SARS-CoV-2 prevalence in an asymptomatic cancer cohort - results and consequences for clinical routine.

BACKGROUND: Starting in December 2019, the current pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confronts the world with an unprecedented challenge. With no vaccine or drug being currently available to control the pandemic spread, prevention and PCR (Polymerase chain reaction) testing becomes a crucial pillar of medical systems. Aim of the present study was to report on the first results of the measures taken in a large German Department of Radiation Oncology, including PCR testing of asymptomatic cancer patients. METHODS: Pandemic-adapted hygiene regulations and prevention measures for patients and staff were implemented. A visiting ban on both wards was implemented from the beginning and medical staff and patients were required to wear face masks at all times. The waiting rooms were rearranged to ensure distance between patients of at least 1.5 m. Clinical follow up was mainly done by telephone and all patients had to complete a questionnaire regarding symptoms and contacts with COVID-19 patients before entering our department. Educational documents were created for patients to raise awareness of symptoms and avoidance strategies for interactions with other people. Indications for therapy and fractionation schemes were adapted when possible. In a subsequent step, all new asymptomatic patients were tested via nasopharyngeal swab at our screening station shortly before their simulation CT. RESULTS: All these measures and implementations have been well accepted semiquantitatively measured by the consent received from patients and staff. Regarding the PCR testing, only 1 out of 139 asymptomatic patients of our cohort so far tested positive for SARS-CoV-2, reflecting a prevalence of 0.72% in this cancer patient population. Up to this point no staff members was tested positive. The start of the treatment for the PCR-positive patient was deferred for 2 weeks. CONCLUSION: Due to the pandemic-adapted implementations, our department seems well prepared during this crisis. The initial screening helps to identify asymptomatic COVID-19 patients in order to protect other patients and our staff from infection and the observed PCR prevalence is in line with comparable studies. A regular PCR testing (e.g. twice a week) of all patients and staff would in principle be desirable but is limited due to testing capacities at present.

Impact of shift work on the diurnal cortisol rhythm: a one-year longitudinal study in junior physicians.

BACKGROUND: Cumulative epidemiological evidence suggests that shift work exerts harmful effects on human health. However, the physiological mechanisms are not well understood. This study aimed to examine the impact of shift work on the dysregulation of the hypothalamic-pituitary-adrenal axis, i.e. diurnal cortisol rhythm. METHODS: Seventy physicians with a mean age 30 years participated in this one-year longitudinal study. Working schedules, either shift work or regular schedules with day shift, were assessed at baseline. Salivary cortisol samples were collected on two consecutive regular working days, four times a day (including waking, + 4 h, + 8 h, and + 16 h), at both baseline and the one-year follow-up. The diurnal cortisol decline (slope) and total cortisol concentration (area under the curve, AUC) were calculated. RESULTS: After adjusting for cortisol secretion at baseline and numerous covariates, shift work at baseline significantly predicted a steeper slope (p < 0.01) and a larger AUC (p < 0.05) of diurnal cortisol rhythm at follow-up in this sample of physicians. In particular, waking cortisol at follow-up was significantly higher among those engaged in shift work than day shift (p < 0.01). CONCLUSIONS: Our findings support the notion that shift work changes the diurnal cortisol pattern, and is predictive of increased cortisol secretion consequently in junior physicians.

Working conditions and effort-reward imbalance of German physicians in Sweden respective Germany: a comparative study.

OBJECTIVE: Work stress among physicians is a growing concern in various countries and has led to migration. We compared the working conditions and the work stress between a migrated population of German physicians in Sweden and a population of physicians based in Germany. Additionally, specific risk factors for work stress were examined country wise. METHOD: Using a cross-sectional design, 85 German physicians employed in Sweden were surveyed on working conditions and effort-reward imbalance and compared with corresponding data on 561 physicians working in Germany. Multiple linear regression analyses were applied on both populations separately to model the associations between working conditions and effort-reward ratio (ERR), adjusted for a priori confounders. RESULTS: German physicians in Sweden had a significantly lower ERR than physicians in Germany: mean (M) = 0.47, standard deviation (SD) = 0.24 vs. M = 0.80, SD = 0.35. Physicians in Sweden worked on average 8 h less per week and reported higher work support and responsibility. Multivariate analyses showed in both populations a negative association between work support and the ERR (ß = -0.148, 95% CI -0.215 to (-0.081) for physicians in Sweden and ß = -0.174, 95% CI -0.240 to (-0.106) for physicians in Germany). Further significant associations with the ERR were found among physicians in Sweden for daily breaks (ß = -0.002, 95% CI -0.004 to (-0.001)) and among physicians in Germany for working hours per week (ß = 0.006, 95% CI 0.002-0.009). CONCLUSION: Our findings show substantial differences in work stress and working conditions in favor of migrated German physicians in Sweden. To confirm our results and to explain demonstrated differences in physicians' work stress, longitudinal studies are recommended.

Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians.

BACKGROUND: We examined the impact of changes in the psychosocial work environment on depressive symptoms in a sample of junior physicians, a high risk group for stress and mental disorders. METHODS: This is a three-wave prospective study in 417 junior physicians during their residency in German hospitals. The psychosocial work environment was measured by the Effort-Reward Imbalance (ERI) Questionnaire at Waves 1 and 2, and the depressive symptoms were assessed with the State-Trait Depression Scales at all three waves. Multivariate linear regression was applied for prospective associations between ERI across Waves 1 and 2, and baseline-adjusted depressive symptoms at Wave 3. RESULTS: Compared with the ERI scores at Wave 1, at Wave 2, and mean scores between the two waves, the baseline-adjusted ERI change scores between the two waves showed slightly better statistical power, predicting depressive symptoms at Wave 3 (ß = 0.78, 95% CI = 0.38-1.18 for increased ERI per SD, ß = 0.64, 95% CI = 0.22-1.06 for increased effort per SD, ß = -0.65, 95% CI = -1.06 to -0.24 for increased reward per SD, and ß = 0.68, 95% CI = 0.27-1.09 for increased overcommitment per SD). CONCLUSIONS: Negative changes in the psychosocial work environment, specifically increased ERI, are associated with depressive symptoms in German junior physicians. Reducing the non-reciprocity of working life, particularly improving reward at work, may have beneficial effects on prevention of mental health problems in the hospital workplace.

Depressive symptoms in junior doctors: a follow-up study on work-related determinants.

PURPOSE: The study investigates the long-term effects of accumulated working conditions on depressive symptoms in junior doctors. Drawing on the Job Demand-Control-Support model, this study aims to identify personal and job-related determinants for self-reported depression in junior doctors-a professional group that is vulnerable to depression. METHODS: We conducted a prospective cohort study with measures of work characteristics and depressive symptoms over three time-points among hospital doctors during postgraduate specialty training in Germany. Participants were 415 junior doctors with full-time contract (47.5% women; mean age, 30.5 years). The outcome was depressive symptoms assessed with the Spielberger State-Depression Scale. Odds ratios (OR) were computed to analyse the cumulative effect of initial depressive symptoms scores, demographic variables, and working characteristics across T1 and T2 on subsequent depressive symptoms at T3. RESULTS: The percentage of junior doctors reporting depressive symptoms scores above a critical value varied between 12.0% at T1, 10.4% at T2, and 13.3% at T3; N = 34 doctors (8.19%) were classified as incident cases during the observation period. Elevated depressive symptoms at T3 were positively predicted by depressive symptoms scores across T1 and T2 (OR: 1.37; 95% confidence interval: 1.25-1.50) and negatively by professional tenure (0.54; 0.31-0.96), free weekends (0.52; 0.28-0.97), and job autonomy (0.35; 0.18-0.65). CONCLUSIONS: After controlling for demographic and working time influences, findings suggest that junior doctors' perceived job autonomy is negatively associated with future depressive symptoms. Enhancing job control emerges as a promising strategy to lower the risk of depression during first years of professional practice.

Cognitive demands and the relationship between age and workload in apron control.

INTRODUCTION: Apron controllers (ACs) determine the taxiways for aircraft entering the apron area until they reach their parking positions and vice versa. The aims of this study were to identify age-sensitive job requirements of apron control (Study 1), and to investigate the relationship between age of ACs and their workload (Study 2). METHODS: Study 1: There were 14 experienced ACs who assessed the job requirements of apron control with the Fleishman-Job Analyses Survey. Additionally, during one shift, the number of parallel processed traffic data sets (indicating memory-load) and the number of delivered radio messages (indicating processing speed requirements) were assessed. Study 2: There were 30 ACs (age: 23-51 yr) who volunteered for trials during late shifts at an international airport. ACs assessed their subjective workload (NASA-Task Load Index) at four times during the shift and carried out an attention test (d2) before and after the shift. Moreover, their heart rate was assessed during the shift and in a reference period. RESULTS: Study 1: Results indicate that apron control requires especially high levels of memory-load and processing speed. Study 2: Hierarchical regression analyses revealed a u-shaped relationship between age and subjective workload (beta = 0.59) as well as heart rate (beta = 0.33). Up to the age of about 35-37 yr, workload and heart rate decreased with age, but afterwards the relationship became positive. There was no association between chronological age and attention performance. DISCUSSION: There is a need for age adequate job design in apron control that should especially aim at the reduction of memory-load and processing speed.

The relation of cognitive load and pupillary unrest.

OBJECTIVE: This study examines the relationship between pupillary unrest (PU) and cognitive load. BACKGROUND: PU represents a measure of reduced central nervous tonic arousal (sleepiness). A loss of tonic arousal can be associated with difficulties in maintaining the required level of performance. Thus, the measurement of tonic arousal in occupational contexts can help to prevent overload or errors. METHOD: We compared a group with high cognitive load (30 apron controllers of an international airport) with a control group with low cognitive load (63 healthy people during their free time) in a non-randomized experimental design with pre- and post-test assessment of PU. PU was scanned by an infrared sensor with a frequency of 25 Hz and a resolution of .05 mm. To control for circadian effects, measurements for both groups were taken at the same time of the day. RESULTS: High PU at the start of the shift correlated with high perceived load during the shift. There were no indications of reverse effects. Analyses of group x time effects with generalized linear models (repeated measures) revealed that cognitive load did in no way affected PU. CONCLUSION: Initially low tonic arousal (indicated by high PU) may predict subsequent workload, but being exposed to high cognitive load does not influence tonic arousal after the end of the shift. With that, the study contributes to valid interpretations of pupillary unrest measurements in occupational contexts.

Exhaled nitric oxide: independent effects of atopy, smoking, respiratory tract infection, gender and height.

Measurement of exhaled nitric oxide is widely used in respiratory research and clinical practice, especially in patients with asthma. However, interpretation is often difficult, due to common interfering factors, and little is known about interactions between factors. We assessed the influences and interactions of factors such as smoking, respiratory tract infections and respiratory allergy concerning exhaled nitric oxide values, with the aim to derive a scheme for adjustment. We studied 897 subjects (514 females, 383 males; mean age+/-standard deviation 34.5+/-13.0 years) with and without respiratory allergy (allergic rhinitis and/or asthma), smoking and respiratory tract infection. Logarithmic nitric oxide levels were described by an additive model comprising respiratory allergy, smoking, respiratory tract infection, gender and height (p0.001 each), without significant interaction terms. Geometric mean was 17.5ppb in a healthy female non smoker of height 170cm, whereby respiratory allergy corresponded to a change by factor 1.50, smoking 0.63, infection 1.24, male gender 1.17, and each 10cm increase (decrease) in height to 1.11 (0.90). Factors were virtually identical when excluding asthma and using the category allergic rhinitis instead of respiratory allergy (n=863). Within each category formed by combinations of these different predictors, the range of residual variation was approximately constant. We conclude that the factors influencing exhaled nitric oxide, which we analyzed, act independently of each other. Thus, circumstances such as smoking and respiratory tract infection do not appear to affect the usefulness of exhaled nitric oxide, provided that appropriate factors for adjustment are applied.

Effects of working permanent night shifts and two shifts on cognitive and psychomotor performance.

OBJECTIVES: The study aimed to clarify whether cognitive and psychomotor performance, which are important for occupational and traffic safety, are impaired by working permanent night shifts (NSs) compared with early-late two shifts (TSs) and whether age and chronobiological type influences the relationship between shift and performance. METHODS: The study included 44 male automobile workers, 20 working TSs and 24 working NSs. Chronobiological type was determined by questionnaire (D-MEQ). Each subject was tested at the beginning and end of the shift for alertness [by a visual analogue scale (VAS)]; feeling of well-being (Basler); concentration and accuracy (d2); reaction speed, orientation and reaction to stress (Vienna System). RESULTS: TS workers were more frequently morning types whereas the NS workers were more frequently evening types. In the performance tests, the TS and NS workers did not differ at shift start or shift end. Over the course of the shift, concentration and accuracy improved in both groups, as did reaction to stress. Chronobiological type alone or in combination with shift type had no effect on performance. CONCLUSIONS: The results of this study indicate that-if chosen voluntarily-working NSs has no immediate negative effects on cognitive and psychomotor performance when compared with working TSs. There was no indication of an increased risk of accidents after working NSs. The unequal distribution of the circadian types in the shift groups may indicate selection.