Implementation of the Danish return-to-work program: process evaluation of a trial in 21 Danish municipalities.

Objectives: The aim of this study was to evaluate the implementation of the Danish national return-to-work (RTW) program in 21 Danish municipalities.

Methods: We conducted a structured process evaluation on (i) reach and recruitment, (ii) fidelity, (iii) dose-delivered, (iv) dose-received, and (v) context by formulating 29 implementation criteria and analyzing qualitative and quantitative data from administrative records, interviews, field notes, and questionnaires.

Results: All municipalities integrated the basic features of the RTW program into the existing framework of the sickness benefit management system to an acceptable degree, ie, establishment of RTW teams, participation of RTW team members in the training courses, and following the general procedures of the program.

Month-to-month variation in sleep among healthy, Scandinavian daytime workers.

Background: The overall purpose of the present study was to attain more insight in month-to-month variation of sleep duration and quality in order to improve design and interpretation of, e.g. epidemiological studies using sleep as outcome.

A multisite randomized controlled trial on time to self-support among sickness absence beneficiaries. The Danish national return-to-work programme.

Background: In 2010, the Danish Government launched the Danish national return-to-work (RTW) programme to reduce sickness absence and promote labour market attainment. Multidisciplinary teams delivered the RTW programme, which comprised a coordinated, tailored and multidisciplinary effort (CTM) for sickness absence beneficiaries at high risk for exclusion from the labour market. The aim of this article was to evaluate the effectiveness of the RTW programme on self-support.

Effect of the Danish return-to-work program on long-term sickness absence: results from a randomized controlled trial in three municipalities.

Objectives: The aim of this study was to evaluate the effect of the Danish return-to-work (RTW) program on long-term sickness absence in a randomized controlled trial in three municipalities.

Methods: The intervention group comprised 1948 participants while the control group comprised 1157 participant receiving ordinary sickness benefit management (OSM). Study participants were working-age adults receiving long-term (≥8 weeks or more) benefits, included regardless of reason for sickness absence or employment status.

Distribution of subjective health complaints, and their association with register based sickness absence in the Danish working population.

Aims: To describe the distribution of subjective health complaints (SHCs) in a Danish working population and the associations between SHC and register based sickness absence.

Methods: The study entailed 2876 men and 3574 women aged 18-59 years that constituted the 2005 panel in the Danish Work Environment Cohort Study (DWECS). All had completed a subjective health complaints inventory and the Nordic Musculoskeletal Questionnaire (NMQ).

The Danish national return-to-work program--aims, content, and design of the process and effect evaluation.

The Danish national return-to-work (RTW) program aims to improve the management of municipal sickness benefit in Denmark. A study is currently ongoing to evaluate the RTW program. The purpose of this article is to describe the study protocol.

Low heart rate variability is associated with extended pain-related sick leave among employed care-seekers.

Objective: To examine the association between autonomic regulation and length of pain-related sick leave in subjects receiving a cognitive behavioural therapy-based return to work intervention.

Methods: Sixty-five persons (29 men, 36 women) on pain-related sick leave participated in the study. Electrocardiograms were recorded in the clinic during supine rest, passive head-up tilt, standing, and seated rest, and in the home during seated rest and sleep.

Cortisol, sleep, and recovery - Some gender differences but no straight associations.

Background: Work related fatigue has been suggested as a link in the assumed sequence of events between repeated adverse work demands and the development of work related stress, which may be associated with changes in concentrations of cortisol, psychological overload and, in the long run, health problems. Insufficient sleep is a contributing factor to lack of recovery, but previous studies on associations between subjective aspects of sleep and recovery, and cortisol, have been inconclusive. The aim with the present study was to examine possible associations between cortisol measures and (I) self-rated recovery, (II) occupational fatigue and (III) subjective sleep quality the night preceding cortisol sampling.

Can the job content questionnaire be used to assess structural and organizational properties of the work environment?

Objective: The theory behind the Job Content Questionnaire (JCQ) presumes that the "objective" social environment is measurable via self-report inventories such as the JCQ. Hence, it is expected that workers in identical work will respond highly similar. However, since no studies have evaluated this basic assumption, we decided to investigate whether workers performing highly similar work also responded similarly to the JCQ.

Cortisol variability and self-reports in the measurement of work-related stress.

We examined whether a high cortisol awakening response (CAR) and low cortisol decline over the day (CDD) are related to self-reported work stress and well-being, and whether there are gender differences in these relationships. Three hundred eighty-three working men and women responded to a survey measuring job stress factors, mastery at work, symptoms and well-being. Salivary cortisol was sampled at awakening, after 45 min and at 21:00, from which the variables CAR and CDD were defined.

Heart rate variability changes in physicians working on night call.

Purpose: Adverse effects by night-call duty have become an important occupational health issue. The aim of this study was to investigate whether the heart rate variability (HRV) differed during recovery from day work and night-call duty between distinct physician specialities.

Methods: We studied the impact of a 16-h night-call duty on autonomic balance, measured by HRV, among two physician groups differing with respect to having to deal with life-threatening conditions while on call.

Sleep and recovery in physicians on night call: a longitudinal field study.

Background: It is well known that physicians' night-call duty may cause impaired performance and adverse effects on subjective health, but there is limited knowledge about effects on sleep duration and recovery time. In recent years occupational stress and impaired well-being among anaesthesiologists have been frequently reported for in the scientific literature. Given their main focus on handling patients with life-threatening conditions, when on call, one might expect sleep and recovery to be negatively affected by work, especially in this specialist group.

Seasonal variation in self-reported arousal and subjective health complaints.

Many aspects of human physiology and behavior are seasonally related. Although there are many studies using self-ratings of, for example, subjective health and stress, few involve adjusting effects for seasonal differences. To estimate the need of adjusting for season in field studies, 24 healthy men and women were studied in a design that required them to fill in questionnaires on one workday every month, for 12 consecutive months.

Delayed manifestations of CNS effects in formerly exposed printers--a 20-year follow-up.

Whether long-term occupational exposure to organic solvents may affect mental and cognitive functioning later in life, remains unclear. In this study, twelve rotogravure printers formerly exposed to toluene and 19 referents, all initially examined in the mid-1980s, were reexamined after twenty years, applying neuropsychological tests, symptoms and social interaction questionnaires, medical examination, and exposure assessment of each individual's cumulative exposure. By far the most extensive exposure, mainly toluene, had occurred before 1985.

Effects on sleep-related problems and self-reported health after a change of shift schedule.

This study prospectively examined the effects of a change of shift schedule from a fast forward-rotating schedule to a slowly backward-rotating one. The initial schedule had a forward rotation from mornings to afternoons to nights over 6 consecutive days, with 2 days on each shift followed by 4 days off before the next iteration of the cycle, whereas the new schedule had a slower backward rotation from mornings to nights to afternoons, with 3 days on a given shift followed by 3 days off before the next shift. Shift workers (n = 118) were compared with a reference group of daytime workers (n = 67) from the same manufacturing plant by means of questionnaires covering subjective health, sleep and fatigue, recovery ability, satisfaction with work hours, work-family interface, and job demands, control, and support.

Physiological and psychological reactions to work in men and women with identical job tasks.

Differences in physiological functioning in the hypothalamus-pituitary-adrenal cortex axis and the autonomic nervous system have been suggested to contribute to many of the health differences that may be observed between men and women as well as being relevant for the development of musculoskeletal pain. To clarify whether men and women with identical work tasks reacted differently when doing work known to induce musculoskeletal pain, ratings and physiological measurements were obtained at work start (15:30) and at the end of the workshift (22:30) on 17 men and 20 women. Men showed a larger decrease in perceived energy levels during the workshift but there were no differences between men and women as regards cortisol, adrenaline, noradrenaline, heart-rate activation, perceived stress, pain and physical exertion.

Seasonal variation in human salivary cortisol concentration.

Measurement of cortisol concentration can contribute important information about an individual's ability to adjust to various environmental demands of both physical and psychosocial origin. However, one uncertainty that affects the possibilities of correctly interpreting and designing field studies is the lack of observations of the impact of seasonal changes on cortisol excretion. For this reason, the month-to-month changes in diurnal cortisol concentration, the awakening cortisol response (ACR), maximum morning concentration, and fall during the day were studied in a group of 24 healthy men and women 32 to 61 yrs of age engaged in active work.

A two-week monitoring of self-reported arousal, worry and attribution among persons with annoyance attributed to electrical equipment and smells.

Non-patients attributing annoyance to either smells (smell annoyed; SA, n= 29) or electrical equipment (electrically annoyed; EA, n= 17), or both (generally annoyed; GA, n= 38), were monitored for 2 weeks through daily self-ratings of arousal (stress), sleep disturbances, health complaints, worry about hypersensitivity reactions, avoidance behaviors, and attributions of health complaints to electrical equipment and smells. In parallel, a demographically matched reference group was followed (n= 56). GA persons reported higher arousal (stress), more subjective health complaints, and more sleep disturbances than the other groups.

High cost-benefit of early team-based biomedical and cognitive-behaviour intervention for long-term pain-related sickness absence.

Objective: To report the results from a prospective, cognitive-behavioural team-based, individually geared, low-intensity, rehabilitation programme, randomly assigned to care-seekers in primary care physiotherapy with new pain-related sick leave, and to examine a possible reduction in social security expenditure.

Methods: A total of 194 care-seekers were included in a stepwise procedure from November 2000 to February 2002. Control group n = 381.

Building-site camps and extended work hours: A two-week monitoring of self-reported physical exertion, fatigue, and daytime sleepiness.

Large-scale construction work often requires people to work longer daily hours and more than the ordinary five days in a row. In order to minimize transportation times and optimize the use of personnel, workers are sometimes asked to live in temporary building-site camps in the proximity of the work site. However, little is known about the biological and psychological effects of this experience.

Impact of an 84-hour workweek on biomarkers for stress, metabolic processes and diurnal rhythm.

Objectives: This study examined the degree to which long workhours in combination with an extended workweek (12 hours/7 days) with permanent day shifts (0700-1900), as requested by the workers, influenced biomarkers for stress, metabolic processes, and diurnal rhythm.

Methods: Construction workers (N=50) working 84 hours a week, with alternate weeks off, were compared with construction workers (N=25) having a traditional 40-hour work schedule. The participants were all male and between the ages of 21 to 65 years.

Adult survivors of childhood acute lymphoblastic leukaemia with GH deficiency have normal self-rated quality of life but impaired neuropsychological performance 20 years after cranial irradiation.

Objective: Cranial radiotherapy (CRT) was, until recently, important for achieving long-term survival in acute lymphoblastic leukaemia (ALL). Because survival rates have improved markedly, the long-term complications, such as GH deficiency (GHD) and neuropsychological impairment, have become increasingly important.

Design And Patients: The level of self-reported quality of life and neuropsychological functioning was investigated in 44 adults (21 women) with a median age of 25 years who had been treated for childhood onset (CO) ALL with CRT (median 24 Gy).

Concentrations of cortisol, testosterone and glycosylated haemoglobin (HbA1c) among construction workers with 12-h workdays and extended workweeks.

Objectives: Working on large scale construction sites have been shown to have severe health consequences in terms of increased risk of hospitalization and disability retirement compared to construction work in general. The aim of the present study was to investigate whether large scale construction work involving 12-h workdays and extended workweeks leads to insufficient recovery measured as increased catabolic and decreased anabolic metabolism.

Methods: The study group comprised 40 male construction workers of which 21 had 12-h workdays and extended workweeks (56 h/workweek).

Salivary cortisol and self-reported stress among persons with environmental annoyance.

Objectives: Increased vulnerability to stress has been suggested as a possible mechanism behind medically unexplained conditions such as sensitivity to electricity and common smells. This study examined whether subjective environmental annoyance among the general population is associated with increased physiological reactivity or subjective stress scores.

Methods: Four groups were studied (N=141): an electrically annoyed (N=17), a smell-annoyed (N=29), and a generally annoyed group (N=39) and a reference group matched for age, gender, and socioeconomic status (N=56).

The sick building syndrome: a chicken and egg situation?

Objectives: To examine the temporal relationship and specificity between self-reports on the indoor environment at work and symptoms that are traditionally connected with the sick building syndrome (SBS).

Methods: This questionnaire study used a prospective full panel design as regards self-reports on exposure and outcome. At the baseline, the sample comprised 2,164 adults selected randomly from the general population.