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Introduction: The pilot study reported here determined the effectiveness of a multidisciplinary group rehabilitation program, Visually Impaired Elderly Persons Participating (VIPP), on psychosocial functioning. Methods: The single-group pretest-posttest pilot study included 29 persons with visual impairments (aged 55 and older) who were referred to a low-vision rehabilitation center. The VIPP intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counseling, and training in problem-solving skills; individual and group goal setting; and a home-based exercise program). Psychosocial adaptation to vision loss, helplessness, self-efficacy, mental health, and fear of falling were used as indicators of psychosocial functioning and were assessed at the baseline, halfway, immediately after completion of the intervention, and at the six-month follow-up. Results: Directly after the intervention, the participants' adaptation to vision loss (ES = 0.57), self-efficacy (ES = 0.50), and mental health (ES = 0.39) improved compared to the baseline. Moreover, helplessness and a generic and vision-specific fear of falling decreased (ES = 0.26, ES = 0.20, and ES = 0.24, respectively). The six-month follow-up measure indicated improved adaptation to vision loss (ES = 0.54), a lesser feeling of helplessness (ES = 0.53), better mental health (ES = 0.22), and a lesser vision-specific fear of falling (ES = 0.27). In contrast, a decrease in self-efficacy (ES = 0.14) and an increase in the generic fear of falling (ES = 0.18) were found. Discussion: The tentative conclusion of this small-scale pilot study is that the VIPP program benefits psychosocial functioning in both the short and long term. Implications for practitioners: The study showed that low-vision rehabilitation centers could implement multidisciplinary group rehabilitation programs, such as VIPP, to improve the psychosocial functioning of elderly people who are visually impaired. (Contains 3 tables and 1 figure.)

Purpose: The aim of the study was to examine whether rheumatoid arthritis (RA) patients with different levels of restriction in social participation differ in disease related as well as psychosocial variables and whether a similar pattern can be found among early and established RA patients. Method: Two samples of RA patients with early (n = 97; age = 53 ± 12.3 years; disease duration = 2.8 ± 1.2 years; 76% women) and established (n = 143; age = 58 ± 10.3 years; disease duration = 16.1 ± 3.6 years; 86% women) were collected. The pattern of differences for the patients with different level of participation restriction (no restriction, mild, moderate or high restriction) was explored by the Jonckheere–Terpstra test.Results: Significant differences were found between patients with different levels of social participation restrictions in both samples in pain, fatigue, functional disability, anxiety, depression and mastery. Generally, it was found that patients with higher restrictions experienced more pain and fatigue, more anxiety and depression and reported lower mastery. Similar pattern of differences concerning disease activity and self-esteem was found mainly in the established group.Conclusions: The study shows that the level of perceived restrictions in social participation are highly relevant regarding the disease related variables such as pain, fatigue and functional disability as well as psychological status and personal resources in both early and established RA.Implications for RehabilitationSupporting involvement and participation of individuals with rheumatoid arthritis is important for decreasing the impact of RA symptoms on everyday life.Recognition and empowerment of individual resources such a mastery and self-esteem of RA patients could be beneficial for overcoming restrictions in participation. [ABSTRACT FROM AUTHOR]

Purpose An assessment tool was developed to assess disability in veterans who suffer from post-traumatic stress disorder (PTSD) due to a military mission. The objective of this study was to determine the reliability, intra-rater and inter-rater variation of the Mental Disability Military (MDM) assessment tool. Methods Twenty-four assessment interviews of veterans with an insurance physician were videotaped. Each videotaped interview was assessed by a group of five independent raters on limitations of the veterans using the MDM assessment tool. After 2 months the raters repeated this procedure. Next the intra-rater and inter-rater variation was assessed with an adjusted version of AG09 computing weighted percentage agreement. Results The results of this study showed that both the intra-rater variation and inter-rater variation on the ten subcategories of the MDM assessment tool were small, with an agreement of 84-100 % within raters and 93-100 % between raters. Conclusions The MDM assessment tool proves to be a reliable instrument to measure PTSD limitations in functioning in Dutch military veterans who apply for disability compensation. Further research is needed to assess the validity of this instrument. [ABSTRACT FROM AUTHOR]

Purpose Expectations strongly influence future employment outcomes and social networks seem to mediate employment success of young adults with intellectual and developmental disabilities. The aim of this study is to examine the expectations of young adults with intellectual and developmental disabilities from special needs education, their parents and their school teachers regarding future work and the extent to which these expectations predict work outcome. Methods Data on 341 young adults with intellectual or developmental disabilities, coming from special needs education, aged 17-20 years, and with an ability to work according to the Social Security Institute were examined. Results The school teacher's expectation was the only perspective that significantly predicted entering competitive employment, with a complementary effect of the expectation of parents and a small additional effect of the expectation of the young adult. Conclusions Expectations of school teachers and parents are valuable in predicting work outcome. Therefore, it is important for professionals working with the young adult in the transition from school to work to incorporate the knowledge of school teachers and parents regarding the abilities of the young adult to enter competitive employment as a valuable source of information. [ABSTRACT FROM AUTHOR]

Purpose To investigate the Work Ability Index (WAI) as tool for identifying workers at risk of premature work exit in terms of disability pension, unemployment, or early retirement. Methods Prospective cohort study of 11,537 male construction workers (mean age 45.5 years), who completed the WAI at baseline and reported their work status (employed, unemployed, disability pension, or retired) after mean 2.3 years of follow-up. Associations between WAI scores and work status were investigated by multinomial logistic regression analysis. The ability of the WAI to discriminate between workers at high and low risk of premature work exit was analyzed by the area (AUC) under the receiver operating characteristic curve. Results 9,530 (83 %) construction workers had complete data for analysis. At follow-up, 336 (4 %) workers reported disability pension, 125 (1 %) unemployment, and 255 (3 %) retirement. WAI scores were prospectively associated with the risk of disability pension at follow-up, but not with the risk of unemployment and early retirement. The WAI showed fair discrimination to identify workers at risk of disability pension [AUC = 0.74; 95 % confidence interval (CI) 0.70-0.77]. The discriminative ability decreased with age from AUC = 0.78 in workers aged 30-39 years to AUC = 0.69 in workers ≥50 years of age. Discrimination failed for unemployment (AUC = 0.51; 95 % CI 0.47-0.55) and early retirement (AUC = 0.58; 95 % CI 0.53-0.61). Conclusions The WAI can be used to identify construction workers <50 years of age at increased risk of disability pension and invite them for preventive interventions. [ABSTRACT FROM AUTHOR]

Purpose To gain in-depth understanding of the number and type of experienced ageing problems, obstacles to perform work tasks, retention factors to maintain work and support needs to continue working life in the next years among workers aged 45 years and older with and without a chronic health condition. Methods A survey of workers' perspectives on problems, obstacles, retention factors and needs due to ageing was carried out in 3,008 workers aged 45 years and older in nine different companies. To classify the open-ended questions we used the International Classification of Functioning and disability (ICF). Results Older workers with a chronic health condition reported more problems due to ageing (56 vs 34 %; p < .001), more obstacles (42 vs 16 %; p < .001) and more needs (51 vs 31 %; p < .001) compared to those without a chronic health condition. No relevant differences were found on type of experienced problems, obstacles, retention factors and needs between both groups. Problems and obstacles were found on physiological and psychological functions. Retention factors and needs to enhance sustainable working life were particularly reported on work-related environmental factors. Conclusion Because workers with a chronic health condition experienced more problems, obstacles and needs, the largest gain of occupational intervention can be achieved in these workers. However, our findings suggest that interventions aimed to enhance sustainable working life of older workers can be similar in content for persons with and without chronic health conditions and should have a central focus on work-related factors. [ABSTRACT FROM AUTHOR]

Objective To identify prognostic factors for the 2-year course of work participation in early osteoarthritis (OA) of hips or knees. Methods In this prospective cohort study, questionnaire data from 925 subjects was analyzed. Rate ratios were calculated to compare work participation with the general Dutch population, corrected for age, sex and education. The overall participation rate at T was compared to baseline. Personal factors, self-reported health status (Western Ontario McMasters Arthritis Index-WOMAC), medical consumption and physical work demands were compared between subjects with sustained work participation and subject who stopped working; factors that differed significantly were included in a logistic regression analysis. Results Work participation in the cohort (mean age 58, 79 % females) decreased from 51 to 46 %, a similar rate to the general population. Subjects who continued working were younger than those who stopped working (mean 4.2 years) and they had less frequently reported sick-leave at baseline; the regression model included both factors. 11 % Of the workers reported sick-leave in the past year because of hip/knee complaints (similar to baseline). 20 % Reported work adaptations, compared to 14 % at baseline. Conclusion The 2-year course of work participation of people with early OA was similar to the general Dutch population. Sustained work participation was predicted by lower age, not by OA related factors. [ABSTRACT FROM AUTHOR]

Background: Sickness absence (SA) is a public health risk marker for morbidity and mortality. The aim of this study was to develop and validate prediction models to identify employees at risk of high SA. Methods: Two prediction models were developed using self-rated health (SRH) and prior SA as predictors. SRH was measured by the categories excellent, good, fair and poor in a convenience sample of 535 hospital employees. Prior SA was retrieved from the employer's register. The predictive performance of the models was assessed by logistic regression analysis with high (&geq;90th percentile) vs. non-high (<90th percentile) SA days and SA episodes as outcome variables and by using bootstrapping techniques to validate the models. Results: The overall performance as reflected in the Nagelkerke's pseudo R2 was 11.7% for the model identifying employees with high SA days and 31.8% for the model identifying employees with high SA episodes. The discriminative ability, represented by the area (AUC) under the receiver operating characteristic (ROC), was 0.729 (95% CI 0.667–0.809) for the model identifying employees with high SA days and 0.831 (95% CI 0.784–0.877) for the model identifying employees with high SA episodes. The Hosmer–Lemeshow test showed acceptable calibration for both models. Conclusions: The prediction models identified employees at risk of high SA, but need further external validation in other settings and working populations before applying them in public and occupational health research and care. [ABSTRACT FROM PUBLISHER]

Background: Associations are examined between socio-demographic, medical, work-related and organizational factors and the moment of first return to work (RTW) (within or after 6 weeks of sick leave) and total sick leave duration in sick leave spells due to common mental disorders. Methods: Data are derived from a Dutch database, build to provide reference data for sick leave duration for various medical conditions. The cases in this study were entered in 2004 and 2005 by specially trained occupational health physicians, based on the physician's assessment of medical and other factors. Odds ratios for first RTW and sick leave durations are calculated in logistic regression models. Results: Burnout, depression and anxiety disorder are associated with longer sick leave duration. Similar, but weaker associations were found for female sex, being a teacher, small company size and moderate or high psychosocial hazard. Distress is associated with shorter sick leave duration. Medical factors, psychosocial hazard and company size are also and analogously associated with first RTW. Part-time work is associated with delayed first RTW. The strength of the associations varies for various factors and for different sick leave durations. Conclusion: The medical diagnosis has a strong relation with the moment of first RTW and the duration of sick leave spells in mental disorders, but the influence of demographic and work-related factors should not be neglected. [ABSTRACT FROM PUBLISHER]

Background: The aims of this study were: (i) to determine the relation between chronological and functional age; (ii) to examine the association between chronological age and work outcomes; and (iii) to examine the association between functional age and work outcomes. An overview of the most reported work outcomes is outlined. Methods: Chronological age refers to the calendar age; functional age was measured with perceived health status (SF-36) and the presence of a chronic health condition. Perspectives on experienced problems, barriers, facilitators and support needs due to ageing and the Work Ability Index were gathered out as work outcomes. Results: The association of chronological and functional age of workers aged &geq;45 years (n = 2971) on work outcomes were significant but small, except for the presence of a chronic health condition. The presence of a chronic health condition was not related to chronological age. Older workers (60–64 years) reported better scores on social functioning, mental health and vitality compared with workers aged 45–59 years. Most reported problems due to ageing were energy decline, muscle function decline, concentration lapses and memory deterioration. Experienced barriers were concentration, work pace problems and mobility; facilitators were support from colleagues, informal relations at work and supervisors. Individual agreement had to be met to continue working life. Conclusions: This study confirmed that both chronological and functional age were associated with a decrease in work outcomes. Workers >60 years did not experience more problems and barriers compared with workers between 45 and 49 years of age. [ABSTRACT FROM AUTHOR]

Objective: This study investigated whether short episodes of sickness absence were associated with job satisfaction. Participants: 199 wage earners who reported sick due to the common cold between January 2003 and April 2003. Methods: Job satisfaction was assessed on the first day of sickness absence and associated with the duration of sickness absence using a multiple logistic regression model to which demographics, working conditions, and the week day on which sick-leave was taken were stepwise added as covariates. Results: Workers with low job satisfaction scores had higher odds (odds ratio [OR] =3.85; 95% confidence interval [CI] 1.74 to 8.51) of being > 3 days absent from work due to the common cold compared to satisfied workers. However, the duration of sickness absence due to the common cold was more strongly related to the day of taking sick-leave with workers who reported sick on Monday or Tuesday being longer absent (OR=5.36; 95% CI 1.44 to 9.90) than those who reported sick on Friday. Conclusions: When having a common cold, dissatisfied workers are longer absent from work although the duration of short episodes of sickness absence seems to be determined by the week day on which sick-leave is taken rather than working conditions or perceptions about work. [ABSTRACT FROM AUTHOR]

Background. Besides the important beneficial effects of regular physical activity on general health, some of the musculoskeletal effects of physical activity are of particular interest for older adults after total hip arthroplasty (THA). However, research on physical activity behavior of patients after THA is scarce. Objective. The purpose of this study was to gain insight into the physical activity behavior and fulfillment of guidelines for health-enhancing physical activity of patients 1 year after THA. Design. This was a prospective multicenter cohort study. Methods. To determine level of physical activity, 653 participants (response rate77%) completed the Short QUestionnaire to ASsess Health-enhancing physical activity (SQUASH). Comparisons were made between participants in 2 age groups (75 and 75 years). Determinants of physical activity behavior were assessed. Results. The participants were physically active a mean of 1,468 minutes per week. Most time was spent in household and leisure activities. Younger participants were physically more active than older participants. A lower body mass index was predictive of a higher level of physical activity. Participants adhered to the guidelinesof health-enhancing physical activity in 67% of cases. The guidelines were met more often by younger participants, male participants, and those without problems in the lower extremities. Limitations. A nonresponse analysis was not conducted; thus, there might have been a selection bias. Use of a self-administered recall questionnaire to assess physical activity behavior may have been subject to memory and recall skill limitations of the participants, and patients tend to overestimate their physical activity level. Conclusions. This study gives detailed insight into the physical activity of patients 1 year after primary THA. As among the general population, a considerable number of patients were found to be insufficiently physically active. [ABSTRACT FROM AUTHOR]

Objective The aim of this study is to investigate the reliability and validity of the Disability Assessment Structured Interview (DASI). The DASI is a semi-structured interview for assessing long-term functional limitations concerning the work disability assessment of claimants. Methods A randomized controlled trial was conducted. Patients applying for a work-disability pension after 21 months of sick leave were independently interviewed and examined either by two physicians who had completed a DASI training period ( n = 32) or by two physicians from a control group ( n = 30) without any DASI training. Agreement percentages within both groups of physicians, eligibility for a disability benefit, and differences between the groups in terms of the scores given on the work-limitation items from the Functional Ability List (FAL) were measured to investigate reliability and concurrent validity. To determine the content validity, the insurance physicians who completed DASI training ( n = 8) were asked to fill out a questionnaire concerning their opinion of the DASI. Additionally, patients filled out a questionnaire to measure their satisfaction as to the behavioral aspects of the physicians. Results The groups showed no important differences in agreement percentages (mean percentage about 80%) and eligibility for a disability benefit. In 9 out of 21 items the physicians of the control group indicated fewer work limitations compared to physicians using the DASI. All physicians agreed on the fact that the DASI was an acceptable tool in daily practice, one that provided a realistic picture of the patient and provided sufficient information to assess functional limitations. In addition, between the two groups, no differences were found as to the satisfaction of patients concerning the behavioral aspects of the physicians. Conclusion The DASI is a tool with a reasonable to good inter-rater reliability and content validity, and it appears to be acceptable to both patients and physicians. It did not improve inter-observer agreement beyond that of usual interview procedures used in the Netherlands. The DASI would seem to be a worthwhile tool for collecting self-reported information in order to assess functional limitations in claimants. [ABSTRACT FROM AUTHOR]

Objectives: To explore regional differences in the effects of the sick leave frequency determinants between two homogeneous groups of workers from two comparable socio-economic regions in the Netherlands, namely Utrecht and South Limburg. Materials and Methods: Data on sick leave frequency for 137 cleaning workers in the regions of Utrecht (mean sick leave frequency: 0.89 spells) and South Limburg (mean sick leave frequency: 1.66 spells) were obtained from a Dutch social fund, and the data regarding their job, and health-related and individual characteristics were elicited by an interview. Results: A statistical analysis of the sick leave frequency in the two regions showed little differences, except for the determinant 'perceived physical workload' which was associated with the sick leave frequency in South Limburg but not in Utrecht. Conclusion: A regional difference in the sick leave frequency was noted with respect to 'perceived physical workload' as the study parameter. This would indicate that the findings of our earlier studies performed in the nineties of the last century. are still relevant. In further research, the principles of the new certification system on sick leave frequency should also be considered, as the previous uniform statutory compensation system has been terminated. [ABSTRACT FROM AUTHOR]

In research on the time to onset of sickness absence and the duration of sickness absence episodes, Cox proportional hazard models are in common use. However, parametric models are to be preferred when time in itself is considered as independent variable. This study compares parametric hazard rate models for the onset of long-term sickness absence and return to work. Prospective cohort study on sickness absence with four follow-up years of 53,830 employees working in the private sector in the Netherlands. The time to onset of long-term (>6 weeks) sickness absence and return to work were modelled by parametric hazard rate models. The exponential parametric model with a constant hazard rate most accurately described the time to onset of long-term sickness absence. Gompertz–Makeham models with monotonically declining hazard rates best described return to work. Parametric models offer more possibilities than commonly used models for time-dependent processes as sickness absence and return to work. However, the advantages of parametric models above Cox models apply mainly for return to work and less for onset of long-term sickness absence. [ABSTRACT FROM AUTHOR]

Objectives: To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive Care (IC) nurses and X-ray technologists. Methods: The study population consists of 3,169 employees affiliated to eight university hospitals in the Netherlands. The study was conducted using a cross-sectional survey design. The parameters under study were having or having had (severe) low back or neck-shoulder complaints during the past year. In logistic regression analyses odds ratio’s and CI 95% were estimated for all relevant risk factors for each of the four professional groups. Results: In all groups prevalence rates of musculoskeletal complaints were high: low back 76%, neck-shoulder 60%. Operation room nurses perceived more neck-shoulder complaints (12 months prevalence) than non-specialized nurses and IC nurses perceived less severe low back complaints than non-specialized nurses. Four physical risk factors and one psychosocial factor were associated with low back complaints in all groups. Conclusions: The results of the present study indicate that both low back complaints and neck-shoulder complaints are major health problems in the four professional groups under study. The prevalence rate of neck-shoulder complaints in operation room nurses is higher than in non-specialized nurses and IC nurses, the latter groups having high prevalence rates already. The exposure to risk factors is perceived differently by each of the professional groups. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups. [ABSTRACT FROM AUTHOR]

Background: Recent research shows the possibility that the link between parental employment status and children's health can be affected by different cultural or societal settings. The aim of this study was to explore whether the effect of father's and mother's employment status on several aspects of adolescents' health differs between Slovakia and the Netherlands. Methods: Two data sets were used: 2616 Slovak adolescents (mean age 14.9) and 2054 Dutch adolescents (mean age 16.3). Self-rated health, GHQ-12, long-term well-being and Rosenberg self-esteem scale were used to assess the health of adolescents. Parental employment status was classified into the following categories: employed, unemployed, disabled, housewife (among mothers only). Logistic regression analyses were done separately for males and females. Results: Results indicate that having an unemployed father negatively influences self-rated health and longterm well-being of Slovak male adolescents, but has no effect on the health of Dutch adolescents. Secondly, having a disabled father has a negative effect on the psychological well-being of Dutch males and the self-rated health of females, but does not influence the health of Slovak adolescents. Thirdly, having a mother who is disabled, unemployed or a housewife has a negative effect on the self-esteem of Slovak adolescents. Fourthly, Dutch males whose mother was a housewife had worse long-term well-being than those with an unemployed mother, whereas Dutch females whose mother was a housewife reported better psychological well-being than those with an employed mother. Conclusion: To conclude briefly our results, father's unemployment seems to be a better predictor of health for Slovak adolescents, father's disablement of health for Dutch ones. Mother's employment status seemed to be important for the self-esteem of Slovak adolescents and mother as a housewife for the health of Dutch ones. This suggests that the link between parental employment status and the health of their children may vary between countries, and therefore further studies involving various cultures are needed. [ABSTRACT FROM AUTHOR]

Presents a study which was conducted to determine whether socioeconomic differences in health risk behaviors are present in male and female adolescents in the Netherlands. Examination of the socioeconomic status (SES) and health risk behaviors among male and female; Effects of SES and gender on separate health risk behaviors; Analysis of data collected; How SES was measured; Results of this study.

Background Sickness absence is a considerable economic and social problem. Short-term sickness absence is known to be associated with behavioural attitudes. The correlation between sickness absence and job satisfaction has been studied infrequently and with contradictory results.Aims This study investigated the correlation between short-term sickness absence and both global and specific job satisfaction. We defined short-term sickness absence as spells of up to 42 days.Methods A random sample of 898 Dutch workers from a variety of economic sectors and companies received a self-report questionnaire on their first day of sick leave. The questionnaire measured global and specific job satisfaction. In our regression analysis, we controlled for the confounding factors of age, gender, educational level, perceived workload, job autonomy and decision latitude. The duration of an absence spell was defined as the amount of calendar days between sick leave and return to work.Results Global job satisfaction did not correlate significantly with the duration of short-term sickness absence. While increasing physical job demands predicted longer absence, increasing job autonomy and educational level predicted shorter absence. Satisfaction with colleagues predicted longer duration absence.Conclusion Global job satisfaction did not correlate with the duration of short-term absence spells, but specific satisfaction with colleagues was associated with longer sickness spells. [ABSTRACT FROM AUTHOR]

Background: Screening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4thEdition (DSM-IV) among disability claimants.Methods: All scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach's α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated.Results: Cronbach's alpha's were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC's for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765).Conclusions: The K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder. [ABSTRACT FROM AUTHOR]

Purpose: Frequent absentees are at risk of long-term sickness absence (SA). The aim of the study is to develop prediction models for long-term SA among frequent absentees., Methods: Data were obtained from 53,833 workers who participated in occupational health surveys in the period 2010-2013; 4204 of them were frequent absentees (i.e., employees with ≥ 3 SA spells in the year prior to the survey). The survey data of the frequent absentees were used to develop two prediction models: model 1 including job demands and job resources and model 2 including burnout and work engagement. Discrimination between frequent absentees with and without long-term SA during follow-up was assessed with the area under the receiver operating characteristic curve (AUC); (AUC) ≥ 0.75 was considered useful for practice., Results: A total of 3563 employees had complete data for analyses and 685 (19%) of them had long-term SA during 1-year follow-up. The final model 1 included age, gender, education, marital status, prior long-term SA, work pace, role clarity and learning opportunities. Discrimination between frequent absentees with and without long-term SA was significant (AUC 0.623; 95% CI 0.601-0.646), but not useful for practice. Model 2 showed comparable discrimination (AUC 0.624; 95% CI 0.596-0.651) with age, gender, education, marital status, prior long-term SA, burnout and work engagement as predictor variables. Differentiating by gender or sickness absence cause did not result in better discrimination., Conclusions: Both prediction models discriminated significantly between frequent absentees with and without long-term SA during 1-year follow-up, but have to be further developed for use in healthcare practice.

Background: In present-day life-insurance medical underwriting practice the risk assessment starts with a standard health declaration (SHD). Indication for additional medical screening depends predominantly on age and amount of insured capital. From a medical perspective it is questionable whether there is an association between the level of insured capital and medical risk in terms of mortality. The aim of the study is to examine the prognostic value of parameters from the health declaration and application form on extra mortality based on results from additional medical testing., Methods: A history register-based cohort study was conducted including about 15.000 application files accepted between 2007 and 2010. Blood pressure, lipids, cotinine and glucose levels were used as dependent variables in logistic regression models. Resampling validation was applied using 250 bootstrap samples to calculate area under the curves (AUC's). The AUC was used to discriminate between persons with and without at least 25% extra mortality., Results: BMI and the overall assessment of the health declaration by an insurance physician or medical underwriter showed the strongest discrimination in multivariable analysis. Including all variables at minimum cut-off levels resulted in an AUC of 0.710 while by using a model with BMI, the assessment of the health declaration and gender, the AUC was 0.708. Including all variables at maximum cut-off levels lead to an AUC of 0.743 while a model with BMI, the assessment of the health declaration and age resulted in an AUC of 0.741., Conclusions: The outcome of this study shows that BMI and the overall assessment of the health declaration were the dominant variables to discriminate between applicants for life-insurance with and without at least 25 percent extra mortality. The variable insured capital set by insurers as factor for additional medical testing could not be established in this study population. The indication for additional medical testing at underwriting life-insurance can possibly be done on limited variables instead of the obligatory medical testing based on age and the amount of insured capital.

Objectives: Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP., Methods: This prospective cohort study comprised 11 537 male construction workers, who completed the WAI at baseline and reported DP after a mean 2.3 years of follow-up. WAS and WAI were calibrated for DP risk predictions with the Hosmer-Lemeshow (H-L) test and their ability to discriminate between high- and low-risk construction workers was investigated with the area under the receiver operating characteristic curve (AUC)., Results: At follow-up, 336 (3%) construction workers reported DP. Both WAS [odds ratio (OR) 0.72, 95% confidence interval (95% CI) 0.66-0.78] and WAI (OR 0.57, 95% CI 0.52-0.63) scores were associated with DP at follow-up. The WAS showed miscalibration (H-L model χ (�)=10.60; df=3; P=0.01) and poorly discriminated between high- and low-risk construction workers (AUC 0.67, 95% CI 0.64-0.70). In contrast, calibration (H-L model χ �=8.20; df=8; P=0.41) and discrimination (AUC 0.78, 95% CI 0.75-0.80) were both adequate for the WAI., Conclusion: Although associated with the risk of future DP, the single-item WAS poorly identified male construction workers at risk of DP. We recommend using the multi-item WAI to screen for risk of DP in occupational health practice.

Background: To investigate mental health symptoms as prognostic risk markers of all-cause and psychiatric sickness absence (SA)., Methods: Mental health symptoms were measured in 1137 office workers with the Four-Dimensional Symptom Questionnaire (4DSQ), including scales for distress, depression, anxiety and somatization. The total number of SA days was accumulated prospectively on the individual level and high SA was defined as ≥30 SA days during 1-year follow-up. Psychiatric SA was also tallied on the individual level during 1-year follow-up. Baseline 4DSQ scores were associated with high all-cause SA and psychiatric SA by logistic regression analysis. The Hosmer-Lemeshow test and calibration slope were used to assess the accuracy of predictions by 4DSQ scores. The ability of 4DSQ scores to discriminate high-risk from low-risk employees was estimated by the area under the receiver operating characteristic curve., Results: Six hundred thirty-three office workers (56%) participated in the study. All 4DSQ scales were prospectively associated with high all-cause SA and with psychiatric SA. Distress and somatization scores showed acceptable calibration, but failed to discriminate between office workers with and without high all-cause SA. The distress scale did show adequate calibration (calibration slope = 0.95) and discrimination (area under the receiver operating characteristic curve = 0.71) for psychiatric SA., Conclusion: Distress was a valid prognostic risk marker for identifying office workers at work, but at risk of future psychiatric SA. Further research is necessary to investigate the prognostic performance of distress as risk marker of psychiatric SA in other working populations and to determine cut-off points for distress.

Purpose: This study aimed to examine under-recognition, under-treatment and severity of under-treated DSM-IV mood and anxiety disorders among disability claimants., Methods: In a representative sample of Dutch disability claimants (n = 346), registry codes certified according to the International Classification of Diseases 10th edition (ICD-10) by insurance physicians, were compared with classifications according to the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) detected by the Composite International Diagnostic Interview (CIDI). Levels of ICD-10/DSM-IV agreement were assessed for mood and anxiety disorders in the total sample, and prevalence of recent DSM-IV mood and anxiety disorders in a pure ICD-10 somatic subgroup. Treatment and severity of under-treated DSM-IV mood and anxiety disorders were assessed in two subgroups of disability claimants with either an ICD-10 somatic or mental disorder as primary cause of disability, irrespective of any ICD-10 comorbidity., Results: Levels of ICD-10/DSM-IV agreement were poor (κ: 0.237 for mood and 0.260 for anxiety disorders). In the pure ICD-10 somatic subgroup, the prevalence of DSM-IV mood and anxiety disorders was 3.8% and 11.4%, respectively. In the ICD-10 somatic subgroup irrespective of any ICD-10 comorbidity, 45.2% (major depressive disorder), 80.0% (social phobia) and 53.3% (general anxiety disorder) were under-treated. In the ICD-10 mental subgroup, these percentages were 44.7%, 80.9% and 33.4%, respectively. In both of these subgroups, under-treated DSM-IV mood and anxiety disorders were predominantly serious in terms of impairment and disability., Conclusions: Serious mental disorders were found to be substantially under-diagnosed and under-treated among disability claimants. To optimize diagnosis and treatment of disabling mental disorder, medical professionals in insurance, occupational and in the health care sector should closely collaborate. For claimants with under-treated mental disorders, tailor-made multidisciplinary interventions are needed to promote return to work and to prevent permanent disability.

Purpose: To explore how social support is associated with anxiety and depression in Parkinson's disease (PD) patients controlling for gender, disease duration and disease severity., Methods: The sample consisted of 124 patients (52.4% male; mean age 68.1 ± 8.4 years; mean disease duration 6.3 ± 5.5 years). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale, social support with the Multidimensional Scale of Perceived Social Support and disease severity with the Unified Parkinson Disease Rating Scale. Data were analyzed using linear regression., Results: Gender, disease duration, disease severity and social support explained 31% of the total variance in anxiety in younger PD patients but did not significantly contribute to the explanation of depression. In the older group, this model explained 41% of the variance in depression but did not significantly contribute to the explanation of anxiety., Conclusion: PD patients experience the positive influence of social support differently according to age. In the younger group, disease duration plays the primary role regarding anxiety. In the older group, poor social support especially from friends is associated with more depression after controlling for the relevant variables. Implications of Rehabilitation PD is a disease of older age with a neurodegenerative character and treatment should focus on increasing quality of life. Anxiety and depression are common co-morbidities in PD patients. The support network should also be screened regularly and involved in enhancing the quality of life.

Purpose: To examine the associations between medical, work-related, organizational and sociodemographic factors and job loss during sick leave in a Dutch population of 4132 employees on sick leave., Methods: Data were assessed by occupational health physicians (OHPs) on sociodemographic, medical, work-related and organizational factors. Odds ratios for job loss were calculated in logistic regression models., Results: Job loss during sick leave is associated with mental disorder, a history of sick leave due to these disorders, lack of co-worker and supervisor support, job insecurity and working as a civil servant or a teacher. Associations vary for gender and for company size., Conclusions: Job loss during sick leave is associated with medical, work-related, organizational and socio-demographic factors. The findings of this study might help the OHP or other health professionals involved in the management of employees on sick leave to identify those employees who are at risk for job loss during sick leave, and might help policymakers to decide on priorities in prevention and treatment. Future studies should have a longitudinal, prospective design and include information about the type of contract, possible causes for job loss, severity and treatment of the disorder causing the sick leave., Implications for Rehabilitation: The labor market moves to more and more flexible and temporary contracts. This leads to more precarious types of employment. The risk of job loss during sick leave is associated with medical, work-related, organizational and sociodemographic factors. Occupational health physicians and other professionals in the field of work rehabilitation should be aware of these associations to prevent job loss due to these factors.

Purpose: To investigate the impact of diagnosis, co-morbidity, secondary conditions (e.g. learning problems, subclinical mental and somatic complaints, addictions, and socio-emotional and behavioral problems) and problems in social context on work ability as assessed by Insurance Physicians (IPs) in young adults applying for a disability benefit., Method: IPs of the Social Security Institute assessed young adults with disabilities (aged 15-27) applying for a disability benefit (n = 1755). Data were analyzed with multilevel ordinal regression techniques., Results: Primary diagnosis, co-morbidity and subclinical mental complaints were associated with IP-assessed work ability. Persons with mental health conditions as primary diagnosis were less likely to reach a higher work ability than persons with somatic diseases. Young adults with two or more co-morbid conditions and those with psychiatric or developmental co-morbidity were less likely to reach a higher work ability level than persons without co-morbidity. Young adults with subclinical mental complaints were half as likely to reach a higher IP-assessed work ability than young adults without this condition., Conclusion: Primary diagnosis, type and number of co-morbid conditions and subclinical mental complaints are associated with IP-assessed work ability. Work-ability assessments among adolescents with disabilities applying for disability benefits still focus mainly on medical factors.

Background: Efforts undertaken during the Return-to-Work (RTW) process need to be sufficient in order to optimize the quality of the RTW process. The purpose of this study was to explore factors relevant to Return-to-Work Effort Sufficiency (RTW-ES) in cases of sick-listed employees with a Depressive Disorder (DD)., Method: A case of a long-term sick-listed employee with a DD applying for disability benefits was used to gather arguments and grounds relevant to the assessment of RTW-ES. Two focus group meetings were held, consisting of Labor Experts working at the Dutch Social Insurance Institute. Factors were collected and categorized using the International Classification of Functioning, Disability and Health (ICF model)., Results: Sixteen factors relevant to RTW-ES assessment in a case of DD were found, categorized in the ICF-model under activities (e.g. functional capacity), personal (e.g. competencies, attitude) and environmental domain (e.g. employer-employee relationship), or categorized under interventions, job accommodations and measures., Conclusions: This study shows that 16 factors are relevant in the assessment of RTW-ES in employees sick-listed due to DD. Further research is necessary to expand this knowledge to other health conditions, and to investigate the impact of these results on the quality of the RTW-ES assessment.

Purpose: To assess determinants of social participation among visually impaired older adults., Methods: This cross-sectional study included visually impaired persons (≥55 years; n = 173) who were referred to a low-vision rehabilitation center. Determinants (i.e., sociodemographic, physical, social and psychological factors, and personal values) of participation were identified in four domains of participation: (1) domestic life; (2) interpersonal interactions and relationships; (3) major life areas; and (4) community, social, and civic life. Study participants completed telephone interviews., Results: Age, physical fitness, and helplessness were determinants of participation in domestic life. Social network size was associated with participation in major life areas. The personal value attached to participation (i.e., perceived importance) was a determinant of participation in interpersonal interactions and relationships, major life areas, and community, social and civic life. Vision-related characteristics (i.e., self-perceived vision and degree of visual impairment) were not associated with participation., Conclusions: Across the participation domains, perceived importance is a major determinant of social participation among visually impaired older adults. Physical health along with social and psychological status, also affect participation. Knowing how participation is determined can be used to develop rehabilitation interventions to enhance participation of visually impaired older adults.

Background: Efforts undertaken during the return to work (RTW) process need to be sufficient to prevent unnecessary applications for disability benefits. The purpose of this study was to identify factors relevant to RTW Effort Sufficiency (RTW-ES) in cases of sick-listed employees with chronic low back pain (CLBP)., Methods: Using focus groups consisting of Labor Experts (LE's) working at the Dutch Social Insurance Institute, arguments and underlying grounds relevant to the assessment of RTW-ES were investigated. Factors were collected and categorized using the International Classification of Functioning, Disability and Health (ICF model)., Results: Two focus groups yielded 19 factors, of which 12 are categorized in the ICF model under activities (e.g. functional capacity) and in the personal (e.g. age, tenure) and environmental domain (e.g. employer-employee relationship). The remaining 7 factors are categorized under intervention, job accommodation and measures., Conclusions: This focus group study shows that 19 factors may be relevant to RTW-ES in sick-listed employees with CLBP. Providing these results to professionals assessing RTW-ES might contribute to a more transparent and systematic approach. Considering the importance of the quality of the RTW process, optimizing the RTW-ES assessment is essential.

Purpose: To pilot test the newly developed multidisciplinary group rehabilitation programme Visually Impaired elderly Persons Participating (VIPP)., Method: A single group pretest-posttest design pilot study included 29 visually impaired persons (≥ 55 years). The intervention (20 weekly meetings) consisted of four components (practical training; education, social interaction, counselling and training of problem-solving skills; individual and group goal setting; home-based exercise programme). Participation was assessed with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P) and the Impact on Participation and Autonomy (IPA) questionnaire at baseline, immediately and 6 months after the intervention., Results: At scale level, no statistical significant changes over time were found whereas the effect size indicated small effects for restrictions and satisfaction with participation, and a medium effect for autonomy outdoors. At item level, improvements tended to occur in frequency of housekeeping, in restrictions in housekeeping and outdoor activities and in satisfaction with the partner relationship. Satisfaction with leisure indoors and autonomy regarding using leisure time tended to increase as well., Conclusions: The tentative conclusion of this small-scale pilot study is that the VIPP programme modestly benefits perceived restrictions in participation, satisfaction with participation and autonomy outdoors of the visually impaired elderly. These preliminary findings warrant further investigation.

Purpose: To determine the agreement between occupational physician (OP) ratings of an employee's readiness to return to work (RRTW)., Method: Anonymized written vignettes of 132 employees, sick-listed for at least 3 weeks, were reviewed by 5 OPs. The OPs intuitively rated RRTW as the ability (knowledge and skills) and willingness (motivation and confidence) of sick-listed employees to resume work. Inter-OP percentages of agreement were calculated and Cohen's kappas (κ) were determined to correct for agreement by chance., Results: The percentage of agreement between OPs was 57% (range 39-89%) on the ability and 63% (range 48-87%) on the willingness of sick-listed employees to resume work. The mean κ was 0.14 (range from -0.21 to 0.79) for ability and 0.25 (range from -0.11 to 0.74) for willingness. The OP-rating of RRTW of employees sick-listed with mental disorders did not differ from the OP-rating of RRTW of employees with musculoskeletal disorders., Conclusion: The inter-OP agreement on intuitively rated RRTW showed a wide variability, which accentuates the need for instruments to establish an employee's RRTW and for training in giving well founded return to work recommendations.

Nurses exposed to high nursing stress report no health complaints as long as they have high coping abilities. The purpose of this study was to investigate coping styles in relation to the health status and work environment of Norwegian and Dutch hospital nurses. This comparative study included a random sample of 5400 Norwegian nurses and a convenience sample of 588 Dutch nurses. Coping, health, and work environment were assessed by questionnaire in both samples and associations were investigated bivariately and multivariately. We found that active problem-solving coping was associated with the health and work environment of Norwegian nurses but not with the health and work environment of Dutch. Passive coping (avoiding problems or waiting to see what happens) was found to relate to poor general health, poor mental health, low job control, and low job support in both Norwegian and Dutch nurses. Improvements in the nursing work environment may not only result in better mental health, but may also reduce passive coping., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors)., Methods: A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?", Results: A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs., Conclusions: Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence.

Purpose: Common mental disorders (CMDs) are an important cause of work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. This study examines the recurrence risk of sickness absence due to CMDs., Methods: A cohort of 9,904 employees with a sickness absence due to CMDs, working in the Dutch Post or Telecommunication company, was studied over a 7-year period. Recurrence was defined as the start of at least one new episode of sickness absence with CMDs after complete return to work for at least 28 days. The recurrence density (RD) of sickness absence with CMDs was calculated per 1,000 person-years., Results: Of the 9,904 employees with a first absence due to CMDs 1,925 (19%) had a recurrence, 90% of recurrences occurred within 3 years. The RD of sickness absence due to CMDs was 84.5 employees per 1,000 person-years (95% CI=80.7-88.3). The RD of sickness absence due to CMDs was similar in women and in men. In men, depressive symptoms were related to higher recurrence of sickness absence due to CMDs than distress symptoms and adjustment disorders. In women, no difference by diagnostic category was found., Conclusions: Employees with a previous episode of sickness absence with CMDs are at increased risk of recurrent sickness absence with CMDs. Relapse prevention consultations are recommended for a period of 3 years after return to work.

Background: Sickness absence leads to understaffing and interferes with nursing efficiency and quality. It has been reported in literature that managerial leadership is associated with self-reported sickness absence in the working population., Purposes: This study investigated the relationship between managerial leadership and sickness absence in health care by associating nurse managers' leadership styles with registered sickness absence among their nursing staff., Methodology: The cross-sectional study included 699 nurses working in six wards (staff range = 91-140 employees) of a Dutch somatic hospital employing a total of 1,153 persons. The nurse managers heading the wards were asked to complete the Leadership Effectiveness and Adaptability Description questionnaire for situational leadership. The Leadership Effectiveness and Adaptability Description scores were linked to employer-registered nursing staff sickness absence., Findings: High relationship-high task behavior (odds ratio [OR] = 0.76, 95% confidence interval [CI] = 0.65-0.85) and high relationship-low task behavior (OR = 0.37, 95% CI = 0.14 -0.98) were inversely related to the number of short (one to seven consecutive days) episodes of sickness absence among the staff. Low relationship-high task styles (OR = 2.44, 95% CI = 1.14-5.22) as well as low relationship-low task styles (OR = 2.44, 95% CI = 1.26-4.71) were positively associated with the number of short episodes of sickness absence. However, the leadership styles only explained 10% of the variance in short episodes of sickness absence., Practice Implications: Leadership styles are associated with registered sickness absence. The nursing staff of relationship-oriented nurse managers has fewer short episodes of sickness absence than the staff of task-oriented managers. Training nurse managers in relational leadership styles may reduce understaffing and improve nursing efficiency and quality.

Background: Assessment of efforts to promote return-to-work (RTW) includes all efforts (vocational and non-vocational) designed to improve the work ability of the sick-listed employee and increase the chance to return to work. Aim of the study was to investigate whether in 13 European countries these RTW efforts are assessed and to compare the procedures by means of six criteria., Methods: Data were gathered in the taxonomy project of the European Union of Medicine in Assurance and Social Security and by means of an additional questionnaire., Results: In seven countries RTW efforts are subject of the assessment in relation to the application for disability benefits. Description of RTW efforts is a prerequisite in five countries. Guidelines on the assessment of RTW efforts are only available in the Netherlands and no countries report the use of the ICF model. Based on the results of the additional questionnaire, the assessor is a social scientist or a physician. The information used to assess RTW efforts differs, from a report on the RTW process to medical information. A negative outcome of the assessment leads to delay of the application for disability benefits or to application for rehabilitation subsidy., Conclusion: RTW efforts are assessed in half of the participating European countries. When compared, the characteristics of the assessment of RTW efforts in the participating European countries show both similarities and differences. This study may facilitate the gathering and exchange of knowledge and experience between countries on the assessment of RTW efforts.

Background: The two primary objectives of this study were to the assess consultation load of occupational health physicians (OHPs), and their difficulties and needs with regard to their sickness certification tasks in sick-listed employees with severe medical unexplained physical symptoms (MUPS). Third objective was to determine which disease-, patient-, doctor- and practice-related factors are associated with the difficulties and needs of the OHPs., Methods: In this cross-sectional study, 43 participating OHPs from 5 group practices assessed 489 sick-listed employees with and without severe MUPS. The OHPs filled in a questionnaire about difficulties concerning sickness certification tasks, consultation time, their needs with regard to consultation with or referral to a psychiatrist or psychologist, and communication with GPs. The OHPs also completed a questionnaire about their personal characteristics., Results: OHPs only experienced task difficulties in employees with severe MUPS in relation to their communication with the treating physician. This only occured in cases in which the OHP attributed the physical symptoms to somatoform causes. If they attributed the physical symptoms to mental causes, the OHPs reported a need to consultate a psychiatrist about the diagnosis and treatment., Conclusions: OHPs experience few difficulties with their sickness certification tasks and consultation load concerning employees with severe MUPS. However, they encounter problems if the diagnostic uncertainties of the treating physician interfere with the return to work process. OHPs have a need for psychiatric expertise whenever they are uncertain about the psychiatric causes of a delayed return to work process. We recommend further training programs for OHPs. They should also have more opportunity for consultation and referral to a psychiatrist, and their communication with treating physicians should be improved.

Background: To improve a sustainable healthy working life, we have developed the intervention 'Staying healthy at work', which endeavours to enhance work participation of employees aged 45 years and older by increasing their problem-solving capacity and stimulating their awareness of their role and responsibility towards a healthy working life. This research study aims to evaluate the process and the effectiveness of the intervention compared with care as usual., Methods/design: The study is a cluster-randomized controlled trial design (randomized at the supervisor level), with a 1-year follow-up. Workers aged 45 years and older have been enrolled in the study. Workers in the intervention group are receiving the intervention 'Staying healthy at work'. The main focus of the intervention is to promote a healthy working life of ageing workers by: (1) changing workers awareness and behaviour, by emphasizing their own decisive role in attaining goals; (2) improving the supervisors' ability to support workers in taking the necessary action, by means of enhancing knowledge and competence; and (3) enhancing the use of the human resource professionals and the occupational health tools available within the organization. The supervisors in the intervention group have been trained how to present themselves as a source of support for the worker. Workers in the control group are receiving care as usual; supervisors in the control group have not participated in the training. Measurements have been taken at baseline and will be followed up at 3, 6 and 12 months. The primary outcome measures are vitality, work ability and productivity. The secondary outcomes measures include fatigue, job strain, work attitude, self-efficacy and work engagement. A process evaluation will be conducted at both the supervisor and the worker levels, and satisfaction with the content of the intervention will be assessed., Discussion: The intervention 'Staying healthy at work' has the potential to provide evidence-based knowledge of an innovative method to promote a sustainable healthy working life in the older working population. The results of the study will be relevant for workers, employers, occupational health professionals and human resource professionals., Trial Registration: The trial is registered with the Dutch Trial Register under number NTR2270.

Background: Common mental disorders (CMDs) are an important cause of sickness absence and long-term work disability. Although CMDs are known to have high recurrence rates, little is known about the recurrence of sickness absence due to CMDs. The aim of this study was to investigate the recurrence of sickness absence due to CMDs, including distress, adjustment disorders, depressive disorders and anxiety disorders, according to age, in male and female employees in the Netherlands., Methods: Data on sickness absence episodes due to CMDs were obtained for 137,172 employees working in the Dutch Post and Telecommunication companies between 2001 and 2007. The incidence density (ID) and recurrence density (RD) of sickness absence due to CMDs was calculated per 1000 person-years in men and women in the age-groups of < 35 years, 35-44 years, 45-54 years, and > or = 55 years., Results: The ID of one episode of CMDs sickness absence was 25.0 per 1000 person-years, and the RD was 76.7 per 1000 person-years. Sickness absence due to psychiatric disorders (anxiety and depression) does not have a higher recurrence density of sickness absence due to any CMDs as compared to stress-related disorders (distress and adjustment disorders): 81.6 versus 76.0 per 1000 person-years. The ID of sickness absence due to CMDs was higher in women than in men, but the RD was similar. Recurrences were more frequent in women < 35 years and in women between 35 and 44 years of age. We observed no differences between age groups in men. Recurrences among employees with recurrent episodes occurred within 3 years in 90% of cases and the median time-to-onset of recurrence was 11 (10-13) months in men and 10 (9-12) months in women., Conclusions: Employees who have been absent from work due to CMDs are at increased risk of recurrent sickness absence due to CMDs and should be monitored after they return to work. The RD was similar in men and in women. In women < 45 years the RD was higher than in women > or = 45 years. In men no age differences were observed.

Introduction: The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability and discharge. Secondary objective was to evaluate determinants of the duration of sickness absence in employees with HLSSS., Methods: 489 sick-listed employees registered with five Occupational Health Physician (OHP) group practices were included in this study. We measured their baseline scores for somatic symptoms severity, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. The OHPs filled in a questionnaire on their diagnosis. A prospective 2-year follow-up was carried out to assess the long-term outcomes concerning sickness absence, and retrospective information was gathered with regard to sickness absence during the 12 months before the employees were sick-listed., Results: The median duration of sickness absence was 78 days longer for employees with HLSSS. They more often remained disabled and were discharged more often, especially due to problems in the relationship between the employer and the employee. HLSSS, health anxiety and older age contributed to a longer duration of sickness absence of employees., Conclusion: High levels of somatic symptom severity are a determinant of prolonged sickness absence, enduring disabilities and health-related job loss. Occupational health physicians should identify employees who are at risk and adhere to guidelines for medically unexplained somatic symptoms.

Background: Most research on sickness absence among nurses has focused on long-term work disability. Absence from work due to short-term sickness, however, is more common and frequent short absences result in understaffing and increased workload of nursing teams., Objectives: To investigate health and work factors in relation to the frequency of short-term sickness absence among nurses., Design: A cross-sectional study linking self-reported health and work factors to the frequency of registered sickness absence episodes in the preceding 3 years., Settings: A regional hospital in the Dutch province Friesland employing 1153 persons., Participants: 459 female nurses working at least 3 years in the clinical wards (n=337) or the outpatient clinic (n=122) of the hospital., Methods: Perceived general health, mental health, demand/control (DC) ratio, workplace social support, effort/reward (ER) ratio, and over-commitment (i.e. the inability to withdraw from work obligations) were assessed by a self-administered questionnaire. The associations between the questionnaire results and the registered number of sickness absence episodes were analysed by negative binomial regression analysis, distinguishing between short (1-7 days) and long (>7 days) sickness absence episodes and controlling for age, hours worked, and duration of employment., Results: 328 (71%) female nurses completed their questionnaires and of these 291 were eligible for analysis. High frequent absentees perceived poorer health, had lower over-commitment scores, and reported higher ER-ratios than low frequent absentees. Esteem rewards were related to sickness absence whereas monetary rewards were not. Feeling respect from the supervisor was associated with fewer short sickness absence episodes and respect from co-workers was associated with fewer long sickness absence episodes., Conclusions: Effort-reward imbalance was associated with frequent short sickness absence episodes among nurses. Work efforts and rewards ought to be potentially considered when managing nurses who are frequently absent from work as these factors can be dealt with by managers., (Copyright 2009. Published by Elsevier Ltd.)

Objectives: Regional differences in sick leave duration determinants were studied between in age and profession homogeneous groups in different regions in The Netherlands, i.e. Utrecht and Southern Limburg, in order to find any effects of socio-cultural factors., Material and Methods: 137 participants in Utrecht and Southern Limburg were interviewed. Data of sick leave duration were obtained from the social fund., Results: A statistical comparison of sick leave duration figures showed that, in Southern Limburg, determinants of 'health status' (questions about perceived health and burnout due to work) and 'individual characteristics and circumstances' (age, gender and satisfaction with private circumstances) were associated with sick leave duration and, in Utrecht, the 'work contents' determinant autonomy., Conclusions: In the regions studied, different determinants appeared to be associated with sick leave duration and for some of them the European integration was assumed to have a lasting effect. Nationwide policy interventions to reduce sick leave duration should take into account the existence of regional differences in determinants predicting sick leave duration and the potential effects of different socio-cultural characteristics on laying claim to social security.

Objective: The Dutch population is healthy in terms of living and working conditions, but the levels of subjective health complaints (SHC) and sickness absence are high in the Dutch workforce. Are SHC related to sickness absence?, Participants: The study population included the personnel of four companies: a library (n= 185), an administrative office (n=114), a cheese factory (n=201) and a company producing metal constructions (n=65)., Methods: The employees received the Basic Occupational Health Questionnaire including 22 common SHC. For each employee, the number and type of SHC but not their intensity was linked to the number of sickness absence episodes between January 2003 and December 2004., Results: The questionnaires of 409 employees (72%) were suitable for statistical analysis. The prevalence of SHC in the study population was 78% between January and June 2003. Employees who reported > or = 5 SHC had higher rates of both short (1-7 days) and medium (8-42 days) sickness absence episodes. Long (> 42 days) episodes were strongly related to SHC amounting to a rate ratio (RR) of 4.2 with a 95% confidence interval [CI] 1.7 to 10.4 in workers reporting multiple SHC relative to those without complaints. Fatigue was associated with medium duration sickness absence (RR=1.6; 95% CI 1.1-2.2) and musculoskeletal complaints, particularly low back pain (RR= 1.8; 95% CI 1.2-2.8), with long episodes., Conclusions: The number of SHC was related to sickness absence. The 20% of participants reporting most SHC were responsible for about 40% of work days lost in the two-year period of study.

Background: Medically unexplained physical symptoms (MUPS) have a high prevalence in the general population and are associated with psychiatric morbidity. There are indications that MUPS are an important determinant of frequent and long-term disability. The primary objective was to assess the prevalence of MUPS in sick-listed-employees and its associations with depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. Secondary objectives were to investigate the classification of the occupational health physicians (OHPs), their opinions about the causes as well as the attributions of the employee., Methods: In a cross-sectional study of 489 sick-listed employees from 5 OHP group practices, MUPS, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment were assessed with the Patient Health Questionnaire (PHQ), the Whitely Index (WI), the Four-Dimensional Symptom Questionnaire (4DSQ) and the Short-Form 36 Health Survey (SF-36). We used a cut off score of 15 on the PHQ for the categorisation of severe MUPS. The opinions of the OHPs were evaluated by means of a separate questionnaire with regard to the presence of employees physical symptoms, and the symptoms attributions, and the diagnoses of the OHPs., Results: Severe MUPS had a prevalence of 15.1% in this population of sick-listed employees. These employees had 4-6 times more depressive and anxiety disorders, and were more impaired. Female gender and PHQ-9 scores were determinants of severe MUPS. Most of the time the OHPs diagnosed employees with severe MUPS as having a mental disorder. The employees attributed their physical symptoms in 66% to mental or to both mental and physical causes., Conclusion: The prevalence of severe MUPS is higher in long-term sick-listed employees than in the non-sick- listed working population and at least equals the prevalence in the general practice population. Severe MUPS are associated with psychiatric morbidity and functional impairment and must therefore be specifically recognised as such. Validated questionnaires, such as the PHQ-15, are useful instruments in order to help OHPs to recognise severe MUPS.

Background: Frequent short sickness absences result in understaffing and interfere with work processes. We need more knowledge about factors associated with this type of absence., Aims: To investigate associations between the frequency of previous sickness absence and self-reported perceptions of health and work., Methods: Cross-sectional study of female hospital care workers in which health, work characteristics and coping styles were assessed by questionnaire and linked to the number of sickness absence episodes recorded in the preceding 5 years using negative binomial regression analysis for counts distinguishing between short (1-7 days) and long (>7 days) episodes of absence after adjusting for age and duration of employment in December 2007 and hours worked between 2003 and 2007., Results: Of 350 women employed for at least 5 years, 237 (68%) answered the questionnaire. The hours worked over the 5 year period [rate ratio (RR) = 1.2] and problem solving coping style score (RR = 1.1) were positively associated with the number of short sickness absence episodes. Age (RR = 0.8) and good general health (RR = 0.7) were inversely related to the number of both short and long episodes. Self-reported mental health and work characteristics were not shown to be related to the frequency of sickness absence., Conclusions: Hours worked, problem-solving coping style, age and general health showed associations with the frequency of previous sickness absence among women who had worked at least 5 years in health care. Future prospective studies on the frequency of sickness absence should consider the impact of these factors further.

Purpose: Most women are diagnosed with breast cancer when they are of working age. How long are breast cancer patients absent? How many of them return to work?, Methods: ArboNed Occupational Health Services documents sickness absence data of 1 million workers of whom 40% were women. Between 2001 and 2005, 2,259 women had 2,361 episodes of sickness absence due to breast cancer. These absence episodes were followed for 2 years using Kaplan-Meier analysis., Results: The mean +/- standard error of mean duration of absence due to breast cancer was 349 +/- 5 days. Thirty-seven percent of absences lasted longer than one year and 12% of absences lasted longer than 2 years particularly in women aged 25-34 years., Conclusions: The mean duration of sickness absence due to breast cancer was nearly a year, but most women returned to work. The results of the study can be used as a reference for return to work of women following breast cancer.

Objectives: The aim of this study was to explore the influence of sick leave frequency determinants on in terms of age and profession homogeneous groups in two socio-economically comparable, but socio-culturally different regions in The Netherlands, i.e., Utrecht (mean frequency 1.10 spells) and South Limburg (mean frequency 1.92 spells). In addition, to get an idea of the study's topical interest, a literature review on sick leave frequency determinants covering the past few decades was performed., Material and Methods: 184 participants in the Utrecht and South Limburg regions were interviewed on work, individual and health characteristics. Sick leave frequency data were obtained from a social fund. For the literature review (inter)national scientific journals, academic theses and Medline were consulted., Results: A comparison of sick leave frequency in the two regions showed that, in South Limburg, the determinants called 'opinion on social-medical support during sick leave', 'type of appointment' and 'annual number of visits (family doctor)' were associated with sick leave frequency whereas this was not the case in Utrecht. The literature review presented a highly consistent picture of determinants of sick leave frequency over the last few decades., Conclusions: In the two regions studied, different determinants appeared to be associated with sick leave frequency. This phenomenon is attributed to the different socio-cultural characters of the regions. As per region different determinants appeared to be associated with sick leave frequency, nationwide interventions to reduce sick leave frequency should take into account the potential influence of regional differences in determinants that predict sick leave frequency. Sick leave frequency determinants have not changed in the past few decades. Although the study was performed in the nineties, its results are still relevant.