Scandinavian journal of work, environment & health最新文献

{"title":"Multidimensional employment precariousness mediates the association between low educational attainment and poor subjective well-being: results from a nationwide cross-sectional study in South Korea.","authors":"Seong-Uk Baek, Min-Seok Kim, Myeong-Hun Lim, Taeyeon Kim, Jong-Uk Won, Jin-Ha Yoon","doi":"10.5271/sjweh.4109","DOIUrl":"10.5271/sjweh.4109","url":null,"abstract":"<p><strong>Objective: </strong>This paper explored how multidimensional employment precariousness (MEP) mediates the relationship between educational attainment and subjective well-being.</p><p><strong>Methods: </strong>A nationwide sample of 46 919 Korean workers participated in surveys between 2017 and 2020. Educational attainment was divided into four categories: elementary school, middle school, high school, and college. Subjective well-being was assessed using the 5-item World Health Organization Well-Being Index, and MEP was evaluated using a modified version of the Employment Precariousness Scale (ERPES-E), with scores ranging from 0 to 100 and higher scores indicating worse employment precariousness. A counterfactual-based logistic mediation analyses were used to estimation.</p><p><strong>Results: </strong>The mean MEP score was 36.0 [standard deviation (SD) 12.1] for college education, 44.3 (SD 11.5) for high school, 49.5 (SD 10.1) for middle school, and 51.1 (SD 10.0) for elementary school. The prevalence of poor subjective well-being was 24.0% for college education, 31.3% for high school, 40.6% for middle school, and 44.8% for elementary school. Odds ratios (OR) for the total effect of education on the poor subjective well-being were 1.44 [95% confidence interval (CI) 1.37-1.53] for high school, 2.19 (95% CI 1.98-2.24) for middle school, and 2.40 (95% CI 2.04-2.82) for elementary school when compared to college education. The OR for the indirect effect mediated through MEP were 1.27 (95% CI 1.25-1.29) for high school, 1.46 (95% CI 1.42-1.51) for middle school, and 1.53 (95% CI 1.48-1.59) for elementary school, accounting for 63.9%, 48.5%, and 48.6% of the total effect, respectively.</p><p><strong>Conclusion: </strong>Our study suggests that MEP is an important contributor to the disparities in subjective well-being resulting from educational gradients.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"506-517"},"PeriodicalIF":6.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10833203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9885619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of a national, voluntary agreement for a more inclusive working life on work participation following long-term sickness absence: a Norwegian cohort study.","authors":"Rachel L Hasting, Ingrid S Mehlum, Karina Undem, Suzan J W Robroek, Alex Burdorf, Jon Michael Gran, Suzanne L Merkus","doi":"10.5271/sjweh.4112","DOIUrl":"10.5271/sjweh.4112","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to estimate the average individual effect of the company-level Norwegian Agreement on a More Inclusive Working Life (IA Agreement) on individuals' (i) sustained return to work after a sickness absence (SA) episode, and (ii) recurrent SA.</p><p><strong>Methods: </strong>Using register data, 79 253 men and 94 914 women born in Norway 1967-1976 were followed for one year between 2005 and 2010 after returning to work from an SA episode (>16 days). Weighted Cox proportional hazard models analysed time to first exit from work by companies' IA status (IA/non-IA). Weighted cumulative incidence differences between IA and non-IA groups with 95% bootstrapped confidence intervals (CI) were calculated for the competing events of full SA, graded (<100%) SA, unemployment/economic inactivity, education, disability pension, and death/emigration. Stabilised inverse probability of treatment weights balanced IA/non-IA groups according to nine covariates. Analyses were stratified by gender, and separately for two initial SA diagnoses (musculoskeletal and psychological).</p><p><strong>Results: </strong>Both men [adjusted hazard ratio (HR) 0.96, 95% CI 0.93-0.99] and women (adjusted HR 0.97, 95% CI 0.94-0.99) in IA companies were less likely to exit work in the year following SA. Similar findings were seen among individuals with musculoskeletal diagnoses and women with psychological diagnoses. Men with psychological diagnoses were more likely to exit work. Recurrent full and graded SA were more likely, and unemployment/economic inactivity less likely, in IA companies. However, the estimated effects were small and the CI often included the null.</p><p><strong>Conclusions: </strong>Individuals working in IA companies were more likely to remain in work. This was mainly due to reduced unemployment/economic inactivity, suggesting the IA Agreement may have influenced work participation through other means than reduced SA.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"466-476"},"PeriodicalIF":6.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10838625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9943939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trajectories of psychosocial working conditions and all-cause and cause-specific mortality: a Swedish register-based cohort study.","authors":"Kuan-Yu Pan, Melody Almroth, Alicia Nevriana, Tomas Hemmingsson, Katarina Kjellberg, Daniel Falkstedt","doi":"10.5271/sjweh.4111","DOIUrl":"10.5271/sjweh.4111","url":null,"abstract":"<p><strong>Objectives: </strong>While psychosocial working conditions have been associated with morbidity, their associations with mortality, especially cause-specific mortality, have been less studied. Additionally, few studies considered the time-varying aspect of exposures. We aimed to examine trajectories of job demand-control status in relation to all-cause and cause-specific mortality, including cardiovascular diseases (CVD), suicide, and alcohol-related mortality.</p><p><strong>Methods: </strong>The study population consisted of around 4.5 million individuals aged 16-60 years in Sweden in 2005. Job control and demands were respectively measured using job exposure matrices (JEM). Trajectories of job control and demands throughout 2005-2009 were identified using group-based trajectory modelling, and job demand-control categories were subsequently classified. Deaths in 2010-2019 were recorded in the national cause of death register. Cox regression models were used.</p><p><strong>Results: </strong>A total of 116 242 individuals died in 2010-2019. For both job control and demands, we identified four trajectories, which were parallel to each other and represented four levels of exposures. Low control and passive jobs were associated with higher all-cause, CVD, and suicide mortality among both men and women. High strain jobs were associated with higher all-cause and CVD mortality among men, while low control, passive jobs, and high strain jobs were associated with higher alcohol-related mortality among women.</p><p><strong>Conclusions: </strong>The trajectories identified may suggest stable levels of job control and demands over time. Poor psychosocial working conditions are related to all-cause and cause-specific mortality, and these patterns vary to some extent between men and women.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"496-505"},"PeriodicalIF":6.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10830330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9895548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of 'motivational interviewing' on sick leave: a randomized controlled trial in a social insurance setting.","authors":"Lene Aasdahl, Martin Inge Standal, Roger Hagen, Marit Solbjør, Gunnhild Bagøien, Heidi Fossen, Vegard Stolsmo Foldal, Johan Håkon Bjørngaard, Tarjei Rysstad, Margreth Grotle, Roar Johnsen, Egil A Fors","doi":"10.5271/sjweh.4117","DOIUrl":"10.5271/sjweh.4117","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the effectiveness of motivational interviewing (MI) - a counselling approach offered by caseworkers at the Norwegian Labor and Welfare Administration (NAV) - on return to work (RTW) for individuals sick-listed for ≥8 weeks due to any diagnoses. MI was compared to usual case management and an active control during 12 months of follow-up.</p><p><strong>Methods: </strong>In a randomized clinical trial with three parallel arms, participants were randomized to MI (N=257), usual case management (N=266), or an active control group (N=252). MI consisted of two MI sessions while the active control involved two sessions without MI, both were offered in addition to usual case management. The primary outcome was number of sickness absence days based on registry data. Secondary outcomes included time to sustainable RTW, defined as four consecutive weeks without medical benefits.</p><p><strong>Results: </strong>The median number of sickness absence days for the MI group was 73 days [interquartile range (IQR) 31-147], 76 days (35-134) for usual care, and 75 days (34-155) for active control. In total 89%, 88% and 86% of the participants, respectively, achieved sustainable RTW. The adjusted hazard ratio (HR) for time to sustainable RTW was 1.12 (95% CI 0.90-1.40) for MI compared to usual case management and HR 1.16 (95% CI 0.93-1.44) compared to the active control.</p><p><strong>Conclusions: </strong>This study did not provide evidence that MI offered by NAV caseworkers to sick-listed individuals was more effective on RTW than usual case management or an active control. Providing MI in this context could be challenging as only half of the MI group received the intervention.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"477-486"},"PeriodicalIF":4.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10439122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The global health and economic impact of low-back pain attributable to occupational ergonomic factors in the working-age population by age, sex, geography in 2019.","authors":"Ningjing Chen, Daniel Yee Tak Fong, Janet Yuen Ha Wong","doi":"10.5271/sjweh.4116","DOIUrl":"10.5271/sjweh.4116","url":null,"abstract":"<p><strong>Objective: </strong>Occupational ergonomic factors (OEF) include physical exertion, demanding posture, repetitive work, hand-arm vibration, kneeling or squatting, rising, and climbing, which are risk factors for low-back pain (LBP). This study aimed to examine the prevalence, years lived with disability (YLD), healthcare costs, and productivity losses of LBP attributable to OEF by age, sex, World Health Organization region, and country in 2019.</p><p><strong>Methods: </strong>In this cross-sectional study, prevalence and YLD were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Employment statistics were obtained from the International Labor Organization websites. Health and economic impact was estimated for 192 countries and territories using the population attributable fraction method.</p><p><strong>Results: </strong>Globally, OEF were responsible for 126.1 million prevalent cases of LBP and 15.1 million YLD in the working-age population (aged 15-84 years) in 2019, with the Western Pacific region suffering most. OEF-attributable LBP led to $216.1 billion of economic losses worldwide. Of these, $47.0 billion were paid in healthcare costs, with the public sector serving as the largest contributor (59.2%). High-income countries bore >70% of global economic burden, whereas middle-income countries experienced >70% of global YLD. Generally, more prevalent cases and healthcare costs were found among females, whereas more YLD, productivity losses, and total costs were found among males.</p><p><strong>Conclusions: </strong>Globally, OEF-attributable LBP presented a heavy burden on health and economic systems. Exercise together with education, active monitoring, evidence-based medical practices, alternative cost-effective solutions, and prioritizing health policies are needed.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"487-495"},"PeriodicalIF":6.3,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10838400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10532294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis.","authors":"Alexander Jahn, Johan Hviid Andersen, David Høyrup Christiansen, Andreas Seidler, Annett Dalbøge","doi":"10.5271/sjweh.4114","DOIUrl":"10.5271/sjweh.4114","url":null,"abstract":"<p><strong>Objectives: </strong>The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP.</p><p><strong>Methods: </strong>The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP).</p><p><strong>Results: </strong>Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP.</p><p><strong>Conclusions: </strong>Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"453-465"},"PeriodicalIF":4.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10838064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10000306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational exposure to silica dust in France: an ongoing concern.","authors":"Laurène Delabre, Marie-Tülin Houot, Adrianna Burtin, Corinne Pilorget","doi":"10.5271/sjweh.4105","DOIUrl":"10.5271/sjweh.4105","url":null,"abstract":"<p><strong>Objectives: </strong>Crystalline silica is found in many construction materials. Although it is one of the oldest known occupational exposures, new exposure contexts have emerged in recent years. In 2021, France classified work involving exposure to respirable crystalline silica (ie, silica dust) generated by a work process as carcinogenic. In order to assess exposure in the French workforce between 1947 and 2020, we developed a silica job-exposure matrix (JEM) for the Matgéné program.</p><p><strong>Method: </strong>The JEM was linked with occupational data from different population censuses (1982, 1990, 1999, 2007 and 2017). The proportions and numbers of workers exposed to silica dust in France at these various census time points were estimated and described by sex and industry for 2017.</p><p><strong>Results: </strong>After decreasing between 1982 and 1999, the proportion of workers exposed to silica dust remained stable at 4%, representing 975 000 workers in 2017. Exposed workers were mostly men (93%), and most worked in the construction industry (64%). This was also the industry where the majority of workers were exposed to a level above the French 8-hour time weighted average occupational exposure limit (TWA-OEL).</p><p><strong>Conclusion: </strong>A large number of workers in France were still exposed (some highly) to silica dust in 2017 so this agent still poses an occupational health concern. The results of this study provide key information about the continued surveillance of the evolution of exposure to silica dust. In a few years, it will be possible to quantify the impact of the 2021 regulation in terms of proportions and number of workers exposed to silica dust.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":" ","pages":"526-534"},"PeriodicalIF":4.7,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10842119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10309360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partnership for European Research in Occupational Safety and Health (PEROSH) - Celebrating 20 years of collaboration.","authors":"Steffen Bohni Nielsen, Margrethe Schøning, Louis Laurent, Jan Michiel Meeuwsen","doi":"10.5271/sjweh.4110","DOIUrl":"10.5271/sjweh.4110","url":null,"abstract":"","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":"49 6","pages":"363-365"},"PeriodicalIF":6.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10825945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10134550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between an international COVID-19 job exposure matrix and SARS-CoV-2 infection among 2 million workers in Denmark.","authors":"Sophie van der Feltz, Vivi Schlünssen, Ioannis Basinas, Luise M Begtrup, Alex Burdorf, Jens P E Bonde, Esben M Flachs, Susan Peters, Anjoeka Pronk, Zara A Stokholm, Martie van Tongeren, Karin van Veldhoven, Karen M Oude Hengel, Henrik A Kolstad","doi":"10.5271/sjweh.4099","DOIUrl":"10.5271/sjweh.4099","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the associations between the Danish version of a job exposure matrix for COVID-19 (COVID-19-JEM) and Danish register-based SARS-CoV-2 infection information across three waves of the pandemic. The COVID-19-JEM consists of four dimensions on transmission: two on mitigation measures, and two on precarious work characteristics.</p><p><strong>Methods: </strong>The study comprised 2 021 309 persons from the Danish working population between 26 February 2020 and 15 December 2021. Logistic regression models were applied to assess the associations between the JEM dimensions and overall score and SARS-CoV-2 infection across three infection waves, with peaks in March-April 2020, December-January 2021, and February-March 2022. Sex, age, household income, country of birth, wave, residential region and during wave 3 vaccination status were accounted for.</p><p><strong>Results: </strong>Higher risk scores within the transmission and mitigation dimensions and the overall JEM score resulted in higher odds ratios (OR) of a SARS-CoV-2 infection. OR attenuated across the three waves with ranges of 1.08-5.09 in wave 1, 1.06-1.60 in wave 2, and 1.05-1.45 in those not (fully) vaccinated in wave 3. In wave 3, no associations were found for those fully vaccinated. In all waves, the two precarious work dimensions showed weaker or inversed associations.</p><p><strong>Conclusions: </strong>The COVID-19-JEM is a promising tool for assessing occupational exposure to SARS-CoV-2 and other airborne infectious agents that mainly spread between people who are in close contact with each other. However, its usefulness depends on applied restrictions and the vaccination status in the population of interest.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":"49 6","pages":"375-385"},"PeriodicalIF":6.3,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10790132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10132011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effectiveness of implementing the Guideline for the Prevention of Mental Ill-health Problems at the Workplace on health-outcomes, organizational and social risk factors: a cluster-randomized controlled trial in Swedish schools.","authors":"Anna Toropova, Andreas Rödlund, Christina Björklund, Liselotte Schäfer Elinder, Irene Jensen, Lydia Kwak","doi":"10.5271/sjweh.4108","DOIUrl":"10.5271/sjweh.4108","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the effectiveness of the multifaceted implementation strategy (multifaceted group) versus a discrete implementation strategy (discrete group) for implementing the Swedish Guideline for the Prevention of Mental Ill-health Problems at the Workplace on the primary intervention outcome - exhaustion - and secondary outcomes of stress, health, recovery, psychosocial safety climate, and social and organizational risk factors. Another aim was to examine whether the primary and secondary outcomes differed on the basis of guideline adherence levels, irrespective of the group.</p><p><strong>Methods: </strong>A cluster-randomized waiting-list controlled trial with 6- and 12-months follow-up was conducted among 19 Swedish public schools. Primary and secondary outcomes as well as guideline adherence were assessed by self-reported questionnaire. Linear mixed modeling was used to compare differences in outcomes between the groups from baseline to 6 and 12 months, and in relation to different adherence levels.</p><p><strong>Results: </strong>The trial comprised 698 employees (83.1%) participated. There were no differences between groups in the primary and secondary outcomes at 6 months, while at 12 months differences were observed for some outcomes to the advantage of the discrete group. Better guideline adherence was associated with improvements in exhaustion at 12 months and the secondary outcomes of psychosocial safety climate, work organization and job content, interpersonal relations and leadership, and recovery over 6 and 12 months.</p><p><strong>Conclusion: </strong>The multifaceted implementation strategy was no more effective than the discrete strategy in improving health outcomes or organizational and social work environment. However, higher adherence to the guideline was associated with larger improvements in health outcomes and organizational and social work environment, irrespective of the implementation strategy used.</p>","PeriodicalId":21528,"journal":{"name":"Scandinavian journal of work, environment & health","volume":"49 6","pages":"428-438"},"PeriodicalIF":4.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10821774/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10489872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}