High-Frequency Heart Rate Variability Is Prospectively Associated With Sleep Complaints in a Healthy Working Cohort.

OBJECTIVE: Vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), has been implicated in a wide range of mental and physical health conditions, including sleep complaints. This study aimed to test associations between HF-HRV measured during sleep (sleep HF-HRV) and subjective sleep complaints 4 years later. METHODS: One hundred forty-three healthy employees (91% male; MAge = 47.8 years [time 2], SD = 8.3 years) of an industrial company in Southern Germany completed the Jenkins Sleep Problems Scale, participated in a voluntary health assessment, and were given a 24-hour ambulatory heart rate recording device in 2007. Employees returned for a health assessment and completed the Jenkins Sleep Problems Scale 4 years later. RESULTS: Hierarchical regression analyses showed that lower sleep HF-HRV measured in 2007 was associated with higher self-reported sleep complaints 4 years later after controlling for covariates (rab,c = -0.096, b = -0.108, 95% CI, -0.298 to 0.081, ΔR2 = 0.009, p = .050). CONCLUSIONS: These data are the first to show that lower sleep HF-HRV predicted worse sleep 4 years later, highlighting the importance of vagus nerve functioning in adaptability and health.

Assessing adverse childhood experiences in young refugees: a systematic review of available questionnaires.

Today, various questionnaires are available to assess Adverse Childhood Experiences (ACEs) in children; however, it is uncertain if these questionnaires are comprehensive in addressing adversities of vulnerable subgroups, specifically refugee children. This review's objectives are to (1) identify current ACE questionnaires and determine if they are suitable in assessing refugee children's adversities, and (2) identify those previously used within a refugee population. A systematic literature search was conducted across five databases for articles published since 2010, including studies using an ACE-questionnaire that recognized multiple adversities in healthy children and were published in English. A total of 103 ACE questionnaires were identified in 506 studies. Only 14 of the 103 questionnaires addressed a refugee-specific adversity. Their ability to capture refugee children's experiences was limited: available questionnaires used a maximum of three items to assess refugee-specific adversities, covering only a fraction of forms of adversities relevant to refugee children. Psychometric characteristics were rarely reported. In addition, only two ACE questionnaires were used within a refugee population. With the tools currently available, it is not possible to comprehensively assess the exposure to and severity of the adversities faced by refugee children. The perpetuation of ongoing crises necessitates assessing refugee children's adversities to understand how their wellbeing is affected and to identify children at risk.

Reducing sick leave, improving work ability, and quality of life in patients with mild to moderate Long COVID through psychosocial, physiotherapeutic, and nutritive supportive digital intervention (MiLoCoDaS): study protocol for a randomized controlled trial.

BACKGROUND: Following SARS-CoV-2 infection, a relevant proportion of patients suffer from persistent or recurring sequela, even after initially mild primary illness. Many patients experience exhaustion and fatigue, rendering them incapable of working. Long COVID exerts a substantial burden on society and the healthcare system: at least 65 million people are currently affected worldwide. The underlying pathobiology is a complex derangement in several organ systems. To date, causal pharmaceutical therapies remain elusive. Waiting lists for specialist care are long. Rapidly scalable digital interventions offering support for the frequent subgroup of patients with mild to moderate impairment from Long COVID are urgently needed. The MiLoCoDaS study compares three intensities of a potentially rapidly scalable digital intervention aiming to accelerate recovery. The overall objective is to figure out if there is a difference in the effect sizes between these modalities. METHODS: The online intervention uses a learning platform (LMS, TYPO3 framework) comprising 12 sessions of medical, psychological, physiotherapeutic, and nutritional content. The three modalities differ as follows: patient information only (sham intervention, control), information plus interactive digital workbook including practical exercises (digital intervention), and the digital workbook augmented by once-weekly online seminars and discussion groups (person and peer-contact). Eligible patients are 18-67 years old satisfying Long COVID diagnostic criteria. Patients are recruited through primary care physicians and randomly allocated. The primary endpoint is the number of sick leave days during the 6-month observation period; secondary endpoints are patient-reported symptoms, quality of life, and work ability. The study size provides a power of 80% at a type I error of < 0.05 to show an effect size of Cohen = 0.3 between the augmented and the sham intervention (N = 152 per arm, total accounting for attrition N = 600). DISCUSSION: If one of the two interventions is superior to providing information alone, MiLoCoDaS would provide the starting point for a rapidly scalable digital intervention for the frequent and currently underserved patient group with mild to moderate impairment from Long COVID. Several caveats pertain to the heterogeneity of Long COVID manifestation and duration prior to inclusion. It is conceivable that the possible effect of the intervention may differ across subgroups. Therefore, a priori defined secondary analysis will be conducted. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00028964. Registered on 24 August 2022.

Development and validation of a self-regulation scale within the German version of the Early Development Instrument.

BACKGROUND: Early childhood self-regulation (SR) is key for many health- and education-related outcomes across the life span. Kindergarten age is a crucial period for SR development, and within this developmental window, potential SR difficulties can still be compensated for (e.g., through interventions). However, efficient measurement of SR through brief, comprehensive, and easy-to-use instruments that identify SR difficulties are scarce. To address this need, we used items of an internationally applied kindergarten teacher questionnaire-the Early Development Instrument (EDI) - to develop and validate a specific SR measurement scale. METHODS: The psychometric evaluation and validation of the selected SR-items was performed in data collected with the German version of the EDI (GEDI), in two independent data sets - (a) the development dataset, with 191 children, and b) the validation dataset, with 184 children. Both included three- to six-year-old children and contained retest and interrater reliability data. First, three independent raters-based on theory-selected items eligible to form a SR scale from the two SR-relevant GEDI domains "social competence" and "emotional maturity". Second, exploratory and confirmatory factor analysis using structural equation modeling examined the item structure across both data sets. This resulted in a defined SR scale, of which internal consistency, test-retest and interrater reliability, cross-validation, and concurrent validity using correlation and descriptive agreements (Bland-Altman (BA) plots) with an existing validated SR-measuring instrument (the Kindergarten Behavioral Scales) were assessed. RESULTS: Confirmatory factor analysis across both data sets yielded the best fit indices with 13 of the GEDI 20 items initially deemed eligible for SR measurement, and a three-factor structure: a) behavioral response inhibition, b) cognitive inhibition, c) selective or focused attention (RMSEA: 0.019, CFI: 0.998). Psychometric evaluation of the resulting 13-item-GEDI-SR scale revealed good internal consistency (0.92), test-retest and interrater reliability (0.85 and 0.71, respectively), validity testing yielded stability across populations and good concurrent validity with the Kindergarten Behavioral Scales (Pearson correlation coefficient: mean 0.72, range 0.61 to 0.84). CONCLUSIONS: The GEDI contains 13 items suitable to assess SR, either as part of regular EDI developmental monitoring or as a valid stand-alone scale. This short 13-item (G)EDI-SR scale may allow early detection of children with SR difficulties in the kindergarten setting in future and could be the basis for public health intervention planning. To attain this goal, future research should establish appropriate reference values using a representative standardization sample.

The longitudinal directional associations of meaningful work with mental well-being - initial findings from an exploratory investigation.

BACKGROUND: An increasing number of studies reveal that more meaning in life is positively related to mental well-being. Meaning in life can be derived from different sources, including the workplace. The aim of this study was to explore the longitudinal directional association of meaningful work with mental well-being. METHODS: Prospective data from 292 persons at two timepoints (two-week interval) were used to estimate the cross-lagged relationship and directionality of meaningful work with mental well-being. RESULTS: The cross-lagged panel model had a good fit to the data (Chi2 ms(90) = 150.9; p < 0.001; RMSEA = 0.048; p = 0.576; CFI = 0.984; TLI = 0.979; SRMR = 0.040) and showed that levels of meaningful work at t1 had a positive effect on mental well-being at t2 (ß = 0.15, p = 0.010). But mental well-being at t1 did not affect meaningful work at t2 (ß = 0.02, p = 0.652). Sub-analyses revealed the effects to be mainly driven by women (as opposed to men) and white-collar workers (as opposed to blue-collar workers). CONCLUSION: This study confirmed a directional association of meaningful work on mental well-being, indicating that more meaningful work has beneficial mental well-being effects.

Negative and protective experiences influencing the well-being of refugee children resettling in Germany: a qualitative study.

OBJECTIVE: Conflict, forced migration and searching for safety in a foreign land are all experiences common to refugee children. They experience potentially traumatic events that are distinct from the general population, yet current adverse childhood experience (ACE) studies do not cover these events. Studies that do examine refugee children's experiences typically focus on a single stage of migration or adversities from the community, offering insight into only a fraction of their realities. This study aimed to identify potentially traumatising and protective experiences subjectively perceived as influencing refugee children's well-being from all stages of migration and all socio-ecological levels. DESIGN: Qualitative study with thematic analysis of semi-structured individual and group interviews. Themes were organised within a socio-ecological model. SETTING: Non-profit organisations, youth welfare facilities and societies that organise civic engagement for refugee families in the Rhine-Neckar region in Germany provided rooms where interviews could be conducted. PARTICIPANTS: Refugee parents and children who spoke one of the four most common languages of those seeking asylum in Germany in 2018 were included. This study excluded refugees who were not fleeing a conflict area. Forty-seven refugee parents and 11 children (aged 8-17 years) from Syria, Iraq, Palestine, Afghanistan and Eritrea participated. RESULTS: Eight major themes emerged from interviews including six reflecting potentially negative experiences and two potentially protective themes. These themes evolved from experiences such as family dispersion, displacement, rigorous immigration and national policies, as well as constructive parenting and community support. CONCLUSION: It is increasingly important to identify these diverse experiences as the refugee population continues to grow, and the increased prevalence of poor health outcomes in refugee children continues to be widely documented. Identifying ACEs specifically relevant to refugee children could contribute to understanding potential pathways and could further serve as a starting point for tailored interventions.

Associations between hair cortisol and subjective stress measures in a large occupational sample.

BACKGROUND: Hair cortisol concentrations (HCC) are commonly used to capture long-term cumulative cortisol secretion in stress research. However, data on associations between HCC and subjective stress measures have been inconsistent. This may partly be due to bias introduced by smaller-sized academic samples. Here, we investigate associations between HCC and (work-) stress-related measures in a large occupational, predominantly male, sample. METHODS: Demographic, anthropometric, and self-reported data were collected as part of an occupational health assessment for employees of an airplane manufacturing company (N = 1258). Hair samples (3 cm) were obtained and glucocorticoid concentrations (HCC and hair cortisone, HairE) were analyzed using liquid chromatography-tandem mass spectrometry. RESULTS: HCC and HairE were unrelated to self-report measures of perceived stress, work-related stress (effort-reward imbalance, overcommitment), and other stress-related constructs. Group-based analyses concerning associations with job strain revealed a small effect of individuals with high job strain (n = 281) exhibiting higher HCC than the remaining sample (n = 811). CONCLUSIONS: Our data replicate previous findings of no consistent associations between hair glucocorticoids and subjective stress-related questionnaire data, besides evidence for elevated HCC in a high job strain group. Further research addressing open methodological questions regarding HCC by means of advanced stress assessment methods is needed.

The Benefits of an Employee-Friendly Company on Job Attitudes and Health of Employees: Findings from Matched Employer-Employee Data.

BACKGROUND: This study explored the association of an employee-friendly work environment with employees' job attitudes (engagement, commitment, turnover intentions, and job satisfaction), and health (mental and general health), applying matched employer-employee data. METHODS: The German Linked Personnel Panel (LPP; n = 14,182) survey simultaneously captures the data of employees and the human resources (HR) management of companies. A two-step cluster analysis of 16 items of the HR valuation identified relatively more- and less-employee-friendly companies (EFCs). Logistic regressions tested differences between these companies in the assessment of job attitudes and health of their employees. RESULTS: Compared to less-EFCS, more-EFCS had a reduced risk of poorer job attitudes and substandard health of their employees. For example, the risk for higher turnover intentions was reduced by 33% in more-EFCS (OR = 0.683, 95% C.I. = 0.626-0.723), and more-EFCS had an 18% reduced chance of poor mental health reporting of their employees (OR = 0.822, 95% C.I. = 0.758-0.892). CONCLUSIONS: More-EFCS have more motivated and healthier employees. The most distinct factors for more-EFCS were: the existence of development plans for employees, opportunities for advancement and development, and personnel development measures.

Expanding the role of non-physician medical staff in primary care in Germany: protocol for a mixed-methods study exploring the perspectives of physicians in rural practices.

INTRODUCTION: Primary care faces substantial challenges worldwide through an increasing mismatch in supply and demand, particularly in rural areas. One option to address this mismatch might be increasing efficiency by delegation of tasks to non-physician medical staff. Possible influencing factors, motives and beliefs regarding delegation to non-physician medical staff and the potential of an expanded role, as perceived by primary care physicians, however, remain unclear. The aim of this study is to assess these factors to guide development of potential interventions for expanding the role of non-physician medical staff in delivering primary care services in rural Germany. METHODS AND ANALYSIS: This mixed-methods study based on the theoretical domains framework (TDF) consists of survey and interviews conducted sequentially. The survey, to be sent to all primary care physicians active in rural Baden-Wuerttemberg (estimated n=1250), includes 37 items: 15 assessing personal and practice characteristics, 15 matching TDF domains and 7 assessing opportunities for delegation. The interview, to be performed in a subsample (estimated n=12-20), will be informed by results of the survey. The initial interview guide consists of 11 questions covering additional TDF domains. Perspectives towards delegation will be maximised by comparing data emerging in either part of the study, seeking confirmation, disagreement or further details. ETHICS AND DISSEMINATION: The Ethics Committee of Heidelberg University approved this study (approval number: 2021-530). Written informed consent will be obtained before each interview; consent for participation in the survey will be assumed when the survey has been returned. Results will be disseminated via publications in peer-reviewed journals and talks at conferences. By combining quantitative and qualitative methods, our results will support future research for crafting potential interventions to expand the role of non-physician medical staff in rural primary care.

The association between supportive social ties and autonomic nervous system function-differences between family ties and friendship ties in a cohort of older adults.

Supportive family and friendship ties can serve different functions and thus might show different associations with an individual's health. Particularly, older adults might show varying health benefits of different types of supportive ties depending on their marital and retirement status. Our aim is to analyze relationships between different types of supportive social ties and autonomic nervous system (ANS) function, a physiological indicator of health that can help to establish the biological plausibility of the association-measured by heart rate variability (HRV). We present cross-sectional linear regression analyses of a German cohort of community-dwelling older adults (2008-2010; n = 1,548; mean age = 68.7 years). Our findings indicate that supportive friendship ties show significant positive associations (i.e., higher HRV) in individuals that are either not married or above retirement age. Supportive family ties show significant positive associations in individuals below retirement age. Significant results vanish or are reduced after accounting for behavioral/physical and psychological/cognitive indicators. We conclude that programs supporting the development or maintenance of friendship ties might be especially beneficial in unmarried older adults and adults above retirement age. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00638-2.

Associations Between Work Characteristics, Engaged Well-Being at Work, and Job Attitudes - Findings from a Longitudinal German Study.

Objective: The Job Demand & Resources model suggests work characteristics are related to mental well-being and work engagement. Previous work describes the development of a combined construct 'engaged well-being at work' (EWB). To what extent changes in measures of this construct are responsive to changes in job demands and resources or associated with changes in job-related attitudes has not been established. Methods: Longitudinal employee-level data from three waves (German Linked Personnel Panel) were used. Logistic and linear fixed effects regression analyses explored longitudinal associations between changes in EWB for participants over a three-year period with changes in job demands and resources and job-related attitudes (job commitment, satisfaction, and turnover intentions). Results: While job resources were associated with increased odds for a change into a healthier and/or more engaged category of EWB, job demands reduced them. Job resources were more strongly related to higher EWB (ORrange = 1.22 - 1.61) than job demands (ORrange = 0.79 - 0.96). Especially psychological job demands showed negative associations with improved EWB (OR = 0.79). A change from the least desirable category 'disengaged strain' to any other category of EWB was associated with greater odds by up to 20.6 % for increased commitment and job satisfaction and lower odds for turnover intentions. Discussion: Improving work characteristics, especially job resources, could increase employees' EWB, emphasizing the importance of job characteristics for a healthy workplace. Because EWB seems to be associated with job attitudes, an improvement of this indicator would be relevant for employees and employers.

The relationship between ambivalence towards supervisor's behavior and employee's mental health.

Ambivalence in social interactions has been linked to health-related outcomes in private relationships and recent research has started to expand this evidence to ambivalent leadership at the workplace by showing that ambivalent supervisor-employee relationships are related to higher stress levels in employees. However, the mental health consequences of ambivalent leadership have not been examined yet. Using a multilevel approach, this study estimated associations of ambivalent leadership with mental health indicators (depression, anxiety, vital exhaustion, fatigue) in 993 employees from 27 work groups. A total effect of ambivalent leadership was found for all four mental health measures, as well as within-group and between-group effects. The consistent relationships of ambivalent leadership with higher symptoms of mental ill-health at the individual- (i.e., within-group) and the group-level (i.e., between-group) support the existence of an un-confounded association, as well as group effects of collective ambivalence.

The Pathobiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Case for Neuroglial Failure.

Although myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) has a specific and distinctive profile of clinical features, the disease remains an enigma because causal explanation of the pathobiological matrix is lacking. Several potential disease mechanisms have been identified, including immune abnormalities, inflammatory activation, mitochondrial alterations, endothelial and muscular disturbances, cardiovascular anomalies, and dysfunction of the peripheral and central nervous systems. Yet, it remains unclear whether and how these pathways may be related and orchestrated. Here we explore the hypothesis that a common denominator of the pathobiological processes in ME/CFS may be central nervous system dysfunction due to impaired or pathologically reactive neuroglia (astrocytes, microglia and oligodendrocytes). We will test this hypothesis by reviewing, in reference to the current literature, the two most salient and widely accepted features of ME/CFS, and by investigating how these might be linked to dysfunctional neuroglia. From this review we conclude that the multifaceted pathobiology of ME/CFS may be attributable in a unifying manner to neuroglial dysfunction. Because the two key features - post exertional malaise and decreased cerebral blood flow - are also recognized in a subset of patients with post-acute sequelae COVID, we suggest that our findings may also be pertinent to this entity.

Perceived importance of pandemic interventions for attending cultural events - findings from Germany.

BACKGROUND: During the first waves of the COVID-19 pandemic, many cultural and sporting events were held without spectators or had to be cancelled. Therefore, several containment strategies to provide requirements for safe events were developed and tested. Nonetheless, every second (50.7%) is afraid of becoming infected on an event. We therefore investigated which hygiene and containment measures are perceived to be important from the visitor's point of view and thus might increase subjective sense of safety. METHODS: This online study was carried out in November 2020. A total of 1,004 persons, who regularly attended events before the pandemic, took part in the study. The importance of different hygiene and containment measures was evaluated using a 5-point Likert-scale (1 "unimportant" to 5 "extremely important"). Potential statistical differences in socio-demographical aspects (age, gender, net disposable income for leisure activities) and attendance on events were tested with analyses of variance. RESULTS: Participants perceived the use of disinfectant (M = 4.10) as the most important element of containment strategies, followed by transparent information on the hygiene strategy (M = 4.00), reduced occupancy (M = 3.98), and optimized ventilation (M = 3.97). Body temperature measurement at the entrance (M = 3.27), a negative SARS-CoV-2 test (M = 3.11), completion of a health questionnaire (M = 3.05), and abandoning breaks and catering (M = 2.98) were considered as less important. Analyses of group differences in socio-demographical aspects found abandoning breaks and catering to be more important to men than to women. This strategy is also more important to people aged 66 and above than to younger age groups (e.g., age 20-40). For women, the use of disinfectant is considerably more important. No other significant differences exist. CONCLUSION: Combining relevant measures appears to be important to provide a safe containment strategy. Measures aimed at positively influencing people's sense of safety do not fully correspond to researched knowledge of effectiveness. There are also target group-specific differences in the rating of measures, which should be considered while preparing containment strategies. To describe the dynamic development of changes in subjective rating of containment strategies, continuing research is needed.

Creating a measure to operationalize engaged well-being at work.

BACKGROUND: Mental well-being and work engagement are both desirable, positive states of mind that help employees to better function in the workplace. While occupational researchers have argued in favor of considering both states concurrently, it is less clear how this might be translated to provide an instrument characterizing the workforce accordingly. The present study describes empirical efforts to operationalize a construct called engaged well-being. METHODS: We used employee-level data (n = 13,538) from three waves of the German linked personnel panel (LPP; 2012-2017). Exploratory factor analysis and a combination of hierarchical and non-hierarchical cluster analyses linked with within-sum-of-squares statistics were used to identify distinct profiles describing mental well-being and work engagement concurrently. These profiles were then used as the basis to identify cut-offs to create replicable categories of engaged well-being. Using the longitudinal data from a subgroup providing data across more than one wave, we observed whether the newly constructed indicator changed over time. RESULTS: The exploratory factor analysis suggested that both states were two distinct factors. Cluster analysis linked with within-sum-of-squares statistics suggested a four-cluster solution: engaged well-being (46.9%), disengaged well-being (27.5%), engaged strain (8.8%), and disengaged strain (16.8%). One cut-off for each state was identified to replicate the cluster solution. Across observation periods, we could observe changes in engaged well-being. CONCLUSIONS: Our measure of engaged well-being can be used to simultaneously characterize a workforce's mental well-being and work engagement. Changes in this measure over time suggest its potential utility in organizational interventions. Future studies are needed to further explore both the antecedents, correlates, and potential effects of engaged well-being.

Stress at work is associated with intima media thickness in older male employees, independent of other sources of stress perception.

Chronic stress at work shows a moderate but robust longitudinal association with cardiovascular disease (CVD). Atherosclerosis is a pathophysiological process of most CVD, for which intima media thickness (IMT) of the carotid artery is used as an early marker. Its relationship with stress at work has remained largely unexplored, and the present study therefore aimed to elucidate the association between stress at work, assessed as effort-reward imbalance (ERI), and IMT. This cross-sectional study comprised of 501 male German employees aged 42 (19-64) years at enrollment into the Mannheim Industrial Cohort Study. Clinical assessments used fasting blood samples and IMT measurement. Self-report questionnaires assessed sources of perceived stress. Analyses adjusted for medical history, life style, and socio-economic status (SES) indicators as well as general perceived stress and worries to determine the specificity of ERI. Linear regression models estimated the association of ERI with IMT, stratifying for age groups and adjusting for potential confounders. ERI ratio increased until the age of 50 years and abated thereafter. In participants younger than 50 years IMT measurements were not associated with ERI ratios. However, despite lower mean ERI ratios in participants older than 50 years, this age group showed a significant relationship with IMT (standardized Beta = .36, p < .01), adjusting for multiple confounders including general perceived stress and worries. These analyses suggest that atherosclerosis in older employees is specifically related to stress at work. Longitudinal studies will help to elucidate the temporal relationship between stress exposure and downstream biological mechanisms.Lay summaryOur study explored the association of job stress and the calcification of the carotid artery in German employees. We found out that this association is stronger in employees older than 50 years. In addition, it is independent of medical risk factors and stress caused by private issues.

The association of cortisol levels with leukocyte distribution is disrupted in the metabolic syndrome.

BACKGROUND: Leukocyte glucocorticoid sensitivity (GCS) pertains to the responsivity of leukocytes to the regulating actions of glucocorticoids, such as cortisol. Impaired endocrine regulation may link the metabolic syndrome (MetS) to the development of cardiovascular disease. We tested if the physiological association between endogenous cortisol levels and peripheral leukocyte composition becomes disrupted in individuals with MetS. METHODS: MetS was assessed among 689 German industrial employees. The covariance between cortisol levels and hematologic parameters (i.e., proportions of neutrophils and lymphocytes) and their ratio was explored, which has been proposed as a proxy for GCS in vivo. Cortisol level before blood collection was assessed by repeated saliva collection, and the area under the curve was calculated. Linear regression models were adjusted for potential confounders including age, gender, BMI, income, and lifestyle factors. RESULTS: Cortisol levels did not differ between subgroups. Participants without MetS (n = 552) showed the expected association of cortisol with hematologic parameters (ß = 0.207 to 0.216; p values < 0.001). No association (ß = 0.078 to 0.083; p values > 0.10) was found among those with MetS (n = 137), consistent with a reduced GCS. Analyses of separate MetS components showed that reduced GCS was associated specifically with decreased high-density lipoprotein and elevated fasting plasma glucose. CONCLUSIONS: Utilizing a novel statistical approach to infer GCS, this study provided first epidemiological evidence of aberrant physiological regulation of leukocyte distribution by endogenous cortisol levels among individuals with MetS. These findings underline the idea that MetS may involve disruption of endocrine-immune regulation.

Estimating the potential reduction in future sickness absence from optimizing group-level psychosocial work characteristics: a prospective, multicenter cohort study in German industrial settings.

BACKGROUND: Absence from work due to sickness impairs organizational productivity and performance. Even in organizations with perfect work conditions, some inevitable baseline sickness absence exists amongst working populations. The excess sickness absence observed above this baseline rate has become the focus of traditional health promotion efforts, addressing preventable physical illness, health behavior and mental health at the personal level. However, a health and safety approach following the TOP-rule would consider work-group psychosocial work characteristics as a potential risk factor amenable to organizational measures. To date, there is a scarcity of studies relating psychosocial work characteristics to possible reduction of excess sickness-absence rates. METHODS: We aimed to estimate the potentially avoidable excess fraction of absence attributable to work-group psychosocial characteristics. We considered work-group averaged perception of psychosocial work characteristics as a proxy to the methodologically elusive objective assessment of organizational characteristics. Participants were recruited from multiple sites of a German automotive manufacturer with individuals nested within work groups. We predicted 12-month follow-up work-group sickness absence rates using data from a baseline comprehensive health examination assessing work characteristics, health behavior, and biomedical risk factors. We considered the quartile of work-groups yielding favorable psychosocial work characteristics as a realistic existing benchmark. Using the population attributable fraction method we estimated the potentially amenable sickness absence from improving work-group psychosocial characteristics. RESULTS: Data from 3992 eligible participants from 29 work groups were analyzed (39% participation rate, average age 41.4 years (SD = 10.3 years), 89.9% males and 49% manual workers.). Work-group absence rates at follow up varied from 2.1 to 8.9% (mean 5.1%, 11.7 missed days). A prediction model of seven psychosocial work characteristics at the work group level explained 70% of the variance of future absence rates. The estimated reduction from improving psychosocial work characteristics to the benchmark level amounted to 32% of all sickness absence, compared to a 31% reduction from eliminating health behavioral and medical risk factors to the benchmark target. CONCLUSIONS: Psychosocial characteristics at the work-group level account for a relevant proportion of all sickness absence. Health promotion interventions should therefore address psychosocial characteristics at the work group level.

Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland.

PURPOSE: COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. METHODS: We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. RESULTS: The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV­2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV­2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. CONCLUSION: Most ROIs reported a deep impact of SARS-CoV­2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.