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Worldwide, millions of office workers use a computer. Reports of adverse health effects due to computer use have received considerable media attention. This systematic review summarises the evidence for a relationship between the duration of work time spent using the computer and the incidence of hand-arm and neck-shoulder symptoms and disorders. Several databases were systematically searched up to 6 November 2005. Two reviewers independently selected articles that presented a risk estimate for the duration of computer use, included an outcome measure related to hand-arm or neck-shoulder symptoms or disorders, and had a longitudinal study design. The strength of the evidence was based on methodological quality and consistency of the results. Nine relevant articles were identified, of which six were rated as high quality. Moderate evidence was concluded for a positive association between the duration of mouse use and hand-arm symptoms. For this association, indications for a dose-response relationship were found. Risk estimates were in general stronger for the hand-arm region than for the neck-shoulder region, and stronger for mouse use than for total computer use and keyboard use. A pathophysiological model focusing on the overuse of muscles during computer use supports these differences. Future studies are needed to improve our understanding of safe levels of computer use by measuring the duration of computer use in a more objective way, differentiating between total computer use, mouse use and keyboard use, attaining sufficient exposure contrast, and collecting data on disability caused by symptoms. [ABSTRACT FROM AUTHOR]

Few studies have examined the concepts of workstyle and overcommitment in relation to the occurrence of neck and upper limb symptoms. The aim of this study was to examine whether a high-risk workstyle is a mediator in the relation of work-related exposure (job demands and computer work) and overcommitment to neck and upper limb symptoms. The study participants comprised 3,855 office workers of a European institute. The Sobel test was applied to test the intermediate effects of 4 workstyle dimensions and of the total workstyle score. The results show that most mediated effects were statistically significant, meaning that the workstyle dimensions acted as a mediator in the relation between work-related exposure and symptoms as well as in the relation between overcommitment and symptoms. Given the results with the total workstyle score, 34% of the effect of prolonged computer work, 64% of the effect of job demands, and 84% of the effect of overcommitment was mediated by workstyle. However, due to possible bias in the assessment of workstyle factor and the cross-sectional design of the study, the conclusions should be drawn with care. [ABSTRACT FROM AUTHOR]

Background: Successful management of workers on sick leave due to low back pain depends on the identification by the occupational physician of modifiable prognostic factors in the early phase of sick-leave. The prognostic value of factors which influence the course of low back pain and return to work in occupational health care is unclear. Methods: Secondary data analysis in a cohort of 299 workers on sick leave between 3 and 6 weeks due to low back pain was applied. We investigated the association of a broad set of prognostic indicators related to characteristics of worker, job, low back pain and psychosocial issues on return to work lasting at least 4 weeks (lasting-RTW) and minimally 1 day of first return to work (first-RTW). Relationships were studied using Cox regression analysis and covered a follow-up period of 12 months. The explained variation of the models was also calculated. Results: The median time to return to work using lasting-RTW and first-RTW was 76 and 71 days respectively. In addition to individual analysis of potential predictive factors a backward selection procedure resulted in the following multivariable model: self-predicted timing of return to work, pain intensity, job satisfaction, social support, pain radiation, expectations of treatment succes of the occupational physician. Similar results were found for first-RTW. The explained variance of the multivariate model of lasting-RTW was 18%. Conclusions: Factors concerning the expectations and beliefs of the worker affected the RTW process. Knowledge of these factors by the occupational physician in the early phase of low back pain and sick-leave may contribute to solutions to promote return to work. [ABSTRACT FROM AUTHOR]

Work related neck and upper limb symptoms have a multi-factorial origin. Possible risk factors are of a physical, psychosocial or personal origin. These factors can reinforce each other and their influence can also be mediated by cultural or societal factors. Initially, most research on neck and upper limb symptoms focused on work-related physical exposure. Nowadays, psychosocial work characteristics are recognized as important risk factors. Various models have been developed to offer frameworks for possible pathways, but their empirical support is still not conclusive.In part I of this paper an overview is presented of the results of recent epidemiological studies on work related psychosocial and personal risk factors for neck and upper limb symptoms. In addition, the interplay between these factors and the possible intermediate role of an individuals work style in this process is explored. In contrast to previous reviews, it is now possible to base the conclusions on the effect of work related psychosocial factors on neck and upper limb symptoms on quite a few longitudinal studies. These studies show that high work demands or little control at work are often related to these symptoms. However, this relationship is neither very strong nor very specific. Perceived stress is studied in not as many studies but more consistently related to neck and upper limb symptoms. This also applies to general distress or other pain (co-morbidity). Job dissatisfaction does not contribute to neck and upper limb symptoms. Too little research on personal characteristics is available to draw any conclusions. It is plausible that behavioural aspects, such as work style, are of importance in the etiology of work related upper limb symptoms. However, studies concerning these factors are promising but too scarce to draw conclusions. Future studies should address these behavioural aspects.In part II, the recent studies on the effectiveness of preventive measures for work related neck and upper limb problems are discussed. Few randomised or non randomised controlled trials have been carried out to evaluate the effectiveness of individual or organisational interventions to improve work related psychosocial factors. Very few have reported on the preventive effect for work related neck and upper limb symptoms. Therefore, there is a great need for additional high quality trials before any conclusions on effectiveness of bio-behavioural interventions for reduction of neck and upper limb problems and return to work after these symptoms can be made. From the low back pain intervention research can be learned that interventions should best be targeted to both the worker and the organisation and that interventions will only be successful when all stakeholders are involved. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to apply the Intervention Mapping approach as a framework in the development of a worksite intervention to improve the work ability of construction workers.Design: Development of an intervention by using the Intervention Mapping approach.Setting: Construction worksite.Participants: Construction workers aged 45 years and older.Measures and Analysis: According to the principles of Intervention Mapping, evidence from the literature was combined with data collected from stakeholders (e.g., construction workers, managers, providers).Results: The Intervention Mapping approach resulted in an intervention with the following components: (1) two individual visits of a physical therapist to lower the physical workload, (2) a Rest-Break tool to improve the balance between work and recovery, and (3) two empowerment training sessions to increase the range of influence at the worksite.Conclusions: Application of Intervention Mapping in the development of a worksite prevention program was useful in the construction industry to obtain a positive attitude and commitment. Stakeholders could give input regarding the program components as well as provide specific leads for the practical intervention strategy. Moreover, it also gives insight in the current theoretical and empirical knowledge in the field of improving the work ability of older workers in the construction industry. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the heterogeneity of psychosocial working conditions of young workers by identifying subgroups of work characteristic configurations within young workers and to assess these subgroups' associations with emotional exhaustion., Design: Latent class analysis. Groups were formed based on 12 work characteristics (8 job demands and 4 job resources), educational level and sex. Differences in emotional exhaustion between subgroups were analysed using analysis of variance and post hoc comparisons., Setting: Data from the 2019 wave of the Netherlands Working Conditions Survey., Participants: 7301 individuals between the age of 18 and 30 years, who worked more than 16 hours per week., Main Outcome Measure: Emotional exhaustion., Results: Five subgroups of work characteristics could be identified and were labelled as: (1) 'low-complexity work' (24.4%), (2) 'office work' (32.3%), (3) 'manual and non-interpersonal work' (12.4%), (4) 'non-manual and interpersonal work' (21.0%), and (5) 'manual and interpersonal work' (9.9%). Mean scores for emotional exhaustion in the two interpersonal work groups (M=3.11, SD=1.4; M=3.45, SD=1.6) were significantly higher than in the first three groups (M=2.05, SD=1.1; M=1.98, SD=1.0; M=2.05, SD=1.1) (all 95% CIs excluding 0). Further, mean scores for emotional exhaustion were significantly higher in the 'manual and interpersonal work' group than in the 'non-manual and interpersonal work' group (95% CI 0.24, 0.45). All results could be replicated in the 2017 and 2021 waves of the Netherlands Working Conditions Survey., Conclusions: Young workers reported heterogeneous work characteristic configurations with substantial differences in degrees of emotional exhaustion between the identified subgroups. Preventing emotional exhaustion should focus on the two interpersonal work subgroups, which showed a high degree of emotional exhaustion. In prevention efforts, these groups' configurations of work characteristics should be taken into account., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: For the general working population, robust evidence exists for associations between psychosocial work exposures and mental health. As this relationship is less clear for young workers, this systematic review aims at providing an overview of the evidence concerning psychosocial work factors affecting mental health of young workers., Methods: The electronic databases used were PubMed, Web of Science, and PsycINFO and were last searched in October 2021. The eligible outcomes included depression-, stress-, burnout- and anxiety-related complaints, and fatigue, excluding clinical diagnoses and suicide-related outcomes. Only studies with workers aged 35 years or younger were included, which reported at least one association between a psychosocial work factor as exposure and a mental health complaint as outcome. Studies had to be in English, German or Dutch. Risk of bias was assessed using an instrument from the National Heart, Lung, and Blood Institute. Data synthesis was conducted using GRADE., Results: In total 17 studies were included in this systematic review, including data from 35,600 young workers in total. Across these studies 86 exposure-outcome associations were reported. Nine exposure-outcome associations could be synthesised. The application of the GRADE framework led to one "low" assessment for the association between psychosocial job quality and mental health. The certainty of evidence for the other eight associations in the synthesis was very low., Conclusions: The current systematic review disclosed a high degree of uncertainty of the evidence due to conceptually fuzzy outcomes and exposures as well as large heterogeneity between studies., (© 2022. The Author(s).)

Aim: Intervention mapping (IM) is a method to systematically design interventions that is applied regularly within the public health domain. This study investigates whether IM is effectively used within the occupational safety and health domain as well. Specifically, this study explores the relation between the fidelity regarding the use of the IM protocol for intervention development, the implementation process and the effectiveness of the occupational risk prevention and health promotion interventions. Methods: A systematic review was conducted including articles on development, implementation, and effects of occupational risk prevention and health promotion interventions that were developed according to the IM-protocol. By means of a checklist, two authors reviewed the articles and rated them on several indicators regarding the fidelity of the IM-protocol, the implementation process, and the intervention effect. Results: A literature search resulted in a total of 12 interventions as described in 38 articles. The fidelity to the IM-protocol was relatively low for participation throughout the development process and implementation planning. No relationship was found between fidelity of the IM-protocol and the intervention effect. A theory-based approach (as one of the core elements of IM) appears to be positively related to a successful implementation process. Conclusion: Results of the review suggest that organizing a participative approach and implementation planning is difficult in practice. In addition, results imply that conducting matrices of change objectives as part of the intervention development, although challenging and time-consuming, may ultimately pay off, resulting in a tailored intervention that matches the target group.

Background: Work stress is an important problem among employees in education in the Netherlands. The present study aims to investigate the effects of a participatory organizational level work stress prevention approach to reduce (quantitative) job demands, increase resources (i.e. autonomy, supervisor and coworker support) and to reduce work stress and increase job satisfaction of employees in primary education., Methods: This study makes use of a multiple case study research design. The stress prevention approach is implemented at 5 primary schools and questionnaires were filled out by 119 employees of the 5 schools at baseline and 1 year later, measuring job demands, resources, work stress, job satisfaction and implementation factors., Results: Multilevel analyses showed a significant decrease in job demands and a significant increase in job satisfaction between baseline and follow up. In addition, employees that were more satisfied with the communication about the intervention showed more improvements in autonomy and job satisfaction. However, employees reporting an increased dialogue in work stress between employees and management showed a smaller decrease in job demands., Conclusion: The study shows a decrease in job demands and an increase in job satisfaction in the schools that implemented a stress prevention approach. Results of the study underline the importance of communication about the intervention as part of the implementation process, impacting the effectiveness of the intervention to improve autonomy and job satisfaction., Trial Registration: ISRCTN registry, study ID: ISRCTN14697835, registration date: 11-10-2019 (retrospectively registered).

Introduction: Precarious employment is associated with poor health. Among employees in precarious employment, those with multiple jobs may face additional health risks, e.g. due to combining work schedules and job roles. Our research question is: do differences in health exist between multiple and single job holders in precarious employment?, Methods: Participants in the Netherlands Working Conditions Survey 2012 aged 25-64 years who were not employed through the Act on Social Work Provision and who had a precarious job were included. To select employees in precarious employment (n = 3,609), latent class analysis was performed, based on variables based on indicators described by Van Aerden. Differences in general self-perceived health, burnout complaints, musculoskeletal health, and sickness absence between multiple and single job holders were studied cross-sectionally using logistic regression analyses., Results: No significant differences were found between multiple and single job holders in precarious employment for self-perceived health (OR = 0.9; 95%CI = 0.7-1.3), burnout complaints (OR = 0.9; 95%CI = 0.7-1.2), and musculoskeletal health (OR = 1.1; 95%CI = 0.8-1.5). In crude analyses, multiple job holders experienced less sickness absence than single job holders (OR = 0.7; 95%CI = 0.5-0.9). In adjusted analyses, this difference was no longer statistically significant (OR = 0.8; 95%CI = 0.6-1.0)., Conclusions: Despite potential health risks related to multiple job holding, we did not find health differences between multiple and single job holders in precarious employment in the Netherlands. More longitudinal research is necessary to provide recommendations for policy makers regarding multiple job holders in precarious employment., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To identify distinct groups of older multiple job holders and to explore health differences between these groups., Methods: We selected respondents from STREAM, a Dutch cohort study among persons aged 45 years and older, who reported having multiple jobs (N = 702). We applied latent class analysis to identify groups of multiple job holders. The association between these groups and health, measured with the SF-12, was studied cross-sectionally and longitudinally (1 year of follow-up), using linear regression analyses., Results: Four groups of older multiple job holders were identified: (1) a vulnerable group (N = 145), who preferred having one job, and had jobs with high demands and low resources; (2) an indifferent group (N = 134), who did not experience many benefits or disadvantages of multiple job holding (MJH); (3) a satisfied hybrid group, who were all self-employed in their second job (N = 310); and (4) a satisfied combination group, who all had a second job as an employee (N = 113). Both the satisfied hybrid and satisfied combination groups preferred MJH and experienced benefits of it. At baseline, the vulnerable group experienced significantly lower physical and mental health than the other groups. We found no significant differences regarding changes in health after 1 year., Conclusions: Four groups of older multiple job holders could be distinguished. The vulnerable group experienced lower physical and mental health at baseline than the other three groups. Policies and interventions supporting vulnerable multiple job holders may need to be developed. Future research is recommended to take heterogeneity among multiple job holders into account.

Background: Multiple job holding (MJH) is a common and growing phenomenon in many countries. Little is known about experiences with MJH among older workers. The objective of the present study is to gain insight in experiences with MJH among Dutch workers aged 45 years and older., Methods: Multiple job holders were selected from the Study on Transitions in Employment, Ability, and Motivation (STREAM), a Dutch cohort study among persons aged 45 years and older. Purposive sampling was applied to assure heterogeneity regarding gender, educational level, health, financial situation, willingness to continue MJH, and type of MJH (only jobs as employee or also being self-employed). Interviews were conducted until data saturation occurred. Fifteen multiple job holders participated in this study (eight men, seven women). Interviews were digitally recorded, transcribed verbatim and analyzed, along with field notes, using thematic content analysis. The data were openly coded, after which codes were aggregated into themes, which formed a thematic map. In each phase of the analysis at least two researchers were involved to increase reliability., Results: Experiences with MJH varied from positive to negative. They were influenced by characteristics of individual jobs, e.g. social support at work, as well as characteristics of the combination of jobs, e.g. positive spill-over effects, and conflicts between work schedules. The personal context of multiple job holders, e.g. their age, or reason for MJH, affected how work characteristics influenced experiences. Negative experiences with one job often coincided with negative experience in the other job(s), and problems in the personal context. Some multiple job holders were able to make changes to their situation when desired. For some, this was not possible, which augmented their negative experience., Conclusions: This study adds to existing knowledge that experiences with MJH are not only influenced by work characteristics but also by the personal context of multiple job holders, and that some workers are able to change their situation when desired, while others are not. Future research should study how different combinations of work and personal characteristics influence sustainable employability of multiple job holders. Policies facilitating life-long learning could increase opportunities to change the MJH situation when desired.

Purpose: To evaluate the effectiveness of an individually tailored intervention for improvement in lifestyle behavior, health indicators, and prevention and reduction of overweight among construction workers., Design: Randomized controlled trial., Setting: Various blue-collar departments of a large construction company in the Netherlands., Participants: Blue-collar workers randomized to an intervention (n = 162) or a control group (n = 152)., Intervention: The intervention group received individual coaching sessions, tailored information, and materials to improve lifestyle behavior during a 6-month period, and the control group received usual care., Measures: Body weight, body mass index (BMI), waist circumference, physical activity (PA) levels, dietary behavior, blood pressure, and blood cholesterol were assessed., Analysis: Effectiveness of the intervention on outcome measures at 6- and 12-month follow-up was assessed by using linear and logistic regression models adjusting for baseline levels., Results: After 6 months, a statistically significant intervention effect was found on body weight ( B = -1.06, P = .010), BMI ( B = -0.32, P = .010), and waist circumference ( B = -1.38, P = .032). At 6 months, the percentage of those meeting public health guidelines for PA increased significantly in the intervention group compared to the control group ( B = 2.06, P = .032), and for sugar-sweetened beverages, an intervention effect was found at 6 months as well ( B = -2.82, P = .003). At 12 months, for weight-related outcomes, these differences were slightly smaller and no longer statistically significant. The intervention was not effective on the total amount of moderate to vigorous PA and other dietary and health outcomes., Conclusion: Intervention participants showed positive changes in vigorous PA and intake of sugar-sweetened beverages compared to controls, as well as effects on weight-related outcomes at 6 months. Long-term effects were still promising but not statistically significant.

Purpose: Multiple job holding (MJH) is common in many countries, but little is known about its (health) consequences. Our aim is to explore the longitudinal association between MJH and long-term sickness absence (LTSA) among Danish employees., Methods: We included employees (N = 8968) who participated in the Danish Work Environment Cohort Study (DWECS), based on a representative sample of the Danish working population. Three dichotomous independent variables were created: MJH in general, combination MJH (i.e. second job as employee) and hybrid MJH (i.e. self-employed in second job). LTSA (≥5 weeks) was measured using the Danish Register for Evaluation of Marginalization during 78 weeks of follow-up. Potential confounders included demographics, health, and work characteristics. Logistic regression analyses were performed to study whether LTSA was associated with MJH in general, combination MJH, and hybrid MJH. Interaction effects for gender, age, total working hours per week (≤37 or >37 h a week), and shift work were tested., Results: In total, 11.7% (N = 1048) of the respondents reported having multiple jobs and 7.6% (N = 678) experienced LTSA during follow-up. After adjustment for confounders, no significant association between LTSA and MJH in general (OR = 0.82), combination MJH (OR = 0.81), or hybrid MJH (OR = 0.83) was found. Among employees working more than 37 h per week, combination MJH was associated with a higher likelihood of LTSA (OR = 1.50)., Conclusions: We did not find evidence for an increased likelihood of LTSA among multiple job holders. Future research should study the likelihood of LTSA among subgroups of multiple job holders, e.g. those working long hours.

This study explored the cost-effectiveness and return-on-investment of a combined social and physical environmental worksite health promotion program compared with usual practice, and of both intervention conditions separately. Participants were randomized to the combined intervention (n = 92), social environmental intervention (n = 118), physical environmental intervention (n = 96), or control group (n = 106). The social environmental intervention consisted of group motivational interviewing and the physical environmental intervention of workplace modifications. Both interventions were aimed at improving physical activity and relaxation. Effects included need for recovery (NFR), general vitality and job satisfaction. Cost-effectiveness analyses were performed from the societal and employer's perspective, and return-on-investment analyses from the employer's perspective. Compared with usual practice, the combined intervention was significantly more effective in improving NFR (-8.4;95% CI:-14.6;-2.2) and significantly more expensive to the employer (3102; 95%CI:598;5969). All other between-group differences were non-significant. For NFR, the combined intervention became the preferred option at willingness-to-pays of ≥€170/point improvement (society) and ≥€300/point improvement (employer). For general vitality and job satisfaction, the interventions' maximum probabilities of cost-effective were low (≤0.55). All interventions had a negative return-on-investment. The combined intervention may be cost-effective for NFR depending on the decision-makers' willingness-to-pay. Both separate interventions are not cost-effective for NFR. All interventions were neither cost-effective for general vitality and job satisfaction, nor cost-saving to the employer., (© The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To construct prediction models for transitions to combination multiple job holding (MJH) (multiple jobs as an employee) and hybrid MJH (being an employee and self-employed), among employees aged 45-64., Methods: A total of 5187 employees in the Netherlands completed online questionnaires annually between 2010 and 2013. We applied logistic regression analyses with a backward elimination strategy to construct prediction models., Results: Transitions to combination MJH and hybrid MJH were best predicted by a combination of factors including: demographics, health and mastery, work characteristics, work history, skills and knowledge, social factors, and financial factors. Not having a permanent contract and a poor household financial situation predicted both transitions. Some predictors only predicted combination MJH, e.g., working part-time, or hybrid MJH, e.g., work-home interference., Conclusions: A wide variety of factors predict combination MJH and/or hybrid MJH. The prediction model approach allowed for the identification of predictors that have not been previously studied., (© 2017 Wiley Periodicals, Inc.)

Objectives: The aim of this study was to conduct a cost-effectiveness and return-on-investment analysis comparing a mindfulness-based worksite intervention to usual practice., Methods: Two hundred fifty-seven governmental research institute employees were randomized to the intervention or control group. Intervention group participants received an eight-week mindfulness training, e-coaching, and supporting elements. Outcomes included work engagement, general vitality, job satisfaction, work ability, and costs. Cost-effectiveness analyses were conducted from the societal and employer's perspective, and a return-on-investment analysis from the employer's perspective., Results: After 12 months, a significant but not clinically relevant adverse effect on work engagement was found (-0.19; 95% confidence interval: -0.38 to -0.01). There were no significant differences in job satisfaction, general vitality, work ability, and total costs. Probabilities of cost-effectiveness were low (≤0.25) and the intervention did not have a positive financial return to the employer., Conclusion: The intervention was neither cost-saving nor cost-effective. Poor e-coaching compliance might partly explain this result.

The trade-off between feasibility and accuracy of measurements of physical exposure at the workplace has often been discussed, but is unsufficiently understood. We therefore explored the effect of two low-back loading measurement tools with different accuracies on exposure estimates and their associations with low-back pain (LBP). Low-back moments of 93 workers were obtained using two methods: a moderately accurate observation-based method and a relatively more accurate video-analysis method. Group-based exposure metrics were assigned to a total of 1131 workers who reported on their LBP status during three follow-up years. The two methods were compared regarding individual and group-based moments and their predictive value for LBP. Differences between the two methods for peak moments were high at the individual level and remained substantial at group level. For cumulative moments, differences between the two methods were attenuated as random inaccuracies cancelled out. Peak moments were not predictive for LBP in any method while cumulative moments were, suggesting comparable predictive values of the two methods. While assessment of low-back load improves from investing in collecting relatively more accurate individual-based data, this does not necessarily lead to better predictive values on a group level, especially not for cumulative loads., (Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Purpose: The objective of the present study is to investigate the effects of a worksite health promotion intervention on musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence., Methods: In a randomized controlled design, 314 construction workers were randomized into an intervention group (n = 162) receiving personal coaching, tailored information, and materials, and a control group (n = 152) receiving usual care. Sickness absence was recorded continuously in company records, and questionnaires were completed before, directly after the 6-month intervention period, and 12 months after baseline measurements. Linear and logistic regression analyses were performed to determine intervention effects., Results: No significant changes at 6 or 12 months of follow-up were observed in musculoskeletal symptoms, physical functioning, work ability, work-related vitality, work performance, and sickness absence as a result of the intervention., Conclusions: This study shows that the intervention was not statistically significantly effective on secondary outcomes. Although the intervention improved physical activity, dietary, and weight-related outcomes, it was not successful in decreasing musculoskeletal symptoms and improving other work-related measures. Presumably, more multifaceted interventions are required to establish significant change in these outcomes.

Objectives: Exposure-outcome studies, for instance on work-related low-back pain (LBP), often classify workers into groups for which exposures are estimated from measurements on a sample of workers within or outside the specific study. The present study investigated the influence on bias and power in exposure-outcome associations of the sizes of the total study population and the sample used to estimate exposures., Methods: At baseline, lifting, trunk flexion, and trunk rotation were observed for 371 of 1131 workers allocated to 19 a-priori defined occupational groups. LBP (dichotomous) was reported by all workers during 3 years of follow-up. All three exposures were associated with LBP in this parent study (P < 0.01). All 21 combinations of n = 10, 20, 30 workers per group with an outcome, and k = 1, 2, 3, 5, 10, 15, 20 workers actually being observed were investigated using bootstrapping, repeating each combination 10000 times. Odds ratios (OR) with P values were determined for each of these virtual studies. Average OR and statistical power (P < 0.05 and P < 0.01) was determined from the bootstrap distributions at each (n, k) combination., Results: For lifting and flexed trunk, studies including n ≥ 20 workers, with k ≥ 5 observed, led to an almost unbiased OR and a power >0.80 (P level = 0.05). A similar performance required n ≥ 30 workers for rotated trunk. Small numbers of observed workers (k) resulted in biased OR, while power was, in general, more sensitive to the total number of workers (n)., Conclusions: In epidemiologic studies using a group-based exposure assessment strategy, statistical performance may be sufficient if outcome is obtained from a reasonably large number of workers, even if exposure is estimated from only few workers per group., (© The Author 2014. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Objectives: Physical exposures (eg, lifting or bending) are believed to be risk factors for low-back pain (LBP), but the literature is inconsistent. Exposure and LBP prevalence differ considerably between occupations, and exposure-outcome associations could be severely modified by the presence of particular occupational groups. We aimed to investigate the influence of such outlying groups on the properties of associations between exposure and LBP., Methods: Lifting and trunk flexion were observed for 371 of 1131 workers within 19 groups. LBP was obtained from all workers during three follow-up years. Both exposure variables were associated with LBP (P<0.01) in this parent dataset. By removing the 19 groups one-by-one and performing logistic regressions analysis on the 18 remaining groups, we demonstrated that one group, mainly road workers, with outlying exposures and LBP prevalence substantially affected the exposure-outcome association in the total population. In order to further examine this phenomenon, we assessed, by simulation, the influence of realistic sizes (n=4, 8, 16, 32, 64, 128), mean exposures (e=2000, 3000, 4000 lifts and e=30, 40, 50% trunk flexion time) and LBP prevalences (p=70, 80, 90, 100%) of the outlying group on the strength and certainty of the eventual relationship between exposure and LBP. For each combination of n, e and p, 3000 virtual studies were constructed, including the simulated group together with the other 18 original groups from the parent data-set. Average odds ratios (OR), 95% confidence limits, and power (P<0.05) were calculated across these 3000 studies as measures of the properties of each virtual study design., Results: OR were attenuated more towards 1 and power decreased with smaller values of n, e, and p in the outlying group. Changes in group size and prevalence had a larger influence on OR and power than changes in mean exposure., Conclusions: The size and characteristics of a single group with high exposure and outcome prevalence can strongly influence both the OR point estimate and the likelihood of obtaining significant exposure-outcome associations in studies of large populations. These findings can guide interpretations of prior epidemiological studies and support informed design of future studies.

Objectives: Determinants in the domains health, job characteristics, skills, and social and financial factors may influence early retirement through three central explanatory variables, namely, the ability, motivation, and opportunity to work. Based on the literature, we created the Early Retirement Model. This study aims to investigate whether data support the model and how it could be improved., Methods: Employees aged 58-62 years (N=1862), who participated in the first three waves of the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) were included. Determinants were assessed at baseline, central explanatory variables after one year, and early retirement after two years. Structural equation modeling was applied., Results: Testing the Early Retirement Model resulted in a model with good fit. Health, job characteristics, skills, and social and financial factors were related to the ability, motivation and/or opportunity to work (significant β range: 0.05-0.31). Lower work ability (β=-0.13) and less opportunity to work (attitude colleagues and supervisor about working until age 65: β=-0.24) predicted early retirement, whereas the motivation to work (work engagement) did not. The model could be improved by adding direct effects of three determinants on early retirement, ie, support of colleagues and supervisor (β=0.14), positive attitude of the partner with respect to early retirement (β=0.15), and not having a partner (β=-0.13)., Conclusions: The Early Retirement Model was largely supported by the data but could be improved. The prolongation of working life might be promoted by work-related interventions focusing on health, work ability, the social work climate, social norms on prolonged careers, and the learning environment.

Objective: To evaluate the process of a health promotion program, aiming to improve physical activity levels and diet among construction workers., Methods: The process evaluation was conducted after the RE-AIM framework for the evaluation of the public health impact of health promotion interventions. Effectiveness was assessed on motivational stage-of-change, self-efficacy, and decisional balance for physical activity and dietary behavior., Results: The external validity of the trial was satisfactory with representative reach of workers and adoption of workplace units in the participating construction company. The extent to which the program was implemented as intended was modest. The intervention was effective on participants' progress through stages of behavior change., Conclusions: Based on the RE-AIM dimensions, it is concluded that for construction workers, the program is feasible and potentially effective, but adjustments are required before widespread implementation.

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Objectives: Reported associations of physical exposures during work (eg, lifting, trunk flexion or rotation) and low-back pain (LBP) are rather inconsistent. Mechanical back loads (eg, moments on the low back) as a result of exposure to abovementioned risk factors have been suggested to be important as such loads provide a more direct relationship with tissue failure and thus LBP. Since information on the effect of such load metrics with LBP is lacking yet, we aimed to assess this effect in a prospective study., Methods: Of 1131 workers, categorised into 19 groups, LBP was prospectively assessed over 3 years. Video and hand force recordings of 4-5 workers per group (93 in total) were used to estimate mechanical low-back loads (peak load and three cumulative load metrics, ie, linear weighted load, squared weighted load and load weighted to the tenth power) during manual materials handling (MMH) tasks using a video analysis method. These data were combined with static mechanical load estimates based on structured observation of non-MMH tasks. Associations of mechanical loads and LBP were tested using generalised estimating equations., Results: Significant effects on LBP were found for cumulative low-back moments (linear and squared weighted; both p<0.01 and ORs of 3.01 and 3.50, respectively) but not for peak and cumulative moments weighted to the tenth power., Conclusions: Results of this first prospective study on the effect of mechanical low-back load on LBP support a LBP aetiology model of cumulative loads, potentially due to accumulation of microdamage or fatigue. Therefore, prevention of LBP should focus on reducing cumulative low-back loads, especially in highly exposed occupational groups, for example, by reducing handling of heavy loads and working in awkward body postures.

Objectives: This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement., Methods: Employees aged 59-63 years (N=2317) were selected from the Study on Transitions in Employment, Ability and Motivation in the Netherlands (STREAM). Individual characteristics, health, job characteristics, skills and knowledge, and social and financial factors were measured using a questionnaire at baseline. Information on early retirement was derived from the one-year follow-up questionnaire. Logistic regression analyses were used to identify predictors of early retirement. Population Attributable Fractions (PAF) were calculated., Results: Older age [odds ratio (OR) 1.79], poor physical health (OR 1.78), a positive attitude of the partner with respect to early retirement (OR 3.85), and the financial possibility to stop working before the age of 65 (OR 10.2) predicted the transition to early retirement, whereas employees that reported high appreciation at work (OR 0.58) and higher focus on development of skills and knowledge (OR 0.54) were less likely to retire early. PAF were 0.75 for the financial possibility to stop working, 0.43 for a positive attitude of the partner with respect to early retirement, 0.27 for low appreciation at work, 0.23 for a low focus on development, and 0.21 for poor health., Conclusions: The financial possibility to stop working before the age of 65 importantly contributes to early retirement. In the context of rapidly diminishing financial opportunities to retire early in the Netherlands, the prolongation of working life might be promoted by workplace health promotion and disability management, and work-related interventions focusing on appreciation and the learning environment.

Objectives: The aim of the present study was to evaluate the effectiveness of a worksite mindfulness-related multi-component health promotion intervention on work engagement, mental health, need for recovery and mindfulness., Methods: In a randomized controlled trial design, 257 workers of two research institutes participated. The intervention group (n = 129) received a targeted mindfulness-related training, followed by e-coaching. The total duration of the intervention was 6 months. Data on work engagement, mental health, need for recovery and mindfulness were collected using questionnaires at baseline and after 6 and 12 months follow-up. Effects were analyzed using linear mixed effect models., Results: There were no significant differences in work engagement, mental health, need for recovery and mindfulness between the intervention and control group after either 6- or 12-months follow-up. Additional analyses in mindfulness-related training compliance subgroups (high and low compliance versus the control group as a reference) and subgroups based on baseline work engagement scores showed no significant differences either., Conclusions: This study did not show an effect of this worksite mindfulness-related multi-component health promotion intervention on work engagement, mental health, need for recovery and mindfulness after 6 and 12 months., Trial Registration: Netherlands Trial Register NTR2199.

Introduction: Overweight and obesity are associated with an increased risk of morbidity. Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain. The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time, sedentary behavior at work, fruit intake and determinants of these behaviors. The control group received information on existing lifestyle behavior- related facilities that were already available at the worksite., Methods: In a randomized controlled trial design (n = 257), 129 workers received a mindfulness training, followed by e-coaching, lunch walking routes and fruit. Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires. Physical activity was also measured using accelerometers. Effects were analyzed using linear mixed effect models according to the intention-to-treat principle. Linear regression models (complete case analyses) were used as sensitivity analyses., Results: There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months. The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up, although the main analyses did not., Conclusions: This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months. The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established.

Background: To prolong sustainable healthy working lives of construction workers, a prevention program was developed which aimed to improve the health and work ability of construction workers. The objective of this study was to analyze the cost-effectiveness and financial return from the employers' perspective of this program., Methods: A total of 293 workers in 15 departments were randomized to the intervention (n = 8 departments) or control group (n = 7). Data on work ability and health were collected using questionnaires. Sick leave data were obtained from the companies. Both the cost-effectiveness analyses and return on investment analyses were performed., Results: After 12 months, the absenteeism costs were significantly lower in the intervention group than in the control group. At 12-month follow-up, no significant differences were found with respect to the primary outcomes (work ability, mental and physical health status) and secondary outcomes (musculoskeletal symptoms), meaning that the intervention was not cost-effective in comparison with the control group. The net-benefit was €641 per worker, and the intervention generated a positive financial return to the employer., Conclusion: The intervention in the present study was cost-saving to the employer due to reduced sickness absenteeism costs in the intervention group compared with the control group. However, the intervention cannot be regarded as cost-effective as no significant effects were found for work ability and health., (© 2013 Wiley Periodicals, Inc.)

Objective: This study aimed to investigate the effectiveness of a prevention program on work ability, health, and sick leave targeted at construction worksites., Methods: A total of 15 departments (N = 297 workers) from 6 construction companies participated in this cluster randomized controlled trial and were randomly allocated to the intervention (8 departments; N = 171 workers) or control (7 departments; N = 122 workers) group. The intervention consisted of two individual training sessions with a physical therapist aimed at lowering the physical workload, a rest-break tool to improve the balance between work and recovery, and two empowerment training sessions to increase the worker's influence at the worksite. Data on work ability, physical and mental health status, and musculoskeletal symptoms were collected at baseline, and at 3, 6, and 12 months follow-up. Sick leave data were obtained from the companies., Results: Overall, no differences in work ability [β 0.02, 95% confidence interval (95% CI) -0.34-0.37] or physical and mental health status (β -0.04, 95% CI -1.43-1.35, and β 0.80 95% CI -0.51-2.11, respectively) were found between the intervention and control group. The intervention showed an overall decline in musculoskeletal symptoms (ranging from OR 0.68, 95% CI 0.34-1.33, to OR 0.86, 95% CI 0.47-1.57) and long-term sick leave (OR 0.44, 95% CI 0.13-1.26) among construction workers. Both reductions were not statistically significant., Conclusion: The prevention program seemed to result in a beneficial but not statistically significant decline in the prevalence of musculoskeletal symptoms and long-term sick leave among construction workers, but showed no effects with regard to work ability, physical health, and mental health.

Valid and reliable low-back load assessment tools that can be used in field situations are needed for epidemiologic studies and for ergonomic practice. The aim of this study was to assess the inter-rater reliability of a low-back load video-analysis method in a field setting. Five raters analyzed 50 work site manual material handling tasks of 14 workers. Peak and mean moments at the level of L5S1, and segment angles were obtained using the video-analysis method. Intra-class correlation coefficients (ICCs) and median standard deviations across raters were calculated. ICCs revealed excellent inter-rater reliability (>0.9) for peak and mean moments, ICCs of segment angles were variable. Median standard deviations showed relatively small inter-rater variance for moments (standard deviation <10 Nm) and segment angle variation ranging from 0° to 20°. The proposed video-analysis method, provides a reliable tool for obtaining low-back loads from occupational field tasks., (Copyright © 2013 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Background: The primary aim of this study was to investigate the association between BMI and musculoskeletal symptoms in interaction with physical workload. In addition, it was aimed to obtain insight into whether overweight and obesity are associated with an increase in occurrence of symptoms and/or decrease in recovery from symptoms., Methods: Based on a large working population sample (n = 44,793), using the data from The Netherlands Working Conditions Survey (NWCS), logistic regression analyses were carried out to investigate the association between BMI and musculoskeletal symptoms, with adjustment for potential confounders. Longitudinal data from the Netherlands Working Conditions Cohort Study (NWCCS) of 7,909 respondents was used for the second research aim (i.e., to investigate the transition in musculoskeletal symptoms)., Results: For high BMI an increased 12-month prevalence of musculoskeletal symptoms was found (overweight: OR 1.13, 95% CI: 1.08-1.19 and obesity: OR 1.28, 95% CI: 1.19-1.39). The association was modified by physical workload, with a stronger association for employees with low physical workload than for those with high physical workload. Obesity was related to developing musculoskeletal symptoms (OR 1.37, 95% CI: 1.05-1.79) and inversely related to recovery from symptoms (OR 0.76, 95% CI: 0.59-0.97)., Conclusion: BMI was associated with musculoskeletal symptoms, in particular symptoms of the lower extremity. Furthermore, the association differed for employees with high or low physical workload. Compared to employees with normal weight, obese employees had higher risk for developing symptoms as well as less recovery from symptoms. This study supports the role of biomechanical factors for the relationship between BMI and symptoms in the lower extremity.

Background: Previous studies have found moderate to vigorous physical activity (MVPA) to be associated with a decreased risk of mental disorders. Although the focus in the field of psychology has shifted towards human strengths and optimal functioning, studies examining associations between MVPA and mental health in general (MH) and between MVPA and well-being are scarce. An indicator of work-related well-being is work engagement (WE). The aim of this study was to explore the associations between MVPA and MH, and between MVPA and WE., Methods: In this study, a total of 257 employees from two research institutes, self-reported their MVPA, MH and level of WE. In addition, a randomly chosen subgroup (n=100) wore an Actigraph accelerometer for a 1-week period to measure their MVPA objectively. Crude and adjusted associations between MVPA and both WE and MH were analyzed using linear regression analyses., Results: There was no statistically significant association between self-reported MVPA and mental health, resulting from both the crude (b=0.058, 95% CI -0.118 - 0.235) and adjusted analyses (b=0.026; 95% CI -0.158- 0.210), nor between objectively measured MVPA and mental health for both crude and adjusted analyses (b=-0.144; 95% CI -1.315- 1.027; b=-0.199; 95% CI 1.417- 1.018 respectively). There was also no significant association between self-reported MVPA and work engagement (crude: b=0.005; 95% CI -0.005-0.016, adjusted: b= 0.002; 95% CI -0.010- 0.013), nor between objectively measured MVPA and work engagement (crude: b= 0.012; 95% CI -0.084- 0.060, adjusted: b=0.007; 95% CI -0.083-0.069)., Conclusions: Although the beneficial effects of MVPA on the negative side of MH (i.e. mental disorders) have been established in previous studies, this study found no evidence for the beneficial effects of MVPA on positive side of MH (i.e. well-being). The possible difference in how the physical activity-mental health relationship works for negative and positive sides of MH should be considered in future studies.

Background: Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers., Methods: An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers' knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared., Results: The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer's costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers., Conclusions: Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.

Background: Due to the aging of the population, there is a societal need for workers to prolong their working lives. In the Netherlands, many employees still leave the workforce before the official retirement age of 65. Previous quantitative research showed that poor self-perceived health is a risk factor of (non-disability) early retirement. However, little is known on how poor health may lead to early retirement, and why poor health leads to early retirement in some employees, but not in others. Therefore, the present qualitative study aims to identify in which ways health influences early retirement., Methods: Face-to-face semi-structured interviews were conducted with 30 employees (60-64 years) who retired before the official retirement age of 65. Participants were selected from the Study on Transitions in Employment, Ability and Motivation. The interviews were transcribed verbatim, a summary was made including a timeline, and the interviews were open coded., Results: In 15 of the 30 persons, health played a role in early retirement. Both poor and good health influenced early retirement. For poor health, four pathways were identified. First, employees felt unable to work at all due to health problems. Second, health problems resulted in a self-perceived (future) decline in the ability to work, and employees chose to retire early. Third, employees with health problems were afraid of a further decline in health, and chose to retire early. Fourth, employees with poor health retired early because they felt pushed out by their employer, although they themselves did not experience a reduced work ability. A good health influenced early retirement, since persons wanted to enjoy life while their health still allowed to do so. The financial opportunity to retire sometimes triggered the influence of poor health on early retirement, and often triggered the influence of good health. Employees and employers barely discussed opportunities to prolong working life., Conclusions: Poor and good health influence early retirement via several different pathways. To prolong working life, a dialogue between employers and employees and tailored work-related interventions may be helpful.

Purpose: Much research has been performed on physical exposures during work (e.g. lifting, trunk flexion or body vibrations) as risk factors for low back pain (LBP), however results are inconsistent. Information on the effect of doses (e.g. spinal force or low back moments) on LBP may be more reliable but is lacking yet. The aim of the present study was to investigate the prospective relationship of cumulative low back loads (CLBL) with LBP and to compare the association of this mechanical load measure to exposure measures used previously., Methods: The current study was part of the Study on Musculoskeletal disorders, Absenteeism and Health (SMASH) study in which 1,745 workers completed questionnaires. Physical load at the workplace was assessed by video-observations and force measurements. These measures were used to calculate CLBL. Furthermore, a 3-year follow-up was conducted to assess the occurrence of LBP. Logistic regressions were performed to assess associations of CLBL and physical risk factors established earlier (i.e. lifting and working in a flexed posture) with LBP. Furthermore, CLBL and the risk factors combined were assessed as predictors in logistic regression analyses to assess the association with LBP., Results: Results showed that CLBL is a significant risk factor for LBP (OR: 2.06 (1.32-3.20)). Furthermore, CLBL had a more consistent association with LBP than two of the three risk factors reported earlier., Conclusions: From these results it can be concluded that CLBL is a risk factor for the occurrence of LBP, having a more consistent association with LBP compared to most risk factors reported earlier.