S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.

Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.

Occupational resource profiles for an addressee orientation in occupational health management: a segmentation analysis.

Introduction: In order to make sustainable decisions in precision prevention and health promotion, it is important to adequately assess people's demands and resources at work. To reach them in an addressee-oriented way, a segmentation of employers and employees based on occupational resources is a promising option. We identified profiles based on personal and perceived organizational resources. Furthermore, we used job demands for profile descriptions to obtain a deeper understanding of the profiles, characterizing people with similar occupational resources. Methods: Personal occupational resources (occupational health literacy and self-efficacy) and perceived organizational resources (job decision latitude and participation in health at work) were assessed among employers and employees (n = 828) in small- and medium-sized enterprises in Germany. Job demands, socioeconomic status, and hierarchy levels in the company were used for further profile descriptions. Results: A six-profile solution fitted best to the data based on cluster and profile analyses. One profile was characterized by above-average occupational resources, and another profile was characterized by below-average resources. The other four profiles showed that the individual and perceived organizational resources contrasted. Either organizational resources such as job decision latitude existed and personal resources were not highly developed or people had high individual motivation but few possibilities to participate in health at work. People with medium or high job demands as well as people with low socioeconomic status were most frequently in below-average resource profiles. Employers with high hierarchy levels were overrepresented in the above-average profiles with high organizational resources. Discussion: Following the segmentation of the addressees, organizations might be supported in identifying needs and areas for prevention and health promotion. Interventions can be optimally developed, tailored, and coordinated through a deeper understanding of job demands and resources. Especially employees with low socioeconomic status and high job demands might profit from an addressee-orientated approach based on resource profiles. For example, employees obtain an overview of their occupational resource profile to recognize the development potential for safe and healthy behavior at work. Follow-up research should be used to examine how this feedback to employers and employees is implemented and how it affects the sustainability of tailored interventions.

Occupational Health Literacy Scale (OHLS): development and validation of a domain-specific measuring instrument.

Occupational health literacy (OHL) is a domain-specific approach that can empower people to make health-appropriate decisions in the work environment. OHL comprises the knowledge, skills and willingness of people to access and process health-related information and to apply it in work situations. The aim of this study was to evolve a conceptual model and validate a scale for OHL, that can be used in many sectors in the Western industrial countries, which does not yet exist. After piloting, item selection and alteration were carried out in a pretest with n = 163 working adults in diverse small- and medium-sized enterprises in Germany. The resulting OHL items were validated in a main survey with n = 828 participants working in small- and medium-sized enterprises and among them 47.5% people with migration background. The final 12-item questionnaire had good structural characteristics and is reliable and valid for measuring OHL. Using exploratory structural equation modeling, good fit indices (root mean square error of approximation = 0.063, comparative fit index = 0.940) confirmed a two-factor structure: (i) knowledge and skill-based processing of health information (internal consistency α = 0.88) and (ii) willingness and responsibility for occupational health (α = 0.74). The OHL scale fills the gap regarding domain-specific OHL questionnaires for working adults in diverse sectors in Western industrial countries. The Occupational Health Literacy Scale can be used to identify the needs of employees and companies and then to adapt and evaluate health promotion measures. Further research could include validation and use in other countries and large companies.

New Work Poses New Challenges-The Importance of Work Design Competencies Revealed in Cluster Analysis.

The continuous transformation process in the world of work, intensified by the COVID-19 pandemic, is giving employees more scope to shape their own work. This scope can be experienced as a burden or as a resource for employees. Work design competencies (WDC) describe employees' experience of their scope for design. Our study draws on existing datasets based on two Germany-wide studies. We used hierarchical cluster analyses to examine patterns between WDC, the age of employees (range: 18-71 years), the amount of weekly work time working from home (WFH), and work ability. In total, the data of N = 1232 employees were analyzed, and 735 of them participated in Study 1. To test the validity of the clusters, we analyzed data from N = 497 employees in Study 2. In addition, a split-half validation was performed with the data from Study 1. In both studies, three clusters emerged that differed in age and work ability. The cluster with the highest mean of WDC comprised employees that were on average older and reported a higher mean of work ability. Regarding WFH, no clear patterns emerged. The results and further theoretical and practical implications are discussed. Overall, WDC appear to be relevant to work ability and, in a broader sense, to occupational health, and are related to sociodemographic factors such as age.

Uptake of Voluntary Occupational Health Care-Assessments of German Occupational Health Physicians and Employees.

Workers' health surveillance is considered essential for employees' health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

Healthy and Happy Working from Home? Effects of Working from Home on Employee Health and Job Satisfaction.

In addition to its catastrophic health effects, the COVID-19 pandemic also acts as a catalyst for new forms of work. Working from home (WFH) has become commonplace for many people worldwide. But under what circumstances is WFH beneficial and when does it increase harms to health? The aim of this study was to investigate the influence of specific characteristics of WFH for health (work ability, stress-related physical and psychological symptoms) and job satisfaction among German employees. The study is based on data from a Germany-wide panel survey with employees from different industries (n = 519). Using multiple regressions, it was found that the functionality of the technical equipment at home has positive effects on the health of employees (i.e., ability to work, stress-related symptoms) and job satisfaction. The percentual weekly amount of WFH influences stress-related symptoms, i.e., a higher amount of weekly working time WFH, was associated with more stress-related symptoms. Furthermore, it negatively influences job satisfaction. The feeling of increased autonomy leads to positive effects on employees' job satisfaction. The results provide starting points for interventions and indicate the need for legal regulations for WFH. Further theoretical and practical implications are discussed.

Start moving - benefits of an onsite workplace health program in the age of digitalization.

BACKGROUND: The process of digitization should simplify our work and improve related processes (i.e. quality, transparency). Moreover, it enables the home office, which is greatly expanded due to the current pandemic. Regarding workplace health, it should be noted that with increasing digitization, physical activity decreases, and as a result, the number of work-related diseases will increase. On the other hand, increasing digitization also offers promising opportunities for new approaches to workplace health promotion. With these positive as well as negative effects in mind, we designed a workshop to increase physical activity at work. This protocol describes our approach to a live workshop concept. METHODS: We use a randomized controlled trial with two intervention groups: a live workshop with and without additional reminders. The workshop intervention design consists of a baseline measurement, two workshops, and one follow-up measurement. Each workshop takes place in small groups (n < 11). We use a randomized allocation to both groups. To control for health-related effects and the expected behavior change we examine (i) physical activity (i.e. active time, taken steps, etc.) by a tracking device (ii) physical wellbeing, motivation, and volition by an online questionnaire, and (iii) participants also report physical activity by a diary. All measurements are taken one week before the respective workshop and 24 weeks after the initial baseline measures. DISCUSSION: A live workshop offers advantages such as very personal interactions and a low technical effort. However, during the current pandemic, there are some limitations (i.e. small groups, pay attention to hygienic guidelines). Based on the upcoming experiences of this workshop, a web-based approach might offer some advantages (i.e. easier daily implementation, independent from a participant's location) regarding home office workplaces and the increasing digitization. On the other hand, there are also mandatory requirements as a stable internet connection and technical equipment (i.e. webcam, microphone). Overall, a step by step development of a web-based workshop, based on the experience of the live workshop, can be regarded as advantageous. TRIAL REGISTRATION: Since this article reports a health promotion intervention concept with human participants, we registered it in the German Clinical Trials Register (DRKS). Number: DRKS00021512 , Date:30.10.2020.

How Are Techno-Stressors Associated with Mental Health and Work Outcomes? A Systematic Review of Occupational Exposure to Information and Communication Technologies within the Technostress Model.

The technostress model has introduced different factors to consider when assessing how information and communication technologies impact individuals in different work settings. This systematic review gathers evidence regarding associations between occupational exposure to technostress and health or work outcomes. In addition, we highlight typical methodological constraints of the technostress model. We conducted electronic literature searches in June 2020 (PubMed, PubMed Central, Web of Science, Scopus, PsycInfo, PsycArticles) and independently screened 321 articles. We report on 21 articles meeting eligibility criteria (working population, technostress exposure, health or work outcome, quantitative design). The most frequently examined techno-stressors, i.e., factors of technostress, were techno-overload and techno-invasion. Techno-stressors were consistently associated with adverse health and work outcomes, apart from a positive impact on work engagement. However, studies may be subject to considerable conceptual overlap between exposure and outcome measures. Future technostress research would benefit from reducing heterogeneity in technostress measures, assessing their external validity and focussing on specific techno-stressors.

Is There a Sampling Bias in Research on Work-Related Technostress? A Systematic Review of Occupational Exposure to Technostress and the Role of Socioeconomic Position.

Technostress is a widespread model used to study negative effects of using information communication technologies at work. The aim of this review is to assess the role of socioeconomic position (SEP) in research on work-related technostress. We conducted systematic searches in multidisciplinary databases (PubMed, PubMed Central, Web of Science, Scopus, PsycInfo, PsycArticles) in June 2020 and independently screened 321 articles against eligibility criteria (working population, technostress exposure, health or work outcome, quantitative design). Of the 21 studies included in the narrative synthesis, three studies did not collect data on SEP, while 18 studies operationalised SEP as education (eight), job position (five), SEP itself (two) or both education as well as job position (three). Findings regarding differences by SEP are inconclusive, with evidence of high SEP reporting more frequent exposure to overall technostress. In a subsample of 11 studies reporting data on educational attainment, we compared the percentage of university graduates to World Bank national statistics and found that workers with high SEP are overrepresented in nine of 11 studies. The resulting socioeconomic sampling bias limits the scope of the technostress model to high SEP occupations. The lack of findings regarding differences by SEP in technostress can partly be attributed to limitations in study designs. Studies should aim to reduce the heterogeneity of technostress and SEP measures to improve external validity and generalisability across socioeconomic groups. Future research on technostress would benefit from developing context-sensitive SEP measures and quality appraisal tools that identify socioeconomic sampling biases by comparing data to national statistics.

Challenges arising for older workers from participating in a workplace intervention addressing work ability: a qualitative study from Germany.

OBJECTIVE: Studies examining what renders workplace interventions to sustain and promote work ability of older workers successful have largely neglected older workers´ perspective. This paper outlines the results of a study with regard to older workers´ experiences and expectations of a workplace intervention. Based on these findings, some reflections on how to improve the design and the implementation of workplace interventions for older workers are provided. METHODS: Semi-structured interviews were conducted with older workers (N = 8) participating in a workplace intervention undertaken at one production site of a large manufacturing company in Baden-Wurttemberg/Germany. The interview guide included questions on participants´ experiences with and expectations of the intervention. The interviews were recorded, transcribed verbatim and analyzed using qualitative content analysis according to Mayring (2014). RESULTS: Older workers´ reported some challenges they face due to their participation in the workplace intervention. These resulted from the work environment (physical challenges), the work process design (new long work cycle), the work organization (tight time allowances, little job rotation, change of teams, age stereotypes) and the management of the workplace intervention (bad information, feeling of occupational insecurity and lack of being valued). CONCLUSIONS: The study shows that challenges arising for older workers from their participation in the workplace intervention may have counteracted the promotion of work ability. As findings suggest, some of these challenges might have been avoided either by considering workers´ perspective during design and implementation of an intervention or by referring to evidence on aging and work ability.

The social and health implications of digital work intensification. Associations between exposure to information and communication technologies, health and work ability in different socio-economic strata.

PURPOSE: Older employees are often thought to be vulnerable to negative effects of information and communication technology (ICT). Our study aims to examine associations between work-related ICT exposure (i.e. ICT use or digital work intensification), physical health, mental health and work ability (WA). We examine whether these associations are modified by socio-economic position (SEP). METHODS: We analysed cross-sectional data from 3180 participants (born in 1959 and 1965) in wave 3 of the representative German lidA cohort study. We performed hierarchical multiple regression to assess the distinct associations of ICT use and digital work intensification with mental and physical health and WA. We stratified analyses by SEP and controlled for age, sex, and digital affinity. RESULTS: 92% of participants reported ICT use at work. Almost 20% reported high levels of digital work intensification, while a similar proportion did not experience digital work intensification. In bivariate analyses, ICT use by itself was not significantly associated with mental health or WA in the total sample or when stratified. Digital work intensification displayed negative associations with mental health and WA. In hierarchical multiple regressions, digital work intensification showed consistently negative associations with mental health and work ability of similar strength across SEP. CONCLUSION: Our results suggest that ICT use, per se, does not negatively impact older workers. Digital work intensification may be associated with worse mental health and work ability. Research on health and social implications of work-related ICT should differentiate patterns of ICT exposure and assess modifications by SEP to better gauge the ambiguous effects of ICT.

The Influence of Different Auditory Stimuli on Attentiveness and Responsiveness in Road Traffic in Simulated Traffic Situations.

The use of portable media has become an integral part of our increasingly mobile society. The use of digital audio books is also growing steadily in Germany. The connection between the psychological effect of music of different volumes and rhythms and the change in reaction in road traffic with a corresponding increase in risk behavior, especially when driving, has already been proven in previous studies. Only a few studies are available on the effects of listening to radio plays on reaction behavior and concentration in road traffic as well as on risk behavior among pedestrians and cyclists. In the present study, we have investigated the influences of pop music and a radio play on reaction behavior and thus driving ability during the execution of a traffic psychological test series from the "Wiener Test System". The central topic deals with the performance of the test subjects in the individual tests. Conclusions are drawn on the reaction behavior and concentration during participation in road traffic and thus the risk of distraction and possible increased risk of accidents. Studies on the influence of auditory stimuli and their effects on concentration and reaction during participation in traffic are of great interest from the point of view of traffic psychology and occupational medicine, since a reduction in the risk of accidents can increase general traffic safety and lead to a decrease in sick leave and therefore fewer absences from work.

Image and perception of physicians as barriers to inter-disciplinary cooperation? - the example of German occupational health physicians in the rehabilitation process: a qualitative study.

BACKGROUND: In the German rehabilitation system, primary care physicians (PCPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different distinct functions and roles. While effective cooperation can improve outcomes of rehabilitation, the cooperation between these groups of stakeholders has been criticized as lacking or insufficient. This article proposes an approach to understand the low levels of cooperation by examining the role of group perception and group identity in intra-professional cooperation as a barrier to cooperation between physicians in different roles. Group perception was evaluated in terms of (1) negative views about another group of medical specialists and (2) differences between the perception of members and non-members of a medical specialty group. To examine this issue, we focused on the role of OPs in the German rehabilitation process. METHODS: We implemented a qualitative study design with eight focus group discussions with PCPs, OPs, RPs, and patients (two focus group discussions per stakeholder group; 4-10 participants) and qualitative content analysis. We used the Social Identity Approach by Tajfel and Turner as a theoretical underpinning. RESULTS: While all protagonists reported a positive perception of their own professional group, we found numerous negative perceptions about other groups, especially regarding OPs. Negative perceptions of OPs included 1) apparent conflict of interest between employer and employee, 2) lack of commitment to patient outcomes, 3) lack of useful specialized knowledge which could have a bearing on rehabilitation outcomes, and 4) distrust on the part of their patients. We also found divergent perceptions regarding roles, responsibilities, and capabilities among the specialist groups. Both negative and conflicting perceptions about roles were characterized as barriers to cooperation by study participants. CONCLUSION: This example of cooperation between RPs, OPs, and PCPs suggests that negative and diverging perceptions about an out-group could create barriers in intra-professional and inter-disciplinary cooperation between physicians. These perspectives might also be useful in explaining problems at intersections between different specialties. We suggest examining the inter-group dimension of perception-based barriers to cooperation in future interventions to overcome problems caused by intra-professional and inter-disciplinary conflicts in addition to other barriers (i.e. organizational hurdles).

[Occupational Health Physicians and Rehabilitation - A Cross-sectional Study on Occupational Health Care in Schleswig-Holstein and Baden-Württemberg]. / Betriebsärzte und Rehabilitation ­ Eine Querschnittsstudie zum betriebsärztlichen Handeln in Schleswig-Holstein und Baden-Württemberg.

Objective Description and explanation of involvement of occupational health physicians in rehabilitation Methods Data were collected by a survey of occupational health physicians in Schleswig-Holstein and Baden-Württemberg. Logistic regression models were calculated to identify determinants of the involvement of occupational health physicians before, during and after rehabilitation. Results During the last year 70% of the occupational health physicians have supported at least one worker when applying for medical rehabilitation. About a half has had at least once contact to a rehabilitation facility during the rehabilitation treatment of an employee, and 9 out of 10 physicians have supported at least one employee after her or his rehabilitation when returning to work. Support by occupational health physicians is more likely when they feel responsible for rehabilitation, are well informed and frequently involved in occupational reintegration management. Conclusions Occupational health physicians may be important stakeholders for preparing and supporting rehabilitation.

Optimizing cooperation between general practitioners, occupational health and rehabilitation physicians in Germany: a qualitative study.

PURPOSE: To achieve successful medical rehabilitation and timely return to work, general practitioners, occupational health and rehabilitation physicians need to cooperate effectively. This cooperation, however, can be hampered by organizational, interpersonal, and structural barriers. In this article, we present and discuss suggestions proposed by physicians and patients on how these barriers can be overcome. METHODS: We conducted eight qualitative focus group discussions with general practitioners (GPs), occupational health physicians (OPs), rehabilitation physicians (RPs) and rehabilitation patients, which we analyzed with qualitative content analysis methods. RESULTS: Room for improvement exists with regard to (1) regulation (e.g. formalized role and obligatory input of occupational physicians), (2) finance (e.g. financial incentives for physicians based on the quality of the application), (3) technology (e.g. communication by email), (4) organizational procedures (e.g. provision of workplace descriptions to RPs on a routine basis), (5) education and information (e.g. joint educational programs, measures to improve the image of OPs), and (6) promotion of cooperation (e.g. between OPs and GPs in regards to the application process). CONCLUSIONS: Many suggestions are practical and could be implemented into the daily routine of physicians, while others demand multi-level, multi-stakeholder approaches. Our findings are supported by numerous international studies (especially from Western Europe). Future quantitative research could assess the relative weight of these findings. Feasibility and effectiveness of the proposed suggestions should be tested in controlled interventional studies.

Experiences, attitudes and possibilities for improvement concerning the cooperation between occupational physicians, rehabilitation physicians and general practitioners in Germany from the perspectives of the medical groups and rehabilitation patients - a protocol for a qualitative study.

INTRODUCTION: Rehabilitation measures for patients in the working age primarily aim at maintaining employability, restoring fitness for work or timely return to work (RTW). To facilitate RTW after long sick leave in Germany, both rehabilitation physicians' knowledge about the patients' workplace and communication between the rehabilitation physician and the occupational physician need to be improved. This research will record the experiences and attitudes of occupational physicians, rehabilitation physicians and general practitioners, as well as of rehabilitation patients, to indicate barriers and possibilities for improvement concerning the intersection between workplace and rehabilitation institution. As a previous literature review has shown, insufficient data on the experiences and attitudes of the stakeholders are available. Therefore, an exploratory qualitative approach was chosen. METHODS AND ANALYSIS: 8 focus group discussions will be conducted with occupational physicians, rehabilitation physicians, general practitioners and rehabilitation patients (2 focus groups with 6-8 interviewees per category). Qualitative content analysis will be used to evaluate the data, thus describing positive and negative experiences and attitudes, barriers and possibilities for improvement at the intersection of general and occupational medicine and rehabilitation with regard to the workplace. The data from the focus groups will be used to develop a standardised quantitative questionnaire for a survey of the medical groups and rehabilitation patients in a follow-up project. ETHICS AND DISSEMINATION: The research will be undertaken with the approval of the Ethics Committee of the Medical Faculty and University Hospital of Tuebingen. The study participants' consent will be documented in written form. The names of all study participants and all other confidential information data fall under medical confidentiality. The results will be published in a peer-reviewed medical journal independent of the nature of the results.