Introducing occupational health management in the German Armed Forces.

Holistic approaches to workplace health promotion (WHP) within the military setting are challenging. In 2015, the German Ministry of Defense initiated a 6-month pilot study of WHP in the Federal Armed Forces. The pilot study was to identify organizational challenges that should be addressed before the Ministry implemented a comprehensive occupational health management policy in all departments. Eleven diverse departments were selected to participate in a WHP program that addressed physical activity, diet, stress management and addiction prevention. As part of the evaluation concept, we interviewed coordinators, and department heads focusing on transfer factors from the perspective of the implementers. All coordinators and their department heads or deputies participated in semi-structured face-to-face on-site interviews. The data were analyzed based on qualitative content analysis. The coordinators (officers with sports science degree) seemed fully prepared and capable to master the new task. They experienced difficulties in adapting WHP activities to local structures and needs, and complications in administering modular activities. Department heads described conflict regarding human resources between the military mission and the implementation of WHP. Commitment to WHP was a strong facilitator. The interviews identified various barriers related to support by middle management (supervisors) and specific work conditions (e.g. shift work). If occupational health management is to be successfully implemented on a large scale, conceptional and practically collaboration is necessary between WHP and occupational safety and health, and organization and leadership, respectively. Supervisors will benefit from open communication about compensation for the release time of their subordinates to attend WHP.

Patterns and predictors of workplace health promotion: cross-sectional findings from a company survey in Germany.

BACKGROUND: Although the popularity of workplace health promotion (WHP) has considerably increased over the years, there are still concerns about the way this concept is being implemented by the companies. There is, however, a seeming lack of empirical knowledge about variations in WHP practice. Therefore, the aim of this study was to determine the prevalence of different patterns (and related quality levels) of WHP activity and the effect of organisational predictors on the chances of these WHP activity levels being implemented. METHODS: Data from an establishment survey (N = 6,500) were used to calculate the prevalences of four configurations of WHP among German companies. Furthermore, multinominal logistic regressions were performed to determine odds ratios for these WHP activity levels according to several organisational characteristics. RESULTS: 9% of companies exhibited the most comprehensive type of WHP including analysis, individual-directed prevention measures and participatory groups concerned with working conditions improvement (level A), 18% featured a combination of analysis and individual-directed prevention (level B), 29% had reported measures from only one of these categories (level C), and 44% showed no WHP activity at all (level D). In the multivariate analysis company size turned out to be the strongest predictor of WHP at all levels. WHP was also predicted by a good economic situation of the company, the availability of safety specialist assistance, the availability of specialist assistance in occupational health and the presence of an employee representative body. These effects usually became stronger when moving up in the hierarchy of WHP levels. For the two sector-level variables (private vs. public, production vs. services) no statistically significant associations with WHP were found. CONCLUSIONS: WHP still shows great potential for improvement both in quantitative and qualitative terms. Especially required are additional efforts in developing and implementing WHP practice models and dissemination strategies which are tailored to the particular conditions and needs of small companies. However, findings suggest that the chances for achieving progress in WHP also depend on developments in adjacent policy areas such as labour relations or occupational safety and health.

Criteria and Guidelines for Human-Centered Work Design in a Digitally Transformed World of Work: Findings from a Formal Consensus Process.

With the increasing digital transformation, work tasks are changing-in some cases, significantly. Our study addresses the question of whether the established criteria for work design are still sufficient or if they should get updated and additional criteria become necessary in the context of digitalization. In a multistage consensus process involving interdisciplinary groups of experts, we have identified specific criteria for the humane design of work in a world increasingly permeated by digitalized work tools. Starting with an expert workshop using a combined nominal group/focus group technique, followed by a real-time Delphi study, a content analysis and a five-stage peer comment process, we detected 13 criteria and 38 design guidelines for human-centered work in digital transformation. Mapping these with established criteria, it became apparent that some established criteria have experienced a new dynamic because of the digital transformation. For other criteria, a need for digitization-sensitive design is discernible. In addition, criteria have emerged whose necessity is rooted in the digital transformation. A diffusion and stronger interconnection of the various levels of the work system in connection with the digital transformation of work is apparent.

ICT-Enabled Mobile Work: Challenges and Opportunities for Occupational Health and Safety Systems.

The development and dissemination of new technologies has brought forward a rise in flexible work arrangements, such as mobile work. In the literature, mobile work has mostly been discussed from a microergonomic perspective, considering detachment, stress, strain, and life-domain balance. However, the macroergonomic or institutional perspectives have often been neglected, although for occupational health and safety (OHS) management, as well as occupational health and safety systems, many questions remain unanswered. Therefore, in the present paper, information and communication technologies (ICT)-enabled mobile work is described taking into account institutional and regulative, as well as company-related, requirements. As the literature-based analysis was able to show, existing regulations cover many aspects of mobile work arrangements but also offer starting points for a more concrete protection of mobile workers. Furthermore, there are challenges regarding the enforcement of regulation. In this regard, new technologies might offer the chance to improve the interactions between institutional and company-related occupational health and safety systems. Additionally, 278 co-funded research projects in Germany were categorized, yielding 18 projects on new ways of work, of which another eleven projects addressed different aspects of mobile work. The project analysis revealed that current research focuses on tools and strategies for designing communication and cooperation. In conclusion, the examination of research trends can be used to generate new knowledge for better OHS management and effective OHS systems.

Type IV hypersensitivity to vitamin K.

The day after intramuscular injection of vitamin K1 (phytomenadione) into her thigh, a 27-year-old-woman with normal liver function developed a relapsing and remitting eczematous reaction localized to the injection site, and later a further eczematous reaction under an adhesive dressing (Duoderm). On patch testing, she was positive to vitamin K1 and cross-reacted to vitamin K4; she was also positive to colophonium and to ester gum rosin, the dressing adhesive. Recurrent angioedema persisted for several months and, 2 years later, symptoms were still occurring over the injection sites. Structure-activity relationships among vitamin K allergens are discussed.

Differentiation-dependent and subset-specific recruitment of T-helper cells into murine liver.

It has been suggested that the liver traps and deletes activated and potentially harmful T cells, especially of the CD8(+) subset, providing mechanisms to limit systemic immune responses. It is unknown whether this also applies to CD4(+) T cells. In this study, we show that activated stages of CD4(+) T cells were trapped in the liver on intraportal injection. Intravital microscopy showed an immediate adhesion of activated CD4(+) T cells within periportal sinusoids after intraportal injection. Furthermore, we detected high frequencies of interferon gamma (IFN-gamma)-- (Th1) and interleukin 4 (IL-4)-- (Th2) synthesizing effector cells in the liver. Transfer experiments were performed to identify those phenotypes showing specific retention in the liver. Our data show that effector stages and activated cells in general are more efficiently recruited into the liver than resting CD4(+) T cells, similar to what has previously been shown for CD45RB(low) memory cells. In addition, we observed a certain preference for Th1-polarized cells to be trapped by the liver. However, the actual cytokine-producing cells did not specifically enrich among the total population. In conclusion, these data indicate that the liver acts as a filter for activated and memory/effector cells. Cells trapped in the liver might subsequently undergo modulatory influences exerted by the postulated specific microenvironment of the liver.