Michel Moreau

Occupational stress and incidence of sick leave in the Belgian workforce: the Belstress study

Context: Sick leave is a major problem in public health. The Karasek demands/control/social support/strain (JDCS) model has been largely used to predict a wide range of health outcomes and to a lesser extent sickness absence. Study objective: The aim of the study was to test the predictive power of the JDCS model in relation with one year incidence of sick leave in a large cohort of workers. Design and setting: Cohort study conducted between 1994 and 1998 in 25 companies across Belgium. Participants: A total of 20 463 workers aged 35 to 59 years were followed up for sick leave during one year after the baseline survey. Outcomes: The outcomes were a high sick leave incidence, short spells (⩾7 days), long spells (⩾28 days), and repetitive spells of sickness absence (⩾3 spells/year). Main results: Independently from baseline confounding variables, a significant association between high strained jobs with low social support and repetitive spells of sickness absence was observed in both sexes with odds ratios of 1.32 (99% CI, 1.04 to 1.68) in men and 1.61 (99% CI, 1.13 to 2.33) in women. In men, high strained jobs with low social support was also significantly associated with high sick leave incidence, and short spells of sick leave with odds ratios of 1.38 (99% CI, 1.16 to 1.64) and 1.22 (99% CI, 1.05 to 1.44) respectively. Conclusions: Perceived high strain at work especially combined with low social support is predictive of sick leave in both sexes of a large cohort of the Belgian workforce.

Obesity, body fat distribution and incidence of sick leave in the Belgian workforce: the Belstress study

OBJECTIVES: In many studies, obesity has been associated with morbidity or mortality, but only a few have studied the relation between obesity and sick leave. Our aim is to analyse the independent effects of both adiposity and body fat distribution in relation to the 1-y incidence of sick leave in a large cohort of male and female workers covering a variety of occupations, taking into account a wide range of socio-demographic, behavioural and bioclinical variables.DESIGN AND SETTING: The baseline survey of the Belstress study was conducted in 25 companies across Belgium between 1994 and 1998. A cohort of 20u2009463 workers (15u2009557 males and 4906 females) aged 35–59u2009y was followed for absenteeism during 1u2009y. The 75th percentile of the distribution of the total annual sickness days was used as a cutoff to classify the workers with a high 1-y incidence rate of sick leave. The relation between sick leave and both obesity and body fat distribution assessed by the body mass index (BMI) and the waist circumference, respectively, was analysed by multivariate logistic regression models.RESULTS: Using a backward procedure based on the likelihood ratio, we found central abdominal fatness to be an independent predictor of sick leave in both genders (high sick-leave incidence and long spells), but not BMI. In men, the odds ratios was 1.31 (99% CI 1.12–1.52, P<0.0001) and in women it ranged from 1.32 (99% CI 1.03–1.70, P=0.005) to 1.47 (99% CI 1.14–1.90, P<0.0001). Two baseline covariables, respiratory problems and perceived health, are confounders or mediators.CONCLUSIONS: In this study, body fat distribution was associated with a high annual sick-leave incidence and long spells of sickness absence. If this link is reversible, employers may benefit from programs aiming at the prevention and treatment of central obesity.

The gap between food-based dietary guidelines and usual food consumption in Belgium, 2004

OBJECTIVEnTo evaluate the gap between food-based dietary guidelines (FBDG) and the usual food consumption in Belgium.nnnDESIGN AND SETTINGnInformation on food intake was collected with two non-consecutive 24 h recalls, using the validated software package EPIC-SOFT in combination with a self-administered FFQ. Habitual food intake was estimated by the Nusser method. Physical activity was evaluated according to the International Physical Activity Questionnaire.nnnSUBJECTSnA representative sample of the Belgian population aged 15 years and older was randomly selected from the National Register using a multistage stratified procedure. Dietary information was obtained from 3245 individuals.nnnRESULTSnFood intakes deviated significantly from the recommendations. In particular, fruit (118 g/d) and vegetable (138 g/d) consumption and intake of dairy and Ca-enriched soya products (159 g/d) were inadequate. Consumption of energy-dense, nutrient-poor foods (soft drinks, alcohol and snacks) was excessive (481 g/d). There were important age and gender differences. Fruit, vegetable and spreadable fat consumption was lowest, while consumption of dairy, starchy and energy-dense, nutrient-poor foods was highest among the youngest age group. Men consumed more animal and starchy foods than women, who consumed more fruits. There were only slight differences by education level.nnnCONCLUSIONnFood intakes differed substantially from the FBDG. Improvement of the Belgian food pattern, in particular among the youngest age group, is necessary for a better prevention of diet-related diseases. In addition, continuous or regular monitoring is crucial to permit trend analyses and to plan effective education or intervention strategies.

Perceptions of job insecurity and the impact of world market competition as health risks: Results from Belstress

Concern has been raised about the impact of job insecurity and fierce world market competition on the well-being and health of workers (Marmot, 1999). For that reason, the Job Content Questionnaire was supplemented with items that relate to the wider organization and, especially, global economy level. Two items relate to the perception of job insecurity (JIS) and three items relate to the perception of impact of world market competition on ones own job (WMC). In the Belstress study, which comprises a sample of 16,335 men and 5084 women aged 35-59 years recruited from 25 companies across Belgium between 1994 and 1998, cross-sectional associations of both factors with health status indicators, health behaviour and cardiovascular risk factors were studied. Scores for JIS and WMC were dichotomized yielding high (upper quartile group) and low levels (else). JIS and WMC are independently associated with job strain and with some health status indicators. No clear or consistent associations are found with health-related behaviours or with cardiovascular risk factors.

Increased absenteeism from work among aware and treated hypertensive and hypercholesterolaemic patients

Aim The ‘labelling hypothesis’ was introduced on the basis of the observation that labelling subjects with blood pressure elevation as hypertensive was associated with an increase in sickness absence. In the Belstress I study this hypothesis was analysed in the same way for the possible influence on sick leave of labelling persons with elevated cholesterol as hypercholesterolaemic. Methods and results The Belstress I cohort concerns a sample of more than 16000 men and 5000 women at work in 24 Belgian industries in various sectors. Baseline data were collected by questionnaire and clinical examination. Awareness was defined as answering positively to the question ‘did a physician ever tell you that your blood pressure/serum cholesterol was too high?’ Sick leave data were independently and objectively recorded during 1 year following the screening. Sick leave was treated in a dichotomous way whereby the event was defined as being in the highest quartile of the annual number of days of sick leave (10 days or more for men and 15 days or more for women) or as being in the highest quartile of the annual number of spells of sick leave (two spells or more for both sexes). Gender-specific logistic regression analyses were performed, with adjustment for a large set of covariates. A positive association was observed between both awareness of hypertension and awareness of hypercholesterolaemia and the various definitions of sick leave, in both sexes and after adjustment for different covariates. When dividing up aware subjects into treated versus untreated, we observed in men the highest sick leave incidence in aware and treated hypertensive patients as well as in aware and treated hypercholesterolaemic patients. In women findings were less consistent, probably due to the smaller sample size. When looking at cumulative effects by examining participants with both hypertension and hypercholesterolaemia and their level of awareness for one or both risk factors, a statistically significant gradient was noticed in men, with the highest sick leave incidence, whatever the definition, in men aware for both risk factors, followed by men aware for one. In women the same trends were observed, but no level of statistical significance was reached. Conclusion Without being able to test the effect of ‘labelling’ as such, our study provides support for the association between awareness of two different coronary risk factors and incidence of sick leave. Probably a common mechanism is at the base of these findings. Further research is needed, in order to reduce potential negative effects of screening on human wellbeing as well as on productivity.

Overall and within-food group diversity are associated with dietary quality in Belgium

OBJECTIVEnTo assess the relationship(s) between overall and within-food group diversity and several indices of dietary quality, such as dietary adequacy, moderation and balance, in Belgian adults. Dietary quality indices were derived from the food-based dietary guidelines (FBDG).nnnDESIGNnInformation on food intake was collected with two 24 h recalls.nnnSETTINGnAverage overall and within-food group diversity scores and dietary adequacy, moderation and balance scores were calculated.nnnSUBJECTSnA representative sample (n 3245) of the Belgian population at the age of 15 years and older was randomly selected from the National Register using a multistage stratified procedure.nnnRESULTSnFor both men and women, total dietary diversity score increased with age and smokers had a significantly lower overall diversity score than non- or former smokers. A positive association was found between overall dietary diversity and both dietary adequacy and balance. For most food groups, especially bread and cereals, vegetables, dairy products and spreadable fats, within-food group dietary diversity was positively associated with the fulfillment of the specific recommendation for the intake of that food group. An inverse association was found between dietary diversity within the meat and the energy-dense, nutrient-poor food groups and dietary balance. Diversity within the dairy and spreadable fat group was responsible for the strongest increase in overall dietary adequacy and balance.nnnCONCLUSIONSnOverall dietary diversity is a useful indicator of dietary quality in Belgium. For some food groups, within-food group dietary diversity is a useful indicator of compliance with the specific FBDG for intake of that food group.

Diabetes Mellitus in Middle-aged People Is Associated with Increased Sick Leave: The BELSTRESS Study

Abstract In a prospective study of the association between self-reported diabetes mellitus and sick leave from work, 21,149 men and women, aged 35-59 years, participated. Prevalence of diabetes was obtained by questionnaire. Sick leave was prospectively obtained from departments of human resources in the year after the baseline survey. Outcome variables related to duration of sick leave, repetitive absences, and long absences of at least seven consecutive days. In gender-specific multivariate analyses the relation between diabetes and sick leave was studied independent of age, body mass index, physical activity, alcohol intake, education, job title, and smoking habit. Prevalence rates of self reported diabetes were 2.8% and 2.2% in men and women, respectively. For each outcome variable a significant association between diabetes and sick leave was observed. Significant associations were found between diabetes and duration of sick leave and repetitive absences in men. In women a similar trend was observed for duration, and a significant association was found for repetitive absences.

Role of physicians in preventing accidents in the home involving children under 15 years in the French-speaking community of Belgium

Objectives. To measure GPs and paediatricians expectations, attitudes, priorities and demands in the area of promoting safety and preventing accidents in the home involving children under 15 years of age. Methods. A phone survey of a random sample of GPs and paediatricians in the French-speaking community of Belgium (Wallonia and Brussels) conducted in the course of September and October 2000. Results. Close to two-thirds of the physicians surveyed stated that they had been contacted at least once in the 2 weeks preceding the survey to handle an injury. Of the physicians, 80% mention accident prevention after a childhood injury, but only 46% mention it during a routine consultation (whatever the reason of the latter may be). The main obstacles to mentioning prevention during routine consultation put forward by the interviewees are: 1) reasons for consultations that do not permit such an approach (79%); 2) the fact that injuries are not priorities for them (66%); 3) the lack of interesting materials to provide the subject with documentation (63%); 4) the unsuitability of the place where the contact occurs for such discussion, given the time required (56%); 5) insufficient information on the subject (41%); and 6) the patients lack of interest (39%). An overwhelming majority (98%) nevertheless feel that they have a role to play in preventing childrens accidents in the home, with 72.5% seeing this as informative (recommendation on safety rules). More than two-thirds of the respondents feel that they have enough requisite information to play such a role. Those who declare that they have not enough information (34%) proposed some priority subjects about which they would like to find information or additional information to be more effective in preventing accidents. The information needs mentioned most frequently were a systematic review of the risks, of the effective prevention strategies and epidemiological data. Conclusions. The present study clearly reveals the interest of physicians for accident prevention and puts forward the current obstacles to offering prevention advice during routine consultation. The obstacles mentioned are fairly comparable to those mentioned in other studies, namely, because the reason for the visit does not give such an opening, the lack of appropriate materials and information, the lack of time, the patients lack of interest, the fact that the issue is not a priority, etc. The problem of lack of priority for certain practitioners underlines the importance of making accident mortality and morbidity statistics available to doctors in order to improve their perception of the magnitude of the problem. The lack of interesting education materials and useful information seems to be a major reason for their failure to carry out such prevention work successfully. These factors should thus be taken into account when developing any policy and/or programme aimed at ‘using’ GPs and paediatricians in the prevention strategies that are adopted.

Application de l’approche globale de l’alimentation dans la population belge

Introduction Depuis quelques annees, la prise en compte de l’alimentation sous forme de profils de consommation s’est developpee comme une approche complementaire en epidemiologie nutritionnelle. Objectif Le present article a pour objectif de presenter et d’appliquer deux methodes de construction de profils alimentaires a partir des donnees issues de la « Belgian Interuniversity Research on Nutrition and Health » (BIRNH). Methodes Une etude prospective a ete menee (1979-1984) aupres de 5 225 hommes et 4 476 femmes de la population belge âges de 25 a 74 ans. Les habitudes alimentaires de chaque participant ont ete etablies par la methode d’un enregistrement de 24 heures et complete pour un sous-echantillon de 1 650 personnes par un enregistrement de 7 jours. L’approche « a priori » a ete utilisee pour la construction d’un index d’alimentation recommandee (IAR) base sur les recommandations nutritionnelles nationales. Une analyse en composantes principales a ete effectuee sur la base, d’une part, des donnees issues de l’enregistrement de 24 heures et, d’autre part, sur celles issues de l’enregistrement de 7 jours. Resultats L’index moyen (SD) de notre echantillon est de 3,7 (± 1,2). Plus l’IAR est eleve, plus l’alimentation est conforme aux recommandations. Les femmes ont un IAR moyen statistiquement plus eleve que les hommes, puisqu’il est respectivement de 3,9 et 3,6 (p Conclusion L’approche globale de l’alimentation permet une meilleure evaluation des habitudes alimentaires. Il est donc important de disposer d’outils qui permettent une estimation plus precise des habitudes alimentaires. D’autres etudes devraient s’interesser a l’analyse de la capacite discriminante de ces profils alimentaires par rapport a un probleme de sante et/ou a la mortalite dans le contexte belge.