People can be affected by various environmental factors (e. g., odor, noise) which can lead to medical complaints or illnesses. Few adequate contact points are available for patients with suspected environmental complaints in Germany. Illustrated by the outpatient clinics for environmental medicine in Hamburg and Munich, this report shows how patients with suspected environmental medical diseases are cared for in Germany. For the exemplary presentation, the data of the environmental medicine outpatient clinics of both the university hospitals from 01.01.2019 to 31.03.2021 are presented and compared. Overall, more female than male patients were treated at both facilities. Suspected exposure to "heavy metals" was most frequently mentioned by patients as the assumed reason for their complaints. Nonetheless, the suspected exposure or "intoxication" could be ruled out in the majority of cases by appropriate examination methods in accordance to current medical guidelines. The data provided by the environmental medicine outpatient clinics show that there is a continuous demand for environmental medical care. A close cooperation between the private practice sector and the outpatient clinics for environmental medicine providing medical care to patients should therefore be sought.
Environmental Medicine , Humans , Male , Female , Hospitals, University , Germany , Ambulatory Care Facilities , Patient Care
BACKGROUND AND AIM OF THE STUDY: The loss of participants during the follow-up of cohort studies can introduce bias if persons who leave the study differ from those who continue to participate over time. Many studies have investigated socio-demographic and health factors associated with participation/non-participation in epidemiological studies. However, relatively few studies are available for school-based cohorts. The aim of this study was to determine predictors of willingness to participate in the Ohrkan study, an ongoing longitudinal survey of adolescents that collects detailed information on leisure time noise exposure and potential effects on hearing. METHODS: Using the Ohrkan cohort of 2,148 persons recruited in 2009-2011 (O-I) among the ninth graders of any secondary school type in Regensburg and followed-up in 2012-14 (O-II) and 2015-16 (O-III). RESULTS: The probability of participating in O-II and O-III was higher for persons without a migration background, who attended university-preparatory secondary school at baseline and whose parents had a higher educational level or lived together. Persons who had not changed their place of residence in the last 2.5 years also participated 3 times as often as respondents who moved inside or outside of Regensburg. CONCLUSION: The knowledge of determinants of attrition and retention makes it easier to specify which groups of a cohort are most likely to be lost to follow-up. These groups can be targeted in order to minimize their loss in the future follow-ups. Moreover, the predictors can be used in statistical missing data techniques such as multiple imputation.
Hearing Loss, Noise-Induced , Leisure Activities , Adolescent , Cohort Studies , Germany/epidemiology , Humans , Longitudinal Studies
AIM OF THE STUDY: This study investigated the impact of migration background on the health outcomes of preschool children from families of various social status levels. METHODS: During the school entrance health examination (Schuleingangsuntersuchung (SEU)) from October 2012 to August 2013, the parents of 5052 preschool children (62% response rate) participated in a cross-sectional health survey within the framework of health-monitoring units (Gesundheits-Monitoring-Einheiten (GME)) in Bavaria, Germany. They were handed a self-administered questionnaire with questions relating to the language spoken at home and other socio-demographic characteristics. By applying the record linkage method, 3747 participants were correctly linked to the corresponding data of the SEU. Based on the merged dataset, 4 definitions of migration background were explored regarding demographic indicators, the parents' mother tongue, and the language spoken at home. The association between migration background and health outcomes of preschool children was analyzed using multivariable logistic regression models separately. The risk estimates were presented for the study population and stratified into high, medium, and low social status. The models were repeated for each of the 4 migration background variables. RESULTS: The results show significant associations between migration background and health outcomes of preschool children (except in pronunciation). A migration background had the strongest impact on the development of word/sentence formation disorder. Compared to non-migrant preschool children, migrant children had twice the chances for full vaccination coverage (OR [95% CI]: 2.4 [1.9-3.1]) but only half the chance to participate in all health examinations from U1 to U9 (0.5 [0.4-0.6]). These children were also at two-fold increased risk to be overweight/obese (2.2 [1.7-2.8]). Moreover, preschool children with double-sided migration from medium social status families faced the highest risk for word/sentence formation disorder (9.5 [5.6-16.1] with SEU definition and 23.3 [10.3-52.6] with GME definition of a migration background). CONCLUSIONS: Future prevention programs at the preschool level should focus on children with double-sided migration from medium social status families. With respect to social and cultural integration, the definition of migration background based on the language spoken at home should be appropriate for future SEUs.
Health Status , Social Stigma , Transients and Migrants , Child, Preschool , Cross-Sectional Studies , Germany , Humans , Overweight , Surveys and Questionnaires
BACKGROUND: Within the last decades the world of work has changed enormously. Due to new Information and Communication Technologies (ICT), working at any time from any place has become possible. Flexibility, availability and the dissolution of boundaries between work and private life are the possible results of this development. The spread of this development and possible consequences on the affected employee's health and wellbeing have been examined so far especially in big companies. Small and medium-sized enterprises (SME) are rarely subjects of scientific studies in this context. OBJECTIVE OF THIS PAPER: The aim of this work was to develop a guideline based on experiences and results of a study regarding flexibility in the business world (FlexA), as well as a systematic literature research. The target populations of this guideline are SMEs, focusing on integrating a health promoting way in dealing with ICT, flexibility and availability within the corporate culture. METHODS: In order to delineate the current state in of research in ICT-related work interventions, a systematic review in data bases e. g. PsycINFO, EconLit and Medline was carried out. The search strategy used the key words "work", "intervention", "ICT", "mental strain", "flexibility" and "availability". In addition, grey literature and findings from the FlexA study were used to formulate the current guideline. RESULTS: Based on the exclusion criteria, all studies from the systematic literature search were excluded after title and abstract screening. Within grey literature research, 4 relevant publications could be identified. The measures, developed during the corporate workshops of the FlexA study, e. g. the implementation of collective regulations in the company, were included in the guideline. CONCLUSION: Due to the ongoing development of ICT and flexibility in daily business life, it is getting more and more important to follow this progress. Executives and corporate management are responsible to actively shape this trend in a health-promoting way in their enterprises. The current guideline was made to support the corporate management in this task and it is an important instrument for a health-promoting use of ICT in daily business life taking in to consideration flexibility and availability.
Communication , Occupational Health , Commerce , Employment , Germany
BACKGROUND: Little data are available on health-related quality of life (HRQOL) of children in Germany at the age of school enrollment. OBJECTIVE: Aim of this study was to investigate the HRQOL of children during school enrollment and to determine its predictors with special focus on environmental factors. METHODS: Data from the fifth survey of the Health-Monitoring-Units (GME) conducted in Bavaria (2010/2011) were analyzed. Parent-reported data on HRQOL using the KINDL-R(evised), the Strength and Difficulties Questionnaire (SDQ), socio-demographic characteristics and characteristics of the living environment were assessed. RESULTS: The sample included a total of 3,744 children (45.9% female; mean age: 6.0; SD=0.4). Girls had significantly higher values than boys in total HRQOL (83.7 vs. 82.4, p ≤0.0001) and in all KINDL-R subscales except "psychological well-being" and "physical well-being". For the latter, boys had significantly higher values than girls (84.1 vs. 82.9, p=0.0103). Multiple linear regression analysis showed that parental annoyance with air or noise pollution, possibility for children to safely play outside and the time a child is outside on weekdays in the summertime were significant predictors of total HRQOL measured by the KINDL-R. Obesity was not linked to HRQOL. Children with migration background had significantly higher values in the subscales "family" and "friends". CONCLUSIONS: Environmental factors are associated with HRQOL in children at the age of school enrollment but only partially of relevant use. Although they show significant associations, their explanatory power of the variability observed is rather limited.
Health Status , Parents , Quality of Life , Child , Child, Preschool , Female , Germany , Humans , Male , Obesity , Surveys and Questionnaires
OBJECTIVE: Analysis of changes in leisure noise exposure among adolescents during 2.5 years of follow-up. METHODS: The analysis is based on the Ohrkan cohort study. A total of 2 149 9th graders in the City of Regensburg (mostly aged 15-16 years) were recruited between 2009-2011. At 2.5-year follow-up, the participants were asked again about leisure noise exposure. Both at baseline (O-I) and in the follow-up (O-II), self-reported frequency of participation in noisy activities was combined with literature-based values of usual sound levels to calculate the total weekly noise exposure. This exposure was compared to the lower exposure action value (lEAV) of 80 dB(A) given by the occupational health and safety regulations. Logistic regression was used to determine the factors associated with leisure noise exposure above the lEAV. RESULTS: Exposure data from both time points were available for 1 704 adolescents (54% female). The percentage of participants who were exposed to leisure noise exceeding the lEAV increased from 75 to 92% due to more persons visiting discotheques in O-II. In both surveys, the activity reported by the highest percentage of participants and with the longest exposure duration was listening to pop music via portable listening devices (PLD) although the proportion of users decreased slightly. Not being a pupil affected PLD use at volume levels >80 dB (A) whereas older age was associated with noise exposure in discotheques. CONCLUSIONS: O-II shows that adolescents are engaged in leisure activities under harmful noise levels and that noise exposure sources are changing with age. These issues should be considered in the developing of prevention programs.
Hearing Loss, Noise-Induced , Leisure Activities , Adolescent , Cohort Studies , Female , Follow-Up Studies , Germany , Humans , Male
For the presented study a computer-based surveillance system for detecting nosocomial infections (NI) with direct data input from attending on-ward physicians was implemented. During a 12-month period surveillance of ventilator-associated pneumonia (VAP) and catheter-associated bloodstream infections (BSI) was performed prospectively by on-ward physicians guided by infection control specialists on an 11-bed medical intensive care unit in a German university hospital. In 603 patients 3282 patient days were assessed. Completeness of data entry during the routine phase was 94% for ventilator days and 88% for central venous catheter days. The concordance of infection detection by automated evaluation and evaluation based clinical considerations was fairly good and was quantified by kappa measures of 0.49 for VAP and 0.57 for BSI. Detected infection rates ranged within the German national reference data. Personnel costs for on-ward physicians and infection control personnel were 1.01 Euro per device day in the routine phase. Time expenditure of less than 3 min per device day, rendered in about equal parts by physicians and infection control personnel, was lower than in studies relying on on-ward assessment by infection control personnel.
Cross Infection/prevention & control , Decision Support Systems, Clinical , Equipment Contamination , Health Plan Implementation/economics , Population Surveillance/methods , Catheterization, Central Venous/adverse effects , Costs and Cost Analysis , Cross Infection/epidemiology , Cross Infection/etiology , Data Collection/methods , Decision Support Systems, Clinical/economics , Germany/epidemiology , Hospital Costs , Humans , Infection Control Practitioners/economics , Intensive Care Units , Physicians/economics , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/prevention & control , Prospective Studies , Sepsis/epidemiology , Sepsis/etiology , Sepsis/prevention & control
OBJECTIVE: To determine the added costs of hygienic measures (barrier precautions, isolation, and decontamination) required for MRSA carriers in German hospitals and possible strategies for cost reduction. DESIGN: On a septic surgical ward caring for 35% of all MRSA cases in a university hospital (1,182 beds), additional costs for personnel time and materials were calculated and medical charts of all MRSA cases admitted to the ward during 1 year were analyzed retrospectively. Twelve of the ward's 13 beds were located in rooms with at least 2 beds. PATIENTS: Four hundred ninety-eight MRSA carrier hospital-days (of 20 MRSA cases) could be assessed. All patients (80% men, 50% older than 74.5 years) had broken skin. RESULTS: In 95% of the cases, microbiological findings suggested transmission of MRSA during the current or a previous stay on this ward. The study found total avoidable costs of approximately 142,794.01 euros in 1 year, averaging 371.95 euros for one MRSA patient hospital-day and 9,261.56 euros per MRSA case. The most expensive single measure was blocked beds in multibed rooms (305.75 euros/day), which accounted for 82% of the extra costs. Costs most likely were underestimated. CONCLUSIONS: Daily additional case costs amounted to 96% of social security payments. Blocked beds in multibed rooms accounted for more than 80% of these excess costs. Isolation has been scientifically validated and is required by law in Germany. Building an adequate number of single-bed rooms should help prevent spread and would greatly lower the added costs of infection.
Hospital Costs/statistics & numerical data , Infection Control/methods , Medical Audit , Methicillin Resistance , Staphylococcal Infections/drug therapy , Staphylococcal Infections/economics , Surgery Department, Hospital/economics , Aged , Cost Control , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Patient Isolation/economics , Staphylococcus aureus/drug effects , Staphylococcus aureus/pathogenicity
Different influences on internal exposure to platinum are investigated and for the first time weighted in environmentally exposed subjects as far as individual internal platinum concentrations are concerned. Detailed medical and environmental histories as well as oral cavity status were assessed in 84 dermatological patients, and internal platinum exposure was determined by analyzing platinum in urine using adsorptive voltammetry (AV). Platinum concentrations ranged from <0.9 (detection limit) to 65.5 ng Pt/l urine. Influence of different types and age of alloy restorations and therefore relevance of the exposure pathway due to solubilization of platinum in saliva could be demonstrated. No platinum-related health effects (contact stomatitis, asthma or kidney conditions) were observed. Analysis of covariance showed the number of noble dental alloy restorations (P<0.0001) and to a lesser extent age (P=0.0017) to independently influence internal platinum exposure. Even though spread of environmental platinum has increased, internal platinum exposure is low in subjects without assessable medical or dental devices (usually <4.5 ng/l urine) and not related to adverse health effects. For the first time, detailed individual information on possible exposure pathways to platinum were considered in an analysis of relevant influential factors: Car traffic exposure and dermatological condition showed no association with internal platinum exposure. Uptake from platinum containing noble metal dental alloy restorations (NMDAR) is of greatest relevance, surmounting the influence of each year of lifetime on platinum body load by more than 10-fold.
Environmental Exposure , Platinum/analysis , Platinum/pharmacokinetics , Adolescent , Adult , Age Factors , Aged , Body Burden , Dental Restoration, Permanent , Dermatitis, Atopic/physiopathology , Female , Humans , Male , Middle Aged , Mouth/chemistry , Psoriasis/physiopathology , Risk Assessment , Risk Factors , Vehicle Emissions/analysis
