Structured Early Consultation with the Occupational Physician Reduces Sickness Absence Among Office Workers at High Risk for Long-Term Sickness Absence: a Randomized Controlled Trial

Objective To examine the efficacy of structured early consultation among employees at high risk for future long-term sickness absence, in the prevention and/or reduction of sickness absence. The focus of the experiment was the timing of the intervention, that is, treatment before sickness absence actually occurs. Methods In the current prospective randomized controlled trial (RCT), employees at high risk for long-term sickness absence were selected based on responses to a 34-item screening questionnaire including demographic, workplace, health and psychosocial factors associated with long-term sickness absence (>28 days). A total of 299 subjects at risk for future long-term sickness absence were randomized in an experimental group (n = 147) or in a control group (n = 152). Subjects in the experimental group received a structured early consult with their occupational physician (OP), in some cases followed by targeted intervention. The control group received care as usual. Sickness absence was assessed objectively through record linkage with the company registers on sickness absence over a 1 year follow-up period. Results Modified intention-to-treat analysis revealed substantial and statistically significant differences (p = 0.007) in total sickness absence duration over 1 year follow-up between the experimental (mean 18.98; SD 29.50) and control group (mean 31.13; SD 55.47). Per-protocol analysis additionally showed that the proportion of long-term sickness absence spells (>28 days) over 1 year follow-up was significantly (p = 0.048) lower in the experimental (9.1%) versus control group (18.3%). Conclusions Structured early consultation with the OP among employees at high risk for future long-term sickness absence is successful in reducing total sickness absence

24hour heart rate variability in shift workers: Impact of shift schedule

Abstract: 24-Hour Heart Rate Variability in Shift Workers: Impact of Shift Schedule: L.G.P.M. van AMELSVOORT, et al. Department of Epidemiology, Maastricht University-Disturbance of the circadian pattern of cardiac autonomic control by working at night when the physiological system anticipates rest could explain part of the elevated cardiovascular risk in shift workers. Analysis of Heart Rate Variability (HRV) is a non-invasive tool to estimate disturbances of the cardiac autonomic control. To assess the influence of working at night on cardiac autonomic control, HRV levels were determined in shift workers. 24-h ECG recordings were made during a day on morning shift and a day on night shift. Within person differences between a morning and a night shift were calculated. Possible modification of the reported effects by the shift schedule was determined. Significantly elevated mean %LF during sleep was found on a day worked on night shift compared with a day on day shift (%LF + 3.04, P<0.01). Type of shift schedule was found to be a significant modifier of this effect. The difference in %LF between the night and day shift for the different shift schedules apart were: + 0.88% for the workers in the fast forward rotating shift, + 3.06% for the fast backward rotating shift, + 6.15% (P<0.001) for the medium speed backward rotating shift and + 1.18% for the shift workers without a regular shift schedule. The results suggest an increased sympathetic dominance during a night shift sleep, indicating an inferior sleep quality. Optimisation of this schedule might diminish this impact and could contribute to a reduction of the cardiovascular disease risk among shift workers. (J Occup Health 2001; 43: 32-38

Different Approaches to Estimate Exposure to Work Stressors, Using Repeated Measurements, and the Association With Cardiovascular Disease

Objective: To explore the stability of exposure to work stressors over time and to examine the impact of different approaches of estimating exposure on the cardiovascular disease (CVD) risk estimation. Methods: The Maastricht Cohort Study Work Stressor Score was used to assess work stressors at three consecutive time points among 6154 employees participating in the Maastricht Cohort Study. Incident CVD was assessed with questionnaires. Five approaches were used to estimate exposure as, for example, cumulative exposure above a cutoff point, total exposure, and average exposure. Results: The correlation between the Work stressor scores assessed at the first and third time point was 0.58. Employees with a stable exposure above the highest quartile had a fully adjusted hazard ratio of 1.58 (95% confidence interval, 0.93 to 2.72). Conclusion: Employees with a stable exposure above the highest quartile score during a minimum of 2 years might have the highest relative CVD risk

Spuriously precise results from meta-analysis. Is better statistical correction or a more critical methodological assessment warranted?

status: publishe