[On the understanding of health in the workplace-An outline of problems]. / Zum Verständnis von Gesundheit in der Arbeitswelt ­ ein Problemaufriss.

Working conditions that maintain and promote health and the ability to work are an essential element in the prevention of work-related illnesses and a decisive factor in ensuring participation in working life. The COVID-19 pandemic and its far-reaching consequences, accelerated climate change and digitalization are huge challenges for health and health protection in the world of work as well. They require a deeper reflection of the professional understanding and the conceptual framework that underlie the term health, beyond current considerations. With this objective, thought-provoking impulses for a contemporary understanding of health, for health protection in the world of work, priorities for the protection needs of employees and suggestions for related research are presented for discussion. Based on the physical, mental and social dimensions of health and their manifold relations to the world of work, the article provides innovative impulses for the development and prioritization of questions for scientific studies on the protection and promotion of health in the workplace and for evaluating the significance and quality of the results of these studies for modern preventive occupational health and safety, which contribute both to the humane design of work and to the relief of the social security systems. In accordance with the Public Health Strategy for Germany, social inequality of health is highlighted as a relevant structural feature.

Long-term indoor gunshot exposure of special police forces induces bronchitic reactions and elevated blood lead levels-The Berlin shooting range study.

BACKGROUND: Gunshot emissions contain toxic elements that can harm those frequently exposed, such as police officers. Several years ago, police indoor firing ranges were closed by the Berlin municipality in response to police officer health complaints, and an investigation was launched into the possible respiratory health risks of frequent gunshot emission exposure. We, therefore, conducted an exploratory cross-sectional study to investigate clinical and functional parameters of respiratory health as well as the burden of trace elements in policemen with long-term high exposure to indoor gunshot emissions, compared to low-exposure and control groups. METHODS: We conducted lung function tests and collected blood and urine samples from Berlin police officers and government employees who were divided into three subject groups based on exposure to gunshot emissions: high exposure (n = 53), low exposure (n = 94) and no exposure (n = 76). Lung function was examined using body plethysmography. Blood and urine samples were tested via inductively coupled plasma mass spectrometry for the presence of common gunshot powder elements (antimony, lead and manganese). Exposure and symptoms were assessed using records as well as questionnaires. RESULTS: Higher exposure was associated with more respiratory symptoms during gun shooting practice (64% vs. 21%, P < 0.001) compared to the low-exposure group. Headache, cough, discoloured mucous and shortness of breath were also more common as were some other symptoms. The cough symptomatology of the high-exposure group also persisted significantly longer (median: 0.67 vs. 0.01 days, range: 0 to 5 days, P = 0.029) compared to the low-exposure group. They also showed a lower forced expiratory volume in 1 s/forced vital capacity quotient (Tiffeneau index), P = 0.018 between the three groups and P = 0.005 for the high-exposure group, a possible marker of early, subclinical bronchial obstruction. We observed increased blood lead concentrations depending on subject's age (+1.2% per year, 95% confidence interval: 0.5-1.9%, P < 0.001) and cumulative gunshot exposure (+0.34% per 100 000 shots, 0.02-0.66%, P = 0.037). CONCLUSIONS: These first results suggest that long-term exposure to indoor gunshot emissions induces bronchitic reactions due to repeated irritation of the airways. Higher levels of exposure lead to more negatively impacted lung function and higher blood lead levels with the possible reason that more frequent exposure may mean shorter regeneration phases for the respiratory mucous membrane. We recommend a reduction of exposure to gunshot emissions in order to decrease symptoms and avoid any-even small-deterioration in spirometry.

Influences on glycocalyx shedding during the Yukon Arctic Ultra: the longest and the coldest ultramarathon.

The endothelial glycocalyx maintains vascular structure and may be subject to shedding during inflammation and also during high-intensive exercise. There are no studies on shedding during ultra-endurance exercise. The "Yukon Arctic Ultra" (YAU) is one of the longest and coldest ultramarathons and its impact on glycocalyx shedding was investigated. Thirteen adults (38.92 ± 8.67 yr, 6 females) of YAU editions 2015-2019 completed 657.03 ± 71.65 km at a moving velocity of 4.17 ± 0.62 km/h. Mean daily temperatures ranged from -12.6°C to -30.5°C. Glycocalyx elements heparan sulfate, hyaluronan, and syndecan CD-138 were quantified from serum at start, 277 km, 383 km, and 690 km. Cortisol, C-reactive protein, creatine kinase, and N-terminal-prohormone of brain natriuretic peptide were also quantified. Seven YAU volunteers (36.14 ± 11.04 yr, 5 females) served as control. There were no time-changes among the control. Among finishers, there was a significant increase for hyaluronan and a significant decrease for syndecan CD-138. Values were greater among female finishers for heparan sulfate at start, 383 km, and 690 km, and among male finishers for hyaluronan at 277 km. Values for syndecan CD-138 were greater among older finishers at all timepoints. There were weak significant correlations (R2 < 0.215) between hyaluronan and distance, creatine kinase, and NT-Pro BNP, respectively. Shedding of glycocalyx elements is shown among participants of the YAU. Greater shedding of heparan sulfate among female, greater increases of hyaluronan among male, and greater shedding of syndecan CD-138 among older athletes indicate complex glycocalyx shedding during ultra-endurance exercise.NEW & NOTEWORTHY This is the first study to investigate changes in glycocalyx elements in an endurance footrace and first study to investigate exercise-induced shedding in both sexes. This study comprised of an athlete group who finished the ultra-long distance of up to 690 km during the Yukon Arctic Ultra as well as a control group. Results indicate relevant and different shedding of glycocalyx elements heparan sulfate, hyaluronan, and syndecan CD-138. Sex, age, BMI, and covered distance appear to have an influence on the shedding. Other serum parameters indicative of stress appear to be associated with shedding.

Adiponectin, leptin, cortisol, neuropeptide Y and profile of mood states in athletes participating in an ultramarathon during winter: An observational study.

Background: The Montane® Yukon Arctic Ultra (YAU) is one of the longest (690 km) and coldest (+10.6°C-43.9°C) ultramarathons worldwide. Taking part in an ultramarathon is associated with great physiological and psychological stress, which can affect one's mood, level of hormones, and peptides. The current study aimed to identify relationships between peptides, hormones, and mood states in participants during this ultramarathon. Methods: The study cohort consisted of 36 participants (19 men, 17 women, 38.64 ± 9.12 years) split into a finisher (n = 10), non-finisher (n = 19), and control group (n = 7). Data were collected at four time points: baseline (PRE), during (D1 after 277 km, D2 after 383 km), and after the race (POST). Questionnaires were used to assess ratings of perceived exertion (RPE), total quality of recovery (TQR), and profile of mood states (POMS-SF). Serum NPY, leptin, adiponectin, and cortisol were measured. Results: Among non-finishers, scores for confusion, anger, depression, and tension-anxiety (PRE vs. D2, p < 0.05) increased, while vigor decreased (PRE vs. D1, p < 0.05). In contrast, finishers' tension-anxiety scores decreased (PRE vs. D1, p < 0.05). Fatigue increased in finishers (PRE vs. POST, p < 0.05) and non-finishers (PRE vs. D1, p < 0.05). In non-finishers, depressive mood correlated positively with leptin, anger, and confusion at several time points (p < 0.001). In finishers, NPY correlated with TQR at PRE (p < 0.05), while leptin correlated negatively with TQR at POST (p < 0.05). Tension-anxiety correlated highly with perceived exertion in non-finishers (p < 0.001) and with cortisol in finishers (p < 0.05) and non-finishers (p < 0.001). In finishers, confusion correlated negatively with NPY (p < 0.01). Conclusion: The study reveals an essential interplay between hormones and mood states affecting performance: Leptin was associated with anger and a depressive mood state in non-finishers and worse recovery in finishers. In contrast, NPY appeared linked to a lower confusion score and heightened recovery in finishers. A simultaneous increase in depressed mood, anger, tension-anxiety, and confusion might harm performance and lead to race failure.

Measuring Core Body Temperature Using a Non-invasive, Disposable Double-Sensor During Targeted Temperature Management in Post-cardiac Arrest Patients.

Background: Precisely measuring the core body temperature during targeted temperature management after return of spontaneous circulation is mandatory, as deviations from the recommended temperature might result in side effects such as electrolyte imbalances or infections. However, previous methods are invasive and lack easy handling. A disposable, non-invasive temperature sensor using the heat flux approach (Double Sensor), was tested against the standard method: an esophagus thermometer. Methods: The sensor was placed on the forehead of adult patients (n = 25, M/F, median age 61 years) with return of spontaneous circulation after cardiac arrest undergoing targeted temperature management. The recorded temperatures were compared to the established measurement method of an esophageal thermometer. A paired t-test was performed to examine differences between methods. A Bland-Altman-Plot and the intraclass correlation coefficient were used to assess agreement and reliability. To rule out possible influence on measurements, the patients' medication was recorded as well. Results: Over the span of 1 year and 3 months, data from 25 patients were recorded. The t-test showed no significant difference between the two measuring methods (t = 1.47, p = 0.14, n = 1,319). Bland-Altman results showed a mean bias of 0.02°C (95% confidence interval 0.00-0.04) and 95% limits of agreement of -1.023°C and 1.066°C. The intraclass correlation coefficient was 0.94. No skin irritation or allergic reaction was observed where the sensor was placed. In six patients the bias differed noticeably from the rest of the participants, but no sex-based or ethnicity-based differences could be identified. Influences on the measurements of the Double Sensor by drugs administered could also be ruled out. Conclusions: This study could demonstrate that measuring the core body temperature with the non-invasive, disposable sensor shows excellent reliability during targeted temperature management after survived cardiac arrest. Nonetheless, clinical research concerning the implementation of the sensor in other fields of application should be supported, as well as verifying our results by a larger patient cohort to possibly improve the limits of agreement.