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Objective: The purpose of this study was to investigate associations among three modifiable risk factors (ie, physical activity, cardiorespiratory fitness, and body mass index), work productivity, and sickness absence in computer workers. Methods: All participants were computer workers with neck and upper limb symptoms in the preceding 6 months, the last 2 weeks, or both. Productivity and sickness absence were assessed with the Health and Performance Questionnaire (HPQ). Results: Physical activity and cardiorespiratory fitness were not associated with work productivity or sickness absence. Obese male workers reported lower absolute productivity than lean workers. Lean and overweight workers reported similar productivity levels. Body mass index was not associated with sickness absence. Conclusions: In a population of white-collar workers with neck and upper limb symptoms, obese male workers showed significantly lower productivity than did lean or overweight workers. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study describes the total physical activity and the contribution of work to total physical activity among Dutch workers. The study was conducted in the Netherlands in the years 2000-2002. METHODS: 2,417 respondents of a cross-sectional survey representing the Dutch adult working population were included. Physical activity was measured by the proportion meeting the current public health physical activity recommendations and by total physical activity (in minutes per week). Seven occupational groups and 28 sectors were distinguished. Unadjusted analyses were carried out using chi-square test and one-way analysis of variance. RESULTS: On average, 53.7% was sufficiently active according to the recommended levels. Work contributed for 30% to total physical activity. There were significant differences between the occupations and sectors in total physical activity levels as well as in the amount of work-related physical activity. Those in policy and higher executive functions were least active at work with work contributing for 19.5% to total physical activity, whereas those working in agricultural occupations were most active at work with work contributing for 55.1% to total physical activity. CONCLUSIONS: Work is still an important source of total physical activity among workers. Based on the differences observed, branch-specific strategies to enhance work-related physical activity are recommended. Copyright © 2006 by Elsevier Inc. [ABSTRACT FROM AUTHOR]

Objective: To investigate the dose-response relation between moderate and vigorous physical activity and sick leave in a working population.Methods: Data were used from three large Dutch databases: two continuous, cross sectional surveys among a representative sample of the Dutch population and one prospective cohort study. A distinction was made between duration, frequency and intensity of physical activity. The outcome measure was the number of days of sick leave. Analyses of variance were used to compare sick leave (in days) for workers with different amounts of physical activity, in particular workers meeting the physical activity recommendations v those who did not. Linear and logistic regression analyses were used to obtain effect estimates in the prospective cohort study, with the generalised estimating equation (GEE) method.Results: No relation was found between moderate physical activity and sick leave. In two databases, workers meeting the recommendation of vigorous physical activity (active at a vigorous level for at least three times a week) had significantly less sick leave: more than one day over two months and more than four days over a year. The duration of vigorous physical activity was not associated with sick leave.Conclusion: Physical activity at a vigorous intensity level for at least three times a week, as in the CDC/ACSM recommendation, has a positive effect on sick leave. [ABSTRACT FROM AUTHOR]

Aims: To investigate the effectiveness of a worksite health promotion programme by individual counselling on sick leave.Methods: Three municipal services of Enschede, the Netherlands, participated in this trial. A total of 299 civil servants were measured at baseline and were randomised by cluster into the intervention (n = 131) or the control group (n = 168). During nine months, subjects in the intervention group received a total of seven consultations, particularly aimed at increasing their physical activity level and improving their dietary habits. Both the intervention and the control subjects received written information as to several lifestyle factors. Sick leave data regarding the nine month intervention period (from May until January) were collected from each municipal service's personnel department. In addition, sick leave data concerning the nine month period pre- and post-intervention were collected. Sick leave data were analysed using multilevel analysis.Results: For both groups, the mean sick leave rate during the intervention increased compared to before the intervention. After the intervention period, the control group increased even more (from 22.9 to 27.6 days), whereas the intervention group slightly decreased (from 21.5 to 20.5 days). Median values of sick leave rate decreased for both groups. No statistically significant intervention effect was found. In both groups, the mean sick leave frequency slightly decreased over time (intervention effects were not significant).Conclusions: Results showed no significant effect of individual counselling on sick leave. Continued research investigating the effectiveness of this individual counselling programme on several health related outcomes is useful to clarify the trend observed in sick leave. [ABSTRACT FROM AUTHOR]

Background: A major contributor of early exit from work is a decline in health with increasing age. As healthy lifestyle choices contribute to better health outcomes, an intervention aimed at an improved lifestyle is considered a potentially effective tool to keep older workers healthy and vital, and thereby to prolong labour participation.Methods: Using the Intervention Mapping (IM) protocol, a lifestyle intervention was developed based on information obtained from 1) literature, 2) a short lifestyle questionnaire aimed at identifying the lifestyle behaviours among the target group, and 3) focusgroup (FG) interviews among 36 older workers (aged 45+ years) aimed at identifying: a) key determinants of lifestyle behaviour, b) a definition of vitality, and c) ideas about how vitality can be improved by lifestyle.The main lifestyle problems identified were: insufficient levels of physical activity and insufficient intake of fruit and vegetables. Using information from both literature and FG interviews, vitality consists of a mental and a physical component. The interviewees suggested to improve the mental component of vitality by means of relaxation exercises (e.g. yoga); physical vitality could be improved by aerobic endurance exercise and strength training.The lifestyle intervention (6 months) consists of three visits to a Personal Vitality Coach (PVC) combined with a Vitality Exercise Programme (VEP). The VEP consists of: 1) once a week a guided yoga group session aimed at relaxation exercises, 2) once a week a guided aerobic workout group session aimed at improving aerobic fitness and increasing muscle strength, and 3) older workers will be asked to perform once a week for at least 45 minutes vigorous physical activity without face-to-face instructions (e.g. fitness). Moreover, free fruit will be offered at the group sessions of the VEP. The lifestyle intervention will be evaluated in a RCT among older workers of two major academic hospitals in the Netherlands. At baseline, after 6 and 12 months, measurements (primary: lifestyle and vitality, and secondary: work-engagement and productivity) will take place.Discussion: The lifestyle programme is developed specifically tailored to the needs of the older workers and which is aimed at improving their vitality.Trial Registration: NTR1240. [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]

Background: Common mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees' cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process., Methods: RESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted., Discussion: Early intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole., Trial Registration: ISRCTN: 90663076. Registered on 5 October 2023., (© 2024. The Author(s).)

Objectives: White collar workers spend an increasing amount of time in occupational sedentary behavior (OSB) and are thereby at risk for adverse health outcomes. Nevertheless, the association between OSB and the need for recovery (NFR), an important indicator of wellbeing, is unknown and therefore examined., Methods: Baseline data from a cluster randomized controlled trial was used. A subgroup of 89 white collar workers wore a triaxial accelerometer for 7 days. NFR was measured using the Questionnaire on the Experience and Evaluation of Work. Compositional data analysis was applied to determine the composition of different OSB bouts (short, medium and long) and occupational physical activity (OPA) (light, moderate and vigorous and standing). Linear regression analyses were performed to explore the associations between occupational compositions and NFR., Results: Relatively more time spent in long OSB bouts was associated with a lower NFR (β: -11.30, 95% CI: -20.2 to -2.4). Short and medium OSB bouts and OPA were not associated with NFR., Conclusion: Associations between OSB bouts, OPA and NFR hinted at contrasting trends, suggesting the need to consider different bout lengths of OSB in future studies., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2024 Smit, Burgers, van Oostrom, Vähä-Ypyä, Husu, Verswijveren and Proper.)

Introduction: An integrated workplace health promotion program (WHPP) targeting multiple health behaviors by implementing activities at the individual and organizational level is potentially effective. The aim of this study was to evaluate the effect of implemented activities on targeted health behaviors., Methods: Data from four organizations in a cluster randomized controlled trial, including 173 employees, were used. Linear multilevel analyses or generalized estimating equations were conducted to assess within- and between-condition differences for physical activity (PA) and nutrition., Results: No between-condition differences were apparent for both health behaviors. Within the PA intervention condition, moderate PA increased and light PA decreased. Within the control condition the odds to consume more sugary drinks was lower., Conclusion: Implemented activities did not affect the targeted health behaviors, although moderate PA increased within the PA intervention condition. Small sample sizes and implementation of minimal, irregular activities may underly the absence of effect. Future research should address this., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Digital interventions are potential tools for reducing and limiting occupational sedentary behaviour (SB) in sedentary desk-based jobs. Given the harmful effects of sitting too much and sitting for too long while working, the aim of this systematic review and meta-analysis was to examine the effectiveness of workplace interventions, that incorporated digital elements, to reduce the time spent in SB in office workers., Methods: Randomised control trials that evaluated the implementation of workplace interventions that incorporated digital elements for breaking and limiting SB among desk-based jobs were identified by literature searches in six electronic databases (PubMed, Web of Science, Scopus, CINAHL, PsycINFO and PEDro) published up to 2023. Studies were included if total and/or occupational SB were assessed. Only studies that reported pre- and postintervention mean differences and standard deviations or standard errors for both intervention arms were used for the meta-analysis. The meta-analysis was conducted using Review Manager 5 (RevMan 5; Cochrane Collaboration, Oxford, UK). Risk of bias was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields QUALSYST tool., Results: Nineteen studies were included in the systematic review. The most employed digital elements were information delivery and mediated organisational support and social influences. Multicomponent, information, and counselling interventions measuring total and/or occupational/nonoccupational SB time by self-report or via device-based measures were reported. Multicomponent interventions were the most represented. Eleven studies were included in the meta-analysis, which presented a reduction of 29.9 (95% CI: -45.2, -14.5) min/8 h workday in SB (overall effect: Z = 3.81)., Conclusions: Multicomponent interventions, using a wide range of digital features, have demonstrated effectiveness in reducing time spent in SB at the workplace among desk-based employees. However, due to hybrid work (i.e., work in the office and home) being a customary mode of work for many employees, it is important for future studies to assess the feasibility and effectiveness of these interventions in the evolving work landscape., Trial Registration: The review protocol was registered in the Prospero database (CRD42022377366)., (© 2024. The Author(s).)

Purpose: This study aimed to assess among hospital night workers (i) to what extent sleep quality, sleep duration and sleep disturbances overlap, and (ii) associations between sociodemographic factors, lifestyle factors and work characteristics and sleep components., Methods: Data were used from 467 hospital night workers participating in the Klokwerk + study, a prospective cohort study with two measurements. Sleep quality was measured by the Pittsburgh Sleep Quality Index, sleep duration and sleep disturbances were measured by the Medical Outcomes Study Sleep Scale. The overlap between the three sleep measures was visualized with a Venn diagram and the proportions of overlap was calculated. Associations between independent variables (sociodemographic factors, lifestyle factors and work characteristics) and the three sleep outcomes were estimated using between-within Poisson regression models., Results: About 50% of the hospital night workers had at least one poor sleep outcome. Overlap in poor sleep outcomes was apparent for 36.8% of these workers, while the majority had a poor outcome in one of the sleep components only (63.1%). Former smoking had a significant association with poor sleep quality. For most independent variables no associations with poor sleep outcomes were observed., Conclusion: Our findings suggest that sleep quality, sleep duration and sleep disturbances are separate entities and should be studied separately. Lifestyle factors and work characteristics were generally not associated with poor sleep. Since these factors can have an acute effect on sleep, future research should consider ecological momentary assessment to examine how exposure and outcomes (co)vary within-persons, over time, and across contexts. Trial registration Netherlands Trial Register trial number NL56022.041.16., (© 2023. The Author(s).)

Background: During the COVID-19 pandemic, many healthcare workers faced extreme working conditions and were at higher risk of infection with the coronavirus. These circumstances may have led to mental health problems, such as anxiety, among healthcare workers. Most studies that examined anxiety among healthcare workers during the COVID-19 pandemic were cross-sectional and focused on the first months of the pandemic only. Therefore, this study aimed to investigate the longitudinal association between working in healthcare and anxiety during a long-term period (i.e., 18 months) of the COVID-19 pandemic., Methods: Data were used from online questionnaires of the Lifelines COVID-19 prospective cohort with 22 included time-points (March 2020-November 2021). In total, 2,750 healthcare workers and 9,335 non-healthcare workers were included. Anxiety was assessed with questions from the Mini-International Neuropsychiatric Interview, and an anxiety sum score (0-7) was calculated. Negative binomial generalized estimating equations (GEE), adjusted for demographic, work and health covariates, were used to examine the association between working in healthcare and anxiety., Results: Anxiety sum scores over time during the COVID-19 pandemic were similar for healthcare workers and non-healthcare workers. No differences between the anxiety sum scores of healthcare workers and non-healthcare workers were found [incidence rate ratio (IRR) = 0.97, 95% CI = 0.91-1.04]., Conclusion: This study did not find differences between healthcare workers and non-healthcare in perceived anxiety during the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Bosma, Feenstra, van Oostrom, Lifelines Corona Research Initiative and Proper.)

Purpose: In March 2020, the WHO declared COVID-19 a pandemic. Previous virus outbreaks, such as the SARS outbreak in 2003, appeared to have a great impact on the mental health of healthcare workers. The aim of this study is to examine to what extent mental health of healthcare workers differed from non-healthcare workers during the first year of the COVID-19 pandemic., Methods: We used data from a large-scale longitudinal online survey conducted by the Corona Behavioral Unit in the Netherlands. Eleven measurement rounds were analyzed, from April 2020 to March 2021 ( N  = 16,615; number of observations = 64,206). Mental health, as measured by the 5-item Mental Health Inventory, was compared between healthcare workers and non-healthcare workers over time, by performing linear GEE-analyses., Results: Mental health scores were higher among healthcare workers compared to non-healthcare workers during the first year of the pandemic (1.29 on a 0-100 scale, 95%-CI = 0.75-1.84). During peak periods of the pandemic, with over 100 hospital admissions or over 25 ICU admissions per day and subsequently more restrictive measures, mental health scores were observed to be lower in both healthcare workers and non-healthcare workers., Conclusion: During the first year of the COVID-19 pandemic, we observed no relevant difference in mental health between healthcare workers and non-healthcare workers in the Netherlands. To be better prepared for another pandemic, future research should investigate which factors hinder and which factors support healthcare workers to maintain a good mental health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 van der Noordt, Proper, Loef, Boot, Kroese, de Bruin and van Oostrom.)

Objective: Work-related mental health problems are a major and growing public and occupational health issue. Although prevention of work-related disease is a central task in the work of occupational physicians, implementation of preventive tasks can still improve. The aim of this paper is to present the development of an intervention to support occupational physicians in the execution of preventive tasks and a protocol for its evaluation., Methods: An intervention to support occupational physicians has been developed making use of the implementation mapping protocol. The intervention was based on barriers and facilitators for the execution of preventive tasks, input from stakeholders, and evidence-based strategies from literature., Results: The intervention consists of three peer group supervision meetings directed to preventive tasks. During these meetings, occupational physicians will receive materials and will use goal-setting to formulate their own action plans. The IM-PROmPt-study (Implementation of PReventive tasks by Occupational Physicians) is a two-armed cluster randomized controlled trial, comparing peer group supervision directed to the implementation of preventive tasks for occupational physicians with usual peer group supervision. The evaluation will include an effect and process evaluation to examine if the intervention is successful in supporting OPs to implement preventive activities, specifically aimed to prevent work-related mental health problems., Discussion: The intervention is expected to lead to more knowledge and awareness of the value of prevention among OPs, anticipated to lead to both organizational and individual gains., Trial Registration: ISRCTN registry; ISRCTN15394765. Registered on 27 June 2023., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: This study investigates the associations between working from home and the presence of MSP during the COVID-19 pandemic. Working from home often involves a lot of sedentary computer screen work and the home working environment might not be optimally equipped, which can lead to health problems, including musculoskeletal pain (MSP)., Methods: Longitudinal data from 16 questionnaire rounds of the Lifelines COVID-19 cohort during the first year of the COVID-19 pandemic (March 2020-February 2021) were used. In total, 40,702 Dutch workers were included. In every round, participants reported whether they worked on location, from home, or hybrid. Logistic Generalized Estimating Equations were used to study the association of work situation with the presence of MSP and the presence of severe MSP., Results: Working from home was associated with higher risks of having MSP in the lower back (OR: 1.05, 95% CI 1.02-1.08), in the upper back (OR: 1.24, 95% CI 1.18-1.31), and in the neck, shoulder(s) and/or arm(s) (OR: 1.18, 95% CI 1.13-1.22). Hybrid working was associated with higher risks of having pain in the upper back (OR: 1.09, 95% CI 1.02-1.17) and in the neck, shoulder(s) and/or arm(s) (OR: 1.14, 95% CI 1.09-1.20). Both home and hybrid workers had higher risks of severe MSP in the different body areas., Conclusion: Home workers, and to a smaller extent hybrid workers, had higher risks of having MSP than location workers during the first year of the COVID-19 pandemic. The results indicate the importance of measures to prevent MSP in future policies involving working from home., (© 2022. The Author(s).)

Objective: Workplace health promotion programs (WHPPs) have shown to be effective in improving lifestyle behaviors of employees. Despite potential benefits for employees, participation rates are generally low. The aim of this study was to gain deeper insight into barriers and facilitators for participation in WHPPs prior to implementation according to employees., Methods: Peer-to-peer interviewing, a method derived from citizen science, was used to actively involve employees in the data collection. Employees working in the cleaning-, ICT- and facility-sector were trained to interview their co-workers. Interviews were recorded and transcribed verbatim. Thematic analysis was performed using the Consolidated Framework for Implementation Research (CFIR), complemented with the constructs 'interpersonal factors' and 'intrapersonal factors' from the social ecological model. Data were coded deductively and inductively, and rated by two researchers independently., Results: Fourteen peer-interviewers conducted 62 peer-to-peer interviews. Main barriers for participation in WHPPs were an unsupportive organizational culture where lifestyle is not a common topic and programs that are not tailored to their needs. Support from peers and supervisors were facilitators. The availability of organizational resources, such as facilities and financial compensation, support participation., Conclusions: To enhance participation of employees in WHPPs it is recommended to take into account the barriers and facilitators identified in this study. For instance, employees should be involved in the development and implementation of WHPPS by the employer and their needs and available resources should be taken into account. This may lead to more successful implementation and higher participation rates in future WHPPs., (© 2022. The Author(s).)

Background: Workplace health promotion programs (WHPPs) can benefit the lifestyle and health of employees. However, not all WHPPs have been successful in their implementation, and thus their effectiveness. This study aimed to identify the barriers and facilitators to implementing an integrated WHPP, which targets multiple lifestyle factors at different levels (individual and organizational), from an employer's perspective., Methods: Data were collected by two online focus groups among 18 representatives of eight different organizations. Data from the focus group discussions were transcribed verbatim and analyzed using thematic analysis. Data were coded both inductively and deductively, using the Consolidated Framework for Implementation Research (CFIR) consisting of the following five domains: (1) intervention characteristics, (2) outer setting, (3) inner setting, (4) characteristics of individuals, and (5) process. Ratings were performed to indicate the positive or negative influence and strength of a construct regarding the implementation of WHPPs., Results: Barriers and facilitators in all domains of the CFIR were found. Regarding characteristics of the WHPP, complexity and costs hindered implementation, while high adaptability facilitated it. An organization that met the needs of employees (the outer setting) facilitated implementation. Available resources, access to knowledge, leadership involvement, and continuity of communication were facilitators within the inner setting. Barriers were different approaches to implementation within one organization and the perceived interference with employees' lives. For the implementation process, the involvement of key stakeholders, including employees, was identified as an important facilitator., Conclusion: Various barriers and facilitators in different domains play a role in the implementation of integrated WHPPs, according to employers. Strategies that tackle the identified barriers and incorporate the facilitators will likely contribute to the successful implementation of integrated WHPPs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Campmans, Smit, van Oostrom, Engels and Proper.)

Introduction: Working from home during the COVID-19 pandemic has been associated both with physical inactivity and musculoskeletal pain. However, it has not been examined whether physical activity and sedentary behavior are underlying mechanisms in the association between working from home and musculoskeletal pain. Therefore, we examined their mediating role in this association., Methods: Data were used from 24 questionnaire rounds of the Lifelines COVID-19 cohort (March 2020-January 2022). Longitudinal information on work situation (location, home, hybrid), physical activity, sedentary behavior, and musculoskeletal pain was collected among 28,586 workers. Analysis of physical activity/sedentary behavior as mediators of the association between working from home and musculoskeletal pain was performed using multilevel structural equation modeling., Results: Home workers more often had pain in the upper back [odds ratio (OR) = 1.17, 95%-confidence interval (CI) = 1.02-1.34] and arm, neck, and/or shoulder (ANS) (OR = 1.32, 95%-CI = 1.19-1.47) than location workers. Furthermore, home workers were more often sedentary for >9 h per work day than location workers (OR = 2.82, 95%-CI = 2.56-3.09), and being more sedentary was associated with musculoskeletal pain (upper back: OR = 1.17, 95%-CI = 1.06-1.30; ANS: OR = 1.25, 95%-CI = 1.16-1.34). Corresponding indirect effects were OR = 1.18 (95%-CI = 1.04-1.33) and OR = 1.26 (95%-CI = 1.12-1.35). No indirect effect was found for physical activity. Similar indirect effects were observed for hybrid workers., Conclusion: Home and hybrid workers were more likely to have pain in the upper musculoskeletal system during the COVID-19 pandemic than location workers, which was partly mediated by increased sedentary behavior, but not by reduced physical activity. Measures to reduce sedentary time in home workers may contribute to preventing musculoskeletal pain., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Loef, van Oostrom, Bosma, Lifelines Corona Research Initiative and Proper.)

Blue-collar workers have, on average, poorer health than white-collar workers. Existing worksite health promotion programs (WHPPs) are often not successful among blue-collar workers. This study evaluates the effect of the Citizen Science-based WHPP on the targeted lifestyle behaviors among construction workers. The data of 114 participants were retrieved from questionnaires before (T0) and after (T1) the WHPP. Outcome measures were mean and categorical changes in daily fruit and vegetable intake and weekly leisure time physical exercise. Changes were tested using Wilcoxon signed rank tests and McNemar tests. No statistically significant changes were found between T0 and T1. In total, 73.7% of the participants felt involved in the WHPP. Changes in the outcome measures were not significantly different between subgroups based on age, nor in subgroups based on feelings of involvedness. The low intensity of the developed program could be an explanation for this lack of significant change. Future studies using the Citizen Science approach in an occupational setting should aim at developing a more intensified program and should test its effectiveness by comparing changes in a (randomized) controlled trial.

Background: Many workplace health promotion programs (WHPPs) do not reach blue-collar workers. To enhance the fit and reach, a Citizen Science (CS) approach was applied to co-create and implement WHPPs. This study aims to evaluate i) the process of this CS approach and ii) the resulting WHPPs., Methods: The study was performed in two companies: a construction company and a container terminal company. Data were collected by questionnaires, interviews and logbooks. Using the framework of Nielsen and Randall, process measures were categorized in the intervention, context and mental models. Interviews were transcribed and thematically coded using MaxQDA software., Results: The involvement in the CS approach and co-creating the WHPPs was positively experienced. Information provision, sustained engagement over time and alignment with the workplace's culture resulted in barriers in the CS process. As to the resulting WHPPs, involvement and interaction during the intervention sessions were particularly experienced in small groups. The reach was affected by the unfavorable planning off the WHPPs and external events of re-originations and the covid-19 pandemic., Discussion: Continuous information provision and engagement over time, better alignment with the workplace's culture and favorable planning are considered to be important factors for facilitating involvement, reach and satisfaction of the workers in a Citizen science approach to design and implement a WHPP. Further studies continuously monitoring the process of WHPPs using the CS approach could be helpful to anticipate on external factors and increase the adaptability., Conclusions: Workers were satisfied with the involvement in WHPPs. Organizational and social cultural factors were barriers for the CS approach and its reach. Involvement and interaction in WHPPs were particularly experienced in small grouped sessions. Consequently, contextual and personal factors need be considered in the design and implementation of WHPPs with CS approach among blue-collar workers., (© 2022. The Author(s).)

Night-shift workers experience disturbances of their circadian rhythm and sleep, which may make them more susceptible to infectious diseases. Therefore, we studied whether night-shift workers are at higher risk of testing positive for SARS-CoV-2 infection than day workers. In this prospective study, data were used from 20 questionnaire rounds of the Dutch Lifelines COVID-19 cohort that was initiated in March 2020. In the different questionnaire rounds, 2285 night-shift workers and 23,766 day workers reported whether they had tested positive for SARS-CoV-2. Cox proportional hazards regression models adjusted for demographic, work, and health covariates were used to compare SARS-CoV-2 incidence between night-shift and day workers. From March 2020-January 2021, 3.4% of night-shift workers and 2.2% of day workers reported to have tested positive for SARS-CoV-2 (p < .001). After adjustment for covariates, night-shift workers had a 37% higher risk of testing positive for SARS-CoV-2 (hazard ratio: 1.37, 95% confidence interval: 1.05-1.77). In this study, we show that night-shift workers were more likely to test positive for SARS-CoV-2 than day workers, which adds to the growing evidence that night-shift work may influence the complex processes involved in infection susceptibility. Further mechanistic insight is needed to understand the relation between night-shift work and (SARS-CoV-2) infection susceptibility.

Objective: Working from home during the COVID-19 pandemic has affected many workers' daily life and possibly their physical activity behavior. We studied the longitudinal association of working from home during the pandemic with physical activity and sedentary behavior., Methods: Longitudinal data from 17 questionnaire rounds of the Lifelines COVID-19 cohort (March 2020-February 2021) were used. In total, 33 325 workers were included. In every round, participants reported their current work situation: location, home, or hybrid (working on location and from home). Physical activity levels and sedentary behavior before and during the pandemic were asked. Logistic generalized estimating equations adjusted for demographic/work/health covariates were used to study the association of work situation with physical activity and sedentary behavior., Results: Home workers were less likely to meet the recommended ≥150 minutes/week of moderate-to-vigorous-intensity activity during the pandemic than location workers [odds ratio (OR) 0.93, 95% confidence interval (CI) 0.90-0.96] and more likely to be less physically active than before the pandemic (OR 1.09, 95% CI 1.04-1.14). Furthermore, compared to location workers, home and hybrid workers were more likely to be more sedentary (sitting ≥8 hours/day) on workdays during than before the pandemic (OR 1.51, 95% CI 1.39-1.64/1.36-1.68, respectively)., Conclusions: Compared to location workers, home workers (and to a lesser extent hybrid workers) were more often physically inactive and sedentary during than before the COVID-19 pandemic. As a substantial part of the working population may continue to work (partly) from home after the pandemic, workers should be supported to increase activity and reduce sitting while working from home.

Background: An integrated workplace health promotion program (WHPP) which targets multiple lifestyle factors at different levels (individual and organizational) is potentially more effective than a single component WHPP. The aim of this study is to describe the protocol of a study to tailor a European good practice of such an integral approach to the Dutch context and to evaluate its effectiveness and implementation., Methods: This study consists of two components. First, the five steps of the Map of Adaptation Process (MAP) will be followed to tailor the Lombardy WHP to the Dutch context. Both the employers and employees will be actively involved in this process. Second, the effectiveness of the integrated Dutch WHPP will be evaluated in a clustered randomized controlled trial (C-RCT) with measurements at baseline, 6 months and 12 months. Clusters will be composed based on working locations or units - dependent on the organization's structure and randomization within each organization takes place after baseline measurements. Primary outcome will be a combined lifestyle score. Secondary outcomes will be the separate lifestyle behaviors targeted, stress, work-life balance, need for recovery, general health, and well-being. Simultaneously, a process evaluation will be conducted. The study population will consist of employees from multiple organizations in different industry sectors. Organizations in the intervention condition will receive the integrated Dutch WHPP during 12 months, consisting of an implementation plan and a catalogue with activities for multiple lifestyle themes on various domains: 1) screening and support; 2) information and education; 3) adjustments in the social, digital or physical environment; and 4) policy., Discussion: The MAP approach provides an appropriate framework to systematically adapt an existing WHPP to the Dutch context, involving both employers and employees and retaining the core elements, i.e. the catalogue with evidence-based activities on multiple lifestyle themes and domains enabling an integrated approach. The following process and effect evaluation will contribute to further insight in the actual implementation and effectiveness of the integrated WHP approach., Trial Registration: NTR (trialregister.nl ), NL9526. Registered on 3 June 2021., (© 2022. The Author(s).)

Objectives: This study aims to provide insight into (i) how the combination of paid work and family care is longitudinally associated with gender-related differences in depressive symptoms and (ii) the role of work characteristics in this association., Methods: Data were derived from STREAM, a Dutch prospective cohort study of older workers aged 45-64 years. Respondents were included if they were employed in at least one measurement between 2015 and 2017 (N=12 447). Mixed-models were applied to disentangle between-person (BP) and within-person (WP) effects of family caregiving on depressive symptoms. Analyses were stratified by gender. Work characteristics (social support, autonomy, emotional and mental workload) were separately added to the multivariable models., Results: For older employees, family caregiving was positively associated with depressive symptoms between and within persons for both women [BP B=0.80, 95% confidence interval (CI) 0.52-1.08; WP B=0.32, 95% CI 0.08-0.56] and men (BP B=0.75, 95% CI 0.45-1.05; WP B=0.25, 95% CI 0.01-0.48). Social support at work reduced the adverse effect of family care on depressive symptoms for women (BP) and men (BP and WP). Emotional workload partly explained the effect of family care for both women and men (BP)., Conclusions: The longitudinal association between family care and mental health was similar for male and female employees. Resources at work (ie, social support) could protect caregiving employees against depressive symptoms. More research is needed regarding the relative impact of the care context compared to the work context of working family caregivers.

The workplace is an ideal environment for promoting workers' health. Nevertheless, preventive health measures are insufficiently implemented, especially in small and medium-sized enterprises (SMEs) with up to 250 employees. The aim of this study was to investigate determinants for the implementation of measures to prevent musculoskeletal and mental health disorders from the perspective of enterprise representatives in Dutch SMEs. An online survey was completed by 79 SME representatives (e.g., owners, HR professionals and occupational health and safety officers) in the cleaning, care, construction and transport sectors. In addition, semi-structured interviews were conducted with 18 enterprise representatives. The interview transcripts were analyzed using an inductive approach. Survey data showed that the focus of prevention efforts by SMEs is on improving working conditions and complying with legally required occupational health requirements, while lifestyle measures are rarely implemented. The determinants of implementation according to enterprise representatives were associated with 10 distinct themes. These were (1) available resources (both finances and staff), (2) complexity of implementation of measures, (3) awareness, (4) knowledge and expertise, (5) availability of time, (6) employer and worker commitment, (7) workers' openness for measures, (8) communication, (9) workers' trust and autonomy and (10) integration in organizational policy. These findings can serve as a support for developing strategies for implementing preventive health measures in SMEs.

Purpose: To investigate the combined effects of occupational physical activity (OPA) and either overweight/obesity or low levels of leisure-time vigorous physical activity (LTVPA) on self-rated health., Methods: A longitudinal study was performed among 29,987 construction workers with complete data on 2 Workers' Health Surveillance Programs during 2010-2018. Self-reported OPA involved strenuous work postures and manual material handling. Low level of LTVPA was defined as self-reported vigorous activity for less than three times per week lasting at least 20 min per session. Overweight and obesity were based on Body Mass Index (BMI) (25.0 ≤ BMI < 30.0 kg/m 2 and BMI ≥ 30.0 kg/m 2 , respectively) using measured body height and weight. Self-rated health was measured using a single item question. Logistic regression analysis was used to investigate the associations between the separate risk factors at baseline and self-rated health at follow-up. The combined effects of demanding OPA and either overweight/obesity or low level of LTVPA on self-rated health were analyzed using the relative excess risk due to interaction (RERI)., Results: Mean follow-up duration was 31.7 (SD = 14.9) months. Construction workers with strenuous work postures (OR 1.35 95% CI 1.25-1.46), manual material handling (OR 1.29 95% CI 1.19-1.40), obesity (OR 1.31 95% CI 1.17-1.47) and low LTVPA (OR 1.13 95% CI 1.01-1.25) were more likely to report poor self-rated health at follow-up. No statistically significant interaction effects were found for OPA and obesity or low LTVPA., Conclusions: OPA, obesity and low level of LTVPA were separate risk factors for poor self-rated health, but did not appear to have a synergistic effect., (© 2021. The Author(s).)

Night shift work is associated with increased health risks. Here we examined the association of metabolic risk factors and immune cell counts, with both night shift work and particular characteristics thereof: frequency, duration and consecutive night shifts. We performed a cross-sectional study using data from 10,201 non-shift workers and 1062 night shift workers of the Lifelines Cohort study. Linear regression analyses, adjusted for demographic, lifestyle and occupational factors, were used to study associations of night shift work characteristics with metabolic risk factors and immune cell counts. Night shift workers had an increased BMI, waist circumference and immune cell counts compared to non-shift workers. This was especially seen in night shift workers who had a higher frequency of night shifts per month (≥ 5: BMI: B = 0.81 kg/m 2 (95%-CI = 0.43-1.10); waist circumference: B = 1.58 cm (95%-Cl = 0.34-1.71; leukocytes: B = 0.19 × 10 9 cells/L (95%-CI = 0.04-0.34 × 10 9 )) and worked more consecutive night shifts (> 3: BMI: B = 0.92 kg/m 2 (95%-CI = 0.41-1.43); waist circumference: B = 1.85 cm (95%-Cl = 0.45-3.24); leukocytes: B = 0.32 × 10 9 cells/L (95%-CI = 0.09-0.55 × 10 9 )). This association was less pronounced in long-term night shift workers (≥ 20 years). Our findings provide evidence for the association between night shift work characteristics and BMI, waist circumference and leukocytes (including, monocytes, lymphocytes, and basophil granulocytes)., (© 2022. The Author(s).)

Purpose: Shift work has been related to obesity and diabetes, but the potential mediating role of lifestyle is yet unknown. Our aim was to investigate this mediating role of physical activity, diet, smoking, and sleep quality in the relationships between shift work, and obesity and diabetes., Methods: In this cross-sectional study, 3188 shift workers and 6395 non-shift workers participated between 2013 and 2018 in periodical occupational health checks. Weight and height were objectively measured to calculate obesity (BMI ≥ 30 kg/m 2 ). Diabetes status, physical activity, diet, smoking, and sleep quality were assessed using standardized questionnaires. Structural equation models adjusted for relevant confounders were used to analyze the mediating role of lifestyle in the relationships between shift work, and obesity and diabetes., Results: Shift workers were more often obese (OR: 1.37, 95% CI 1.16-1.61) and reported more often to have diabetes (OR:1.35, 95% CI 1.003-1.11) than non-shift workers. Shift workers had lower physical activity levels, ate fruit and vegetables less often, smoked more often, and had poorer sleep quality (p < 0.05). Mediation analysis revealed that shift workers had a higher odds of obesity (OR: 1.07, 95% CI 1.01-1.15) and diabetes (OR: 1.13, 95% CI 1.02-1.27) mediated by poorer sleep quality. Lower physical activity levels (OR: 1.11, 95% CI 1.05-1.19) and lower intake of fruit and vegetables (OR: 1.04, 95% CI 1.01-1.15) were also mediators in the relationship between shift work and obesity, but not in the relationship between shift work and diabetes (p ≥ 0.05)., Conclusion: These results imply that interventions targeting diet, physical activity and in particular sleep problems specifically developed for shift workers could potentially reduce the adverse health effects of shift work., (© 2021. The Author(s).)

Background: Little is known about the relationship between shift work and perceived health, including potential underlying mechanisms such as unhealthy behaviors. The aim of this study was to investigate whether unhealthy behaviors mediate the relationship between shift work and perceived mental and physical health, taking into account potential differences by level of education., Methods: Data from 1633 workers participating in the Doetinchem Cohort Study during 1995-2016 were used. Being engaged in shift work was determined at 1 year preceding the assessment of health behaviors. Mental and physical health were assessed after 5 years of follow-up by the 5-item Mental Health Inventory and the physical functioning scale of the 36-item Short Form Health Survey. Smoking, physical inactivity, alcohol consumption, and overweight were considered as potential mediators and education was treated as moderator. Moderated mediation analyses using generalized estimated equations were performed., Results: Shift work was not statistically significantly related to either mental or physical health. Despite this, statistically significant mediation effects of smoking (Beta - 0.09; 95% Confidence Interval - 0.20 - -0.01, respectively B -0.09; 95%CI -0.21 - -0.01) and physical inactivity (B 0.11; 95%CI 0.03-0.23, respectively B 0.08; 95%CI 0.01-0.18) were found in the relationship between shift work and mental or physical health. Direct and indirect effects outweighed each other in the relationship between shift work and mental health, since the direction of these effects was opposite. The relationship between shift work, unhealthy behavior, and health was not different by educational level., Conclusion: Shift workers did not report lower mental or physical health than non-shift workers. Though mediation effects of unhealthy behavior were observed in the relationship between shift work and perceived health, these small effects had minor public health relevance.

Many informal caregivers of older adults combine their caregiving tasks with a paid job. Adequate support is important to enable them to combine paid work with caregiving, while maintaining their health and wellbeing. To date, however, knowledge about working caregivers' support needs is fragmented. This study, therefore, aimed to obtain more insight into the support needs of working caregivers of older adults. We conducted six online semi-structured focus group interviews with in total 25 working caregivers of older adults living at home. Data were complemented with information from seven working caregivers participating in the study's advisory board. Data were analyzed using inductive and deductive thematic analysis. Six themes related to working caregivers' needs were identified: (1) Recognition of caregivers, including the challenges they face; (2) Attention for caregivers' health, wellbeing and ability to cope; (3) Opportunities to share care responsibilities; (4) Help with finding and arranging care and support; (5) Understanding and support from the work environment; (6) Technological support tailored to the needs and capacities of caregivers and older adults. To address these needs, working caregivers suggested several options in multiple domains of life (i.e., work, home and social life, care environment, personal health and wellbeing). To successfully support them, a multi-faceted effort, involving actors from multiple settings, is needed.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates., Objectives: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence)., Data Sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts., Study Eligibility and Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. We included randomized controlled trials, cohort studies, case-control studies and other non-randomized intervention studies with an estimate of the effect of occupational exposure to ergonomic risk factors (any exposure to force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing ≥ 2 h/day) compared with no or low exposure to the theoretical minimum risk exposure level (<2 h/day) on the prevalence or incidence of MSD or OA., Study Appraisal and Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. Missing data were requested from principal study authors. We combined odds ratios using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using Navigation Guide tools adapted to this project., Results: In total eight studies (4 cohort studies and 4 case control studies) met the inclusion criteria, comprising a total of 2,378,729 participants (1,157,943 females and 1,220,786 males) in 6 countries in 3 WHO regions (Europe, Eastern Mediterranean and Western Pacific). The exposure was measured using self-reports in most studies and with a job exposure matrix in one study and outcome was generally assessed with physician diagnostic records or administrative health data. Across included studies, risk of bias was generally moderate. Compared with no or low exposure (<2 h per day), any occupational exposure to ergonomic risk factors increased the risk of acquiring MSD (odds ratio (OR) 1.76, 95% confidence interval [CI] 1.14 to 2.72, 4 studies, 2,376,592 participants, I 2 70%); and increased the risk of acquiring OA of knee or hip (OR 2.20, 95% CI 1.42 to 3.40, 3 studies, 1,354 participants, I 2 13%); Subgroup analysis for MSD found evidence for differences by sex, but indicated a difference in study type, where OR was higher among study participants in a case control study compared to study participants in cohort studies., Conclusions: Overall, for both outcomes, the main body of evidence was assessed as being of low quality. Occupational exposure to ergonomic risk factors increased the risk of acquiring MSD and of acquiring OA of knee or hip. We judged the body of human evidence on the relationship between exposure to occupational ergonomic factors and MSD as "limited evidence of harmfulness" and the relationship between exposure to occupational ergonomic factors and OA also as "limited evidence of harmfulness". These relative risks might perhaps be suitable as input data for WHO/ILO modelling of work-related burden of disease and injury. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053 PROSPERO registration number: CRD42018102631., (Copyright © 2021 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

Objective Using a novel mediation method that presents unbiased results even in the presence of exposure-mediator interactions, this study estimated the extent to which working conditions and health behaviors contribute to educational inequalities in self-rated health in the workforce. Methods Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 16 countries were selected, aged 50-64 years, in paid employment at baseline and with information on education and self-rated health (N=15 028). Education, health behaviors [including body mass index (BMI)] and working conditions were measured at baseline and self-rated health at baseline and two-year follow-up. Causal mediation analysis with inverse odds weighting was used to estimate the total effect of education on self-rated health, decomposed into a natural direct effect (NDE) and natural indirect effect (NIE). Results Lower educated workers were more likely to perceive their health as poor than higher educated workers [relative risk (RR) 1.48, 95% confidence interval (CI) 1.37-1.60]. They were also more likely to have unfavorable working conditions and unhealthy behaviors, except for alcohol consumption. When all working conditions were included, the remaining NDE was RR 1.30 (95% CI 1.15-1.44). When BMI and health behaviors were included, the remaining NDE was RR 1.40 (95% CI 1.27-1.54). Working conditions explained 38% and health behaviors and BMI explained 16% of educational inequalities in health. Including all mediators explained 64% of educational inequalities in self-rated health. Conclusions Working conditions and health behaviors explain over half of the educational inequalities in self-rated health. To reduce health inequalities, improving working conditions seems to be more important than introducing health promotion programs in the workforce.

Objectives: The objective of this study is to examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relationship between high job strain and self-rated poor health in workers with a low education., Methods: A total of 8369 low educated workers, who participated in the Lifelines cohort study during the period 2012-2017, were included. Self-reported job strain, health behaviors (smoking, physical activity, and fruit and vegetable consumption), and BMI were assessed at baseline, and self-rated health after 2 years. To assess mediation by the health behaviors and BMI, structural equation modeling with logistic and multinomial regression analyses were performed., Results: Workers with high job strain had a higher odds of poor health (OR 1.34; 95% CI 1.13-1.60) compared to those with low job strain. Workers with high job strain were more likely to have a lack of physical activity (OR 1.14; 95% CI 1.01-1.28), but were not more likely to smoke, to be overweight or obese, or to have a low fruit or vegetable consumption. Workers who smoke, have a lack of physical activity or are overweight or obese are more likely to report poor health (OR 1.37; 95% CI 1.16-1.60, OR 1.25; 95% CI 1.08-1.43, OR 1.37; 95% CI 1.16-1.61, OR 2.25; 95% CI 1.86-2.72). Indirect (mediating) effects of unhealthy behaviors and BMI in the relationship between high job strain and poor health were small and not statistically significant., Conclusions: No mediating effects of unhealthy behaviors or BMI were found in the relationship between high job strain and self-rated poor health among workers with a low educational level.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic and human data suggests that occupational exposure to ergonomic (or physical) risk factors may cause osteoarthritis and other musculoskeletal diseases (excluding rheumatoid arthritis, gout, and back and neck pain). In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to physical ergonomic risk factors for estimating the number of disability-adjusted life years from these diseases that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates., Objectives: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to ergonomic risk factors for osteoarthritis and other musculoskeletal diseases., Data Sources: We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts., Study Eligibility and Criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (<15 years) and unpaid domestic workers. The exposure was defined as any occupational exposure to one or more of: force exertion, demanding posture, repetitive movement, hand-arm vibration, kneeling or squatting, lifting, and/or climbing. We included all study types with an estimate of the prevalence of occupational exposure to ergonomic risk factors., Study Appraisal and Synthesis Methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates., Results: Five studies (three cross-sectional studies and two cohort studies) met the inclusion criteria, comprising 150,895 participants (81,613 females) in 36 countries in two WHO regions (Africa, Europe). The exposure was generally assessed with questionnaire data about self-reported exposure. Estimates of the prevalence of occupational exposure to ergonomic risk factors are presented for all five included studies, disaggregated by country, sex, 5-year age group, industrial sector or occupational group where feasible. The pooled prevalence of any occupational exposure to ergonomic risk factors was 0.76 (95% confidence interval 0.69 to 0.84, 3 studies, 148,433 participants, 35 countries in the WHO Europe region, I 2 100%, low quality of evidence). Subgroup analyses found no statistically significant differences in exposure by sex but differences by age group, occupation and country. No evidence was found for publication bias. We assessed this body evidence to be of low quality, based on serious concerns for risk of bias due to exposure assessment only being based on self-report and for indirectness due to evidence from two WHO regions only., Conclusions: Our systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent. The current body of evidence is, however, limited, especially by risk of bias and indirectness. Producing estimates for the burden of disease attributable to occupational exposure to ergonomic risk factors appears evidence-based, and the pooled effect estimates presented in this systematic review may perhaps be used as input data for the WHO/ILO Joint Estimates. Protocol identifier:https://doi.org/10.1016/j.envint.2018.09.053. PROSPERO registration number: CRD42018102631., (Copyright © 2020 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

Objective: This study aimed to investigate the association between shift work, and burnout and distress, and differences by degree of satisfaction with shift schedule and its impact on private life., Methods: Population 4275 non-shift factory workers and 3523 rotating 5-shift workers. Workers participated between 2009 and 2016 one to three times in the companies' periodical occupational health checks. Burnout was measured using the distance, exhaustion and competence subscales of the Dutch Maslach Burnout Inventory and distress by the subscale of the Four-Dimensional Symptom Questionnaire (scale: 0-100). Multiple-adjusted linear mixed models were used to assess between- and within-subject associations between shift work and outcomes, and differences by age, years of shift work, and satisfaction with and impact of shift schedule., Results: Shift work was significantly associated with lower scores on burnout distance (B - 1.0, 95% - 1.8 to 0.3), and among those aged < 48 years with burnout exhaustion (range B - 1.3 to - 1.6). However, the effect sizes were small. Compared to non-shift workers, shift workers dissatisfied with their schedule and those experiencing a high impact on private life had significantly higher burnout (range B 1.7-6.3) and distress levels (range B 4.9-6.1). In contrast, satisfied shift workers and those experiencing a low impact of shift schedule had lower burnout (range B - 0.2 to - 2.2) and no difference in distress levels (P ≥ 0.05). No clear pattern by years of shift work was observed., Conclusions: Shift work was associated with burnout and distress in those who were dissatisfied with or who had perceived high impact on the private life of their shift schedule.

Objectives Shift work may be associated with an increased incidence of respiratory infections. However, underlying mechanisms are unclear. Therefore, our aim was to examine the mediating role of sleep, physical activity, and diet in the association between shift work and respiratory infections. Methods This prospective cohort study included 396 shift and non-shift workers employed in hospitals. At baseline, sleep duration and physical activity were measured using actigraphy and sleep/activity diaries, sleep quality was reported, and frequency of meal and snack consumption was measured using food diaries. In the following six months, participants used a smartphone application to report their influenza-like illness/acute respiratory infection (ILI/ARI) symptoms daily. Mediation analysis of sleep, physical activity, and diet as potential mediators of the effect of shift work on ILI/ARI incidence rate was performed using structural equation modeling with negative binomial and logistic regression. Results Shift workers had a 23% [incidence rate ratio (IRR) 1.23, 95% CI 1.01-1.49] higher incidence rate of ILI/ARI than non-shift workers. After adding the potential mediators to the model, this reduced to 15% (IRR 1.15, 95% CI 0.94-1.40). The largest mediating (ie, indirect) effect was found for poor sleep quality, with shift workers having 29% more ILI/ARI episodes via the pathway of poorer sleep quality (IRR 1.29, 95% CI 1.02-1.95). Conclusions Compared to non-shift workers, shift workers had a higher incidence rate of ILI/ARI that was partly mediated by poorer sleep quality. Therefore, it may be relevant for future research to focus on perceived sleep quality as an underlying mechanism in the relation between shift work and increased infection susceptibility.

This study aimed to compare sickness absenteeism, work performance, and healthcare use due to respiratory infections, as well as general sickness absenteeism and work performance between shift and non-shift workers. In this study, 589 shift and non-shift workers employed in hospitals were included. For 6 months, participants kept a daily record of their influenza-like illness/acute respiratory infection (ILI/ARI) symptoms using a diary application. After an episode of ILI/ARI symptoms ended, participants (n = 531) were questioned about their sickness absenteeism (occurrence and duration in hours), work performance (on a 10 point scale), and healthcare use during the ILI/ARI episode. At the end of the 6 months follow-up, participants (n = 498) were also asked about general sickness absenteeism and work performance in the past 4 weeks. Mixed-model and regression analyses were used to compare absenteeism, work performance, and healthcare use between shift and non-shift workers. No differences were found in sickness absenteeism [Odds Ratio (OR) = 1.00 (95%‒Confidence Interval (CI): 0.61‒1.64)] and work performance [Regression coefficient (B) = -0.19 (95%‒CI: -0.65‒0.26)] due to ILI/ARI between shift and non-shift workers. In addition, healthcare use due to ILI/ARI was similar between shift and non-shift workers. Furthermore, similar general sickness absenteeism rates and work performance levels were found between shift and non-shift workers. As this is the first study that examined the associations with shift work due to ILI/ARI, further studies are needed to confirm our findings.

Objectives: To examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relation between high physical workload and self-rated health in male construction workers., Methods: Longitudinal data over 2010 to 2018 were used of 30,224 male construction workers in The Netherlands. Smoking, lack of physical activity, and alcohol consumption were self-reported. BMI was based on measured body weight and height. Multilevel modeling path analyses were used to determine the mediating role of unhealthy behaviors in the relation between physical workload and poor health., Results: A direct effect of high physical workload on poor health adjusted for unhealthy behaviors and BMI was found (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.38 to 1.68). Indirect effects of the unhealthy behaviors and BMI in the relation between high physical workload and poor health were small (OR varying from 0.96 to 1.04)., Conclusion: The pathway of high physical workload and poor health through unhealthy behaviors and BMI was not supported.

Purpose: This study aimed to investigate the relationship between the moderating role of lifestyle, age, and years working in shifts and, shift work and being overweight., Methods: Cross-sectional data were used of 2569 shift and 4848 non-shift production workers who participated between 2013 and 2018 in an occupational health check. Overweight (BMI ≥ 25 kg/m 2 ) was calculated using measured weight and height; lifestyle was assessed by questionnaires. Multiple-adjusted logistic regression with interaction terms between shift work and potential moderators assessed multiplicative interaction; the relative excess risk due to interaction assessed additive interaction (synergism)., Results: Shift work was significantly related to being overweight (OR 1.53, 95% CI 1.33 1.76). The strength of this association did not differ by level of sleep quality, fruit and vegetable intake, and physical activity (p ≥ 0.05). Additive and multiplicative interaction by smoking status was present (p < 0.01), with a stronger relationship between shift work and being overweight among non-smokers compared to smokers. Older age as well as more years of exposure to shift work were, independently from each other, related to a stronger relationship between shift work and being overweight (multiplicative interaction p < 0.05)., Conclusion: Shift work was to a similar extent related to being overweight among those with a healthy and unhealthy lifestyle. This does, however, not imply that shift workers can behave unhealthy without any harm. Based on the evident health benefits of a healthy lifestyle, it is still recommended to get sufficient quality of sleep and to meet the recommended level of daily physical activity and, fruit and vegetable intake.

Health interventions often do not reach blue-collar workers. Citizen science engages target groups in the design and execution of health interventions, but has not yet been applied in an occupational setting. This preliminary study determines barriers and facilitators and feasible elements for citizen science to improve the health of blue-collar workers. The study was conducted in a terminal and construction company by performing semi-structured interviews and focus groups with employees, company management and experts. Interviews and focus groups were analyzed using thematic content analysis and the elements were pilot tested. Workers considered work pressure, work location and several personal factors as barriers for citizen science at the worksite, and (lack of) social support and (negative) social culture both as barriers and facilitators. Citizen science to improve health at the worksite may include three elements: (1) knowledge and skills, (2) social support and social culture, and (3) awareness about lifestyle behaviors. Strategies to implement these elements may be company specific. This study provides relevant indications on feasible elements and strategies for citizen science to improve health at the worksite. Further studies on the feasibility of citizen science in other settings, including a larger and more heterogeneous sample of blue-collar workers, are necessary.

Objective Unfavorable eating patterns might contribute to the adverse health effects of shift work. Our objective was to examine differences in meal and snack frequency, as well as the quality of snacks, between shift and day workers and between different types of shifts. Methods Cross-sectional data from 485 healthcare workers aged 18-65 years of the Klokwerk+ cohort study was used. Dietary intake was assessed using 3-day food diaries, and meals and snacks were classified by the food-based classification of eating episodes method. Using multivariable-adjusted regression analyses, we estimated differences in meal and snack frequency and the quality of snacks between shift and day workers. Within the shift working group, eating frequency on day, evening, and night shifts were compared to work-free days. Results Meal and snack frequency as well as the quality of snacks showed no significant differences between shift and day workers (P≥0.05). Shift workers had a higher frequency of high-quality snacks [β 0.29, 95% confidence interval (CI) 0.12-0.46] and a lower frequency of low-quality snacks (β -0.29, 95% CI -0.49- -0.09) on evening shifts compared to their work-free days. Compared to work-free days, shift workers had a higher frequency of high-quality snacks on days shifts (β 0.24, 95% CI 0.10-0.38), and only those aged ≤40 years had a higher frequency of snacks on night shifts (β 0.53, 95% CI 0.06-1.00) (interaction by age P<0.05). Conclusion This study observed no differences between day and shift workers either in meal and snack frequency or in the quality of snacks. However, snacking patterns differed across shifts. Future research should investigate whether these snacking patterns contribute to the adverse health effects of shift work.