Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland.

PURPOSE: COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. METHODS: We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. RESULTS: The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV­2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV­2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. CONCLUSION: Most ROIs reported a deep impact of SARS-CoV­2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.

Associations of Changes in Organizational Justice with Job Attitudes and Health-Findings from a Prospective Study Using a Matching-Based Difference-in-Difference Approach.

BACKGROUND: Ample evidence indicates that unfairness at the workplace (organizational injustice) is associated with both job attitudes and health of employees. Several factors that influence these associations have been identified: e.g., personality traits, such as the Big Five traits, justice sensitivity, type of occupation (e.g., white-collar), and unobserved time-invariant factors. Previous studies only addressed parts of these issues, and the ideal research design to mitigate biases-an experiment with random assignment to a treatment and control group-is not feasible. This study therefore mimics a randomized experiment using two statistical techniques. METHODS: First, matching was implemented to balance the treatment and control group in confounding factors (demographics and personality) in two prospective waves (2012-2014) of observational data (4522 white-collar, 2984 blue-collar) taken from the Linked Personnel Panel, which is an employee survey representative for German private sector companies with more than 50 employees. Second, a difference-in-difference approach excludes unobserved time-invariant factors by estimating associations of changes in organizational justice (distributive, procedural, interactional) with job attitudes (job satisfaction, turnover intention) and health (general and mental) in these groups, separate for white- and blue-collar employees. RESULTS: A decrease in perceived justice was associated with lower job attitudes (less job satisfaction and higher turnover intentions), while an increase was associated with higher values. This pattern was found for white- and blue-collar workers and also for health indicators, with the latter, however, being less pronounced. CONCLUSIONS: Increased fairness at the workplace is related to better job attitudes and health for white- and blue-collar employees, independent of personality traits and unobserved time-invariant factors.

Injustice at work and leukocyte glucocorticoid sensitivity: findings from a cross-sectional study.

OBJECTIVE: Organizational justice refers to perceived fairness at the workplace. Low organizational justice has been identified as a major source of distress and a predictor of poor health. Impaired regulation of immunological and inflammatory pathways may, in part, underlie these health effects. The present study investigated the association of organizational justice with leukocyte glucocorticoid sensitivity in vivo. METHODS: Organizational justice was assessed among 541 male factory workers (mean [standard deviation] age = 46 [9] years) by questionnaire. Cortisol release was measured at three time points before blood collection and summed as the area under the curve. Blood was used to assess leukocyte (white blood cell [WBC] count) subsets (neutrophils [%WBC], lymphocytes [%WBC], and the neutrophil/lymphocyte ratio). Glucocorticoid sensitivity was operationalized as the correlation between cortisol release and these hematologic parameters. Associations were adjusted for demographics, work characteristics, and life-style variables. RESULTS: A dose-response relationship between organizational justice and glucocorticoid sensitivity was found. Cortisol and hematologic parameters showed the expected significant association among individuals reporting high (all ß values ≥ |.26|; all p values ≤.001) or medium organizational justice (all ß values ≥ |.15|; all p values ≤.050), but not among those reporting low organizational justice (all ß values ≤ |.04|; all p values > .10). These regression slopes differed significantly between organizational justice groups (p values for interaction < .050). CONCLUSIONS: Low justice at work is associated with an impaired ability of endogenous cortisol to regulate leukocyte distribution in vivo. These findings identify a novel biological pathway by which organizational justice may affect health.

Organizational justice is related to heart rate variability in white-collar workers, but not in blue-collar workers-findings from a cross-sectional study.

BACKGROUND: Perceived injustice at work predicts coronary heart disease. Vagal dysregulation represents a potential psychobiological pathway. PURPOSE: We examined associations between organizational justice and heart rate variability (HRV) indicators. Grounded in social exchange and psychological contract theory, we tested predictions that these associations are more pronounced among white-collar than among blue-collar workers. METHODS: Cross-sectional data from 222 blue-collar and 179 white-collar men were used. Interactional and procedural justice were measured by questionnaire. Ambulatory HRV was assessed across 24 h. Standardized regression coefficients (ß) were calculated. RESULTS: Among white-collar workers, interactional justice showed positive relationships with 24-h HRV, which were strongest during sleeping time (adjusted ßs≥0.26; p values≤0.01). No associations were found for blue-collar workers. A comparable but attenuated pattern was observed for procedural justice. CONCLUSIONS: Both dimensions of organizational injustice were associated with lowered HRV among white-collar workers. The impact of justice and possibly its association with health seems to differ by occupational groups.

Psychometric properties of a German organizational justice questionnaire (G-OJQ) and its association with self-rated health: findings from the Mannheim Industrial Cohort Studies (MICS).

PURPOSE: The objective of the present study was to validate a German 11-item organizational justice questionnaire (G-OJQ) that consists of two subscales, referred to as "procedural justice" (PJ) and "interactional justice" (IJ) adapted from Moorman's organizational justice (OJ) questionnaire. A second objective was to determine associations of the G-OJQ with self-rated health. METHODS: This study used cross-sectional data from an occupational cohort of 1518 factory workers from Germany (87.7 % male; mean age = 38.8 with SD = 11.9). After splitting the sample in two random subsamples, we assessed structural validity by exploratory factor analyses in one subsample and by confirmatory factor analysis in the other subsample. Internal validity was assessed by Cronbach's α. Associations with self-reported poor health were estimated by logistic regression. RESULTS: The full scale and its subscales yielded Cronbach's α's of ≥0.9, and item-total correlations were ≥0.5. Factor analyses confirmed the expected 2-factor structure, labeled "interactional justice" (IJ, 4 items, λ 0.43-0.94) and "procedural justice" (PJ, 7 items, λ 0.46-0.83), respectively, and showed an acceptable fit to the data (χ (2) = 61; p = .001; CFI = 0.995; RMSEA = 0.037). The OJ total score as well as subscale scores in the lowest quartile, when compared to the highest quartile, was associated with an ≥2.3 increased odds of reporting poor health. CONCLUSION: The G-OJQ seems to be a valid and useful tool for observational and intervention studies in occupational settings. Future studies may additionally explore longitudinal associations and test the generalizability of the present findings to other populations and health outcomes.

A participatory physical activity intervention in preschools: a cluster randomized controlled trial.

BACKGROUND: Previous studies on physical activity interventions in preschools have reported limited effectiveness. Participatory community-based approaches hold promise for increasing intervention effectiveness and involving parents as key stakeholders in a sustainable way. PURPOSE: To assess whether a participatory parent-focused approach using parents as agents of behavioral change enhances the efficacy of a preschool physical activity (PA) intervention. DESIGN: Two-armed, cluster-RCT with preschool as unit of randomization and children as unit of analysis. SETTING/PARTICIPANTS: 39 South German preschools applying for an existing state-sponsored PA program with 826 children (52% boys, aged 5.0±0.2 years), with 441 allocated to the intervention arm. INTERVENTION: Control preschools received a state-sponsored program consisting of twice-weekly gym classes over 6 months. In intervention preschools, this program was augmented by motivating parents to develop and implement their own project ideas for promoting children's PA. MAIN OUTCOME MEASURES: Primary outcomes included mean accelerometry counts and time spent in moderate- to vigorous-intensity PA or sedentary behavior. Secondary outcomes were BMI, percentage body fat, quality of life, sleep quality, and general health. Outcomes were measured at baseline and at 6 and 12 months in both study arms (time period: 2008-2010). Using an intention-to-treat-analysis, linear multilevel regression models assessed change over time and across study arms, adjusted for age, gender, season, and preschool location. Analysis was conducted in 2011. RESULTS: In 15 intervention preschools, parents implemented 25 PA projects. Compared with controls, intervention arm children were 11 minutes less sedentary per day (95% CI=5.39, 17.01, p=0.014); had significantly more mean accelerometry counts (1.4 counts/15 seconds [95% CI=0.22, 2.54], p=0.019); and showed benefits in perceived general health and quality of life. All other outcomes showed no difference between study arms. CONCLUSIONS: A participatory preschool intervention focusing on parents as agents of behavioral change may be able to promote PA and reduce sedentary behavior in preschoolers. These benefits may go beyond the effects of existing nonparticipatory interventions. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov NCT00987532.

Positive impact of a pre-school-based nutritional intervention on children's fruit and vegetable intake: results of a cluster-randomized trial.

OBJECTIVE: To assess the short-term impact of a nutritional intervention aimed at reducing childhood overweight in German pre-school children. DESIGN: Using a cluster-randomized study design with waiting-list controls, we tested a 6-month intervention administered once weekly by a nutrition expert consisting of joint meal preparation and activities for children and parents such as tasting and preparing nutritious, fresh foods. At baseline, 6 and 12 months, a parent-completed questionnaire assessed fruit and vegetable intakes (primary outcomes) and water and sugared drinks consumption (secondary outcomes). Direct measurement assessed BMI, skinfold thickness and waist-to-height-ratio. An intention-to-treat analysis used random-effects panel regression models to assess the intervention effect, adjusted for each child's age, gender, immigrant background and maternal education. SETTING: Eighteen pre-schools from three south German regions. SUBJECTS: Healthy children aged 3-6 years. RESULTS: Three hundred and seventy-seven (80 %) eligible pre-school children participated in the study. Of these, 348 provided sufficient data for analysis. The sample mean age was 4·26 (sd 0·78) years; the majority (53·2 %) were boys. Children's fruit and vegetable intakes increased significantly (P < 0·001 and P < 0·05, respectively); no significant changes in the consumption of water, sugared drinks or anthropometric measurements were noted. CONCLUSIONS: Nutritional interventions in pre-schools have the potential to change eating behaviours in young children, which in the long term might reduce risk for developing overweight.

A participatory parent-focused intervention promoting physical activity in preschools: design of a cluster-randomized trial.

BACKGROUND: With rates of childhood obesity increasing, physical activity (PA) promotion especially in young children has assumed greater importance. Given the limited effectiveness of most interventions to date, new approaches are needed. The General Systems theory suggests that involving parents as intervention targets may be effective in fostering healthier life styles in children. We describe the development of a parent-focused participatory intervention and the procedures used to evaluate its effectiveness in increasing daily PA in preschoolers. METHODS/DESIGN: Thirty-seven South German preschools were identified for this study and agreed to participate. Using a two-armed, controlled cluster-randomized trial design we test a participatory intervention with parents as the primary target group and potential agents of behavioural change. Specifically, the intervention is designed to engage parents in the development, refinement and selection of project ideas to promote PA and in incorporating these ideas into daily routines within the preschool community, consisting of children, teachers and parents. Our study is embedded within an existing state-sponsored programme providing structured gym lessons to preschool children. Thus, child-based PA outcomes from the study arm with the parent-focused intervention and the state-sponsored programme are compared with those from the study arm with the state-sponsored programme alone. The evaluation entails baseline measurements of study outcomes as well as follow-up measurements at 6 and 12 months. Accelerometry measures PA intensity over a period of six days, with the mean over six days used as the primary outcome measure. Secondary outcomes include childrens' BMI, a sum of averaged skin fold thickness measurements across multiple sites, and PA behaviour. Longitudinal multilevel models are used to assess within-subject change and between-group differences in study outcomes, adjusted for covariates at the preschool and individual levels. Teacher qualitative interviews monitor the intervention implementation process. DISCUSSION: Participatory approaches that actively involve parents have the potential to promote PA in ways that might be better tailored to local needs and more sustainable. Our mixed methods approach to assess the intervention efficacy and implementation employing both quantitative and qualitative measures within a cluster-randomized controlled trial may serve as a framework for evaluating public health interventions in preschool settings. TRIAL REGISTRATION: clinicaltrials.gov No: NCT00987532.

High-throughput ambulatory assessment of digital reactive hyperemia: concurrent validity with known cardiovascular risk factors and potential confounding.

OBJECTIVES: Reactive hyperemia index (RHI) measurement through digital peripheral arterial tonometry (PAT) is proposed for cardiovascular disease (CVD) risk screening. We evaluated the concurrent validity of RHI, measured in a high-throughput ambulatory setting, with known CVD risk factors and biomarkers. METHODS: PAT was included in the 2007 EADS/Augsburg (Germany) cohort follow-up. CVD risk factors (age, sex, hypertension, hyperlipidemia, diabetes, smoking, physical activity, prevalent coronary heart disease, family history, cholesterol, triglycerides, blood pressure (BP), waist-to-hip ratio (WHR)) and biomarkers (d-dimers, fibrinogen, log(c-reactive protein)) were assessed. The relationship between RHI and CVD risk factors and biomarkers was evaluated using multivariate linear regression, controlling for potential confounders (time of day, time since subject's last meal, baseline heart rate, examiner). RESULTS: Of 926 subjects approached, 710 underwent PAT and 603 (mean age 44.9+/-10 years, 88.7% men) with complete data were included for analysis. RHI was significantly related to being female (beta=0.128, p=0.02), low-density lipoprotein cholesterol (beta=-0.001, p=0.02), systolic BP (beta=0.007, p<0.001), WHR (beta=-1.04, p<0.01), time of day (beta=-0.011, p=0.04) and time since last meal (beta=0.013, p<0.01). CONCLUSIONS: Concurrent validity was partially demonstrated, while the need to control for potential confounding was reinforced. Participation was high and may be higher in less time-constrained settings.

A one-item subjective work stress assessment tool is associated with cortisol secretion levels in critical care nurses.

BACKGROUND: Stress-related diseases are increasing in prevalence, with workplace interventions targeting stress receiving greater attention. Cortisol levels, a marker of physiological stress reaction, can be used to evaluate intervention effects, but measurement can be challenging to implement. Objective workload and subjective stress measures are alternatives previously related to cortisol secretion. We evaluated the validity of a one-item subjective stress measure based on its association with cortisol levels. METHODS: Eighty-two pediatric critical care nurses participated in a prospective cohort study in Switzerland between September 2004 and March 2005. Salivary cortisol samples were collected during three, nine-day periods. Sampling occurred at shift start, repeating every two hours. Subjective stress was recorded with each sample and at shift end. Objective workload for each shift and nursing unit was derived from the hospital's LEP Nursing Workload Management System. Multilevel regression models were employed in the analysis. RESULTS: Subjective stress, measured contemporaneously (beta=0.098, p=0.044), but not retrospectively (beta=0.012, p=0.556), was significantly related to increased cortisol secretion. Objective workload was not significantly associated with cortisol levels. CONCLUSIONS: The one-item summary measure of subjective work stress, administered contemporaneously,may be a valid tool for evaluation of workplace interventions. Future study is needed to establish reliability and generalizability

Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial.

BACKGROUND: There is a lack of research on the possible contribution of a structured risk assessment to the reduction of aggression in psychiatric in-patient care. AIMS: To assess whether such risk assessments decrease the incidence of violence and coercion. METHOD: A cluster randomised controlled trial was conducted with 14 acute psychiatric admission wards as the units of randomisation, including a preference arm. The intervention comprised a standardised risk assessment following admission with mandatory evaluation of prevention in high-risk patients. RESULTS: Incidence rates decreased substantially in the intervention wards, whereas little change occurred in the control wards. The adjusted risk ratios suggest a 41% reduction in severe aggressive incidents and a 27% decline in the use of coercive measures. The severity of aggressive incidents did not decrease. CONCLUSIONS: Structured risk assessment during the first days of treatment may contribute to reduced violence and coercion in acute psychiatric wards.

G-CSF and IL-8 for early diagnosis of sepsis in neonates and critically ill children - safety and cost effectiveness of a new laboratory prediction model: study protocol of a randomized controlled trial [ISRCTN91123847].

INTRODUCTION: Bacterial infection represents a serious risk in neonates and critically ill paediatric patients. Current clinical practice is characterized by frequent antibiotic treatment despite low incidence of true infection. However, some patients escape early diagnosis and progress to septic shock. Many new markers, including cytokines, have been suggested to improve decision making, but the clinical efficacy of these techniques remains uncertain. Therefore, we will test the clinical efficacy of a previously validated diagnostic strategy to reduce antibiotic usage and nosocomial infection related morbidity. METHODS: All patients admitted to the multidisciplinary neonatal and paediatric intensive care unit of a university children's hospital will be included. Patients will be allocated either to routine sepsis work up or to the intervention strategy with additional cytokine measurements. Physicians will be requested to estimate the pre-test probability of sepsis and pneumonia at initial suspicion. In the treatment arm, physicians will receive raw cytokine results, the likelihood ratio and the updated post-test probability. A high post-test probability will suggest that immediate initiation of antibiotic treatment is appropriate, whereas a low post-test probability will be supportive of watchful waiting or discontinuing prophylactic empirical therapy. Physicians may overrule the suggestions resulting from the post-test probability. CONCLUSION: This trial will ascertain the clinical efficacy of introducing new diagnostic strategies consisting of pre-test probability estimate, novel laboratory markers, and computer-generated post-test probability in infectious disease work up in critically ill newborns and children.

[Concepts in studying cost effectiveness of pediatric asthma treatment in Germany, Switzerland and Austria]. / Konzepte zur Erforschung der Kosteneffektivität der Asthmabehandlung bei Kindern in Deutschland, der Schweiz und Osterreich.

Increasing expenditures of health care systems in industrialised western countries are caused by chronic diseases. Hence, issues on the cost-effectiveness of private as well as public financial resources for asthma therapy in children are gaining importance. In order to study cost-effectiveness issues of defining outcome-measures as well as the reliability and validity of methods to assess these outcomes have to be addressed. Data on direct and indirect costs of asthma have to be gathered. In a first step, comparative costs of asthma therapy of children in Germany, Switzerland and Austria have to be analysed. Subsequently, a randomised, prospective study will be able to demonstrate, whether treatment according to national evidence-based guidelines will be more cost-effective than treatment not taking guidelines into account. Data on the cost-effectiveness of therapy guidelines will help in decision-making of national health care authorities.

Assessment of exhaustion and related risk factors in employees in the manufacturing industry--a cross-sectional study.

OBJECTIVES: Vital exhaustion, a construct overlapping with burnout, is an independent risk factor for adverse health outcomes, including cardiovascular disease. We aimed to assess vital exhaustion in employees in the manufacturing industry and identify work characteristics associated with exhaustion. METHODS: Cross-sectional study. A stratified, representative random sample of employees from a manufacturing plant for airplane parts and assemblies was invited ( n=647), of whom 537 employees (83% accrual) volunteered to participate. Scores obtained by the nine-item Shortened Maastricht Exhaustion Questionnaire were compared with the mental and physical summary scales of the SF-12 General Health Survey and to a list of 20 health complaints. Pathogenic and salutogenic work characteristics were assessed by the self-reported 52-item, 13-subscale SALSA questionnaire. RESULTS: Vital exhaustion correlated with the mental summary score of the SF-12 and the number of health complaints and was positively associated with age. Exhaustion was not associated with gender, position (socio-economic status) or being on a wage (paid per completed item up to a contracted amount) or salary (payment as fixed monthly income). The instrument identified departments with high levels of exhaustion. Of the observed variance in exhaustion, 29% was explained by age, department, and five work characteristics: High levels of exhaustion (score >10) were related to excessive workload or qualitative demands (scoring in the highest quartile; OR(adj) 7.5; 95% CI 2.4-23), to adverse physical work conditions (OR(adj) 6.9; 95% CI 2.2-21), to adverse co-worker behavior (OR(adj) 4.8; 95% CI 1.4-16), to qualification potential (OR(adj) 0.32; 95% CI 0.11-0.97), and to social support by co-workers (OR(adj) 0.34; 95% CI 0.13-0.99), respectively. CONCLUSIONS: The nine-item instrument allows rapid screening of employees for self-reported levels of exhaustion. Besides physical work conditions and workload, absence or presence of social support by co-workers is strongly associated with exhaustion.