Exploring expected and perceived facilitators and barriers of an indicated prevention strategy to prevent future long-term sickness absence; a qualitative study among employers and employees.

BACKGROUND: An indicated prevention strategy (IPS), consisting of a screening questionnaire and early treatment, was found to be effective for the prevention of future long-term sickness absence (LTSA) in two large Dutch RCT's. This IPS aims to detect employees who have a high risk to become absent, and subsequently offer them early treatment. Despite the overall effectiveness, only a few companies have implemented this strategy so far. This suggests that companies may not be convinced of the (cost) effectiveness of this strategy yet. In companies where IPS has been implemented, screenings uptake and adherence to early treatment appeared to be moderate, indicating that both employees and employers might perceive barriers. METHODS: The aim of this qualitative study was to explore the expected and perceived facilitators and barriers for the implementation of the IPS. Semi-structured interviews were conducted with 9 employers and 11 employees (acquainted and unacquainted with IPS) from large companies. Purposive sampling was used to recruit participants. All interviews were transcribed and analyzed thematically. RESULTS: The employers believed they were primarily responsible for psychological and work-related health complaints and SA, while the employees felt responsible for health complaints related to their lifestyle. According to the employees, the responsibility of the employer was solely related to work-related health. This finding exposed a relation with the health culture, which was solely based on creating a safe work environment, omitting psychological health issues. The efficacy of this IPS regarding reducing SA was estimated positive, however, the efficacy regarding LTSA was questioned. Fear of a privacy breach was often mentioned by the respondents as an important barrier. CONCLUSIONS: This study showed that the health culture within a company may be important for the perceived responsibility towards SA and health. A health culture which primarily focuses on physical complaints may raise barriers for the adoption and implementation of this preventive strategy. Participant' perceptions of the nature of LTSA and the fact that not all participants were familiar with the exact content and phasing of IPS may have doubted the efficacy regarding LTSA. This study provides important clues for future and improved implementation of IPS.

The course of complaints of arm, neck and/or shoulder: a cohort study in a university population participating in work or study.

BACKGROUND: Not much is known about the characteristics, course and prognosis of complaints of arm, neck and/or shoulder that have not been caused by a trauma or systemic disease (CANS), in a screened population. This study aims to: (1) describe personal and complaint characteristics in a screened population; (2) describe the course during one-year follow-up, in terms of the three different domains of functioning of the International Classification of Functioning, Disability and Health (ICF); and (3) to explore prognostic factors for the different domains of functioning at one-year follow-up. Additionally, this study aims to investigate the manifestation of selection effects (i.e. tertiary selection effects), in order to understand their impact on the interpretation of results. METHODS: A cross-sectional survey was conducted in a university population. Survey respondents who fulfilled eligibility criteria were asked to participate in a longitudinal cohort study. The course of CANS was assessed in terms of the three ICF domains of functioning. Possible prognostic factors across the different components of the ICF were selected to investigate their influence on outcome at one-year follow-up. Non-response analyses were performed to investigate the presence of tertiary selection effects. RESULTS: The results revealed a population with relatively mild complaints at baseline, and a relatively stable course during follow-up. Because of the small change in scores between baseline and follow-up measurements, examination of prognostic factors was not feasible. The results of the non-response analyses revealed some indications for the potential presence of tertiary selection effects, which may imply that the results obtained are a slight overestimation of the true results. CONCLUSION: The results of this study demonstrate mild complaints at baseline and an overall stable course during one-year follow-up. Since selection effects cannot be ruled out, the true course might possibly be somewhat less favourable than our results suggest.

The impact of work-related and personal resources on older workers' fatigue, work enjoyment and retirement intentions over time.

This study aims to examine the impact of work-related and personal resources on older workers' retirement intentions by studying the pathways (fatigue and work enjoyment) from resources to retirement intentions, the buffering role of resources for psychological job demands, in a cross-sectional and longitudinal timeframe. Longitudinal results on a subsample of full-time, older workers (n = 1642) from the Maastricht Cohort Study suggest that over four years of follow-up personal resources like personal mastery and perceived health related to less (prolonged) fatigue and more work enjoyment. Personal mastery also related to later retirement intentions. A work-related resource like decision authority related to less prolonged fatigue. (Prolonged) fatigue related to earlier retirement intentions, suggesting that fatigue may be a pathway to early retirement. Finally, little evidence was found for effect modification by resources. This prospective study indicates that work-related and personal resources may be useful for prolonging working careers. Practitioner Summary: To date, the impact of work-related and personal resources on older workers' retirement intentions is rarely studied. As this prospective study shows that resources may impact older workers' (prolonged) fatigue, work enjoyment and retirement intentions, the monitoring and fostering of resources is of importance for prolonging their working careers.

Towards a preventive strategy for complaints of arm, neck and/or shoulder (CANS): the role of help seeking behaviour.

BACKGROUND: When developing an effective early preventive strategy for employees and students with CANS (Complaints of Arm, Neck or Shoulder, not caused by acute trauma or systemic disease), insight in help seeking behaviour and knowledge of factors associated with help seeking behaviour within the target population, is a prerequisite. The aim of this study was to examine whether perceived hindrance is associated with help seeking behaviour, specifically in employees and students identified with CANS. Additionally, the associations of factors related to functioning and participation, work-environment and demographics with help seeking behaviour were explored in these groups. METHODS: A cross-sectional survey was conducted among employees and students of two universities in the South of the Netherlands. The questionnaire included questions to assess (1) demographics, work/study and activity related factors (2) experience of CANS (3) perceived hindrance (4) help seeking behaviour. A subpopulation of the survey, consisting of those employees and students with self-reported CANS, received additional questionnaires to examine the impact of (1) participant characteristics (2) complaint and health related variables (3) functioning and participation (4) work-environment and social support, on help seeking behaviour. RESULTS: 37.3% of the employees and 41.4% of the students reported CANS. Of these, respectively 43.3% and 45.5%, did not seek help and had no intention to seek help either. Employees and students who had not sought help reported less hindrance, less perceived disabilities and shorter duration of complaints, compared those who did seek help. Employees and students within this group who had also no intention to seek help, perceived fewer disabilities and reported shorter duration of complaints. CONCLUSION: The absence of help seeking behaviour in respondents with CANS is a bottleneck for implementation of preventive strategies. In employees and students with CANS, help seeking behaviour is primarily determined by factors related to experienced hindrance. Our findings emphasize the need to tailor preventive strategies, in order to optimize screening and participation in early interventions for CANS.

Cardiovascular Morbidity and Mortality Among Working Individuals With Rheumatic Disease: Results From a Large Prospective Cohort Study.

BACKGROUND: Cardiovascular comorbidities are common in rheumatic diseases and are associated with an increased mortality risk but have not been studied in a working population, with less severe disease. Also, the impact of premature cardiovascular mortality on work participation has been neglected until now. OBJECTIVES: The objectives of this study were to evaluate the cardiovascular risk in working individuals with inflammatory rheumatic diseases and to explore whether cardiovascular morbidity and mortality are associated with decreased work participation in this population. METHODS: Employees from 45 companies in The Netherlands (n = 12,140) were prospectively followed up from 1998 onward by annual questionnaires. Data covering 10 years of follow-up was available (1998-2008) for rheumatic and cardiovascular morbidities. Self-reported rheumatic and cardiovascular diseases were verified by clinical review in hospital records in a subsample living in 1 specific region of The Netherlands. Information on the vital status was obtained by linking our records to national registries. Cox proportional hazards models were used to determine the contribution of cardiovascular comorbidity on mortality, with adjustment for confounders. RESULTS: In the sample verified by clinical review, the 10-year risk of developing cardiovascular diseases tended to be increased in workers with inflammatory rheumatic diseases (n = 17) at baseline (relative risk, 2.30; 95% confidence interval [CI], 0.91-5.81) and was significantly increased in those with gout (n = 18) at baseline (relative risk, 3.64; 95% CI, 1.64-8.09) as compared with those without inflammatory rheumatic diseases or gout, respectively. Gout (n = 31; hazard ratio, 4.19; 95% CI, 1.33-13.25) and cardiovascular diseases (n = 206; hazard ratio, 2.19; 95% CI, 1.24-3.84) were significantly related to 10-year mortality. No deaths had occurred in individuals with inflammatory rheumatic diseases during follow-up. CONCLUSIONS: In this study, gout was significantly associated with cardiovascular comorbidity and mortality, but inflammatory rheumatic diseases were not. Decreased work participation in workers with gout and potentially inflammatory rheumatic diseases can be expected because of an increased morbidity but not mortality risk.

Female Bladder Dysfunction Following Boari Bladder Flap Ureteral Reconstruction.

OBJECTIVE: To describe our institution's experience with Boari flap ureteral reconstruction, specifically focusing on the development of postoperative lower urinary tract symptoms (LUTS). METHODS: A retrospective review of all Boari flaps performed at our institution between 2013 and 2023 was performed, excluding patients with urothelial carcinoma and males, given the frequency of LUTS from benign prostatic hyperplasia. Primary outcome was the development of new onset LUTS and subsequent treatment. Secondary outcomes included postoperative infections and ureteral stricture. RESULTS: Twenty-nine total patients were identified. Mean age was 52.2 years (standard deviation (SD) 13.1). Mean follow-up was 22.3 months (SD 25.3). Primary reasons for ureteral reconstruction were radiation damage (37.9%) and iatrogenic surgical injury (37.9%). A concurrent psoas hitch was performed in 18/29 (62%) cases, nephropexy was utilized in 1/29 (3.4%) cases, and contralateral bladder pedicles were ligated in 10/29 (34.5%) for increased bladder mobilization. Postoperatively, 8 patients (27.6%) developed new-onset LUTS, effectively managed with oral anticholinergics. Recurrent urinary tract infections occurred in 5 patients (17.2%) and pyelonephritis in 1 (3.4%) patient. Two patients (6.9%) developed ureteral strictures, one treated with ileal ureter replacement and the other with ureteral balloon dilation. CONCLUSION: Boari bladder flap ureteral reconstruction leads to moderate rates of new onset LUTS postoperatively, which is important information when counseling women on reconstructive options. Boari flap ureteral reconstruction has a high success rate, and serious complications are rare. In the setting of ureteral injury, reconstruction using Boari flaps with or without psoas hitch should be considered for definitive management.

Opportunities, barriers and facilitators of an indicated prevention strategy to prevent future long-term sickness absence in SMEs: A qualitative study.

BACKGROUND: The efficacy of an indicated prevention strategy for long-term absence due to sickness has been demonstrated and is implemented in multinational companies. Such a strategy may also be beneficial for small and medium-sized enterprises (SMEs). However, due to the different contexts, adoption, and implementation of this strategy in SMEs may be quite different. OBJECTIVE: This study aims to investigate the opportunities, barriers, and facilitators for adoption and implementation of this preventive strategy, as anticipated by employers and employees of SMEs. METHODS: A qualitative needs assessment was conducted using semi-structured interviews with higher managers (n = 15) and a focus group with employees (n = 8). Purposive sampling was used, and data were analyzed using content analysis. RESULTS: Employers had positive expectations concerning the gains of the preventive strategy, whereas employees had more reservations. Anticipated gains and intentions to implement the preventive strategy were rooted in underlying conceptions of the causes of sickness absence and the responsibilities of stakeholders. One key barrier shared across employers and employees concerned the potential lack of confidentiality. For employees, the role of the occupational health professional in the prevention of sickness absence was perceived as uncommon. Employers stressed lack of capacity and resources as a barrier, whereas employees stressed lack of follow-up by the employer as a barrier. CONCLUSIONS: SMEs are considerably receptive to the implementation of an indicated prevention strategy for long-term absence. Insight into the barriers and facilitators gives clues for wider and optimal implementation across a wider range of organizational settings.

Chronic conditions and self-perceived health among older employees in relation to indicators of labour participation and retirement over time.

BACKGROUND: A significant proportion of older employees leave the labour market early, amongst others via unemployment or disability benefits, implying that health might affect possibilities to extend working life. OBJECTIVE: This study 1) examined associations between chronic conditions (subtypes) and self-perceived health (SPH), independently, and indicators of labour participation and retirement over six-year follow-up among older employees, and 2) explored the impact of differences between prevalent and incident presence of chronic condition(s) in this relation. METHODS: Older workers (aged > 45 years) included in the Maastricht Cohort Study were studied (n = 1,763). The Health and Work Performance Questionnaire assessed chronic conditions and one item from the Short Form health survey-36 assessed SPH. Cox regression analyses assessed associations between chronic conditions and SPH, independently, and retirement intentions, employment status, decreasing working hours, and changes in work over time. RESULTS: Employees with coexistent physical-mental chronic conditions showed higher risks to lose employment and to receive a disability benefit (HR 1.85, 95% CI 1.23-2.78; HR 8.63, 95% CI 2.47-30.11) over time compared to healthy employees. No statistically significant associations were found between SPH and indicators of labour participation and retirement over time. Having chronic condition(s) was cross-sectionally associated with lower SPH scores and larger proportion of part-timers -compared to healthy employees. CONCLUSIONS: Chronic condition(s) among older employees were substantially associated with indicators of labour participation and retirement over time. The role of SPH was mainly instantaneous. Findings provide valuable input for preventive measures aiming to prevent an early labour market exit of older employees.

Vaccines against the original strain of SARS-CoV-2 provide T cell memory to the B.1.1.529 variant.

BACKGROUND: The SARS-CoV-2 variant B.1.1.529 potentially escapes immunity from vaccination via a heavily mutated Spike protein. Here, we analyzed whether T cell memory towards the B.1.1.529 Spike protein is present in individuals who received two or three doses of vaccines designed against the original Wuhan strain of SARS-CoV-2. METHODS: PBMCs were isolated from two- and three-times vaccinated study participants and incubated in vitro with peptide pools of the Spike protein derived from sequences of the original Wuhan or the B.1.1.529 strains of SARS-CoV-2. Activated antigen-specific T cells were detected by flow cytometry. In silico analyses with NetMHCpan and NetMHCIIpan were used to determine differences in MHC class presentation between the original strain and the B.1.1.529 strain for the most common MHCs in the European-Caucasian population. RESULTS: Here we show, that both CD4 and CD8 responses to the B.1.1.529 Spike protein are marginally reduced compared to the ancestor protein and a robust T cell response is maintained. Epitope analyses reveal minor differences between the two SARS-CoV-2 strains in terms of MHC class presentations for the MHC-alleles being most common in the European-Caucasian population. CONCLUSIONS: The memory T cell response induced via first generation vaccination remains robust and is mostly unaffected by B.1.1.529 mutations. Correspondingly, in silico analyses of MHC presentation of epitopes derived from the B.1.1.529 Spike protein shows marginal differences compared to the ancestral SARS-CoV-2 strain.

Vaccination against SARS-CoV-2 results in the production of proteins called antibodies, that bind and inactivate the virus, and cells that help to eliminate it from the body in a future encounter, such as memory T cells. Both antibodies and memory T cells remain in the body after vaccination with memory T cells being present for longer than antibodies. Here, we determined that even though most of the first generation vaccines were created to prevent infection with the original SARS-CoV-2 virus, the memory T cells generated by this vaccination can also detect the omicron variant.

Prevention of long-term sickness absence and major depression in high-risk employees: a randomised controlled trial.

OBJECTIVES: To examine the efficacy of early intervention on the prevention of long-term sickness absence and major depression among employees at high risk of future sickness absence and with mild to severe depressive complaints. METHODS: Randomised controlled trial conducted among employees working in an office environment. 139 employees were identified both at high risk of future sickness absence and with mild to severe depressive complaints through screening. Subsequently, they were randomly assigned to the intervention group (n = 69) or the control group (n = 70). Objective sickness absence was analysed at 12 and 18 months of follow-up. Depressive complaints were assessed by the Beck Depression Inventory (BDI-II) at baseline, and at 6 and 12 months of follow-up. RESULTS: Intention-to-treat analyses showed a significant difference in total sickness absence duration between the intervention (27.5 calendar days (SD 44.7)) and control group (50.8 days (SD 75.8)) over 12 months of follow-up, a reduction of 46% (p = 0.017). The intervention group showed a non-significantly lower proportion of long-term sickness absence spells compared with the control group (p = 0.127). Statistically significant and clinically relevant differences in depressive complaints were found after both 6 months (p = 0.001) and 12 months (p = 0.005) of follow-up, in favour of the intervention group. Relative risk reductions (RRR) were 19.2% and 19.8% respectively. Sickness absence data were available for all participants over 18 months of follow-up. Questionnaire data were available for 99 (at 6 months) and 90 participants (at 12 months). No adverse events or side effects occurred. CONCLUSIONS: Early intervention in employees with mild to severe depressive complaints and high risk of future long-term sickness absence proved to be effective in preventing/reducing both sickness absence and depressive complaints.

Efficacy of an indicated prevention strategy on sickness absence and termination of the employment contract: a 5-year follow-up study.

OBJECTIVE: It was shown that an indicated prevention strategy (IPS), based on screening and early intervention, can considerably decrease future risk of long-term sickness absence (LTSA>28 days) over one year. Given the nature of the interventions, the potential of an effect extending beyond the original one year of follow-up might be present. This study aims to determine the efficacy of this IPS on LTSA and termination of employment contract over five years by extended follow up of IPS trials. METHODS: Company records on sickness absence and termination of employment contract over five years were used from two randomized controlled trials (RCT) on the efficacy of the IPS (RCT I employees at high-risk for LTSA: intervention: N=263; RCT II high-risk employees with concurrent mild depressive complaints: intervention: N=139). Survival analysis was used to model time until the first LTSA episode and termination of employment contract. RESULTS: RCT I showed a decrease of 43.2 days of sickness absence (P=0.05) and a lower 5-year risk of LTSA in the intervention, as compared to the control group [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.41-0.90], however no considerable impact on employment contract (HR 0.85, 95% CI 0.54-1.35) (intention-to-treat, ITT). For RCT II, we found no large difference in days of SA and no difference in LTSA risk over five years (HR 1.31, 95% CI 0.70-2.47), whereas the risk of termination of the employment contract was lower (HR 0.62, 95% CI 0.39-0.99) (ITT). CONCLUSION: Effects of the IPS were observed over five years, albeit differential between the two approaches. A combination of elements of both interventions might lead to optimal results but needs further study.

Changes in mental health as a predictor of changes in working time arrangements and occupational mobility: results from a prospective cohort study.

OBJECTIVE: The aim of this prospective study was to gain insight into a possible causal relationship between mental health and characteristics of the work situation. METHODS: Using longitudinal data from the Maastricht Cohort Study, this study examines whether deterioration in mental health (prolonged fatigue, need for recovery, and psychological distress) results in a subsequent change in working time arrangements (assessed by means of logistic regression analysis) or occupational mobility (assessed by means of Cox regression analysis). RESULTS: Compared to employees not experiencing a deterioration in mental health, employees who became a prolonged fatigue case were more likely to reduce their working hours (OR 2.49; 95% CI 1.42-4.35) and leave a shift work job (OR 3.44; 95% CI 1.42-8.38). Employees who became a need for recovery case were more likely to reduce their working hours (OR 2.83; 95% CI 1.53-5.26) or change jobs within the company (RR 1.31; 95% CI 1.07-1.61). Employees who became a psychological distress case were more likely to change jobs within the company (RR 1.38; 95% CI 1.16-1.65) or to change jobs from one employer to another (RR 1.45; 95% CI 1.03-2.03). CONCLUSION: The results of this study provide evidence for a possible causal relationship between deterioration in mental health and subsequent change in working time arrangements or occupational mobility. These results suggest that workers adapt to the onset of a mental health problem by reducing their working hours, by leaving a shift work job, by changing jobs within the company, or by changing jobs from one employer to another.

Working Time Society consensus statements: Evidence-based effects of shift work and non-standard working hours on workers, family and community.

Working time arrangements that require shift work or other non-standard working hours have significant potential to encroach on time that is highly valued for family, social and leisure activity. This can often result in workers experiencing poorer work-family or work-life balance. Based on an extensive literature search and expert knowledge, primary risk factors were identified including shift work; long, irregular and unpredictable working hours; and work on evenings and weekends (in combination and independent of shift work). On the other hand, flexibility, in the form of adequate worker control over work schedules, may be a protective factor. In addition, workers experiencing excessive work-life conflict are likely to reduce their working hours, reflecting a reciprocal relationship between working hours and work-life balance. Workers' families are also affected by shift work and non-standard working hours. Parents' shift work is associated with poorer emotional and developmental outcomes for their children, and to a greater likelihood of risky behavior in adolescence. Additionally, the risk of separation or divorce is increased, especially for parents working night shifts. Due to relationships such as those above, the consequences of shiftwork and non-standard working hours on family and social life are largely dependent on a complex interaction between specific work schedules, other aspects of work organization, and family and individual worker characteristics. This article provides an overview of current evidence regarding the relationships between working time arrangements and various social and family variables, and concludes with shift scheduling and intervention recommendations to improve work-life balance and social well-being.

Risk factors for interpersonal conflicts at work.

OBJECTIVES: The main goal of this study was to identify work-related risk factors for the onset of interpersonal conflicts at work. METHODS: Longitudinal data from the Maastricht Cohort Study on "fatigue at work" (N=9241) were used. After the respondents who reported an interpersonal conflict at baseline were excluded, logistic regression analyses were used to determine the role of several work-related risk factors at baseline in the onset of a conflict with coworkers or supervisors after 1 year of follow-up. RESULTS: Higher psychological job demands, higher levels of role ambiguity, the presence of physical demands, higher musculoskeletal demands, a poorer physical work environment, shift work, overtime, and higher levels of job insecurity significantly predicted the onset of both a coworker conflict and a supervisor conflict. Higher levels of coworker and supervisor social support, more autonomy concerning the terms of employment, good overall job satisfaction, monetary gratification, and esteem reward significantly protected against the onset of both a coworker conflict and a supervisor conflict. Higher levels of decision latitude and more career opportunities also significantly protected against the onset of a supervisor conflict. CONCLUSIONS: Several factors in the work environment were related to the onset of interpersonal conflicts at work. Given the rather serious consequences of interpersonal conflicts at work with respect to health and well-being, the observed risk factors can serve as a starting point for effective prevention and intervention strategies in the workplace.

Evaluating Model Fit in Bayesian Confirmatory Factor Analysis With Large Samples: Simulation Study Introducing the BRMSEA.

Bayesian confirmatory factor analysis (CFA) offers an alternative to frequentist CFA based on, for example, maximum likelihood estimation for the assessment of reliability and validity of educational and psychological measures. For increasing sample sizes, however, the applicability of current fit statistics evaluating model fit within Bayesian CFA is limited. We propose, therefore, a Bayesian variant of the root mean square error of approximation (RMSEA), the BRMSEA. A simulation study was performed with variations in model misspecification, factor loading magnitude, number of indicators, number of factors, and sample size. This showed that the 90% posterior probability interval of the BRMSEA is valid for evaluating model fit in large samples (N≥ 1,000), using cutoff values for the lower (<.05) and upper limit (<.08) as guideline. An empirical illustration further shows the advantage of the BRMSEA in large sample Bayesian CFA models. In conclusion, it can be stated that the BRMSEA is well suited to evaluate model fit in large sample Bayesian CFA models by taking sample size and model complexity into account.

Work-family conflict and depressive complaints among Dutch employees: examining reciprocal associations in a longitudinal study.

Objectives The aim of this study was to examine the reciprocal association between work-family conflict and depressive complaints over time. Methods Cross-lagged structural equation modeling (SEM) was used and three-wave follow-up data from the Maastricht Cohort Study with six years of follow-up [2416 men and 585 women at T1 (2008)]. Work-family conflict was operationalized by distinguishing both work-home interference and home-work interference, as assessed with two subscales of the Survey Work-Home Interference Nijmegen. Depressive complaints were assessed with a subscale of the Hospital Anxiety and Depression scale. Results The results showed a positive cross-lagged relation between home-work interference and depressive complaints. The results of the χ 2difference test indicated that the model with cross-lagged reciprocal relationships resulted in a significantly better fit to the data compared to the causal (Δχ 2(2)=9.89, P=0.001), reversed causation model (Δχ 2(2)=9.25, P=0.01), and the starting model (Δχ 2(4)=16.34, P=0.002). For work-home interference and depressive complaints, the starting model with no cross-lagged associations over time had the best fit to the empirical data. Conclusions The findings suggest a reciprocal association between home-work interference and depressive complaints since the concepts appear to affect each other mutually across time. This highlights the importance of targeting modifiable risk factors in the etiology of both home-work interference and depressive complaints when designing preventive measures since the two concepts may potentiate each other over time.

Health effects of transitions in work schedule, workhours and overtime in a prospective cohort study.

OBJECTIVES: The aim of this study was to examine the longitudinal relationship between transitions in work schedules, workhours and overtime and changes in several self-reported health outcomes (general health, fatigue, need for recovery, and psychological distress). METHODS: Three-year follow-up data from the Maastricht Cohort Study on fatigue at work were used. Gender-stratified logistic regression analyses using generalized estimating equations were conducted for each of the dichotomized health outcomes, with control for a range of possible confounding factors. RESULTS: In this study, transitions in worktime arrangements were prospectively related to changes in several self-reported health outcomes. Substantial and significant associations were found for transitions in work schedule and the incidence of prolonged fatigue and for the need for recovery among men. Moreover, transitions in workhours affected the need for recovery among men, while they influenced general health and psychological distress among women. Finally, transitions in overtime were significantly associated with the incidence of the need for recovery among both men and women and with the incidence of psychological distress among men only. CONCLUSIONS: Transitions in worktime arrangements are related to changes in health, and studying transitions might be an important means of gaining insight into a possible causal relationship between employment and health. Given the considerable impact of worktime arrangements on the individual worker, employers, and society and the high frequency in which transitions within worktime arrangements can occur, these findings underline the need for interventions addressing worktime arrangements in order to reduce or prevent their impact on employee health.

Experiences of occupational physicians with the implementation of indicated prevention for long term sickness absence.

BACKGROUND: Functioning including work participation, is an emerging challenge in occupational health. The prevention of long term sickness absence (LTSA) through a strategy involving screening and structured early consultation (preventive strategy) was proven effective and can address participation issues. Implementation of this strategy has proven difficult. OBJECTIVE: The aim of this study is to investigate the experiences of occupational physicians (OPs) delivering a structured early consultation to office workers, in order to enhance implementation of the strategy. METHODS: In this case study, a mixed method design was used. Interviews and surveys were conducted to obtain an in-depth picture of OPs experiences. RESULTS: Factors hindering implementation in relation to the OPs were difficulties in communicating the risk of future sick leave, prioritization of other tasks, maintaining a reactive approach due to work pressure, preference for prevention on the level of the work environment, privacy issues related to labeling workers to have mental or psychosocial issues, and the biomedical model being the mental model in use. CONCLUSIONS: Implementation of the preventive strategy seems to require a more profound focus on the biopsychosocial approach. Training of relevant skills is important to achieve a focus on prevention and fostering health over the lifespan.

Smoking among shift workers: More than a confounding factor.

In studies on the cardiovascular disease risk among shift workers, smoking is considered to be a confounding factor. In a study of 239 shift and 157 daytime workers, it was found that shift work was prospectively related to increased cigarette consumption, indicating that smoking might be in the causative pathway; however, the number of study subjects was too low to warrant sound conclusions. Therefore, data from the Maastricht Cohort study were used to investigate the longitudinal relation between smoking and shift work in a much larger population. In this study, a total of 12,140 employees were followed for two years by means of self-administered questionnaires. The authors compared workers who normally worked during daytime hours only (74%) with those who worked other than day shifts (26%). Logistic regression analyses were performed, adjusting for demographic factors of age, gender, and educational level to evaluate the risk of starting to smoke (n = 25) in the group of non-smoking workers and the risk of quitting (n = 318) in the group of smoking workers. Logistic regression analysis showed a significant association between shift work and taking up smoking during the two-year follow-up (odds ratio: 1.46, p = 0.03). The risk to stop smoking was somewhat lower in shift workers (odds ratio: 0.91) but not statistically significant (p = 0.5). To conclude, this study showed that, independent of educational level, shift workers are more prone to start smoking. This finding might have important implications for studies on the health effects of shift workers and for possible interventions aimed at the reduction of the excess health risk among shift workers.