[Accident-related and workplace-related vascular disorders of the hand]. / Unfall- und arbeitsplatzbezogene Erkrankungen der Hand mit gefäßmedizinischem Hintergrund.

BACKGROUND: Limited hand function as the result of occupational exposure or accidental injury could primarily be of vascular origin. Since it is quite rarely seen in the course of routine traumatology, special awareness of this is needed. AIM OF THE PAPER: The occupational diseases hypothenar/thenar hammer syndrome (occupational disease 2114) and vibration-induced vasospastic syndrome (occupational disease 2104) are presented on the basis of their etiological and pathogenetic characteristics, taking aspects of occupational medicine and expert opinion into consideration. DISCUSSION: Blunt force trauma to vascular structures of the hand can damage the tunica intima of the affected thenar or hypothenar arteries. Chronic exposure of the arms, hands and fingers to vibration can lead to the injury of nerve and vascular structures. Thermometry and pallesthesiometry are used in the diagnostics alongside methods of vascular medicine. CONCLUSION: Vascular entities can also play a role in the surgical assessment of the impact of an accident or of an occupational disease after exposure to vibration. Awareness of them can shorten the latency between the onset of symptoms and a definitive diagnosis.

Ultrafine particles in scanning sprays: a standardized examination of five powders used for dental reconstruction.

BACKGROUND: Intraoral matting sprays for chairside systems can release fine or ultrafine particles or nanoparticles at dentists' workplaces and cause work-related health problems by inhalation exposure. Until now, little is known about the magnitude of the ultrafine fraction, when using these scanning sprays. Hence, more information is needed for workplace risk assessments in dental practices. METHODS: Five commonly used dental spray-powders were examined under standardized conditions. Ingredients were taken from the respective safety data sheet. Particle number-size distributions and total number concentrations were analyzed with a fast mobility particle sizer, and reported graphically as well as mean particle fractions smaller than 100 nm. Based on these measurements, risk assessments were conducted, and particle depositions in the lung were modelled. RESULTS: The mean fraction of particles smaller than 100 nm varied between 9 and 93% depending on the matting agent and mode of application of the intraoral scanning spray. Propellants can represent a large fraction of these particles. Titanium dioxide, pigment-suspensions, talcum and others particles, which can pose relevant health risks, were listed as ingredients of scanning sprays in safety data sheets. Nevertheless, the deposited fraction of hazardous particles in the lung of employees in dental practices seems to be small (15%) during this dental procedure. CONCLUSIONS: Our results suggest that dentists' personnel can be exposed to hazardous fine and ultrafine particles. Though extensive standardized measurements and systematic evaluation of safety data sheets were used for this study, they cannot sufficiently assess and categorize potential workplace-related health risks.

[The description of meniscopathy in the sense of German occupational disease No. 2102 : Results of an interdisciplinary working group]. / Das Krankheitsbild im Sinne der Berufskrankheit 2102 Meniskopathie : Ergebnisse einer interdisziplinären Arbeitsgruppe.

On behalf of the Medical Advisory Committee for occupational diseases at the German Federal Ministry for Work and Social an interdisciplinary working group with medical experts in the field of casualty surgery, occupational health, orthopaedics, and radiology discussed the description of meniscopathy in the sense of the German occupational disease No. 2102. According to the medical guideline "Meniscopathy" of the German Society of Orthopaedics and Casualty Surgery (2015) meniscopathy is diagnosed clinically and radiologically by magnetic resonance imaging (MRI). The working group came to the conclusion that a bilateral, at least third-grade meniscopathy according to Stoller, in the posterior part of the inner meniscus should be required in the MRI.

Accurate quantification of mercapturic acids of styrene (PHEMAs) in human urine with direct sample injection using automated column-switching high-performance liquid chromatography coupled with tandem mass spectrometry.

Styrene is one of the most important industrial chemicals, with an enormously high production volume worldwide. The urinary mercapturic acids of its metabolite styrene-7,8-oxide, namely N-acetyl-S-(2-hydroxy-1-phenylethyl)-L-cysteine (PHEMA 1) and N-acetyl-S-(2-hydroxy-2-phenylethyl)-L-cysteine (PHEMA 2), are specific biomarkers for the determination of individual internal exposure to this highly reactive intermediate of styrene. We have developed and validated a fast, specific and very sensitive method for the accurate determination of the sum of phenylhydroxyethyl mercapturic acids (PHEMAs) in human urine with an automated multidimensional liquid chromatography-tandem mass spectrometry method using (13)C(6)-labelled PHEMAs as internal standards. Analytes were stripped from the urinary matrix by online extraction on a restricted access material, transferred to the analytical column and subsequently determined by tandem mass spectrometry. The limit of quantification (LOQ) for the sum of PHEMAs was 0.3 microg/L urine and allowed us to quantify the background exposure of the (smoking) general population. Precision within series and between series ranged from 1.5 to 6.8% at three concentrations ranging from 3 to 30 microg/L urine; the mean accuracy was between 104 and 110%. We applied the method to spot urine samples from 40 subjects of the general population with no known occupational exposure to styrene. The median levels (range) for the sum of PHEMAs in urine of non-smokers (n = 22) were less than 0.3 microg/L (less than 0.3 to 1.1 microg/L), whereas in urine of smokers (n = 18), the median levels were 0.46 microg/L (less than 0.3 to 2.8 microg/L). Smokers showed a significantly higher excretion of the sum of PHEMAs (p = 0.02). Owing to its automation and high sensitivity, our method is well suited for application in occupational or environmental studies.

[Over-indebtedness and additional payments to the German health-care system - discrimination upon destitution in expenditure]. / Uberschuldung und Zuzahlungen im deutschen Gesundheitssystem - Benachteiligung bei Ausgabenarmut.

AIM OF THE STUDY: In the past few years, the number of over-indebted private households in Germany has steadily increased and is currently estimated to have reached 3.13 million. Financial difficulties culminating in private insolvencies of the persons concerned may lead to a restrained usage of health-care services that require additional payment. For the first time ever this study has examined whether over-indebted individuals refrain from seeking medical treatment or from buying prescribed medicine because of their financial situation. METHODS: The cross-sectional study covered over-indebted persons in Rhineland-Palatinate and was conducted between July 2006 and March 2007. In cooperation with 53 debt counselling agencies in Rhineland-Palatinate and in cooperation with the specialized debtor counselling centre of the Johannes Gutenberg-University of Mainz a singular, anonymous questionnaire-based survey in written form was conducted. RESULTS: Altogether 666 persons (51% female) between 18 and 79 years old (mean value: 41,0 years, standard deviation: 11,2 years; median: 41 years) participated in this evaluation, which amounts to a participation rate of 35.5%. The majority of participants stated to refrain from buying prescribed medication (65.2%) as well as from seeking medical advice and paying euro 10.00 own contribution (60.8%) because of their financial situation. The multivariate, binary logistic end-model showed age, family situation, insolvency proceedings, medical conditions and the self-reported attitude towards health alertness to be relevant factors of influence for both target variables. CONCLUSION: The enacted own financial contribution when seeking health care or when receiving medication in Germany might cause a discrimination of indebted persons or households with regard to health care and medical treatment. Because of the obligation of additional payment, health services are not independent of an individual's financial resources, meaning that especially destitution in expenditure affects equal opportunities in the health care system.

[Gender-specific risk factors for acute low back pain: starting points for target-group-specific prevention]. / Geschlechtsspezifische Risikofaktoren akuter Rückenschmerzen: Ansatzpunkte für eine zielgruppenspezifische Prävention.

BACKGROUND: Women complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified. METHODS: Secondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (chi(2)) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals). RESULTS: Women (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment. CONCLUSION: The present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.

A method for the quantification of biomarkers of exposure to acrylonitrile and 1,3-butadiene in human urine by column-switching liquid chromatography-tandem mass spectrometry.

1,3-Butadiene and acrylonitrile are important industrial chemicals that have a high production volume and are ubiquitous environmental pollutants. The urinary mercapturic acids of 1,3-butadiene and acrylonitrile-N-acetyl-S-(3,4-dihydroxybutyl)cysteine (DHBMA) and MHBMA (an isomeric mixture of N-acetyl-S-((1-hydroxymethyl)-2-propenyl)cysteine and N-acetyl-S-((2-hydroxymethyl)-3-propenyl)cysteine) for the former and N-acetyl-S-2-cyanoethylcysteine (CEMA) for the latter-are specific biomarkers for the determination of individual internal exposure to these chemicals. We have developed and validated a fast, specific, and very sensitive method for the simultaneous determination of DHBMA, MHBMA, and CEMA in human urine using an automated multidimensional LC/MS/MS method that requires no additional sample preparation. Analytes are stripped from urinary matrix by online extraction on a restricted access material, transferred to the analytical column, and subsequently determined by tandem mass spectrometry using labeled internal standards. The limits of quantification (LOQs) for DHBMA, MHBMA, and CEMA were 10 microg/L, 2 microg/L, and 1 microg/L urine, respectively, and were sufficient to quantify the background exposure of the general population. Precision within series and between series for all analytes ranged from 5.4 to 9.9%; mean accuracy was between 95 and 115%. We applied the method on spot urine samples from 210 subjects from the general population with no occupational exposure to 1,3-butadiene or acrylonitrile. A background exposure of the general population to acrylonitrile was discovered that is basically influenced by individual exposure to passive smoke as well as active smoking habits. Smokers showed a significantly higher excretion of MHBMA, whereas DHBMA levels did not differ significantly. Owing to its automation, our method is well suited for application in occupational or environmental studies.