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Purpose To design a model based on the three pillars of new institutional theory (NIT), that facilitates cross-country comparison of labor participation (LP) of people with chronic diseases. This model should support getting a comprehensive overview of factors representing country differences, understanding these differences and should support estimating cross-country transferability of policies and interventions in the context of Work Disability Prevention. Methods Based on NIT, a draft model was designed by means of (1) a literature review of empirical studies; (2) theoretical books and articles; (3) a focus group with six expert researchers. This draft model was (4) adapted in the context of academic education. Literature was searched on Web of Science and EBSCO host. Feedback on (use of) the model was received from the focus group, four different academic courses at 28 occasions and two international conferences. Results The cross-country comparison model for labor participation (CCC model for LP) of persons with chronic diseases is proposed consisting of five factors: (1) Legislation; (2) Norms & values in practice; (3) Culture; (4) Organization of WDP in practice; (5) Labor market characteristics. Within these factors and based on (in)direct empirical evidence, subfactors are distinguished. The feedback received led to renaming (sub) factors, improved visual representation and a tool for estimating transferability. Conclusions The CCC model for LP of persons with chronic diseases allows for a comprehensive understanding of country differences and cross-country transferability of policies and interventions. The CCC model can be used for other populations when population-specific subfactors are included.

Rationale & Objective: Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD.Study Design: Qualitative study using semi-structured interviews.Setting & Participants: 27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands.Analytical Approach: Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework.Results: Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators.Limitations: The study sample of Dutch patients may limit the transferability of these findings to other countries.Conclusions: The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.

School absenteeism and its underlying causes can have negative effects on the cognitive, psychosocial and health development of a child. Research in primary education shows high rates of sickness absence. Many stakeholders are involved in addressing school absenteeism, including primary school professionals, child and youth healthcare physicians, school attendance officers and parents. This study explores these stakeholders' perspectives, their approaches and what they envisage to be necessary in order to improve. It also aims to unveil opportunities and challenges in addressing sickness absence among primary school pupils. Qualitative research was performed with six semi-structured focus group interviews and involving 27 participants from the West-Brabant and Amsterdam regions of the Netherlands. Thematic analysis was used. The overarching theme was aiming for the child's wellbeing. Each focus group interview started with low awareness of sickness absence as a threat to this wellbeing, but awareness grew during the interviews. The participating stakeholders regarded problematic sickness absence as complex due to a wide variety of causes, and felt that each other's expertise was necessary to reduce sickness absence. Schools registered absence, but only occasionally used planned steps; they based the identification of problematic sickness on gut feeling rather than any agreed-upon criteria. To be able to systematically address sickness absence and thus improve the wellbeing of children, stakeholders felt the need for a clearly structured approach, including monitoring of sickness absence of all pupils, identifying problematic absence and promoting collaboration with other stakeholders. An approach should allow for tailoring solutions to the individual child.

Background Patients with a chronic disease are more vulnerable in the labor market, and work-related support in clinical care would enhance the timely support greatly needed in each phase of their working life. This paper describes the development of a generic stay-at-work intervention to provide work-related support in clinical care to patients with a chronic disease. Methods Steps 1–4 of Intervention Mapping (IM) were combined with action research principles. A needs assessment (Step 1) involved the project group formation, a literature review, qualitative studies with healthcare professionals (HCPs; n = 9) and patients (n = 10), consultation with financial staff and testing, and resulted in objectives (Step 2). Guided by methods and applications (Step 3), the intervention was developed, tested and finalized (Step 4). Results The needs assessment revealed the importance of behavioral change in HCPs, including changing attitude, self-efficacy, and social influence. For that purpose, a pathway and training sessions were developed. Testing these unveiled the need for practical tools and intervision. The final intervention comprises a care pathway as part of working routines, including screening, risk stratification, and tailored support. Practical tools, training sessions, and intervision for HCPs were developed. Conclusions Combining IM with action research principles resulted in a generic stay-at-work intervention in clinical care via behavioral change in HCPs. A generic care pathway, practical tools, training sessions, and intervision were developed. More specific alignment to specific patient groups is possible. To implement the intervention in another hospital, the local context, (financial) resources, and the national legislation should be considered.

Objective: To explore how managers find out about common mental disorders (CMDs) among employees and associations with managers' work- and knowledge-related characteristics and attitude to CMDs. Methods: Data from an online survey in 2017 with Swedish managers (n = 1810) were used. Different ways managers find out about CMDs were measured, and multivariate logistic regression analysis was conducted for associations with manager characteristics. Results: Few managers found out about CMDs themselves; another source was more common, for example, employees' self-disclosure. Managers' overseeing fewer subordinates and those with a negative attitude to depression were more likely to find out about CMDs themselves. The significance of mental health training and education could not be established. Conclusion: Managers' awareness about employees' CMDs mainly came about through employees' self-disclosure. Managers' attitudes and work conditions were related to the way of finding out.

PURPOSE: Despite our knowledge of how to prevent burnout, we know little about whether burnout can be stopped at an early stage as it is emerging. In a first step to develop this knowledge, we focus on line managers’ perspectives and responses when an employee who seems to be heading for burnout is still at work. METHODS: We interviewed 17 line managers working in the educational and health care/local government sectors, who had been confronted with the sickness absence of at least one employee due to burnout in the past. Interviews were transcribed verbatim, coded in NVivo, and analyzed thematically. RESULTS: During the period that the employee seems to be developing burnout while still at work, line managers experienced three different, successive phases: picking up signals, role-taking, and re-evaluation. Line managers’ personal frame of reference (e.g., having experience with burnout) related to whether and how they picked up signals of burnout. When they picked up the signals, the participating managers generally took an active role: they started a conversation, changed work tasks, and - at a later stage - adapted the employee’s job description without consulting the employee. They felt powerless yet learned from the experience when subsequently re-evaluating the period during which employees developed symptoms of burnout. These re-evaluations resulted in intentions for taking a more active role when other employees start to show symptoms of burnout. CONCLUSION: This study shows that improving line managers’ frame of reference, e.g., by organizing meetings and/or training, may help them to detect early signals of burnout and take action. This is a first step to prevent the further development of early burnout symptoms.

Background: Sustainable employability (SE) is important for work organizations. Recently, the MAastricht Instrument for Sustainable Employability (MAISE-NL) was developed and validated. This study describes the development and validation of an adapted version of the MAISE-NL, the MAISE-Easy, which can be used for employees in low-skilled jobs. Methods: The adaptation of the MAISE-NL was based on six focus groups with employees in low-skilled jobs in various sectors. The MAISE-Easy was distributed among employees in five organizations. The response rate (n = 1033) was 53%. Construct validity, reliability and criterion validity were analyzed by means of principal component analysis (PCA), confirmatory factor analysis (CFA), Cronbach’s alpha and correlational analyses. Results: The MAISE-Easy included 17 scales divided over four main areas: (1) level of SE; (2) factors affecting SE; (3) overall responsibility for SE; (4) responsibility for factors affecting SE. Construct validity, reliability and criterion validity were adequate to good. Conclusions: The MAISE-Easy is a well-validated instrument for measuring SE among employees in low-skilled jobs in terms of the level of SE, factors affecting SE, responsibility for SE and responsibility for factors affecting SE. MAISE-Easy is recommended for both needs assessments and evaluation research in as yet underserved groups of low-skilled workers.

Background Primary healthcare centres (PHCs) form the foundation of the Indian public health system, and thus their effective functioning is paramount in ensuring the population's health. The World Health Organisation (WHO) has set six aspects of performance assessment for general health systems, which are hardly applicable to the PHC setup in a low‐ and middle‐income country. The Primary Health Care Performance Initiative (PHCPI) has prescribed a framework with five domains consisting of 36 indicators for primary healthcare performance assessment from a policy point of view. For the assessment to be realistic, it should include inputs from stakeholders involved in care delivery, so this study examines the perspectives of healthcare providers at PHCs in India. Methodology The authors used qualitative research methodology in the form of responsive evaluations of healthcare provider's interviews to understand the indicators of PHC performance. Results and Conclusion The study results showed that healthcare providers considered efficient teamwork, opportunities for enhancing provider skills and knowledge, job satisfaction, effective PHC administration, and good community relationship as PHC performance assessment. These domains of performance could be considered the ‘missing link’ in PHC assessment, since they are deemed important by providers and did not coincide with the WHO aspects and the PHCPI performance assessment framework.

Samenvatting Inleiding Om de kwetsbaarheid van werknemers met chronische aandoeningen te verkleinen is een stepped care-interventie ontwikkeld, bestaande uit vier onderdelen: een e‑health Werkscan met gepersonaliseerde feedback, met optioneel de keus om gebruik te maken van een informatieve online gids, een helpdesk en een Werkscan-gesprek met een arbeidsdeskundige. Doel van dit onderzoek was om belemmerende factoren voor deelname aan te wijzen en tevredenheid over deze interventie te evalueren. Methoden De data werden verzameld door een Werkscan-gesprek af te nemen, naast aanvullende online vragenlijsten aan de start van het onderzoek en drie maanden erna. De deelnemers voldeden aan de volgende inclusiecriteria: tussen de 18 en 65 jaar oud, werkend (betaald werk en/of vrijwilligerswerk) en behorend tot de doelgroep mensen met chronische nieraandoeningen, sarcoïdose, neurofibromatose, chronische hoofdpijn, hiv en/of taaislijmziekte. Resultaten De deelnemers (n = 84) hebben zeer beperkt gebruikgemaakt van de gids, helpdesk en het gesprek met een arbeidsdeskundige. De deelnemers die dit gesprek wel hadden beoordeelden het met een gemiddeld rapportcijfer van 8,6. Conclusie Om interventies voor kwetsbare werknemers te laten slagen moeten ze gefinancierd worden aangeboden, op maat worden gemaakt (tailored) en gericht (targeted) onder de aandacht worden gebracht.

Objective: Manager characteristics (personal, work-, and competence-related) were investigated as determinants of managerial preventive actions (MPAs) in relation to common mental disorders (CMDs) among employees. Methods: A web survey (n=2921) among Swedish managers measured diverse managerial characteristics and two types of MPAs: reviewing assignments and work situation (MPA-review); talking about CMDs at the work place (MPA-talk). Results: MPA-review was reported by 50% and MPA-talk by 57% of managers. Characteristics that related to more MPAs were female gender, workplace offering lectures on CMDs, workplace offering stress counseling, being responsible for the work environment, management training on CMDs, and more than 10 years of managerial experience (MPA-talk only). Conclusion: Managers who are female, have had training on CMDs, and work for organizations paying attention to CMD prevention initiate MPAs more often.

The Covid-19 pandemic has revealed the importance of social protection systems, including income security, when health problems arise. The aims of this study are to compare the follow-up regimes for sick-listed employees across nine European countries, and to conduct a qualitative assessment of the differences with respect to burden and responsibility sharing between the social protection system, employers and employees. The tendency highlighted is that countries with shorter employer periods of sick-pay typically have stricter follow-up responsibility for employers because, in practice, they become gatekeepers of the public sickness benefit scheme. In Germany and the UK, employers have few requirements for follow-up compared with the Nordic countries because they bear most of the costs of sickness absence themselves. The same applies in Iceland, where employers carry most of the costs and have no obligation to follow up sick-listed employees. The situation in the Netherlands is paradoxical: employers have strict obligations in the follow-up regime even though they cover all the costs of the sick-leave themselves. During the pandemic, the majority of countries have adjusted their sick-pay system and increased coverage to reduce the risk of spreading Covid-19 because employees are going to work sick or when they should self-quarantine, except for the Netherlands and Belgium, which considered that the current schemes were already sufficient to reduce that risk.

Background Absence from school can lead to lower educational achievement and poor health. Little is known about school absence in primary education. This study’s first aim was to examine the prevalence of school absence in primary schools and differing types of absence, including sickness absence. The second aim was to determine which pupil characteristics and types of absence were associated with extensive sickness absence. Methods The school absence registries for the school year 2015–2016 were analysed retrospectively in eight mainstream primary schools with 2216 pupils, and six schools for special primary education with 1000 pupils in the West-Brabant region of the Netherlands. Descriptive analyses, χ2-tests, Mann-Whitney U tests and logistic regression analyses were performed. Results The one-year prevalence of school absence was 85% in mainstream primary schools and 79% in special schools. Sickness absence was the most prevalent type of absence, occurring in 75 and 71% of pupils, respectively The prevalence of extensive sickness absence was 13 and 23%, respectively. In mainstream schools, extensive sickness absence was associated with a young age, low parental educational level, more doctor’s visits and unauthorised absence, and in special schools with more doctor’s visits, other authorised absence, tardiness and unauthorised absence. Conclusions The prevalence of extensive sickness absence was high, and as this was associated with other types of absence, these pupils missed even more days of school. Public health research, policy and practice should address sickness absence among primary school pupils, to prevent adverse effects on children’s development.

Background Depression is prevalent among employees and a major reason for sickness absence. First-line managers’ attitudes towards employees with depression might influence return to work and the scant literature indicates gender differences in attitudes. The objective of this study was to investigate gender differences in managers’ attitudes to employees with depression. Methods A cross-sectional study was conducted among 4737 Swedish managers in 2017 (response rate 71%, n = 3358). Attitudes towards depression were measured with the instrument “Managerial stigma towards employees with depression” (12 items). The response patterns of women and men, the level of stigma and the direction of the gender differences were investigated with independent t tests and binary logistic regression analyses with covariates. Results The likelihood of reporting high negative attitudes (score ≥ 36) was lower among women than men (odds ratio, 1.64; 95% confidence interval, 1.28–2.10) after adjusting for age, level of education, work sector, distribution of women and men among the staff, current workplace experience in management, lifetime experience in management, managerial position and presence of staff members at the current workplace who had depression and/or anxiety disorders. Conclusions Based on these findings, a gender-sensitive approach is suggested for future interventions to improve managers’ attitudes towards employees with depression and other mental disorders.

Background Societal expenditures on work-disability benefits is high in most Western countries. As a precursor of long-term work restrictions, long-term sickness absence (LTSA) is under continuous attention of policy makers. Different healthcare professionals can play a role in identification of persons at risk of LTSA but are not well trained. A risk prediction model can support risk stratification to initiate preventative interventions. Unfortunately, current models lack generalizability or do not include a comprehensive set of potential predictors for LTSA. This study is set out to develop and validate a multivariable risk prediction model for LTSA in the coming year in a working population aged 45–64 years. Methods Data from 11,221 working persons included in the prospective Study on Transitions in Employment, Ability and Motivation (STREAM) conducted in the Netherlands were used to develop a multivariable risk prediction model for LTSA lasting ≥28 accumulated working days in the coming year. Missing data were imputed using multiple imputation. A full statistical model including 27 pre-selected predictors was reduced to a practical model using backward stepwise elimination in a logistic regression analysis across all imputed datasets. Predictive performance of the final model was evaluated using the Area Under the Curve (AUC), calibration plots and the Hosmer-Lemeshow (H&L) test. External validation was performed in a second cohort of 5604 newly recruited working persons. Results Eleven variables in the final model predicted LTSA: older age, female gender, lower level of education, poor self-rated physical health, low weekly physical activity, high self-rated physical job load, knowledge and skills not matching the job, high number of major life events in the previous year, poor self-rated work ability, high number of sickness absence days in the previous year and being self-employed. The model showed good discrimination (AUC 0.76 (interquartile range 0.75–0.76)) and good calibration in the external validation cohort (H&L test: p = 0.41). Conclusions This multivariable risk prediction model distinguishes well between older workers with high- and low-risk for LTSA in the coming year. Being easy to administer, it can support healthcare professionals in determining which persons should be targeted for tailored preventative interventions.

Background: Sustainable employability (SE) is top priority for employers. Measures based on the employee perspective of SE that would give direction to interventions to be initiated by employers currently fall short. This study aims to develop and validate an instrument that captures these issues: the MAastricht Instrument for Sustainable Employability (MAISE). Methods: MAISE items were generated from an extensive literature review and interviews with employers and employees. A questionnaire containing these items as well as proxy variables (health and vitality) and demographics was answered online by 632 employees (response rate 50.3%). Construct validity, reliability, and criterion validity were tested through Principal Component Analysis (PCA), Confirmatory Factor Analysis (CFA), Cronbach&rsquo, s alpha, and correlational analyses. Results: The MAISE comprises 12 scales divided over five areas: (1) Meaning of SE, (2) Level of SE, (3) Factors affecting my SE, (4) Overall responsibility for SE, and (5) Responsibility for factors affecting my SE. Reliability, construct, and criterion validity were adequate to good. SE of the employees was relatively high, and SE was considered a shared responsibility of the employee and employer. Conclusions: This study showed the MAISE to be reliable and valid in various employee groups. More validation studies are needed. We recommend that employers use the MAISE as a needs assessment in order to develop SE interventions that will be readily accepted.

Objectives: To elucidate the role and pathways of psychosocial home demands, psychosocial home resources, and psychosocial job resources in relation to sickness absence among nurses working in residential elder care. Methods: Longitudinal (SEM) analyses with bootstrapping with a 1 year follow-up among 365 nurses were performed. Survey data and registered sickness absence data were used. Results: A complete mediation model showed the best fit. More psychosocial job resources (b = -1.50) like "work schedule fit with private life" predicted less and more psychosocial home demands (b = 0.62) predicted more psychosomatic health complaints. The job resources and home demands predicted sickness absence duration and episodes 1-year later mediated through nurses' health. Conclusions: More attention is needed for nurses' work schedule fit with private life and their home demands to potentially reduce health-related sickness absence among nurses working in residential elder care.

SamenvattingIn deze verkorte versie van de inaugurele rede uitgesproken bij de aanvaarding van het ambt van hoogleraar ‘Arbeid en Gezondheid, in het bijzonder arbeidsre-integratie’ aan de Faculty of Health, Medicine and Life Sciences van de Universiteit Maastricht wordt beargumenteerd waarom aandacht voor de menselijke maat arbeidsre-integratie beter maakt. In Nederland zijn jaarlijks 2 miljoen mensen bezig om te re-integreren naar arbeid. Het is van belang dat werk aan de mens aangepast wordt in plaats van andersom, iets wat al sinds de industriële revolutie wordt betoogd. Wat we kunnen concluderen op basis van onderzoek is: (1) goede arbeidsomstandigheden zijn een belangrijke voorwaarde voor arbeidsre-integratie, zeker bij mensen met chronische aandoeningen; (2) arbeidsre-integratie wordt door veel verschillende factoren bepaald, dus een reintegratietraject moet maatwerk zijn. In dit artikel wordt een handreiking gedaan in de vorm van zestien aandachtspunten, waarvan twaalf betrekking hebben op de voorbereiding van de daadwerkelijke terugkeer naar werk. Ten slotte worden vier aandachtsgebieden voor toekomstig onderzoek en onderwijs toegelicht: (1) Nederlands beleid en internationale vergelijking; (2) de overbrugging tussen ziekenhuiszorg en werkplek; (3) het perspectief van werkgevers;en 4) preventief organisatiebeleid. Nederlands re-integratiebeleid is effectief, maar in feite slechts van toepassing op een kleine helft van de huidige beroepsbevolking.

Purpose This study explored employer’s perspectives on (1) their experience of good practice related to workers diagnosed with cancer and their return to work (RTW), and (2) their perceived needs necessary to achieve good practice as reported by employers from nine separate countries. Methods Twenty-five semi-structured interviews were held in eight European countries and Israel with two to three employers typically including HR managers or line managers from both profit and non-profit organisations of different sizes and sectors. Interviews were recorded and transcribed verbatim. A grounded theory/thematic analysis approach was completed. Results Employers’ experience with RTW assistance for workers with cancer appears to be a dynamic process. Results indicate that good practice includes six phases: (1) reacting to disclosure, (2) collecting information, (3) decision-making related to initial actions, (4) remaining in touch, (5) decision-making on RTW, and (6) follow-up. The exact details of the process are shaped by country, employer type, and worker characteristics; however, there was consistency related to the need for (1) structured procedures, (2) collaboration, (3) communication skills training, (4) information on cancer, and (5) financial resources for realizing RTW support measures. Conclusions Notwithstanding variations at country, employer, and worker levels, the employers from all nine countries reported that good practice regarding RTW assistance in workers with a history of cancer consists of the six phases above. Employers indicate that they would benefit from shared collaboration and resources that support good practice for this human resource matter. Implications for cancer survivors Further research and development based on the six phases of employer support as a framework for a tool or strategy to support workers with a history of cancer across countries and organisations is warranted.

Objective To assess the exchangeability of self-reported and administrative health care resource use measurements for cost estimation. Study Design and Setting In a systematic review (NHS EED and MEDLINE), reviewers evaluate, in duplicate, the methodological reporting quality of studies comparing the validation evidence of instruments measuring health care resource use. The appraisal tool Methodological Reporting Quality (MeRQ) is developed by merging aspects form the Guidelines for Reporting Reliability and Agreement Studies and the Standards for Reporting Diagnostic Accuracy. Results Out of 173 studies, 35 full-text articles are assessed for eligibility. Sixteen articles are included in this study. In seven articles, more than 75% of the reporting criteria assessed by MERQ are considered “good.” Most studies score at least “fair” on most of the reporting quality criteria. In the end, six studies score “good” on the minimal criteria for reporting. Varying levels of agreement among the different data sources are found, with correlations ranging from 0.14 up to 0.93 and with occurrences of both random and systematic errors. Conclusion The validation evidence of the small number of studies with adequate MeRQ cautiously supports the exchangeability of both the self-reported and administrative resource use measurement methods.

This chapter addresses two laws that are the most striking part of the extensive Dutch work disability policy. Since 2004, Dutch employers have been required to formulate an action plan within eight weeks of a worker reporting sick, and they must pay at least 70% of the absent worker’s income for up to two years. Although these laws are effective, they are internationally completely out of range. Using sources that have remained largely inaccessible internationally, this chapter provides the historical backgrounds of the two laws. Their effects are explained, and the extent to which these laws are transferable to other countries and sustainable is discussed.

PURPOSE: There is scarce research on age and sustainable employability of nurses working in various types of work schedules. Earlier research showed that nurses working in work schedules differ regarding age. Different operationalisations of age might explain variations in sustainable employability. Therefore, the aim of this study was to investigate how nurses working in various types of work schedule differ regarding sustainable employability, and the role that age plays in these differences. Age was defined as chronological age, organisational age, life-span age, and functional age. METHOD: Questionnaires were distributed to 974 Dutch nurses in residential elder care (response rate 51 %) with questions about the type of work schedule, aspects of sustainable employability, various operationalisations of age, and registered sickness absence data were used. RESULTS: Nurses working in various types of work schedules differed regarding aspects of sustainable employability, also when operationalisations of age were added. The 'life-span age' was directly related to aspects of sustainable employability. Statistically, work ability and job satisfaction were only explained by varying operationalisations of age. CONCLUSIONS: Nurses' sustainable employability appeared to be mainly related to differences between the types of work schedule rather than age. Fixed early shifts are characterised by the most positive aspects of sustainable employability, and three rotating schedules score worst. To improve sustainable employability, organisations should implement a system in which nurses with different types of work schedule are monitored in combination with their life-span perspective.

Objective: The purpose of this study is to assess the cost-effectiveness, -utility, and -benefit of a new organizational return-to-work intervention to improve COoperation between Sick-listed employees and their Supervisors (COSS). Methods: A field study with 6 months follow-up comparing COSS with common practice randomized participants aged 18 to 60, working at least 12 hours/week and absent for at least 2 weeks. Outcomes were initial return-to-work, quality-adjusted life years, and productivity gains. Results: After 6 months, COSS generated less costs when compared with common practice. Participants in the COSS group returned to work earlier, improvement in quality-adjusted life years were uncertain. Net benefits of COSS versus common practice yielded a productivity gain of (sic)395.89. Conclusions: Implementing COSS for sick-listed employees has potentials to reduce costs and improve productivity, and potentially quality of life. Longitudinal research might detect whether COSS also has the potential reaching sustainable return-to-work.

Background: Despite growing interest in sustainable employability (SE), studies on the effectiveness of interventions aimed at employees’ SE are scarce. In this review, SE is defined by four core components: health, productivity, valuable work, and long-term perspective. The aim of this review is to summarize the effectiveness of employer-initiated SE interventions and to analyze whether their content and outcome measures addressed these SE components. Methods: A systematic search was performed in six databases for the period January 1997 to June 2018. The methodological quality of each included study was assessed. A customized form was used to extract data and categorize interventions according to SE components. Results: The initial search identified 596 articles and 7 studies were included. Methodological quality ranged from moderate to weak. All interventions addressed the components ‘health’ and ‘valuable work’. Positive effects were found for ‘valuable work’ outcomes. Conclusions: The quality of evidence was moderate to weak. The ‘valuable work’ component appeared essential for the effectiveness of SE interventions. Higher-quality evaluation studies are needed, as are interventions that effectively integrate all SE core components in their content.

BACKGOUND: In Canada and other countries, sickness absence among workers is a significant concern. Local return-to-work policies developed by both management and workers' representatives are preferred to tackle the problem. OBJECTIVE: This article examines how managers perceive this local bipartite agreed upon return-to-work policy, wherein a social constructivist view on the policy process is taken. METHODS: In-depth interviews were held with 10 managers on their experiences with execution of this policy in a Canadian healthcare organization. Interviews were transcribed verbatim and qualitative analyses were completed to gain deep insight into the managers' perspectives. RESULTS: Results show that the managers viewed themselves as a linchpin between the workplace and the worker. They did not feel heard by the other stakeholders, wrestled with worker's limitations, struggled getting plans adjusted and became overextended to meet return-to-work objectives. CONCLUSIONS: The study shows that the managers felt unable to meet the responsibilities the policy demanded and got less involved in the return-to-work process than this policy intended. RTW policy needs to balance on the one hand, flexibility to safeguard active involvement of managers and, on the other hand, strictness regarding taking responsibility by stakeholders, particularly the health care and re-integration professionals.

Increasing numbers of organisations offer flexible working hours to help employees balance work and personal life. However, studies about the effects of flexible working hours on work-life balance and organisational outcomes are ambiguous. The aim of this study is to gain greater insights into how employees experience the influence of flexible working hours on their work-life balance. A qualitative research was performed by in-depth interviews with a variant sample of 15 employees and thematic analysis of the data. The more family responsibilities the respondents have, the more they tend to perceive flexible working hours as a necessity rather than an extra benefit. According to the interviewees, the system creates a situation which is advantageous for both employer and employee. The extent to which this is achieved though depends on how organisations apply and implement it. It is concluded that when flexible working hours are supported by management and fit the work culture, they are highly appreciated both for private and work-related reasons. Moreover, its meaning for the private life varies according to life stage. Findings are important for policy makers and human resources managers alike in order to implement and deal with flexible working hours effectively. Consequently, this will help employees strike a proper balance between work and personal life generating beneficial organisational outcomes.

Purpose: In this manuscript, we evaluated the effectiveness of an intervention programme consisting of integrated care and a participatory workplace intervention on supervisor support, work instability and at-work productivity after 6 months of follow-up among workers with rheumatoid arthritis (RA). Methods: We conducted a randomized controlled trial; we compared the intervention programme to usual care. Eligible patients were diagnosed with RA, had a paid job (>?8?h per week) and who experienced, at least, minor difficulties in work functioning. Supervisor support was measured with a subscale of the Job Content Questionnaire, work instability with the Work Instability Scale for RA, and at-work productivity with the Work Limitations Questionnaire. Data were analyzed using linear regression analyses. Results: A beneficial effect of the intervention programme was found on supervisor support among 150 patients. Analyses revealed no effects on work instability and at-work productivity. Conclusion: We found a small positive effect of the intervention on supervisor support, but did not find any effects on work instability and at-work productivity loss. Future research should establish whether this significant but small increase in supervisor support leads to improved work functioning in the long run. This study shows clinicians that patients with RA are in need of efforts to support them in their work functioning. •Implications for Rehabilitation. •Rheumatoid arthritis (RA) is a chronic inflammatory disease with a severe impact on work functioning, even when a patient is still working. •It is important to involve the workplace when an intervention is put in place to support RA patients in their work participation. •Supervisor support influences health outcomes of workers, and it is possible to improve supervisor support by an intervention which involves the workplace and supervisor.

With the increased attention on labour market participation, the field of work reintegration support has grown dramatically. In order to improve professionals' performance, standards and performance measures are introduced in this field. We question whether this will improve the quality of their work. Closer scrutiny needs to be paid to the inherently normative and structuring role of professional judging. We applied the concept of ‘frames of reference’ to the process of professional judgement in work reintegration. This concept helped us to understand how a work reintegration professional structures a client's story through implicit rules that escape formalization and control mechanisms. On the basis of 24 in-depth interviews with diverse work reintegration professionals in the Netherlands, we distinguish five of these frames: a procedural, a work-focused, a caring, a learning and a facilitating frame of reference. Furthermore, we show that professionals differ widely in the images they have of clients, leading to a large variety in judgement of, and interaction with, clients. Though differences between professionals are inherent to a complex and dynamic field as work reintegration, the current variety in professional-client contact in work reintegration seems to depend too much on arbitrary professional preferences. Therefore, reflection on these differences, both among professionals and by policymakers, is needed in order to improve the professional practice of work reintegration service.

Introductieomvangrijk schoolverzuim kan leiden tot uitstroom naar een lager onderwijsniveau of voortijdig schoolverlaten. Beiden hangen sterk samen met gezondheidsproblemen en hogere sterftecijfers. In het huidige onderzoek werd nagegaan hoe studieloopbaanbegeleiders (slb’ers) de begeleiding bij ziekteverzuim van mbo’ers inhoud en vorm geven en waarom ze dat zo doen.methodekwalitatief onderzoek met semigestructureerde interviews, afgenomen bij elf slb’ers werkzaam op drie mbo-scholen in west-brabant.resultatenvolgens slb’ers zijn er drie vormen van ziekteverzuim: verzuim vanwege ziekte, vanwege psychosociale problemen en vanwege ‘niet naar school willen komen’. In de verzuimbegeleiding hanteren slb’ers drie soorten rollen: een controlerende, een structurerende en een empathische rol. Omdat er volgens de slb’ers vaak sprake is van ziekteverzuim vanwege ‘niet naar school willen komen’, wat ze niet legitiem verzuim vinden, hanteren ze vooral een controlerende rol, terwijl ze met deze rol weinig affiniteit hebben. De slb’ers benoemen de randvoorwaarden die volgens hen nodig zijn om de rollen bij ziekteverzuimbegeleiding goed in te kunnen vullen. Deze randvoorwaarden zijn niet specifiek voor bepaalde rollen.conclusieshoewel slb’ers in hun visie op ziekteverzuim onderscheid maken in drie vormen van ziekteverzuim, blijken ze in hun werkwijze vooral onderscheid te maken tussen legitiem en niet legitiem verzuim. Door deze focus op legitimiteit hanteren ze vooral een controlerende rol. Ze voelen zich echter niet prettig bij deze rol en nemen liever een structurerende of een empathische rol op zich. Hierdoor ervaren slb’ers ziekteverzuimbegeleiding als een ambigue taak.

BACKGROUND: The diagnosis of breast cancer increasingly implies a return-to-work (RTW) challenge as survival rates increase. RTW is regarded as a multidisciplinary process and a country's legislation affects the degree of involvement of the different stakeholders. We elucidated on bottlenecks and contributing factors and the relationship between policy and practice regarding RTW of employees with breast cancer as perceived by Belgian (Flemish) stakeholders. METHODS: Three multidisciplinary groups (n = 7, n = 9, n = 10) were interviewed during a breast cancer conference. Treating physicians (n = 4), employers (n = 6), social security physicians (n = 3), occupational physicians (n = 4), survivors (n = 5) and representatives of patient associations (n = 4) were included. The major theme was the legal and practical role in the RTW process as experienced by the participants. Qualitative thematic analysis was performed to analyse stakeholders' experiences of women's RTW after breast cancer. RESULTS: The stakeholders reported different perspectives. Employees focus on treatment and feel ill-informed about the RTW options. Treating physicians do not feel competent about advising on work-related questions. Employers have to balance the interests of both the business and the employee. Social security physicians assess ability to work and facilitate RTW options. Occupational physicians see opportunities but the legislation does not support their involvement. Stakeholders expressed the need for coordination and reported finding ways to accommodate the employee's needs by being flexible with the legislation to support the RTW process. CONCLUSIONS: Two factors might hamper RTW for breast cancer patients: the varying stakeholder perspectives and Belgian legislation which emphasizes the patient or disability role, but not the employee role. When stakeholders are motivated they find ways to support RTW, but improved legislation could support the necessary coordination of RTW for these patients. ispartof: Journal of Occupational Rehabilitation vol:22 issue:2 pages:241-251 ispartof: location:Netherlands status: published

Introduction Workplace disability prevention is important, but stakeholders can differ in their appreciation of such interventions. We present a responsive evaluation of a workplace disability prevention intervention in a Canadian healthcare organization. Three groups of stakeholders were included: designers of the intervention, deliverers, and workers. The aim was to examine the appreciation of this intervention by analyzing the discrepancies with respect to what these various stakeholders see as the causes of work disability, what the intervention should aim at to address this problem, and to what extent the intervention works in practice. Methods A qualitative research method was used, including data-triangulation: (a) documentary materials; (b) semi-structured interviews with the deliverers and workers (n = 14); (c) participatory observations of group meetings (n = 6); (d) member-checking meetings (n = 3); (e) focus-group meetings (n = 2). A grounded theory approach, including some ethnographic methodology, was used for the data-analysis. Results Stakeholders' perceptions of causes for work disability differ, as do preferred strategies for prevention. Designers proposed work-directed measures to change the workplace and work organizations, and individual-directed measures to change workers' behaviour. Deliverers targeted individual-directed measures, however, workers were mostly seeking work-directed measures. To assess how the intervention was working, designers sought a wide range of outcome measures. Deliverers focused on measurable outcomes targeted at reducing work time-loss. Workers perceived that this intervention offered short-term benefits yet fell short in ensuring sustainable return-to-work. Conclusion This study provides understanding of where discrepancies between stakeholders' perceptions about interventions come from. Our findings have implications for workplace disability prevention intervention development, implementation and evaluation criteria.

Objective: To explore how female breast cancer patients experience work incapacity during the treatment and return-to-work phases and how interactions between patients and stakeholders affect this experience. Method: Database search for full text articles published between January 1995 and January 2008 that focused on employed female breast cancer patients, factors related to work incapacity, and returning to work. Only results based on self-report data were included. Studies focusing on treatment, financial factors, rate of return, or absence were excluded. Results: Six articles met the inclusion criteria. Women with breast cancer receive varied reactions but little advice about returning to work. Women were primarily concerned with disclosing the diagnosis to their employer and to relatives. Uncertainties about physical appearance, ability to work, and possible job loss affected the women's decisions about working during the treatment phase. After treatment, most women wanted to regain their ‘normal life’, but concentration and arm or fatigue problems potentially interfered. Although supportive work environments were helpful, the individual needs of women differed. Employers and employees need to find a balance in defining accommodating work. Many women received favourable support, but some reported feeling discriminated against. Many women re-evaluated the role of work in their lives after being confronted with breast cancer. Conclusion: Work adjustments could help women to keep their jobs during illness and recovery. To resolve women's concerns about returning to work, employers, physicians, and insurance institutions should consider increasing and improving communication with breast cancer patients and playing a more active and supportive role. Copyright © 2009 John Wiley & Sons, Ltd.

A rapid, high-throughput antimicrobial screening assay for the detection of fluoroquinolone and 4-quinolone residues in foods of animal origin has been developed in ampoule format. The assay employs a single Escherichia coli species sensitive to those Gram-negative inhibitiory antimicrobial compounds and is presented in a comparable format to the existing commercially available Premi ® Test and Delvotest ® ampoule-based microbial inhibition tests (DSM, Delft, The Netherlands). In the novel E. coli assay the microorganism, in vegetative state, is inoculated into a nutrient agar pellet containing a pH sensitive acid–base indicator dye. A simple extraction protocol that is selective for fluoroquinolone and quinolone compounds was developed to recover, cleanup and concentrate the target analyte(s) from a variety of tissue types and matrices prior to screening analysis. The method detected 16 target compounds at concentrations equal to or below the maximum residue limits (where applicable). The method has been validated using the prototype assay in accordance with the 2002/657/EC guidelines for the validation of qualitative screening assays. False positive and false negative responses rates for the procedure have been determined as less than 5%. The stability of a selection of representative target analytes has been demonstrated for a 20-week period under a variety of storage conditions both in tissue and in extract.

Title. Nurses' satisfaction with shiftwork and associations with work, home and health characteristics: a survey in the Netherlands. Aim. This paper is a report of a study conducted to determine if satisfaction with irregular working hours that are a form of shiftwork operates as a mediator between work and home characteristics and health problems. Background. Shiftwork contributes to health problems, decreased well-being and poorer health habits. It also affects employees’ decisions to leave the healthcare sector. Although many nurses voluntarily work shifts, there have been few studies of their satisfaction with irregular working hours when these are a form of shiftwork. Methods. A survey was carried out with 144 nurses working in three nursing homes and one care home in the Netherlands. Questionnaires were distributed in 2003 to 233 nurses who worked shifts (response rate 60%). The questionnaire contained items on work and home characteristics, satisfaction with irregular working hours that are a form of shiftwork and health. A new scale to measure satisfaction with irregular working hours was constructed. Results. All work characteristics, but no home characteristics, were associated with satisfaction with irregular working hours. The work characteristics ‘job demands’ and the home characteristics ‘autonomy at home’ and ‘home demands’ were associated with health. Satisfaction with irregular working hours did not mediate between work/home characteristics and health. Those reporting more social support, lower job demands and more job autonomy were more satisfied with their irregular working times that were a form of shiftwork. Conclusions. Satisfaction with irregular working hours is a useful construct that requires further longitudinal study. The results also underline the importance of considering home characteristics when predicting health outcomes.

This article describes (i) gender differences in initial return to work (RTW) and lasting return to work (LRTW); (ii) health characteristics that predicted the observed gender differences in LRTW; and (iii) associations between health characteristics and (L)RTW in men and women separately. A 13-month prospective cohort study was performed with 119 employees (54 women and 65 men) who had reported sick for more than 1 month because of mental or musculoskeletal complaints. These employees were interviewed bimonthly about their work status and health. The health characteristics included were self-rated health, the reason for reporting sick, the presence of at least one long-term disease, early improvement in health and a change in diagnosis. Cox regression analyses on the time to (L)RTW were performed. No gender differences were found regarding RTW. Women, however, did report a longer time to LRTW than men. This was predicted by their reason for reporting sick, the presence of at least one long-term disease, lack of early improvement in health and change in diagnosis. Women who experienced no early improvement and/or whose diagnosis changed during their sickness absence had lower chances of attaining a LRTW than other women. Men who were absent owing to mental complaints were less likely to RTW than men with musculoskeletal complaints. Men who had at least one long-term disease were also less likely to RTW than men who had no long-term diseases. The findings showed a delayed LRTW for women when compared with men, as predicted by health characteristics. The health characteristics, however, that predicted LRTW in women differed from those that predicted LRTW in men. Clearly, the findings support a gender-specific approach to sickness absence guidance. The results also suggest that women are misdiagnosed more often than men. This requires further investigation.

Purpose The purpose of this study is to improve web-based employability interventions for employees with work-related health problems for both intervention content and study design by means of a pilot economic evaluation. Methods Uptake rate analysis for the intervention elements, cost effectiveness, cost utility and subgroup analyses were conducted to identify potential content-related intervention improvements. Differences in work ability and quality-adjusted life years and overall contribution of resource items to the total costs were assessed. These were used to guide study design improvements. Results Sixty-three participants were a-select allocated to either the intervention (n = 29) or the control (n = 34) group. Uptake regarding the intervention elements ranged between 3% and 70%. Cost-effectiveness and cost-utility analyses resulted in negative effects although higher total costs. Incremental effects were marginal (work ability -0.51; QALY -0.01). Conclusions The web-based tool to enhance employability among work disabled employees requires improvements regarding targeting and intensity; outcome measures selected and collection of cost data. With respect to the studies of disability and rehabilitation, the findings and methods presented in this pilot economic evaluation could guide the assessment of future assistive "e-health" technologies. IMPLICATIONS FOR REHABILITATION The methods presented in this pilot economic evaluation have large potentials to guide the assessment of future assistive e-health technologies addressing work-disabilities. The findings show that the web-based tool requires content related improvements with respect to targeting and intensity to enhance employability among work disabled employees. The findings show that the web-based tool would benefit from improvements related to the study design by more adequately selecting and collecting both outcome measures and cost data. The burden attributable to large-scale studies and implementation issues were prevented as the outcomes of the pilot economic evaluation did not support the implementation of the web-based tool.

BACKGROUND: In Canada and other countries, sickness-based absences among workers is an economic and sociological problem. Return-to-work (RTW) policy developed by both employer and worker' representatives (that is, bipartite policy) is preferred to tackle this problem. OBJECTIVE: The intent was to examine how this bipartite agreed-upon RTW policy works from the perspective of occupational health professionals (those who deliver RTW services to workers with temporary or permanent disabilities) in a public healthcare organization in Canada. METHODS: In-depth interviews were held with 9 occupational health professionals and transcribed verbatim. A qualitative, social constructivist, analysis was completed. RESULTS: The occupational health professionals experienced four main problems: 1) timing and content of physicians' medical advice cannot be trusted as a basis for RTW plans; 2) legal status of the plans and thus needing workers' consent and managers' approval can create tension, conflict and delays; 3) limited input and thus little fruitful inference in transdisciplinary meetings at the workplace; and yet 4) the professionals can be called to account for plans. CONCLUSIONS: Bipartite representation in developing RTW policy does not entirely delete bottlenecks in executing the policy. Occupational health professionals should be offered more influence and their professionalism needs to be enhanced.