Although heterogeneous in methodology and content, 32 studies from 13 countries on bus drivers' work and health are similar in their conclusions. Bus-driving (characterized by high demands, low control and low support) can be regarded as a classic example of high-strain occupation, with high risks of physical and mental occupational ill-health, leading to absenteeism and to decreased productivity of employees and enterprises. Several recommendations (some of them already being implemented by bus companies) are presented in order to reduce work stress in bus drivers. They relate to: (a) ergonomics of the bus cabin; (b) job rotation and `combination jobs'; (c) timetables, shift schedules and quality of break periods; and (d) the social work environment and management style. Stress monitoring and stress reduction is not merely a technical process based on a technical analysis and on the simple `straightforward' realization of recommendations and findings. It related to changing and improving organizations and organizational processes. Such organization changes can best be obtained through a stepwise and participative approach. There are indications that those companies that invest in preventive measures receive their rewards.
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