Professional football training and recovery: A longitudinal study on the effects of weekly conditioning session and workload variables.

The main purpose of this longitudinal study was to investigate football players' recovery status, through hormonal response, in relation to accumulated workload at two comparable time points of the first (T1) and second half (T2) of the competitive season. Moreover, this study investigated athletes' hormonal response to a typical weekly conditioning session (5 days before match: MD-5), at T1 and T2, to detect changes in players' recovery capability over time. Salivary cortisol (sC) and testosterone (sT) of 24 professional players (27.8 ± 4.1 years of age) were collected before, after, and 24 hours following MD-5 in two comparable microcycles of T1 and T2. GPS training data (total and high-intensity distance) of the 7 and 28 days before sampling were used to obtain athletes' acute and chronic workloads. Results showed a pre-training significant decrease of sT and an increase of sC (p<0.05) in T2, compared to T1. Moreover, athletes showed high sC and low sT levels before, after and 24 hours following MD-5 in T2. Workload analysis revealed significant correlations of chronic load with sC (r = 0.45, p = 0.056) and T/C ratio (r = -0.59; p = 0.007). These results suggested that, in professional football, chronic workload has a greater impact on players' recovery time than acute workload over the sport season. Moreover, athletes' hormonal response to the weekly conditioning session at T2 revealed an altered anabolic/catabolic balance, highlighting the key role of continuous internal and external workload monitoring during the season.

Can the stress be managed? Stress mindset as a mitigating factor in the influence of job demands on burnout.

AIM: Despite the serious consequences of exposure to high job demands for nursing staff, few studies have identified pathways that could reduce the influence of high job demands on burnout. The current study aimed to exaime whether a stress mindset mitigates the positive relationship between job demands and burnout. DESIGN: A cross-sectional survey was adopted and data were collected employing self-report questionnaires. METHODS: A convenience sample of 676 nurses recruited from six regional hospitals in China were invited to complete a demographic questionnaire, the Psychological Job Demand Scale, the Stress Mindset Scale and the Burnout Scale. Hierarchical multiple regression analysis and simple slope analysis were used to examine the moderating role of stress mindset. RESULTS: Higher job demands were positively linked to burnout, and stress mindset was negatively linked to burnout. Stress mindset moderated the positive relationship between job demands and burnout. Specifically, compared to nurses with a stress-is-debilitating mindset, the relationship will be smaller for nurses holding a stress-is-enhancing mindset. PATIENT OR PUBLIC CONTRIBUTIONS: Based on these findings, nursing leaders should foster nurses' stress-is-enhancing mindset, which can ameliorate the adverse effect of job demands.

Public health care staff during the COVID-19 pandemic: a comparison of job demands and work functioning between temporary and permanent staff.

BACKGROUND: The COVID-19 pandemic posed an enormous challenge on the public health workforce, leading to the hiring of much temporary staff. Temporary staff may experience poorer working conditions compared to permanent staff. From a public health perspective, we need to know how working conditions are experienced when there is an acute pressure on recruiting sufficient public health care staff. This study aimed to investigate differences in job demands and work functioning between temporary and permanent public health care staff, during the fourth wave of the COVID-19 pandemic in the Netherlands and compare it with available pre-pandemic data from the general working population. METHODS: This cross-sectional study included temporary (n = 193) and permanent (n = 98) public health care staff from a municipal health care service in the north of the Netherlands. The participants completed a questionnaire with items about quantitative, cognitive, emotional demands (Copenhagen PsychoSOcial Questionnaire, COPSOQ, range 1-100) and work functioning (Work Role Functioning Questionnaire, WRFQ, range 1-100). The participants' scores were compared to the general working population and differences between temporary and permanent staff were investigated using linear regression analysis. In addition, explorative analyses were conducted with temporary staff stratified by task and permanent staff by department. RESULTS: Permanent staff had relatively high scores on job demands compared to the general working population, whereas temporary staff had relatively low scores. On work functioning, permanent staff had similar scores as the general working population and temporary staff had better scores. Compared to permanent staff, temporary staff had lower, i.e. better, scores on quantitative (regression coefficient (B)=-26.7; 95% Confidence Interval (CI) -30.8 to -22.5), cognitive (B=-24.4; 95% CI -29.0 to -19.9), and emotional demands (B=-11.8; 95% CI -16.0 to -7.7), and better scores on work functioning (B = 7.8; 95% CI 4.5 to 11.3). CONCLUSIONS: Temporary staff experienced lower job demands and reported better work functioning than permanent staff. The acute expansion of the public health workforce did not seem to negatively impact the job demands and work functioning of temporary public health care staff.

Occupational stressors experienced by healthcare professionals in the course of the COVID-19 crisis.

The novel coronavirus has significantly impacted healthcare systems worldwide, exposing healthcare professionals (HCPs) to work-related stressors to prevent the spread of SARS-CoV-2. This study aimed to assess the occupational stress of HCPs in Lagos State, Nigeria, using a qualitative approach. The study involved nine HCPs from various departments, including doctors, nurses, and medical laboratory technicians. The main causes of stress were workload, policy changes, and extended use of personal protective gear. The study found high levels of occupational stress among HCPs, with workload being the main cause. The impact of the disease outbreak crisis on HCPs' lives and work demands was observed, with occupational demands categorized into safety risk at work and public perceptions. Employers and unions must respond to HCPs' needs for workplace protection and appropriate help to address stressors.

Le nouveau coronavirus a eu un impact significatif sur les systèmes de soins de santé dans le monde entier, exposant les professionnels de la santé (HCP) à des facteurs de stress liés au travail pour empêcher la propagation du SARS-CoV-2. Cette étude visait à évaluer le stress professionnel des HCP dans l'État de Lagos, au Nigeria, en utilisant une approche qualitative. L'étude a impliqué neuf HCP de divers départements, y compris des médecins, des infirmières et des techniciens de laboratoire médical. Les principales causes du stress étaient la charge de travail, les changements de politique et l'utilisation prolongée d'équipements de protection personnelle. L'étude a révélé des niveaux élevés de stress professionnel parmi les HCP, avec la charge de travail étant la principale cause. L'impact de la crise de l'épidémie sur la vie et les exigences professionnelles des HCP a été observé, les demandes de travail étant classées en catégories de risques pour la sécurité au travail et de perceptions du public. Les employeurs et les syndicats doivent répondre aux besoins des HCP en matière de protection des lieux de travail et d'aide appropriée pour faire face aux facteurs de stress.

Intraoperative teamwork and occupational stress during robot-assisted surgery: An observational study.

Robot-assisted surgery (RAS) differs from traditional OR set-ups in several ways such as operation of technology and obstructed team communication that potentially affect surgical staff's stress experiences. The current study investigates the effects of key intraoperative job demands and resources on mental workload and perceived stress in RAS. We focused on the role of intraoperative teamwork as a resource that potentially reduces occupational stress. Combining standardized expert observations in the OR with healthcare providers' self-reports, the study involved two types of robot-assisted, urological interventions. The sample consisted of 73 observed surgeries and included 242 post-operative surveys on perceived stress and mental workload from surgeons and surgical nurses. Multilevel regression analyses reveal differential effects for stress and workload. Importantly, whereas better surgical teamwork was associated with lower stress, it was unrelated to workload. Our findings provide a nuanced picture of occupational stress in RAS, particularly regarding the role of intraoperative teamwork.

Study approaches mediate associations between learning environment and academic performance.

BACKGROUND: While study approaches have been directly associated with students' academic performance, learning environment factors may play a more indirect role. The aim of this study was (i) to assess learning environment factors as predictors of students' average exam grades, and (ii) whether study approaches mediated associations between learning environment factors and exam grades. METHODS: Three annual surveys (2017-2019) yielded data from a total of 263 Norwegian occupational therapy students. Learning environment factors were assessed with the Course Experience Questionnaire, and the Approaches and Study Skills Inventory for Students were used to assess study approaches. Linear regression analyses and mediation analyses were performed. RESULTS: Higher levels of 'student autonomy' were directly associated with lower averaged grades whereas higher levels of 'appropriate workload' were associated with higher averaged grades. There were statistically significant total indirect effects of 'clear goals' and 'appropriate workload' on grades; these effects occurred through the study approach variables. However, all learning environment variables showed one or more relationships with academic performance that was mediated by study approach variables. CONCLUSION: Learning environment variables appear to be complexly associated with academic performance, both directly and indirectly.

Assessing the impact of COVID-19 management on the workload of human resources working in India's National Tuberculosis Elimination Program.

BACKGROUND: In 1993, WHO declared tuberculosis (TB) as a global health emergency considering 10 million people are battling TB, of which 30% are undiagnosed annually. In 2020 the COVID-19 pandemic took an unprecedented toll on health systems in every country. Public health staff already engaged in TB control and numerous other departments were additionally tasked with managing COVID-19, stretching human resource (HR) capacity beyond its limits. As part of an assessment of HR involved in TB control in India, The World Bank Group and partners conducted an analysis of the impact of COVID-19 on TB human resources for health (HRH) workloads, with the objective of describing the extent to which TB-related activities could be fulfilled and hypothesizing on future HR requirements to meet those needs. METHODS: The study team conducted a Workload Indicators and Staffing Needs (WISN) analysis according to standard WHO methodology to classify the workloads of priority cadres directly or indirectly involved in TB control activities as over-, adequately or under-worked, in 18 districts across seven states in India. Data collection was done via telephone interviews, and questions were added regarding the proportion of time dedicated to COVID-19 related tasks. We carried out quantitative analysis to describe the time allocated to COVID-19 which otherwise would have been spent on TB activities. We also conducted key informant interviews (KII) with key TB program staff about HRH planning and task-shifting from TB to COVID-19. RESULTS: Workload data were collected from 377 respondents working in or together with India's Central TB Division (CTD). 73% of all respondents (n = 270) reported carrying out COVID-19 tasks. The average time spent on COVID-19 tasks was 4 h / day (n = 72 respondents). Multiple cadres highly instrumental in TB screening and diagnosis, in particular community outreach (ASHA) workers and CBNAAT/TrueNAAT laboratory technicians working at peripheral, block and district levels, were overworked, and spending more than 50% of their time on COVID-19 tasks, reducing time for TB case-finding. Qualitative interviews with laboratory technicians revealed that PCR machines previously used for TB testing were repurposed for COVID-19 testing. CONCLUSIONS: The devastating impact of COVID-19 on HR capacity to conduct TB case-finding in India, as in other settings, cannot be overstated. Our findings provide clear evidence that NTEP human resources did not have time or essential material resources to carry out TB tasks during the COVID pandemic without doing substantial overtime and/or compromising on TB service delivery. To minimize disruptions to routine health services such as TB amidst future emerging infectious diseases, we would do well, during periods of relative calm and stability, to strategically map out how HRH lab staff, public health resources, such as India's Health and Wellness Centers and public health cadre, and public-private sector collaboration can most optimally absorb shocks to the health system.

Behind the scenes of research ethics committee oversight: a qualitative research study with committee chairs in the Middle East and North Africa region.

BACKGROUND: Research cites shortcomings and challenges facing research ethics committees in many regions across the world including Arab countries. This paper presents findings from qualitative in-depth interviews with research ethics committee (REC) chairs to explore their views on the challenges they face in their work with the oversight of research involving human populations. METHODS: Virtual in-depth interviews were conducted with chairs (n = 11) from both biomedical and/or social-behavioral research ethics committees in six countries, transcribed, coded and subject to thematic analysis for recurring themes. RESULTS: Two sets of recurring themes impede the work of the committees and pose concerns for the quality of the research applications: (1) procedures and committee level challenges such as heavy workload, variations in member qualification, impeding bureaucratic procedures, member overwork, and intersecting socio-cultural values in the review process; (2) inconsistencies in the researchers' competence in both applied research ethics and research methodology as revealed by their applications. CONCLUSIONS: Narratives of REC chairs are important to shed light on experiences and issues that are not captured in surveys, adding to the body of knowledge with implications for the region, and low- and middle-income countries (LMICs) in other parts of the world. International research collaborations could benefit from the findings.

The extent of interruptions to primary care medical officers' consultations in the Western Cape.

BACKGROUND:  Administrative tasks are an increasing burden for primary care doctors globally and linked to burnout. Many tasks occur during consultations. They cause interruptions with possible effects on patients' and doctors' experiences and care. The burden and typology of interruptions of doctors in primary care consultations have not been studied in South Africa. Given the link between administrative loads and burnout, describing the extent of these interruptions would help. This study's aim was to assess the extent of interruptions on primary care doctors in the Western Cape. METHODS:  This was a descriptive cross-sectional survey. Doctors from rural and urban primary care clinics in the Western Cape answered an online self-administered survey on the types of interruptions experienced during consultations. Interruptions were categorised and their prevalence calculated. Clinical and non-clinical interruption categories were compared. RESULTS:  There were 201 consultations from 30 doctors. Most interruptions were from retrieving and recording the current patient's information (93.0%), paperwork for other patients (50.7%), and telephone calls about the current patient (41.8%). Other prevalent interruptions were for emergencies (39.8%) and acquiring consumables (37.3%). The median (interquartile range [IQR]) of four (2-4) interruption types per consultation was higher than global settings. CONCLUSION:  Doctors experienced many interruptions during consultations. Their wide range included interruptions unrelated to the current patient.Contribution: This study adds insights from the global south on clinicians' administrative burden. It elaborates on the types of activities that interrupt consultations in an upper-middle income primary care setting. Exploration of interventions to decrease this burden is suggested.

Performance During a Task That Simulates Passive Sonar Operator Duties Under Conditions of Varying Workloads.

INTRODUCTION: It is critical to develop and implement lab-based computer experiments that simulate real-world tasks in order to characterize operational requirements and challenges or identify potential solutions. Achieving a high degree of laboratory control, operational generalizability, and ease-of-use for a task is challenging, often leading to the development of tasks that can satisfy some facets but not all. This can result in insufficient solutions that leave real-world stakeholders with unsolved problems. MATERIALS AND METHODS: This issue is addressed using a customized passive sonar simulator application that provides extensive researcher control over the design and manipulation of a sonar task; a visual appearance and cognitive demand similar to a true submarine-based sonar task; and a convenient and short training routine for sonar novices. The task requires participants to watch for multiple signal sources of varying appearance and salience and subsequently classify these signals into their respective categories. RESULTS: The current study investigated the effects of stimulus signal strength and signal density on sonar task performance-including metrics of classification accuracy, classification confidence, and response times-finding an interaction between signal density and signal strength that resulted in greater performance errors with high signal density at the weakest signal strength. CONCLUSIONS: The lab-based sonar application provides new possibilities for research, not limited to signal intensity and signal density but also through the manipulation of parameters such as the number of unique targets, target appearance, and task duration. This application may illuminate the operational demands that each of these factors may have on operator behavior within the dynamic tasks.

[Twenty-five years of child and adolescent psychiatry in the Netherlands: patterns of practice]. / 25 jaar Nederlandse kinder- en jeugd­psychiatrie in de praktijk.

BACKGROUND: The department of child- and adolescent psychiatry of the Dutch Association of Psychiatry has regularly investigated the practice of child- and adolescent psychiatry since 1996. This article reports the results of the 2021 survey. AIM: Investigating the composition and practice of the group of child- and adolescent psychiatrists, with special attention to the effect of the decentralization of child mental healthcare to the municipalities in 2015. METHOD: A postal survey; descriptive analysis of collected data. RESULTS: The number of child- and adolescent psychiatrists remained constant since 2012: 445, with sixty-eight percent women. Eighty percent works in institutional practice. Ten percent holds an interim position. Eighty percent reports an increase in workload. Professional satisfaction is mainly derived from patient care. CONCLUSION: Despite the unrest caused by the decentralization, the number of child- and adolescent psychiatrists remained stable over the last ten years. Since 2021 there have been negative, as well as positive developments. Therefore repetition of this survey in a few years is recommended.

A comparative analysis of nurses' reported number of patients and perceived appropriate number of patients in integrated nursing care services.

This study aimed to compare the number of assigned and appropriate patients per nurse in integrated nursing care service wards and analyze factors associated with the gap. For this cross-sectional secondary analysis, data were collected from surveys of 2312 nurses and institutional data from their affiliated 106 hospitals in Korea. We used the Wilcoxon signed-rank test and t-test to compare the number of patients assigned to nurses with the number they considered appropriate. We used ratio analysis for measuring the gap between these numbers, and robust regression to evaluate the factors affecting this gap. The results found an average gap of 1.45, indicating that the reported number of assigned patients per nurse was 1.45 times higher than the appropriate number. Gender, employment type, wage satisfaction, workload, overtime work, and hospital level of care were identified as factors associated with the gap. Findings suggest that the current nurse staffing standard should be revised to consider nurses' professional judgments of appropriate staffing levels and adopt policies that reduce nurses' workload.

Unraveling the interplay between mental workload, occupational fatigue, physiological responses and cognitive performance in office workers.

Recently, cognitive demands in workplaces have surged significantly. This study explored the intricate relationship among mental workload (MWL), occupational fatigue, physiological responses, and cognitive performance in office workers by using collective semi-parametric models. One hundred office workers were selected from twenty offices involved in cognitive performance. MWL was assessed through the NASA Task Load Index (NASA-TLX), and occupational fatigue was measured using the Persian version of the Swedish Occupational Fatigue Inventory. Physiological responses, including respiratory rate, the electrical conductivity of the skin (ECS), Heart Rate (HR), and other heart-related parameters, were recorded from the participants during a work shift. Selective and Divided Attention tests were chosen to evaluate workers' cognitive function based on cognitive task analysis. The mean of MWL and occupational fatigue scores were 66.28 ± 11.76 and 1.62 ± 1.07, respectively. There was a significant moderate correlation between two dimensions, mental demand (0.429) and frustration (0.409), with functional fatigue. Also, Significant and, of course, nonlinear relationships were observed between MWL and HR (R2 = 0.44, P-value < 0.001) and ECS (R2 = 0.45, P-value < 0.001) and reaction time in selected (R2 = 0.34, P-value < 0.001) and divided test (R2 = 0.48, P-value < 0.001). Similarly, nonlinear relationships were observed between physiological responses and cognitive performance with fatigue among participants who had experienced higher levels of occupational fatigue. The MWL and fatigue seem to have a significant and non-linear effect on physiological parameters such as HR and ECS and cognitive parameters such as reaction time. Moreover, MWL can influence the dimension of functional fatigue of workers.

A Bayesian approach to reveal the role of psychological factors on turnover intention among nurses during the COVID-19 pandemic.

BACKGROUND: Turnover intention is considered a significant challenge for healthcare and treatment organizations. The challenging conditions of treating COVID-19 patients and the physical and mental stress imposed on nurses during the pandemic may lead them to leave their jobs. The present study aimed to determine the role of psychological factors (general health, mental workload, work-family conflicts, and resilience) on turnover intention using a Bayesian approach during the COVID-19 pandemic. METHODS: The present cross-sectional study was carried out during the winter of 2021 at three hospitals in Khuzestan Province, Iran. To collect data for this investigation, 300 nurses were chosen based on Cochran's formula and random sampling technique. Seven questionnaires, including General Health, Mental Workload, Work-Family Conflict, Resilience, Job Stress, Fear of COVID-19, and Turnover Intention Questionnaires. Bayesian Networks (BNs) were used to draw probabilistic and graphical models. A sensitivity analysis also was performed to study the effects of the variables. The GeNIe academic software, version 2.3, facilitated the examination of the Bayesian network. RESULTS: The statistically significant associations occurred between the variables of fear of COVID-19 and job stress (0.313), job stress and turnover intention (0.302), and resilience and job stress (0.298), respectively. Job stress had the highest association with the fear of COVID-19 (0.313), and resilience had the greatest association with the work-family conflict (0.296). Also, the association between turnover intention and job stress (0.302) was higher than the association between this variable and resilience (0.219). At the low resilience and high job stress with the probability of 100%, the turnover intention variable increased by 20%, while at high resilience and low job stress with the probability of 100%, turnover intention was found to decrease by 32%. CONCLUSION: In general, the results showed that four psychological factors affect job turnover intention. However, the greatest impact was related to job stress and resilience. These results can be used to manage job turnover intention in medical environments, especially in critical situations such as COVID-19.

Development, validation, and cut-off points for a questionnaire to measure sources of stress in veterinary medicine (SOS-VetMed).

BACKGROUND: Occupational stress is a serious problem in veterinary medicine; however, validated instruments to measure this problem are lacking. The aim of the current study was to address this literature gap by designing and validating a questionnaire and establishing the cut-off points for identifying veterinarians with high and low levels of stress. METHODS: The study involved two sub-studies with two Spanish samples. The first study (N = 30 veterinarians; 66.7% women; 63.33% from small animal clinics) investigated the factors related to the work environment that caused the most stress; the results were analyzed using thematic content analysis. The second study (N = 1082; 70.8% women; 71.4% from small animal clinics) involved designing and validating a questionnaire to measure sources of stress in veterinary medicine, as well as establishing the cut-off points for interpreting the results using receiver operating characteristics (ROC) curve analysis. RESULTS: The first study showed the main sources of stress and allowed items to be defined for the questionnaire. The second study validated the Sources of Stress in Veterinarian Medicine (SOS-VetMed) questionnaire and confirmed five sources of stress with adequate reliability and validity indices: "work overload," "work-family conflict," "emotional burden of work," "organizational factors," and "emergency problems." Exploratory and confirmatory factor analyses verified a structure of five factors (Cronbach's alpha values ranging between 0.92 and 0.69). The five subscales of the SOS-VetMed questionnaire were positively correlated with two indicators of distress: "psychological complaints" and "psychosomatic complaints." The cut-off points indicated that 45.83% and 19.95% of the veterinarians surveyed had high and low levels of stress, respectively. CONCLUSIONS: The results confirmed that the SOS-VetMed questionnaire could be used to determine the stress levels of veterinarians and to design intervention programs to improve their workplace health.

Workload disparities and their role in the health of migrants and natives in Germany.

BACKGROUND: This study explores the health status differences between migrants and native Germans, focusing on potential disparities in their workloads. Physical and mental workloads can negatively impact individual health. Since various occupations come with distinct health-related patterns, occupational selection may contribute to systematic health disparities among socio-economic groups. Given the generally poorer health of migrants, they might experience systematic workload differences overall. METHODS: We suggest a conceptual framework for the empirical analysis based on the theory of health as a durable good with health consumption and health investment as key parameters. We quantify the role of work tasks, job requirements and working conditions on individual health based on detailed information from the BIBB/BAuA labour force survey 2012 and 2018. RESULTS: The empirical results reveal that migrants, i.e. foreigners and German citizens with a migration background, have a higher perception of workload and related health afflictions within the same occupation. Native Germans, on the other hand, experience a higher burden by high job requirements, both physically and mentally. The findings imply heterogeneous health impacts of work for migrants and native Germans due to differences in health consumption. CONCLUSIONS: The analysis shows that migrants report worse health than natives, with stronger negative effects of work-related conditions on their health, both physically and mentally. Women, in general, report poorer health conditions than men. The findings emphasize the importance of promoting human capital to reduce economic and health disparities, though caution is advised regarding affirmative actions for migrants; further research is needed to understand the underlying mechanisms and address these issues effectively.

A comparative analysis of weekly internal and external workloads between starting and non-starting professional soccer players: A retrospective 21-week examination.

OBJECTIVES: Aims of the present investigation encompassed: (i) the quantification of training and match loads experienced by starters and non-starters within a professional soccer team; (ii) the identification of variations in these loads across different training modalities, namely, Preparation Training (PT), Match and Match Compensation Training (M&MCT), and their cumulative sum (Total Load; TL); and (iii) the formulation of guidelines aimed at harmonizing the weekly workloads between the groups. METHODS: Internal and external load of training sessions (n = 97), competitive matches (n = 21) and running based sessions (n = 4) were recorded for 21 weeks to investigate possible heterogeneity between starters and non-starters across PT, M&MCT and TL. RESULTS: During PT, time spent in heart rate zone 5 (HRZ5) was increased for non-starters (+46.1%). During M&MCT, lower loads for non-starters were found in the rate of perceived exertion (sRPE) (-45.6%), HRZ4 (-54%) and HRZ5 (-77.8%), total distance (TD) (-37%), number of sprints (-58.1%), distance in speed zone 1 (-51.1%), zone 3 (-61.5%) and zone 4 (-59.8%) (SZ1, SZ3&4) and all acceleration and deceleration zones (Acc1-4; Dec1-4) (Acc1: -53.1%; Acc2: -56.3%; Acc3: -59.2%; Acc4: 57.8%) (Dec1: -45.9%; Dec2: -55.2%; Dec3: -63.2%; Dec4: -67.7%). Regarding TL, the non-starters' loads remain lower compared to starters for sRPE (-19.2%), HRZ4 (-21.6%) and HRZ5 (-41.4%), number of sprints (-26.7%), SZ3 (-34.2%), Acc3 (-24.4%), Acc4 (-26.1%), Dec2 (-18.7%), Dec3 (-24%) and Dec4 (-31.2%). CONCLUSIONS: By implementing a running-based regimen on matchday and MCT the day after (MD+1), TD, distances in SZ1, SZ2, SZ4, SZ5, and counts of accelerations in Acc1&2, as well as Dec1, were effectively replicated for non-starters. All other variables remained unaligned for the non-starters. Given the prevalent emphasis on Small-Sided Games (SSGs) during MCT at MD+1, the incorporation of an additional running-based session for non-starters on MD is advised to address gaps in TD, sprint counts, and high-intensity load variables, such as HRZ4&5 and SZ 3 to 5.

[Lack of skilled medical personnel as a structural problem]. / Medizinischer Fachkräftemangel als strukturelles Problem.

The healthcare system in Germany is characterized by a comprehensive local patient care. Nevertheless, due to the increasing lack of medical personnel bottlenecks are impending, which are not only of a temporary nature. The increasing demography-related needs for care, insufficient healthcare competence of many people and the inadequate prevention will strengthen the demand for medical and nursing personnel. At the same time, physicians and nursing personnel from the high birth rate baby boomer years are leaving the healthcare system. This age cohort must now be replaced by a younger workforce; however, in Germany too few physicians are being trained when measured against the requirements. A marked increase in the number of university study places in medicine will not be able to alleviate the deficit in the short term but prospectively there is no way past an expansion of capacities. The decline in panel physicians, especially in general practitioner care, is accompanied by a clear increase of employees in the outpatient sector. The desire for reduced working hours is clearly recognizable throughout all age cohorts. The part-time quota is increasing. The discrepancy between desired and actual working times is largely underestimated. The increased part-time quota already shows that something must fundamentally change to be able to provide sufficient medical manpower and working hours for the treatment of patients. The association between increased part-time quota and dissatisfaction with the working situation in hospitals is obvious and has repercussions for the medical care. In a multifactorial process the causes and sequelae of bottlenecks in skilled personnel are mutually strengthened in a negative spiral. In the short term, the deficit in medical personnel can only be counteracted by a better cooperation between the outpatient and inpatient fields of care and by a massive reduction in bureaucracy. The digitalization can without doubt contribute to the relief of the healthcare system. Telemedical applications can improve the treatment in rural and structurally weak regions.