Counseling and support services for healthcare workers in German university hospitals during the pandemic-descriptive results of a Germany-wide cross-sectional survey.

Background: Due to the SARS-CoV-2 pandemic, healthcare workers (HCWs) are experiencing tremendous levels of emotional and physical stress. Hospitals are trying to help personnel cope with work-related pressure. The aim of this study was to assess HCWs' awareness and utilization of counseling and support services during the pandemic, HCWs' unmet counseling and support needs, and the type and content of these services. Methods: A cross-sectional online survey was conducted from January to June 2021 through the German national research organization Network University Medicine (NUM). All participating hospitals (6 in total) were asked to inform their employees about the study. Results: A total of 1,495 HCWs were included in the analysis. Of these, 42.8% (n = 637) were frontline HCWs (who had contact with COVID-19 patients), 23.1% (n = 344) were second-line HCWs (who only had contact with non-COVID-19 patients) and 34.1% (n = 508) had no contact with any patients. Participating hospitals offer various counseling and support services for their staff. The percentage of respondents who were unaware of available counseling and support services ranged from 5.0 to 42.0%. Depending on the type of counseling and support services, 23.0-53.6% of the respondents indicated that counseling and support services were provided but not used, while 1.7-11.6% indicated that, despite the need for them, such services were not available. HCWs' overall satisfaction with the provided counseling and support services and their unmet support needs differed by patient contact: Frontline HCWs reported more unmet needs for counseling and support than second-line HCWs, while second-line HCWs reported more unmet needs than HCWs without patient contact. Conclusion: The results indicate that hospitals should make more efforts to inform HCWs about available counseling and support services. Hospitals could also create networks where HCWs could share information about the type and content of services and their experiences with various counseling and support services. These steps would enable hospitals to respond more quickly and effectively to the problems facing HCWs during pandemics.

Hepatitis A and hepatitis B infection risk among employees at schools for disabled pupils.

Aim of this project was to assess occupational biological hazards with regard to the risk of hepatitis A (HAV) and hepatitis B (HBV) and the need for occupational health care in schools for pupils with special needs. Teachers and educational specialists were surveyed about activities potentially providing exposure to biological agents and their individual immune status regarding HAV and HBV by a detailed questionnaire. Descriptive analyses, group comparisons and logistic regression were performed to identify factors influencing the HAV and HBV immune status. 1398 teachers and educational specialists took part. 1381 respondents reported having physical contact with pupils at work (98%). Daily contact was reported by up to 84% of all employees. Being scratched, bitten or spat at was reported by up to 93%. Hazardous activities are performed by both teachers and educational specialists. The vaccination rate was reported to be 58% for HAV and 64% for HBV. In regression analyses, failing to receive vaccine counselling [HAV: aOR 0.36 (95% CI 0.28; 0.46; p < 0.001), HBV: aOR 0.43 (95% CI 0.33; 0.55; p < 0.001)] or non-participation in infection prevention instruction [HBV: aOR 0.54 (95% CI 0.39; 0.75; p < 0.001)] were found to be significant predictors of low vaccination rates. Employees who are at risk due to occupational exposure should be instructed about infection prevention and vaccination against HAV and HBV.

[Willingness to get vaccinated among hospital staff in Germany: What is the role of COVID-19 conspiracy assumptions?] / Impfbereitschaft von Krankenhauspersonal in Deutschland: Welche Rolle spielen Verschwörungsannahmen zu COVID-19?

BACKGROUND: A critical factor in achieving widespread immunity against COVID-19 is the willingness of previously unvaccinated individuals to get vaccinated. Medical staff play a key role in this, as they ensure healthcare during the pandemic and for many serve as a source of information about vaccinations. Among the factors that negatively influence the general willingness to get vaccinated are conspiracy assumptions and the spread of misinformation. OBJECTIVE: The willingness of hospital staff in Germany to get vaccinated and various influencing variables were examined to obtain indicators that could help increase the general willingness to get vaccinated. METHODS: Between January and June 2021, a voluntary and anonymous online survey conducted as part of the egePan joint project of the national network for university medicine (funded by the Federal Ministry of Education and Research) was used to assess the willingness to be vaccinated, individual social characteristics, the belief in conspiracy assumptions, and communication items in German hospitals. RESULTS: In comparison with the general population, physicians and scientific staff in particular indicated an increased willingness to get vaccinated. Conspiracy assumptions were not very widespread but most frequent among administrative and nursing staff. Conspiracy assumptions were negatively associated with the willingness to get vaccinated. Predictors for a higher willingness to get vaccinated were the perceived safety and effectiveness of vaccinations and a higher age. DISCUSSION: Since the perceived safety and effectiveness of vaccinations have a positive effect on the willingness to get vaccinated, educational work and transparent information transfer could counteract the spread of conspiracy assumptions and increase vaccination rates among hospital staff.

The Prevalence of Dietary Supplement Usage in Military Aviators.

BACKGROUND: The prevalence of dietary supplement (DS) and energy drink (ED) usage in military personnel differs from branch to branch and is between 55% and 76% (higher values in special operations forces). Aviators with highly demanding tasks might be especially interested in using dietary supplements. To date, there are only limited data available for this special profession inside the military. METHODS: An internet-based survey was conducted on the prevalence of DS and ED usage, the reasons for their usage and the place of purchase for all wings of the German Armed Forces. RESULTS: Of the 181 pilots who participated in the survey, 34% used DSs and 16% EDs. Usage was linked to sports activities but not to the type of aircraft. DSs were purchased on the internet by 50% of the respondents; mostly protein supplements, magnesium and omega-3fatty acids. Only 42% said they would feel an effect from taking DSs. CONCLUSIONS: Although the present study showed that the prevalence of usage was comparable to that of the civilian population, the sources of supply and the range of the substances taken give cause for concern. This calls for education and information campaigns to make the pilots aware of the possible risks to their health.

Do working characteristics influence the participation at health measures? Findings from a trial phase of workplace health promotion.

BACKGROUND: Health behavior is presumed to be influenced by organizational factors. This study analyzes how workplace characteristics influence health behavior in terms of participation at health measures. METHODS: Employees of the German Federal Ministry of Defense were surveyed at the beginning (January / February 2015) and at the end (June 2015) of the trial phase of workplace health promotion (WHP). Differences in participation of characteristic groups were calculated using Pearson's Chi2-Test and T-Test, chances of participation were estimated using multilevel logistic regression. RESULTS: Employees who reported higher satisfaction with work demand participated more often in health measures (aOR: 1.02, 95%-CI = 1.01, 1.04, p < 0.001). Large amount of variance in participation can be attributed to department level. CONCLUSION: Participation at WHP varies significantly between settings after controlling for individuals' characteristics. Thus, working characteristics should be considered as a decisive factor for WHP effectiveness. There is consensus that behavioral prevention is most effective when conditional prevention is granted as behavior is presumed to be influenced by individuals´ environmental conditions. Though objective working conditions may seem similar further context characteristics which remain unconsidered may lead to different behavior patterns. This article shows that more attention must be payed to setting specific characteristics with regard to effective Occupational Health Promotion.This project is registered by the Federal Ministry of Defense (research number: E/U2AD/ED003/EF555).

Smoking prevalence in the area of responsibility of the German Ministry of Defense - results of the employee survey in the context of occupational health management.

BACKGROUND: Tobacco use, correlated with reduced physical fitness, is one of the leading causes of avoidable death worldwide. It increases the risk of dementia and can shorten the lifespan by 10 years. For the German Armed Forces (Bundeswehr), figures on smoking behavior have not been comprehensively captured. This study analyzes current data in a large sample from this population. METHODS: Based on an employee survey as part of the Occupational Health Management System, data on smoking behavior from 13,326 participants were analyzed in relation to age, gender, professional status, education level and membership in military operational units versus other agencies. RESULTS: Smoking behavior varied significantly (P < 0.001) by age group (younger > older), gender, professional status, military agency membership status, and education level (the lower the education level, the higher the smoking rates). With the exception of the downward trend in smoking behavior with increasing age among civilian employees, these results were all significant (P < 0.005). CONCLUSIONS: This data analysis shows that smoking prevalence among personnel in the area of responsibility of the Federal Ministry of Defense is comparable to the current data from corresponding surveys of the German population. Depending on gender, they generally show values that are slightly above those of the German population. The well-known trend in the general population of decreasing smoking prevalence with increasing age is also seen in this analysis. However, there are considerable differences in the smoking prevalence among individual subgroups (professional status, agency, gender, education level). The data show that particular young soldiers in the armed forces should be the target group for further preventive measures.

[Differences in Self-Reported Working Conditions at Diverse Departments During Introduction of an Occupational Health Management System]. / Unterschiede der selbst-berichteten Arbeitsbedingungen in unterschiedlichen Dienststellen bei der Einführung eines Betrieblichen Gesundheitsmanagements.

AIM OF STUDY: An occupational health management system was initiated at 11 departments under the German Ministry of Defense (MoD) at the beginning of 2015. The departments were characterized by the heterogeneity of employees and the tasks of the departments. The aim of this pilot phase was to get experience and knowledge for implementation of this system in other departments. At the beginning of the pilot phase, an employee attitude survey was conducted to examine the situation. METHODS: The survey included all 9,267 employees of the eleven departments. A combination of a web-based online survey and a paper-pencil survey was used. RESULTS: In total, 2,076 (22.4%) of all employees took part in the survey. There were significant difference between the departments in all topics assessed ("leadership behaviour/social issues", "work habits", "job design", "work equipment", "environment conditions", "mental health", "stress", "diet", "exercise", "job responsibility") but not in "health behavior". CONCLUSION: This study shows clearly that a department-based analysis is necessary for a goal-oriented meaningful occupational health management system, especially if only limited resources are available.

Blue-yellow dyschromatopsia in toluene-exposed workers.

PURPOSE: To evaluate the effects of a chronic occupational exposure to toluene on color vision. METHODS: Color vision was tested in 51 workers exposed to pure toluene and in 51 matched control subjects. Current exposure was determined by biological monitoring. Blood samples were taken at the end of a Friday shift. Color vision ability was assessed using the Ishihara plates (to screen for congenital dyschromatopsia), the Farnsworth panel D-15 test, the Lanthony panel D-15 desaturated test, the Velhagen plates, and the Standard Pseudoisochromatic Plates Part 2. RESULTS: Median toluene concentration was 1.59 mg/l (quartiles 0.78 and 2.65). The whole group of workers did not perform worse than the controls. The same applies to 20 printers, who regularly assessed hues. Assessed with the most sensitive Lanthony panel D-15 desaturated test, color vision of 24 permanently exposed assistants was impaired (median color confusion index of the 1st eyes 1.08 vs. 1.02, p < 0.02; 2nd eyes 1.08 vs. 1.0, p < 0.05; sign test). The assistants made almost exclusively blue-yellow errors. The other color vision tests did not reveal any differences between the groups. CONCLUSION: Changes in the retina are a possible explanation for the observed blue-yellow dyschromatopsia.

[What Enhances Teachers' Health at Inclusive Primary Schools? A Mixed-Methods Approach]. / Was trägt zur Verbesserung der gesundheitlichen Situation von Lehrkräften (LK) am Arbeitsplatz Schwerpunktgrundschule (SPGS) bei? Ein Mixed-Methods-Ansatz.

AIM: Teachers' suggestions to enhance their health at inclusive primary schools ("Schwerpunktgrundschulen") were analyzed by quantitative content analysis taking personal or job-related parameters of effort and strain into consideration. METHOD: The paper and pencil cross-sectional study was conducted by Institut für Lehrergesundheit (IFL) between August 2013 and April 2015 at 14 schools in Rhineland-Palatinate. Overall response rate was 46.3% (143/309 teachers). The answers to the open-ended question "Which concrete job-related measures would enhance your wellbeing or health situation at your work place?" was categorized and quantified. An analysis of the item-non-response was undertaken. The aim was to identify by logistic regression, personal or job-related parameters of effort or strain associated with a specific category. RESULTS: Data from 143 teachers were analyzed. 79 teachers made 362 suggestions to enhance the health situation at their work place. Making a suggestion was not related to socio-demographic parameters. 33.6% of the teachers addressed physical environmental conditions of work, e. g., climatic or acoustic conditions or the availability of space for recreation. 29.4% of the teachers made suggestions concerning human resource strategy (e. g., "double teaching"). 9.1% of the teachers referred to aspects of relationships with colleagues. After regression analysis, there were relationships between suggestions of single categories and specific job-related parameters of effort. Furthermore, teachers under (high) strain - here: teachers who (very) strongly experienced their work as hazardous to health - showed significantly higher odds to make suggestions of the categories "Colleagues" (aOR 3.71; 95%CI 1.00-13.76) or "External Support" (e. g., "supervision") (aOR 3.92; 95%CI 1.15-13.41) than teachers experiencing less stress. CONCLUSIONS: Teachers of inclusive primary schools are ready to take active part in health-related organizational development. The development of problem- and group-specific measures of intervention will be facilitated by the combined analysis of qualitative and quantitative data.

Seroepidemiology of hepatitis A and B and vaccination status in staff at German schools for the handicapped.

This study aims to assess serostatus and vaccination status of hepatitis A and B among staff at schools for the handicapped. We also wanted to investigate factors associated with serostatus, number of infections with hepatitis A/hepatitis B at work, and factors influencing being vaccinated or not. The cross-sectional study was carried out between August 2010 and August 2012 at 13 German schools for severely handicapped. Data were analyzed using blood samples, vaccination documents, and questionnaires. A total of 395 persons participated in our study (response: 59.7%), information on 367 could be used for analysis. Two respondents have been infected with HAV at work, 53.4% were anti-HAV seropositive. Vaccination against hepatitis A was influenced by information about infectious diseases before starting to work, level of education, and marital status. One person got infected with hepatitis B during work, 53.2% were anti-HBs-seropositive. Vaccination against hepatitis B depended on perceived burden by nursing activities, and vaccination costs being paid by employer. Immunity to hepatitis A and B in our sample is insufficient and does not correspond to the infectious risks. Two persons got infected with hepatitis A and one person with hepatitis B during work at school, indicating an urgent need for preventive actions. J. Med. Virol. 89:825-833, 2017. © 2016 Wiley Periodicals, Inc.

How can the health situation and well-being of staff at German schools for the severely handicapped be improved?

PURPOSE: The aim of the study was to describe measures suggested by staff at German schools for the severely handicapped regarding possibilities to improve their health situation and well-being at work. We further wanted to analyze whether sociodemographic, occupation-related, and health-related characteristics influence the type of measures proposed. METHODS: The cross-sectional study was carried out between August 2010 and August 2012 at 13 schools for the handicapped focusing on motoric and/or holistic development of severely handicapped pupils. Data of teachers and educational staff were surveyed using written questionnaires. The analysis is based on free-text answers regarding the question: "What specific occupation-related measures would lead to an improvement of your well-being or health situation at the workplace?" RESULTS: A total of 395 persons (response proportion: 59.7 %) with a mean age of 45 years and predominantly female (86.8 %) participated in our survey. A total of 205 persons answered the study question providing 456 improvement suggestions, which were classified into 6 main and 13 subcategories. The main categories were professional education and supervision, organization of working tasks and time, work safety and work equipment, social aspects of work, human resources and contractual framework, and other. Measures proposed were influenced by gender, burden by nursing activities, teaching, and administrative tasks, and frequency of deterioration in working atmosphere. DISCUSSION: Proposed measures raise awareness for job-related health stressors and are a starting point to improve working conditions at these schools. Since suggestions vary widely by school and composition of staff, individual priorities have to be set and discussed with the school management.

Occupational injuries of teachers and educational staff at special schools with multiple and severely handicapped children in Rhineland-Palatinate (Germany): results of a cross-sectional study.

OBJECTIVES: The present study aimed to describe the prevalence, type, and influencing factors of occupational injuries of staff working at special schools with multiple and severely handicapped pupils in Southwestern Germany. METHODS: This cross-sectional study was carried out between August 2010 and August 2012 at 13 special schools with focus on motoric and/or holistic development of handicapped pupils in Rhineland-Palatinate (Germany). Participants were interviewed using a written questionnaire. RESULTS: There were 395 participants (response proportion: 59.7%) in our study, with 390 being eligible for statistical analysis. Respondents were on average 45 years old and mainly female (86.9%). The 12-month injury prevalence was 16.9%. Joint dislocations, sprains, and torn ligaments (41.6%) were the main types of injuries. Pupils (59.8%) and auxiliary equipment (12.2%) were identified as the main causes of injury by the respondents. Multivariable logistic regression analysis showed that washing pupils (using auxiliary equipment) (aOR, 3.93; 95% CI, 1.66-9.31) and daily physical strain due to unexpected conduct of pupils (aOR, 3.70; 95% CI, 1.20-11.37) were the main influencing factors for an occupational injury. CONCLUSIONS: Almost one in five persons suffered an occupational injury in the previous 12 months. Nursing activities, including close contact with pupils, were identified as the most important factors for an injury. In order to prevent injuries at special schools, a multifaceted approach is necessary. This includes sufficient supply of auxiliary devices including proper technical maintenance. Furthermore, regular participation in training for manual handling of heavy loads and schooling on the technical use of auxiliary devices should be encouraged.

Prevalence and influencing factors of chronic back pain among staff at special schools with multiple and severely handicapped children in Germany: results of a cross-sectional study.

BACKGROUND: In Germany, about 70,000 teachers and educational staff were teaching at more than 3,000 special schools during the school year 2010/2011. Nursing services like lifting pupils form a substantial part of the work content of the staff at special schools. Since nursing care often involves carrying and lifting pupils, there is a reason to assume an adverse effect on the musculoskeletal health of teachers and other professionals. With the present study we aimed to describe the prevalence and risk factors of chronic back pain among employees at this type of school. METHODS: The cross-sectional survey was carried out between August 2010 and August 2012 at 13 special schools focusing on motoric and/or holistic development of handicapped children in Rhineland-Palatinate (Germany). Teachers and educational staff were interviewed using a questionnaire. We applied multivariable logistic regression analyses to identify influencing factors of chronic back pain. RESULTS: Altogether 395 persons (response rate: 59.7%) participated in our study. Respondents were mostly female (86.8%) with a mean age of 45 years. The prevalence of chronic back pain was 38.7%. More than 40% reported frequently carrying and lifting heavy loads (>20 kg). Age [adjusted OR = 1.03 (95%-CI 1.00-1.05) for 1-year increase in age], current smoking [adjusted OR = 2.31 (95%-CI 1.27-4.23)], depression/depressive mood [adjusted OR = 1.85 (95%-CI 1.12-3.06)], frequently carrying and lifting heavy loads [adjusted OR = 2.69 (95%-CI 1.53-4.75)], and frequent exposure to environmental impacts [adjusted OR = 2.18 (95%-CI 1.26-3.76)] were influencing factors of chronic back pain in the final multivariable regression model. CONCLUSIONS: A large proportion of teachers and educational staff suffered from chronic back pain in our study, indicating a high need for treatment in this professional group. Increasing age, current smoking, a diagnosed depression/depressive mood, carrying and lifting heavy loads, and exposure to environmental impacts were associated with chronic back pain. Due to the sparse literature on the topic, further studies using a longitudinal design are necessary for a better understanding of the risk factors of chronic back pain.

Acute exposure to 50ppm toluene does not increase sleepiness.

The Pupillographic Sleepiness Test (PST) is a new neurophysiological method to assess sleepiness. In an exposure study to a constant exposure level of 50ppm toluene on 20 healthy men, our aim was to find out, if increased sleepiness could be seen with PST. PST was performed before and after 4.5h of exposure. General complaints were assessed with the Swedish Performance Evaluation System (SPES) self-assessment questionnaire, once before and during exposure. Values obtained during exposure were related to pre-exposure values. Parametric cross-over analysis of logarithmic Pupillary Unrest Index (PUI) values did not show an effect of toluene exposure. In a nonparametric cross-over analysis of SPES-scores a significant increase of the scores of unpleasant smell and irritation to the throat, but not of tiredness was found. In conclusion, acute exposure to 50ppm toluene, corresponding to the German threshold limit value, did not increase sleepiness.

Respiratory function and blood gas variables in cystic fibrosis patients during reduced environmental pressure.

Patients with cystic fibrosis (CF) suffer from hypoxaemia even under normobaric conditions and the reduction of inspiratory PO2 (O2 partial pressure) during air travel corresponding to an altitude of 1,800-2,450 m might be a problem for these patients. Ten CF patients and 27 healthy control subjects were investigated in a chamber where the ambient pressure was reduced to that found at 2,000 and 3,000 m. The respiratory function was reduced in the CF patients with a vital capacity of 3.1 (0.3) l [vs 4.9 (0.2) l in controls; mean (SEM)] and a forced expiratory 1-s volume of 2.1 (0.3) l [vs 4.3 (0.20 l in controls], unrelated to the reduction in ambient pressure. Mean arterial PO2 decreased from 75 (4) mmHg [85 (1) mmHg in controls, P<0.01] at sea level to 58 (3) mmHg at 580 mmHg and to 46 (1) mmHg [58 (1) mmHg and 49 (2) mmHg in controls, n.s.] at 513 mmHg ambient pressure. These results indicate that during air travel with a cabin pressure that corresponds to an altitude of 2,500 m, the arterial PO2 of CF patients is likely to remain above the accepted critical value of 50 mmHg. However, a further reduction of the pressure to that found at 3,000 m altitude may lead to severe hypoxia in patients with moderate airway obstruction.

Effects of caffeine intake on the pharmacokinetics of melatonin, a probe drug for CYP1A2 activity.

AIMS: The aim of this study was to assess the influence of concomitant caffeine intake on the pharmacokinetics of oral melatonin, a probe drug for CYP1A2 activity. METHODS: Twelve healthy subjects, six smokers and six nonsmokers, were given melatonin (6 mg) either alone or in combination with caffeine (3 x 200 mg). Blood samples for the analysis of melatonin or caffeine and paraxanthine were taken from 1 h before until 6 h after intake of melatonin. Subjects were genotyped with respect to the CYP1A2*1F (C734A) polymorphism. RESULTS: When caffeine was coadministered the Cmax and AUC of melatonin were increased on average by 142% (P = 0.001, confidence interval on the difference 44, 80%) and 120% (P < 0.001, confidence interval on the difference 63, 178%), respectively. The inhibitory effect of caffeine was more pronounced in nonsmokers and in individuals with the *1F/*1F genotype. CONCLUSION: The results of this study revealed a pronounced effect of caffeine on the bioavailability of orally given melatonin, most probably due to inhibition of CYP1A2 activity.