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Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603 838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528 908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35–40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02–1·26; p=0·02) and incident stroke (1·33, 1·11–1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30–1·42). We recorded a dose–response association for stroke, with RR estimates of 1·10 (95% CI 0·94–1·28; p=0·24) for 41–48 working hours, 1·27 (1·03–1·56; p=0·03) for 49–54 working hours, and 1·33 (1·11–1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001). Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

ObjectiveThis study explored the role of occupational physical activity (OPA), physical demands and psychosocial work-related factors on low back pain (LBP) and neck–shoulder pain (NSP) amongst workers with physically demanding professions.MethodsData from 331 participants within the service and manufacturing sector in the Flemish Employees’ Physical Activity (FEPA) study were used, with objective measures of OPA and subjective measures of physical and psychosocial work environment. A modified Nordic questionnaire collected data on LBP and NSP.ResultsLBP (> 30 days over a year) was reported by 25% of participants, NSP (> 30 days over a year) by 30% and the composite measure of LBP/NSP simultaneously by 17%. Objective measures of OPA were not significantly associated with any pain groups. In the final model, self-reported physical demands were associated with NSP (OR 2.03, 95% CI 1.30–3.18) and LBP/NSP (OR 2.00, 95% CI 1.16–3.45) but not LBP. Job control was negatively associated with LBP (OR 0.59, 95% CI 0.35–0.99) and LBP/NSP (OR 0.54, 95% CI 0.3–0.98).ConclusionObjective measures were not associated with LBP or NSP. Self-reported measures provided insights into potential workplace hazards such as physical demands and job control which can be used to inform future strategies to prevent the development of LBP and NSP.

Background Occupational stress among healthcare professionals, especially those in emergency departments, is associated with high job demands and inadequate resources, impacting both service delivery and worker well-being. This study explored a participatory organizational intervention intended to reduce stress and improve working conditions among emergency department staff. Methods A one-group pretest‒posttest design was used to examine changes in outcomes among healthcare professionals ( n  = 59). Standardized self-report questionnaires administered before and after the intervention assessed perceived stress levels, psychosocial work factors, and general satisfaction. The nine-week intervention consisted of structured group discussions to identify stressors and co-develop solutions, followed by targeted adjustments in work processes and the environment. The primary outcome was perceived stress (Perceived Stress Scale-10, PSS-10). Secondary outcomes included working conditions (Danish Psychosocial Work Environment Questionnaire, DPQ). Paired samples t-tests compared pre- and posttest scores, and Pearson correlations assessed associations between process indicators and changes in perceived stress. Results Postintervention findings indicated a marginally significant reduction in perceived stress and improvements in several aspects of the psychosocial work environment, including work‒life balance and supervisory recognition. These results suggest that the participatory intervention may be associated with improvements in the perceived work environment. Process evaluation results indicated moderate employee engagement, with generally positive perceptions of involvement and overall satisfaction. A marginally significant negative correlation was found between employee involvement and stress reduction, suggesting that greater involvement was associated with greater decreases in perceived stress. Conclusions While the absence of a control group limits causal inference, the study offers exploratory evidence that participatory organizational approaches may be linked to perceived improvements in staff well-being and working conditions in emergency care settings. Further research using comparative designs is needed to confirm these preliminary findings and to better understand how participatory interventions might contribute to workforce sustainability in healthcare.

ObjectiveTo examine the relation between long working hours and change in body mass index (BMI).MethodsWe performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35–40 h, reference), 41–48 h, 49–54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25–29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline.ResultsOf the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90–1.00) for part-time work, 1.07 (1.02–1.12) for 41–48 weekly working hours, 1.09 (1.03–1.16) for 49–54 h and 1.17 (1.08–1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity.ConclusionsThis analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.

Objectives This study aimed to assess the feasibility and acceptability of using EMA questionnaires and physiological data via wristbands to measure day-to-day occupational stress, musculoskeletal pain, and mental health among university employees ( N  = 23), across 10 work days. Adherence to the study protocol as well as participant experiences (via semi-structured interviews) with the protocol were used to assess feasibility and acceptability of the method. Results Adherence to the study protocol was excellent. Participants wore the wristband for a mean of 9.7 days. Participants completed a mean of 24.5 EMAs (out of 30). Semi-structured interviews with participants revealed that a small number of participants had difficulties uploading data from the wristband. The timing of EMAs was challenging for some participants, resulting in missed EMAs, raising questions about whether EMA frequency and timing could be changed to improve adherence. Some EMA items were difficult to answer due to the nature of participants’ roles and the work undertaken. Overall, the protocol was feasible and acceptable but highlighted future potential changes including using a different physiological data collection tool, reducing the number of EMAs, adjusting EMA timings, and reviewing EMA items.

Background The Occupational Sitting and Physical Activity Questionnaire (OSPAQ) was developed as an easy-to-use instrument for self-reported assessment of percentage sitting, standing, walking, and performing heavy labour in a workplace setting. This study aimed to evaluate the concurrent validity of all dimensions of the OSPAQ compared to accelerometer-assessed measures of occupational physical activities in a mixed sample of sedentary and physically active professions. Methods Data from the Flemish Employees’ Physical Activity (FEPA) study were used, including employees from the service and production sector. All participants filled in a questionnaire, underwent clinical measurements, and wore two Axivity AX3 accelerometers for at least 2 consecutive working days. Intraclass (ICC) and Spearman rho correlations (r) were analyzed to assess concurrent validity. Results The sample included 401 workers (16% sedentary profession) with a mean age of 39.2 (± 11) years. Concurrent validity was good and moderate for assessing percentage of sitting (ICC = 0.84; r  = 0.53), and standing (ICC = 0.64; r  = 0.53), respectively. The concurrent validity for walking was weak to moderate (ICC = 0.50; r  = 0.49), and weak for performing heavy labour (ICC = 0.28; r  = 0.35). Stronger validity scores were found in sedentary professions for occupational sitting and standing. In physically active professions, an underestimation of self-reported sitting and standing was found, and an overestimation of self-reported walking and heavy labour. No significant self-reported over- or underestimation was found for sitting and heavy labour in sedentary professions, but an underestimation of self-reported standing and an overestimation of self-reported walking was observed. Conclusions The OSPAQ has acceptable measurement properties for assessing occupational sitting and standing. Accelerometer-assessed measures of occupational walking and heavy labour are recommended, since a poor concurrent validity was found for both.

Background This umbrella review aims to systematically synthesize the current evidence on the factors associated with personnel turnover in the healthcare and welfare sectors, the methodologies used to measure turnover, and the effectiveness of interventions designed to reduce turnover. Methods Following PRISMA-P guidelines, we analyzed data from January 2013 to July 2023 across multiple databases, including PubMed, Web of Science, CINAHL, Cochrane Database of Systematic Reviews, and Embase. Two reviewers independently screened titles and abstracts for predefined eligibility criteria. They also collaboratively examined 10% of the full texts to ensure compliance with these criteria. Study quality was evaluated using AMSTAR 2, and a Corrected Covered Area analysis was conducted. Results The analysis included 37 studies with a total of 511 primary studies. Turnover factors were grouped into three categories: socio-demographics and health status, work environment characteristics, and personal attitude and functioning, highlighting a wide range of factors that influence both turnover intention and actual turnover. Various measurement methodologies were identified, with a notable lack of standardization. Interventions targeting work-related factors showed mixed effectiveness, underscoring the importance of context-specific strategies. Conclusions The findings show the complexity and context-specific nature of turnover in healthcare and welfare sectors, requiring targeted, context-specific interventions to address the diverse factors involved. Standardization of measurement methodologies is necessary for comparing turnover rates and the effectiveness of interventions. Future research should focus on filling existing gaps, particularly in non-hospital settings, and on developing and evaluating multifaceted interventions.

OBJECTIVES: This prospective study aimed to investigate the relation between occupational physical activity (OPA), leisure-time physical activity (LTPA) and sickness absence (SA). A second aim was to explore the possible interaction effects between OPA and LTPA in determining SA. METHODS: The study is based on data from 304 workers in the service and manufacturing sector. Moderate-to-vigorous physical activity (MVPA) was measured by two Axivity AX3 accelerometers for 2–4 consecutive working days. Participants reported on the level of their physically demanding tasks by using a 5-item scale from the Job Content Questionnaire. Data on SA was provided by the administration departments of the participating companies during a 1 year follow-up period. We used negative binomial regression models for our statistical analysis. RESULTS: After adjusting for potential confounders, physically demanding tasks were significantly associated with a higher number of SA episodes and days. Accelerometer-assessed MVPA during leisure time but not during work was correlated with lower SA. Our results show a significant interaction effect between MVPA during work and leisure time in the sense that more MVPA during work increased the risk for SA days only among workers with low LTPA, but not among workers with moderate-to-high LTPA. CONCLUSIONS: Our results indicate that LTPA and OPA are related to opposite SA outcomes. MVPA during leisure time and work interact in their effect on SA, whereas we found no interaction effect between LTPA and self-reported physically demanding tasks in determining SA.

Background High levels of absenteeism, presenteeism, and productivity loss are significant issues, especially for small and medium-sized enterprises (SMEs), which form a large part of the workforce in Flanders. The FitBonus program, commissioned by the Flemish Government, aims to improve the physical, mental, and social well-being of employers and employees in SMEs. This protocol outlines the methodology for a realist evaluation of the FitBonus program to understand how, why, for whom and under what circumstances the program enhances overall well-being and perceived workability among employers and employees in SMEs in Flanders. Methods The evaluation is conducted in three phases: Phase 1 involves developing an Initial Program Theory (IPT) through stakeholder consultations, program documentation review, and literature review. Phase 2 validates the IPT using a mix of quantitative data from online surveys and qualitative data from interviews and focus groups. Phase 3 refines the IPT based on the findings, resulting in a detailed theory and practical recommendations. Discussion This realist evaluation protocol aims to elucidate the mechanisms and contextual factors influencing the FitBonus program’s potential success in improving physical, mental, and social well-being, as well as perceived workability. The insights gained from this evaluation will offer actionable recommendations for optimizing the program’s implementation and effectiveness. Additionally, by enhancing the understanding of how well-being interventions work in various organizational contexts, this study can inform the development of future workplace well-being programs, leading to more targeted and effective interventions.

Background While chronic workplace stress is known to be associated with health-related outcomes like mental and cardiovascular diseases, research about day-to-day occupational stress is limited. This systematic review includes studies assessing stress exposures as work environment risk factors and stress outcomes, measured via self-perceived questionnaires and physiological stress detection. These measures needed to be assessed repeatedly or continuously via Ecological Momentary Assessment (EMA) or similar methods carried out in real-world work environments, to be included in this review. The objective was to identify work environment risk factors causing day-to-day stress. Methods The search strategies were applied in seven databases resulting in 11833 records after deduplication, of which 41 studies were included in a qualitative synthesis. Associations were evaluated by correlational analyses. Results The most commonly measured work environment risk factor was work intensity, while stress was most often framed as an affective response. Measures from these two dimensions were also most frequently correlated with each other and most of their correlation coefficients were statistically significant, making work intensity a major risk factor for day-to-day workplace stress. Conclusions This review reveals a diversity in methodological approaches in data collection and data analysis. More studies combining self-perceived stress exposures and outcomes with physiological measures are warranted.