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.

Depression and anxiety in female refugees from East Africa and the Middle East displaced to Germany: cross-sectional results of the female refugee study, taking sociodemographic and migration-related factors into account.

At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees' mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.

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.

Urinary excretion of heptanones, heptanoles and 2,5-heptanedione after controlled acute exposure of volunteers to n-heptane.

A lack of well-established parameters and assessment values currently impairs biomonitoring of n-heptane exposure. Using controlled inhalation experiments, we collected information on urinary n-heptane metabolite concentrations and the time course of metabolite excretion. Relationships between external and internal exposure were analysed to investigate the suitability of selected metabolites to reflect n-heptane uptake. Twenty healthy, non-smoking males (aged 19-38 years, median 25.5) were exposed for 3 h to 167, 333 and 500 ppm n-heptane, each. Spot urine samples of the volunteers, collected before exposure and during the following 24 h, were analysed for heptane-2-one, 3-one, 4-one, 2,5-dione, 1-ol, 2-ol, 3-ol, and 4-ol using headspace solid phase dynamic extraction gas chromatography/mass spectrometry (HS-SPDE-GC/MS). Starting from median pre-exposure concentrations between <0.5 (3-one) and 82.9 µg/L (4-one), exposure increased the concentrations for all parameters except for 4-one. Median post-exposure concentrations ranged up to 840.4 µg/L (2-ol) and decreased with half-lifes <3 h after exposure. Non-parametric correlation analyses (n = 47, p < 0.05) revealed weak to moderate associations of volume related metabolite excretion with external exposure for 2-one, 3-one and 2,5-dione (R = 0.332-0.753). Heptanol excretion was moderately associated with exposure (R ≥ 0.509) only after creatinine adjustment. Lacking association with external exposure impedes the use of 4-one as heptane biomarker, whereas 2-ol and 3-ol turned out to be sensitive indicators of exposure if creatinine correction is applied. By providing fundamental data on a panel of eight potential heptane metabolites, our study can help to promote biological monitoring of n-heptane exposure.

Biomonitoring and evaluation of permethrin uptake in forestry workers using permethrin-treated tick-proof pants.

We conducted a randomized case-control trial to analyze uptake of the insecticide/arcaricide permethrin in wearers of permethrin-impregnated and non-impregnated pants in German forestry. Eighty-two male workers were each equipped for a 16-week period with permethrin-treated (test group) or with non-treated work pants (control group). Pants with or without lining to protect against cuts, obtained from two different distributors, were worn in each group. Urinary permethrin metabolite levels were measured by GC-MS/MS before, during and after wearing of the pants. Permethrin uptake was calculated using additional questionnaire data. In the control group, metabolite levels in the range of environmental background exposure (median: ~0.5 µg/l) were measured. Subjects wearing impregnated pants showed consistently significantly higher exposure levels even before the first use of the pants with a maximum after 1 week of wearing the pants (median: ~12.5 µg/l). Significant differences in internal exposure were found depending on which of the distributors the pants came from. Metabolite levels decreased probably due to permethrin losses associated with laundering the pants. Calculated permethrin uptake is below the value corresponding to the WHO-proposed acceptable daily intake. Based on our data, a marginally increased cancer risk compared with the general population cannot be excluded when wearing impregnated pants over a working-lifetime period.

Protective efficacy of permethrin-treated trousers against tick infestation in forestry workers.

INTRODUCTION AND OBJECTIVE: Prevention of tick borne diseases in forestry workers is essentially based on the use of appropriate clothing. The objective of this pragmatic, randomized, controlled trial was to assess the potential benefit of permethrin-treated working trousers for the prevention of tick infestation during forestry work. MATERIALS AND METHODS: N=164 male forestry workers were equipped for a period of 16 weeks with permethrin-treated (intervention group-I) or untreated work trousers (control group-II). Subgroups, according to the use of trousers with (I-1, II-1) or without cut protection lining (I-2, II-2) were constituted. Tick infestation (quantity of ticks on the body surface) was assessed by questionnaire after 16 workdays. Control and intervention groups were compared by calculating the infestation rate (percentage of subjects with ticks) and the average number of ticks per workday. RESULTS: The infestation rate in the intervention group was significantly lower than in the control group (36.6 vs. 63.4%, p=0.001; Fisher-test). Further analysis revealed a significant reduction of tick infestation by permethrin treatment only for subjects wearing trousers without the cut protection lining (I-2: 34.2 vs. II-2: 80.0%, p<0.001), while users of cut protection trousers did not benefit from such treated trousers (I-1: 38.6 vs. II-1: 47.6%, n.s.). Similar results were found for comparisons based on the average number of ticks per workday. CONCLUSIONS: The use of permethrin-treated trousers does not completely prevent tick infestations. Improvement of tick protection has been shown only for some applications, but not in general. Additional prevention measures are therefore still indispensable.

Uptake and elimination of permethrin related to the use of permethrin treated clothing for forestry workers.

Wearing of permethrin treated clothing usually implicates an uptake of permethrin by the user. Aim of our study was to examine the kinetics of internal permethrin exposure in volunteers during and after a single 8h-use of treated clothing as well as factors potentially influencing permethrin uptake. 28 male volunteers (age: 20-34 years) were equipped with permethrin treated jackets and pants from two different suppliers. The clothing was worn for 8h, simulating differing external conditions, including comfort conditions as well as conditions of increased temperature and humidity without and with additional physical workload. Internal permethrin exposure was monitored by determination of permethrin metabolites (DCCA and 3-PBA) in a set of 12 urine samples, covering a period of 504 h from the beginning of the wearing interval. Time-concentration curves showed an increase of internal exposure associated with wearing of the clothing (individual maximum: 109.5 µg/L) followed by a first-order like decay (mean half-life: 38.5 h). Metabolite excretion was affected by the make of clothing, which could be explained by differing permethrin contents of the garment. Furthermore, internal exposure increased with increasing temperature/humidity and additional physical workload. Assuming dermal uptake of permethrin, this may be ascribed to an alteration of the barrier function of the skin.

Biomonitoring in wearers of permethrin impregnated battle dress uniforms in Afghanistan and Germany.

OBJECTIVES: To analyse differences in uptake of the insecticide permethrin in wearers of non-impregnated and permethrin impregnated battle dress uniforms (BDU) in Afghanistan and Germany. METHODS: In two separate studies, in April 2003-January 2004 (study I, n=549) and in February-April 2005 (study II, n=195), healthy female and male members of the German Federal Armed Forces were equipped with permethrin impregnated BDU (two sub-cohorts in Germany and one in Afghanistan) while members equipped with non-impregnated uniforms served as a control group. Human biomonitoring was conducted before, during and after wearing the uniforms by measuring permethrin metabolites in urine samples via GC-MS. RESULTS: Subjects of the Afghan and German control groups had permethrin levels in the range of the German general population. In contrast, subjects wearing impregnated BDU had about 200-fold higher exposure levels. Within this group, subjects located in Afghanistan and smokers had significantly higher exposure levels. Internal exposure decreased with increasing duration of use of impregnated BDU. CONCLUSIONS: There is no evidence for a higher background permethrin contamination in military bases located in Afghanistan compared to Germany. Daily use of permethrin impregnated BDU is associated with significantly higher permethrin uptake compared to the general population. Hand-mouth contact by smoking can increase uptake which also seems to be influenced by the duration of use of impregnated BDU.

Application of headspace solid phase dynamic extraction gas chromatography/mass spectrometry (HS-SPDE-GC/MS) for biomonitoring of n-heptane and its metabolites in blood.

Solid phase dynamic extraction (SPDE) is an innovative sample preparation and enrichment technique in connection with gas chromatography (GC). Using SPDE, we developed a method for simultaneous determination of n-heptane and its mono-oxygenated metabolites heptane-4-one, 3-one, 2-one, 4-ol, 3-ol, 2-ol, and 1-ol in blood. After adjustment of various extraction and desorption parameters, method validation resulted in limits of detection (LOD) between 0.006 (heptane-4-one) and 0.021mg/L (heptane-1-ol). Intra-assay coefficients of variation ranged between 4.8% and 20.8% while relative recovery ranged between 100% and 117% (spiked concentration 0.128mg/L, n=8). The method was applied to blood samples, which have been collected from 20 volunteers after controlled inhalative exposure to 167, 333, and 500ppm n-heptane. After 3h of exposure, n-heptane and heptane-2-one were detectable in all samples in concentrations ranging up to 2.903 and 0.495mg/L, while the concentrations of the remaining analytes were closer to the respective LOD or even below. A significant linear relationship with ambient exposure (R(2)=0.701, p<0.001, n=55) was found for n-heptane in blood, which could be helpful for evaluation of biological exposure limits in future. Due to its high abundance in blood, 2-heptanone could be an interesting candidate as a biomarker also in alternative matrices such as urine or saliva.

X-irradiation of cells on glass slides has a dose doubling impact.

Immunofluorescence detection of gammaH2AX foci is a widely used tool to quantify the induction and repair of DNA double-strand breaks (DSBs) induced by ionising radiation. We observed that X-irradiation of mammalian cells exposed on glass slides induced twofold higher foci numbers compared to irradiation with gamma-rays. Here, we show that the excess gammaH2AX foci after X-irradiation are produced from secondary radiation particles generated from the irradiation of glass slides. Both 120 kV X-rays and (137)Cs gamma-rays induce approximately 20 gammaH2AX foci per Gy in cells growing on thin ( approximately 2 microm) plastic foils immersed in water. The same yield is obtained following gamma-irradiation of cells growing on glass slides. However, 120 kV X-rays produce approximately 40 gammaH2AX foci per Gy in cells growing on glass, twofold greater than obtained using cells irradiated on plastic surfaces. The same increase in gammaH2AX foci number is obtained if the plastic foil on which the cells are grown is irradiated on a glass slide. Thus, the physical proximity to the glass material and not morphological differences of cells growing on different surfaces accounts for the excess gammaH2AX foci. The increase in foci number depends on the energy and is considerably smaller for 25 kV relative to 120 kV X-rays, a finding which can be explained by known physical properties of radiation. The kinetics for the loss of foci, which is taken to represent the rate of DSB repair, as well as the Artemis dependent repair fraction, was similar following X- or gamma-irradiation, demonstrating that DSBs induced by this range of treatments are repaired in an identical manner.