[Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies]. / Erwartungen und Motive des arbeitsmedizinischen Nachwuchses: eine quantitative Befragung in fünf deutschen Akademien.

STUDY AIM: The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. METHODS: At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. RESULTS: Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. CONCLUSIONS: The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance).

BACKGROUND: Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up. METHODS: At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R2) to estimate the predictive performance of the questionnaires. RESULTS: The models' R2 was comparable to the original baseline analyses at both t0 and t1 (R2 range: ERI 0.10-0.43; COPSOQ 0.10-0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R2 range: ERI 0.07-0.19; COPSOQ 0.07-0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t0 or t1 confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions. CONCLUSIONS: Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships.

Comparing SARS-CoV-2 case rates between pupils, teachers and the general population: results from Germany.

Given the inconsistent state of research regarding the role of pupils and teachers during the SARS-CoV-2 pandemic in Germany, statewide and nationwide data of infection case rates were analyzed to contribute to the discourse. Infection data from official sources ranging from mid to late 2020 were collected, prepared and analyzed to answer the question if pupils, teachers and general population differed in active case rates or not. The data showed that pupils and teachers case rates didn't exceeded those of the general population. In conclusion, it seems appropriate to appraise school-related measures to mitigate the SARS-CoV-2 pandemic sufficiently. Data quality is a yet to overcome obstacle to provide good evidence-based recommendations regarding the management around infection cases in schools.

Self-reported cardiovascular health of teachers: results from the 5-year follow-up of the Gutenberg Health Study cohort.

OBJECTIVES: Following an exploratory approach, we examined cardiovascular disease risk factors at baseline and the 5-year incidence proportion of self-reported doctor-diagnosed cardiovascular diseases (CVD) in teachers and other occupational groups of the Gutenberg Health Study. METHODS: Study participants lived in the region of Mainz, Germany. Data from 6510 working participants without prevalent CVD at baseline (2007-2012) were analyzed. Participants were teachers (n = 215), other professionals from the health, social or educational (HSE) fields (n = 1061) or worked outside the HSE fields (n = 5234). For occupational comparisons, we estimated prevalence ratios (PR) for each CVD risk factor at baseline with robust Poisson regression analyses. We calculated crude CVD incidence rates based on the observed 5-year CVD cumulative incidence at follow-up and estimated age-weighted incidence proportions. All analyses were stratified by sex. RESULTS: Male non-HSE workers showed a higher prevalence of smoking and physical inactivity than male teachers (PR 2.26; 95%-CI: 1.06-4.82/PR 1.89; 95%-CI: 1.24-2.87). In contrast, non-HSE workers and other HSE professionals were less likely to have reported an unhealthy alcohol intake than teachers. Differences were attenuated after SES-adjustment. We did not detect occupational group-specific differences in CVD incidence. However, there were only two cases of CVD among the teachers. CONCLUSION: Particularly male teachers showed a healthier lifestyle regarding physical inactivity and smoking. Nevertheless, occupational-medical care practitioners and researchers need to be aware of the relatively heightened prevalence of unhealthy alcohol intake in female and male teachers, and in absolute terms, the high hypertension prevalence in male teachers.

Burdens, resources, health and wellbeing of nurses working in general and specialised palliative care in Germany - results of a nationwide cross-sectional survey study.

BACKGROUND: Palliative care in Germany is divided into general (GPC) and specialised palliative care (SPC). Although palliative care will become more important in the care sector in future, there is a large knowledge gab, especially with regard to GPC. The aim of this study was to identify and compare the burdens, resources, health and wellbeing of nurses working in GPC and SPC. Such information will be helpful for developing prevention programs in order to reduce burdens and to strengthen resources of nurses. METHODS: In 2017, a nationwide cross-sectional survey was conducted. In total, 437 nurses in GPC and 1316 nurses in SPC completed a questionnaire containing parts of standardised instruments, which included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Patient Health Questionnaire (PHQ-2), the Resilience Scale (RS-13) Questionnaire, a single question about back pain from the health survey conducted by the Robert Koch Institute as well as self-developed questions. The differences in the variables between GPC and SPC nurses were compared. RESULTS: SPC nurses reported higher emotional demands as well as higher burdens due to nursing care and the care of relatives while GPC nurses stated higher quantitative demands, i.e. higher workload. SPC nurses more often reported organisational and social resources that were helpful in dealing with the demands of their work. Regarding health, GPC nurses stated a poorer health status and reported chronic back pain as well as a major depressive disorder more frequently than SPC nurses. Furthermore, GPC nurses reported a higher intention to leave the profession compared to SPC nurses. CONCLUSIONS: The findings of the present study indicate that SPC could be reviewed as the best practice example for nursing care in Germany. The results may be used for developing target group specific prevention programs for improving health and wellbeing of nurses taking the differences between GPC and SPC into account. Finally, interventional and longitudinal studies should be conducted in future to determine causality in the relationship of burdens, resources, health and wellbeing.

Arbeitsbedingungen von Pflegekräften in der allgemeinen Palliativversorgung in Deutschland.

Working conditions of nurses in general palliative care in Germany - A cross-sectional survey Abstract. Background: Most terminally ill people are treated within general palliative care including outpatient care, nursing homes and hospitals. In contrast, only a small number is treated within specialised palliative care. Nursing research within the framework of palliative care focuses on the latter. AIM: To investigate the working conditions of nurses working in general palliative care and to analyse potential differences between nurses in outpatient care, in nursing homes and in hospitals. METHODS: A cross-sectional survey was conducted among nurses working in outpatient care, in nursing homes and in hospitals. The questionnaire included questions about working conditions, parts of the Copenhagen Psychosocial Questionnaire and self-developed questions. Descriptive and bivariate analyses were conducted. RESULTS: 437 questionnaires entered final analyses (response rate 16.7 %). On average, nurses spend 20 % of their working time with palliative care. Every fourth nurse (n = 104) express the wish for an additional qualification in palliative care. The following demands are reported: confrontation with pain, death and dying, as well as care of relatives. 59 % (n = 249) of the nurses evaluate the quality of palliative care as good / very good. CONCLUSIONS: Nurses are faced with demands, which so far had only been a subject of discussion within the framework of the specialised palliative care. Further steps for action, in particular the additional qualification in palliative care for nurses, should be discussed.

Health and intention to leave the profession of nursing - which individual, social and organisational resources buffer the impact of quantitative demands? A cross-sectional study.

BACKGROUND: The aim of this study was to analyse the buffering effect of individual, social and organisational resources on health and intention to leave the profession in the context of burden due to quantitative job demands. METHODS: In 2017, a cross-sectional survey was carried out anonymously among nurses in palliative care in Germany. One thousand three hundred sixteen nurses responded to the questionnaire (response rate 38.7%), which contained, amongst others, questions from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Moderator analyses were conducted to investigate the buffering effect of different resources on health ('self-rated health' and 'burnout') and 'intention to leave' in the context of quantitative demands. RESULTS: 'Self-rated health' was significantly buffered by the resources 'recognition through salary' (p = 0.001) and 'good working team' (p = 0.004). Additionally, buffering effects of the resources 'workplace commitment' and 'good working team' on 'burnout' (p = 0.001 and p = 0.006, respectively) as well as of the resources 'degree of freedom', 'meeting relatives after death of patients', 'recognition from supervisor' and 'possibilities for development' on 'intention to leave' (p = 0.014, p = 0.012, p = 0.007 and p = 0.036, respectively) were observed. CONCLUSIONS: The results of our study can be used to develop and implement job (re) design interventions with the goal of reducing the risk of burnout and enhancing job satisfaction among nurses in palliative care. This includes for example adequate payment, communication training and team activities or team events to strengthen the team as well as the implementation of some rituals (such as meeting relatives after the death of patients). As our study was exploratory, the results should be confirmed in further studies.

[Burdens and resources of nurses working in the specialist palliative care: an explorative cross-sectional study]. / Belastungen und Ressourcen von Pflegekräften der spezialisierten Palliativversorgung.

Burdens and resources of nurses working in the specialist palliative care: an explorative cross-sectional study Abstract. Background: For Germany, there are no studies so far which compare the burdens and the resources of nurses working in the specialized palliative care settings. AIM: The aim of this study was to analyse and compare burdens and resources of nurses working in palliative care wards, inpatient hospices and in specialized outpatient palliative care services. METHOD: In 2015, nurses from the referred settings in Rhineland-Palatinate were invited to complete a self-developed questionnaire on burdens and resources. Contingency tables, Kruskal-Wallis tests and regressions were calculated. RESULTS: 149 nurses (response rate: 34.5 %) participated in the survey. Nurses working in palliative care wards indicated higher values in all types of burdens than nurses working in hospices and specialized outpatient palliative care. Nurses in palliative care wards and hospices reported emotional burdens as the most stressful factor, while nurses working in specialized outpatient care services expressed the highest levels of burdens in patient-related areas. An association between the experienced amount of burdens and having acquired an additional qualification in palliative care was determined (adjusted Odds Ratio (aOR) for burden due to organizational conditions: 2.56, CI: 1.06 - 6.19; aOR for burden due to support for family members: 2.99, CI: 1.06 - 8.46). The three settings in our study differ in terms of the availability of the resources family, group supervision and additional qualifications. CONCLUSIONS: This study provides an insight into the burdens and the resources of nurses working in palliative care wards, hospices and specialized outpatient palliative care services in Rhineland-Palatinate, Germany. Future preventative measures should be tailored to the respective settings.

An acute exposure to ozone impairs human olfactory functioning.

INTRODUCTION: Ozone is a ubiquitous and irritant gas. We questioned whether an acute exposure to 0.2 ppm ozone impaired olfactory functioning. METHODS: Healthy, normosmic subjects were exposed according to a parallel group design either to 0.2 ppm ozone (n = 15) or to sham (n = 13) in an exposure chamber for two hours. Possible irritating effects were assessed by questionnaire (range 0-5). The detection threshold of n-butanol was measured with the Sniffin' Sticks test before and after exposure. Olfactory thresholds were logarithmized and a two-way analysis of variance (ANOVA) with repeated measurements was carried out to test the effects of exposure (ozone vs. sham) and time (before vs. after exposure). Additionally, nasal secretions were taken at a preliminary examination and after exposure to determine interleukins 1ß and 8. RESULTS: No irritating effects to the upper airways were observed. In the ozone group, the median score for cough increased from 0 to 2 at the end of exposure (sham group 0 and 0, respectively, p < 0.001). The ANOVA showed a main effect for ozone exposure (F (1, 26) = 27.6, p = 0.0002), indicating higher olfactory thresholds in the ozone group. Concentrations of interleukins in nasal secretions did not increase following ozone exposure. CONCLUSIONS: This study shows a clear impairment of olfactory functioning following an acute exposure to 0.2 ppm ozone.

Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study).

BACKGROUND: It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany. METHODS: The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men. RESULTS: 92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain. CONCLUSION: While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.

[What Enhances Teachers' Health at Inclusive Primary Schools? A Mixed-Methods Approach]. / Was trägt zur Verbesserung der gesundheitlichen Situation von Lehrkräften (LK) am Arbeitsplatz Schwerpunktgrundschule (SPGS) bei? Ein Mixed-Methods-Ansatz.

AIM: Teachers' suggestions to enhance their health at inclusive primary schools ("Schwerpunktgrundschulen") were analyzed by quantitative content analysis taking personal or job-related parameters of effort and strain into consideration. METHOD: The paper and pencil cross-sectional study was conducted by Institut für Lehrergesundheit (IFL) between August 2013 and April 2015 at 14 schools in Rhineland-Palatinate. Overall response rate was 46.3% (143/309 teachers). The answers to the open-ended question "Which concrete job-related measures would enhance your wellbeing or health situation at your work place?" was categorized and quantified. An analysis of the item-non-response was undertaken. The aim was to identify by logistic regression, personal or job-related parameters of effort or strain associated with a specific category. RESULTS: Data from 143 teachers were analyzed. 79 teachers made 362 suggestions to enhance the health situation at their work place. Making a suggestion was not related to socio-demographic parameters. 33.6% of the teachers addressed physical environmental conditions of work, e. g., climatic or acoustic conditions or the availability of space for recreation. 29.4% of the teachers made suggestions concerning human resource strategy (e. g., "double teaching"). 9.1% of the teachers referred to aspects of relationships with colleagues. After regression analysis, there were relationships between suggestions of single categories and specific job-related parameters of effort. Furthermore, teachers under (high) strain - here: teachers who (very) strongly experienced their work as hazardous to health - showed significantly higher odds to make suggestions of the categories "Colleagues" (aOR 3.71; 95%CI 1.00-13.76) or "External Support" (e. g., "supervision") (aOR 3.92; 95%CI 1.15-13.41) than teachers experiencing less stress. CONCLUSIONS: Teachers of inclusive primary schools are ready to take active part in health-related organizational development. The development of problem- and group-specific measures of intervention will be facilitated by the combined analysis of qualitative and quantitative data.

Seroepidemiology of hepatitis A and B and vaccination status in staff at German schools for the handicapped.

This study aims to assess serostatus and vaccination status of hepatitis A and B among staff at schools for the handicapped. We also wanted to investigate factors associated with serostatus, number of infections with hepatitis A/hepatitis B at work, and factors influencing being vaccinated or not. The cross-sectional study was carried out between August 2010 and August 2012 at 13 German schools for severely handicapped. Data were analyzed using blood samples, vaccination documents, and questionnaires. A total of 395 persons participated in our study (response: 59.7%), information on 367 could be used for analysis. Two respondents have been infected with HAV at work, 53.4% were anti-HAV seropositive. Vaccination against hepatitis A was influenced by information about infectious diseases before starting to work, level of education, and marital status. One person got infected with hepatitis B during work, 53.2% were anti-HBs-seropositive. Vaccination against hepatitis B depended on perceived burden by nursing activities, and vaccination costs being paid by employer. Immunity to hepatitis A and B in our sample is insufficient and does not correspond to the infectious risks. Two persons got infected with hepatitis A and one person with hepatitis B during work at school, indicating an urgent need for preventive actions. J. Med. Virol. 89:825-833, 2017. © 2016 Wiley Periodicals, Inc.

Liquid release as a source of potential drug exposure during the handling of intravenous infusions in nursing.

PURPOSE: This study aims at experimentally determining the incidence and extent of liquid releases onto the operator's hands and into the work environment during common nursing operations involving infusions. METHODS: A sequence of operations related to the preparation and administration of infusions was conducted by three subjects for 15 times each using fluorescein marked infusion solutions and two different infusion sets (standard set vs. safety-optimized set). Unintended release of liquid was quantified by glove and surface wipe sampling and HPLC/FD analysis of the samples. Operations concerning the disposal of infusions were also part of the study. RESULTS: In over 90% of the simulations, a release of infusion solution was observed in a standard workflow, comprising priming and decapping the infusion set, connecting it to a peripheral intravenous (IV) cannula, and detaching it again. Based on median values (229 vs. 26 µl), the release of infusion solution was about ninefold higher when using the non-optimized standard infusion set. During decapping, a hand contamination was found in a majority of cases. CONCLUSIONS: The handling of infusions may involve a risk of nurses' exposure to active agents by release of infusion solution into the work environment. According to our results with different infusion sets, exposure risks can be reduced technically and by appropriate handling. Nevertheless, hand contaminations found for both sets emphasize the necessity for additional measures such as more consistent use of protective gloves.

How can the health situation and well-being of staff at German schools for the severely handicapped be improved?

PURPOSE: The aim of the study was to describe measures suggested by staff at German schools for the severely handicapped regarding possibilities to improve their health situation and well-being at work. We further wanted to analyze whether sociodemographic, occupation-related, and health-related characteristics influence the type of measures proposed. METHODS: The cross-sectional study was carried out between August 2010 and August 2012 at 13 schools for the handicapped focusing on motoric and/or holistic development of severely handicapped pupils. Data of teachers and educational staff were surveyed using written questionnaires. The analysis is based on free-text answers regarding the question: "What specific occupation-related measures would lead to an improvement of your well-being or health situation at the workplace?" RESULTS: A total of 395 persons (response proportion: 59.7 %) with a mean age of 45 years and predominantly female (86.8 %) participated in our survey. A total of 205 persons answered the study question providing 456 improvement suggestions, which were classified into 6 main and 13 subcategories. The main categories were professional education and supervision, organization of working tasks and time, work safety and work equipment, social aspects of work, human resources and contractual framework, and other. Measures proposed were influenced by gender, burden by nursing activities, teaching, and administrative tasks, and frequency of deterioration in working atmosphere. DISCUSSION: Proposed measures raise awareness for job-related health stressors and are a starting point to improve working conditions at these schools. Since suggestions vary widely by school and composition of staff, individual priorities have to be set and discussed with the school management.

The Gutenberg health study: associations between occupational and private stress factors and work-privacy conflict.

BACKGROUND: Work-privacy conflict (WPC) is no longer a rarity but constitutes a societal problem. The objectives of the present study were (1) to investigate the distribution and prevalence of WPC among the employed participants in the Gutenberg Health Study at baseline and (2) to study the dependence of WPC on a broad range of private life and occupational characteristics as well as on psychosocial working conditions. METHODS: This analysis is based on a representative, population-based sample of 3,709 employees participating in the Gutenberg Health Study. Descriptive and bivariable analyses were carried out separately for women and men. Distribution and prevalence of WPC were examined according to socio-demographic and occupational characteristics as well as psychosocial working conditions. Further, stepwise selection of Poisson log-linear regression models were performed to determine which socio-demographic and occupational characteristics were most associated with the outcome variable WPC and to obtain adjusted prevalence ratios from the final model. The multivariable analyses were conducted both separately for women and men and with all subjects together in one analysis. RESULTS: There was a high prevalence of WPC in the present study (27.4 % of the men and 23.0 % of the women reported a high or very high WPC). A variety of factors was associated with WPC, e.g. full-time employment, depression and many of the psychosocial risk factors at work. Also, the multivariable results showed that women were of higher risk for a WPC. CONCLUSIONS: By affecting the individual work life, home life, and the general well-being and health, WPC may lead to detrimental effects in employees, their families, employers, and society as a whole. Therefore, the high prevalence of WPC in our sample should be of concern. Among women, the risk for suffering from WPC was even higher, most likely due to multiple burdens.

Development of a mobbing short scale in the Gutenberg Health Study.

PURPOSE: Despite its highly detrimental potential, most standard questionnaires assessing psychosocial stress at work do not include mobbing as a risk factor. In the German standard version of COPSOQ, mobbing is assessed with a single item. In the Gutenberg Health Study, this version was used together with a newly developed short scale based on the Leymann Inventory of Psychological Terror. The purpose of the present study was to evaluate the psychometric properties of these two measures, to compare them and to test their differential impact on relevant outcome parameters. METHODS: This analysis is based on a population-based sample of 1441 employees participating in the Gutenberg Health Study. Exploratory and confirmatory factor analyses and reliability analyses were used to assess the mobbing scale. To determine their predictive validities, multiple linear regression analyses with six outcome parameters and log-binomial regression models for two of the outcome aspects were run. RESULTS: Factor analyses of the five-item scale confirmed a one-factor solution, reliability was α = 0.65. Both the single-item and the five-item scales were associated with all six outcome scales. Effect sizes were similar for both mobbing measures. CONCLUSION: Mobbing is an important risk factor for health-related outcomes. For the purpose of psychosocial risk assessment in the workplace, both the single-item and the five-item constructs were psychometrically appropriate. Associations with outcomes were about equivalent. However, the single item has the advantage of parsimony, whereas the five-item construct depicts several distinct forms of mobbing.

Analgesics use in competitive triathletes: its relationship to doping and on predicting its usage.

The two major objectives of this study were (i) to assess variables that predict the use of analgesics in competitive athletes and (ii) to test whether the use of analgesics is associated with the use of doping. A questionnaire primarily addressing the use of analgesics and doping was distributed among 2,997 triathletes. Binary logistic regression analysis was performed to predict the use of analgesics. Moreover, the randomised response technique (RRT) was used to estimate the prevalence of doping in order to assess whether users of analgesics have a higher potential risk for doping than non-users. Statistical power analyses were performed to determine sample size. The bootstrap method was used to assess the statistical significance of the prevalence difference for doping between users and non-users of analgesics. Four variables from a pool of 16 variables were identified that predict the use of analgesics. These were: "version of questionnaire (English)", "gender (female)", "behaviour in case of pain (continue training)", and "hours of training per week (>12 h/week)". The 12-month prevalence estimate for the use of doping substances (overall estimate 13.0%) was significantly higher in athletes that used analgesics (20.4%) than in those athletes who did not use analgesics (12.4%). The results of this study revealed that athletes who use analgesics prior to competition may be especially prone to using doping substances. The predictors of analgesic use found in the study may be of importance to prepare education material and prevention models against the misuse of drugs in athletes.

Measuring mechanical pain: the refinement and standardization of pressure pain threshold measurements.

Pain thresholds are widely used in behavioral research, but unlike other pain modalities, a standardized assessment of pressure pain remains a challenge. In this research, we describe the application of an automatic pressure algometer with a linear increase in force. Ergonomically designed fixation devices were developed to increase the accuracy and to shorten the time of each measurement. Ten healthy volunteers were included in a pilot study to test the algometry method. Pressure pain thresholds (PPTs) were investigated over 2 experimental days in three nonconsecutive runs at 29 measurement sites. During the experiment, subjects reported their subjective sleepiness, level of state-anxiety, psychological status and the perceived pain intensity of each measurement. Pain intensity ratings indicate that instructions were followed. State-anxiety and subjective sleepiness levels were low throughout the experiment. The method has proven to be suitable for standardized PPT measurements across the body in an ergonomic, safe, and user-friendly fashion.

Biomonitoring in wearers of permethrin impregnated battle dress uniforms in Afghanistan and Germany.

OBJECTIVES: To analyse differences in uptake of the insecticide permethrin in wearers of non-impregnated and permethrin impregnated battle dress uniforms (BDU) in Afghanistan and Germany. METHODS: In two separate studies, in April 2003-January 2004 (study I, n=549) and in February-April 2005 (study II, n=195), healthy female and male members of the German Federal Armed Forces were equipped with permethrin impregnated BDU (two sub-cohorts in Germany and one in Afghanistan) while members equipped with non-impregnated uniforms served as a control group. Human biomonitoring was conducted before, during and after wearing the uniforms by measuring permethrin metabolites in urine samples via GC-MS. RESULTS: Subjects of the Afghan and German control groups had permethrin levels in the range of the German general population. In contrast, subjects wearing impregnated BDU had about 200-fold higher exposure levels. Within this group, subjects located in Afghanistan and smokers had significantly higher exposure levels. Internal exposure decreased with increasing duration of use of impregnated BDU. CONCLUSIONS: There is no evidence for a higher background permethrin contamination in military bases located in Afghanistan compared to Germany. Daily use of permethrin impregnated BDU is associated with significantly higher permethrin uptake compared to the general population. Hand-mouth contact by smoking can increase uptake which also seems to be influenced by the duration of use of impregnated BDU.