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Introduction Early childhood development can be described by an underlying latent construct. Global comparisons of children's development are hindered by the lack of a validated metric that is comparable across cultures and contexts, especially for children under age 3 years. We constructed and validated a new metric, the Developmental Score (D-score), using existing data from 16 longitudinal studies. Methods Studies had item-level developmental assessment data for children 0-48 months and longitudinal outcomes at ages >4-18 years, including measures of IQ and receptive vocabulary. Existing data from 11 low-income, middle-income and high-income countries were merged for >36 000 children. Item mapping produced 95 'equate groups' of same-skill items across 12 different assessment instruments. A statistical model was built using the Rasch model with item difficulties constrained to be equal in a subset of equate groups, linking instruments to a common scale, the D-score, a continuous metric with interval-scale properties. D-score-for-age z-scores (DAZ) were evaluated for discriminant, concurrent and predictive validity to outcomes in middle childhood to adolescence. Results Concurrent validity of DAZ with original instruments was strong (average r=0.71), with few exceptions. In approximately 70% of data rounds collected across studies, DAZ discriminated between children above/below cut-points for low birth weight (

Purpose The aim of this study was to develop prediction models to determine the risk of sick leave due to musculoskeletal disorders (MSD) in non-sick listed employees and to compare models for short-term (i.e., 3 months) and long-term (i.e., 12 months) predictions. Methods Cohort study including 49,158 Dutch employees who participated in occupational health checks between 2009 and 2015 and sick leave data recorded during 12 months follow-up. Prediction models for MSD sick leave within 3 and 12 months after the health check were developed with logistic regression analysis using routinely assessed health check variables. The performance of the prediction models was evaluated with explained variance (Nagelkerke’s R-square), calibration (Hosmer–Lemeshow test) and discrimination (area under the receiver operating characteristic curve, AUC) measures. Results A total of 376 (0.8%) and 1193 (2.4%) employees had MSD sick leave within 3 and 12 months after the health check. The prediction models included similar predictor variables (educational level, musculoskeletal complaints, distress, supervisor social support, work-home interference, intrinsic motivation, development opportunities, and work pace). The explained variances were 7.6% and 8.8% for the model with 3 and 12 months follow-up, respectively. Both prediction models showed adequate calibration and discriminated between employees with and without MSD sick leave 3 months (AUC = 0.761; Interquartile range [IQR] 0.759–0.763) and 12 months (AUC = 0.740; IQR 0.738–0.741) after the health check. Conclusion The prediction models could be used to determine the risk of MSD sick leave in non-sick listed employees and invite them to preventive consultations with occupational health providers.

EUSUHM-congres: kennisdelen voor en samenwerken aan een gezonde jeugd! Changing contexts—influencing youth and their surroundings. Het thema van het congres was ‘Changing contexts – influencing youth and their surroundings’. Met dit thema komt tot uiting dat gezondheid meer is dan lichaam en geest en dat lichaam en geest worden beïnvloed door de context waarin zij zich bevinden. Dit is waar publieke gezondheid over gaat.

Nederland kent een groeiend aantal flexwerkers. Dat maakt inzicht in welke flexwerkers een kwetsbare arbeidsmarktpositie hebben essentieel. Dit onderzoek beantwoordt de vraag in hoeverre persoonlijke factoren, werkkenmerken en het contracttype de uit-stroom van flexwerkers naar een vast contract of naar een uitkeringssituatie beïnvloe-den. Hiertoe is multinomiale logistische regressie toegepast op de data van 4733 flexwerknemers uit de NEA (Nationale Enquête Arbeidsomstandigheden) van TNO en CBS en hun 5-jaar follow-up uitstroomgegevens uit het Sociaal Statistisch Bestand van het CBS. Eerder onderzoek naar arbeidsmarkttransities van flexwerkers richtte zich voornamelijk op demografische kenmerken, opleidingsniveau en formele baanken-merken, zoals sector. Dit onderzoek kijkt daarnaast ook naar de werk-privébalans, gezondheid, leerrijk werk en werkbelasting van flexwerkers. De resultaten laten zien dat de relatieve kans op uitstroom naar een vaste arbeidsre-latie ten opzichte van langdurig verblijf in de flexibele schil groter is voor vrouwen, hoogopgeleiden en werknemers met een tijdelijk contract (in plaats van uitzend- en oproepkrachten). De relatieve kans op uitstroom naar de sociale voorzieningen ten opzichte van langdurig verblijf in de flexibele schil is groter voor vrouwen en ouderen. Daarnaast verhogen een slechte gezondheid, burn-outklachten en beperkte steun van de leidinggevende deze relatieve kans aanzienlijk. Meer aandacht voor het welzijn van flexwerkers in organisaties door de leidinggevende en betere begeleiding van flexwerkers met gezondheidsproblemen of burn-outklachten zijn dus belangrijke aangrijpingspunten bij het voorkomen van uitval op de arbeidsmarkt.

Background: Gestational weight gain differs according to pre-pregnancy body mass index and is related to the risks of adverse maternal and child health outcomes. Gestational weight gain charts for women in different pre-pregnancy body mass index groups enable identification of women and offspring at risk for adverse health outcomes. We aimed to construct gestational weight gain reference charts for underweight, normal weight, overweight, and grades 1, 2 and 3 obese women and to compare these charts with those obtained in women with uncomplicated term pregnancies. Methods: We used individual participant data from 218,216 pregnant women participating in 33 cohorts from Europe, North America, and Oceania. Of these women, 9065 (4.2%), 148,697 (68.1%), 42,678 (19.6%), 13,084 (6.0%), 3597 (1.6%), and 1095 (0.5%) were underweight, normal weight, overweight, and grades 1, 2, and 3 obese women, respectively. A total of 138, 517 women from 26 cohorts had pregnancies with no hypertensive or diabetic disorders and with term deliveries of appropriate for gestational age at birth infants. Gestational weight gain charts for underweight, normal weight, overweight, and grade 1, 2, and 3 obese women were derived by the Box-Cox t method using the generalized additive model for location, scale, and shape. Results: We observed that gestational weight gain strongly differed per maternal pre-pregnancy body mass index group. The median (interquartile range) gestational weight gain at 40 weeks was 14.2 kg (11.4-17.4) for underweight women, 14.5 kg (11.5-17.7) for normal weight women, 13.9 kg (10.1-17.9) for overweight women, and 11.2 kg (7.0-15.7), 8.7 kg (4.3-13.4) and 6.3 kg (1.9-11.1) for grades 1, 2, and 3 obese women, respectively. The rate of weight gain was lower in the first half than in the second half of pregnancy. No differences in the patterns of weight gain were observed between cohorts or countries. Similar weight gain patterns were observed in mothers without pregnancy complications. Conclusions: Gestational weight gain patterns are strongly related to pre-pregnancy body mass index. The derived charts can be used to assess gestational weight gain in etiological research and as a monitoring tool for weight gain during pregnancy in clinical practice. © 2018 The Author(s).

Previous studies showed that missing data in multi-item scales can best be handled by multiple imputation of item scores. However, when many scales are used, the number of items will become too large for the imputation model to reliably estimate imputations. A solution is to use passive imputation or a parcel summary score that combine and consequently reduce the number of variables in the imputation model. The performance of these methods was evaluated in a simulation study and illustrated in an example. Passive imputation, which updated scale scores from imputed items, and parcel summary scores that use the average over available item scores were compared to using all items simultaneously, imputing total scores of scales and complete-case analysis. Scale scores and coefficient estimates from linear regression were compared to "true" parameters on bias and precision. Passive imputation and using parcel summaries showed smaller bias and more precision than imputing total scores and complete-case analyses. Passive imputation or using parcel summary scores are valid missing data solutions in studies that include many multi-item scales.

The aim of this study was to provide answers to questions concerning OSH risk management, and in particular psychosocial risk management: Is exposure to OSH risks, both in general and more specifically in relation to environmental risks, risks of musculoskeletal disorders (MSDs) and psychosocial risks (PSRs), as reported by employees, related to risk awareness and risk management in enterprises? Are work-related health outcomes and well-being, as reported by employees, related to risk awareness and risk management in enterprises? (3) How well is risk management explained by exposure to work-related risks, both general and specific, and by work-related health outcomes, as reported by employees? Do drivers, such as management commitment and employee participation, or barriers, such as lack of resources or expertise, explain the relationship between risk management at the enterprise level and risk perception by employees? These questions are answered by a combined analysis of data from data from enterprises in the European Survey of Enterprises on New and Emerging Risks (ESENER-2), data from employees in the Labour Force Survey 2013 ad hoc module on accidents at work and other work related health problems (LFS 2013 ad hoc module) and the 6th European Working Conditions Survey (6th EWCS). For the multilevel modelling we used two common background variables ‘country’ and ‘sector (within countries)’ to combine the data sets. Risks reported by employees are positively related to risk management for all three types of risks studied (OSH/environmental risks, MSDs and PSRs), meaning that more risk exposure as reported by employees is related to more risk management in enterprises. Specific information on risks as reported by employees (EWCS) strongly increased the explained variance in risk management in enterprises. As for health problems, only the reporting of mental health problems reported by employees significantly increased the variance explained in psychosocial risk management in enterprises. For the management of psychosocial risks involvement of employees in the design and set up of measures specifically directed at psychosocial risks significantly and positively related to psychosocial risk management.

Objective: The concept of specific agreement (SA) has been proposed for dichotomous outcomes for two or more raters. We aim to extend this concept for variables with more than two ordinal or nominal categories and more than two raters. Study Design and Setting: We used two data sets: four plastic surgeons classifying photographs after breast reconstruction on a 5-point ordinal scale and six raters classifying psychiatric patients into five diagnostic categories. For m raters, all (i.e., m(m−1)/2) pairwise agreement tables were summed to calculate the observed agreement (OA), SA and conditional probabilities. The 95% confidence intervals were obtained by bootstrapping. Results: SA was calculated for each ordinal or nominal category to examine when one of the raters scored in a specific category, what is the probability that the other raters scored in that same category. And suppose one of the raters scored X1, what is the probability that the other raters scored X1 or any of the other categories (conditional probability). It appeared, for example, that among the psychiatric disorders, depression and personality disorders were often mixed up, whereas neurosis was rarely mixed up with schizophrenia. Conclusion: The concept of SA for variables with ordinal and multiple nominal categories provides relevant clinical information. The extension to conditional probabilities of alternative categories broadens the clinical application with examining which categories are most often mixed up. © 2017 Elsevier Inc.

This report examines barriers to and drivers of workplace psychosocial risk management, and how this is influenced by different national and organisational contexts. The exposure of workers to psychosocial risks is increasing. However, the level of risk and the effectiveness of management vary across sectors and countries. Based on the findings of a quantitative analysis of ESENER-2 data combined with other country-specific data, it shows that the national context — culture, economy and occupational safety and health initiatives by social partners — is related to the level of psychosocial risk management in the workplace. It also reveals that management commitment and worker involvement are likely to be most effective organisational drivers of managing psychosocial risks, regardless of the national context. The practical implications of these findings are also discussed. Including summary.

General objective of the project commissioned by the European Agency for Safety and Health at Work (EU-OSHA) is to support policy makers in stimulating successful psychosocial risk (PSR) management. Since the national and cultural context may influence the effectiveness of drivers and barriers of PSR management, the following research questions will be answered: (1) What are determinants (drivers and barriers) of PSR management? (2) What is the influence of the cultural context on PSR management? (3) Does cultural context influence the drivers and barriers of PSR management and (4) do these drivers and barriers have the same impact in a different cultural context? Multilevel analyses were performed to answer these questions. Data were used from the second edition of a Europe-wide survey among enterprises, the European Survey of Enterprises on New and Emerging Risks (ESENER-2, EU-OSHA), carried out in 2014. The dataset was supplemented with data on GDP per capita, data on national initiatives regarding occupational safety and health or PSR, and data on three cultural dimensions considered of potential relevance for PSR management (Power Distance, Uncertainty Avoidance and Masculinity) based on Hofstede. All analyses were adjusted for country, size, sector and respondent type. Results from the analyses were discussed in a focus group meeting of international experts from different cultural backgrounds to assist the interpretation of the results. In line with previous research, results show several drivers and barriers at the organisational level to be associated with PSR management, defined as the amount of measures in place to deal with psychosocial risks. Strongest driver was management commitment, and strongest barriers were lack of awareness among management and lack of expertise. On the cultural dimensions ‘Power Distance’ and ‘Uncertainty Avoidance’, a high score was associated with less PSR management. The cultural dimensions were highly associated with other factors of the national context (a high GDP per capita and national OSH and PSR initiatives), which were also associated with PSR management. The strong relation between the context variables enabled a distinction between a favourable and an unfavourable context for psychosocial risk management. Most drivers and barriers were not or only weakly related to cultural factors. Differences in impact of barriers and drivers in a different cultural context were found, but they were only marginal. Conclusion of the analyses and the discussion in the focus group was that national context matters and contributes significantly to the level of psychosocial risk management in companies. However, since national context is not easy to change, interventions may best be aimed at encouraging management commitment and employee involvement.

This report presents the results of a survey of national and international data sources on the costs of work-related injuries, illnesses and deaths. The aim was to evaluate the quality and comparability of different sources as a first step towards estimating the costs of accidents and ill-health at work in Europe. The survey found that there were insufficient data to determine these costs exactly; however, recommendations are made on using estimates to bridge the data gap. Including the summary.

van het Mind the gap! Building bridges to better health for all young people, EUSUHM (European Union for School and University Health and Medicine) congres 2017, Leuven.

Background: In 2010, the human papillomavirus (HPV) vaccination was introduced in the Dutch National Immunization Program for 12-year-old girls, aiming to reduce the incidence of cervical cancer in women. HPV vaccination uptake turned out to be lower than expected: 61% versus 70%, respectively. Mothers were shown to play the most important role in the immunization decision about this vaccination. They had also expressed their need for interactive personal information about the HPV vaccination over and above the existing universal general information. To improve the effectiveness of the existing education about the HPV vaccination, we systematically developed a Web-based tailored intervention with virtual assistants providing mothers of girls to be invited with tailored feedback on their decision making about the HPV vaccination. Objective: The aim of this study was to evaluate the effectiveness of the Web-based tailored intervention for promoting HPV vaccination acceptance by means of a randomized controlled trial (RCT). Methods: Mothers were recruited via the Dutch vaccination register (Praeventis) (n=36,000) and three Web-based panels (n=2483). Those who gave informed consent (N=8062) were randomly assigned to the control (n=4067) or intervention condition (n=3995). HPV vaccination uptake, as registered by Praeventis once the HPV vaccination round was completed, was used as the primary outcome. Secondary outcomes were differential scores across conditions between baseline (before the provided access to the new tailored intervention) and follow-up (just before the first vaccination) regarding the mothers’ degree of informed decision making (IDM), decisional conflict, and critical determinants of HPV vaccination uptake among which are intention, attitude, risk perception, and outcome beliefs. Results: Intention-to-treat analysis (N=8062) showed a significant positive effect of the intervention on IDM, decisional conflict, and nearly all determinants of HPV vaccination uptake (P

Om de meer dan 217 miljoen werkenden in de Europese Unie (EU) beter te beschermen tegen werkgerelateerde ongevallen en ziekten heeft de Europese Commissie in 2014 het strategisch EU-kader voor gezondheid en veiligheid op het werk 2014-2020 (1) aangenomen. Daarin stelt zij belangrijke uitdagingen en strategische doelstellingen vast in de context van gezondheid en veiligheid op het werk. Het strategisch kader heeft allereerst tot doel ervoor te zorgen dat de EU een vooraanstaande rol blijft spelen bij het bevorderen van hoge normen voor arbeidsomstandigheden. Ten tweede moet de tenuitvoerlegging van de bestaande regelgeving op het gebied van veiligheid en gezondheid worden verbeterd, met name door kleine en micro-ondernemingen beter in staat te stellen effectieve en efficiënte strategieën voor risicopreventie uit te voeren. De derde doelstelling is de preventie van werkgerelateerde ziekten te verbeteren door nieuwe en opkomende risico’s aan te pakken zonder bestaande risico’s te veronachtzamen. Om deze uitdagingen het hoofd te bieden, worden in het strategisch kader diverse maatregelen voorgesteld, zoals het verbeteren van de wijze waarop statistieken worden verzameld om beter bewijs te genereren en de gegevens adequater te gebruiken, en het verder verbeteren van monitoringinstrumenten.

Background. Multiple imputation is a recommended method to handle missing data. For significance testing after multiple imputation, Rubin’s Rules (RR) are easily applied to pool parameter estimates. In a logistic regression model, to consider whether a categorical covariate with more than two levels significantly contributes to the model, different methods are available. For example pooling chi-square tests with multiple degrees of freedom, pooling likelihood ratio test statistics, and pooling based on the covariance matrix of the regression model. These methods are more complex than RR and are not available in all mainstream statistical software packages. In addition, they do not always obtain optimal power levels. We argue that the median of the p-values from the overall significance tests from the analyses on the imputed datasets can be used as an alternative pooling rule for categorical variables. The aim of the current study is to compare different methods to test a categorical variable for significance after multiple imputation on applicability and power. Methods. In a large simulation study, we demonstrated the control of the type I error and power levels of different pooling methods for categorical variables. Results. This simulation study showed that for non-significant categorical covariates the type I error is controlled and the statistical power of the median pooling rule was at least equal to current multiple parameter tests. An empirical data example showed similar results. Conclusions. It can therefore be concluded that using the median of the p-values from the imputed data analyses is an attractive and easy to use alternative method for significance testing of categorical variables.

In order to better protect the more than 217 million workers in the European Union (EU) from work-related accidents and diseases, in 2014 the European Commission adopted the Strategic Framework on Health and Safety at Work 2014-2020 (1), which identifies key challenges and strategic objectives for health and safety at work. The Strategic Framework aims to ensure that the EU continues to play a leading role in the promotion of high standards for working conditions, to improve implementation of existing safety and health rules, in particular by enhancing the capacity of micro- and small enterprises to implement effective and efficient risk prevention strategies and to improve the prevention of work-related diseases by tackling new and emerging risks, without neglecting existing risks. This Framework proposes to address these challenges with a range of actions, including the improvement of statistical data collection to generate better evidence and to make more appropriate use of the data, as well as further improvements in monitoring tools.

This report presents the key findings of a joint analysis of EU-OSHA’s second European Survey of Enterprises on New and Emerging Risks (ESENER-2), Eurostat’s Labour Force Survey (LFS) 2013 ad hoc module on accidents at work and other work-related health problems, and Eurofound’s 6th European Working Conditions Survey (EWCS). The aim was to have a comprehensive overview of the state of OSH in Europe by bringing together, on the one hand, the perspectives of establishments on risk management and risk awareness, and on the other, those of workers on exposure to risks and OSH outcomes. Including the summary.

promotiedatum: 6-1-2015 � prom-id: 11900

BACKGROUND: The 70-gene signature test (MammaPrint) has been shown to improve prediction of clinical outcome in women with early-stage breast cancer. We sought to provide prospective evidence of the clinical utility of the addition of the 70-gene signature to standard clinical-pathological criteria in selecting patients for adjuvant chemotherapy. METHODS: In this randomized, phase 3 study, we enrolled 6693 women with early-stage breast cancer and determined their genomic risk (using the 70-gene signature) and their clinical risk (using a modified version of Adjuvant! Online). Women at low clinical and genomic risk did not receive chemotherapy, whereas those at high clinical and genomic risk did receive such therapy. In patients with discordant risk results, either the genomic risk or the clinical risk was used to determine the use of chemotherapy. The primary goal was to assess whether, among patients with high-risk clinical features and a low-risk gene-expression profile who did not receive chemotherapy, the lower boundary of the 95% confidence interval for the rate of 5-year survival without distant metastasis would be 92% (i.e., the noninferiority boundary) or higher. RESULTS: A total of 1550 patients (23.2%) were deemed to be at high clinical risk and low genomic risk. At 5 years, the rate of survival without distant metastasis in this group was 94.7% (95% confidence interval, 92.5 to 96.2) among those not receiving chemotherapy. The absolute difference in this survival rate between these patients and those who received chemotherapy was 1.5 percentage points, with the rate being lower without chemotherapy. Similar rates of survival without distant metastasis were reported in the subgroup of patients who had estrogen-receptor-positive, human epidermal growth factor receptor 2-negative, and either node-negative or node-positive disease. CONCLUSIONS: Among women with early-stage breast cancer who were at high clinical risk and low genomic risk for recurrence, the receipt of no chemotherapy on the basis of the 70-gene signature led to a 5-year rate of survival without distant metastasis that was 1.5 percentage points lower than the rate with chemotherapy. Given these findings, approximately 46% of women with breast cancer who are at high clinical risk might not require chemotherapy. (Funded by the European Commission Sixth Framework Program and others; ClinicalTrials.gov number, NCT00433589; EudraCT number, 2005-002625-31.).