Teachers' working time as a risk factor for their mental health - findings from a cross-sectional study at German upper-level secondary schools.

BACKGROUND: The work of teachers has changed due to an increase in the range of tasks. However, there is a lack of current information on working hours, task distribution and the possible health effects. METHODS: For the first time for Germany as a whole, a cross-sectional survey determined how long teachers at upper-level secondary schools work per week, what influences their working hours and how different recording methods affect the total working hours. To this end, 6,109 full-time teachers estimated their working hours based on twelve categories and then documented these daily over 4 weeks. Afterwards, the effects of long working hours on teachers' ability to recover and emotional exhaustion were analysed. RESULTS: The article shows the large interindividual variance in the working hours of teachers and a significant influence of sex, age, and subject profile. Self-reported working hours varied substantially by method used to record working time with work time reported via daily diaries totaling 2 h per week more than hours recorded by a single estimation. A substantial proportion of the teachers (36%) work longer per week than European guidelines allow (> 48 h); 15% work even more than 55 h per week. Teachers who work more than 45 h per week suffer more often from inability to recover (46%) and emotional exhaustion (32%) than teachers who work less than 40 h per week (26% and 22% respectively). CONCLUSIONS: Taking professional experience and teaching subjects into account could in future contribute to a fairer distribution of workload among teachers. This could protect individual teachers from long working hours, ensure sufficient recovery and also reduce the risk of emotional exhaustion. In order to identify teachers whose health is at risk at an early stage, voluntary preventive care offers would be considerably helpful.

Cardiovascular recovery after workload in German shift workers in the hotel and catering industry: results of 24-hour-ambulatory monitoring of heart rate and blood pressure.

PURPOSE: Shift work is associated with an impairment of sleep-wake cycles that can affect cardiovascular recovery (CR) negatively. The aim of this study was to examine CR of shift and day workers in the hotel and catering industry (HCI) and identify predictors of CR. METHODS: The sample consisted of 64 alternating and 96 day workers in the HCI. Monitoring of blood pressure (BP) and heart rate (HR) was conducted for 24 hours per working day during work, leisure and sleep. The CR process was examined for differences between work and leisure, work and sleep regarding a reduction in BP and HR. Lifestyle (physical activity, smoking, drinking) was assessed through questionnaires, BP over a four-day, self-assessment period (38% hypertensives). Participants taking BP medication (n = 12) were excluded from analyses. RESULTS: Shift workers had significantly higher BP (Ø 146/87 vs. Ø 140/84 mmHg; p = 0.034-0.044) and HR (Ø 86 vs. 82 bpm; p = 0.032) during their work phase verses day workers. There were no differences found for the CR between work and leisure nor work and sleep. As predictors of the CR, classic cardiovascular indicators (blood pressure status, smoking, age, physical activity, sex) were found which explains between 14% (HR) and 30% (BP) of the variance. Shift work was not a predictor for CR. CONCLUSIONS: Employees in the HCI show that their CR is mainly determined by the known cardiovascular indicators and less by shift work. This effect needs to be discussed in relation to the job requirements and the cardiovascular health of the employees.

Psychophysical workload in the operating room: primary surgeon versus assistant.

BACKGROUND: Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting. METHODS: Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed. RESULTS: Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p < 0.05; η(2) = 0.283), temporal demands (p < 0.05; η(2) = 0.260), effort (p < 0.05; η(2) = 0.287), and NASA-TLX sum score (p < 0.01; η(2) = 0.287). CONCLUSIONS: Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.

Heart rate and heart rate variability as indirect markers of surgeons' intraoperative stress.

OBJECTIVE: In a difficult and demanding environment such as the operating room, the individual workload response of physicians is of particular importance. The aim of this study was to examine the specific effects of intraoperative stress on the cardiovascular system by measuring heart rate (HR) and heart rate variability (HRV). METHODS: In a cross-sectional study, the effect of intraoperative stress on autonomic balance, measured by HRV, among surgeons differing with respect to their intraoperative stress levels was studied. Based on their perceived stress (State Trait Anxiety Inventory), surgeons were classified into a stressed and a non-stressed sample. Data on HR and HRV were collected by means of ambulatory ECG-recordings. Changes in autonomic nervous system activity were quantified by frequency and time domain analysis of R-R interval variability. Demographic, anthropometric, and surgery-related group differences were assessed by non-parametric Mann-Whitney U test, differences between relative changes of HR and HRV by Wilcoxon signed-ranks test. In multivariate linear analysis of covariance, group differences were adjusted for possible confounding factors. RESULTS: There was a significant difference in intraoperative HR for stressed and non-stressed surgeons (median: 99.3 vs. 63.7; P < 0.05). During sleep, HRV indices indicated a reduced autonomic recovery in stressed participants. CONCLUSIONS: Our results reveal that higher perceived stress in the operating room is associated with increased intraoperative HR and decreased HRV at night. Non-stressed surgeons show greater relaxation during sleep compared to their stressed colleagues.

Health effects and acceptance of a physical activity program for older long-term unemployed workers.

PURPOSE: Long-term unemployment has negative effects on both mental and physical health. In combination with an inactive lifestyle, it often leads to functional or constitutional limitations that make reemployment in the labor market difficult especially for older adults. The presented pilot study examined a 3-month-long interventional program for improving health of older, long-term unemployed persons with regard to its effectiveness and acceptance by the target group. METHODS: The low-threshold intervention was offered by a job training center that supports reemployment and was divided into lectures for enhancing the individual health competence and a supervised physical training part in a fitness center. One hundred and nineteen long-term unemployed workers (53.7 ± 3 years) took part in a prospective investigation with 3 data collection points: before intervention (T1), after intervention (T2, n = 94), and 6 month after intervention (T3, n = 59). The spectrum of methods included the assessment of nutritional status, cardiovascular risk factors, physical fitness, chronic backache, and depression. RESULTS: As a result of the intervention, the physical fitness improved significantly (maximal oxygen uptake: p < 0.002). Cardiovascular risk factors like systolic and diastolic blood pressure (p < 0.016; p < 0.001) and percentage body fat (p < 0.017) decreased significantly. There were also remarkable effects in the reduction in depression (p < 0.028). Chronic backache was lowered in more than 50% of the cases. CONCLUSION: The health promotion program reached people who have a desire to improve both physical and mental health. To assume responsibility for their own health may be a first step in regaining self-confidence and lowering the work placement barriers.

Working time reduction, mental health, and early retirement among part-time teachers at German upper secondary schools - a cross-sectional study.

Objective: Many secondary school teachers work part-time in order to cope with the high workload and to remain as healthy as possible until regular retirement. However, due to the acute shortage of teachers, the increase in the teaching obligation for part-time teachers (PTT) has become a topic of discussion in Germany. Whether a reduction in teaching hours is associated with benefits for mental health has not yet become evident. Therefore, this study investigated the relationship between the real working hours of PTT and their mental health as well as individual pension prognosis. Methods: The cross-sectional study included 5,905 PTT at German upper secondary schools (female proportion: 81%, average age: 44 ± 9 years) who logged their working hours over four weeks. Four part-time groups (PTG) were formed based on the proportion of a full-time position worked: maximum (<100-90% = PTGmax - reference group - 17%), high (<90-75% = PTGhigh - 34%), medium (<75-50% = PTGmed - 40%) and low (<50% = PTGlow - 9%) teaching commitment. These groups were compared in terms of their average weekly working hours, mental health (inability to recover, risk of burnout) and predicted retirement age. Results: The contractually agreed working time is exceeded to a relevant extent for PTT. The extent of unpaid overtime increases significantly the lower the teaching obligation is and lies on average between -0.4 (PTGmax) and 7.3 (PTGlow) hours/week. A reduction in teaching hours is neither related to the mental health of teachers nor to their decision to retire early (42%) or regularly (58%). However, predicted retirement is mainly explained by mental health status, gender and age (variance explanation: 24%, OR of predictors: maximum 2.1). One third of PTT reported inability to recover, 47% burnout symptoms and 3% a burnout syndrome. Conclusion: Mental health is also a risk for PTT; reducing teaching hours alone does not improve it. However, good mental health increases the chance of regular retirement. Therefore, instead of a legal obligation, PTT should be encouraged to increase the number of teaching hours voluntarily in order to counteract the general shortage of teachers.

Gender-Specific Aspects of Teachers Regarding Working Behavior and Early Retirement.

Worldwide, a significant proportion of teachers retires prematurely for health reasons or at their own request. The study examines whether male and female teachers differ in terms of working conditions and coping with high work demands as well as individual factors that promote early retirement. A cross-sectional study was conducted to collect data from 6,109 full-time teachers in high schools (56% women). Weekly working hours from a four-week working time record and psychosocial work stress (effort-reward model, ER ratio) were used as workloads. In addition, emotional exhaustion (Maslach Burnout Inventory) and coping strategies that endangered health were recorded in the form of overcommitment and inability to recover. Also, the teachers gave a prediction and reasons for early retirement and made their own suggestions on how to prevent this. The results show that both workloads and emotional exhaustion are comparable between the genders, but women have a greater tendency than men to overcommit and be unable to recover. As ER ratio and emotional exhaustion increase, the chances for both genders to reach the regular retirement age decrease significantly; for health-endangering coping strategies, the relationship is somewhat weaker. The majority of male and female teachers (79%) indicates excessive workloads as the main reason for leaving the profession early. In order to protect teachers from high workloads, measures at the organizational, social, and individual level are necessary. Proposals for schools and policy makers are critically discussed on the basis of teacher recommendations.

Influence of Work-Related and Personal Characteristics on the Burnout Risk among Full- and Part-Time Teachers.

Teachers are at increased risk of stress-related illnesses and burnout symptoms. Thus, a cross-sectional study involving 6109 full-time and 5905 part-time teachers at upper-level secondary schools examined the influence of presumed work-related and personal characteristics on burnout risk between January and April 2018. Burnout was recorded using the Maslach Burnout Inventory-General Survey (MBI-GS). Work-related characteristics were weekly working hours and work stress, operationalized with the effort-reward imbalance (ERI) model. Overcommitment and the inability to recover were determined as personal characteristics. Multiple linear regression analyses were performed, adjusted for age and gender. Overall, 47% of the teachers reported burnout symptoms and 3% had an indication of burnout. Full-time and part-time teachers did not differ in their risk of burnout. ERI, overcommitment, and inability to recover were identified as predictors of burnout risk (explained variance: 29%), whereby the inability to recover was the strongest predictor. In contrast, weekly working hours, extent of employment, gender and age were not related to the burnout risk. ERI was found in 33%, inability to recover in 36% and overcommitment in 39% of all the teachers studied. In particular, the inability to recover should be taken into account as an early indicator of burnout.

Comparison of three mobile devices for measuring R-R intervals and heart rate variability: Polar S810i, Suunto t6 and an ambulatory ECG system.

The first aim of this study was to compare an ambulatory five-lead ECG system with the commercially available breast belt measuring devices; Polar S810i and Suunto t6, in terms of R-R interval measures and heart rate variability (HRV) indices. The second aim was to compare different HRV spectral analysis methods. Nineteen young males (aged between 22 and 31 years, median 24 years) underwent simultaneous R-R interval recordings with the three instruments during supine and sitting rest, moderate dynamic, and moderate to vigorous static exercise of the upper and lower limb. For each subject, 17 R-R interval series of 3-min length were extracted from the whole recordings and then analyzed in frequency domain using (1) a fast Fourier transform (FFT), (2) an autoregressive model (AR), (3) a Welch periodogram (WP) and (4) a continuous wavelet transform (CWT). Intra-class correlation coefficients (ICC) and Bland-Altman limits of agreement (LoA) method served as criteria for measurement agreement. Regarding the R-R interval recordings, ICC (lower ICC 95% confidence interval >0.99) as well as LoA (maximum LoA: -15.1 to 14.3 ms for ECG vs. Polar) showed an excellent agreement between all devices. Therefore, the three instruments may be used interchangeably in recording and interpolation of R-R intervals. ICCs for HRV frequency parameters were also high, but in most cases LoA analysis revealed unacceptable discrepancies between the instruments. The agreement among the different frequency transform methods can be taken for granted when analyzing the normalized power in low and high frequency ranges; however, not when analyzing the absolute values.

Early Detection of Undiagnosed Hypertension Based on Occupational Screening in the Hotel and Restaurant Industry.

Blood pressure is the most important, modifiable risk factor for cardiovascular diseases. Lifestyle factors and also workload are the main, potential risk factors for the development of hypertension. This study focused on the early detection of unknown hypertension by screening employees in the hotel and restaurant industry (HRI). 148 HRI employees without hypertension (mean age: 34 years, men: 45%) self-measured their blood pressure during rest and for 24 hours of a normal workday. Individuals with a resting blood pressure ≥ 135/85 mmHg were classified as hypertensive. A further analysis investigated whether the currently applicable thresholds for hypertension during work, leisure, and sleep were exceeded on a working day. At rest, 36% of the study participants suffered from hypertension, which increased to 70% under workload and 46% during leisure time and dropped to 8% during sleep. Normal nocturnal dipping (10-20%) occurred only in 18% of cases; 78% were extreme dippers (>20%). Occupational hypertension screening is a suitable component of preventive healthcare. Resting blood pressure measurement alone is insufficient for the early detection of risk individuals and should be supplemented by 24-hour ambulatory blood pressure monitoring under working conditions. The impact of workload on blood pressure needs to be given more attention in the guidelines.

German version of the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ): translation and validation.

BACKGROUND: Musculoskeletal disorders are a public health problem with significant effects on work ability. In the context of the promotion and prevention of work-related health, there is a need for valid, simple, time-saving and universally applicable methods for the assessment of musculoskeletal pain and complaints. The aim of this study was the translation of the English Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) into German and the validation of the German version. METHODS: The linguistic and cultural adaption of the CMDQ into German (D-CMDQ) followed international guidelines. The adapted pre-version was initially tested in terms of comprehensibility on 44 persons with different educational and occupational backgrounds. The questionnaire was validated further on 68 employees with the reference of an 11-point Numeric Rating Scale (Cohen's Kappa and Spearman's rank correlation coefficients). Finally, reliability (Cohen's Kappa) and internal consistency (Cronbach's alpha) were verified. RESULTS: The D-CMDQ meets the requirements for comprehensibility and demonstrated good validity: The values of Cohen's Kappa and Spearman's rank correlation coefficient obtained substantial to excellent agreement, with one exception. The Kappa values for the test-retest reliability were mainly in the moderate to substantial range whilst taking the prevalence effect into account. The internal consistency was proven satisfactory. CONCLUSIONS: The D-CMDQ meets the psychometric requirements for questionnaires. A clear one-sided presentation of body areas enables the time-saving assessment of musculoskeletal complaints and their effects on work ability. As a result, a broad application in the German-speaking world for different occupational groups seems possible, whether performing physical, manually repetitive or sedentary work.

Heart rate variability and blood pressure during dynamic and static exercise at similar heart rate levels.

UNLABELLED: Aim was to elucidate autonomic responses to dynamic and static (isometric) exercise of the lower limbs eliciting the same moderate heart rate (HR) response. METHOD: 23 males performed two kinds of voluntary exercise in a supine position at similar heart rates: static exercise (SE) of the lower limbs (static leg press) and dynamic exercise (DE) of the lower limbs (cycling). Subjective effort, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), rate pressure product (RPP) and the time between consecutive heart beats (RR-intervals) were measured. Time-domain (SDNN, RMSSD), frequency-domain (power in the low and high frequency band (LFP, HFP)) and geometric measures (SD1, SD2) as well as non-linear measures of regularity (approximate entropy (ApEn), sample entropy (SampEn) and correlation dimension D2) were calculated. RESULTS: Although HR was similar during both exercise conditions (88±10 bpm), subjective effort, SBP, DBP, MAP and RPP were significantly enhanced during SE. HRV indicators representing overall variability (SDNN, SD 2) and vagal modulated variability (RMSSD, HFP, SD 1) were increased. LFP, thought to be modulated by both autonomic branches, tended to be higher during SE. ApEn and SampEn were decreased whereas D2 was enhanced during SE. It can be concluded that autonomic control processes during SE and DE were qualitatively different despite similar heart rate levels. The differences were reflected by blood pressure and HRV indices. HRV-measures indicated a stronger vagal cardiac activity during SE, while blood pressure response indicated a stronger sympathetic efferent activity to the vessels. The elevated vagal cardiac activity during SE might be a response mechanism, compensating a possible co-activation of sympathetic cardiac efferents, as HR and LF/HF was similar and LFP tended to be higher. However, this conclusion must be drawn cautiously as there is no HRV-marker reflecting "pure" sympathetic cardiac activity.

Tri-axial high-resolution acceleration for oxygen uptake estimation: Validation of a multi-sensor device and a novel analysis method.

We validated a multi-sensor chest-strap against indirect calorimetry and further introduced the total-acceleration-variability (TAV) method for analyzing high-resolution accelerometer data. Linear regression models were developed to predict oxygen uptake from the TAV-processed multi-sensor data. Individual correlations between observed and TAV-predicted oxygen uptake (V̇O2) were strong (mean r = 0.94) and bias low (1.5 mL·min(-1)·kg(-1), p < 0.01; 95% confidence interval: 8.7 mL·min(-1)·kg(-1); -5.8 mL·min(-1)·kg(-1)); however, caution should be taken when a single-model value is used as a surrogate for V̇O2.

Fuzzy techniques for subjective workload-score modeling under uncertainties.

This paper deals with the development of a computer model to estimate the subjective workload score of individuals by evaluating their heart-rate (HR) signals. The identification of a model to estimate the subjective workload score of individuals under different workload situations is too ambitious a task because different individuals (due to different body conditions, emotional states, age, gender, etc.) show different physiological responses (assessed by evaluating the HR signal) under different workload situations. This is equivalent to saying that the mathematical mappings between physiological parameters and the workload score are uncertain. Our approach to deal with the uncertainties in a workload-modeling problem consists of the following steps: 1) The uncertainties arising due the individual variations in identifying a common model valid for all the individuals are filtered out using a fuzzy filter; 2) stochastic modeling of the uncertainties (provided by the fuzzy filter) use finite-mixture models and utilize this information regarding uncertainties for identifying the structure and initial parameters of a workload model; and 3) finally, the workload model parameters for an individual are identified in an online scenario using machine learning algorithms. The contribution of this paper is to propose, with a mathematical analysis, a fuzzy-based modeling technique that first filters out the uncertainties from the modeling problem, analyzes the uncertainties statistically using finite-mixture modeling, and, finally, utilizes the information about uncertainties for adapting the workload model to an individual's physiological conditions. The approach of this paper, demonstrated with the real-world medical data of 11 subjects, provides a fuzzy-based tool useful for modeling in the presence of uncertainties.