[General practitioner or specialist at home or abroad?]. / Hausarzt oder Spezialist im In- oder Ausland?

This study investigated the career preferences of medical graduates in Germany with regard to discipline, place and position after the completion of postgraduate training. We also investigated differences in career options according to gender and region of study (former German Federal Republic vs. former German Democratic Republic).The study is based on a standardised postal survey among all last year medical students in the medical faculties of Erlangen, Giessen, Hamburg, Heidelberg, Cologne, Leipzig and Magdeburg in 2009. 2 107 persons were contacted and 1 012 (48%) participated in the survey.96% of participants stated their intention to pursue a postgraduate training in a medical discipline, and only 0.4% denied such an objective. 7% of the graduates preferred a career towards general practice, and a similar percentage preferred general internal medicine which usually also leads to a primary care activity. 84% aimed at becoming a medical specialist. In total, 28% intended to work in a specialist practice, and 10% in a general practice. Only one-fifth of the latter aimed at working in a countryside setting. 7% aimed at starting postgraduate training outside of Germany, and 8% preferred to work outside Germany after completion of the postgraduate training. In both cases, Switzerland was by far the most preferred country.The results contradict the thesis that young graduates are reluctant to enter clinical medicine. Working abroad is within the scope of less than 10% of the graduates. A dramatic difference between the demand for general practitioners and the career intentions of medical graduates is observed. Measures to increase the attractiveness of primary care, especially in the countryside, are urgently needed.

The German experience 10 years after the latex allergy epidemic: need for further preventive measures in healthcare employees with latex allergy.

OBJECTIVES: Powdered latex gloves or latex gloves with high allergen content are forbidden in Germany since 1998. It was the aim of this study to test the hypothesis that nationwide preventive measures enable health care workers with latex allergy to work without health risks about 10 years afterwards. METHODS: Ninety-one health care workers who had been reported to the accident insurance between 1996 and 2004 for occupational latex allergy were examined in 2007. The survey included a questionnaire, a physical examination, spirometry, methacholine testing, skin prick testing and serum IgE measurements to latex and environmental allergens. RESULTS: Recent work-related possibly allergic symptoms were reported by 32 subjects (35%), among them 18 subjects (20%) with symptoms of the eyes, nose or airways. Current sensitization to latex was detected in 61 subjects (67%), and 60 subjects (66%) were atopic. Eleven subjects (12%) showed mild airway obstruction, and 27 subjects (30%) were considered hyperresponsive to methacholine. Whereas overall recent symptoms of the eyes, nose or airways were associated with current latex sensitization (OR 4.5; 95% CI 1.3-16.2), this was not the case for objective outcome parameters (spirometry, bronchial hyperresponsiveness). CONCLUSIONS: Although most subjects had only mild disease, ongoing work-related symptoms of the eyes, nose or airways in a substantial number of subjects with latex allergy suggest the need for further secondary preventive measures in German healthcare.

[Health indicators and preventive behaviour of older employees in geriatric care]. / Gesundheitsindikatoren und Präventionsverhalten bei älteren Beschäftigten in der Altenpflege.

STUDY OBJECTIVE: As a consequence of the demographic transition, the proportion of geriatric nurses aged over 50 is increasing. The present study examines whether the prevalence of skin and back diseases and preventive behaviour differ between this group and younger employees. An additional objective was to record the proportion of older employees with a health- and occupation-related impairment. METHODS: 2 149 nurses working in home care settings and nursing homes were questioned in written form about their working ability, their preventive behaviour and their health situation. They were also subjected to dermatological investigation (with the Osnabrück Hand Eczema Severity Index - OHSI) and orthopaedic investigation (based on the multiple-step inventory of examinations). RESULTS: Older nurses more often rated their working ability as "(fairly) poor" than did younger nurses. This applied both to physical demands (11 vs. 4%) and to psychological demands (10 vs. 5%). They were also more affected by symptoms in the cervical spine (28 vs. 13%) and the lumbar spine (56 vs. 37%). Hand eczema was not more prevalent in older nurses. The state of health of 10% of the nurses aged over 50 indicated a health- and occupation-related impairment in regard to work ability and back complaints. Roughly equal proportions of the younger and older groups participated in measures for the primary prevention of back symptoms. The older nurses participated more often in advisory sessions on skin protection and more frequently applied cream to their hands. The younger nurses were in skin contact with water or fluids for shorter periods and more often exclusively used disinfectants after patient contact. CONCLUSION: Geriatric nurses with a health- and occupation-related impairment require intensive measures to support their health and to prevent health damage and to stop them from leaving work prematurely. If at all possible, these measures should not be restricted to a single social insurance agency. The individual preventive behaviour to avoid occupational back symptoms is not dependent on age. An age effect was observed for individual measures to protect the skin. Nevertheless, these had no effect on the risk of disease. The results indicate that more attention should be given to older employees during occupational training.

[Equipment and use of equipment in nursing homes]. / Hilfsmittelausstattung und -nutzung in der stationären Altenpflege.

AIM OF THE STUDY: The aim of this research study was to describe the provision of aids and their use in the transport of residents. The study was also intended to analyse prior experience with the methods and concepts of resident transfer, paying due attention to back problems. The resulting knowledge is to support work on the implementation of procedures in geriatric in-patient care which are suited to workers with back problems. METHODS: This is a cross-sectional study, in which 217 nurses and 43 superior nurses were interviewed, with the help of a standardised questionnaire which they are expected to complete. RESULTS: The majority of those questioned felt that they were not well informed about the availability of aids. This is reflected both in the deficient equipment with the aids and in how rarely they are used. The superior nurses regarded themselves as being rather better informed. In general, there are fewer small than large aids in the institutions and these are also used more rarely. "Lack of time" and "lack of acceptance by the residents" were the main reasons given for lack of use. About half of the superior nurses and nurses feel that they are well or very well informed about mobility concepts and working methods which spare the back. According to this, these concepts are only applied in a quarter of old people's homes, although training is more frequent. Instruction in the use of aids takes place too rarely. This can be concluded from the evaluation of the data from the superior nurses and the 109 spontaneous comments from the nurses, who not only advocated the purchase of the aids, but also emphasised the need for more information and training. CONCLUSIONS: The results indicate that current work on equipment with aids and training in their use must be optimised and must also incorporate recent advances in scientific knowledge. Implementation of specific risk assessment analyses of stress at work and regular training in dealing with aids could help to support the use of aids for geriatric in-patients.