiban significantly reduced early stent thrombosis (2.1% vs. 5.2%, P = 0.006) and was associated with a lower incidence of urgent repeat PCI (1.9% vs. 5.2%, P = 0.005). Early stent thrombosis, as well as pre-hospital initiation of high-dose tirofiban, was independently associated with 30-day mortality. CONCLUSIONS: Pre-hospital initiation of high-dose tirofiban reduces the 30-day incidence of stent thrombosis in STEMI patients treated with primary PCI and stenting. Early stent thrombosis and pre-hospital initiation of high-dose tirofiban were independent predictors of 30-day mortality.

Trends in the incidence of sickness absence due to common mental disorders between 2001 and 2007 in the Netherlands.

BACKGROUND: Mental disorders are an important public health problem because of their prevalence and the probability of long-term work disability. The incidence of sickness absence with mental disorders has increased between 1985 and 2000, but little is known about trends in recent years. This study investigated the incidence of sickness absence due to common mental disorders in the Netherlands from 2001 to 2007. METHODS: Observational study in about 1 million employees, working in various economic sectors, representative for the Dutch workforce. Sickness absence episodes were medically certified by an occupational physician utmost in the fifth week of absence. The 12-month incidence of medically certified sickness absence was calculated for each year by dividing incident episodes by the number of employees. Sick days due to common mental disorders were computed as percentage of the total number of medically certified sick days. RESULTS: The 12-month incidence of sickness absence due to common mental disorders was 2.2% in 2001, increased to 2.7% in 2004 and decreased thereafter to 2.0% in 2007. The percentage of sick days due to common mental disorders was highest in the education sector (39%) followed by financial services (31%) and health care (30%). CONCLUSIONS: In the Netherlands, the incidence of sickness absence with common mental disorders was highest in 2004 and has decreased since then probably because of changes in sick leave compensation, economic market position and company policies.

Psychosocial work conditions and registered sickness absence: a 3-year prospective cohort study among office employees.

PURPOSE: To investigate associations between a wide variety of psychosocial work conditions and sickness absence in a medium-sized company. METHODS: Prospective cohort study of 395 employees working in an insurance office. Self-reported psychosocial work conditions were measured by questionnaire in January 2002 and linked to registered sickness absence in the period January 2002 to December 2004 adjusting for earlier sick leave and psychological distress. RESULTS: The questionnaires of 244 employees were eligible for analysis. Decision authority and co-worker support were associated with sickness absence days, but their associations with sickness absence episodes were not significant. Role clarity was associated with the number of sickness absence days, but only with the number of short sickness absence episodes in women. CONCLUSIONS: The wide variety of investigated psychosocial work conditions contributed little to the explanation of sickness absence in the medium-sized insurance office.

Which work factors determine job satisfaction?

BACKGROUND: Job satisfaction is associated with mental health. Employees could be counselled on how they feel about their work. If specific aspects of their job are causing particular dissatisfaction, they could be assisted to appropriately change these aspects. OBJECTIVE: There is no 'gold standard' indicating the aspects that should be taken into account when job satisfaction is measured. This study investigated which work factors determine job satisfaction. METHOD: A self-report questionnaire was sent to a random sample of 822 out of 1908 active employees. The questionnaire examined overall job satisfaction as well as satisfaction with specific work aspects using valid single-item measures. RESULTS: The response rate was 63%. Overall job satisfaction was 5.3 +/- 1.3 on a Likert-scale ranging from 1 (strongly disagree) to 7 (strongly agree). The work factors explained 54% of the variance in job satisfaction. Specific satisfaction with task variety, colleagues, working conditions, and workload were positively related to overall job satisfaction, as were career perspectives and job autonomy. CONCLUSION: Task variety, working conditions, workload, and career perspectives determine the greater part of job satisfaction. An instrument including these factors would provide beneficial information beyond current measures of job satisfaction.

Sickness absence due to depressive symptoms.

OBJECTIVE: There is no information on the duration of absence of depressed Dutch workers. The aim of this study was to determine the duration of sickness absence due to depressive symptoms in the working population. METHODS: In this observational study of 15% of the Dutch working population, all absence episodes (n = 9,910) starting between April 2002 and November 2005 diagnosed as depression were selected. For these episodes, Kaplan-Meier survival curves were computed. RESULTS: The mean (and median) duration of sickness absence due to depressive symptoms was 200 (179) days in men and 213 (201) days in women. In both sexes, older employees had longer absence durations. Depressive symptoms had an estimated rate of chronicity (1 year of absence) of 24%. Employees in educational and public services (232 days in men and 242 days in women), commercial services (213 days in men and 219 days in women) and health care (212 days in men and 214 days in women) had the longest mean duration of absence with depressive symptoms. Men in the industrial sector (189 days) had the shortest absence periods. Employees in large sized companies (188 days in men and 208 days in women) had shorter absence episodes as compared to companies with less than 75 employees (214 days in men and 226 days in women). CONCLUSIONS: Workers with depressive symptoms were absent for a long time. Explanations for the long duration are discussed. It is recommended to develop and apply tools for recognizing employees at risk for chronic depression.

Frequent and long-term absence as a risk factor for work disability and job termination among employees in the private sector.

OBJECTIVES: Frequent and long-term absentees were monitored over 5 years with regard to the risk of work disability and job termination. METHODS: A prospective longitudinal cohort study in 53,990 employees of Dutch postal and telecommunications companies. In the first year of the study, employees who were absent four times or more (frequent absentees; n = 4126), for 6 weeks or more (long-term absentees; n = 3585), and combined frequent and long-term absentees (n = 979) were distinguished, together with a reference population consisting of 45,300 employees. The disability rate (defined as the number of employees who were absent for >1 year per 100 employee-years) and the risk of job termination were determined over a period of 4 years. RESULTS: In the reference population, women had a higher disability rate (2.2 per 100 employee-years) than men (0.8 per 100 employee-years). Frequent absentees had a disability rate amounting to 2.5 per 100 employee-years in men and 4.2 per 100 employee-years in women. Long-term absentees had a disability rate of 6.7 per 100 employee-years in men and 9.1 per 100 employee-years in women. Combined frequent and long-term absentees had an even higher disability rate. The risk of employment being terminated (involuntarily) was higher in prior absentees as compared with the reference population (RR = 1.2-2.1 for job termination and RR = 1.5-2.5 for involuntary job termination). In men, absences due to neoplasms, mental disorders and respiratory disorders were associated with an increased disability risk as compared with musculoskeletal disorders. Neoplasms and mental disorders were also associated with a higher risk of job termination in men, whereas infectious and neurological diseases were associated with a higher risk of job termination in women. CONCLUSIONS: Prior frequent and/or long-term absentees show high work disability in a 4-year follow-up period. Moreover, they are at higher risk of (involuntary) job termination.

Job demands and health complaints in white and blue collar workers.

BACKGROUND: General health in the working population is thought to depend on working conditions. OBJECTIVE: This survey studied job demands and health complaints in working white and blue collar employees. We expect physical and psychological job demands to be differentially distributed among white and blue collar workers. Do they report health complaints consistent with their working conditions? METHOD: Cross-sectional study of 323 white and 383 blue collar workers. They completed the Basic Occupational Health Questionnaire, a valid and reliable self-report questionnaire about health, work and working conditions. The results were analysed using Chi-square and logistic regression analysis, controlling for educational level as a proxy of socioeconomic status. RESULTS: The questionnaires of 280 white and 251 blue collar workers were suitable for analysis. White collar workers reported higher psychological job demands, and blue collar workers reported higher physical demands. In both occupational groups, low back pain, fatigue and upper respiratory complaints were most common. The rates of low back pain and pain in the lower extremity were higher in blue collar workers, as were regular headaches, pain in the cardiac region and feeling sleepy. However, these relationships substantially weakened when the educational level was adjusted for. CONCLUSIONS: Despite the differential distribution of job demands, white and blue collar workers reported similar health complaints. Health in the working population depended predominantly on socioeconomic status. Interventions to improve general health of employees should be directed at their socioeconomic position instead of working conditions.