Lifestyle factors and risk of sickness absence from work: a multicohort study

Can home care work be organized to promote musculoskeletal health for workers? Results from the GoldiCare cluster randomized controlled trial

BACKGROUND

Workers in home care have high sick leave rates, predominantly because of musculoskeletal pain. The Goldilocks Work Principle proposes that health should be promoted by a "just right" composition of work tasks. Weekly workloads differ substantially between home care workers, suggesting that certain workers may have workloads that are too high, impacting their musculoskeletal health. The aim of this study was to evaluate the effectiveness of a "GoldiCare" intervention redistributing weekly workloads to become more equal among the homecare workers. Outcomes were pain in the neck/shoulder and lower back, and the implementation of the intervention was also evaluated.

METHODS

A 16-week cluster randomized controlled trial was conducted with 125 workers from 11 home care units, divided into six intervention units and five control units. The operation coordinators of each intervention unit were educated in the Goldilocks Work Principle and provided with a planning tool to facilitate an even distribution of high care need clients. The control group continued their usual work. Primary outcomes were pain intensity in the neck/shoulder and lower back (0 to 10). Secondary outcomes included fatigue (0 to 10), composition of physical behaviors and postures (accelerometers), adherence to the intervention (weekly usage rates of the planning tool), and performance of the intervention (percentage of workers with an even distribution of workload).

RESULTS

The analysis showed no difference between the intervention and control groups in change in lower back pain (0.07, 95%CI[-0.29;0.43]), neck/shoulder pain (-0.06, 95%CI[-0.49;0.36]) or fatigue (0.04, 95%CI[-0.52;0.61]. No significant changes were observed in the composition of physical behaviors (p = 0.067) or postures (p = 0.080-0.131) between the two groups. The intervention was succesfully implemented in three units of the six, with adherence ranging from 82-100% across the intervention period. The remaining three units had an adherence of 0-47%. No improvement in performance was observed.

CONCLUSION

No significant intervention effects were observed on musculoskeletal pain, fatigue, or the composition of physical behaviors and postures. The findings suggest that the intervention was not adequately implemented within the organization. Consequently, we cannot discern whether the lack of positive results were due to poor implementation or an ineffective intervention. Results thus highlight the need for a more comprehensive understanding of organizational structures within home care to facilitate more effective implementations. The hypothetical effectiveness of a fully implemented intervention remains unknown.

TRIAL REGISTRATION

Clinicaltrials.gov ID: NCT05487027, submitted: 03/08/2022.

Long-term sickness absence trajectories and associated occupational and lifestyle-related factors: a longitudinal study among young and early midlife Finnish employees with pain

OBJECTIVES

This study aimed to identify distinct trajectories of long-term sickness absence (LTSA, >10 consecutive working days) among young and early midlife Finnish employees who experienced pain at baseline. It also aimed to determine the pain characteristics and occupational and lifestyle factors associated with these LTSA patterns.

DESIGN

Longitudinal occupational cohort study with register linkage.

SETTING

The largest municipal employer in Finland.

PARTICIPANTS

The study population comprised 19-39-year-old Finnish municipal employees (n=1685) who reported pain in 2017.

OUTCOME MEASURES

Prospective register data on all-cause LTSA through March 2020 were obtained from the Social Insurance Institution of Finland. Group-based trajectory modelling was used to identify distinct all-cause LTSA trajectories. Multinomial logistic regression was used to examine associations of pain characteristics and work- and lifestyle-related factors with trajectory group membership.

RESULTS

Three distinct LTSA-trajectory groups were identified: no LTSA (74%), decreasing (18%) and increasing (8%). The decreasing trajectory group had a higher prevalence of chronic or multisite pain, smoking (average marginal effects (AME) 6% points, 95% CI 2 to 11), obesity (AME 8% points, 95% CI 2 to 13), manual or routine non-manual occupation (AME 9% points, 95% CI 4 to 13) and high physical workload, after adjusting for age and gender. No predictor was identified for the increasing trajectory.

CONCLUSION

A majority of young and early midlife employees with pain had no LTSA during follow-up; however, chronic and multisite pain, smoking, overweight or obesity, lower occupational class and higher physical workload were associated with the decreasing LTSA trajectory. Interventions at workplaces and in occupational healthcare to prevent LTSA should aim at supporting employees who work with pain and have these risk factors.

Sickness absence trajectories among young and early midlife employees with psychological distress: the contributions of social and health-related factors in a longitudinal register linkage study

PURPOSE

Psychological distress has been associated with sickness absence (SA), but less is known about whether there are distinct patterns in the development of SA among people with psychological distress. We examined trajectories of short- and long-term SA among employees with psychological distress and how social and health-related factors are associated with them.

METHODS

We used the employer's register data on all-cause short- (≤ 10 working days) and long-term (> 10 working days) SA with a two-year follow-up. We prospectively linked the Helsinki Health Study survey data on 19-39-year-old employees of the City of Helsinki, Finland, in 2017, to the SA data. We included 1060 participants (81% women) who reported experiencing psychological distress, measured by the emotional wellbeing scale of RAND-36. Survey responses of age; gender; education; marital status; social support, procedural and interactional organisational justice, and bullying at work; physical activity; diet; tobacco and alcohol use; prior SA; and the level of psychological distress were included as exposures. Group-based trajectory modelling and multinomial logistic regression were used for the analyses.

RESULTS

We identified four short-term SA trajectories: 'low' (n = 379, 36% of participants), 'descending' (n = 212, 20%), 'intermediate' (n = 312, 29%), and 'high' (n = 157, 15%); and two long-term SA trajectories: 'low' (n = 973, 92%) and 'high' (n = 87, 8%). A higher education, fewer prior SA, and lower levels of psychological distress were associated with the 'low' short- and long-term SA trajectories.

CONCLUSION

SA trajectories differ among employees with psychological distress. Early intervention and support are needed among employees with mental health symptoms to prevent future SA.

Sex-Specific Associations Between Lifestyle Factors and Sick Leave in the Serbian Working Population: Findings from the National Health Survey

Background/Objectives: Sick leave is influenced by various modifiable lifestyle factors and sex differences. This study investigates the associations between body mass index, fruit and vegetable consumption, physical activity, smoking, and alcohol consumption and sick leave among Serbia's working population, with emphasis on sex differences. Methods: Data from the 2019 National Health Survey of Serbia were analyzed, involving a sample of 4652 individuals. Chi-square tests and logistic regression models assessed the relationships between lifestyle factors and sick leave. Results: Among the participants, 15.8% reported sick leave in the past 12 months, with higher rates among women in both short-term (13.9% vs. 10.6%) and long-term (3.4% vs. 2.2%) sick leave. This study identifies obesity (OR = 2.6), poor dietary habits (fruit OR = 2.1; vegetables OR = 2.8), smoking (OR = 1.9), and risky alcohol consumption (OR = 4.1) as key predictors of sick leave in men, while smoking (OR = 1.8) and risky alcohol consumption (OR = 3.1) are major predictors in women. The inconsistent association between diet, physical activity, and sick leave may be attributed to differences in reporting accuracy, differing definitions of healthy intake, or the influence of unmeasured lifestyle factors. Conclusions: Smoking and risky alcohol consumption increase the odds of sick leave for both sexes. Interventions targeting smoking cessation and mitigating risky alcohol consumption could significantly decrease sick leave rates. While fruit and vegetable consumption, along with physical activity, showed inconsistent effects in both sexes, further studies are warranted to elucidate their roles.

Associations of depressive symptoms and psychosocial working conditions with sickness absences in a Finnish cohort of 11,495 employees

Objective

To examine the relevance of questions on psychosocial working conditions and depressive symptoms, as used in a screening questionnaire in preventive occupational health care, to predict repetitive short or long sickness absences.

Methods

The participants were 11,495 employees of various occupations in Finnish companies. The data were prospectively collected by one occupational healthcare service provider (Finla) and included register data of sickness absences and responses to a questionnaire used in pre-employment and periodic health examinations between 2011 and 2019. Long sickness absences of > 30 days and repetitive short sickness absences of one to ten days in a 24-month follow-up were used as outcome variables for multiple logistic regression analysis.

Results

Strong associations were found between repetitive short and long sickness absences, and the questions on depressive symptoms "felt hopeless about the future", "felt melancholic", "felt everything was an effort", and "feelings of worthlessness". Among questions on psychosocial working conditions, strong associations were found between sickness absences and questions on decision authority, self-reformation opportunities, job versatility, and appreciation for their work.

Conclusions

Questionnaires on depressive symptoms and psychosocial work environment can help identify patients with an increased risk of sickness absence. Data accumulating in occupational health care should be used more systematically to reduce the risk of work disability through targeted occupational health interventions.

Asthma Is Associated With Increased Sickness Absence Among Young Adults

BACKGROUND

There is limited knowledge about how asthma affects sickness absence in young adulthood.

OBJECTIVE

To examine how asthma and different asthma phenotypes affect sickness absence among young adults and potential modifying factors. A secondary aim was to estimate productivity losses related to sickness absence for asthma.

METHODS

The study included 2391 participants from the Swedish population-based cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology). Information on asthma, asthma phenotypes, and lifestyle factors was collected from questionnaires and clinical examinations at age approximately 24 years (2016-2019). Information on sickness absence for longer than 14 days was obtained from a national register for the years 2020 and 2021. Associations between asthma, asthma phenotypes, and sickness absence were analyzed with logistic regression models adjusted for sex, birth year, education, and overweight status.

RESULTS

At age 24 years, 272 (11.4%) fulfilled the definition of asthma. Sickness absence was more common among those with asthma than among those without (15.1% vs 8.7%; P = .001; adjusted odds ratio 1.73; 95% CI, 1.19-2.51). Analyses of asthma phenotypes showed that the association tended to be stronger for persistent asthma, uncontrolled asthma, and asthma in combination with rhinitis; no consistent differences were observed across phenotypes related to allergic sensitization or inflammation. The association tended to be stronger among those with overweight than among those with normal weight. Asthma, especially uncontrolled asthma, was associated with higher productivity losses from sickness absence.

CONCLUSIONS

Asthma may be associated with higher sickness absence and productivity losses. Achieving better asthma control and reducing allergic symptoms may reduce sickness absence among individuals with asthma.

Joint associations of leisure time physical activity and screen sitting time with long-term sickness absence due to mental and musculoskeletal diseases: a registry linked follow-up study

OBJECTIVES

To examine joint associations of leisure-time physical activity (LTPA) and screen sitting time with subsequent sickness absence among the adult population.

STUDY DESIGN

Registry linked follow-up study.

METHODS

A representative sample of Finnish adults (n = 10,300) were asked to fill out a questionnaire for the FinHealth 2017 survey. Self-reported LTPA was classified into three groups: inactive, moderately active, and active, and screen sitting time into two groups: 3 h or less and over three hours a day, yielding a six-category variable for the joint analyses. Questionnaire data were linked to the Finnish Social Insurance Institution's register data on sickness benefits (over 9 days), including diagnoses (follow-up 2.9 years). The analytical samples were restricted to working age (18-64 years), which included 5098 participants. Associations were examined using logistic regression analysis adjusting for covariates with SPSS 29.

RESULTS

The inactive and high sitting time had a higher risk for sickness absence due to mental disorders (OR 2.07, 95% CI 1.03-4.18) compared with the physically active, low-sitting time group. Additionally, the inactive and low sitting time (OR 1.69 95% CI 1.12-2.55) and the moderately active and high-sitting time groups (OR 2.06 95% CI 1.15-3.67) had a higher risk. No significant associations were found for all-cause and musculoskeletal diseases sickness absence.

CONCLUSION

Employers and policymakers could support reducing sitting in front of a screen and increase LTPA outside working hours to prevent mental health problems and related sickness absences.

Does the distribution of musculoskeletal pain shape the fate of long-term sick leave? A prospective cohort study with register follow-up

ABSTRACT

Although multisite pain can markedly reduce work ability, the relevance of the bodily pain distribution as a predictor of long-term sick leave is still unknown. This study aimed to investigate the association between musculoskeletal pain distributions and long-term sick leave in the general working population of Denmark and included 66,177 currently employed wage earners without long-term sick leave during the prior 52 weeks. Participants reported whether they had pain in the lower extremity (hips/knees), upper extremity (neck/shoulders), or the low back. The analysis controlled for age, sex, year of survey reply, educational level, occupational group, psychosocial work factors, body max index, smoking, leisure-time physical activity, and mental health confounders. The results demonstrated that the risk of long-term sick leave increased with the number of pain sites. Compared with no pain, localized pain in any body region increased the risk/hazard by 25% to 29% (HR [95% CI]: 1.29 [1.07-1.54] for pain only in the low back), whereas pain in 2 regions increased the risk by 39% to 44% (HR [95% CI]: 1.41 [1.18-1.69] for pain in the low back + hips/knees). Workers reporting pain in all 3 regions experienced a 72% increased risk (HR [95% CI]: 1.72 [1.55-1.91]). Thus, the number of pain regions seems to matter more than the exact pain location. The spatial extension of musculoskeletal pain in workers functions as a gradient system, where pain spread throughout the body is an independent indicator of the high risk of long-term sick leave.

Narrative review of occupational exposures and noncommunicable diseases

OBJECTIVE

Within the scope of the Exposome Project for Health and Occupational Research on applying the exposome concept to working life health, we aimed to provide a broad overview of the status of knowledge on occupational exposures and associated health effects across multiple noncommunicable diseases (NCDs) to help inform research priorities.

METHODS

We conducted a narrative review of occupational risk factors that can be considered to have "consistent evidence for an association," or where there is "limited/inadequate evidence for an association" for 6 NCD groups: nonmalignant respiratory diseases; neurodegenerative diseases; cardiovascular/metabolic diseases; mental disorders; musculoskeletal diseases; and cancer. The assessment was done in expert sessions, primarily based on systematic reviews, supplemented with narrative reviews, reports, and original studies. Subsequently, knowledge gaps were identified, e.g. based on missing information on exposure-response relationships, gender differences, critical time-windows, interactions, and inadequate study quality.

RESULTS

We identified over 200 occupational exposures with consistent or limited/inadequate evidence for associations with one or more of 60+ NCDs. Various exposures were identified as possible risk factors for multiple outcomes. Examples are diesel engine exhaust and cadmium, with consistent evidence for lung cancer, but limited/inadequate evidence for other cancer sites, respiratory, neurodegenerative, and cardiovascular diseases. Other examples are physically heavy work, shift work, and decision latitude/job control. For associations with limited/inadequate evidence, new studies are needed to confirm the association. For risk factors with consistent evidence, improvements in study design, exposure assessment, and case definition could lead to a better understanding of the association and help inform health-based threshold levels.

CONCLUSIONS

By providing an overview of knowledge gaps in the associations between occupational exposures and their health effects, our narrative review will help setting priorities in occupational health research. Future epidemiological studies should prioritize to include large sample sizes, assess exposures prior to disease onset, and quantify exposures. Potential sources of biases and confounding need to be identified and accounted for in both original studies and systematic reviews.

What have we learned about risk assessment and interventions to prevent work-related musculoskeletal disorders and support work participation?

OBJECTIVE

The Scandinavian Journal of Work, Environment & Health (SJWEH) was established half a century ago. This paper provides an overview of research on musculoskeletal disorders (MSD) published over these 50 years. Three themes are described: risk assessment, interventions to prevent work-related MSD, and interventions to support work participation. Finally, implications for future research are highlighted.

METHODS

A systematic literature search was performed for all papers on MSD published in SJWEH. Each paper was coded on several criteria including research topic, type of MSD, risk factor(s), and number of citations. Findings were tabulated, and discussions within the author team defined the main results and future research directions.

RESULTS

The search resulted in 1056 papers, of which 474 were included. The most reported-on MSD was low-back pain (LBP, 18%) and the most reported-on work-related risk factors were physically demanding work (14%) and psychosocial factors (12%). Research has contributed to improving case definitions, refining work-related exposure criteria, and recognizing the varying importance of physical and psychosocial factors across different MSD. Research on the association between work-related risk factors and LBP continues to emerge. Effective interventions for prevention of MSD are characterised by sufficient exposure reduction, while supporting work participation requires integrating health care, with multidisciplinary actions directed at factors involving the worker, employer, and workplace.

CONCLUSION

Research has provided valuable insights into risk assessment, interventions for preventing work-related MSD, and supporting work participation. Intervention studies remain warranted and new areas include adopting whole-system approaches to prevent work-related MSD and promoting the concept of musculoskeletal health.

Physical activity, musculoskeletal disorders, burnout, and work engagement: a cross-sectional study on Italian white-collar employees

Introduction

Both mental and physical health of office workers had a positive relationship with their work engagement, with the latter relationship being driven by the association of a healthy diet and physical activity (PA). This observational study aimed to investigate the associations between PA levels, musculoskeletal disorders (MSDs), burnout, and work engagement, in a sample of white-collar employees.

Methods

A total of 615 workers (age 42.2 ± 9.5 years) successfully completed an online questionnaire comprising work-related information and standardized questionnaires on PA, MSDs, burnout and work engagement.

Results

36.9% of the participants did not meet the PA guidelines, 19.0% adhered to them, and 44.1% exceeded them. A significant portion of participants reported suffering from MSDs, primarily neck/shoulder and/or low back/hip pain. Those exceeding PA guidelines had fewer MSDs compared to non-compliant participants and exhibited better mental health and work engagement. Compliance with PA guidelines was associated with a 38% reduced risk of emotional exhaustion, with an even greater reduction of 47% among those surpassing the guidelines.

Discussion

PA could exert a positive effect on physical and mental health of employees, but only if performed above a certain amount. The study supports the need to identify workplaces as suitable for health-focused interventions and lifestyle changes.

Dual trajectories of short-term and long-term sickness absence and their social- and health-related determinants among women in the public sector

BACKGROUND

Short- and long-term sickness absence (SA) vary in their determinants. We examined short- and long-term SA contemporaneously as two interconnected phenomena to characterize their temporal development, and to identify employees with increasing SA at an early stage.

METHODS

We extracted 46- to 55-year-old employed women from the Helsinki Health Study occupational cohort during 2000-17 (N = 3206) and examined the development of short- (1-14 days) and long-term (>14 days) SA using group-based dual trajectory modelling. In addition, we investigated the associations of social-, work- and health-related factors with trajectory group membership.

RESULTS

For short-term SA, we selected a three-group solution: 'no short-term SA' (50%), 'low frequency short-term SA' (40%), and 'high frequency short-term SA' (10%) (7 spells/year). For long-term SA, we also selected three trajectory groups: 'no long-term SA' (65%), 'low long-term SA' (27%), and 'high long-term SA' (8%). No SA in the short-term SA model, indicated a high probability of no SA in the long-term model and vice versa. The developmental pattern was far less certain if participant was assigned to a trajectory of high SA in either one of the models (short- or long-term SA model). Low occupational class and poor health behaviours were associated with the trajectory groups with more SA.

CONCLUSION

SA does not increase with age among most employees. If either SA rate was high, the developmental patterns were heterogenous. Employers' attention to health behaviours might aid in reducing both short- and long-term SA.

Development and feasibility of a function-based preventive intervention for lifestyle-related disorders

BACKGROUND

The enormous effect of lifestyle-related disorders on health of the global population warrants the development of preventive interventions. Focusing on musculoskeletal health and physical activity may be a way to encourage necessary lifestyle changes by making them more concrete and understandable. The aims of the current study were to develop a function-based preventive intervention aimed at lifestyle-related disorders in physically inactive 40-year-old people and to investigate the feasibility of the intervention. The feasibility study aimed to solve practical and logistical challenges and to develop the intervention based on the experiences of participants and involved clinical personnel according to defined criteria.

METHODS

Development of the standardised functional examination was based on literature-validated tests and clinical reasoning. Development of a risk profile was based on the functional examination and similar profiles which have already proved feasible. The feasibility of the functional examination and risk profile, together with function-based lifestyle counselling was tested on 27 participants in a pilot study with two physiotherapist examinations over a four-month period. Practical results and feedback from participants and collaborating personnel were examined.

RESULTS

The functional examination consists of 20 established tests not requiring specialised equipment or training which were deemed relevant for a middle-aged population and a sub-maximal ergometer test. The risk profile consists of seven functional dimensions: cardiovascular fitness, strength in upper extremity, lower extremity and trunk, mobility, balance and posture, and three non-functional dimensions: weight, self-assessed physical activity and pain. Each dimension contains at least two measures. The participants appreciated the intervention and found it motivating for making lifestyle changes. They found the tests and risk profile understandable and could see them as tools to help achieve concrete goals. The examination required 60-75 min for one physiotherapist. The recruitment rate was low and recruited participants were highly motivated to making lifestyle changes.

CONCLUSION

This project developed a functional test battery and risk profile aimed at inactive 40-year-olds which fulfilled our feasibility criteria. Functional screening and lifestyle counselling were found to be of value to a sub-group of inactive 40-year-olds who were already motivated to improve their health situations.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05535296 first posted on 10/09/2022.

Older adults' perceptions of online physical exercise management

The study addresses the challenges of digitally transforming physical exercises for older adults (aged more than 55 years) to be performed in virtual environments (during the COVID-19 pandemic) as a long-term proactive strategic initiative in response to the global ageing society and technological development trend. A focus group with a sample of 24 older adults and three trainers were used as part of a 3-month physical exercise pilot conducted by the Jožef Stefan Institute to identify the skills and well-being gained and identify factors that influence success with online exercises for older adults on the individual and organisational levels. First, on the individual level, communication differences were identified when comparing face-to-face exercises with online exercises. Second, on the organisational level, the study identified several challenges arising from the digital transformation of exercises (i.e., onboarding, technical, structural, isolation and motivational). Finally, recommendations are proposed to transform older adults' exercises when performed in a virtual environment. The study results can also benefit health management practices and theory in the work environment to ensure that older workers can still utilise their strengths to perform successfully while remaining healthy. Online physical exercises tailored to older adults' needs and specifications could be provided as part of corporate wellness programmes in organisations.

Association between healthy lifestyle combinations and periodontitis in NHANES

BACKGROUND

Periodontitis is closely associated with chronic systemic diseases. Healthy lifestyle interventions have health-enhancing effects on chronic systemic disorders and periodontitis, but the extent to which healthy lifestyle combinations are associated with periodontitis is unclear. Therefore, this study aimed to investigate the association between periodontitis and different healthy lifestyle combinations.

METHODS

5611 participants were included from the National Health and Nutrition Examination Survey (NHANES, 2009-2014). Six healthy lifestyles factors were defined as fulfilling either: non-smoking, moderate drinking, moderate body mass index (BMI), physical activity, healthy sleep and appropriate total energy intake. Then, the adjusted logistic regression models were performed to identify the association between the periodontitis and the scoring system composed of six lifestyles (0-6 scale). Finally, different scenarios were dynamically and randomly combined to identify the optimal and personalized combination mode.

RESULTS

Higher healthy lifestyle scores were significantly associated with lower periodontitis prevalence (p < 0.05). Four lifestyle factors (smoking, drinking, BMI, and sleep) significantly varied between the periodontitis and healthy groups (p < 0.05). Smoking was considered as a strong independent risk factor for periodontitis in both former and current smokers. Results further indicated that the combination of these four lifestyles played the most essential role in determining the magnitude of periodontitis occurrence (odds ratio [OR]: 0.33; 95% confidence interval [CI]: 0.21 to 0.50). In the total population, the majority of three lifestyle combinations outperformed the two combination models, whereas the two-combination of nonsmoking-drinking (OR: 0.39; 95% CI: 0.27 to 0.58) had relatively lower periodontitis prevalence than the three-combination of healthy drinking-BMI-sleep (OR: 0.42; 95% CI: 0.26 to 0.66).

CONCLUSION

This cross-sectional study suggests that smoking, drinking, BMI, and sleep are significantly related with periodontitis and smoking is the principal risk factor related among them. This study provides various customized lifestyle combinations for periodontitis prevention.

Projected health and economic effects of the increase in childhood obesity during the COVID-19 pandemic in England: The potential cost of inaction

BACKGROUND

The prevalence of overweight and obesity in young children rose sharply during the COVID-19 pandemic. Here we estimate the potential future health and economic effects of these trends in England.

METHODS

Using publicly available annual Body Mass Index (BMI) data from 2006-2022, we calculated the increase in overweight/obesity prevalence (BMI ≥85th reference percentile) during the COVID-19 pandemic among children aged 4-5 and 10-11, and variation by deprivation and ethnicity. We projected the impact of child BMI trends on adult health measures to estimate added lifelong medical and social costs.

RESULTS

During 2020-2021 there were steep increases in overweight and obesity prevalence in children. By 2022, overweight and obesity prevalence in children aged 4-5 returned to expected levels based on pre-pandemic trends. However, overweight and obesity prevalence in children aged 10-11 persisted and was 4 percentage points (p<0.001) higher than expected, representing almost 56,000 additional children. The increase was twice as high in the most compared with the least deprived areas. The additional lifelong healthcare cost in this cohort will amount to £800 million with a cost to society of £8.7 billion. We did not find an increase in maternal obesity associated with the COVID-19 pandemic, however, prevalence grew faster in the post pandemic period.

DISCUSSION

The return of overweight and obesity prevalence to pre-pandemic trends in children aged 4-5 provides a clear policy target for effective intervention to tackle this growing and serious population health concern.

The social return on investment of physical activity and nutrition interventions-a scoping review

Introduction

Scarcity of resources and mounting pressures on health systems make it critical to evaluate new and existing public health interventions related to physical activity and nutrition. The Social Return on Investment (SROI) framework has gained prominence for capturing traditional variables such as economic costs and returns, as well as wider beneficial social and environmental outcomes. A scoping review was conducted to present the existing evidence on the SROI of physical activity and nutrition interventions, demonstrating the wider benefits of these interventions.

Methodology

Existing peer-reviewed evidence and grey literature was collated to identify physical activity and nutrition interventions that were evaluated using the SROI framework between January 1996 up until February 2022. Only literature published in the English language, interventions that were conducted in high-income countries were considered for inclusion. Study information and economic data was entered into a pre-prepared data extraction sheet and eligible studies were quality assessed using a 12-point quality assessment framework for SROI studies.

Results

This review identified a total of 21 SROI studies, with only four deriving from peer-reviewed literature sources. In total, 18 studies evaluated physical activity interventions, one study was purely focused on nutrition, whereas the two remaining studies presented a mix of physical activity and nutrition. The majority of studies derived from the United Kingdom (n = 16) with very few of the studies published prior to 2010 (n = 1). In total, four studies were classified as low quality based on the 12-point quality assessment framework used for this review. Outcomes of the relevant studies show that the benefits of these interventions have added value to families, communities and the wider environments of the target groups.

Conclusion

This scoping review is adding to research conducted to understand the wider value of public health interventions such as physical activity and nutrition interventions using the SROI framework. This is important so that the development and implementation of public health interventions have the greatest value to people and society, which also benefits decision-makers to effectively and sustainably allocate scarce resources.

Psychosocial factors associated with sickness absence in employees at a federal public university

Introduction

There is a need to understand which factors are associated with sickness absence in the context of public service in order to guide efforts to prevent illness in workers.

Objectives

We investigated whether lifestyle, locus of health control, work-related stress, and self-perception of physical and mental health are associated with sickness absence from a biopsychosocial perspective.

Methods

This is a cross-sectional study using an online questionnaire and the participants comprised 898 employees at a federal university. The assessment included instruments on sociodemographic and occupational characteristics, sickness absence, lifestyle (FANTASTIC Lifestyle scale), locus of control (Multidimensional Health Locus of Control Scale), workrelated stress (Health Safety Executive), and physical and mental health (Short-Form Health Survey 12 - version 2). A Poisson regression model was constructed using Generalized Estimating Equations to identify the variables associated with sickness absence, with a p ≤ 0.05 significance level.

Results

We found that work-related stress, locus of control, physical and mental health, administrative or technical job role, female gender, and longer service time at the institution were associated with a higher number of days absent from work due to illness (for all associations, p < 0.001).

Conclusions

The present study contributes to the literature by offering additional data on sickness absence in the context of Brazilian public university employees.

Moderating effect of cardiorespiratory fitness on sickness absence in occupational groups with different physical workloads

Sickness absence from work has a large adverse impact on both individuals and societies in Sweden and the costs for sickness absence were calculated to 64.6 billion Swedish kronor (approx. 5.6 billion in Euros) in 2020. Although high cardiorespiratory fitness may protect against potential adverse effects of high physical workload, research on the moderating effect of respiratory fitness in the relation between having an occupation with high physical workload and sickness absence is scarce. To study the moderating effect of cardiorespiratory fitness in the association between occupation and psychiatric, musculoskeletal, and cardiorespiratory diagnoses. Data was retrieved from the HPI Health Profile Institute database (1988-2020) and Included 77,366 participants (mean age 41.8 years, 52.5% women) from the Swedish workforce. The sample was chosen based on occupational groups with a generally low education level and differences in physical workload. Hurdle models were used to account for incident sickness absence and the rate of sickness absence days. There were differences in sickness absence between occupational groups for musculoskeletal and cardiorespiratory diagnoses, but not for psychiatric diagnoses. In general, the association between occupation and musculoskeletal and cardiorespiratory diagnoses was moderated by cardiorespiratory fitness in most occupational groups with higher physical workload, whereas no moderating effect was observed for psychiatric diagnoses. The study results encourage community and workplace interventions to both consider variation in physical workload and to maintain and/or improve cardiorespiratory fitness for a lower risk of sickness absence, especially in occupations with high physical workload.

Productivity-adjusted life-years and correlates of uncontrolled hypertension at two health facilities in Zambia

BACKGROUND

Hypertension has in the recent past surfaced as one of the conditions that has a significant impact on workforce productivity in emerging economies. Zambia is no different and has in the recent past recorded increasing cases. Despite the impact of hypertension being of great importance in regards to productivity, we have scarcity of data and studies on hypertension-related Productivity-Adjusted Life-Years (PALYs) in Zambia and Africa at large. This study assessed the impact of hypertension on PALYs lost and socioeconomic factors associated with nonadherence to antihypertensive medication (NATAM).

METHODS

This was a cross-sectional study of 198 participants from Livingstone University Teaching Hospital and Maramba Clinic situated in Livingstone, Zambia. Structured questionnaires were used to collect data. Productivity index multiplied by years lived was used to calculate PALYs and descriptive statistics were used to summarize sociodemographic, clinical and economic variables. Multivariable logistic regression was used to determine factors associated with NATAM.

RESULTS

The participants had a median age (interquartile range (IQR)) of 49 years (41, 59) and 60.1% (n = 119) were females while 39.9% (n = 79) were male. Our estimated PALYs lost per person due to hypertension were 0.2 (IQR 0.0, 2.7). Cumulative PALYs value lost due to the burden of hypertension was estimated to be at $871,239.58 in gross domestic product (GDP). The prevalence of NATAM was 48% (n = 95). The factors that were significantly associated with NATAM were age (odds ratio (OR) 0.94; 95% confidence interval (CI) 0.90, 0.98), female sex (OR 2.52; 95%CI 1.18, 5.40), self-employment (OR 2.57; 95%CI 1.02, 6.45) and absenteeism from work (OR 3.60; 95%CI 1.16, 11.22).

CONCLUSIONS

Findings in our study highlight a high economic loss of PALYs due to hypertension with a potential to impact GDP negatively. We also found that NATAM reduced productivity and income among individuals of working age further impacting PALYs lost due to hypertension. The factors associated with NATAM were age, sex, employment status and absenteeism from work. This study underscores the need for interventions targeting young people, females, self-employed individuals, and absentees at work to improve adherence to antihypertensive drugs in order to reduce PALYs lost due to hypertension.

Seasonal patterns of sickness absence due to diagnosed mental disorders: a nationwide 12-year register linkage study

AIMS

Although seasonality has been documented for mental disorders, it is unknown whether similar patterns can be observed in employee sickness absence from work due to a wide range of mental disorders with different severity level, and to what extent the rate of change in light exposure plays a role. To address these limitations, we used daily based sickness absence records to examine seasonal patterns in employee sickness absence due to mental disorders.

METHODS

We used nationwide diagnosis-specific psychiatric sickness absence claims data from 2006 to 2017 for adult individuals aged 16-67 (n = 636,543 sickness absence episodes) in Finland, a high-latitude country with a profound variation in daylength. The smoothed time-series of the ratio of observed and expected (O/E) daily counts of episodes were estimated, adjusted for variation in all-cause sickness absence rates during the year.

RESULTS

Unipolar depressive disorders peaked in October-November and dipped in July, with similar associations in all forms of depression. Also, anxiety and non-organic sleep disorders peaked in October-November. Anxiety disorders dipped in January-February and in July-August, while non-organic sleep disorders dipped in April-August. Manic episodes reached a peak from March to July and dipped in September-November and in January-February. Seasonality was not dependent on the severity of the depressive disorder.

CONCLUSIONS

These results suggest a seasonal variation in sickness absence due to common mental disorders and bipolar disorder, with high peaks in depressive, anxiety and sleep disorders towards the end of the year and a peak in manic episodes starting in spring. Rapid changes in light exposure may contribute to sickness absence due to bipolar disorder. The findings can help clinicians and workplaces prepare for seasonal variations in healthcare needs.

Predicting long-term sickness absence with employee questionnaires and administrative records: a prospective cohort study of hospital employees

OBJECTIVE

This study aimed to compare the utility of risk estimation derived from questionnaires and administrative records in predicting long-term sickness absence among shift workers.

METHODS

This prospective cohort study comprised 3197 shift-working hospital employees (mean age 44.5 years, 88.0% women) who responded to a brief 8-item questionnaire on work disability risk factors and were linked to 28 variables on their working hour and workplace characteristics obtained from administrative registries at study baseline. The primary outcome was the first sickness absence lasting ≥90 days during a 4-year follow-up.

RESULTS

The C-index of 0.73 [95% confidence interval (CI) 0.70-0.77] for a questionnaire-only based prediction model, 0.71 (95% CI 0.67-0.75) for an administrative records-only model, and 0.79 (95% CI 0.76-0.82) for a model combining variables from both data sources indicated good discriminatory ability. For a 5%-estimated risk as a threshold for positive test results, the detection rates were 76%, 74%, and 75% and the false positive rates were 40%, 45% and 34% for the three models. For a 20%-risk threshold, the corresponding detection rates were 14%, 8%, and 27% and the false positive rates were 2%, 2%, and 4%. To detect one true positive case with these models, the number of false positive cases accompanied varied between 7 and 10 using the 5%-estimated risk, and between 2 and 3 using the 20%-estimated risk cut-off. The pattern of results was similar using 30-day sickness absence as the outcome.

CONCLUSIONS

The best predictive performance was reached with a model including both questionnaire responses and administrative records. Prediction was almost as accurate with models using only variables from one of these data sources. Further research is needed to examine the generalizability of these findings.

Reach and effectiveness of a worksite health promotion program combining a preventive medical examination with motivational interviewing; a quasi-experimental study among workers in low socioeconomic position

BACKGROUND

This study aimed to evaluate individual characteristics associated with participation and effectiveness of a worksite health promotion program with motivational interviewing targeting health and health behaviour among Dutch workers in low socioeconomic position.

METHODS

In a production company and a hospital, 838 workers were invited for a Preventive Medical Examination and subsequent coaching with motivational interviewing up to 7 sessions within 6 months. Follow-up information was collected after 6 months. Characteristics associated with participation in coaching were assessed with logistic regression models. The effectiveness of coaching on body mass index (BMI), bodyweight, self-rated health, vigorous physical activity, smoking, alcohol intake, fruit- and vegetable consumption, work ability, and sickness absence was evaluated with linear regression models and on participation in health promotion activities with logistic regression analysis. The analyses on effectiveness were performed without and with propensity score adjustment.

RESULTS

Of the 838 invited workers, 313 workers participated in the Preventive Medical Examination and follow-up data were available for 176 workers, of whom 100 workers with increased cardiovascular risk attended coaching. The majority of workers with obesity (73%), overweight (60%), and unhealthy behaviours (58%-69%) at baseline participated in motivational interviewing. Males, workers with overweight or obesity, workers at the production company, workers with insufficient vigorous physical activity, and workers with a low educational level were most likely to participate in coaching. Coaching with motivational interviewing after the Preventive Medical Examination was associated with a 4.74 times higher likelihood [95% confidence interval (CI): 1.99;11.32] to participate in health promotion activities and 10.9% (95%CI: 0.6;21.3) more persons who quit smoking compared to workers without coaching. No statistically significant effects were observed on BMI, bodyweight, health, health behaviour, work ability and sickness absence.

CONCLUSIONS

The program combining a Preventive Medical Examination with follow-up coaching reached - as intended - workers with obesity or overweight, those with a low education and with unhealthy behaviours. Adding coaching with motivational interviewing to a Preventive Medical Examination contributed to higher participation in health promotion activities and an increase in smoking cessation after 6 months among workers with a lower socioeconomic position, but was not effective on other outcomes.

TRIAL REGISTRATION

The study was registered retrospectively in the Netherlands Trial Register as NL8178 on 22/11/2019.

Associations between improvements in psychological variables and subsequent sick leave among persons receiving a multimodal intervention for exhaustion disorder

BACKGROUND

The incidence of sick leave due to stress-related disorders such as exhaustion disorder (ED) is high in many economically developed countries. Meanwhile, knowledge about facilitating return to work during clinical interventions for ED patients is still limited. The current study aimed to investigate if improvements in exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability during treatment of ED were associated with subsequent sick leave in the year following treatment.

METHODS

Using a cohort of 880 ED patients who had participated in a multimodal intervention based on Cognitive Behavior Therapy, we estimated the association between one standard deviation (SD) improvement in treatment-related variables and the rate of net days of sick leave one-year following treatment.

RESULTS

Our results showed that improvements in all treatment-related variables were associated with lower sick leave rates one year following treatment. Improvements in exhaustion symptoms (rate ratio (RR): 0.70 [95% CI 0.66; 0.75]) and self-perceived work ability (RR 0.56 [95% CI 0.50; 0.63]) showed the strongest associations to subsequent sick leave.

CONCLUSIONS

These findings suggest that interventions focusing on exhaustion symptoms, insomnia, perfectionistic behaviors, psychological flexibility, and perceived work ability can have a meaningful impact on ED patients' subsequent sick leave.

TRIAL REGISTRATION

Clinicaltrials.gov (Identifier: NCT03360136).

International Society for the Advancement of Spine Surgery Statement: Restorative Neurostimulation for Chronic Mechanical Low Back Pain Resulting From Neuromuscular Instability

This International Society for the Advancement of Spine Surgery statement has been generated to respond to growing requests for background, supporting literature and evidence, and proper coding for restorative neurostimulation for chronic low back pain. Chronic low back pain describes the diverse experience of a significant proportion of the population. Conservative management of these patients remains the predominant care pathway, but for many patients, symptom relief is poor. The application of new techniques in patients who have exhausted traditional care paradigms should be undertaken with a detailed understanding of the pathology being treated, the mechanisms involved, and the data supporting efficacy. This statement on restorative neurostimulation places this technology in the context of the current understanding of the etiology of mechanical low back pain and the currently available evidence for this technique. In an appropriately selected cohort with a specific subset of chronic low back pain symptoms, this technique may provide benefit to payers and patients.

Musculoskeletal pain intensity and risk of long-term sickness absence in the general working population: A prospective cohort study with register follow-up

Determining predictors of sickness absence could allow for better screening, guidance, and development of preventive efforts aimed at those in increased risk. This study aimed to determine the prospective association between musculoskeletal pain intensity and risk of incident register-based long-term sickness absence in the general working population, as well as to determine the population attributable fraction. Drawing on data from a nation-wide questionnaire survey, this prospective cohort study followed a representative sample of the Danish general working population without recent long-term sickness absence (≥6 consecutive weeks) (n = 69,273) for long-term sickness absence up to two years (mean follow-up: 93 weeks) in a national register. The predictor was musculoskeletal pain intensity in the neck/shoulder and low-back during the preceding three months rated on an 11-point numerical rating scale from 0 to 10. The weighted incidence of long-term sickness-absence was 8.9% during two-year follow-up (n = 6165). We observed a clear dose-response association between musculoskeletal pain intensity of the neck/shoulder or low-back and the risk of incident long-term sickness absence, with a lower threshold of increased risk of 4 and 3 (scale 0-10) for neck/shoulder (HR (95% CI): 1.25 (1.09-1.42)) and low-back pain (HR (95% CI): 1.13 (1.00-1.29)), respectively. Prevention of pain intensities at or above 4 out of 10 could potentially prevent 17% (population attributable fraction, PAF (95% CI): 16.8 (13.6-20.1)) of the total long-term sickness absence in the general working population. Large-scale interventions to prevent and manage musculoskeletal pain need to be documented and implemented.

Is there a bidirectional relationship between workplace bullying and the risk of sickness absence? Systematic review and meta-analysis of prospective studies

Exposure to workplace bullying increases the risk of sickness absence. However, the extent and direction of this relationship for different follow-up lengths are not well established. To provide evidence regarding the direction and extent of the relationship between workplace bullying and different durations of sickness absence. We searched nine databases from their inception to 29 November 2022. Multiple independent observers screened the literature, extracted the data and used the Risk Of Bias In Non-randomised Studies of Exposure to assess the methodological quality. The overall effect sizes of odds ratio, relative risk, hazard ratio and 95% confidence intervals were calculated. Our meta-analysis demonstrated a 26% increased risk of sick leave among workers exposed to workplace bullying for all follow-up lengths (95% CI 1.18 to 1.35), even after adjusting for confounding factors. Moreover, we found a significant association between long-term sickness absence and a higher likelihood of subsequent exposure to workplace bullying, with a pooled OR of 1.63 (95% CI 1.21 to 2.04). Our study established a bidirectional relationship between workplace bullying and long-term sickness absence, highlighting that it increases the risk of sickness absence at different follow-up lengths among employees who have been bullied. Hence, organisations should be mindful of workers who resume work after prolonged absences due to illness and adopt appropriate management strategies to prevent workplace bullying.

Long-term sickness absence trajectories among ageing municipal employees - the contribution of social and health-related factors

BACKGROUND

The ageing work force is heterogeneous, following distinct development in work ability. This study aims to identify trajectories of long-term sickness absence (SA) in later careers and to examine potentially modifiable factors associated with the development of SA.

METHODS

Data comprised of municipal employees of the city of Helsinki aged 50-60 years during 2004-2018 (N = 4729, 80% women). The developmental trajectories of long-term (> 10 working days) SA were examined with Group-based trajectory modelling (GBTM) using SA records of the Social Insurance Institution of Finland during 2004-2018. All-cause and diagnosis-specific (mental disorder- and musculoskeletal disease-related) SA days were analysed. The association of social and health-related factors with trajectory membership was examined using multinomial logistic regression (odds ratios and 95% confidence intervals).

RESULTS

A model with three trajectories was selected for both all-cause and diagnosis-specific SA. Regarding all-cause long-term SA trajectories, 42% had no long-term SA, 46% had low levels of SA, and 12% had a high rate of SA during follow-up. Lower occupational class, reporting smoking, overweight or obesity, moderate or low leisure-time physical activity, and sleep problems were associated with a higher likelihood of belonging to the trajectory with a high rate of SA in both all-cause and diagnosis-specific models.

CONCLUSIONS

Most ageing employees have no or little long-term SA. Modifiable factors associated with trajectories with more SA could be targeted when designing and timing interventions in occupational healthcare.

Latent classes of unhealthy behaviours and their associations with subsequent sickness absence: a prospective register-linkage study among Finnish young and early midlife employees

OBJECTIVES

Unhealthy behaviours are associated with increased sickness absence (SA), but few studies have considered person-oriented approach in these associations. Using latent class analysis, we examined clustering of unhealthy behaviours among Finnish municipal employees and their associations with subsequent SA.

DESIGN

A prospective register-linkage study.

SETTING

Unhealthy behaviours (low leisure-time physical activity, non-daily fruit and vegetable consumption, insufficient sleep, excessive alcohol use and tobacco use) were derived from the Helsinki Health Study questionnaire survey, collected in 2017 among 19- to 39-year-old employees of the City of Helsinki, Finland.

PARTICIPANTS

A total of 4002 employees (81% women) of the City of Helsinki, Finland.

PRIMARY OUTCOME MEASURES

The questionnaire data were prospectively linked to employer's SA register through March 2020. Associations between latent classes of unhealthy behaviours and subsequent SA (1-7 days/8+ days/all lengths) were examined using negative binomial regression.

RESULTS

Among women, a three-class latent class model was selected: (1) few unhealthy behaviours (84%), (2) excessive alcohol and tobacco use (12%) and (3) several unhealthy behaviours (5%). Women belonging to classes 2 and 3 had increased SA rates compared with those in class 1, regardless of the length of SA spells. Among men, a 2-latent class model was selected: (1) few unhealthy behaviours (53%) and (2) several unhealthy behaviours (47%). Men belonging to class 2 had increased rates of 1-7 days' SA compared with men in class 1.

CONCLUSIONS

This study suggests that preventive actions aiming to reduce employees' SA should consider simultaneously several unhealthy behaviours. Targeted interventions may benefit of identifying the clustering of these behaviours among occupational groups.

Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review

BACKGROUND

The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings.

OBJECTIVE

We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions.

METHODS

A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

RESULTS

In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%).

CONCLUSIONS

This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges.

TRIAL REGISTRATION

PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777.

Short High-Intensity Interval Exercise for Workplace-Based Physical Activity Interventions: A Systematic Review on Feasibility and Effectiveness

BACKGROUND

Workplace exercise interventions showed good results, but lack of time was often reported as a barrier to participation. To overcome this problem, several studies attempted to implement short high-intensity interval training (HIT) within the workplace.

OBJECTIVES

The aim of this systematic review is to explore the feasibility and effectiveness of HIT interventions within the workplace setting.

DATA SOURCES

A systematic literature search was conducted in PubMed and SPORTDiscus to identify articles related to HIT within the workplace.

STUDY ELIGIBILITY CRITERIA

Only interventions that consisted of HIT programmes within the workplace and tested at least one physiological, psychological, or work-related outcome were included.

RESULTS

Seven studies (317 participants) met the inclusion criteria. HIT interventions lasted 6-12 weeks, with a frequency of 2-4 sessions/week and a duration of 8-30 min per session. Feasibility was qualitatively investigated in four studies, with key positive aspects reported for HIT time-appeal, the sense of competence driven by individual intensity, and improved intention to exercise; five studies reported adherence rates > 80%. Small-to-large effect sizes were reported for improvements in cardiorespiratory and muscular fitness. Small-to-medium effect sizes were reported for blood parameters and health-related quality of life.

CONCLUSIONS

HIT interventions in the workplace showed limited effectiveness in improving health-related outcomes, while promising results regarding feasibility were reported, mainly due to the time-efficiency and the positive post-exercise psychosocial responses. However, further high-quality studies involving more participants are still needed to make firm conclusions on HIT effectiveness and feasibility compared to other types of exercise in this context.

Developing Action Plans Based on Machine Learning Analysis to Prevent Sick Leave in a Manufacturing Plant

OBJECTIVE

We aimed to develop action plans for employees' health promotion based on a machine learning model to predict sick leave at a Japanese manufacturing plant.

METHODS

A random forest model was developed to predict sick leave. We developed plans for workers' health promotion based on variable importance and partial dependence plots.

RESULTS

The model showed an area under the receiving operating characteristic curve of 0.882. The higher scores on the Brief Job Stress Questionnaire stress response, younger age, and certain departments were important predictors for sick leave due to mental disorders. We proposed plans to effectively use the Brief Job Stress Questionnaire and provide more support for younger workers and managers of high-risk departments.

CONCLUSIONS

We described a process of action plan development using a machine learning model, which may be beneficial for occupational health practitioners.

Sick Leave Patterns in Common Rheumatological Diseases

Objectives The study aims to analyze the patterns and determinants of sick leaves (SL) associated with the most common rheumatological diseases and estimate the associated productivity loss cost (PLC). Method A retrospective study reviewed all SLs that were issued from a rheumatology outpatient clinic between 2016 and 2019 for the following diagnoses: low back pain (LBP), knee osteoarthritis (OA), rheumatoid arthritis (RA), and disc disorders. The duration of each sick leave was captured and analyzed by patients' age category, gender, and diagnosis. The human capital method was used to estimate the PLC. Result One thousand and two SLs have been issued during the study period, for a cumulative 4,649 days. The majority of the patients were female (86.3%), and the mean (SD) age was 42.01 (10.71) years. SL durations ranged from 2 to 14 days. The most frequent diagnosis was RA (34.3%), followed by LBP (30.1%). Disc disorder, knee OA, and RA were independently associated with 2.01 (p=0.014), 9.07 (p<0.001), and 7.75 (p<0.001) odd ratios for long SL (≥7 days), by reference to LBP. The average PLC was estimated at $235.29 per day of sick leave, for a total cumulative cost of $235,755.30. Conclusion Rheumatological diseases are responsible for approximately 4.5 days of SL prescribing per day in our clinic, with an average yearly cost of $58,938.83. Monitoring the pattern of sick leave and identifying the interplay between their cofactors are essential to developing a comprehensive approach to enable evidence-based clinical practices along with advancements in work-based protective measures and policies.

Employee perceptions of non-communicable diseases health risks, absenteeism and the role of organisational support in a South African pharmaceutical manufacturing company

BACKGROUND

The growing prevalence of non-communicable diseases (NCDs) in South African workers has been shown to be associated with absenteeism and increased risk of morbidity. Low-income workers living in urban settings are particularly vulnerable. Consultation with workers is crucial for understanding risks and identifying opportunities for intervention to promote health in the workplace. The purpose of this study was to examine South African pharmaceutical manufacturing workers' perspectives of health risk factors and absenteeism, and to identify how they perceived a role for the organisation to initiate interventions to improve their health.

MATERIALS AND METHODS

Five focus groups were conducted to capture 27 employees' perspectives. The semi-structured focus group discussions were recorded and analysed using a thematic content analysis approach.

RESULTS

Participants indicated that they were aware of behavioural health risks such as prolonged sitting. They showed insight into strategies to prevent injuries and stay healthy, but also expressed dissatisfaction about the lack of organisational support, leading to stress and consequently absenteeism. Participants emphasized the responsibility of the organisation to support a range of health promoting strategies.

CONCLUSIONS

The findings of this study are important for cultivating a tailored workplace intervention to reduce NCD risk factors in the pharmaceutical manufacturing workforce. It is vital that these be supported by leadership of the company through the provision of funding and the development of internal healthcare services.

Investigating the Association Between the Co-Occurrence of Behavioral Health Risk Factors and Sick Days in General Hospital Patients

Objectives: To investigate the co-occurrence of 4 behavioral health risk factors (BHRFs), namely tobacco smoking, alcohol at-risk drinking, physical inactivity and unhealthy diet and their association with sick days prior to hospitalization in general hospital patients.

Methods: Over 10 weeks (11/2020-04/2021), all 18-64-year-old patients admitted to internal medicine, general and trauma surgery, and otorhinolaryngology wards of a tertiary care hospital were systematically approached. Among 355 eligible patients, 278 (78.3%) participated, and 256 (72.1%) were analyzed. Three BHRF sum scores were determined, including current tobacco smoking, alcohol use, physical inactivity and 1 of 3 indicators of unhealthy diet. Associations between BHRF sum scores and sick days in the past 6 months were analyzed using multivariate zero-inflated negative binomial regressions.

Results: Sixty-two percent reported multiple BHRFs (≥2). The BHRF sum score was related to the number of sick days if any (p = 0.009) with insufficient vegetable and fruit intake as diet indicator.

Conclusion: The majority of patients disclosed multiple BHRFs. These were associated with sick days prior to admission. The findings support the need to implement interventions targeting multiple BHRFs in general hospitals.

Lifestyle, Demographic and Socio-Economic Determinants of Mental Health Disorders of Employees in the European Countries

Ensuring the health and well-being of workers should be a top priority for employers and governments. The aim of the article is to evaluate and rank the importance of mental health determinants: lifestyle, demographic factors and socio-economic status. The research study is based on EHIS 2013-2015 data for a sample of N = 140,791 employees from 30 European countries. The results obtained using machine learning techniques such as gradient-boosted trees and SHAPley values show that the mental health of European employees is strongly determined by the BMI, age and social support from close people. The next vital features are alcohol consumption, an unmet need for health care and sports activity, followed by the affordability of medicine or treatment, income and occupation. The wide range of variables clearly indicates that there is an important role for governments to play in order to minimize the risk of mental disorders across various socio-economic groups. It is also a signal for businesses to help boost the mental health of their employees by creating holistic, mentally friendly working conditions, such as offering time-management training, implementing morning briefings, offering quiet areas, making employees feel valued, educating them about depression and burnout symptoms, and promoting a healthy lifestyle.

Concurrent trajectories of self-rated health and working hour patterns in health care shift workers: A longitudinal analysis with 8-year follow-up

Background

The association between health and working hours is hypothesized to be reciprocal, but few longitudinal studies have examined changes in both health and working hour patterns over time. We examined combined trajectories of self-related health and two working hour patterns (working <35 h/week and working night shifts) and the extent to which these trajectories were predicted by employees' lifestyle and mental health.

Methods

Participants of this cohort study with a 8-year follow-up were 5,947 health care shift workers. We linked self-reports of health from three repeated surveys with objective pay-roll based data on working hours. Using group-based multi-trajectory analysis we identified concurrent trajectories for self-rated health and working hour patterns. We examined their associations with baseline lifestyle-related factors (smoking, at-risk alcohol use, obesity, and physical inactivity) and mental health (sleep problems and psychological distress) using multinomial regression analysis.

Results

Three combined trajectories of self-rated health and working <35 h/week and four combined trajectories of self-rated health and night work were identified. Unhealthy lifestyle and poor mental health were associated with trajectories of moderate and declining health. Sleep problems were linked with working <35 h/week. Younger age and good mental health were associated with a combined trajectory of good health and continued night shift work.

Conclusion

Trajectories of suboptimal and declining health are associated with trajectories of reducing working hours and leaving night work, and are more common in employees with unhealthy lifestyle, sleep problems, and psychological distress.

Can a Healthy Lifestyle Prevent Disability Pension among Female Healthcare Workers with Good and Poor Self-Rated Health? Prospective Cohort Study with 11-Year Register Follow-Up

BACKGROUND

Our purpose was to investigate whether healthy lifestyle habits prevent disability pension among female healthcare workers.

METHODS

We conducted a prospective cohort study with an 11-year register follow-up in which 8159 female healthcare workers from Denmark completed a questionnaire concerning self-rated health, work environment, leisure-time physical activity (LTPA), smoking, and body mass index (BMI). Data on disability benefit payments were obtained from the Danish Register for Evaluation of Marginalization during an 11-year follow-up. Potential confounders included age, occupational education, psychosocial work factors, and physical exertion during work.

RESULTS

Among workers in good health at baseline, smoking, obesity, and low levels of LTPA were risk factors for disability pension during 11-year follow-up. Among workers with poor health, only low levels of physical activity were a risk factor for disability pension.

CONCLUSIONS

This underscores the importance of a healthy lifestyle, specially being physically active, for preventing premature exit from the labor market in female healthcare workers.

Association of alcohol use with years lived without major chronic diseases: A multicohort study from the IPD-Work consortium and UK Biobank

Background

Heavy alcohol consumption increases the risk of several chronic diseases. In this multicohort study, we estimated the number of life-years without major chronic diseases according to different characteristics of alcohol use.

Methods

In primary analysis, we pooled individual-level data from up to 129,942 adults across 12 cohort studies with baseline data collection on alcohol consumption, drinking patterns, and history between 1986 and 2005 (the IPD-Work Consortium). Self-reported alcohol consumption was categorised according to UK guidelines - non-drinking (never or former drinkers); moderate consumption (1-14 units); heavy consumption (>14 units per week). We further subdivided moderate and heavy drinkers by binge drinking pattern (alcohol-induced loss of consciousness). In addition, we assessed problem drinking using linked data on hospitalisations due to alcohol abuse or poisoning. Follow-up for chronic diseases for all participants included incident type 2 diabetes, coronary heart disease, stroke, cancer, and respiratory disease (asthma and chronic obstructive pulmonary disease) as ascertained via linkage to national morbidity and mortality registries, repeated medical examinations, and/or self-report. We estimated years lived without any of these diseases between 40 and 75 years of age according to sex and characteristics of alcohol use. We repeated the main analyses using data from 427,621 participants in the UK Biobank cohort study.

Findings

During 1·73 million person-years at risk, 22,676 participants in IPD-Work cohorts developed at least one chronic condition. From age 40 to 75 years, never-drinkers [men: 29·3 (95%CI 27·9-30·8) years, women 29·8 (29·2-30·4) years)] and moderate drinkers with no binge drinking habit [men 28·7 (28·4-29·0) years, women 29·6 (29·4-29·7) years] had the longest disease-free life span. A much shorter disease-free life span was apparent in participants who experienced alcohol poisoning [men 23·4 (20·9-26·0) years, women 24·0 (21·4-26·5) years] and those with self-reported heavy overall consumption and binge drinking [men: 26·0 (25·3-26·8), women 27·5 (26·4-28·5) years]. The pattern of results for alcohol poisoning and self-reported alcohol consumption was similar in UK Biobank. In IPD-Work and UK Biobank, differences in disease-free years between self-reported moderate drinkers and heavy drinkers were 1·5 years or less.

Interpretation

Individuals with alcohol poisonings or heavy self-reported overall consumption combined with a binge drinking habit have a marked 3- to 6-year loss in healthy longevity. Differences in disease-free life between categories of self-reported weekly alcohol consumption were smaller.

Funding

Medical Research Council, National Institute on Aging, NordForsk, Academy of Finland, Finnish Work Environment Fund.

Diabetes, prediabetes, and long-term sickness absence due to mental disorders: Japan Epidemiology Collaboration on Occupational Health Study

OBJECTIVES

To investigate the association of diabetes and prediabetes with long-term sickness absence (LTSA) due to mental disorders or specific mental disorders.

METHODS

A prospective cohort study was conducted using data from the Japan Epidemiology Collaboration on Occupational Health Study. A total of 62,065 workers who received health check-ups in 2011 (nine companies) or 2014 (two companies) and were followed up to March 31, 2020 were included in this study. Diabetes status was defined based on the American Diabetes Association criteria, and diabetes was differentiated into diabetes with/without anti-diabetic treatment for additional analysis. A Cox proportional hazards regression model was used to investigate these associations.

RESULTS

During maximum 8-year follow-up period, 1024 participants underwent LTSA due to mental disorders. The adjusted hazard ratio (aHR) and corresponding 95% confidence interval (CI) of LTSA due to all mental disorders were 1.10 (0.88-1.38) and 1.45 (1.07-1.98) for prediabetes and diabetes, respectively. Diabetic individuals with/without treatment were both at a high risk of LTSA due to mental disorders. For specific mental disorders, diabetes was associated with a higher risk of LTSA due to reaction to severe stress and adjustment disorders (aHR = 3.02, 95% CI = 2.01-4.52) while it was marginally associated with LTSA due to depressive episode (aHR = 1.25, 95% CI = 0.98-1.60). Prediabetes was also associated with LTSA due to reaction to severe stress and adjustment disorders (aHR = 1.41, 95% CI = 1.08-1.84).

CONCLUSIONS

The present study suggests the importance of screening diabetes status and providing psychological support for decreasing the risk of LTSA due to mental disorders within working populations.

Physical Activity Advice for Prevention and Rehabilitation of Low Back Pain- Same or Different? A Study on Device-Measured Physical Activity and Register-Based Sickness Absence

Purpose We lack knowledge on whether the advice of "being physically active" should be the same for prevention and rehabilitation of low back pain (LBP). Sickness absence is a key outcome for LBP prevention and rehabilitation. We investigated the associations between physical activity and long-term sickness absence (LTSA) among employees with and without LBP. Methods Between 2011 and 2013, 925 Danish employees wore a Actigraph GTX3 accelerometer for 1-5 workdays to measure physical activity and reported LBP in past 7 days. Employees were followed for 4 years to determine their first register-based LTSA event (≥ 6 consecutive weeks). Results Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work (ie., sitting, standing and light-intensity activity) by 20 min was associated with 38% (95% CI 17%; 63%) higher LTSA risk. Increasing light-intensity activity at work by 20 min and decreasing 20 min from the remaining behaviors was associated with 18% (95% CI 4%; 30%) lower risk. During leisure, increasing moderate-to-vigorous-intensity activity by 20 min or standing by 40 min was associated with 26% (95% CI 3%; 43%) lower and 37% (95% CI 0%; 87%) higher risk, respectively. Among employees without LBP, we found no such associations. Conclusions The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity. At work, employees with LBP should be advised to spend time on light-intensity physical activity and limit their time on moderate-to-vigorous-intensity physical activity. During leisure, employees should spend time on moderate-to-vigorous-intensity physical activity.

Distribution of sickness absence risk across different levels and patterns of drinking: findings from the Stockholm Public Health Cohort

Aim:

This study estimated (i) the risk function between different indicators of alcohol use and long-term sickness absence, adjusting for possible confounding factors, (ii) whether the risk function between average volume of consumption and sickness absence is modified by heavy episodic drinking (HED), and (iii) to what extent the risk for sickness absence among abstainers is due to health selection bias.

Data and methods:

The study was based on data from the Stockholm Public Health Cohort 2006, with an analytical sample of 16,477 respondents aged 18–64 years. The outcome included register-based long-term (> 14 days) sickness absence. Negative binominal regression was used to estimate the association between sickness absence and average weekly volume of consumption, frequency of HED, and both in interaction.

Results:

Abstainers, chronic heavy drinkers and respondents with the highest frequency of HED had approximately two-fold higher rates of sickness absence relative to the reference groups, i.e., moderate drinkers and those with HED one to 6 times per year. Adjustment for confounding factors did not materially affect the shape of the risk function. After exclusion of abstainers with alcohol-related problems, or poor health, the estimates for abstainers became non-significant. Moderate drinkers with HED did not have significantly higher rates of sickness absence than moderate drinkers without HED.

Conclusions:

Our results suggest a significant association between alcohol use and sickness absence. There were indications that the U-shaped risk function may largely be due to health selection bias among abstainers. We found no indication of effect modification of HED on moderate drinking.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Obesity and sickness absenteeism among health workers in a private hospital in South Africa

Background

There is a worldwide trend among the general population including health workers to become more overweight and obese. Such obesity can reduce work ability as manifested through sickness absenteeism. The aim of this study was to describe the obesity among health workers in a private hospital in central South Africa, as measured by the body mass index (BMI) as well as the association of obesity and sickness absenteeism.

Methods

A cohort analytical study was conducted to describe changes in the BMI of employed health workers as well as the association of obesity and absenteeism in a private hospital in South Africa. The BMI measurement on employment, a repeat BMI at the time of the study as well as the sick leave days taken since employment of all health workers who had been employed for more than one year were analysed.

Results

Full time employees (n = 344) participated in the study of whom 33.7% were obese; 26.2% were overweight; 36.3% had normal weight and 3.7% were underweight at employment. On repeat BMI done in February 2016, 43.0% were obese; 27.6% were overweight; 28.2% had normal weight and 1.2% were underweight. There was no difference in the amount of sick leaves taken between the normal weight, overweight and obese groups.

Conclusion

A trend among health workers to change to a higher BMI category during employment is concerning, but there was no statistically significant association between the different weight groups and sickness absenteeism. The negative impact of obesity on the productivity of workers cannot be ignored.

Doenças osteomusculares são a principal causa de absenteísmo-doença entre trabalhadores da indústria de petróleo no Brasil: resultados de um estudo de coorte

Resumo Objetivo: descrever indicadores de absenteísmo-doença entre trabalhadores de indústria de petróleo. Métodos: estudo de coorte retrospectiva, realizado de 2012 a 2016, com dados secundários de prontuários médicos e de bases de dados da empresa. Foram calculados indicadores de absenteísmo por morbidade, características sociodemográficas e ocupacionais. Resultados: participaram 2.028 trabalhadores, do sexo masculino (87,6%), com idade maior ou igual a 50 anos (46,9%), nível médio de escolaridade (49,2%) e que trabalhavam em atividade não-operacional (65,1%). A incidência acumulada de afastamento do trabalho foi de 71,5% e a taxa de incidência de 25,8/100 pessoas-ano. Maiores taxas foram observadas entre mulheres (31,6), trabalhadores com 50 ou mais anos (29,9), 30 ou mais anos de serviço (31,9), menor escolaridade (29,2), em atividade operacional (27,9) e horário regular (26,1). Doenças osteomusculares (n=2001), respiratórias (n=1016) e digestivas (n=967) foram responsáveis pelo maior número de licenças. Os maiores números de dias de ausência ao trabalho foram por doenças osteomusculares (n=11640), lesões por causas externas (n=6267) e transtornos mentais (n=5042). Dor lombar foi o diagnóstico com maior número de dias de absenteísmo (n=3632). Conclusão: mulheres, trabalhadores com mais tempo de serviço e de menor escolaridade devem ser alvo de programas de saúde que visem o controle das morbidades identificadas.

Musculoskeletal diseases are the main cause of sick leave among oil industry workers in Brazil: results of a cohort study

Abstract Objective: to describe the incidence of sickness absence among workers of an oil industry in Brazil. Methods: retrospective cohort study conducted with 2,028 workers. Study data were obtained from workers’ medical records from 2012 to 2016. Indicators of absenteeism were calculated by sociodemographic characteristics, occupational characteristics, and morbidity. Results: of the participants, 87.6% were men, 49.2% with high school educational level, 46.9% aged 50 years or older, 65.1% worked in non-operational activities. The cumulative incidence of sick leave was 71.5% and its incidence rate, 25.8 per 100 person-years. We found the highest incidence rates amongst women (31.6), workers aged 50 years or older (29.9), lower educational attainment (29.2), work experience spanned 30 years or more (31.9), working in operational activities (27.9), and regular work schedule (26.1). Musculoskeletal (n=2,001), respiratory (n=1,016), and digestive diseases (n=967) were responsible for the largest number of sick leaves. The highest number of absence days was due to musculoskeletal diseases (n=11,640), followed by injuries (n=6,267) and mental disorders (n=5,042). Low back pain diagnostic was responsible for the greatest number of absence days (n=3,632). Conclusions: health programs aimed at controlling the identified morbidities should target women, those with longer work experiences, and those with lower educational attainment.

The Prospective Association Between Physical Activity, Insomnia Symptoms and Productivity in an Australian Population-based Cohort

OBJECTIVES

To investigate the joint, prospective associations of physical inactivity and insomnia symptoms and productivity using the 2013 and 2014 Household Income and Labor Dynamics in Australia Survey panel data.

METHODS

The association between i) presenteeism (yes/no, n=5864) and ii) absenteeism (sick leave days, n = 4324) and the mutually exclusive groups "active without insomnia", "active with insomnia", "inactive without insomnia" and "inactive with insomnia" was assessed.

RESULTS

Participants "active with insomnia" or "inactive with insomnia" had greater odds of presenteeism than those "active without insomnia" (OR = 1.41, 95%CI: 1.07-1.85 and OR=1.44, 95%CI: 1.14-1.83 respectively). Participants "inactive with insomnia" had a greater incidence of absenteeism than participants "active without insomnia" (IRR=1.28, 95%CI: 1.07-1.54).

CONCLUSIONS

Findings suggest improving physical activity levels and insomnia symptoms concurrently may improve productivity by reducing presenteeism and sick leave.

Causes of Sickness Absenteeism in Europe-Analysis from an Intercountry and Gender Perspective

This study aims to extract and explain the territorially varied relation between socioeconomic factors and absence rate from work due to own illness or disability in European countries in the years 2006-2020. For this purpose, several causes were identified, depending on men and women. To explain the absenteeism and emphasize gender as well as intercountry differences, geographically weighted regression was applied. For men, there were five main variables that influenced sickness absence: body mass index, the average rating of satisfaction by job situation, employment in the manufacturing sector, social benefits by sickness/health care, and performing health-enhancing physical activity. For women, there were five main variables that increased the absence rate: the risk of poverty or social exclusion, long-standing illness or health problems, employment in the manufacturing sector, social protection benefits, and deaths due to pneumonia. Based on the conducted research, it was proven that the sickness absence observed in the analyzed countries was highly gender and spatially diverged. Understanding the multifactorial factors playing an important role in the occurrence of regional and gender-divergent sickness absence may be a good predictor of subsequent morbidity and mortality as well as be very useful to better prevent this outcome.

Effects of a workplace exercise intervention on cardiometabolic health: study protocol for a randomised controlled trial

INTRODUCTION

The worldwide rising levels of physical inactivity especially in the United Arab Emirates (UAE) and the Eastern Mediterranean region are alarming. The UAE reports one of the highest rates of non-communicable disease mortality and insufficient physical activity (PA) is a major underlying cause. Therefore, action is required to reduce physical inactivity using evidence-based strategies. This study aimed to evaluate the efficacy of a worksite exercise intervention on cardiometabolic health in the UAE.

METHODS AND ANALYSIS

This is a protocol for a pragmatic parallel randomised controlled trial with a 1:1 allocation ratio to the intervention group and delayed intervention group. A total of 150 participants will be recruited from a semigovernment telecommunications company in Dubai (UAE) after meeting the eligibility criteria. The intervention group will receive 2 hours of exercise per week during working hours for 12 weeks (maximum 1 hour/day). The intervention group will be assigned to attend personal trainer sessions in the workplace gym throughout the intervention period. After the intervention is completed, the delayed intervention group will also receive 2 hours of exercise time per week from working hours for 4 weeks. The main outcome measure is the change in the cardiometabolic risk components, that is, systolic or diastolic blood pressure, waist circumference, glycated haemoglobin, fasting plasma glucose, low-density lipoprotein cholesterol from baseline to the end of the intervention. The secondary outcome is to examine whether the workplace exercise intervention improves PA levels 4 weeks postintervention.

ETHICS AND DISSEMINATION

The study has been approved by the Dubai Scientific Research Ethics Committee (DSREC-SR-08/2019_02). The results will be disseminated as follows: at various national and international scientific conferences; as part of a PhD thesis in Public Health at the College of Medicine and Health Sciences, UAE University; and in a manuscript submitted to a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT04403789.