Hearing loss is highly prevalent and the third largest cause of years lived with disability. The most frequent cause of adult-onset hearing loss is older age. As the retirement age increases in many countries, a growing number of workers will experience hearing loss, which may affect work participation. Limited research has been done on the consequences of hearing loss in workers in communicative professions. The present study examines the associations of hearing loss with work ability and sick leave among teachers. Dutch teachers were recruited via schools, educational sector organizations, and trade unions. Teachers completed a survey questionnaire and performed a valid and reliable online speech-in-noise screening test for hearing loss. The survey measured work ability with the single-item Work Ability Score (range 0–10); scores were dichotomised into poor-moderate (score 0–7) and good-excellent (score 8–10) work ability. Teachers were asked if they had been on sick leave in the past three months (no / yes; if yes: how many days). Robust Poisson regression analyses were performed to examine the cross-sectional associations of hearing loss with both work ability (poor to moderate versus good to excellent) and sick leave (yes versus no), adjusted for age, sex, level of education, type of work tasks (only teaching versus a mixture with other (e.g. management) tasks, current work hours per week, and working as a physical education teacher. A total of 737 teachers participated in the study, of whom 86 (12

Purpose Sickness absence is a major public health problem, given its high cost and negative impact on employee well-being. Understanding sickness absence duration and recovery rates among different groups is useful to develop effective strategies for enhancing recovery and reducing costs related to sickness absence. Methods Our study analyzed data from a large occupational health service, including over 5 million sick-listed employees from 2010 to 2020, out of which almost 600,000 cases were diagnosed by an occupational health physician. We classified each case according to diagnosis and gender, and performed descriptive statistical analysis for each category. In addition, we used survival analysis to determine recovery rates for each group. Results Mean sickness duration and recovery rate both differ significantly among groups. Mental and musculoskeletal disorders had the longest absence duration. Recovery rates differed especially during the first months of sickness absence. For men the recovery rate was nearly constant during the first 1.5 year, for women the recovery rate was relatively low in the first three months, and then stayed nearly constant for 1.5 year. Conclusion Across almost all diagnostic classes, it was consistently observed that women had longer average sickness absence durations than to men. Considering mental disorders and diseases of the musculoskeletal system, women had relatively lower recovery rates during the initial months compared to men. As time progressed, the recovery rates of both genders converged and became more similar.

BACKGROUND:To date, hand eczema (HE)-related presenteeism has never been assessed within the general population, and general population-based studies on HE-related sickness absence are limited.OBJECTIVES:To assess the prevalence of HE-related presenteeism and sickness absence, and factors associated with HE-related presenteeism, within the Dutch general population.METHODS:Within the Lifelines Cohort Study, participants with HE in the last year (aged 18-65 in 2020), were identified by a questionnaire including questions regarding HE-related presenteeism and sickness absence. Socio-demographic factors were collected from 2006 to 2020.RESULTS:Out of the 3.703 included participants with HE, 2.7% (n = 100) reported HE-related presenteeism, with 19.8% (n = 57) among those with severe-to-very-severe HE. HE-related sickness absence was reported by 0.5% (n = 20) and 5.9% (n = 17), respectively. Logistic regression analyses, adjusted for age and sex, showed negative associations between HE-related presenteeism and higher educational attainment, higher income (>€2500) and higher occupational skill level, and positive associations for high-risk occupations, chronic HE, moderate and severe-to-very-severe HE (compared to almost clear), atopic dermatitis and occupational wet exposure.CONCLUSIONS:A high prevalence of HE-related presenteeism was found among participants with severe-to-very-severe HE. Future studies should focus on longitudinal associations with the clinical course of HE, as HE-related presenteeism might aggravate symptoms of HE.

OBJECTIVES: Return to work (RTW) of workers with mental disorders is often a process of gradually increasing work hours over time, resulting in a RTW trajectory. This study aimed to investigate 2-year RTW trajectories by mental disorder diagnosis, examining the distribution of age, sex and contracted work hours across the diagnosis-specific RTW trajectories. METHODS: Sickness absence episodes diagnosed within the ICD-10 chapter V (mental and behavioral disorders) and ICD-10 Z73.0 (burnout) were retrieved from a Dutch occupational health service register, together with age, sex and contracted work hours. Sickness absence episodes due to adjustment disorders (N=25 075), anxiety disorders (N=1335), burnout (N=3644), mood disorders (N=5076), and post-traumatic stress disorders (N=2393) were most prevalent and included in latent class growth analysis (LCGA) to estimate 23-month RTW trajectories. RESULTS: Four main RTW trajectories were identified for all mental disorder diagnoses: fast full RTW [range 82.4% (mood disorders) to 92.0% (adjustment disorders) of the study population], slow full RTW [3.5% (burnout) to 6.1% (mood disorders)], slow partial RTW [0.6% (adjustment disorders) to 1.6% (mood disorders)] and no RTW [2.2% (adjustment disorders) to 9.7% (mood disorders)]. Trajectories with a late onset of fast full RTW included higher percentages of women and lower percentages of full-time workers. CONCLUSIONS: RTW trajectories were similar for different mental disorder diagnoses although the distribution differed across diagnoses, with more partial and no RTW trajectories among workers with mood disorders. To better guide workers back to work, more knowledge is needed of factors associated with late, partial, or no RTW.

Purpose Although there is increasing awareness that significant others' perceptions and behavior can affect health outcomes, the role of interpersonal processes between sick-listed workers and significant others in sick leave and return to work (RTW) has hardly been studied. This study aims to examine the associations between illness perceptions, RTW expectations, and behaviors of significant others (engagement, buffering and overprotection) with sick leave duration within dyads of sick-listed workers with chronic diseases and their significant others. Methods We used survey data linked with sick leave registry data of 90 dyads. Pearson correlations were used to study the interdependence within dyads. Multiple linear regression analyses were conducted to examine associations between survey data of both dyad members and sick leave duration. Results We found moderate to strong correlations between workers and significant others, indicating interdependence within dyads regarding illness perceptions, RTW expectations and perceived significant other behaviors. Dyad members' illness perceptions (R-2 = .204, p = .001) and RTW expectations (R-2 = .326, p = < .001) were associated with sick leave duration, explaining respectively 12.3% and 24.5% of the variance. We found no associations between sick leave duration and active engagement, protective buffering and overprotection. Conclusions This study indicates that negative illness perceptions and RTW expectations of both workers and their significant others are associated with a longer sick leave duration. Considering the interdependence within dyads, involving significant others when intervening on maladaptive illness perceptions and RTW expectations may be more effective than solely focusing on the worker's perceptions and expectations.

The COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population. This cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants’ scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department. Permanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95

Insight into the work functioning of workers with chronic diseases may help to improve their sustainable employability. This study examines the work functioning of workers with cardiovascular disease (CVD), diabetes mellitus type 2 (DM2), chronic obstructive pulmonary disease (COPD), rheumatoid arthritis and depression across early, mid, and late working life. This cross-sectional study used data from 38,470 participants of the Dutch Lifelines study. Chronic diseases were classified based on clinical measures, self-reports, and medication. Work functioning was measured with the Work Role Functioning Questionnaire (WRFQ), covering work scheduling and output demands, physical demands, mental and social demands, and flexibility demands. Multivariable linear and logistic regression analyses were used to examine associations between chronic diseases and work functioning (continuous) and low work functioning (dichotomous). Depression was associated with lower work functioning across all subscales and working life stages, with the lowest score in the work scheduling and output demands subscale in late working life (B:-9.51;95%CI:-11.4,-7.65). Rheumatoid arthritis was most strongly associated with lower work functioning in the physical demands subscale, with the lowest score in early working life (B:-9.97;95%CI:-19.0,-0.89). Associations between CVD and DM2 and work functioning were absent in early working life but present in mid and late working life. Associations between COPD and work functioning were absent in mid working life but present in late working life. Occupational health professionals could use the WRFQ to identify workers' perceived difficulties in meeting specific work demands, pointing out directions for interventions to mitigate perceived difficulties and thereby improve sustainable employability.

Abstract Background Hearing loss is the third leading cause of years lived with disability. As the retirement age is rising, age-related hearing loss (HL) is an increasing occupational health (OH) problem. This study aimed to examine long-term changes in employment and work outcomes in teachers with HL and to identify barriers to and facilitators for their work participation. Methods In this prospective cohort study with 7-year follow-up, teachers completed an internet survey and an online hearing test. Teachers were classified as normal hearing (NH) and teachers with HL. For those who had stopped working during follow-up, we compared retirement age and proportions receiving disability pension in both groups. For those still working, differences between NH and teachers with HL in work outcome changes, i.e. work ability (Work Ability Scale), work performance (Health & Work Performance Questionnaire), and sustainable employability (Capability Set for Work Questionnaire) were investigated with ANOVA. Furthermore, teachers with HL answered questions on work participation barriers and facilitators for a thematic analysis. Results Of the invited N = 325 teachers, n = 211 (65%) responded and n = 89 were teachers with HL. Among those who had stopped working (n = 89), the mean retirement age was 64.6 years for both NH and teachers with HL. At follow-up, n = 10 received disability pension of which n = 9 had HL (p < 0.01). No differences were found over time for changes in work outcomes. Barriers for work participation were attending meetings, teaching, and poor classroom acoustics. Facilitators were job satisfaction, cooperation of the work environment, task adjustment, good acoustics, and technical equipment. Conclusions Teachers with HL retired at the same age as NH teachers, but more often received disability pension. No differences were found in work outcomes over time. Our study identified barriers and facilitators relevant for OH professionals when advising teachers with HL about work participation. Key messages • Although work outcomes over time were not different for teachers with and without hearing loss, teachers with hearing loss more often stopped working because of disability pensioning. • The identified barriers to and facilitators can be used to advise teachers with hearing loss and their employers about workplace accommodations.

Abstract The COVID-19 pandemic posed an enormous challenge on the public health workforce, particularly the need for substantial numbers of temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health staff during the fourth wave of the COVID-19 pandemic in the Netherlands. This cross-sectional study included temporary (N = 194) and permanent (N = 98) public health staff from a municipal health service and an employment agency respectively. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ) and work functioning (Work Role Functioning Questionnaire, WRFQ). Differences between temporary and permanent staff were investigated with linear regressions. To investigate differences between temporary staff performing testing, vaccination or client services and contact tracing, exploratory descriptive analyses were performed. Compared to permanent staff, temporary staff had better scores on quantitative (-26.51; 95% CI -30.64 to 22.38), cognitive (-24.31; 95% CI -28.86 to -19.76), emotional demands (-11.67; 95% CI -15.82 to -7.53) and work functioning (7.66; 95% CI 4.20 to 11.30). None of the task groups within temporary staff had consistently higher scores. Temporary staff had better scores on job demands and work functioning than permanent staff. The relatively better scores of temporary staff were not expected, but might be explained by a healthy worker effect and they may be less affected by poor working conditions due to short-term exposures. From a public health perspective, it is important to know how temporary staff experience working conditions when the public health workforce suddenly needs to increase. Our study encourages to not only focus on tasks within the public health system but also on working conditions. Key messages • To our knowledge this is the first study that compared the experienced working conditions of temporary and permanent public health staff during COVID-19. • Employing temporary staff appeared an adequate solution to strengthen the public health workforce during a pandemic, according to our result that temporary staff is not affected by working conditions.

Abstract Background Long-term sickness absence is not only an organizational, but also a societal public health problem. Many sick-listed workers experience challenges in self-directing their return-to-work (RTW), where RTW is considered as a gradual process in which work hours and tasks are gradually increased. This view of RTW as a process is common in several European countries, such as The Netherlands, Sweden, Denmark, Norway, Austria, Germany and Switzerland. Self-direction in RTW can reduce long-term sickness absence. The aim of this study is to provide a multi-perspective view on the experiences and needs regarding workers’ self-direction in RTW. Methods We conducted semi-structured interviews with (previously) sick-listed workers (n = 7) and focus groups with occupational physicians and labour experts (n = 10), case managers and job coaches (n = 6) and organizational representatives (n = 8). The interviews and focus groups were recorded, transcribed and coded thematically by two independent researchers. Preliminary results All stakeholders considered (self-directing) RTW as a learning process. Barriers to self-direct RTW were lack of sufficient support from employers and involved RTW professionals, lack of knowledge about the RTW process and responsibilities among both workers and their supervisors, and employers complying with legal requirements rather than applying a person-centered approach. Workers and the involved professionals emphasized the need to gain insight into long-term employability perspectives and scenarios to maintain work. Conclusions This qualitative study shows that there is a need for knowledge among workers and person centered support in RTW. The findings can be used in policy and practice to improve self-direction of sick-listed workers during RTW. Key messages • (Self-directing) RTW is a learning process for sick-listed workers. • Sick-listed workers need knowledge and person-centered support from employers and professionals to self-direct RTW.

Abstract Background Dyadic processes of workers and significant others like partners, family members and friends can play an important role in adaptation to chronic disease, thereby influencing health and work outcomes. This study aimed to increase our understanding of dyadic processes in sick leave duration of workers with chronic diseases. We examined illness perceptions, return to work expectations (RTWE) and perceptions about significant other responses (i.e., engagement, buffering and overprotection) of workers and their significant others in relation to sick leave duration. Methods This study used survey and registry data of 90 dyads of sick-listed workers with a chronic disease and their significant others. Simple and multiple regressions in which perceptions of workers and significant others were included simultaneously were used to examine associations with sick leave duration. Results Workers’ and significant others’ perceptions were moderately to strongly correlated (r ranged from .46 to .80). Sick leave duration was associated with illness perceptions of both workers (b = 8.58, p=.001) and significant others (b = 6.46, p=.008), with more negative illness perceptions associated with a longer sickness absence. In the multiple regression, illness perceptions explained 12.3% of the variation in sick leave duration. Sick leave duration was also associated with RTWE of workers (b=-76.87, p<.001) and their significant others (b=-92.47, p<.001), with more positive RTWE associated with a shorter sickness absence. The RTWE of dyad members accounted for 24.5% of the variance of sick leave duration. Conclusions Illness perceptions and RTWE of workers and their significant others are strongly interdependent and associated with sick leave duration of workers with chronic diseases. A dyadic approach targeted at improving illness perceptions and RTWE of both workers and significant others might be more effective than an individualistic approach in preventing long-term sickness absence. Key messages • Return to work expectations and illness perceptions of workers and their significant others are associated with the duration of sickness absence of workers with chronic diseases. • A dyadic approach targeted at both workers and their significant others might be more effective than an individualistic approach in the prevention of long-term sickness absence.

COVID-19 posed enormous challenges for nursing home staff, which may have caused stress and mental health problems. This study aimed to measure the prevalence of mental health problems among nursing home staff and investigate the differences in job demands, work functioning and mental health between staff with and without COVID contact or COVID infection and across different levels of COVID worries. In this cross-sectional study, 1669 employees from 10 nursing home organizations filled in an online questionnaire between June and September 2020. The questionnaire measured the participants’ characteristics, COVID contact, infection and worries, job demands, work functioning, depressive symptoms and burnout. Differences were investigated with multilevel models to account for clustering at the organization level. Of the participants, 19.1% had high levels of depressive symptoms and 22.2% burnout. Job demands, work functioning, depressive symptoms and burnout differed between participants who never worried and participants who often or always worried about the COVID crisis. Differences were smaller for participants with and without COVID contact or infection. Most models improved when clustering was accounted for. Nursing homes should be aware of the impact of COVID worries on job demands, work functioning and mental health, both at the individual and organizational level.

Objective This study tested and validated an existing tool for its ability to predict the risk of long-term (ie, >= 6 weeks) sickness absence (LTSA) after four days of sick-listing. Methods A 9-item tool is completed online on the fourth day of sick-listing. The tool was tested in a sample (N=13 597) of food retail workers who reported sick between March and May 2017. It was validated in a new sample (N=104 698) of workers (83% retail) who reported sick between January 2020 and April 2021. LTSA risk predictions were calibrated with the Hosmer-Lemeshow (H-L) test; non-significant H-L P-values indicated adequate calibration. Discrimination between workers with and without LTSA was investigated with the area (AUC) under the receiver operating characteristic (ROC) curve. Results The data of 2203 (16%) workers in the test sample and 14 226 (13%) workers in the validation sample was available for analysis. In the test sample, the tool together with age and sex predicted LTSA (H-L test P=0.59) and discriminated between workers with and without LTSA [AUC 0.85, 95% confidence interval (CI) 0.83-0.87]. In the validation sample, LTSA risk predictions were adequate (H-L test P=0.13) and discrimination was excellent (AUC 0.91, 95% CI 0.90-0.92). The ROC curve had an optimal cut-off at a predicted 36% LTSA risk, with sensitivity 0.85 and specificity 0.83. Conclusion The existing 9-item tool can be used to invite sick-listed retail workers with a >= 36% LTSA risk for expedited consultations. Further studies are needed to determine LTSA cut-off risks for other economic sectors.

Purpose To examine the associations between illness perceptions and expectations about full return to work (RTW) of workers with chronic diseases and their significant others. Methods This study used cross-sectional data of 94 dyads consisting of workers with chronic diseases and their significant others. We performed dyadic analyses based on the Actor-Partner Interdependence Model (APIM), estimating associations of illness perceptions of the two members of the dyad with their own expectations about the worker’s full RTW within six months (actor effect) as well as with the other dyad member’s expectations about the worker’s RTW (partner effect). Results Illness perceptions of one dyad member were significantly associated with his or her own RTW expectations (actor effect composite illness perceptions score; B = −0.05, p < .001; r d = .37) and with the other dyad member’s RTW expectations (partner effect composite illness perceptions score; B = −0.04, p < .001; r d = .35). That is, more negative illness perceptions of one member of the dyad were associated with more negative RTW expectations in both dyad members. For most illness perception domains, we found small to moderate actor and partner effects on RTW expectations ( r d range: .23–.44). Conclusions This study suggests that illness perceptions and RTW expectations should be considered at a dyadic level as workers and their significant others influence each other’s beliefs. When trying to facilitate adaptive illness perceptions and RTW expectations, involving significant others may be more effective than an individualistic approach targeted at the worker only.

BACKGROUND:When resources are limited, occupational health survey participants are usually invited to consultations based on an occupational health provider's subjective considerations. This study aimed to find health survey participants at risk of long-term (i.e., ≥ 42 consecutive days) sickness absence (LTSA) for consultations with occupational health providers (OHPs).METHODS:The data of 64 011 non-sicklisted participants in occupational health surveys between 2010 and 2015 were used for the study. In a random sample of 40 000 participants, 27 survey variables were included in decision tree analysis (DTA) predicting LTSA at 1-year follow-up. The decision tree was transferred into a strategy to find participants for OHP consultations, which was then tested in the remaining 24 011 participants.RESULTS:In the development sample, 1358 (3.4%) participants had LTSA at 1-year follow-up. DTA produced a decision tree with work ability as first splitting variable; company size and sleep problems were the other splitting variables. A strategy differentiating by company size would find 75% of the LTSA cases in small (≤99 workers) companies and 43% of the LTSA cases in medium-sized (100-499 workers) companies. For large companies (≥500 workers), case-finding was only 25%.CONCLUSIONS:In small and medium-sized companies, work ability and sleep problems can be used to find occupational health survey participants for OHP consultations aimed at preventing LTSA. Research is needed to further develop a case-finding strategy for large companies.

Abstract Objective The Work Role Functioning Questionnaire 2.0 (WRFQ), measuring the percentage of time a worker has difficulties in meeting the work demands for a given health state, has shown strong reliability and validity in various populations with different chronic conditions. The present study aims to validate the WRFQ in working cancer patients. Methods A validation study of the WRFQ 2.0 was conducted, using baseline data from the longitudinal Work Life after Cancer study. Structural validity (Confirmatory Factor Analysis, CFA), internal consistency (Cronbach's alpha) and discriminant validity (hypothesis testing) were evaluated. Results 352 working cancer patients, most of them diagnosed with breast cancer (48%) and 58% in a job with mainly non‐manual tasks, showed a mean WRFQ score of 78.6 (SD = 17.1), which means that they had on average difficulties for 78.6% of the time they spent working. Good internal consistency (α = 0.96) and acceptable to good fit for both the four and five‐factor model (CFA) was found. The WRFQ distinguished between cancer patients reporting good vs. poor health (80.3 vs. 73.0, p = 0.001), low vs. high fatigue (82.0 vs. 72.2, p < 0.001), no vs. clinical depression (80.4 vs. 58.8, p < 0.001) and low vs. high cognitive symptoms (86.1 vs. 64.7, p < 0.001). Conclusions The WRFQ 2.0 is a reliable and valid instrument to measure work functioning in working cancer patients. Further psychometric research on responsiveness is needed to support its use in health practice.