Hair cortisol concentration and its association with acute stress responses and recovery in a sample of medical students in Germany.

INTRODUCTION: Experiencing acute and chronic stress can contribute to adverse health outcomes. Responses to acute stress differ between individuals (i.e., stress reactivity) and the experience of chronic stress has been discussed to be associated with acute stress responses and stress recovery. This study thus aims to investigate whether hair cortisol concentration (HCC), being an indicator for hypothalamus-pituitary-adrenal (HPA) axis activity over a prolonged period of time, is associated with acute stress responses and recovery in a sample of medical students. MATERIAL AND METHODS: From July 2020 to July 2021, medical students (n = 54) underwent a virtual-reality Trier Social Stress Test in which their blood pressure and heart rate variability (HRV) were measured, and hair samples were taken to determine HCC. Piecewise linear growth analyses were used to investigate whether HCC (categorized into low, medium and high levels) is associated with acute stress responses and recovery regarding blood pressure and HRV. RESULTS: Significant interaction effects in piecewise linear growth analyses showed that participants with higher levels of HCC had lower systolic and diastolic blood pressure responses compared to participants with medium levels of HCC. No significant interaction effects were observed for HRV responses or for recovery measures. CONCLUSIONS: The study suggests that higher levels of HCC are associated with a lower cardiovascular response in terms of blood pressure to an acute stressor in medical students. Therefore, long-term HPA-axis activity may contribute to different magnitudes of acute stress responses in the autonomic nervous system. As the shown lower blood pressure responses to acute stress in individuals with increased long-term HPA-axis activity may represent inadequate stress responses, these should be further studied in order to find out more about their interaction and potential subsequent disease risks.

Comparison of the Perceived Stress Reactivity Scale with physiological and self-reported stress responses during ecological momentary assessment and during participation in a virtual reality version of the Trier Social Stress Test.

Valid approaches to conveniently measure stress reactivity are needed due to the growing evidence of its health-impairing effects. This study examined whether the Perceived Stress Reactivity Scale (PSRS) predicts cardiovascular and psychological responses to psychosocial stressors during daily life and during a virtual reality (VR) Trier Social Stress Test (TSST). Medical students answered a standardized baseline questionnaire to assess perceived stress reactivity by the PSRS. The PSRS asks participants to rate the intensity of their typical affective responses to common stressors during daily life. They were further asked to participate in a VR-TSST and in an ecological momentary assessment (EMA) over a period of three consecutive workdays during daily life. Blood pressure and self-reported stress were repeatedly, heart rate variability (HRV) continuously measured during the VR-TSST and EMA. Furthermore, participants repeatedly assessed task demands, task control and social conflict during the EMA. Data was analysed using multilevel analysis and multiple linear regression. Results indicate that the PSRS moderates associations between blood pressure (but not HRV) and demands and control during daily life. Furthermore, the PSRS directly predicted self-reported stress, but did not moderate associations between self-reported stress and demands, control and social conflict. The PSRS did not predict physiological and self-reported stress responses to the VR-TSST. This study partly confirmed convergent validity of the PSRS to stress reactivity in daily life. Furthermore, the lack of association between the PSRS and stress responses to the VR-TSST calls for future studies to search for reliable and valid ways to assess stress reactivity.

Determinants of the intention to seek psychotherapeutic consultation at work - a cross-sectional study in Germany.

BACKGROUND: Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A. METHODS: Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression. RESULTS: Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A. CONCLUSION: Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation.

The association between study conditions and hair cortisol in medical students in Germany - a cross-sectional study.

BACKGROUND: Medical students often experience high levels of stress due to adverse study conditions, which may have adverse health consequences. Hair cortisol concentration (HCC) has been described as a physiological marker for chronic stress and might thus help to identify students under stress and examine the study conditions being responsible for long-term physiological stress responses. This study therefore investigated the association between study conditions and HCC in a sample of medical students. METHODS: Fifty-five students from a medical school in Germany completed a paper-based questionnaire and had hair samples collected between May 2020 and July 2021. Study conditions were assessed with student versions of questionnaires based on the Job-Demand-Control-Support model (StrukStud, 25 items) and Effort-Reward Imbalance model (Student ERI, nine items). HCC of two centimeters closest to the scalp were determined by a cortisol luminescence immunoassay. Linear multiple regression analyses were performed to examine associations between study conditions and HCC. RESULTS: Demands (B = 0.23, p = 0.002), effort (B = 0.12, p = 0.029) and the effort-reward-ratio (B = 0.28, p = 0.007) were positively associated with HCC in separate regression analyses, adjusted for age and sex. Only the association between demands and HCC remained significant when all components of the respective questionnaire were considered in the same model (B = 0.22, p = 0.003). CONCLUSION: The results suggest that adverse study conditions may be associated with activation of the hypothalamic-pituitary-adrenal axis stress response as reflected by increased HCC. Longitudinal research is needed to confirm these cross-sectional results and examine effects of more prolonged stress due to adverse study conditions.

Employees' preferences on organisational aspects of psychotherapeutic consultation at work by occupational area, company size, requirement levels and supervisor function - a cross-sectional study in Germany.

BACKGROUND: Common mental disorders affect a significant proportion of the population worldwide at any given time. Psychotherapeutic consultation at work offers employees with mental distress short-term and low-threshold access to psychotherapeutic treatment. However, this offer is only accepted by one to two percent of the employees to whom it is offered. Taking into account employees ' preferences regarding organisational aspects might increase the use of psychotherapeutic consultation at work. This study therefore aimed to identify preferences on organisational aspects of psychotherapeutic consultation at work among employees of diverse occupational areas, company sizes, supervisor functions and job requirement levels. METHODS: A total of 755 employees were recruited via advertisements on social media (Instagram, Facebook and LinkedIn). Participants rated on a 5-point Likert scale their agreement to different implementation options of psychotherapeutic consultation at work: type (in-person/video/telephone), location (on/outside company premises), time (within/outside working hours), scope (diagnostic/diagnostic + treatment) and purpose (private/occupational). Additionally, the maximum accepted distance to the location of consultation was assessed. Various analyses of variances (ANOVA) were conducted to determine differences in agreement to implementation options within each organisational aspect and to analyse differences between occupational areas, company sizes, requirement levels and between employees with and without supervisor function. RESULTS: Participants indicated a preference for in-person psychotherapeutic consultation that takes places outside company premises and outside working hours. Furthermore, they preferred offers including diagnostic and treatment sessions compared to offers including diagnostic sessions only. Even though participants agreed that consultation should be offered for all purposes, agreement for occupational issues was stronger than for private issues. For some implementation options, the level of agreement varied according to occupational field, company size, supervisor function and level of requirement. However, these differences did not affect the key findings mentioned above. CONCLUSION: Those findings give practical indications on the organisational design of psychotherapeutic consultation at work. The results suggest that in-person consultation outside company premises and working hours combining diagnostic and treatment sessions will be accepted by employees regardless of their occupational area, company size, supervisor function and requirement level.

Requirements for an electronic handover system for interprofessional collaboration between psychotherapists and occupational health professionals - a qualitative study.

BACKGROUND: An electronic handover system provides a potential way to bridge the interface between psychotherapy and occupational health. This qualitative study therefore aimed assessing (1) content-related and (2) functional requirements that psychotherapists and occupational health professionals expect from an electronic handover system to exchange relevant information about their patients with common mental disorders. METHODS: Five focus groups with psychotherapists and occupational health professionals (occupational physicians and members of company integration management) were conducted via video conference using an interview guide. The focus groups were transcribed and content-analysed using MAXQDA. RESULTS: With regard to content-related requirements, information that serve to assess employee's ability to work was described as particularly relevant by occupational physicians and members of company integration management (e.g. restrictions in certain work areas or ability to work under time pressure). Psychotherapists indicated that information about the employee's working conditions is particularly relevant. This includes description of work tasks or conflicts at the workplace. Concerning functional requirements, all professional groups attached importance to data security and functions to improve communication and collaboration (e.g. the use of standardised handover forms). CONCLUSION: This study provides insight into the desired content-related and functional requirements by psychotherapists, occupational physicians and members of company integration management for an electronic handover system. However, the theoretical and practical development of such a system requires several additional steps, such as the involvement of further relevant stakeholders (e.g. patients, software developers).

Physiological reactions to acute stressors and subjective stress during daily life: A systematic review on ecological momentary assessment (EMA) studies.

OBJECTIVE: This review aims to provide an overview of ecological momentary assessment (EMA) studies analyzing stress reactivity during daily life in terms of direct and moderated influence of acute stress on physiological responses. MATERIALS AND METHODS: A systematic literature search was performed on November 29, 2021 using Web of Science, MEDLINE and PsycINFO to identify prospective EMA studies targeting acute stressors or stress under naturalistic conditions, without restrictions of publication date or population. Study quality was assessed for multiple EMA-specific sources of bias. RESULTS: Out of 4285 non-duplicate records, 107 publications involving 104 unique studies were included. The majority of studies assessed acute physiological stress responses primarily through salivary cortisol (n = 59) and cardiovascular outcomes (n = 32). Most studies performed at least three measurements per day (n = 59), and had a moderate risk of recall bias (n = 68) and confounding (n = 85). Fifty-four studies reported a compliance of ≥80%. Direct, non-moderated positive associations were observed between acute stress exposure and concurrent cortisol levels (44%, n = 11/25), systolic (44%, 8/18) and diastolic blood pressure (53%, 8/15) and heart rate (53%, 9/17). Several inter- and intra-individual moderators were identified, such as age, gender, health status, chronic stress, work-related resources, physical activity and stress coping indicators. CONCLUSIONS: About half of the reviewed EMA studies demonstrated direct associations between everyday acute stress exposure and physiological responses, including increased cortisol levels, blood pressure and heart rate. Results further suggested various moderator variables that could help develop tailored prevention strategies and identify groups at higher risk for dysfunctional stress responses. REGISTRATION: PROSPERO-Reg.-No.: PROSPERO 2020 CRD42020163178.

Early intervention, treatment and rehabilitation of employees with common mental disorders by using psychotherapeutic consultation at work: study protocol of a randomised controlled multicentre trial (friaa project).

BACKGROUND: Common mental disorders are one of the leading causes for sickness absence and early retirement due to reduced health. Furthermore, a treatment gap for common mental disorders has been described worldwide. Within this study, psychotherapeutic consultation at work defined as a tailored, module-based and work-related psychotherapeutic intervention will be applied to improve mental health care. METHODS: This study comprises a randomised controlled multicentre trial with 1:1 allocation to an intervention and control group. In total, 520 employees with common mental disorders shall be recruited from companies being located around five study centres in Germany. Besides care as usual, the intervention group will receive up to 17 sessions of psychotherapy. The first session will include basics diagnostics and medical indication of treatment and the second session will include work-related diagnostics. Then, participants of the intervention group may receive work-related psychotherapeutic consultation for up to ten sessions. Further psychotherapeutic consultation during return to work for up to five sessions will be offered where appropriate. The control group will receive care as usual and the first intervention session of basic diagnostics and medical indication of treatment. After enrolment to the study, participants will be followed up after nine (first follow-up) and fifteen (second follow-up) months. Self-reported days of sickness absence within the last 6 months at the second follow-up will be used as the primary outcome and self-efficacy at the second follow-up as the secondary outcome. Furthermore, a cost-benefit assessment related to costs of common mental disorders for social insurances and companies will be performed. DISCUSSION: Psychotherapeutic consultation at work represents a low threshold care model aiming to overcome treatment gaps for employees with common mental disorders. If successfully implemented and evaluated, it might serve as a role model to the care of employees with common mental disorders and might be adopted in standard care in cooperation with sickness and pension insurances in Germany. TRIAL REGISTRATION: The friaa project was registered at the German Clinical Trial Register (DRKS) at 01.03.2021 (DRKS00023049): https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023049 .

Exploring medical students' views on digital mental health interventions: A qualitative study.

BACKGROUND: Medical students show a relatively high prevalence for common mental disorders. Only few of those in need for treatment seek professional help. Therefore, easily accessible interventions are required. While several evidence-based internet- and mobile-based interventions (IMIs) have been proposed, little is known about medical students' attitudes towards using them. OBJECTIVE: We aimed to explore the views of medical students on IMIs as well as facilitators and barriers to use them and gain first insights into their preferences for tailored IMIs. METHODS: We conducted four focus groups with 26 medical students enrolled at a German medical school in March 2020. Focus groups were audio-recorded, transcribed and analyzed following established approaches for qualitative content analysis. RESULTS: Medical students valued IMIs for their low-threshold and flexible access, their potential to bridge waiting times and as a first step towards face-to-face-therapy. However, medical students preferred face-to-face interventions in case of severe mental health problems. The main disadvantages named by students included difficulties to find or decide on suitable IMIs based on clear quality criteria, fear of a misdiagnosis and lack of personalisation and human interaction. Some students also questioned the effectiveness of IMIs. Easy handling, flexible use, data safety and easily understandable terms of use were believed to facilitate the uptake of IMIs, whereas technical problems, frequent notifications, required internet access, need to register, lack of anonymity, high time expenditure and costs were reported to hinder their use. Most students did not prefer IMIs tailored to medical students but rather wanted to use IMIs suitable for students of all disciplines. CONCLUSION: Our results suggest overall positive views regarding IMIs for mental health promotion but concerns regarding their use for severe mental disorders and acute crises. Our findings indicate that IMIs may represent promising tools for stress prevention and early interventions for medical students. Students explicitly stated to prefer quality-approved IMIs recommended and provided by their university.

The moderating role of psychosocial working conditions on the long-term relationship between depressive symptoms and work ability among employees from the Baby Boom generation.

OBJECTIVE: Mental disorders have been identified as a leading cause for reduced work ability in industrialized countries. Identification of workplace factors that can increase the work ability of employees with depressive symptoms from the Baby Boom generation is, therefore, highly relevant. This study thus aims to investigate whether changes in psychosocial working conditions can moderate the negative association between depressive symptoms and work ability. METHODS: Two waves with a 3-year time lag of the German lidA cohort study with 3609 participants born in 1959 and 1965 (aged 46 and 52 years at first wave) were analyzed. Self-report data about depressive symptoms at baseline and changes of working conditions from baseline to follow-up were used to calculate main and interaction effects on perceived work ability at follow-up. These analyses were controlled for baseline work ability and working conditions. RESULTS: Depressive symptoms were predictive for an unfavorable course of work ability from baseline to follow-up (B = - 0.173, 95% CI = - 0.219 to - 0.128). However, no interaction effect between depressive symptoms and psychosocial working conditions was found. Instead, independent from the level of depressive symptoms, a decrease in quantitative demands (B = - 0.279, 95% CI = - 0.326 to - 0.232) and increases in leadership quality (B = 0.242, 95% CI = 0.192-0.292) and development opportunities (B = 0.177, 95% CI = 0.127-0.277) were related to a more favorable course of work ability. Only small effects were found for social support (B = 0.057, 95% CI = 0.008-0.106) and job control (B = 0.043, 95% CI = - 0.005-0.091). CONCLUSIONS: The results indicate that the lagged and negative effect of depressive symptoms on work ability was not moderated by changes in psychosocial working conditions. However, the promotion of favorable working conditions may contribute to a positive development of work ability among employees from the Baby Boom generation independently from the level of depressive symptoms.

Students' perspectives on interventions to reduce stress in medical school: A qualitative study.

The mental health of medical students remains to be a matter of concern. Numerous setting-based and individual-based interventions for student mental health have been proposed in the literature. However, the student perspective on those interventions has been largely neglected. This study aims to explore how medical students perceive different interventions and if they desire any additional changes with regard to their studies. Eight focus groups with 71 participants were conducted at a large German medical school. Focus groups were recorded, transcribed and content-analyzed using MAXQDA 18. We found that medical students prefer setting-based interventions. Most proposed interventions were on a setting-based level. For instance, students asked for more information on the university's psychosocial counseling services and for better information management regarding contact persons. Interventions proposed in the literature received mixed reactions: Several participants did not favour a pass/fail grading system. Students considered a peer-to-peer mentoring program for freshmen very helpful. Students had diverse attitudes towards Balint groups. They approved of several self-management courses, most of them being related to time or stress management. Interestingly, the most urgently wanted interventions appear to be rather easy to implement (e.g. a mentoring program). This study explored the medical student perspective on student mental health interventions. Additionally, our study illustrates the benefit and feasibility of involving students early on in the conception of interventions. Further research with a representative sample is needed to obtain broader information on the acceptance of the suggested interventions.

The prevention of musculoskeletal complaints: long-term effect of a work-related psychosocial coaching intervention compared to physiotherapy alone-a randomized controlled trial.

PURPOSE: Research shows that psychosocial factors play a significant role in the emergence of musculoskeletal complaints (MSC). The aim of this study was to determine the long-term effects on unspecific MSC by a combined physiotherapy and coaching intervention compared to physiotherapy alone. The coaching intervention focussed on enabling better strategies for coping with work stressors. METHODS: The participants of a previous randomized controlled intervention were invited to participate again in a third follow-up survey 22 months after the end of the intervention. In 2014, 65 nurses completed a 10-week personalised physiotherapy. Additionally, the intervention group (n = 33) passed five individual coaching sessions, plus an opening and closing session. 44 nurses (IG: n = 24; CG: n = 20) passed again a physical examination as well as another questionnaire assessment in 2016. The primary outcome was MSC, secondary outcomes were work ability and work-related well-being. Due to missing data, multiple imputations were conducted using the mice package in R. Data were analysed by ANOVA with two-way repeated measures, t tests for independent samples and Chi-squared tests. RESULTS: In respect of MSC, stronger improvement of movement in the vertebral column was observed in the IG compared to the CG. No differences between the IG and CG regarding other long-term effects were observed. CONCLUSIONS: The results suggest that the combined intervention of work-related coaching and physiotherapy had only a marginally stronger long-term effect with respect to MSC than physiotherapy alone.

Country-specific differences of age stereotypes towards older hospital staff and their association with self-efficacy, work ability and mental well-being.

AIMS: To compare stereotypes towards older workers between hospital staff in Germany and Latvia and to analyse the relationship between those stereotypes and self-efficacy, subjective work ability and irritation. DESIGN: Cross-sectional study. METHODS: In 2018, hospital staff, including nurses, physicians and other professions, of two German and three Latvian hospitals were asked to complete the standardized study questionnaire on subjective work ability, occupational self-efficacy, irritation and stereotypes towards older workers. In the latter scale older workers were defined as ≥45 years of age and the scale ranged from 27-135 whereby higher values reflect higher levels of positive stereotypes. To analyse the relationship between stereotypes and those work-related outcomes, multiple linear regression models, including interaction terms between stereotypes and age, were built and adjusted for occupational group, sex and country. RESULTS: Data from 300 employees of Latvian and from 113 employees of German hospitals were included in the analyses. Hospital staff in Germany reported higher levels of positive stereotypes (mean = 87.46, SD 10.04) than hospital staff in Latvia (mean = 84.69, SD 10.10; t(411) = -2.496, p = .013). When analysing the entire sample of hospital staff in Germany and Latvia, a more positive view on older workers was associated with higher self-efficacy (ß = 0.136, p = .008) and subjective work ability (ß = 0.063, p < .001) and lower levels of irritation (ß = -0.191, p = .017). The association with self-efficacy and subjective work ability increased in strength by participant's age. Country-stratified analyses yielded similar results. CONCLUSION: The results provide first evidence that stereotypes towards older workers of hospital staff may differ between different European countries. Furthermore, they suggest that counteracting negative stereotypes towards older workers may help to improve self-efficacy and subjective work ability and reduce irritation levels of older employees. IMPACT: Those findings emphasize the importance of age stereotypes when examining and promoting older hospital staffs' self-efficacy, subjective work ability and irritation in a cross-national context.

Stressors and resources related to academic studies and improvements suggested by medical students: a qualitative study.

BACKGROUND: Prior evidence suggests that medical students' mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students' perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. METHODS: Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. RESULTS: Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. CONCLUSIONS: Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students' wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement.

Individual consequences of age stereotypes on older workers : A systematic review.

BACKGROUND: The relevance of work participation of older persons is steadily increasing due to demographic changes; however, older workers are often confronted with negative age stereotypes such as being less flexible, adaptable and productive. OBJECTIVE: Against this background this systematic review summarizes research evidence on individual consequences of age stereotypes on older workers. It further discusses potential processes behind those relationships and gives suggestions for future research and practice. MATERIAL AND METHODS: A systematic literature search was conducted in PsycINFO, Web of Science and Medline to identify relevant studies examining individual effects of age stereotypes on older workers. In addition, all included studies were evaluated with a standardized quality assessment tool. RESULTS: A total of 25 studies could be included in this review; however, none of those studies met all quality criteria. Most studies found significant associations between negative age stereotypes and decreased self-efficacy, job satisfaction, performance as well as learning, development or increased retirement intentions of older employees. CONCLUSION: The results of this review indicate a number of negative consequences that negative age stereotypes have on older workers and also serious flaws in the study quality of existing research. It thereby stresses the importance of more high-quality research but also the reduction of those age stereotypes to promote well-being and work participation of older persons.

Learning on the job, the use of selection, optimization, and compensation strategies, and their association with telomere length as an indicator of biological aging.

PURPOSE: Due to the increased need for retention of older workforce caused by demographic changes in industrialized countries, support of healthy aging in occupational settings is of increasing relevance. This study examines the relationship between leucocyte telomere length (LTL), a potential biomarker for biological aging, and selection, optimization, and compensation (SOC) and learning opportunities as strategies involving efficient management and gain of resources at work. METHODS: Within a cross-sectional study, blood samples were drawn from 141 geriatric care professionals to measure LTL by quantitative real-time polymerase-chain reaction. Furthermore, all participants were asked with standardized questionnaires to rate their learning opportunities at work and use of SOC strategies. Analyses were performed by multiple linear regressions. RESULTS: SOC use, especially compensation, tended to be negatively, and learning opportunities tended to be positively associated with LTL. Furthermore, a significant interaction was found between optimization and learning opportunities, such that LTL and learning opportunities were only positively associated when optimization was high. CONCLUSIONS: Resources at work were weakly associated with telomere length, which is not unexpected in view of the multiplicity of factors affecting LTL. The results further suggest that a mismatch between SOC and learning opportunities may negatively affect successful aging. They also suggest that more detailed research on biological aging and its relation to resources at work is needed.

Gender differences in paid employment after retirement : Psychosocial working conditions and well-being.

BACKGROUND: An increasing number of persons continue to work after retirement age. This decision is often different between men and women as well as working histories, sectors and hierarchical positions; however, whether gender differences in working conditions and occupational well-being also exist in paid employment after retirement (PEAR) has not yet been investigated. OBJECTIVE: This study aimed to examine gender differences in working conditions and well-being of workers in PEAR. MATERIAL AND METHODS: In this study 784 employees (23.5% female) aged 65 years and older who were contracted by a Dutch temporary employment agency, participated in the baseline survey in 2011. Furthermore, a panel of 228 employees (25.9% female) participated again during a second wave in 2012. Job demands, job control, emotional exhaustion and job engagement were assessed at both time points by validated self-reporting measures. RESULTS: Female employees worked fewer years in paid employment before 65 years of age, were more likely to be single, divorced or widowed, had a smaller income and worked less hours during PEAR than men. In the baseline analysis, females reported less job control and higher job stress than men. No gender differences were found on emotional exhaustion, engagement or job demands. Over the study period emotional exhaustion only increased in females. The longitudinal trend of job demands, control and engagement did not significantly differ between both sexes. CONCLUSION: The results suggest that working conditions of PEAR are less favorable for women than for men. Furthermore, the longitudinal trend of emotional exhaustion seems to be more disadvantageous for women.

Prognostic effects of selection, optimization and compensation strategies on work ability: results from the representative lidA cohort study on work, age, and health in Germany.

PURPOSE: Regarding the increased need for the retention of older employees in the workforce, this study investigates whether there are main and interactive longitudinal effects of selection, optimization, compensation and working conditions according to the job demand-control model on work ability in older employees. METHODS: Longitudinal data of computer-assisted personal interviews with one follow-up after 3 years of 3961 participants (born in 1959 and 1965) of the representative German lidA cohort study was used. Multiple linear regressions were performed, analyzing prospective main and interactive effects of selection, optimization, compensation and working conditions during baseline on perceived work ability at follow-up. RESULTS: Regarding selection, optimization and compensation, only compensation had a positive, but weak effect on work ability. Working conditions were more strongly related to work ability: decision authority and skill discretion had independent positive and job demands had independent negative effects on work ability. One interaction effect was observed between loss-based selection and decision authority, such that they mutually enhanced their positive effects on work ability. Only few and weak interactions among the sub-strategies, selection, optimization and compensation, were observed. CONCLUSIONS: Results indicate that especially favorable working conditions in terms of high job control and low job demands, but also compensation might help older employees to maintain work ability.

Effects of Flow Disruptions on Mental Workload and Surgical Performance in Robotic-Assisted Surgery.

BACKGROUND: Robotic systems introduced new surgical and technical demands. Surgical flow disruptions are critical for maintaining operating room (OR) teamwork and patient safety. Specifically for robotic surgery, effects of intra-operative disruptive events for OR professionals' workload, stress, and performance have not been investigated yet. This study aimed to identify flow disruptions and assess their association with mental workload and performance during robotic-assisted surgery. METHODS: Structured expert-observations to identify different disruption types during 40 robotic-assisted radical prostatectomies were conducted. Additionally, 216 postoperative reports on mental workload (mental demands, situational stress, and distractions) and performance of all OR professionals were collected. RESULTS: On average 15.8 flow disruptions per hour were observed with the highest rate after abdominal insufflation and before console time. People entering the OR caused most flow disruptions. Disruptions due to equipment showed the highest severity of interruption. Workload significantly correlated with severity of disruptions due to coordination and communication. CONCLUSIONS: Flow disruptions occur frequently and are associated with increased workload. Therefore, strategies are needed to manage disruptions to maintain OR teamwork and safety during robotic-assisted surgery.