Behind the times? Associations of working-time autonomy with health-related and occupational outcomes in health care personnel- a latent profile analysis.

BACKGROUND: In the light of personnel shortage, the health care sector is facing the challenge to combine increasing employees' as well as patients' needs. The aim of this study was to investigate the association between working-time autonomy and health-related (fatigue, psychosomatic complaints and work ability), as well as occupational outcomes (job satisfaction and turnover intention) in a large sample of health care employees. METHOD: Based on data of the BauA-Working Time survey, a sample of n = 1,093 employees working in the health care sector was analysed. Outcomes were assessed by the German Fatigue Scale, the Work Ability-Index and single-item measurements. Besides descriptive analyses, latent profile analysis (LPA) was used to determine clusters of employees based on working-time autonomy. Subsequently, regression analyses have been conducted to examine the association between autonomy clusters with health-related and occupational outcomes, controlling for sociodemographic characteristics and employment status. RESULTS: LPA revealed that a three-cluster model was most suitable: high autonomy (cluster 1), medium autonomy (cluster 2) and low autonomy (cluster 3). The extracted profiles of working-time autonomy differed significantly in terms of sociodemographic and occupational characteristics, but not in terms of average working hours per week or monthly household income. The multivariate regression analysis revealed that being in the low-autonomy cluster was associated with more psychosomatic health complaints (IRR: 1.427, p = 0.008), lower work ability (OR 0.339, p < 0.001), as well as less job satisfaction (OR 0.216, p < 0.001). DISCUSSION: Overall, the analyses indicate that it is crucial to prospectively consider working-time autonomy as an important factor of satisfaction, well-being and turnover intention in health care employees.

Perceived stress of mental demands at work, objective stress and resilience - an analysis of the LIFE-Adult-study.

BACKGROUND: So far, previous research suggests positive effects of mental demands at the workplace. However, it may depend on how stressfull these demands are perceived on an individual level. OBJECTIVE: The aim was to build on previous research by investigating how mental demands are related to stress, overload, and work discontent and whether this relationship is mediated by individuals resources, such as resilience. METHOD: A sub-sample of the LIFE Adult Cohort (n = 480) was asked to answer questions on sociodemographic characteristics, objective stress (using the Trier Inventory of Chronic Stress (TICS)), and perceptions of stress with regard to verbal and executive mental demands at work. RESULTS: According to generalized linear regression models, higher verbal as well as executive mental demands were associated with higher levels of chronic stress, work overload and discontent. Higher levels of resilience were associated with lower levels of these outcomes. Analyses regarding interaction effects revealed that the interaction between resilience and perceived stress of verbal mental demands was significant only in terms of work overload. CONCLUSION: Higher perceived stressfulness of mental demands was associated with higher chronic stress, work overload and work discontent. Therefore, mental demands should be targeted by occupational interventions that aim to improve job conditions and employees' overall well-being. Besides resilience, other potential influencers or personal resources should be focused on in future studies to develop interventions.

Characteristics of Hoof Landing in Sound Horses and the Influence of Trimming and Shoeing Examined With Hoof-Mounted Inertial Sensors.

The aim of the current in vivo, observational study was to investigate the effects of different hoof manipulations on landing duration (LandD), location (ICloc) and angle of initial contact (ICangle) in the front feet of horses. A novel, hoof-mounted, inertial measurement unit sensor system (IMU) was used. Ten sound, crossbred horses were fitted with an IMU sensor at the dorsal hoof wall and examined barefoot and after trimming. Additionally, the application of 120 g lateral weights and 5° medial side wedges as well as steel, aluminium, egg bar, and lateral extension shoes were tested. Horses were guided in a straight line on firm ground. The use of steel shoes increased LandD compared to barefoot and enhanced the individual ICloc in trot. Application of rolled toe shoes caused a longer LandD than use of plain shoes. None of the other modifications significantly influenced the timing or spatial variables of hoof landing. Trimming and shoeing have less impact on the landing pattern of horses than assumed in practice. Still, the use of steel shoes changes sliding properties of the hooves on firm ground and increases weight causing a longer LandD and reinforcement of the individual ICloc.

The impact of BMI on psychological health in oldest old individuals-Are there differences between women and men?

OBJECTIVE: The aim of this study was to determine the association of mental health issues associated with BMI and gender in the oldest old population (secondary data analyses). METHOD: The data were taken from the second follow-up of a long-term study investigating the impact of the COVID-19 pandemic on health in oldest old individuals (range: 77-96 years). The response rate was 80.0%. Apart from sociodemographic characteristics (age, gender, weight and height); anxiety, depression, somatic complaints and social support were assessed in this survey. RESULTS: Analyses revealed gender-specific differences, indicating that male participants with excess weight show more complaints compared to their counterparts without excess weight. According to regression results, BMI was associated with somatization, but not depression or anxiety. CONCLUSION: High BMI contributed to more somatic complaints and men may be affected differently by BMI regarding their mental well-being. Longitudinal results are needed in order to confirm these findings and develop suitable interventions based on individual needs of the oldest old.

The relationship between weight history and psychological health-Differences related to gender and weight loss patterns.

BACKGROUND: The prevalence and burden of obesity continues to grow worldwide. Psychological comorbidities may not only influence quality of life, but may also hinder successful weight loss. The causality between excess weight and mental health issues is still not fully understood. The aim of the study was to investigate whetherweight history parameters, (ie.age of onset) are related to psychological comorbidities. METHOD: The data were derived from a representative telephone survey in Germany, collecting information on weight loss patterns and mental health outcomes among individuals with BMI>30kg/m2. Overall, 787 participants were examined in terms of depressive symptoms (Patient Health Questionnaire, PHQ-9) and anxiety (Generalized Anxiety Disorder Questionnaire, GAD7). In addition, participants were asked about different aspects of their weight history (ie. weight loss patterns and trajectories) over the lifespan. The relationship between weight history and mental health was analyzed using multivariate statistics. RESULTS: According to regression analyses, having had more weight loss attempts, a greater weight loss being desired and being a "weight maintainer" was associated with more symptoms of depression (p < 0.001), whereas a greater desired weight loss and being categorized as a "weight maintainer" was associated with more anxiety (p < 0.001). Moroever, the prevalence of depressive symptoms was significantly higher in male individuals who desire to lose more weight or had more weight loss attempts in the past. CONCLUSION: Gender-specific differences were observed in terms of weight history parameters, as well as mental health outcomes. Especially for men, weight loss patterns seem to be related to depressive symptoms. Concerning the overall results, it becomes clear that screening for weight history at the beginning of a multidisciplinary weight loss program in the context of gender-specific psychological comorbidities is important. The question remains why some aspects of weight history seem to be more important than others.

[Views on Retirement by General Practitioners]. / Renteneintrittswünsche und mögliche Determinanten bei Hausärztinnen und Hausärzten.

EINLEITUNG: In Hinblick auf den immer größer werdenden Ärztemangel und gleichzeitig steigenden Versorgungsbedarf in der Allgemeinbevölkerung war das Ziel der vorliegenden Untersuchung, ein detailliertes Bild über Renteneintrittswünsche der aktiven Hausärztinnen und Hausärzte (N=143) zu erfassen. METHODE: Die Daten wurden im Rahmen einer Baseline-Befragung einer Langzeitstudie erhoben (repräsentative Ärztebefragung). Es wurde untersucht, inwiefern soziodemographische als auch berufsbezogene Variablen mit einem vorzeitigen bzw. späteren Renteneintritt in Zusammenhang gebracht werden können und welche Gründe für eine ärztliche Tätigkeit über das Rentenalter hinaus sprechen. ERGEBNISSE: Die Ergebnisse zeigen, dass die Hälfte der Befragten zwischen 29 und 66 Jahren vorzeitig in den Ruhestand gehen möchte und diese Entscheidung vor allem von Familienstand, aber auch von Arbeitszufriedenheit und Arbeitsbelastung abhängig ist. Zu den Gründen, die für einen späteren Eintritt sprechen, zählen "Freude an der Arbeit", "sich nützlich und gebraucht fühlen" und ein allgemein "berufliches Interesse". SCHLUSSFOLGERUNG: Renteneintrittswünsche sollten bei der zukünftigen Planung der Versorgung berücksichtigt werden, um Maßnahmen zu ergreifen, die einem ungewollten oder vorzeitigen Ausstieg der Mediziner aus der Versorgung entgegenwirken. BACKGROUND: There is a steadily increasing shortage of doctors and simultaneously an increasing need for health care of the general population. The aim of the present survey was to investigate retirement planning by family doctors (n=143). METHOD: Data was collected as part of a baseline survey (longitudinal design, representative sample of physicians). Possible association between socio-demographic and occupation-related variables with early or later retirement was investigated and also why some physicians may consider continuing in their profession beyond retirement age. RESULTS: The results showed that half of the respondents between 29 and 66 of age would like to retire early and that this decision depended primarily on marital status, but also on job satisfaction and workload. Reasons for late retirement were "enjoying work", "feeling useful and needed" and general "professional interest". CONCLUSION: The results indicate that retirement wishes of GPs must be taken into account in the future planning of health care and that measures should be taken to counteract their early retirement from professional activity.

The work-life balance of general practitioners as a predictor of burnout and motivation to stay in the profession.

BACKGROUND: Work-life balance (WLB) is associated with a variety of health-related outcomes in the general population. Since General Practitioners (GPs) play a fundamental role in the health system, we wanted to analyze the associations between their WLB and burnout scores as well as motivation to stay in the profession. METHODS: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 188 GPs that were working full time, 61.7% were female. RESULTS: Multivariate analysis showed a beneficial association between WLB and all three dimensions of burnout (Emotional Exhaustion, Cynicism, and Professional Efficacy) as well as the motivation to stay in the profession. CONCLUSIONS: Improving GPs WLB could be a way to reduce physician burnout, strengthen the healthcare system, and attract a new generation of talented physicians.

It's about time - Associations between working time dimensions and well-being of physicians.

Several working time characteristics have been linked to negative outcomes for health personnel. The aim was to investigate the impact of working time dimensions on well-being in a representative sample of physicians. Data was collected during a baseline study. Linear regression analysis was performed on a sample including 669 physicians of different medical specialties. The questionnaire included sociodemographic characteristics and information on working time dimensions (e.g. shift work). In addition, job satisfaction, workload and self-reported health were explored. The majority were female, working in internal medicine and the mean age was 42.5 years. Findings reveal that overtime hours (ß = -0.478, p = .011) and autonomy (ß = 0.444, p < .001) were significantly associated with job satisfaction. The number of free weekends (ß = -2.622, p = .005) and autonomy significantly predicted personal (ß = -6.153, p < .001), work-related (ß = -6.597, p < .001) and patient-related workload (ß = -4.731, p < .001). Overall health was only affected by working time autonomy (ß = 3.804, p < .001). In conclusion, the study suggests that working time characteristics have negative consequences for well-being and need to be addressed to ensure health, performance and safety of physicians.

[Occupational Participation of Syrian Refugees with Posttraumatic Stress in Germany]. / Berufliche Teilhabe von syrischen Geflüchteten mit posttraumatischer Stress-Symptomatik in Deutschland.

OBJECTIVE: Description of employment situation and search for determinants of employment depending on symptom severity in refugees with posttraumatic stress. METHODS: Standardized interviews with 133 Syrian refugees (18 to 65 years) living in Germany with posttraumatic stress symptoms and exploratory data analysis. RESULTS: 27.1 % of the participants were employed; including 13.9 % women and 86.1 % men (p = 0.001). Links between mental health and employment can be shown (posttraumatic stress p = 0.039, depressiveness p = 0.020, somatisation p = 0.026). With regard to social support and type of trauma, as well as residence status and duration of residence, there were no differences between refugees with and without employment. CONCLUSION: The current analysis on the employment situation of a circumscribed group of Syrian refugees focuses on the importance of psychological symptom burden.

Predictors of psychological distress in Syrian refugees with posttraumatic stress in Germany.

Syria has been the main country of citizenship of refugees in Germany since 2013. Syrians face numerous human rights violations in their country that can be accompanied by the experience of potentially traumatic events, loss and displacement. Along the migration process, refugees are exposed to various factors that can have an impact on mental health. The aim of this study is to investigate sociodemographic, war- and flight-related as well as post-migration factors as predictors of posttraumatic stress, depression, somatization and anxiety in Syrian refugees with posttraumatic stress symptoms based in Germany. Data were based on the baseline sample of the "Sanadak" randomized-controlled trial. A total of 133 adult Syrian refugees participated in the study. A questionnaire covered sociodemographic and flight-related questions as well as standardized instruments for symptoms of PTSD (PDS-5), depression (PHQ-9), somatization (PHQ-15), anxiety (GAD-7), generalized self-efficacy (GSE), religiousness (Z-Scale), social support (ESSI) and mental health stigma (SSMIS-SF). Linear regression models were executed to predict mental health outcomes. Sociodemographic predictors (i.e., female sex, higher education) and flight-related predicting factors (i.e., variability of traumatic events) have a negative impact on mental health in Syrian refugees with posttraumatic stress symptoms in Germany. Mental health stigma predicts worse mental health outcomes. Post-migration factors have a major impact on mental health, such as low income, lack of social support, low life satisfaction or a strongly felt connection to Syria. Somatization is an important manifestation of mental distress in Syrian refugees with posttraumatic stress symptoms. Our study showed a range of factors predicting the mental health of Syrian refugees with posttraumatic stress symptoms. Measures to foster mental health could be securing financial security, promoting gender equality and tailored psychosocial programs addressing mental health stigma, loss and social support networks.

Burnout and work-life balance among physicians: the role of migration background.

BACKGROUND: We want to analyze the effect of migration background (MB) on physician burnout and work-life balance. METHODS: In September 2019, physicians from various specialties answered a questionnaire on work and health. We analyzed a subsample of 526 physicians that were working full time in a hospital, 14% with an MB and 47.9% were female. RESULTS: Multivariate analysis showed that physicians with an MB exhibit significantly less favorable scores on all three burnout dimensions, and this effect persisted in the regression analysis after adding age, gender, and marital status as control variables. There were no differences with regard to work-life balance. CONCLUSIONS: To our knowledge, our study is the first one to suggest that MB plays a significant role in physician mental health. Future research will benefit from identifying the factors behind that connection, e.g., problems related to acculturation, communication and social integration, which can then be addressed by policymakers in order to maintain and improve the medical infrastructure.

Influence of trimming, hoof angle and shoeing on breakover duration in sound horses examined with hoof-mounted inertial sensors.

OBJECTIVE: Aim of the current in vivo, observational study was to investigate the effect of trimming, heel elevation and different types of shoeing on breakover duration (BreakD) with a novel, hoof-mounted inertial measurement unit (IMU) sensor system. METHODS: Ten sound, crossbred horses were examined barefoot before and after trimming fitted with an IMU sensor at the dorsal hoof wall. Additionally, application of 5° heel wedges, plain steel shoes, rolled-toe shoes and palmarly-placed quarter-clip shoes was tested. Horses were guided in a straight line on firm ground. Obtained data were speed corrected prior to calculations testing the influence of different manipulations for their significance on BreakD. RESULTS: Trimming had no significant influence on BreakD. Heel elevation caused a significant decrease of BreakD in walk and trot. Shoeing with a plain steel shoe resulted in a significant increase in BreakD in walk. This could be rescinded by creating a rolled toe or placing the shoe palmarly. CONCLUSION: Obtained results emphasize the use of heel wedges or rolled-toe and palmarly-placed shoes to ease breakover in the context of therapeutic shoeing. Hoof-mounted IMU sensors with high resolution seem to be a practical and valuable approach to accurately examine BreakD and factors influencing this parameter.

Detection of Equine Hoof Motion by Using a Hoof-Mounted Inertial Measurement Unit Sensor in Comparison to Examinations with an Optoelectronic Technique - A Pilot Study.

This study aimed to determine whether a hoof-mounted inertial measurement unit (IMU) system would provide similar timing characteristics and step lengths, in walk and trot on different grounds, compared to those of an established optoelectronic motion system. The right hoof of one horse was equipped with an IMU sensor with an optical reference marker on top. Fifteen steps on firm ground, and five on penetrable ground, were performed at walk and trot. Level of agreement between the two measurement systems was determined by assessing the concordance correlation coefficients, accuracy, and precision of the duration of different gait events and step length. Timing characteristics and step length were in strong agreement between the two techniques for the majority of assessed parameters in walk and trot on both grounds. The agreement between techniques decreased for breakover and landing duration at trot on penetrable ground. Disparity between the measurement techniques was related to difficulties in accurately defining single parts of the stance phase with marker-based optoelectronic analysis on penetrable ground. Detailed examinations of different parts of the stance phase are more accurately performed using hoof-mounted IMU sensors. Results emphasise the great potential of IMU sensors for equine motion analysis in daily practice.

Health Care Services Utilization and Health-Related Quality of Life of Syrian Refugees with Post-Traumatic Stress Symptoms in Germany (the Sanadak Trial).

Refugees who have fled from the ongoing civil war in Syria that arrived in Germany often develop post-traumatic stress symptoms (PTSS). The aim of this study was to determine health care services utilization (HCSU), health care costs and health-related quality of life (HrQoL) of Syrian refugees with mild to moderate PTSS without current treatment in Germany. The study was based on the baseline sample of a randomized controlled trial of a self-help app for Syrian refugees with PTSS (n = 133). HCSU and HrQoL based on the EQ-5D-5L and its visual analogue scale (EQ-VAS) were assessed with standardized interviews. Annual health care costs were calculated using extrapolated four-month HCSU and standardized unit costs. Associations between health care costs, HrQoL and PTSS severity were examined using generalized linear models. Overall, 85.0% of the sample utilized health care services within four months. The mean total annual health care costs were EUR 1920 per person. PTSS severity was not associated with health care costs. The EQ-5D-5L index score and the EQ-VAS score was 0.82 and 73.6, respectively. For Syrian refugees with higher PTSS severity, the EQ-5D-5L index score was lower (-0.17; p < 0.001). The HCSU and the resulting health care costs of Syrian refugees with mild to moderate PTSS without current treatment are low and those with a higher PTSS severity had a lower HrQoL.

Correction: A Self-Help App for Syrian Refugees With Posttraumatic Stress (Sanadak): Randomized Controlled Trial.

[This corrects the article DOI: 10.2196/24807.].

Comparing burnout and work-life balance among specialists in internal medicine: the role of inpatient vs. outpatient workplace.

BACKGROUND: Compared to the general population, physicians are more likely to experience increased burnout and lowered work-life balance. In our article, we want to analyze whether the workplace of a physician is associated with these outcomes. METHODS: In September 2019, physicians from various specialties answered a comprehensive questionnaire. We analyzed a subsample of 183 internists that were working full time, 51.4% were female. RESULTS: Multivariate analysis showed that internists working in an outpatient setting exhibit significantly higher WLB and more favorable scores on all three burnout dimensions. In the regression analysis, hospital-based physicians exhibited higher exhaustion, cynicism and total burnout score as well as lower WLB. CONCLUSIONS: Physician working at hospitals exhibit less favorable outcomes compared to their colleagues in outpatient settings. This could be a consequence of workplace-specific factors that could be targeted by interventions to improve physician mental health and subsequent patient care.

A Self-Help App for Syrian Refugees With Posttraumatic Stress (Sanadak): Randomized Controlled Trial.

BACKGROUND: Syrian refugees residing in Germany often develop posttraumatic stress as a result of the Syrian civil war, their escape, and postmigration stressors. At the same time, there is a lack of adequate treatment options. The smartphone-based app Sanadak was developed to provide cognitive behavioral therapy-based self-help in the Arabic language for Syrian refugees with posttraumatic stress. OBJECTIVE: The aim of this study was to evaluate the effectiveness and cost-effectiveness of the app. METHODS: In a randomized controlled trial, eligible individuals were randomly allocated to the intervention group (IG; app use) or control group (CG; psychoeducational reading material). Data were collected during structured face-to-face interviews at 3 assessments (preintervention/baseline, postintervention/after 4 weeks, follow-up/after 4 months). Using adjusted mixed-effects linear regression models, changes in posttraumatic stress and secondary outcomes were investigated as intention-to-treat (ITT) and per-protocol (PP) analysis. Cost-effectiveness was evaluated based on adjusted mean total costs, quality-adjusted life years (QALYs), and cost-effectiveness acceptability curves using the net benefit approach. RESULTS: Of 170 screened individuals (aged 18 to 65 years), 133 were eligible and randomized to the IG (n=65) and CG (n=68). Although there was a pre-post reduction in posttraumatic stress, ITT showed no significant differences between the IG and CG after 4 weeks (Posttraumatic Diagnostic Scale for DSM-5, Diff -0.90, 95% CI -0.24 to 0.47; P=.52) and after 4 months (Diff -0.39, 95% CI -3.24 to 2.46; P=.79). The same was true for PP. Regarding secondary outcomes, ITT indicated a treatment effect for self-stigma: after 4 weeks (Self-Stigma of Mental Illness Scale/SSMIS-stereotype agreement: d=0.86, 95% CI 0.46 to 1.25; stereotype application: d=0.60, 95% CI 0.22 to 0.99) and after 4 months (d=0.52, 95% CI 0.12 to 0.92; d=0.50, 95% CI 0.10 to 0.90), the IG showed significantly lower values in self-stigma than the CG. ITT showed no significant group differences in total costs and QALYs. The probability of cost-effectiveness was 81% for a willingness-to-pay of €0 per additional QALY but decreased with increasing willingness-to-pay. CONCLUSIONS: Sanadak was not more effective in reducing mild to moderate posttraumatic stress in Syrian refugees than the control condition nor was it likely to be cost-effective. Therefore, Sanadak is not suitable as a standalone treatment. However, as the app usability was very good, no harms detected, and stigma significantly reduced, Sanadak has potential as a bridging aid within a stepped and collaborative care approach. TRIAL REGISTRATION: German Clinical Trials Register DRKS00013782; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013782. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-019-2110-y.

[Burnout Among Physicians Working in Psychiatric and Psychosomatic Care]. / Burnout bei jungen Ärztinnen und Ärzten: Ein Vergleich der Tätigkeitsgebiete Psychiatrie/Psychosomatik und somatische Medizin.

OBJECTIVE: Burnout is considered to be a major risk factor that can contribute secondary disorders due to persistent work related stress. International studies showed that physicians working in psychiatric care are more frequently affected by burnout than physicians working in somatic care. Studies from Germany are lacking. METHODS: In a cross-sectional study all physicians 40 years and younger and registered with the State Chamber of Physicians of Saxony, Germany, received an anonymous paper-pencil questionnaire. Burnout was measured using the Maslach Burnout Inventory. RESULTS: Physicians working in psychiatric/psychosomatic care did not differ from physicians working in somatic care regarding the subscales emotional exhaustion and depersonalization. Physicians working in psychiatric/psychosomatic care reported higher personal accomplishment. Working in psychiatric/psychosomatic care was associated with a lower likelihood for a high degree of burnout on the subscale personal accomplishment. CONCLUSION: Previous studies suggesting a higher prevalence of burnout among physicians working in psychiatric care could not be confirmed.

[Urban vs. Rural: A cross-sectional study on Job Satisfaction and Work Load among Young Physicians in Saxony]. / Stadt vs. Land: Eine Querschnittsstudie zu Arbeitszufriedenheit und ­belastung von jungen Ärzten in Sachsen.

BACKGROUND: A shortage of physicians and corresponding inadequate patient care threaten particularly rural, structurally weak regions. Previous studies have focused on factors that encourage or discourage doctors in their decision to establish a practice in rural areas. Little is known about factors such as job satisfaction and workload and geographical differences in Germany. The aim of the study was to investigate these factors in a detailed urban-rural comparison as part of a secondary data analysis. METHOD: For this purpose, data from 1813 physicians practicing in Saxony (age: 25-40), who were contacted by post, were analyzed. RESULTS: The results show that there are only slight differences with regard to job satisfaction. In terms of workload, there are no significant differences between physicians working in rural or in urban areas. CONCLUSION: Since workload and job satisfaction are not different between doctors working in urban and rural regions, other approaches must be made to encourage more doctors to establish rural practices and thus improve patient care in rural regions.