Regarding the second and third questions of

Regarding the second and third questions of the decision tree (Fig. 1), identifying health- and work-functioning problems that could either be related to the occupational exposures or reflect a lack of resources on the part of the hospital physicians to cope with the job demands, and the prevalence of these health effects among hospital physicians was evaluated by looking for international evidence, and locally through self-reporting by 900 hospital physicians and medical residents [8,17]. With respect to question three, our expert group of researchers decided to label the prevalence of health effects as ‘high’ when exceeding a prevalence rate of 10% or when this was higher among hospital physicians compared with the general population.
To answer the fourth research question (Fig. 1), our expert group of researchers identified three aspects to decide upon the impact of the specific health- or work functioning problem: (1) whether it abiraterone acetate bothered the individual worker; (2) whether it led to restrictions in daily work functioning; and (3) whether it posed a potential risk for others. When hardly bothering the individual, hardly restricting daily work function and posing no risk for others, the impact was considered small. The impact was labeled as medium when the health effect was bothering the individual in some way, but was not restrictive in daily work functioning or posing a risk for others. When a health problem was significantly restrictive in daily work functioning and/or formed a potential risk for others, the impact was considered high.

Results
First of all, the questions of the decision trees were answered for the different types of occupational exposures, job demands, and job requirements. To finally decide whether or not to include the occupational exposure, job requirement or health effect in the job-specific WHS, a priori decision rules were followed that used the information resulting from the questions of the decision trees. For both the physical job demands and the biological, chemical, and physical exposures, screening of the health- or work-functioning problems was included when: (1) the prevalence of the health- or work functioning-effect was high and the impact medium or big; or (2) the prevalence of the health- or work functioning-effect was low or unknown, but the impact big. Regarding the psychological job demands, other rationales were formed. Screening of the health effects was included in the WHS in one of the following cases: (1) prevalence of the emotionally demanding situation was high and the impact medium or big; (2) accidental exposure to the emotionally demanding situation is sufficient to lead to health- or work-functioning problems and the impact of these problems is medium or big; or (3) prevalence of the emotionally demanding situation is low, but the impact is considered big. Table 1 lists some examples of how these decision trees and decision rules were followed for different occupational exposures, job demands, or job requirements.
In addition to the inclusion of job demands, occupational exposures, and job requirements resulting from the decision tree, specific or safety job requirements were included in the WHS, given the existing Dutch guidelines for occupational physicians and the guide on specific job demands [18]. For example, the work of hospital physicians requires them to maintain a heightened state of alertness 24/7. In acute complex situations anus need to be able to act quickly and adequately. Screening in the WHS on aspects that could negatively affect the ability to maintain this heightened state of alertness was, therefore, found to be feasible and relevant. These aspects include the chosen content of screening for psychological health complaints (e.g., depressive symptoms), drug use, and alcohol consumption. Furthermore, with the aim of maintaining and promoting the health status of hospital physicians in relation to their work, monitoring risk factors for developing cardiovascular diseases was found relevant to be included in the WHS as well. Finally, to detect general problems that might affect the work ability of the hospital physicians, the self-reported Work Ability Index [19] was included, as well as enquiring after all other unaddressed health problems that might affect their work ability. An overview of the WHS protocol is shown in Table 2.