[Occupational and Health Strains of Pensioners with Reduced Earning Capacity Due to Mental or Physical Illnesses - Implications for the Health Care System]. / Unterschiedliche berufliche und gesundheitliche Belastungen psychisch und körperlich erkrankter EM-Rentner*innen ­ Implikationen für das Gesundheitswesen.

OBJECTIVE: Demographic changes with an increasing number of people receiving pensions and a decreasing number of working people paying into the pension system represent major challenges for the German social security system. In particular, it is important to support people to continue working so that there is no (premature) reduction in their earning capacity and pensioners with reduced earning capacity (disability pensioners) should be helped to return to gainful employment. The aim of this study was to investigate the differing needs of two kinds of disability pensioners, namely those with mental illness and those who were physically ill. METHODS: A total of 453 persons receiving disability pension because of temporararily reduced earning capacity were interviewed over the telephone. Differences in demographic variables, occupational characteristics before applying for disability pension, and general resources were examined in descriptive analyses and multivariate analyses of variance with post-hoc tests. RESULTS: A third of the sample (33.1%) suffered from mental illness and the rest from somatic disorders. Those with mental illness reported higher perceived mental age, lower work-related self-efficacy, and lower quality of life concerning their mental health. Moreover, they reported higher levels of mental stressors at work. CONCLUSION: Mentally ill disability pensioners differ considerably from those with somatic illnesses. Accordingly, to promote a return to work, interventions need to target different factors in these two groups.

[Curriculum Hannover - Web-based vs. Analogue Psychotherapeutic aftercare after Psychosomatic Rehabilitation and vs. Care as Usual]. / Curriculum Hannover ­ webbasierte vs. analoge Durchführung der psychosomatischen Nachsorge und vs. Care as usual.

PURPOSE: In order to maintain the effect achieved in the psychosomatic rehabilitation measure, psychosomatic rehabilitation aftercare is indicated for most rehabilitation patients. Due to the low availability of aftercare therapists close to home, the use of digital offers is a possibility to enable access independent of location. The aim of the study was to evaluate the therapeutic effects of web-based aftercare in comparison to face-to-face (F2F) therapy (both on the conceptual basis of the Curriculum Hannover) in the equivalence study and to no standardized aftercare (care as usual, CAU) in the superiority study. METHODS: 300 rehabilitation patients with an indication for psychosomatic aftercare were assigned to the equivalence study if an aftercare service close to home was available and then randomized to F2F or online aftercare. Without a service close to home, the participants were assigned to the superiority study and randomized to online or CAU group. The outcomes (primary: psychological and somatoform complaints, secondary: subscales of the HEALTH-49, employment prognosis, ability to work) were assessed by online questionnaires at the end of rehabilitation, 9 or 12 and 15 or 18 months after rehabilitation and evaluated with multiple imputation and intention-to-treat-analyses. For the primary outcome, a sensitivity analysis was also carried out on the basis of the completed dataset. RESULTS: After excluding non-adherent participants, n=142 participants were evaluated in the equivalence study and n=111 in the superiority study. In the equivalence study, no significant differences (d=0,28 and 0,10 with ITT-analyses; d=0,09 and 0,03 with completed dataset) were found between online and F2F follow-up with regard to short-term and long-term psychological and somatoform complaints. In the superiority study, long-term psychological and somatoform complaints decrease in the online group, while in the CAU group they first decreased at T2 (d=0,56) and increased again at T3 (d=0,72). The latter finding is confirmed with the analysis of the completed dataset (d=0,12), while an increase was seen in the online group at T3 (d=0,10). CONCLUSION: According to the results of the present study, web-based psychosomatic aftercare seems to have a longer-term advantage for rehabilitants without access to previous aftercare. Compared to F2F implementation, it can be considered equivalent.

Screening and assessment for post-acute COVID-19 syndrome (PACS), guidance by personal pilots and support with individual digital trainings within intersectoral care: a study protocol of a randomized controlled trial.

BACKGROUND: Because the clinical patterns and symptoms that persist after a COVID-19 infection are diverse, a diagnosis of post-acute COVID-19 syndrome (PACS) is difficult to implement. The current research project therefore aims to evaluate the feasibility and the practicability of a comprehensive, interdisciplinary, and cross-sectoral treatment program consisting of a low-threshold online screening and holistic assessment for PACS. Furthermore, it aims to evaluate digital interventions and the use of so-called personal guides that may help to facilitate the recovery of PACS. METHODS: This German study consists of a low-threshold online screening for PACS where positively screened participants will be supported throughout by personal pilots. The personal pilots are aimed at empowering patients and helping them to navigate through the study and different treatment options. Patients will then be randomly assigned either to an intervention group (IG) or an active control group (ACG). The IG will receive a comprehensive assessment of physiological and psychological functioning to inform future treatment. The ACG does not receive the assessment but both groups will receive a treatment consisting of an individual digital treatment program (digital intervention platform and an intervention via a chatbot). This digital intervention is based on the needs identified during the assessment for participants in the IG. Compared to that, the ACG will receive a more common digital treatment program aiming to reduce PACS symptoms. Importantly, a third comparison group (CompG) will be recruited that does not receive any treatment. A propensity score matching will take place, ensuring comparability between the participants. Primary endpoints of the study are symptom reduction and return to work. Secondary outcomes comprise, for example, social participation and activities in daily life. Furthermore, the feasibility and applicability of the online screening tool, the holistic assessment, digital trainings, and personal pilots will be evaluated. DISCUSSION: This is one of the first large-scale studies to improve the diagnosis and the care of patients with PACS by means of empowerment. It is to be evaluated whether the methods utilized can be used for the German and international population. Trial registration ClinicalTrials.gov Identifier: NCT05238415; date of registration: February 14, 2022.

Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants.

BACKGROUND: Hand hygiene is crucial to avoid healthcare-associated infections and the transmission of COVID-19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social-cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers' adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID-19 pandemic. METHODS: In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre-COVID-19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social-cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations. RESULTS: Adherence to hand hygiene recommendations increased from 47 per cent pre-COVID-19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self-efficacy was associated with the intention to sanitise hands (ß = .397, p < .001). Coping self-efficacy mediated the association of intention with hand hygiene adherence. CONCLUSIONS: Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID-19 pandemic. To further improve interventions, social-cognitive determinants should be considered, especially intention and (coping) self-efficacy.