Objectives-To evaluate the validity of the checklist individual strength questionnaire (CIS) in the working population. This 20 item self reported questionnaire has often been used in patients with chronic fatigue. To date, no research has focused on the validity of the CIS in occupational groups. Methods-To evaluate the discriminant validity the CIS was filled out by five groups of employees with expected diVerences in fatigue. The convergent validity was evaluated by comparing the results of the CIS with the results of three related measures: measured unidimensional fatigue, burnout, and need for recovery. Results-The CIS was able to discriminate between fatigued and non-fatigued employees in occupational groups. The expected agreement between the results of the CIS and related measures was confirmed. Conclusions-The CIS seems to be an appropriate instrument for measuring fatigue in the working population. (Occup Environ Med 2000;57:353-357)

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This study examined both risk factors for the onset of work-family conflict and consequences in terms of need for recovery and prolonged fatigue for men and women separately. Two-year follow-up data from the Maastricht Cohort Study on "Fatigue at Work" (n = 12,095) were used. At baseline, the prevalence of work-family conflict was 10.8% (9.0% in women; 11.1% in men), the cumulative incidence at 1 year follow-up was 5.1%. For men, several work-related demands, shift work, job insecurity, conflicts with coworkers or supervisor, having full responsibility for housekeeping, and having to care for a chronically ill child or other family member at home were risk factors for the onset of work-family conflict, whereas decision latitude and coworker and supervisor social support protected against work-family conflict. In women, physical demands, overtime work, commuting time to work, and having dependent children were risk factors for work-family conflict, whereas domestic help protected against work-family conflict at 1 year follow-up. Work-family conflict was further shown to be a strong risk factor for the onset of elevated need for recovery from work and fatigue.

Objective: The purposes of this study were: (1) to explore the relationship between fatigue and psychological distress in the working population; (2) to examine associations with demographic and health factors; and (3) to determine the prevalence of fatigue and psychological distress. Methods: Data were taken from 12,095 employees. Fatigue was measured with the Checklist Individual Strength, and the General Health Questionnaire (GHQ) was used to measure psychological distress. Results: Fatigue was fairly well associated with psychological distress. A separation between fatigue items and GHQ items was shown. No clear, distinct pattern of associations was found for fatigue vs. psychological distress with respect to demographic factors. The prevalence was 22% for fatigue and 23% for psychological distress. Of the employees reporting fatigue, 43% had fatigue only, whereas 57% had fatigue and psychological distress. Conclusions:The results indicate that fatigue and psychological distress are common in the working population. Although closely associated, there is some evidence suggesting that fatigue and psychological distress are different conditions, which can be measured independently. D

Aims: To determine whether fatigue and need for recovery are risk factors for being injured in an occupational accident. Methods: These associations were investigated within the Maastricht Cohort Study of "Fatigue at Work", a prospective cohort study of employees from a wide range of companies and organisations. For 7051 employees information was available on fatigue as measured with the Checklist Individual Strength (CIS), need for recovery as measured with the VBBA, and possible confounding factors such as age, smoking, alcohol consumption, educational level, shift work, and work environment. Information on the risk factors was collected in May 1999 and January 2000, before the occurrence of the occupational accidents. The incidence of being injured in an occupational accident was inventoried over the year 2000. A total of 108 employees reported having been injured in an occupational accident in 2000. Results: For the highest CIS fatigue score tertile a for age, gender, educational level, smoking, shift work, and work environment, adjusted relative risk for being injured in an occupational accident of 1.29 (95% CI: 1.03 to 2.78) was found compared to the lowest tertile, and for the highest tertile of need for recovery a relative risk of 2.28 (95% CI: 1.41 to 3.66) was found. Conclusions: Fatigue and need for recovery were found to be independent risk factors for being injured in an occupational accident. This means that in the push back of occupational accidents, fatigue, and even more importantly need for recovery, need special attention.

In the Netherlands, a large-scale prospective cohort study was started on prolonged fatigue in the working population. The 1st issue that had to be addressed was the determination of a cutoff point for fatigue for use in the working population. Fatigue is measured with the Checklist Individual Strength (CIS), a 20-item self-report questionnaire. This article demonstrates the process of decision making in the determination of the cutoff point. Total CIS scores were calculated, sensitivity and specificity were compared for potential cutoff points, and a receiver operating characteristics analysis was conducted. A CIS total cutoff point for fatigue of >76 was determined, with a specificity of 90% and a sensitivity of 73%. Limitations regarding the use of cutoff points are discussed. It is concluded that the defined cutoff point seems to be appropriate for use in the working population.

In this paper working hours, patterns and work schedules of employees were evaluated in terms of need for recovery from work. Self-administered questionnaire data from employees of the Maastricht Cohort Study on Fatigue at Work (n = 12,095) were used. Poisson regression analyses and multivariate logistic regression analyses revealed that higher working hours a day and working hours a week generally went together with more need for recovery from work. Overtime work was particularly associated with higher need for recovery from work in both genders. Both male and female three-shift or irregular shift workers had higher odds of elevated need for recovery compared to day workers. When additionally controlling for work-related factors, need for recovery levels among shift workers substantially lowered. This study clearly showed that working hours and schedules are associated with need for recovery from work, with different associations for men and women. Especially the associations between work schedules and need for recovery from work were very interrelated with other work-related factors. Future studies could further investigate the possibility that shift work might function as a proxy of other work-related factors that explain the different levels in need for recovery from work, or that job demands are perceived higher among shift workers and may therefore lead to more need for recovery from work.