Workdays

in-between

workdays

and

the

weekend

a

diary

study

on

effort

and

recovery

Objectives

Effort-recovery

theory

-LRB-

Meijman

and

Mulder

in

Handbook

of

work

and

organizational

psychology

Psychology

Press/Erlbaum

Hove

pp

-RRB-

proposes

that

effort

expenditure

may

have

adverse

consequences

for

health

in

the

absence

of

sufficient

recovery

opportunities

Thus

insight

in

the

relationships

between

effort

and

recovery

is

imperative

to

understand

work-related

health

This

study

therefore

focused

on

the

relation

between

work-related

effort

and

recovery

-LRB-

-RRB-

during

workdays

-LRB-

-RRB-

in-between

workdays

and

-LRB-

-RRB-

in

the

weekend

For

these

three

time

periods

we

compared

a

group

of

employees

reporting

relatively

low

levels

of

work-related

effort

-LRB-

low-effort

group

-RRB-

and

a

group

of

employees

reporting

relatively

high

levels

of

work-related

effort

-LRB-

high-effort

group

-RRB-

with

respect

to

-LRB-

-RRB-

activity

patterns

-LRB-

-RRB-

the

experience

of

these

activity

patterns

and

-LRB-

-RRB-

health

and

well-being

indicators

Introduction

Much

research

has

shown

that

high

levels

of

job

demands

are

related

to

increased

levels

of

physical

and

psychological

health

problems

across

time

-LRB-

e.g.

De

Lange

et

al.

-RRB-

Despite

this

strong

focus

on

the

relations

between

job

demands

and

health

relatively

little

attention

has

been

paid

to

the

psychological

and

physiological

processes

that

may

explain

why

health

is

adversely

affected

by

high

job

demands

One

notable

exception

is

effort-recovery

-LRB-

ER

-RRB-

theory

-LRB-

Meijman

and

Mulder

Geurts

and

Sonnentag

-RRB-

ER

theory

argues

that

working

inevitably

requires

effort

as

an

appeal

is

made

to

workers

abilities

and

their

willingness

to

dedicate

these

abilities

to

the

work

task

Expending

effort

at

work

-LRB-

work-related

effort

-RRB-

produces

two

kinds

of

outcomes

the

tangible

result

of

work

activities

i.e.

a

product

or

service

and

the

psychological

and

physiological

costs

or

load

reactions

-LRB-

e.g.

fatigue

-RRB-

associated

with

working

These

load

reactions

are

usually

short-lived

and

reversible

they

disappear

after

respite

from

work

However

under

certain

circumstances

the

recovery

process

may

be

insufficient

or

inadequate

and

then

short-term

work-related

load

reactions

may

turn

into

adverse

and

more

chronic

health

problems

such

as

prolonged

fatigue

chronic

tension

and

sleep

deprivation

-LRB-

Åkerstedt

Härmä

Sluiter

et

al.

Van

Hooff

et

al.

-RRB-

Recovery

opportunities

after

work

may

be

inadequate

in

terms

of

quantity

-LRB-

time

-RRB-

and/or

quality

Recovery

time

may

be

insufficient

in

case

of

prolonged

exposure

to

high

demands

for

instance

when

workers

continue

to

pursue

job-related

activities

during

non-work

time

-LRB-

e.g.

by

working

overtime

-RRB-

or

engage

in

other

demanding

-LRB-

e.g.

domestic

-RRB-

activities

Recovery

is

particularly

at

stake

when

during

private

time

an

appeal

is

made

upon

the

same

psychophysiological

systems

that

were

activated

on

the

job

The

quality

of

recovery

may

be

endangered

when

individuals

psychophysiological

systems

show

prolonged

activation

even

if

not

exposed

to

any

special

demands

during

the

recovery

period

This

may

happen

when

workers

have

difficulty

to

relax

at

home

after

a

stressful

working

day

For

example

Brosschot

et

al.

-LRB-

-RRB-

showed

that

when

workers

worry

in

their

private

time

about

the

past

or

upcoming

working

day

the

psychophysiological

systems

that

were

activated

on

the

job

remain

activated

thus

impeding

the

recovery

process

-LRB-

cf.

Ursin

and

Erikson

-RRB-

Due

to

repeated

or

prolonged

activation

of

psychophysiological

systems

these

systems

are

in

danger

of

chronic

overactivity

producing

lasting

changes

in

homeostatic

mechanisms

-LRB-

i.e.

allostatic

load

McEwen

-RRB-

Consequently

these

originally

adaptive

systems

may

start

to

malfunction

by

showing

either

hyperactivity

-LRB-

the

systems

fail

to

shut-off

-RRB-

or

hypoactivity

-LRB-

the

systems

are

not

turned

on

when

needed

-RRB-

constituting

a

serious

health

risk

For

example

chronic

stress

may

cause

the

immune

system

to

be

not

sensitive

enough

-LRB-

hypoactivity

-RRB-

allowing

infectious

agents

-LRB-

viruses

and

bacteria

-RRB-

to

enter

the

body

and

cause

infectious

diseases

Alternatively

the

system

may

become

overreactive

so

that

the

immune

system

itself

causes

ill

health

-LRB-

such

as

autoimmune

diseases

and

allergic

diseases

Clow

-RRB-

The

present

study

Effort

and

recovery

are

nowadays

salient

research

topics

-LRB-

Zijlstra

and

Sonnentag

-RRB-

The

present

study

builds

on

and

extends

this

body

of

knowledge

in

at

least

four

regards

Firstly

although

the

effort-recovery

process

is

assumed

to

unfold

on

a

daily

basis

there

is

only

a

limited

number

of

studies

examining

this

process

from

such

a

day-to-day

perspective

-LRB-

e.g.

Cropley

et

al.

Meijman

et

al.

Rook

and

Zijlstra

Sonnentag

Sonnentag

and

Zijlstra

Totterdell

et

al.

-RRB-

The

majority

of

research

in

this

area

still

focuses

on

either

cross-sectional

or

on

global

long-term

relations

between

job

demands

lack

of

recovery

and

health

-LRB-

e.g.

Kompier

Sluiter

et

al.

-RRB-

Thus

in

order

to

obtain

more

insight

in

de

day-to-day

relations

between

effort

and

recovery

the

present

study

examines

the

relation

between

work-related

effort

and

recovery

on

a

daily

basis

both

during

and

after

working

time

Furthermore

although

weekends

may

offer

important

opportunities

for

recovery

they

are

hardly

included

in

previous

studies

Exceptions

are

Fritz

and

Sonnentag

's

-LRB-

-RRB-

diary

study

which

showed

that

well-being

after

the

weekend

was

higher

when

individuals

had

engaged

in

social

activities

during

the

weekend

Also

Totterdell

et

al.

-LRB-

-RRB-

reported

that

sleep

mood

and

social

satisfaction

were

worse

on

the

first

rest

day

following

work

shifts

in

comparison

with

subsequent

rest

days

In

a

study

among

shift-working

nurses

Rook

and

Zijlstra

-LRB-

-RRB-

found

weekends

to

be

important

for

recovery

as

well

To

increase

the

understanding

of

the

weekend

as

potential

recovery

period

the

present

study

also

included

the

weekend

Thirdly

only

limited

attention

has

been

given

to

actual

activity

patterns

during

work

and

non-work

time

in

research

on

effort

and

recovery

until

now

-LRB-

see

for

exceptions

Fritz

and

Sonnentag

Sonnentag

Sonnentag

and

Bayer

-RRB-

This

is

remarkable

as

several

work

psychological

theories

-LRB-

e.g.

action

theory

Frese

and

Zapf

Taris

and

Kompier

-RRB-

assume

that

job

characteristics

affect

worker

well-being

through

worker

behavior

it

is

what

people

do

that

makes

them

feel

tired

or

enthusiastic

Thus

in

order

to

fully

understand

effort-recovery

patterns

during

and

in-between

workdays

we

must

know

how

people

spend

their

time

on

work

as

well

as

on

home

activities

Therefore

the

present

study

provided

a

detailed

assessment

of

employees

activity

patterns

during

and

in-between

working

time

Finally

what

can

be

a

burden

for

one

individual

may

constitute

a

pleasure

to

the

other

Consequently

insight

in

activity

patterns

in

the

work

and

private

domain

is

insufficient

to

fully

understand

workers

effort-recovery

patterns

and

preferably

workers

experience

of

the

time

spent

on

-LRB-

non

-RRB-

work

activities

must

be

examined

in

this

context

-LRB-

see

also

the

recommendations

by

Sonnentag

-RRB-

Until

now

the

extent

to

which

workers

experience

their

daily

work

and

home

activities

as

effortful

and/or

pleasant

has

nonetheless

remained

largely

ignored

Therefore

the

present

study

provided

a

detailed

assessment

of

how

employees

experience

their

activities

during

and

in-between

working

time

in

terms

of

effort

and

pleasure

We

distinguished

between

workers

who

reported

a

relatively

high

level

of

work-related

effort

-LRB-

i.e.

who

generally

experienced

their

workdays

as

effortful

-RRB-

during

a

standard

work

week

-LRB-

further

referred

to

as

the

high-effort

group

-RRB-

and

workers

who

reported

a

relatively

low

level

of

work-related

effort

-LRB-

low-effort

group

-RRB-

This

division

of

our

sample

was

employed

in

order

to

maximize

the

contrast

between

the

two

subgroups

in

terms

of

reported

effort

The

two

effort-groups

were

compared

with

respect

to

-LRB-

-RRB-

activity

patterns

-LRB-

i.e.

the

time

spent

on/frequency

of

engaging

in

work

activities

domestic

activities

active

leisure

and

passive

leisure

-RRB-

-LRB-

-RRB-

experiences

of

activities

-LRB-

i.e.

the

specific

effort

and

pleasure

experienced

while

engaging

in

a

specific

work

or

home

activity

-RRB-

and

-LRB-

-RRB-

health

and

well-being

indicators

-LRB-

i.e.

fatigue

sleep

quality

sleep

time

preoccupation

with

work

and

work

motivation

-RRB-

Fatigue

is

included

an

indicator

of

-LRB-

lack

of

-RRB-

recovery

As

sleep

provides

the

most

natural

recovery

opportunity

for

humans

sleep

quality

and

sleep

time

are

incorporated

as

well

-LRB-

Åkerstedt

-RRB-

Preoccupation

with

work

is

assessed

because

it

may

prolong

physiological

activation

and

therefore

interfere

with

the

recovery

process

-LRB-

Brosschot

et

al.

-RRB-

Finally

to

avoid

focusing

exclusively

on

the

negative

consequences

of

working

work

motivation

is

added

in

this

study

to

acknowledge

that

work

may

be

related

to

positive

aspects

of

worker

behavior

as

well

These

constructs

were

measured

in

three

time

periods

-LRB-

-RRB-

during

work

time

-LRB-

-RRB-

in-between

successive

workdays

and

-LRB-

-RRB-

during

the

weekend

In

order

to

minimize

the

amount

of

time

elapsed

between

the

occurrence

and

the

reports

of

a

certain

activity

or

experience

we

utilized

a

diary

design

covering

five

uninterrupted

weekdays

directly

followed

by

two

weekend

days

In

this

vein

the

risk

of

retrospection

bias

was

reduced

-LRB-

Bolger

et

al.

-RRB-

This

study

examines

three

interrelated

research

questions

How

is

work-related

effort

associated

with

-LRB-

a

-RRB-

time

spent

on

work

activities

-LRB-

b

-RRB-

experiences

of

work

activities

and

-LRB-

c

-RRB-

health

and

well-being

during

the

workday?As

the

distinction

between

the

two

groups

is

based

on

employees

reports

of

work-related

effort

we

expect

that

the

high-effort

group

will

also

report

to

have

expended

higher

effort

on

-LRB-

at

least

some

of

-RRB-

the

specific

work

activities

compared

to

the

low-effort

group

-LRB-

Hypothesis

-RRB-

Support

for

this

hypothesis

is

important

from

the

perspective

of

validation

of

the

effort-measure

used

to

differentiate

between

the

two

effort-groups

As

the

high-effort

group

should

have

invested

higher

levels

of

effort

during

the

work

day

than

the

low-effort

group

we

expect

to

observe

higher

levels

of

fatigue

at

the

end

of

the

workday

-LRB-

Hypothesis

-RRB-

as

well

as

a

-LRB-

stronger

-RRB-

increase

in

fatigue

during

the

workday

-LRB-

Hypothesis

-RRB-

in

the

first

group

We

do

not

hold

a

priori

expectations

concerning

the

experiences

of

pleasure

associated

with

work

activities

and

with

respect

to

the

time

spent

on

and

the

frequency

of

engaging

in

each

work

activity.How

is

work-related

effort

associated

with

-LRB-

a

-RRB-

time

spent

on

home

activities

-LRB-

b

-RRB-

experiences

of

home

activities

and

-LRB-

c

-RRB-

health

and

well-being

in-between

successive

workdays?We

distinguish

among

four

categories

of

home

activities

i.e.

-LRB-

-RRB-

domestic

activities

-LRB-

e.g.

household

chores

-RRB-

-LRB-

-RRB-

overtime

work

-LRB-

-RRB-

active

leisure

activities

-LRB-

e.g.

exercising

-RRB-

and

-LRB-

-RRB-

passive

leisure

activities

-LRB-

e.g.

reading

for

pleasure

watching

TV

listening

to

music

see

also

Sonnentag

-RRB-

The

latter

category

is

considered

as

passive

whereas

the

other

three

categories

of

activities

demand

effort

to

some

extent

and

are

therefore

labeled

as

active

Based

on

ER

theory

it

can

be

argued

that

our

capacity

to

expend

effort

is

limited

and

that

the

more

effort

is

expended

at

work

the

less

remains

for

home

activities

Accordingly

the

high-effort

group

is

expected

to

spend

less

time

on

and

to

engage

less

often

in

active

home

activities

and

consequently

will

spend

more

time

on

and

engage

more

often

in

passive

leisure

activities

-LRB-

Hypothesis

-RRB-

Because

of

the

supposed

limited

amount

of

energy

left

in

the

high-effort

group

we

further

expect

that

this

group

will

experience

engagement

in

active

home

activities

as

more

effortful

relative

to

the

low-effort

group

-LRB-

Hypothesis

-RRB-

As

we

do

not

have

a

priori

expectations

regarding

differences

between

the

groups

in

the

pleasure

experienced

in

home

activities

possible

differences

are

examined

in

an

exploratory

fashion

Further

we

expect

that

those

who

have

expended

high

effort

on

the

job

-LRB-

high-effort

group

-RRB-

will

report

higher

levels

of

fatigue

and

more

sleep

complaints

in-between

workdays

compared

to

the

low-effort

group

-LRB-

Hypothesis

-RRB-

In

order

to

obtain

a

full

picture

of

the

participants

recovery

in-between

workdays

sleep

time

is

also

examined

Finally

we

assume

that

workers

who

have

expended

higher

effort

during

working

time

will

also

be

more

preoccupied

with

their

job

after

work

-LRB-

Hypothesis

-RRB-

This

expectation

is

in

line

with

Sonnentag

and

Bayer

's

-LRB-

-RRB-

finding

that

those

who

experienced

high

workload

during

the

workday

found

it

more

difficult

to

detach

from

work

during

evenings

than

others

We

do

not

formulate

a

priori

expectations

regarding

possible

differences

in

work

motivation

between

the

two

effort-groups

How

is

work-related

effort

associated

with

-LRB-

a

-RRB-

time

spent

on

home

activities

-LRB-

b

-RRB-

experiences

of

home

activities

and

-LRB-

c

-RRB-

health

and

well-being

during

the

weekend

days?The

hypotheses

formulated

for

the

period

in-between

workdays

-LRB-

in

Research

question

-RRB-

can

be

extended

to

the

weekend

Hence

we

expect

that

those

who

have

spent

high

effort

on

the

job

during

week

days

-LRB-

the

high-effort

group

-RRB-

will

during

the

weekend

spend

less

time

on

and

engage

less

often

in

active

and

will

spend

more

time

on

and

will

engage

more

often

in

passive

home

activities

-LRB-

Hypothesis

-RRB-

experience

active

home

activities

as

more

effortful

-LRB-

Hypothesis

-RRB-

report

more

fatigue

and

more

sleep

complaints

during

the

weekend

-LRB-

Hypothesis

-RRB-

and

will

be

more

preoccupied

with

the

upcoming

workweek

than

the

low-effort

group

-LRB-

Hypothesis

-RRB-

Method

Participants

and

procedure

This

study

was

conducted

in

two

stages

among

academic

staff

members

of

a

medium-sized

Dutch

university

Of

the

employees

who

were

tenured

and

worked

at

least

days

a

week

only

those

could

participate

who

-LRB-

-RRB-

did

not

have

a

job

outside

this

university

-LRB-

to

keep

the

variation

in

work

activities

within

acceptable

limits

-RRB-

and

-LRB-

-RRB-

lived

with

a

partner

who

worked

at

least

days

a

week

-LRB-

to

increase

the

likelihood

that

the

participants

fulfilled

at

least

some

home

obligations

-RRB-

Of

the

employees

who

agreed

to

participate

-LRB-

-RRB-

completed

a

general

questionnaire

-LRB-

first

stage

of

the

study

-RRB-

Data

from

of

these

were

removed

as

they

apparently

did

not

meet

one

or

both

of

the

selection

criteria

To

already

reduce

the

influence

of

one

possible

confounder

-LRB-

i.e.

working

hours

-RRB-

of

the

associations

between

work-related

effort

and

the

variables

of

interest

this

study

was

restricted

to

employees

who

worked

at

least

contractual

hours

a

week

As

a

result

our

sample

comprised

employees

-LRB-

male

child

living

in

the

household

Mage

years

SD

was

assistant

professor

associate

professor

full

professor

other

jobs

e.g.

researcher

or

lecturer

-RRB-

Due

to

strict

privacy

regulations

we

did

not

know

how

many

of

the

employees

that

were

approached

for

participation

in

the

study

actually

met

our

inclusion

criteria

-LRB-

i.e.

had

no

job

outside

the

university

and

lived

together

with

a

partner

who

worked

at

least

days

a

week

-RRB-

Therefore

we

do

not

have

insight

in

how

many

employees

were

in

fact

eligible

for

participation

in

the

study

meaning

that

the

overall

response

rate

and

the

representativeness

of

our

sample

are

unknown

In

the

second

stage

of

this

study

starting

about

ten

days

after

the

completion

of

the

general

questionnaire

the

daily

variables

of

interest

were

assessed

by

means

of

short

questionnaires

that

were

completed

three

times

a

day

from

Monday

to

Sunday

-LRB-

-RRB-

a

morning

questionnaire

-LRB-

to

be

completed

after

awaking

in

the

morning

between

and

a.m.

-RRB-

-LRB-

-RRB-

an

afternoon

questionnaire

-LRB-

to

be

completed

around

p.m.

-RRB-

and

-LRB-

-RRB-

an

evening

questionnaire

-LRB-

to

be

completed

before

bedtime

between

and

p.m.

-RRB-

Only

diaries

that

were

completed

within

an

acceptable

time

range

around

the

requested

time

were

included

in

the

final

database

We

thus

removed

morning

questionnaires

that

were

completed

more

than

h

after

awakening

afternoon

questionnaires

that

were

completed

before

p.m.

after

p.m.

or

less

than

h

after

the

morning

questionnaires

and

evening

questionnaires

that

were

filled

in

less

than

h

after

the

afternoon

questionnaire

or

after

a.m.

This

procedure

resulted

in

valid

morning

diaries

valid

afternoon

diaries

and

valid

evening

diaries

Variables

derived

from

the

general

questionnaire

-LRB-

general

measures

-RRB-

Job

types

included

assistant

professor

associate

professor

full

professor

and

other

such

as

researcher

and

teacher

Age

was

measured

in

years

Gender

was

coded

as

for

male

and

for

female

Parental

status

was

coded

as

for

having

no

children

living

in

the

household

and

for

having

at

least

one

child

living

in

the

household

The

last

three

variables

are

potential

confounders

in

the

relationships

of

interest

and

are

therefore

included

as

covariates

in

further

analyses

General

fatigue

was

assessed

with

the

ten-item

fatigue

assessment

scale

-LRB-

Michielsen

et

al.

-RRB-

An

exemplary

item

is

I

am

bothered

by

fatigue

-LSB-

-LRB-

almost

-RRB-

never

-LRB-

almost

-RRB-

always

-RSB-

with

higher

scores

reflecting

higher

levels

of

fatigue

-LRB-

α

-RRB-

Work

engagement

was

measured

with

five

items

adapted

from

Rothbard

-LRB-

-RRB-

An

example

is

When

I

am

working

I

often

lose

track

of

time

-LRB-

strongly

disagree

strongly

agree

α

-RRB-

Job

pressure

was

measured

with

five

items

from

the

job

content

questionnaire

-LRB-

Karasek

-RRB-

that

were

rephrased

as

questions

-LSB-

e.g.

Do

you

have

to

work

very

fast

-LRB-

almost

-RRB-

never

-LRB-

almost

-RRB-

always

α

-RSB-

Job

control

was

measured

with

six

items

from

Van

Veldhoven

et

al.

-LRB-

-RRB-

An

exemplary

item

is

Can

you

take

a

short

break

if

you

feel

this

is

necessary

-LSB-

-LRB-

almost

-RRB-

never

-LRB-

almost

-RRB-

always

α

-RSB-

Social

support

from

colleagues

-LSB-

e.g.

My

colleagues

show

their

appreciation

for

the

way

I

do

my

job

-LRB-

almost

-RRB-

never

-LRB-

almost

-RRB-

always

α

-RSB-

and

Social

support

from

supervisor

-LSB-

e.g.

My

supervisor

shows

her/his

appreciation

for

the

way

I

do

my

job

-LRB-

almost

-RRB-

never

-LRB-

almost

-RRB-

always

α

-RSB-

were

both

measured

with

four

items

adapted

from

Geurts

et

al.

-LRB-

-RRB-

Positive

affect

and

negative

affect

were

measured

by

means

of

the

positive

and

negative

affect

schedule

-LRB-

PANAS

Watson

and

Clark

-RRB-

Following

Rothbard

-LRB-

-RRB-

we

distinguished

between

positive

and

negative

affect

regarding

work

and

positive

and

negative

affect

regarding

family

Sample

items

for

negative

affect

are

upset

and

distressed

and

examples

for

positive

affect

are

enthusiastic

and

proud

-LRB-

very

slightly

or

not

at

all

extremely

-RRB-

with

higher

scores

indicating

higher

negative

or

positive

affect

-LRB-

negative

affect

Cronbach

's

α

for

work

and

for

home

positive

affect

Cronbach

's

α

for

work

and

for

home

-RRB-

Life

events

Participants

could

report

for

ten

events

-LRB-

e.g.

birth

of

a

child

financial

troubles

change

of

job

-RRB-

whether

or

not

they

had

experienced

this

event

during

the

past

year

The

number

of

events

experienced

was

summed

Measures

derived

from

the

daily

questionnaires

-LRB-

daily

measures

-RRB-

To

limit

the

participants

burden

the

questionnaires

contained

a

combination

of

validated

scales

as

well

as

single-item

report-marks

Work-related

effort

In

the

afternoon

questionnaire

participants

were

requested

to

indicate

with

a

report

mark

the

extent

to

which

they

considered

the

preceding

workday

as

effortful

-LRB-

not

at

all

extremely

-RRB-

Activities

Time

spent

daily

on

work

activities

Participants

received

a

list

of

major

work

activities

and

indicated

the

time

-LRB-

h

h

and

h

-RRB-

they

had

spent

on

each

activity

during

regular

work

time

i.e.

until

p.m.

-LRB-

afternoon

questionnaire

-RRB-

and

during

nonwork

time

i.e.

after

p.m.

-LRB-

evening

questionnaire

-RRB-

We

recoded

this

time

range

to

obtain

an

estimate

of

the

actual

time

in

hours

by

assuming

that

the

actual

time

spent

on

an

activity

would

lie

halfway

the

two

extremes

-LRB-

e.g.

the

category

h

was

recoded

as

-RRB-

Time

spent

on

research

activities

by

day

comprised

the

time

spent

on

conducting

research

data-analysis

reading

specialist

literature

and

writing

papers

-LRB-

until

p.m.

-RRB-

Time

spent

on

teaching

activities

by

day

included

the

time

spent

on

preparing

a

lecture

giving

a

lecture

reading

-LRB-

Ph.D.

-RRB-

students

assignments

and

appointments

with

-LRB-

Ph.D

-RRB-

students

-LRB-

until

p.m.

-RRB-

Time

spent

on

administrative

activities

by

day

consisted

of

time

spent

on

preparing

a

meeting

attending

a

meeting

and

e-mail/phone

The

category

informal

contact

with

colleagues

was

entered

in

the

analyses

separately

A

activity

other

was

not

incorporated

in

further

analyses

as

on

average

only

h

were

devoted

daily

to

these

activities

All

work

activities

are

potentially

relevant

to

all

participants

as

in

the

Netherlands

lecturers

also

have

some

research

time

and

researchers

will

usually

also

teach

Overtime

work

was

computed

by

summing

the

time

spent

on

all

work

activities

after

p.m.

-LRB-

this

university

did

not

offer

evening

classes

-RRB-

during

weekdays

and

by

summing

the

total

time

spent

on

work

activities

before

and

after

p.m.

on

Saturday

and

on

Sunday

Time

spent

daily

on

home

activities

Participants

indicated

in

both

the

afternoon

-LRB-

until

p.m.

-RRB-

and

evening

questionnaires

-LRB-

from

p.m.

-RRB-

the

amount

of

time

they

spent

that

day

on

ten

categories

of

home

activities

-LRB-

largely

based

on

those

used

in

Sonnentag

's

-LRB-

-RRB-

diary

study

-RRB-

Answer

possibilities

and

recoding

procedure

were

identical

to

those

used

for

work

activities

To

ease

interpretation

of

the

categories

participants

received

examples

of

activities

in

each

category

Time

spent

on

domestic

activities

was

calculated

by

summing

the

total

time

-LRB-

i.e.

before

and

after

p.m.

-RRB-

devoted

each

day

to

household

activities

doing

odd

jobs

in

or

around

the

house

doing

the

groceries

care

giving

activities

and

businesslike

activities

Time

spent

on

active

leisure

activities

comprised

the

total

time

spent

daily

on

physical

activities

creative

activities

and

social

activities

The

total

time

spent

on

passive

leisure

activities

was

computed

by

summing

the

time

devoted

to

these

activities

-LRB-

e.g.

reading

for

pleasure

watching

TV

listening

to

music

-RRB-

before

and

after

p.m.

The

tenth

category

other

was

omitted

from

further

analysis

as

the

mean

time

spent

on

these

activities

ranged

from

only

h

on

Saturday

to

h

during

weekdays

Experiences

Participants

indicated

for

each

engaged

work

and

home

activity

the

extent

to

which

they

considered

it

as

effortful

and

as

pleasant

-LRB-

not

at

all

extremely

-RRB-

An

estimate

of

the

average

daily

effort

and

pleasure

for

each

category

of

activities

was

obtained

by

computing

a

weighted

mean

score

Thus

the

summed

product

of

hours

spent

on

each

activity

within

a

category

and

the

effort

-LRB-

pleasure

-RRB-

experienced

while

executing

the

activity

was

divided

by

the

total

hours

spent

on

the

activities

in

the

respective

category

By

employing

such

a

weighted

score

the

time

spent

on

an

activity

is

controlled

for

assuring

that

the

effort

-LRB-

pleasure

-RRB-

score

really

reflects

effort

-LRB-

pleasure

-RRB-

Health

and

well-being

Fatigue

at

work

-LRB-

weekdays

afternoon

questionnaire

-RRB-

was

measured

with

eight

items

adapted

from

Van

Veldhoven

et

al.

-LRB-

-RRB-

for

example

I

felt

tired

mentally

-LRB-

not

at

all

extremely

-RRB-

Participants

rated

each

item

twice

-LRB-

-RRB-

with

respect

to

the

first

hour

of

the

workday

-LRB-

Cronbach

's

α

-RRB-

and

-LRB-

-RRB-

with

respect

to

the

last

hour

of

the

workday

-LRB-

Cronbach

's

α

-RRB-

Fatigue

was

measured

in

the

morning

afternoon

and

evening

questionnaires

Participants

rated

their

current

state

of

fatigue

-LRB-

How

fatigued

do

you

currently

feel

-RRB-

with

a

report

mark

varying

from

-LRB-

not

at

all

-RRB-

to

-LRB-

extremely

-RRB-

Sleep

complaints

-LRB-

each

morning

questionnaire

-RRB-

were

assessed

using

a

five-item

sleep

quality

scale

-LRB-

Van

Veldhoven

et

al.

-RRB-

slightly

adapted

to

make

it

suitable

for

day-to-day

measurement

An

exemplary

item

is

Last

night

I

woke

up

several

times

-LRB-

yes

no

α

across

all

seven

consecutive

days

-RRB-

Note

that

each

day

's

values

for

this

scale

refer

to

the

previous

night

Sleep

time

-LRB-

each

morning

questionnaire

-RRB-

was

computed

by

calculating

the

self-reported

number

of

hours

in-between

the

time

they

went

to

sleep

last

night

-LRB-

what

time

did

you

go

to

sleep

last

night

-RRB-

and

the

time

they

woke

up

this

morning

-LRB-

what

time

did

you

wake

up

this

morning

-RRB-

Again

each

day

's

values

for

this

scale

refer

to

the

previous

night

Preoccupation

with

work

-LRB-

each

morning

questionnaire

-RRB-

was

assessed

with

one

self-developed

item

I

am

already

mentally

involved

with

the

things

I

have

to

do

at

work

today

-LSB-

next

week

-RSB-

-LRB-

not

at

all

extremely

-RRB-

Work

motivation

-LRB-

each

morning

questionnaire

-RRB-

regarding

the

upcoming

workday

-LRB-

during

weekdays

-RRB-

or

the

next

workweek

-LRB-

during

weekend-days

-RRB-

was

assessed

with

one

self-developed

item

I

feel

like

starting

the

next

workday

-LSB-

workweek

-RSB-

-LRB-

not

at

all

extremely

-RRB-

A

table

with

correlations

between

the

study

variables

can

be

obtained

from

the

first

author

on

request

Figure

gives

an

overview

of

the

measurement

structure

Fig.

of

the

measurement

structure

Creation

of

the

two

effort-groups

The

global

report

mark

for

work-related

effort

as

assessed

in

the

afternoon

questionnaire

was

used

to

create

the

two

effort-groups

A

workday

was

labeled

as

effortful

if

a

report

mark

of

six

or

higher

was

given

The

number

of

effortful

workdays

was

summed

for

each

participant

to

obtain

an

estimate

of

how

effortful

he/she

considered

the

workweek

To

increase

reliability

only

participants

who

gave

a

report

mark

during

at

least

three

out

of

the

five

possible

workdays

were

selected

resulting

in

a

final

sample

of

of

the

original

participants

The

low-effort

group

-LRB-

n

Meffort

-RRB-

consisted

of

participants

who

considered

-LRB-

out

of

three

-RRB-

or

only

one

workday

-LRB-

out

of

four

or

five

-RRB-

as

effortful

-LRB-

-RRB-

The

high-effort

group

-LRB-

n

Meffort

-RRB-

included

participants

who

labeled

two

or

three

-LRB-

out

of

three

-RRB-

three

or

four

-LRB-

out

of

four

-RRB-

or

four

or

five

-LRB-

out

of

five

-RRB-

workdays

as

effortful

Statistical

analyses

Data

were

analyzed

by

means

of

-LRB-

M

-RRB-

ANCOVA

which

allows

the

examination

of

relationships

between

a

categorical

independent

variable

-LRB-

the

effort-subgroups

-RRB-

and

continuous

dependent

variables

-LRB-

Maxwell

and

Delaney

-RRB-

Gender

age

number

of

children

in

the

household

and

number

of

contractual

work

hours

-LRB-

or

more

-RRB-

were

included

as

covariates

in

the

analyses

because

these

may

affect

the

relationships

between

work-related

effort

and

the

other

variables

of

interest

in

this

study

One

key

assumption

of

MANCOVA

is

that

the

criterion

variables

are

multivariately

normally

distributed

-LRB-

Maxwell

and

Delaney

-RRB-

To

examine

whether

this

assumption

could

be

maintained

the

distributions

of

the

criterion

variables

were

inspected

for

univariate

normality

both

for

the

total

sample

and

for

the

low

and

high

effort

subgroups

The

skewness

of

the

criterion

variables

was

for

out

of

variables

in

the

study

lower

than

As

this

number

is

already

expected

on

basis

of

chance

this

finding

suggests

that

the

assumption

of

a

multivariate

normal

distribution

of

the

criterion

variables

could

be

maintained

for

practical

purposes

Results

Preparatory

analyses

Table

shows

the

descriptive

statistics

for

the

general

measures

for

the

total

sample

as

well

as

for

the

two

effort

groups

The

total

sample

can

be

characterized

as

middle-aged

rather

engaged

and

not

very

tired

The

mean

level

of

fatigue

in

the

sample

does

not

significantly

differ

from

that

in

a

heterogeneous

sample

of

employees

-LRB-

M

SD

T

-LRB-

-RRB-

ns

Geurts

et

al.

-RRB-

Participants

report

relatively

high

levels

of

work

pressure

and

job

control

Levels

of

job

control

are

higher

than

those

in

a

heterogeneous

sample

of

employees

-LRB-

M

SD

T

-LRB-

-RRB-

P

Geurts

et

al.

-RRB-

Table

and

standard

deviations

for

the

total

sample

and

for

the

two

effort-groups

for

the

measures

derived

from

the

general

questionnaireTotal

sample

-LRB-

N

-RRB-

Low-effort

group

-LRB-

N

-RRB-

High-effort

group

-LRB-

N

-RRB-

Work

Work

Job

Social

support

Social

support

Positive

affectivity

Positive

affectivity

Negative

affectivity

Negative

affectivity

Life

To

investigate

possible

differences

in

the

composition

of

the

two

effort-groups

these

groups

were

compared

with

respect

to

the

general

measures

No

significant

differences

were

observed

regarding

age

-LRB-

T

df

ns

-RRB-

gender

-LRB-

χ2

df

ns

-RRB-

parental

status

-LRB-

χ2

df

ns

-RRB-

job

type

-LRB-

χ2

df

ns

-RRB-

general

fatigue

-LRB-

T

df

ns

-RRB-

and

work

engagement

-LRB-

T

df

ns

-RRB-

Also

the

MANOVA

executed

with

respect

to

job

characteristics

-LRB-

job

pressure

job

control

social

support

from

colleagues

and

supervisor

-RRB-

was

not

significant

F

-LRB-

-RRB-

ns

Furthermore

the

groups

report

comparable

levels

of

positive

and

negative

affect

-LRB-

work

T

-LRB-

-RRB-

ns

family

T

-LRB-

-RRB-

ns

-RRB-

and

positive

affect

-LRB-

work

T

-LRB-

-RRB-

ns

family

T

-LRB-

-RRB-

ns

-RRB-

Finally

the

two

effort-groups

did

not

differ

significantly

regarding

the

number

of

life

events

experienced

-LRB-

T

-LRB-

-RRB-

ns

-RRB-

Thus

in

sum

there

were

no

significant

differences

between

the

two

effort-groups

with

respect

to

the

general

measures

Differences

between

Saturday

and

Sunday

Preliminary

analyses

showed

that

the

variables

under

study

did

not

differ

significantly

between

Saturday

and

Sunday

-LRB-

F-values

ranged

from

F

-LRB-

-RRB-

ns

for

effort

reported

for

active

leisure

to

F

-LRB-

-RRB-

ns

for

effort

reported

for

overtime

work

-RRB-

Therefore

further

analyses

are

based

on

mean

scores

across

the

two

weekend

days

Research

question

Table

presents

the

means

standard

deviations

and

F-statistics

for

the

daily

variables

for

the

total

sample

and

for

each

of

the

two

effort-groups

As

to

work

activities

two

analyses

were

conducted

First

for

each

participant

the

percentage

of

days

on

which

time

was

spent

on

each

work

activity

was

computed

MANCOVA

revealed

that

these

percentages

did

not

differ

significantly

between

the

two

effort-groups

Secondly

for

each

participant

we

computed

the

mean

time

they

spent

daily

on

each

work

activity

across

the

five

weekdays

Again

MANCOVA

did

not

reveal

any

significant

difference

between

the

two

effort-groups

Thus

the

two

effort-groups

did

not

differ

significantly

in

their

work

activity

patterns

during

the

workday

Table

patterns

experiences

and

recovery

indicators

during

the

workdayHypothesisTotal

sample

-LRB-

N

-RRB-

Low-effort

group

-LRB-

N

-RRB-

High-effort

group

-LRB-

N

-RRB-

F

-LRB-

df

-RRB-

PMSDMSDMSD

Days

Multivariate

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

Informal

-LRB-

-RRB-

Time

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

Informal

-LRB-

-RRB-

Hypothesis

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

Informal

-LRB-

-RRB-

Pleasure

-LRB-

-RRB-

Multivariate

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

-LRB-

-RRB-

Informal

-LRB-

-RRB-

Hypotheses

and

Hypothesis

and

well-being

Work-related

fatigue

first

Time

-LRB-

-RRB-

Group

-LRB-

-RRB-

Work-related

fatigue

last

Time

group

-LRB-

-RRB-

P-values

and

means

and

standard

deviations

for

the

total

sample

and

for

the

two

effort-groups

To

study

possible

differences

in

experiences

two

MANCOVA

's

were

conducted

both

based

on

mean

scores

across

the

five

workdays

The

first

analysis

revealed

that

the

two

effort-groups

differed

significantly

in

the

average

amount

of

effort

reported

with

respect

to

the

four

work

activities

Univariate

tests

showed

that

the

high-effort

group

experienced

each

activity

as

more

effortful

-LRB-

Hypothesis

supported

-RRB-

The

second

analysis

revealed

that

the

two

effort

groups

did

not

differ

significantly

with

respect

to

the

pleasure

they

derived

from

their

work

activities

Possible

differences

between

the

two

effort-groups

in

fatigue

at

work

were

examined

in

a

-LRB-

Time

first

hour

vs.

last

hour

-RRB-

-LRB-

Group

low

vs.

high

effort

-RRB-

repeated-measures

ANCOVA

The

development

of

fatigue

during

the

workday

differed

significantly

between

the

two

effort-groups

-LRB-

significant

time

group

interaction

-RRB-

Post-hoc

analyses

showed

that

there

were

no

significant

differences

between

the

two

groups

in

their

level

of

fatigue

during

the

first

hour

of

the

workday

-LRB-

T

df

ns

-RRB-

However

the

high-effort

group

reported

a

significantly

higher

mean

level

of

fatigue

during

the

last

hour

of

the

workday

-LRB-

T

df

P

-RRB-

indicating

that

the

high-effort

group

reported

more

fatigue

at

the

end

of

the

workday

-LRB-

Hypothesis

supported

-RRB-

and

showed

a

stronger

increase

in

fatigue

-LRB-

Hypothesis

supported

-RRB-

during

the

workday

In

sum

the

participants

in

the

two

effort-groups

do

not

engage

in

different

types

of

work

activities

nor

do

they

experience

their

work

activities

differently

in

terms

of

pleasantness

However

the

high-effort

group

reports

to

spend

significantly

more

effort

on

each

of

the

work

activities

experiences

significantly

higher

work-related

levels

of

fatigue

at

the

end

of

the

work

day

as

well

as

a

stronger

increase

in

fatigue

during

the

workday

Research

question

Means

standard

deviations

and

F-statistics

are

presented

in

Table

As

to

home

activity

patterns

two

analyses

were

performed

First

for

every

participant

we

computed

the

percentage

of

workdays

they

spent

time

on

each

type

of

home

activity

-LRB-

domestic

active

leisure

overtime

work

and

passive

leisure

-RRB-

For

each

of

these

activities

an

ANCOVA

was

conducted

Results

showed

that

the

groups

only

differed

significantly

with

respect

to

active

leisure

activities

whereas

the

high-effort

group

spent

on

less

than

half

of

the

work

days

-LRB-

-RRB-

time

on

this

type

of

activities

the

low-effort

group

spent

on

more

than

half

of

the

work

days

-LRB-

-RRB-

time

on

this

type

of

activities

Secondly

we

conducted

four

ANCOVA

's

based

on

each

participant

's

mean

time

spent

daily

on

each

of

the

four

activities

during

the

five

weekdays

but

these

revealed

no

differences

between

the

two

effort-groups

These

results

provide

partial

support

for

Hypothesis

by

showing

that

participants

in

the

high-effort

group

engage

on

average

less

often

in

active

leisure

activities

Table

patterns

experiences

recovery

indicators

work

involvement

and

work

motivation

in-between

workdaysHypothesisTotal

sample

-LRB-

N

-RRB-

Low-effort

group

-LRB-

N

-RRB-

High-effort

group

-LRB-

N

-RRB-

F

-LRB-

df

-RRB-

PMSDMSDMSDHypothesis

Days

-LRB-

-RRB-

Active

leisure

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Hypothesis

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Hypothesis

-LRB-

-RRB-

Multivariate

-LRB-

-RRB-

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Pleasure

-LRB-

-RRB-

Multivariate

-LRB-

-RRB-

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Hypothesis

and

and

well-being

Fatigue

Time

-LRB-

-RRB-

Fatigue

Group

-LRB-

-RRB-

Fatigue

Time

group

-LRB-

-RRB-

Sleep

-LRB-

-RRB-

Sleep

-LRB-

-RRB-

Preoccupation

-LRB-

-RRB-

Work

-LRB-

-RRB-

P-values

and

means

and

standard

deviations

for

the

total

sample

and

for

the

two

effort-groups

In

order

to

investigate

possible

differences

in

their

experiences

of

home

activities

two

MANCOVA

's

were

computed

both

based

on

mean

scores

across

the

five

weekdays

The

first

analysis

showed

an

overall

significant

difference

between

the

two

effort-groups

in

the

extent

to

which

they

considered

home

activities

as

effortful

Univariate

tests

demonstrated

that

the

high-effort

group

considered

active

leisure

activities

and

overtime

work

as

more

effortful

-LRB-

Hypothesis

supported

-RRB-

The

second

analysis

revealed

that

the

two

effort-groups

did

not

differ

significantly

as

to

their

pleasure

regarding

their

home

activities

Regarding

health

and

well-being

three

analyses

were

conducted

each

based

on

mean

scores

across

the

five

workdays

For

fatigue

a

-LRB-

time

morning

vs.

afternoon

vs.

evening

-RRB-

-LRB-

group

low

vs.

high

effort

-RRB-

repeated-measures

ANCOVA

indicated

that

fatigue

did

not

vary

significantly

as

a

function

of

time

However

the

two

effort-groups

did

differ

significantly

in

their

average

level

of

fatigue

-LRB-

main

effect

of

Group

-RRB-

Post-hoc

analyses

demonstrated

that

the

high-effort

group

reported

higher

levels

of

fatigue

-LRB-

M

-RRB-

compared

to

the

low-effort

group

-LRB-

M

T

df

P

Hypothesis

supported

for

fatigue

-RRB-

The

development

of

fatigue

during

the

day

did

not

vary

significantly

as

a

function

of

effort-group

-LRB-

time

group

interaction

ns

-RRB-

Furthermore

ANCOVA

revealed

that

the

high-effort

group

reported

significantly

more

sleep

complaints

-LRB-

Hypothesis

supported

for

sleep

complaints

-RRB-

The

third

analysis

-LRB-

ANCOVA

-RRB-

showed

that

the

two

effort-groups

did

not

differ

significantly

with

regard

to

sleep

time

Concerning

preoccupation

with

work

ANCOVA

revealed

that

the

high-effort

group

was

significantly

more

preoccupied

-LRB-

Hypothesis

supported

-RRB-

A

similar

analysis

conducted

for

work

motivation

did

not

reveal

any

significant

differences

between

the

two

effort-groups

In

sum

the

high-effort

group

engaged

less

often

in

active

leisure

activities

in-between

successive

workdays

but

did

not

differ

significantly

from

the

low

effort-group

regarding

the

experience

of

pleasure

associated

with

these

activities

Further

the

high-effort

group

experienced

the

home

activities

as

more

effortful

In

addition

we

systematically

observed

higher

levels

of

fatigue

more

sleep

complaints

and

a

higher

preoccupation

with

work

in

the

high-effort

group

in-between

workdays

Research

question

Table

presents

the

relevant

means

standard

deviations

and

F-statistics

for

the

total

sample

and

for

the

two

effort-groups

To

map

possible

differences

in

activity

patterns

between

the

two

effort-groups

two

analyses

were

conducted

First

we

computed

for

each

participant

the

percentage

of

weekend

days

on

which

time

was

spent

on

each

home

activity

The

four

ANCOVA

's

-LRB-

one

for

each

percentage

-RRB-

conducted

for

these

percentage

revealed

no

differences

between

both

effort-groups

Secondly

with

respect

to

the

time

spent

on

the

four

types

of

home

activities

also

for

each

activity

an

ANCOVA

was

conducted

Results

revealed

one

important

difference

in

activity

patterns

the

high-effort

group

spent

significantly

more

time

on

overtime

work

during

the

weekend

compared

to

the

low-effort

group

-LRB-

Hypothesis

partially

supported

-RRB-

Table

patterns

experiences

recovery

indicators

work

involvement

and

work

motivation

during

the

weekendTotal

sample

-LRB-

N

-RRB-

Low-effort

group

-LRB-

N

-RRB-

High-effort

group

-LRB-

N

-RRB-

F

-LRB-

df

-RRB-

PMSDMSDMSDHypothesis

Days

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

Passive

-LRB-

-RRB-

-LRB-

-RRB-

Hypothesis

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

Passive

-LRB-

-RRB-

-LRB-

-RRB-

Hypothesis

-LRB-

-RRB-

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Pleasure

-LRB-

-RRB-

Domestic

-LRB-

-RRB-

Active

-LRB-

-RRB-

-LRB-

-RRB-

Passive

-LRB-

-RRB-

Hypothesis

and

and

well-being

Fatigue

-LRB-

-RRB-

Time

-LRB-

-RRB-

Fatigue

-LRB-

-RRB-

Group

-LRB-

-RRB-

Fatigue

-LRB-

-RRB-

Time

group

-LRB-

-RRB-

Sleep

-LRB-

-RRB-

Sleep

-LRB-

-RRB-

Preoccupation

-LRB-

-RRB-

Work

-LRB-

-RRB-

P-values

and

means

and

standard

deviations

for

the

total

sample

and

for

the

two

effort-groups

Conducting

multivariate

analyses

for

pleasure

and

effort

would

result

in

very

restricted

sample

sizes

-LRB-

n

in

both

groups

-RRB-

Therefore

only

univariate

tests

were

computed

revealing

that

the

high-effort

group

considered

all

four

activities

significantly

more

effortful

-LRB-

Hypothesis

supported

-RRB-

Again

the

two

effort-groups

did

not

differ

significantly

with

respect

to

pleasure

associated

with

their

activities

Three

analyses

were

conducted

to

examine

possible

differences

between

the

two

effort-groups

regarding

health

and

well-being

indicators

A

-LRB-

time

morning

vs.

afternoon

vs.

evening

-RRB-

-LRB-

group

low

vs.

high-effort

-RRB-

repeated-measures

ANCOVA

revealed

a

main

effect

of

Time

Post-hoc

analyses

indicated

that

fatigue

increased

significantly

during

the

day

that

is

was

lowest

in

the

morning

-LRB-

M

-RRB-

somewhat

higher

in

the

afternoon

-LRB-

M

-RRB-

and

highest

in

the

evening

-LRB-

M

-RRB-

Furthermore

overall

the

two

effort-groups

reported

different

levels

of

fatigue

-LRB-

significant

main

effect

of

group

-RRB-

Post-hoc

analyses

showed

that

the

high-effort

group

reported

significantly

higher

levels

of

fatigue

-LRB-

M

-RRB-

than

the

low-effort

group

-LRB-

M

Hypothesis

supported

for

fatigue

-RRB-

Finally

fatigue

did

not

vary

significantly

between

the

effort-groups

as

a

function

of

time

of

the

day

-LRB-

non-significant

time

group

interaction

-RRB-

Two

ANCOVAs

indicated

that

sleep

complaints

and

sleep

time

did

not

vary

significantly

between

the

effort-groups

-LRB-

Hypothesis

rejected

for

sleep

complaints

-RRB-

Two

additional

ANCOVAs

indicated

that

the

two

effort-groups

did

not

significantly

differ

with

respect

to

preoccupation

with

work

during

the

weekend

-LRB-

Hypothesis

rejected

-RRB-

but

that

the

high-effort

group

felt

less

like

starting

the

next

working

week

-LRB-

work

motivation

-RRB-

In

sum

the

two

effort-groups

did

not

show

significantly

different

activity

patterns

during

the

weekend

regarding

domestic

work

active

and

passive

leisure

However

the

high-effort

group

spent

significantly

more

hours

on

overtime

work

during

the

weekend

than

the

low-effort

group

Furthermore

the

high-effort

group

experienced

all

home

activities

as

significantly

more

effortful

although

not

as

less

pleasant

than

the

low

effort-group

We

also

observed

significantly

higher

levels

of

fatigue

during

the

weekend

and

less

motivation

to

start

the

upcoming

workweek

in

the

high-effort

group

Discussion

The

present

study

was

devised

to

enhance

our

insight

in

the

associations

between

work-related

effort

and

recovery

from

that

effort

To

this

purpose

we

compared

two

groups

of

employees

reporting

different

levels

of

work-related

effort

-LRB-

high

vs.

low

-RRB-

with

respect

to

their

activities

experiences

and

health

and

well-being

in

three

time-periods

-LRB-

-RRB-

during

work

time

-LRB-

-RRB-

in-between

work

days

and

-LRB-

-RRB-

during

the

weekend

Activity

patterns

Our

results

revealed

that

the

two

effort-groups

did

not

differ

significantly

in

terms

of

their

activity

patterns

at

work

However

two

significant

differences

were

observed

in

the

home

domain

The

first

manifested

itself

in-between

work

days

the

high-effort

group

performed

active

leisure

activities

on

fewer

days

than

the

low-effort

group

which

is

unfortunate

as

active

leisure

activities

seem

to

promote

recovery

-LRB-

Sonnentag

-RRB-

A

second

difference

appeared

during

the

weekend

Contrary

to

our

expectations

-LRB-

Hypothesis

-RRB-

employees

in

the

high-effort

group

spent

more

time

on

working

overtime

in

the

weekend

This

implies

that

these

employees

devote

part

of

potential

recovery

time

during

the

weekend

to

activities

that

may

interfere

with

the

recovery

process

-LRB-

cf.

Sonnentag

-RRB-

The

amount

of

time

devoted

to

domestic

activities

during

the

weekdays

and

weekend

days

did

not

vary

significantly

between

the

two

effort-groups

This

may

be

due

to

the

fact

that

many

domestic

activities

are

obligatory

in

nature

-LRB-

e.g.

it

is

difficult

to

circumvent

doing

the

household

chores

-RRB-

Finally

no

significant

differences

between

the

groups

emerged

concerning

low-effort

activities

both

during

weekdays

and

weekend

days

Experiences

Regarding

experiences

we

distinguished

between

effort

and

pleasure

The

high-effort

group

reported

significantly

more

effort

for

all

work

activities

In

the

home

domain

the

high-effort

group

judged

overtime

and

active

leisure

activities

as

more

effortful

during

weekdays

and

judged

all

activities

as

more

effortful

during

the

weekend

No

significant

differences

between

the

groups

were

observed

with

respect

to

pleasure

neither

during

work

time

nor

in-between

workdays

nor

in

the

weekend

Hence

work-related

effort

is

independent

of

the

pleasure

derived

from

work

and

home

activities

Health

and

well-being

We

observed

a

stronger

increase

in

work-related

fatigue

during

the

workday

for

the

high-effort

group

than

for

the

low-effort

group

Thus

whereas

the

two

groups

did

not

differ

significantly

in

work-related

fatigue

at

the

start

of

the

working

day

the

high-effort

group

was

more

fatigued

at

the

end

of

the

working

day

This

difference

persisted

in-between

workdays

This

finding

might

explain

why

the

high-effort

group

engaged

less

often

in

active

leisure

in-between

workdays

than

the

low-effort

group

Also

during

the

weekend

the

high-effort

group

remained

significantly

more

fatigued

than

the

low-effort

group

Possibly

this

may

be

due

to

the

fact

that

the

former

group

spent

more

time

on

overtime

A

somewhat

different

pattern

of

results

was

observed

with

respect

to

sleep

complaints

The

high-effort

group

reported

more

sleep

complaints

during

the

week

but

not

in

the

weekend

The

additional

finding

that

the

two

groups

did

not

differ

significantly

with

respect

to

sleep

time

suggests

that

work-related

effort

relates

to

sleep

quality

but

not

sleep

quantity

During

the

week

the

high-effort

group

was

apparently

more

preoccupied

with

work

than

the

low-effort

group

However

it

can

not

be

excluded

that

this

is

partly

due

to

our

item

wording

Although

we

asked

participants

to

indicate

the

extent

to

which

they

were

already

preoccupied

with

the

upcoming

workday

it

would

seem

possible

that

this

measure

-LRB-

also

-RRB-

reflects

the

extent

to

which

participants

were

still

ruminating

about

their

past

working

day

In

the

weekend

the

two

groups

did

not

differ

significantly

in

their

preoccupation

with

the

upcoming

workweek

This

is

surprising

as

the

high-effort

group

spent

more

time

on

work-related

activities

during

these

days

The

high-effort

group

nonetheless

reported

less

work

motivation

than

the

low-effort

group

Limitations

and

suggestions

for

future

research

Six

issues

with

respect

to

the

present

study

must

be

discussed

First

as

we

employed

a

single

item

report

mark

to

create

the

two

effort-subgroups

the

reliability

and

validity

of

this

measure

can

be

questioned

However

we

believe

that

there

are

good

arguments

in

favor

of

employing

this

report

mark

-LRB-

-RRB-

we

did

not

rely

on

a

single

observation

of

this

measure

as

each

participant

completed

the

item

on

at

least

three

occasions

-LRB-

-RRB-

employees

in

the

high-effort

group

considered

each

of

the

four

categories

of

work

activities

as

more

effortful

than

the

low-effort

group

thus

suggesting

that

the

report

mark

correctly

reflects

the

effort

experienced

during

the

workday

and

-LRB-

-RRB-

there

is

a

correlation

of

-LRB-

P

-RRB-

between

our

single-item

effort-measure

and

a

weighted

mean

score

of

the

effort

experienced

during

the

separate

work

activities

The

latter

was

computed

by

first

weighting

the

number

of

hours

spent

on

each

activity

by

the

effort

expended

to

this

activity

the

sum

of

these

weighted

scores

was

divided

by

the

total

number

of

work

hours

Thus

our

single-item

report

mark

seems

to

measure

a

very

similar

quantity

as

a

much

more

refined

measure

of

effort

A

second

point

of

concern

is

the

procedure

used

to

create

the

two

effort-subgroups

These

groups

were

created

based

on

the

number

of

days

participants

considered

their

work

as

effortful

To

probe

the

possibility

that

our

findings

are

biased

by

this

somewhat

arbitrary

procedure

we

repeated

our

analyses

using

a

slightly

different

effort

indicator

For

each

participant

who

completed

the

report

mark

of

global

work-related

effort

on

at

least

three

occasions

the

mean

score

on

this

report

mark

across

the

week

was

computed

Based

on

these

scores

two

new

subgroups

were

created

One

including

participants

with

scores

in

the

highest

tertile

and

a

second

with

participants

having

scores

in

the

lowest

tertile

Analyses

were

repeated

for

these

two

groups

yielding

results

that

were

highly

similar

to

those

found

for

the

original

subgroups

-LRB-

results

can

be

obtained

from

the

first

author

on

request

-RRB-

Thus

our

findings

appear

robust

across

different

measures

of

effort

expenditure

Thirdly

our

study

relied

exclusively

on

self-report

measures

and

this

might

have

resulted

in

an

overestimation

of

the

associations

among

the

variables

due

to

common

method

variance

However

this

should

have

inflated

all

relations

studied

and

not

just

part

of

these

the

fact

that

some

relationships

were

found

while

others

were

not

argues

against

the

influence

of

common

method

variance

in

our

study

Besides

alternative

measures

such

as

observational

or

physiological

measures

are

not

free

of

error

variance

either

and

should

therefore

not

be

considered

superior

to

self-report

measures

-LRB-

Semmer

et

al.

see

also

Kompier

-RRB-

Furthermore

by

demonstrating

-LRB-

-RRB-

that

using

self-reports

does

not

guarantee

finding

significant

results

-LRB-

-RRB-

that

potential

biasing

variables

-LRB-

social

desirability

negative

affectivity

and

acquiescence

-RRB-

do

not

generally

inflate

correlations

among

study

variables

and

-LRB-

-RRB-

that

monomethod

correlations

are

not

by

definition

higher

than

multimethod

correlations

Spector

-LRB-

-RRB-

concludes

that

the

popular

position

suggesting

common

method

variance

automatically

affects

variables

measured

with

the

same

method

is

a

distortion

and

oversimplification

of

the

true

state

of

affairs

-LRB-

p

-RRB-

Thus

all

in

all

we

do

not

believe

that

common

method

bias

severely

biased

our

findings

although

the

use

of

physiological

and

performance

measures

in

addition

to

self-reports

could

provide

interesting

insights

in

future

research

A

fourth

issue

is

the

impact

of

potential

third

variables

One

might

argue

that

differences

between

the

two

effort-groups

regarding

-LRB-

experiences

of

-RRB-

activities

and

health

and

well-being

indicators

might

be

due

to

personality

characteristics

or

other

person

or

work-related

constructs

rather

than

to

work-related

effort

However

in

our

study

we

attempted

to

exclude

the

influence

of

these

variables

to

our

best

ability

The

two

effort-groups

turned

out

not

to

differ

regarding

the

number

of

life

events

experienced

general

work

characteristics

-LRB-

work

pressure

job

control

social

support

-RRB-

fatigue

work

engagement

age

and

positive

and

negative

affect

Of

course

this

does

not

exclude

the

possibility

that

other

third

variables

-LRB-

e.g.

other

aspects

of

personality

-RRB-

may

have

acted

as

third

variables

in

this

study

Fifth

this

study

did

not

offer

insight

in

the

intriguing

question

into

the

origin

of

the

differences

in

work-related

effort

between

the

two

subgroups

studied

It

may

be

that

these

differences

are

at

least

partly

due

to

differences

in

participants

objective

work

performance

-LRB-

e.g.

number

of

publications

or

student

evaluations

-RRB-

but

such

measure

was

not

incorporated

in

this

study

Thus

it

is

unclear

how

the

differences

between

the

two

effort-groups

in

their

work-related

effort

are

related

to

real

output

differences

and

future

studies

on

this

topic

should

also

include

objective

measures

of

task

performance

Finally

the

present

research

employed

a

very

specific

sample

consisting

of

academic

staff

members

who

worked

at

least

h

a

week

and

who

lived

together

with

a

partner

who

worked

at

least

days

a

week

and

who

as

is

common

for

tenured

academics

in

the

Netherlands

have

relatively

high

job

security

and

are

not

dependent

on

fund

raising

Although

we

believe

that

our

main

findings

on

the

relations

among

effort

recovery

health

and

well-being

are

not

unique

to

this

sample

it

is

desirable

to

replicate

this

study

for

employees

in

other

professions

in

other

family

situations

and/or

with

other

working

hours

Thus

future

studies

should

employ

samples

from

other

contexts

to

broaden

our

understanding

of

effort

and

recovery

patterns

Assets

of

this

study

In

spite

of

these

limitations

we

believe

that

the

present

study

extends

and

enhances

previous

research

on

effort

and

recovery

in

at

least

four

respects

First

this

study

is

among

the

very

few

that

examine

effort

and

recovery

from

a

day-to-day

perspective

allowing

us

to

demonstrate

that

work-related

effort

is

related

to

various

aspects

of

daily

work

and

-LRB-

potential

-RRB-

recovery

time

In

this

vein

this

study

shows

how

effort

expenditure

at

work

is

actually

imbedded

in

everyday

life

and

how

it

relates

to

recovery

during

time-off-the

job

Secondly

this

study

emphasized

the

importance

of

the

weekend

as

a

-LRB-

potential

-RRB-

opportunity

for

recovery

Whereas

some

differences

between

the

two

effort-groups

persisted

throughout

the

weekend

-LRB-

e.g.

higher

levels

of

fatigue

and

effort-investment

for

the

high-effort

group

-RRB-

other

differences

manifested

themselves

only

during

the

working

week

-LRB-

i.e.

less

active

leisure

more

sleep

complaints

and

more

preoccupation

with

work

for

the

high-effort

group

-RRB-

or

only

during

the

weekend

-LRB-

i.e.

more

overtime

work

and

less

work

motivation

for

the

high-effort

group

-RRB-

Thus

not

all

workers

employ

the

recovery

opportunities

offered

by

the

weekend

in

a

similar

fashion

some

seem

to

employ

the

weekend

as

a

means

to

catch

up

with

their

overdue

tasks

These

results

suggest

that

it

would

be

worthwhile

to

study

the

reasons

why

workers

differ

in

the

way

they

use

their

weekend

Thirdly

by

paying

attention

to

employees

activity

patterns

at

work

and

outside

work

we

were

able

to

show

that

effort

expenditure

at

work

relates

to

activity

patterns

in

the

home

domain

Namely

high

levels

of

effort

expenditure

at

work

were

associated

with

less

engagement

in

active

leisure

and

more

overtime

work

This

finding

thus

suggests

that

for

some

workers

high

effort

expenditure

at

work

is

not

compensated

by

a

corresponding

degree

of

participation

in

recovery

activities

Given

that

an

imbalance

between

effort

and

recovery

is

associated

with

adverse

health

outcomes

this

particular

group

of

workers

may

in

the

long

run

be

a

risk

group

for

the

development

of

ill

health

Fourthly

we

demonstrated

that

experiences

associated

with

engagement

in

work

and

home

activities

are

important

higher

effort

investment

at

work

is

related

to

experiences

of

higher

effort

expenditure

outside

work

but

not

to

experiences

of

less

pleasure

regarding

work

or

home

activities

Practical

implications

Based

on

our

study

's

results

three

practical

suggestions

can

be

formulated

Firstly

adequate

control

opportunities

in

the

job

setting

will

allow

workers

to

adjust

their

work

behavior

to

their

current

need

for

recovery

and

thus

to

prevent

the

development

of

negative

load

reactions

during

working

Secondly

employees

should

be

encouraged

to

engage

in

leisure

activities

that

potentially

contribute

to

the

recovery

process

such

as

active

leisure

Finally

the

time

spent

on

overtime

work

should

be

kept

within

acceptable

limits

as

overtime

work

impedes

the

recovery

process

Employers

should

not

to

demand

excessive

overtime

work

from

their

employees

in

order

to

guarantee

sufficient

-LRB-

potential

-RRB-

recovery

time

-LRB-

see

also

Beckers

et

al.

in

press

-RRB-

Theoretical

implications

Our

study

revealed

that

workers

who

invest

high

effort

at

work

differ

in

their

off-the-job

activity

patterns

from

those

who

invest

low

effort

at

work

members

of

the

first

group

are

to

a

lesser

degree

engaged

in

active

leisure

during

evenings

in-between

work

days

and

they

spend

more

time

on

overtime

work

during

the

weekend

This

different

activity

pattern

may

have

consequences

for

the

recovery

process

as

previous

research

suggests

that

active

leisure

promotes

recovery

whereas

overtime

work

impedes

this

process

-LRB-

Sonnentag

-RRB-

That

recovery

is

endangered

in

the

high-effort

group

is

also

evidenced

by

the

higher

levels

of

fatigue

during

non-work

time

-LRB-

evenings

and

weekends

-RRB-

and

the

lower

sleep

quality

during

the

week

Apart

from

a

different

activity

pattern

those

expending

high

effort

at

work

also

expend

high

effort

on

home

activities

which

also

may

endanger

the

recovery

process

Therefore

despite

the

fact

that

those

investing

high

effort

at

work

do

not

experience

their

activities

as

less

pleasant

than

those

expending

low

effort

they

may

be

considered

at

risk

for

developing

health

problems

in

the

long

run


Family history is neglected in the work-up of patients with colorectal cancer : a quality assessment using cancer registry data In the diagnostic work-up of hereditary non-polyposis colorectal cancer -LRB- HNPCC , Lynch syndrome -RRB- , high-risk patients can be identified using information from the family history on cancer -LRB- ` Amsterdam criteria ' and ` Bethesda guidelines ' -RRB- . To investigate to what extent the medical specialists apply these criteria to patients with colorectal carcinoma and a suspicion of HNPCC , we collected information on diagnostic work-up of 224 patients of seven hospitals in the region of the Comprehensive Cancer Centre West in Leiden , The Netherlands . These patients were diagnosed with colorectal cancer between 1999 and 2001 and satisfied at least one of the Bethesda guidelines . A complete family history was recorded for 38 of the 244 patients -LRB- 16 % -RRB- . Patients with a complete family history were more likely to be referred to the Clinical Genetic Centre than those with an incomplete or absent family history -LRB- 53 % vs. 13 % and 4 % , respectively ; P < 0.0001 -RRB- , and more likely to be analyzed for microsatellite instability -LRB- MSI -RRB- , which is a characteristic of HNPCC -LRB- 34 % vs. 6 % and 1 % , respectively ; P < 0.0001 -RRB- . We conclude that the family history is neglected in the majority of patients with colorectal cancer and MSI-analysis is only performed in a small proportion of the patients that meet the guidelines for this analysis . Introduction Colorectal cancer -LRB- CRC -RRB- is one of the most common forms of cancer in Western society . Every year 9,500 patients in the Netherlands are diagnosed with the disease and almost half of them die from it -LRB- Dutch Cancer Registry , 2002 -RRB- . It is estimated that in around 20 % of the patients with a colorectal tumour genetic factors play a role in the aetiology -LSB- 1 -RSB- . About 1 -- 5 % of the patients with CRC are thought to have hereditary non-polyposis colorectal cancer -LRB- HNPCC , Lynch Syndrome -RRB- ; a dominant hereditary disease , which is caused by a defect in one of the DNA-Mismatch Repair -LRB- MMR -RRB- genes -LSB- 2 -RSB- . The most important clinical characteristics of CRC associated with HNPCC , are the relatively young age at which patients are diagnosed with the disease -LRB- average < 45 years old -RRB- and the proximal localisation of the tumour in the colon . Besides an increased risk of developing a tumour in the colon , there is an increased risk of developing a tumour elsewhere in the body , especially in the endometrium -LRB- lifetime risk : 50 % -RRB- , the small intestines , the ovaries , the brain , the urinary tract , the biliary tract and the development of a keratoacanthoma or a carcinoma of the sebaceous glands of the skin -LSB- 3 -RSB- . The identification of patients with hereditary colorectal carcinoma is of great importance for the patient , because the treatment and follow-up of the tumour differ from those with non-hereditary colorectal carcinoma -LSB- 4 -RSB- . Furthermore , the identification of these patients is important , because it offers efficient manners for the prevention of colorectal carcinoma and other forms of cancer for the patient himself as well as his family -LSB- 5 -RSB- . It has been shown that a colonoscopy every three years can lead to a decline in mortality of at least 65 % -LSB- 6 -RSB- . The genetic defect in HNPCC can be detected by immunohistochemic staining of the MMR proteins in tumour cells -LSB- 7 -RSB- . Another method to select families for mutation analysis of the MMR genes is analysis of errors in repetitive DNA-sequences , i.e. , Micro Satellite Instability -LRB- MSI -RRB- -LSB- 8 -RSB- . MSI is found in around 15 % of the non-selected CRC and in more than 95 % of the colorectal tumours associated with HNPCC -LSB- 9 -RSB- . In 1996 , guidelines were formulated for patients whose tumours should be analyzed for MSI -LSB- 10 -RSB- . These so-called Bethesda-guidelines describe practically all situations , where there is a suspicion of HNPCC . Recently these guidelines have been revised -LRB- Table 1 -RRB- -LSB- 11 -RSB- . Table 1Guidelines for the performance of MSI-analysis of colorectal tumour -LSB- 11 -RSB- Revised Bethesda-guidelinesA person with colorectal carcinoma diagnosed at age ≤ 50A person with colorectal carcinoma and MSI-associated pathologya < 60 yearsA person with colorectal carcinoma and a HNPCC associated tumourbA person with colorectal carcinoma and a first degree relative with a colorectal or HNPCC associated tumour ; at least one of the tumours is diagnosed before the age of 50Three relatives diagnosed with colorectal carcinoma or a HNPCC associated tumour , diagnosed at any age ; one patient needs to be a first degree relative of the other twoaThe presence of tumor-infiltrating lymphocytes , so called , `` Crohn 's like lymfocyte reaction '' , mucinous or signet ring cell carcinoma differentiation or medullary growth patternbCarcinoma of the endometrial tissue , stomach , small intestines , pancreatic gland , biliary tract , urinary tract , ovaries , brain , keratoacanthoma and carcinoma of the sebaceous glands Before the discovery of the MMR-genes , the most common approach in the diagnostic work-up for HNPCC was to use the ` Amsterdam criteria ' . These criteria are met if there are , within one family , three individuals with a colorectal -LRB- or another HNPCC-associated kind of -RRB- tumour , of whom one person is a first degree family member of the other two and at least one carcinoma is diagnosed before the age of fifty -LSB- 12 -RSB- . To evaluate the Amsterdam criteria in patients with CRC , a complete history on cancer in the patient 's family has to be obtained . Until now it is not known whether an adequate family history is taken of all patients with a colorectal carcinoma . We also do not know to what extent medical specialists use the above mentioned clinical Bethesda guidelines and if the tumours of all the patients who match the criteria are tested for MSI . The objective of the present study was to answer these questions using data of the Cancer Registry of the Comprehensive Cancer Centre West -LRB- CCCW -RRB- in Leiden , The Netherlands . Patients and methods We selected patients who were diagnosed with a primary and invasive colorectal tumour in the period 1999 -- 2001 from the Cancer Registry -LRB- CR -RRB- of the Comprehensive Cancer Centre West -LRB- CCCW -RRB- in The Netherlands . The patients had to satisfy one of the following two Bethesda guidelines : the patient had to have more than one tumour , i.e. , one colorectal carcinoma and a second one -LRB- colorectal cancer or another HNPCC-associated kind of tumour -RRB- , or the patient had to be fifty years or younger at diagnosis . The selected patients were considered to have an indication for the performance of MSI-analysis and/or referral to the Clinical Genetic Centre -LRB- CGC -RRB- . Patients with a carcinoma in situ or a carcinoïd of the appendix were not included in the analysis . Between 1999 and 2001 , 434 patients who complied with the above mentioned criteria were diagnosed with CRC in one of the twelve hospitals in the CCCW-region . Seven hospitals gave permission for the collection of information concerning family history , MSI-analysis and referral to the CGC . We extracted this information from the various -LRB- electronic -RRB- medical reports . The family history was considered complete if the medical records reported on cancer in the family , and if so , information about the age at the time of the diagnosis , the type of cancer and the occurrence of cancer within first-degree and second-degree family members . Data were collected of 244 patients . Of these patients , 120 patients had multiple tumours , 109 patients were fifty years or younger at the time of diagnosis , and 15 patients had both characteristics . For comparisons between patients with multiple tumours and patients who were young at diagnosis , those with both characteristics were allocated to the `` multiple tumours '' group . The data were analyzed using SPSS statistical software -LRB- version 12.0.1 -RRB- . Univariate comparisons of proportions between patient groups were performed by Chi-squared test . Multivariate logistic regression analysis was used to study whether the presence of a complete family history or referral to a CGC could be explained by age , sex , inclusion criterion -LRB- multiple tumours or young age at diagnosis -RRB- , hospital or type of medical specialist . Results The study group consisted of 244 persons , who complied with one of the Bethesda guidelines and therefore were considered to be referred for MSI-analysis and/or genetic counselling . The male : female ratio was 49:51 and did not differ between the groups selected on the basis of multiple tumours or age ≤ 50 years at diagnosis . A complete family history was recorded in the medical records of 38 -LRB- 16 % -RRB- of the 244 patients . For 136 patients -LRB- 55 % -RRB- limited information on the family history was available , and for 70 -LRB- 29 % -RRB- patients no information on the family history was found in the medical records . In the seven participating hospitals , a family history was reported for 38 -- 91 % of the patients . Of the 38 patients with a complete family history , 20 -LRB- 53 % -RRB- were referred to the CGC . This percentage was higher than that of patients with an incomplete family history -LRB- 13 % -RRB- and that of patients without any information on family history -LRB- 4 % -RRB- -LRB- P < 0.0001 , Table 2 -RRB- . MSI-analysis was performed more often in the patients with a complete family history : 34 % of patients with a complete family history compared to 6 % of patients with an incomplete family history and 1 % of patients without any family history -LRB- P < 0.0001 -RRB- -LRB- Table 2 -RRB- . Presence of a complete family history and the performance of MSI-analysis were not associated with age , sex , inclusion criterion -LRB- multiple tumours or young age at diagnosis -RRB- , hospital or type of medical specialist -LRB- multivariate logistic regression analysis ; data not shown -RRB- . Table 2Diagnostic work-up for HNPCC in 244 patients with colorectal cancer , by completeness of the family history as reported in the medical recordsDiagnostic workupFamily history complete -LRB- n = 38 -RRB- Family history incomplete -LRB- n = 136 -RRB- Family history absent -LRB- n = 70 -RRB- Referred to CGC20 -LRB- 53 % -RRB- 17 -LRB- 13 % -RRB- 3 -LRB- 4 % -RRB- MSI-analysis performed13 -LRB- 34 % -RRB- 8 -LRB- 6 % -RRB- 1 -LRB- 1 % -RRB- Results of MSI-analysis3 MSI , 10 stable7 stable , 1 unknown1 stableDiagnosis of HNPCC6 -LRB- 16 % -RRB- 3 -LRB- 2 % -RRB- 1 -LRB- 1 % -RRB- Discussion We used the Bethesda-guidelines to select a group of patients with a suspicion of HNPCC . These patients were diagnosed with colorectal cancer between 1999 and 2001 , a period during which MSI-analysis and the Bethesda guidelines were already available . Therefore we expected that for these patients , physicians would have examined and reported their patients ' family history and that MSI-analysis would have been performed . In our study group , however , the family history of the patients diagnosed with colorectal carcinoma was not sufficiently examined and reported in the medical records . For this reason , we believe the Bethesda-guidelines were not sufficiently applied by the physicians . As a consequence , MSI-analysis was performed on a small proportion of the tumours . More patients with a complete family history in their medical records were referred by their physicians to the CGC than patients without such a family history . MSI-analysis was also performed more often in this group . We expect that in a low-risk population , i.e. , patients with colorectal cancer who do not meet the Bethesda guidelines , these results would be even more dramatic . On the one hand , our results may appear to be better than they actually are . We collected our data using medical records from various medical specialties , while the treating physician will not have this overview in practice . On the other hand , it is possible that when a physician examined a family history and none of the family members was diagnosed with cancer , he did not report it in the medical records . In this case , the family history was considered as absent , although it in fact was examined . Nevertheless we expect that if MSI-analysis was performed or the patient was referred to the CGC , this would have certainly been reported . We found that the attention for HNPCC in the diagnostic workup for CRC differed widely . For the seven participating hospitals , the proportion of patients with a reported family history on cancer ranged from 38 % to 91 % . Furthermore , only half of the approached hospitals were willing to cooperate . For these reasons , we can not generalise our results for the whole CCCW-region . Nevertheless , we conclude that the family history appears to be neglected in the majority of patients with colorectal cancer in our study period , and that MSI-analysis was only performed in a small proportion of the patients that meet the guidelines for this analysis . Possibly , the attention for identification of patients with HNPCC has increased in more recent years . Our findings underscore the importance of implementation of family history and Bethesda guidelines in the physician education .

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colorectal cancer
family history
lynch syndrome
microsatellite instability