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1.  Prediction of trapezius muscle activity and shoulder, head, neck, and torso postures during computer use: results of a field study 
Background
Due to difficulties in performing direct measurements as an exposure assessment technique, evidence supporting an association between physical exposures such as neck and shoulder muscle activities and postures and musculoskeletal disorders during computer use is limited. Alternative exposure assessment techniques are needed.
Methods
We predicted the median and range of amplitude (90th-10th percentiles) of trapezius muscle activity and the median and range of motion (90th-10th percentiles) of shoulder, head, neck, and torso postures based on two sets of parameters: the distribution of keyboard/mouse/idle activities only (“task-based” predictions), and a comprehensive set of task, questionnaire, workstation, and anthropometric parameters (“expanded model” predictions). We compared the task-based and expanded model predictions based on R2 values, root mean squared (RMS) errors, and relative RMS errors calculated compared to direct measurements.
Results
The expanded model predictions of the median and range of amplitude of trapezius muscle activity had consistently better R2 values (range 0.40-0.55 compared to 0.00-0.06), RMS errors (range 2-3%MVC compared to 3-4%MVC), and relative RMS errors (range 10-14%MVC compared to 16-19%MVC) than the task-based predictions. The expanded model predictions of the median and range of amplitude of postures also had consistently better R2 values (range 0.22-0.58 compared to 0.00-0.35), RMS errors (range 2–14 degrees compared to 3–22 degrees), and relative RMS errors (range 9–21 degrees compared to 13–42 degrees) than the task-based predictions.
Conclusions
The variation in physical exposures across users performing the same task is large, especially in comparison to the variation across tasks. Thus, expanded model predictions of physical exposures during computer use should be used rather than task-based predictions to improve exposure assessment for future epidemiological studies. Clinically, this finding also indicates that computer users will have differences in their physical exposures even when performing the same tasks.
doi:10.1186/1471-2474-15-292
PMCID: PMC4161866  PMID: 25186007
2.  Responsiveness of the individual work performance questionnaire 
BMC Public Health  2014;14:513.
Background
Individual work performance is an important outcome measure in studies in the workplace. Nevertheless, its conceptualization and measurement has proven challenging. To overcome limitations of existing scales, the Individual Work Performance Questionnaire (IWPQ) was recently developed. The aim of the current study was to gain insight into the responsiveness of the IWPQ.
Methods
Data were used from the Be Active & Relax randomized controlled trial. The aim of the trial was to investigate the effectiveness of an intervention to stimulate physical activity and relaxation of office workers, on need for recovery. Individual work performance was a secondary outcome measure of the trial. In total, 39 hypotheses were formulated concerning correlations between changes on the IWPQ scales and changes on similar constructs (e.g., presenteeism) and distinct constructs (e.g., need for recovery) used in the trial.
Results
260 Participants completed the IWPQ at both baseline and 12 months of follow-up. For the IWPQ scales, 23%, 15%, and 38%, respectively, of the hypotheses could be confirmed. In general, the correlations between change scores were weaker than expected. Nevertheless, at least 85% of the correlations were in the expected direction.
Conclusions
Based on results of the current study, no firm conclusions can be drawn about the responsiveness of the IWPQ. Several reasons may account for the weaker than expected correlations. Future research on the IWPQ’s responsiveness should be conducted, preferably in other populations and intervention studies, where greater changes over time can be expected.
doi:10.1186/1471-2458-14-513
PMCID: PMC4049474  PMID: 24885593
3.  Ethical considerations of worksite health promotion: an exploration of stakeholders’ views 
BMC Public Health  2014;14:458.
Background
Developing, implementing and evaluating worksite health promotion requires dealing with all stakeholders involved, such as employers, employees, occupational physicians, insurance companies, providers, labour unions and research and knowledge institutes. Although worksite health promotion is becoming more common, empirical research on ethical considerations of worksite health promotion is scarce.
Methods
We explored the views of stakeholders involved in worksite health promotion in focus group discussions and we described the ethical considerations that result from differences between these views. The focus group discussions were organised per stakeholder group. Data were analysed according to the constant comparison method.
Results
Our analyses show that although the definition of occupational health is the same for all stakeholders, namely ‘being able to perform your job’, there seem to be important differences in the views on what constitutes a risk factor to occupational health. According to the employees, risk factors to occupational health are prevailingly job-related. Labour unions agree with them, but other stakeholders, including the employer, particularly see employee-related issues such as lifestyle behaviour as risk factors to occupational health. The difference in definition of occupational health risk factors translates into the same categorisation of worksite health promotion; employee-related activities and work-related activities. The difference in conceptualisation of occupational health risk factors and worksite health promotion resonates in the way stakeholders understand ‘responsibility’ for lifestyle behaviour. Even though all stakeholders agree on whose responsibility lifestyle behaviour is, namely that of the employee, the meaning of ‘responsibility’ differs between employees, and employers. For employees, responsibility means autonomy, while for employers and other stakeholders, responsibility equals duty. This difference may in turn contribute to ambivalent relationships between stakeholders.
Conclusion
All stakeholders, including employees, should be given a voice in developing, implementing and evaluating worksite health promotion. Moreover, since stakeholders agree on lifestyle being the responsibility of the employee, but disagree on what this responsibility means (duty versus autonomy), it is of utmost importance to examine the discourse of stakeholders. This way, ambivalence in relationships between stakeholders could be prevented.
doi:10.1186/1471-2458-14-458
PMCID: PMC4047781  PMID: 24886339
Worksite health promotion; Ethics; Focus group discussion; Face-to-face interviews; Stakeholder analysis
4.  Correlation between pedometer and the Global Physical Activity Questionnaire on physical activity measurement in office workers 
BMC Research Notes  2014;7:280.
Background
This study aimed to examine the correlation of physical activity levels assessed by pedometer and those by the Global Physical Activity Questionnaire (GPAQ) in a population of office workers.
Methods
A cross-sectional study was conducted on 320 office workers. A self-administered questionnaire was distributed to each office worker by hand. Physical activity level was objectively assessed by a pedometer for 7 consecutive days and subjectively assessed by the GPAQ. Based on the pedometer and GPAQ outcomes, participants were classified into 3 groups: inactive, moderately active, and highly active.
Results
No correlation in the physical activity level assessed by the pedometer and GPAQ was found (rs = .08, P = 0.15). When considering the pedometer as the criterion for comparison, 65.3% of participants had underestimated their physical activity level using the GPAQ, whereas 9.3% of participants overestimated their physical activity level.
Conclusions
Physical activity level in office workers assessed by a subjective measure was greatly different from assessed by an objective tool. Consequently, research on physical activity level, especially in those with sedentary lifestyle, should consider using an objective measure to ensure that it closely reflects a person’s physical activity level.
doi:10.1186/1756-0500-7-280
PMCID: PMC4023491  PMID: 24886593
5.  Factors associated with work disability in employed cancer survivors at 24-month sick leave 
BMC Cancer  2014;14:236.
Background
Identification of factors associated with work disability in cancer survivors on long term sick leave may support these survivors in choosing effective measures to facilitate vocational rehabilitation and return to work. Therefore, this study aims to disclose factors associated with work disability in cancer survivors at 24 months of sick leave.
Methods
A cross sectional study was conducted. The study population consisted of employed sick-listed cancer survivors, aged between 18 and 64 years. They received a questionnaire at 24-month sick leave, the maximum period of sick leave allowed by Dutch social security legislation. Data were linked with the outcome of work disability assessment, as performed by the Dutch social security agency. A hierarchical multivariate logistic regression analysis was performed to identify factors associated with work disability.
Results
Data of 351 valid cases were analysed. The multivariate analysis showed that, for cancer survivors at 24-month sick leave, Dutch nationality, higher education, receiving hormone therapy, metastatic disease, physical limitations and low self-reported work ability were associated with an increased risk for work disability.
Conclusions
This study identified factors associated with work disability of employed cancer survivors at 24 months of sick leave. The results of the current study may serve as a starting point to investigate the course of work disability beyond the maximum period of 24 months of sick leave. In order to enhance work participation of cancer survivors beyond this term, prospective data on work disability in the Netherlands are required.
doi:10.1186/1471-2407-14-236
PMCID: PMC3976500  PMID: 24693855
Cancer; Survivors; Work disability; Return to work; Limitations; Sick leave
6.  Effectiveness of a Worksite Mindfulness-Related Multi-Component Health Promotion Intervention on Work Engagement and Mental Health: Results of a Randomized Controlled Trial 
PLoS ONE  2014;9(1):e84118.
Objectives
The aim of the present study was to evaluate the effectiveness of a worksite mindfulness-related multi-component health promotion intervention on work engagement, mental health, need for recovery and mindfulness.
Methods
In a randomized controlled trial design, 257 workers of two research institutes participated. The intervention group (n = 129) received a targeted mindfulness-related training, followed by e-coaching. The total duration of the intervention was 6 months. Data on work engagement, mental health, need for recovery and mindfulness were collected using questionnaires at baseline and after 6 and 12 months follow-up. Effects were analyzed using linear mixed effect models.
Results
There were no significant differences in work engagement, mental health, need for recovery and mindfulness between the intervention and control group after either 6- or 12-months follow-up. Additional analyses in mindfulness-related training compliance subgroups (high and low compliance versus the control group as a reference) and subgroups based on baseline work engagement scores showed no significant differences either.
Conclusions
This study did not show an effect of this worksite mindfulness-related multi-component health promotion intervention on work engagement, mental health, need for recovery and mindfulness after 6 and 12 months.
Trial registration
Netherlands Trial Register NTR2199
doi:10.1371/journal.pone.0084118
PMCID: PMC3904825  PMID: 24489648
7.  Effectiveness of a worksite mindfulness-based multi-component intervention on lifestyle behaviors 
Introduction
Overweight and obesity are associated with an increased risk of morbidity. Mindfulness training could be an effective strategy to optimize lifestyle behaviors related to body weight gain. The aim of this study was to evaluate the effectiveness of a worksite mindfulness-based multi-component intervention on vigorous physical activity in leisure time, sedentary behavior at work, fruit intake and determinants of these behaviors. The control group received information on existing lifestyle behavior- related facilities that were already available at the worksite.
Methods
In a randomized controlled trial design (n = 257), 129 workers received a mindfulness training, followed by e-coaching, lunch walking routes and fruit. Outcome measures were assessed at baseline and after 6 and 12 months using questionnaires. Physical activity was also measured using accelerometers. Effects were analyzed using linear mixed effect models according to the intention-to-treat principle. Linear regression models (complete case analyses) were used as sensitivity analyses.
Results
There were no significant differences in lifestyle behaviors and determinants of these behaviors between the intervention and control group after 6 or 12 months. The sensitivity analyses showed effect modification for gender in sedentary behavior at work at 6-month follow-up, although the main analyses did not.
Conclusions
This study did not show an effect of a worksite mindfulness-based multi-component intervention on lifestyle behaviors and behavioral determinants after 6 and 12 months. The effectiveness of a worksite mindfulness-based multi-component intervention as a health promotion intervention for all workers could not be established.
doi:10.1186/1479-5868-11-9
PMCID: PMC3905927  PMID: 24467802
8.  Relationships between the intention to use guidelines, behaviour of insurance physicians and their determinants 
Background
We studied the intention of a group of insurance physicians to use the guidelines for depression, and their behaviour in disability assessments. We considered attitude, social norm and self-efficacy, knowledge/skills and stimuli, based on the Attitude - Social norm - self-Efficacy model (ASE model) as possible determinants of both intention and behaviour.
The aim of this study was to understand the determinants of insurance physicians’ behaviour when they are expected to use guidelines in daily practice.
Method
A representative sample of 42 insurance physicians participated in this study. Cross-sectional data were collected by means of a questionnaire based on the ASE model. We developed the questionnaire on the basis of literature and ascertained the content validity of it. Behaviour was made to comprise both “use of the guidelines” and “change in disability assessment behaviour” by the insurance physicians. Reliability analyses were performed to form additive scales of the ASE constructs. These scales were analysed with structural equations modelling (LISREL), by modifying a start model into a final model with a good fit, within theoretical constraints. In these analyses special attention was paid to the fact that the sample size was small.
Results
The most important determinants of the intention and the self-reported use of the guidelines, were: the influence of colleagues, the self-efficacy of the insurance physicians in their use of the guidelines, and the way the guidelines were implemented. The intention to use the guidelines for depression was not associated with the self-reported use of these guidelines, but there proved to be a faint, positive association with the self-reported change in assessment behaviour.
Conclusions
Almost all the insurance physicians in this study intended to use at least elements of the guidelines. Their intention, self reported use of the guidelines and self-reported change in assessment behaviour were explored with help of the ASE model. The model suggested relationships between intention, self reported use of the guidelines and self-reported change in assessment behaviour on the on the one hand and various determinants on the other hand. Be that as it may, we see opportunities to improve insurance physicians’ guideline adherence by offering them a multifaceted training in which they learn to apply the guidelines for depression.
doi:10.1186/1472-6963-13-400
PMCID: PMC3851955  PMID: 24103198
Insurance physician; Guidelines for depression; Intention; Behaviour; ASE model
9.  Development and evaluation of an intervention aiming to reduce fatigue in airline pilots: design of a randomised controlled trial 
BMC Public Health  2013;13:776.
Background
A considerable percentage of flight crew reports to be fatigued regularly. This is partly caused by irregular and long working hours and the crossing of time zones. It has been shown that persistent fatigue can lead to health problems, impaired performance during work, and a decreased work-private life balance. It is hypothesized that an intervention consisting of tailored advice regarding exposure to daylight, optimising sleep, physical activity, and nutrition will lead to a reduction of fatigue in airline pilots compared to a control group, which receives a minimal intervention with standard available information.
Methods/design
The study population will consist of pilots of a large airline company. All pilots who posses a smartphone or tablet, and who are not on sick leave for more than four weeks at the moment of recruitment, will be eligible for participation.
In a two-armed randomised controlled trial, participants will be allocated to an intervention group that will receive the tailored advice to optimise exposure to daylight, sleep, physical activity and nutrition, and a control group that will receive standard available information. The intervention will be applied using a smartphone application and a website, and will be tailored on flight- and participant-specific characteristics. The primary outcome of the study is perceived fatigue. Secondary outcomes are need for recovery, duration and quality of sleep, dietary and physical activity behaviours, work-private life balance, general health, and sickness absence. A process evaluation will be conducted as well. Outcomes will be measured at baseline and at three and six months after baseline.
Discussion
This paper describes the development of an intervention for airline pilots, consisting of tailored advice (on exposure to daylight and sleep-, physical activity, and nutrition) applied into a smartphone application. Further, the paper describes the design of the randomised controlled trial evaluating the effect of the intervention on fatigue, health and sickness absence. If proven effective, the intervention can be applied as a new and practical tool in fatigue management. Results are expected at the end of 2013.
Trial registration
Netherlands Trial Register: NTR2722
doi:10.1186/1471-2458-13-776
PMCID: PMC3765738  PMID: 23971514
Flight crew; Pilots; Irregular working hours; Fatigue; Intervention; Tailored advice; Implementation; Smartphone application; mHealth
10.  Design of the Bottom-up Innovation project - a participatory, primary preventive, organizational level intervention on work-related stress and well-being for workers in Dutch vocational education 
BMC Public Health  2013;13:760.
Background
In the educational sector job demands have intensified, while job resources remained the same. A prolonged disbalance between demands and resources contributes to lowered vitality and heightened need for recovery, eventually resulting in burnout, sickness absence and retention problems. Until now stress management interventions in education focused mostly on strengthening the individual capacity to cope with stress, instead of altering the sources of stress at work at the organizational level. These interventions have been only partly effective in influencing burnout and well-being. Therefore, the “Bottom-up Innovation” project tests a two-phased participatory, primary preventive organizational level intervention (i.e. a participatory action approach) that targets and engages all workers in the primary process of schools. It is hypothesized that participating in the project results in increased occupational self-efficacy and organizational efficacy. The central research question: is an organization focused stress management intervention based on participatory action effective in reducing the need for recovery and enhancing vitality in school employees in comparison to business as usual?
Methods/Design
The study is designed as a controlled trial with mixed methods and three measurement moments: baseline (quantitative measures), six months and 18 months (quantitative and qualitative measures). At first follow-up short term effects of taking part in the needs assessment (phase 1) will be determined. At second follow-up the long term effects of taking part in the needs assessment will be determined as well as the effects of implemented tailored workplace solutions (phase 2). A process evaluation based on quantitative and qualitative data will shed light on whether, how and why the intervention (does not) work(s).
Discussion
“Bottom-up Innovation” is a combined effort of the educational sector, intervention providers and researchers. Results will provide insight into (1) the relation between participating in the intervention and occupational and organizational self-efficacy, (2) how an improved balance between job demands and job resources might affect need for recovery and vitality, in the short and long term, from an organizational perspective, and (3) success and fail factors for implementation of an organizational intervention.
Trial registration number
Netherlands Trial Register NTR3284
doi:10.1186/1471-2458-13-760
PMCID: PMC3751794  PMID: 23947538
Stress management; Controlled trial; Need for recovery; Vitality; Occupational self-efficacy; Teachers
11.  The relation between body mass index and musculoskeletal symptoms in the working population 
Background
The primary aim of this study was to investigate the association between BMI and musculoskeletal symptoms in interaction with physical workload. In addition, it was aimed to obtain insight into whether overweight and obesity are associated with an increase in occurrence of symptoms and/or decrease in recovery from symptoms.
Methods
Based on a large working population sample (n = 44,793), using the data from The Netherlands Working Conditions Survey (NWCS), logistic regression analyses were carried out to investigate the association between BMI and musculoskeletal symptoms, with adjustment for potential confounders. Longitudinal data from the Netherlands Working Conditions Cohort Study (NWCCS) of 7,909 respondents was used for the second research aim (i.e., to investigate the transition in musculoskeletal symptoms).
Results
For high BMI an increased 12-month prevalence of musculoskeletal symptoms was found (overweight: OR 1.13, 95% CI: 1.08-1.19 and obesity: OR 1.28, 95% CI: 1.19-1.39). The association was modified by physical workload, with a stronger association for employees with low physical workload than for those with high physical workload. Obesity was related to developing musculoskeletal symptoms (OR 1.37, 95% CI: 1.05-1.79) and inversely related to recovery from symptoms (OR 0.76, 95% CI: 0.59-0.97).
Conclusion
BMI was associated with musculoskeletal symptoms, in particular symptoms of the lower extremity. Furthermore, the association differed for employees with high or low physical workload. Compared to employees with normal weight, obese employees had higher risk for developing symptoms as well as less recovery from symptoms. This study supports the role of biomechanical factors for the relationship between BMI and symptoms in the lower extremity.
doi:10.1186/1471-2474-14-238
PMCID: PMC3751130  PMID: 23937768
Musculoskeletal disorders; Overweight/obesity; Physical workload; Worker population
12.  An exploratory study of associations of physical activity with mental health and work engagement 
BMC Public Health  2013;13:558.
Background
Previous studies have found moderate to vigorous physical activity (MVPA) to be associated with a decreased risk of mental disorders. Although the focus in the field of psychology has shifted towards human strengths and optimal functioning, studies examining associations between MVPA and mental health in general (MH) and between MVPA and well-being are scarce. An indicator of work-related well-being is work engagement (WE). The aim of this study was to explore the associations between MVPA and MH, and between MVPA and WE.
Methods
In this study, a total of 257 employees from two research institutes, self-reported their MVPA, MH and level of WE. In addition, a randomly chosen subgroup (n=100) wore an Actigraph accelerometer for a 1-week period to measure their MVPA objectively. Crude and adjusted associations between MVPA and both WE and MH were analyzed using linear regression analyses.
Results
There was no statistically significant association between self-reported MVPA and mental health, resulting from both the crude (b=0.058, 95% CI -0.118 - 0.235) and adjusted analyses (b=0.026; 95% CI -0.158- 0.210), nor between objectively measured MVPA and mental health for both crude and adjusted analyses (b=-0.144; 95% CI -1.315- 1.027; b=-0.199; 95% CI 1.417- 1.018 respectively). There was also no significant association between self-reported MVPA and work engagement (crude: b=0.005; 95% CI -0.005-0.016, adjusted: b= 0.002; 95% CI -0.010- 0.013), nor between objectively measured MVPA and work engagement (crude: b= 0.012; 95% CI -0.084- 0.060, adjusted: b=0.007; 95% CI -0.083-0.069).
Conclusions
Although the beneficial effects of MVPA on the negative side of MH (i.e. mental disorders) have been established in previous studies, this study found no evidence for the beneficial effects of MVPA on positive side of MH (i.e. well-being). The possible difference in how the physical activity-mental health relationship works for negative and positive sides of MH should be considered in future studies.
doi:10.1186/1471-2458-13-558
PMCID: PMC3682939  PMID: 23758966
Work engagement; Physical activity; Accelerometry
13.  Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector 
Background
Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers.
Methods
An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared.
Results
The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers.
Conclusions
Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.
doi:10.1186/1748-5908-8-57
PMCID: PMC3674944  PMID: 23731570
Occupational health and safety; Interventions; Decision-making process; Information needs; Evidence-based practice
14.  ‘All those things together made me retire’: qualitative study on early retirement among Dutch employees 
BMC Public Health  2013;13:516.
Background
Due to the aging of the population and subsequent higher pressure on public finances, there is a need for employees in many European countries to extend their working lives. One way in which this can be achieved is by employees refraining from retiring early. Factors predicting early retirement have been identified in quantitative research, but little is known on why and how these factors influence early retirement. The present qualitative study investigated which non-health related factors influence early retirement, and why and how these factors influence early retirement.
Methods
A qualitative study among 30 Dutch employees (60–64 years) who retired early, i.e. before the age of 65, was performed by means of face-to-face interviews. Participants were selected from the cohort Study on Transitions in Employment, Ability and Motivation (STREAM).
Results
For most employees, a combination of factors played a role in the transition from work to early retirement, and the specific factors involved differed between individuals. Participants reported various factors that pushed towards early retirement (‘push factors’), including organizational changes at work, conflicts at work, high work pressure, high physical job demands, and insufficient use of their skills and knowledge by others in the organization. Employees who reported such push factors towards early retirement often felt unable to find another job. Factors attracting towards early retirement (‘pull factors’) included the wish to do other things outside of work, enjoy life, have more flexibility, spend more time with a spouse or grandchildren, and care for others. In addition, the financial opportunity to retire early played an important role. Factors influenced early retirement via changes in the motivation, ability and opportunity to continue working or retire early.
Conclusion
To support the prolongation of working life, it seems important to improve the fit between the physical and psychosocial job characteristics on the one hand, and the abilities and wishes of the employee on the other hand. Alongside improvements in the work environment that enable and motivate employees to prolong their careers, a continuous dialogue between the employer and employee on the (future) person-job fit and tailored interventions might be helpful.
doi:10.1186/1471-2458-13-516
PMCID: PMC3674915  PMID: 23714371
Early retirement; Pull factors; Push factors; Qualitative study
15.  Pathways through which health influences early retirement: a qualitative study 
BMC Public Health  2013;13:292.
Background
Due to the aeging of the population, there is a societal need for workers to prolong their working lives. In the Netherlands, many employees still leave the workforce before the official retirement age of 65. Previous quantitative research showed that poor self-perceived health is a risk factor of (non-disability) early retirement. However, little is known on how poor health may lead to early retirement, and why poor health leads to early retirement in some employees, but not in others. Therefore, the present qualitative study aims to identify in which ways health influences early retirement.
Methods
Face-to-face semi-structured interviews were conducted with 30 employees (60–64 years) who retired before the official retirement age of 65. Participants were selected from the Study on Transitions in Employment, Ability and Motivation. The interviews were transcribed verbatim, a summary was made including a timeline, and the interviews were open coded.
Results
In 15 of the 30 persons, health played a role in early retirement. Both poor and good health influenced early retirement. For poor health, four pathways were identified. First, employees felt unable to work at all due to health problems. Second, health problems resulted in a self-perceived (future) decline in the ability to work, and employees chose to retire early. Third, employees with health problems were afraid of a further decline in health, and chose to retire early. Fourth, employees with poor health retired early because they felt pushed out by their employer, although they themselves did not experience a reduced work ability. A good health influenced early retirement, since persons wanted to enjoy life while their health still allowed to do so. The financial opportunity to retire sometimes triggered the influence of poor health on early retirement, and often triggered the influence of good health. Employees and employers barely discussed opportunities to prolong working life.
Conclusions
Poor and good health influence early retirement via several different pathways. To prolong working life, a dialogue between employers and employees and tailored work-related interventions may be helpful.
doi:10.1186/1471-2458-13-292
PMCID: PMC3621068  PMID: 23551994
Early retirement; Health; Qualitative study; Dialogue
16.  Effectiveness of an intervention at construction worksites on work engagement, social support, physical workload, and need for recovery: results from a cluster randomized controlled trial 
BMC Public Health  2012;12:1008.
Background
To prolong sustainable healthy working lives of construction workers, a worksite prevention program was developed which aimed to improve the health and work ability of construction workers. The aim of the current study was to investigate the effectiveness of this program on social support at work, work engagement, physical workload and need for recovery.
Methods
Fifteen departments from six construction companies participated in this cluster randomized controlled trial; 8 departments (n=171 workers) were randomized to an intervention group and 7 departments (n=122 workers) to a control group. The intervention consisted of two individual training sessions of a physical therapist to lower the physical workload, a Rest-Break tool to improve the balance between work and recovery, and two empowerment training sessions to increase the influence of the construction workers at the worksite. Data on work engagement, social support at work, physical workload, and need for recovery were collected at baseline, and at three, six and 12 months after the start of the intervention using questionnaires.
Results
No differences between the intervention and control group were found for work engagement, social support at work, and need for recovery. At 6 months follow-up, the control group reported a small but statistically significant reduction of physical workload.
Conclusion
The intervention neither improved social support nor work engagement, nor was it effective in reducing the physical workload and need for recovery among construction workers.
Trial registration
NTR1278
doi:10.1186/1471-2458-12-1008
PMCID: PMC3534539  PMID: 23171354
Construction industry; Sustainable employability; Intervention study; Empowerment; Physical therapist
17.  Changes in Insurance Physicians’ Attitudes, Self-Efficacy, Intention, and Knowledge and Skills Regarding the Guidelines for Depression, Following an Implementation Strategy 
Introduction To improve guideline adherence by insurance physicians (IPs), an implementation strategy was developed and investigated in a randomized controlled trial. This implementation strategy involved a multifaceted training programme for a group of IPs in applying the guidelines for depression. In this study we report the impact of the implementation strategy on the physicians’ attitude, intention, self-efficacy, and knowledge and skills as behavioural determinants of guideline adherence. Any links between these self-reported behavioural determinants and levels of guideline adherence were also determined. Methods Just before and 3 months after the implementation of the multifaceted training, a questionnaire designed to measure behavioural determinants on the basis of the ASE (attitude, social norm, self-efficacy) model was completed by the intervention (n = 21) and the control group (n = 19). Items of the questionnaire were grouped to form scales of ASE determinants. Internal consistency of the scales was calculated using Cronbach’s alphas. Differences between groups concerning changes in ASE determinants, and the association of these changes with improvements in guideline adherence, were analyzed using analysis of covariance. Results The internal consistency of the scales of ASE determinants proved to be sufficiently reliable, with Cronbach’s alphas of at least 0.70. At follow-up after 3 months, the IPs given the implementation strategy showed significant improvement over the IPs in the control group for all ASE determinants investigated. Changes in knowledge and skills were only weakly associated with improvements in guideline adherence. Conclusions The implementation strategy developed for insurance physicians can increase their attitude, intention, self-efficacy, and knowledge and skills when applying the guidelines for depression. These changes in behavioural determinants might indicate positive changes in IPs’ behaviour towards the use of the guidelines for depression. However, only changes in knowledge and skills related to the use of the guidelines were associated with improvements in IPs’ actual performance when applying the guidelines.
Electronic supplementary material
The online version of this article (doi:10.1007/s10926-012-9378-9) contains supplementary material, which is available to authorized users.
doi:10.1007/s10926-012-9378-9
PMCID: PMC3563952  PMID: 22763493
Guideline adherence; Insurance physicians; Guidelines for depression; ASE determinants
18.  The identification of job opportunities for severely disabled sick-listed employees 
BMC Public Health  2012;12:156.
Background
Work disability is a major problem for both the worker and society. To explore the work opportunities in regular jobs of persons low in functional abilities, we tried to identify occupations low in task demands. Because of the variety of functional abilities and of the corresponding work demands, the disabled persons need to be classified by type of disability in a limited number of subgroups. Within each subgroup, occupations judged suitable for the most seriously disabled will be selected as having a very low level of the corresponding task demands. These occupations can be applied as reference occupations to assess the presence or absence of work capacity of sick-listed employees in regular jobs, and as job opportunities for people with a specific type of functional disability.
Methods
Registered data from 50,931 disability assessments within the Dutch social security system were used in a second order factor analysis to identify types of disabilities in claimants for a disability pension. Threshold values were chosen to classify claimants according to the severity of the disability. In the disability assessment procedure, a labour expert needs to select jobs with task demands not exceeding the functional abilities of the claimant. For each type of disability, the accessible jobs for the subgroup of the most severely disabled claimants were identified as lowest in the corresponding demand.
Results
The factor analysis resulted in four types of disabilities: general physical ability; autonomy; psychological ability; and manual skills. For each of these types of disablement, a set of four to six occupations low in task demands were selected for the subgroup of most severely disabled claimants. Because of an overlap of the sets of occupations, 13 occupations were selected in total. The percentage of claimants with at least one of the occupations of the corresponding set (the coverage), ranged from 84% to 93%. An alternative selection of six occupations for all subgroups with even less overlap had a coverage ranging from 84% to 89% per subgroup.
Conclusion
This study resulted in two proposals for a set of reference occupations. Further research will be needed to compare the results of the new method of disability assessment to the results of the method presently used in practice.
doi:10.1186/1471-2458-12-156
PMCID: PMC3311569  PMID: 22394686
19.  VIP in construction: systematic development and evaluation of a multifaceted health programme aiming to improve physical activity levels and dietary patterns among construction workers 
BMC Public Health  2012;12:89.
Background
The prevalence of both overweight and musculoskeletal disorders (MSD) in the construction industry is high. Many interventions in the occupational setting aim at the prevention and reduction of these health problems, but it is still unclear how these programmes should be designed. To determine the effectiveness of interventions on these health outcomes randomised controlled trials (RCTs) are needed. The aim of this study is to systematically develop a tailored intervention for prevention and reduction of overweight and MSD among construction workers and to describe the evaluation study regarding its (cost-)effectiveness.
Methods/Design
The Intervention Mapping (IM) protocol was applied to develop and implement a tailored programme aimed at the prevention and reduction of overweight and MSD. The (cost-) effectiveness of the intervention programme will be evaluated using an RCT. Furthermore, a process evaluation will be conducted. The research population will consist of blue collar workers of a large construction company in the Netherlands.
Intervention
The intervention programme will be aimed at improving (vigorous) physical activity levels and healthy dietary behaviour and will consist of tailored information, face-to-face and telephone counselling, training instruction (a fitness "card" to be used for exercises), and materials designed for the intervention (overview of the company health promoting facilities, waist circumference measuring tape, pedometer, BMI card, calorie guide, recipes, and knowledge test).
Main study parameters/endpoints
The intervention effect on body weight and waist circumference (primary outcome measures), as well as on lifestyle behaviour, MSD, fitness, CVD risk indicators, and work-related outcomes (i.e. productivity, sick leave) (secondary outcome measures) will be assessed.
Discussion
The development of the VIP in construction intervention led to a health programme tailored to the needs of construction workers. This programme, if proven effective, can be directly implemented.
Trial registration
Netherlands Trial Register (NTR): NTR2095
doi:10.1186/1471-2458-12-89
PMCID: PMC3280176  PMID: 22289212
Obesity/overweight; Musculoskeletal disorders; RCT; Energy balance related behaviour; Physical activity; Dietary behaviour; Construction workers; Intervention mapping
20.  An implementation strategy to improve the guideline adherence of insurance physicians: an experiment in a controlled setting 
Background
The aim of this study was to investigate the efficacy of a newly developed implementation strategy for the insurance medicine guidelines for depression in the Netherlands. We hypothesized that an educational intervention would increase the insurance physicians' (IPs) guideline adherence in a controlled setting.
Methods
Forty IPs were allocated in a randomised controlled trial (RCT) to an intervention group (IG) (n = 21) and a control group (CG) (n = 19). The IG received tailored training in applying the guidelines for depression, while the CG received an alternative programme. Baseline (T0) and follow-up (T1) measurements were conducted before and after the intervention within a period of two weeks. The intervention consisted of a workshop in which the evidence-based theory of the guidelines was translated for use in practice, with the help of various tools. The IPs had to write a case-report on the basis of video cases, two before and two after the training. Specially trained and blinded test IPs judged the case reports independently on the basis of six performance indicators. Primary outcome measure in the controlled setting of the trial was guideline adherence measured by six performance indicators on a scale of one to seven. Secondary outcome measure was knowledge of the guidelines for depression. Analyses were performed using Linear Mixed Models, and ANCOVA.
Results
We found significantly higher scores in the IG than in the CG at T1 for both outcomes. The interaction effect (standard error; p-value) of group crossed with time was 0.97 (0.19; p < 0.0005) for guideline adherence in the controlled setting. The group effect at T1 for the knowledge test was 0.86 (0.40; p = 0.038).
Conclusions
The newly developed implementation strategy for the insurance medicine guidelines for depression improved the guideline adherence of the trained IPs in disability assessments of clients with depression when performed in a controlled setting. Furthermore, the trained IPs showed gains in knowledge of the guidelines for depression.
Trial registration
Netherlands' Trial Register NTR1863.
doi:10.1186/1748-5908-6-131
PMCID: PMC3265414  PMID: 22188876
21.  Short and long term effects of a lifestyle intervention for construction workers at risk for cardiovascular disease: a randomized controlled trial 
BMC Public Health  2011;11:836.
Background
The prevalence of overweight and elevated cardiovascular disease (CVD) risk among workers in the construction industry is relatively high. Improving lifestyle lowers CVD risk and may have work-related benefits. The purpose of the study was to evaluate the effects on physical activity (PA), diet, and smoking of a lifestyle intervention consisting of individual counseling among male workers in the construction industry with an elevated risk of cardiovascular disease (CVD).
Methods
In a randomized controlled trial including 816 male blue- and white-collar workers in the construction industry with an elevated risk of CVD, usual care was compared to a 6-month lifestyle intervention. The intervention consisted of individual counseling using motivational interviewing techniques, and was delivered by an occupational physician or occupational nurse. In three face to face and four telephone contacts, the participant's risk profile, personal determinants, and barriers for behavior change were discussed, and personal goals were set. Participants chose to aim at either diet and PA, or smoking. Data were collected at baseline and after six and 12 months, by means of a questionnaire. To analyse the data, linear and logistic regression analyses were performed.
Results
The intervention had a statistically significant beneficial effect on snack intake (β-1.9, 95%CI -3.7; -0.02) and fruit intake (β 1.7, 95%CI 0.6; 2.9) at 6 months. The effect on snack intake was sustained until 12 months; 6 months after the intervention had ended (β -1.9, 95%CI -3.6; -0.2). The intervention effects on leisure time PA and metabolic equivalent-minutes were not statistically significant. The beneficial effect on smoking was statistically significant at 6 (OR smoking 0.3, 95%CI 0.1;0.7), but not at 12 months (OR 0.8, 95%CI 0.4; 1.6).
Conclusions
Beneficial effects on smoking, fruit, and snack intake can be achieved by an individual-based lifestyle intervention among male construction workers with an elevated risk of CVD. Future research should be done on strategies to improve leisure time PA and on determinants of maintenance of changed behavior. Considering the rising prevalence of unhealthy lifestyle and CVD, especially in the aging population, implementation of this intervention in the occupational health care setting is recommended.
Trial registration
Current Controlled Trials ISRCTN60545588
doi:10.1186/1471-2458-11-836
PMCID: PMC3247875  PMID: 22040007
22.  Mindful "Vitality in Practice": an intervention to improve the work engagement and energy balance among workers; the development and design of the randomised controlled trial 
BMC Public Health  2011;11:736.
Background
Modern working life has become more mental and less physical in nature, contributing to impaired mental health and a disturbed energy balance. This may result in mental health problems and overweight. Both are significant threats to the health of workers and thus also a financial burden for society, including employers. Targeting work engagement and energy balance could prevent impaired mental health and overweight, respectively.
Methods/Design
The study population consists of highly educated workers in two Dutch research institutes. The intervention was systematically developed, based on the Intervention Mapping (IM) protocol, involving workers and management in the process. The workers' needs were assessed by combining the results of interviews, focus group discussions and a questionnaire with available literature. Suitable methods and strategies were selected resulting in an intervention including: eight weeks of customized mindfulness training, followed by eight sessions of e-coaching and supporting elements, such as providing fruit and snack vegetables at the workplace, lunch walking routes, and a buddy system. The effects of the intervention will be evaluated in a RCT, with measurements at baseline, six months (T1) and 12 months (T2). In addition, cost-effectiveness and process of the intervention will also be evaluated.
Discussion
At baseline the level of work engagement of the sample was "average". Of the study population, 60.1% did not engage in vigorous physical activity at all. An average working day consists of eight sedentary hours. For the Phase II RCT, there were no significant differences between the intervention and the control group at baseline, except for vigorous physical activity. The baseline characteristics of the study population were congruent with the results of the needs assessment. The IM protocol used for the systematic development of the intervention produced an appropriate intervention to test in the planned RCT.
Trial registration number
Netherlands Trial Register (NTR): NTR2199
doi:10.1186/1471-2458-11-736
PMCID: PMC3189893  PMID: 21951433
Work Engagement; Energy balance related behaviours; Physical Activity; Sedentary behaviour; Dietary behaviour; RCT; Mindfulness
23.  A process evaluation of a worksite vitality intervention among ageing hospital workers 
Background
The process evaluation of the Vital@Work intervention was primary aimed at gaining insight into the context, dose delivered, fidelity, reach, dose received, and participants' attitude. Further, the differences between intervention locations were evaluated.
Methods
Eligible for this study were 730 workers, aged ≥ 45 years, from two academic hospitals. Workers randomised to the intervention group (n = 367) received a 6-months intervention consisting a Vitality Exercise Programme (VEP) combined with three visits to a Personal Vitality Coach (PVC), aimed at goal setting, feedback, and problem solving. The VEP consisted of a guided yoga session, a guided workout session, and aerobic exercising without direct face-to-face instruction, all once a week. Data were collected by means of a questionnaire after the intervention, attendance registration forms (i.e. attendance at guided VEP group sessions), and coaching registration forms (filled in by the PVCs).
Results
The dose delivered of the yoga and workout sessions were 72.3% and 96.3%. All PVC visits (100%) were offered. The reach for the yoga sessions, workout sessions and PVC visits was 70.6%, 63.8%, and 89.6%, respectively. When taken these three intervention components together, the reach was 52%. This differed between the two locations (59.2% versus 36.8%). The dose received was for the yoga 10.4 sessions/24 weeks and for the workout 11.1 sessions/24 weeks. The attendance rate, defined as the mean percentage of attended group sessions in relation to the total provided group sessions, for the yoga and workout sessions was 51.7% and 44.8%, respectively. For the yoga sessions this rate was different between the two locations (63.2% versus 46.5%). No differences were found between the locations regarding the workout sessions and PVC visits. Workers attended on average 2.7 PVC visits. Overall, workers were satisfied with the intervention components: 7.5 for yoga sessions, 7.8 for workout sessions, and 6.9 for PVC visits.
Conclusions
The implementation of the intervention was accomplished as planned with respect to the dose delivered. Based on the reach, most workers were willing to attend the guided group sessions and the PVC visits, although there were differences between the locations and between intervention components. Overall, workers were positive about the intervention.
Trial registration
Trial registration NTR1240
doi:10.1186/1479-5868-8-58
PMCID: PMC3127968  PMID: 21663610
process evaluation; ageing workers; vitality; lifestyle intervention
24.  A Participatory Return-to-Work Program for Temporary Agency Workers and Unemployed Workers Sick-Listed Due to Musculoskeletal Disorders: a Process Evaluation Alongside a Randomized Controlled Trial 
Introduction Beside (cost-)effectiveness, the feasibility of an intervention is important for successful implementation in daily practice. This study concerns the process evaluation of a newly developed participatory return-to-work (RTW) program for workers without an employment contract, sick-listed due to musculoskeletal disorders. The program consisted of a stepwise process, guided by an independent RTW coordinator, aimed at making a consensus-based RTW plan with the possibility of a temporary (therapeutic) workplace. The aims of this study were to describe the reach and extent of implementation of the new program, the satisfaction and experiences of all stakeholders, and the perceived barriers and facilitators for implementation of the program in daily practice. Methods Temporary agency workers and unemployed workers, sick-listed for 2–8 weeks due to musculoskeletal disorders were eligible for this study. Data were collected from the workers; their insurance physicians and labour experts at the Dutch Social Security Agency; RTW coordinators; and case managers from participating vocational rehabilitation agencies. Data collection took place using professionals’ reports, standardized matrices, questionnaires at baseline and at 3-month follow-up, and group interviews with the professionals. Results Of the 79 workers who were allocated to the participatory RTW program group, 72 workers actually started with the intervention. Overall, implementation of the program was performed according to protocol. However, offering of suitable temporary workplaces was delayed with 44.5 days. Results showed satisfaction with the RTW coordinator among the workers and three quarters of the labour experts experienced a minor or major contribution of the presence of the RTW coordinator. Several barriers for implementation were identified, such as the administrative time-investment, unclear information about the program, no timely offering of temporary (therapeutic) workplaces, and the need for additional support in case of complex health problems. Conclusions This study indicates overall feasibility for implementation of the participatory RTW program in daily practice. However, to overcome important barriers, more attention should be paid to improve timely offering of suitable temporary workplaces, to describe more clearly the program goals and the professional’s roles, and to offer additional support for workers suffering from complex multi-causal health problems. Trial registration NTR1047.
doi:10.1007/s10926-011-9314-4
PMCID: PMC3274681  PMID: 21656252
Feasibility; Implementation; Return to work; Occupational health care; Vocational rehabilitation; Worker without employment contract
25.  Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice 
BMC Medical Education  2011;11:28.
Background
Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course.
Methods
A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation.
Results
A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial.
Conclusions
The feasibility and practical relevance of the communication skills training course that was developed seem promising. Such a course may be relevant for physicians in many countries who perform work disability assessments. The development of the first training course of this type represents an important advancement in this field.
doi:10.1186/1472-6920-11-28
PMCID: PMC3138427  PMID: 21639871

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