[Investigating work, age, health and work participation in the ageing work force in Germany]. / Untersuchung von Arbeit, Gesundheit und Erwerbsteilhabe in Zeiten älter werdender Belegschaften in Deutschland.

Working life in Germany is changing. The work force is ageing and the number of people available to the labour market will - from now on - shrink considerably. Prospectively, people will have to work longer; but still today, most people leave employment long before reaching official retirement age. What are the reasons for this? In this report, a conceptual framework and the German lidA Cohort Study are presented. The "lidA conceptual framework on work, age, health and work participation" visualises determinants of employment (11 "domains") in higher working age, e. g., "work", "health", "social status" and "life style". The framework reveals 4 key characteristics of withdrawal from work: leaving working life is the result of an interplay of different domains (complexity); (early) retirement is a process with in part early determinants in the life course (processual character); retirement has a strong individual component (individuality); retirement is embedded in a strong structural frame (structure). On the basis of this framework, the "lidA Cohort Study on work, age, health and work participation" (www.lida-studie.de) investigates long-term effects of work on health and work participation in the ageing work force in Germany. It is the only large study in Germany operationalising the concept of employability in a broad interdisciplinary approach. Employees subject to social security and born in 1959 or in 1965 will be interviewed (CAPI) every 3 years (N[wave 1]=6 585, N[wave 2]=4 244) and their data will be linked (where consented) with social security data covering employment history and with health insurance data. The study design ("Schaie's most efficient design") allows for a tri-factor model that isolates the impact of age, cohort and time. In 2014, the second wave was completed. In the coming years lidA will analyse the association of work, health and work participation, and identify age as well as generation differences. lidA will investigate the complexity of work participation and assess the benefit of broader conceptual and methodological research approaches in the field.

[Determining the quality of long-term care. A comparative analysis of transparency criteria, resident-related indicators, and staff assessment]. / Messung der Pflegequalität in der Langzeitpflege. Eine vergleichende Analyse von Pflegetransparenzkriterien, bewohnerbezogenen Indikatoren und Beurteilungen der Mitarbeiter.

INTRODUCTION: From 2009, the quality of care in nursing homes in Germany is inspected, rated, and publicized. This study investigates the association between staff-perceived nursing quality, clinical quality indicators, and ratings of health insurance medical services based on the transparency of stationary care agreement (PTVS). METHODS: This was a cross-sectional study merging publicly reported data, clinical quality indicators of a national health provider system, and data from staff surveys. Data from 83 nursing homes were adjusted for sample size, age, and care level and analyzed using Kendall's tau coefficients and scatter plots. RESULTS: There were pronounced differences in staff-perceived nursing quality and some of the clinical indicators between facilities that were not detected by the PTVS. There was a weak association between staff-perceived quality and care quality rated by external inspections. No associations were found between the PTVS and clinical quality indicators. CONCLUSIONS: Differences between nursing home providers were detected to varying degrees by the three approaches and were if at all weakly associated. Given the aims followed by public reporting initiatives of nursing home providers, the results stress the importance of revising the PTVS.

[Perspectives of work, age, health, and labor market participation in Germany]. / Perspektiven von Arbeit, Alter, Gesundheit und Erwerbsteilhabe in Deutschland.

The German population is aging and shrinking. This will have a significant impact on the labor market, because labor supply will start to shrink. Consequently, there is a need to develop additional labor market resources. In this setting, a crucial issue is the health and employment of the older working population. This article discusses--on the basis of nine articles in this special issue--the health of the working population in the context of work, age, and labor participation. It shows the diversity of morbidity in the work force in general and particularly in older age, and it identifies older labor force groups with good health and those with bad health. The latter shows that "working while having a bad state of health" is today's reality. Labor market participation is less dependent on health than on the "work ability" and/or the "motivation to work" of older workers. The employment dynamics of an aging population will be a key issue in future political debate. A reliable knowledge base is needed for proper discussion, judgment, and action in the economic, political, and social fields. Current research is often focused on subtopics or on subgroups; however, a network of all the related scientific disciplines and the establishment of new comprehensive research approaches are needed in this area.

[Self-rated general health by occupation and age in the working population in Germany]. / Selbstberichteter allgemeiner Gesundheitszustand nach Beruf und Alter in der Erwerbsbevölkerung.

In occupations, self-rated general health status was examined under special consideration of age. Data from the GEDA 2009 and 2010 surveys (N = 26,303) were analyzed. Professionals had a low prevalence of poor health, whereas unskilled service workers and-among males-unskilled manual workers had a high prevalence. In older workers the prevalence of poor general health was greater than among younger workers. However, the difference in health between young and old was significantly smaller than the general pattern among male managers and women in skilled commercial and administrative occupations. Among male skilled workers and female unskilled manual workers, the difference in health between young and old was greater. The-with increasing age-growing health gap between occupational groups should receive more attention. In order to understand the relationship between work, age and health, targeted longitudinal sectional studies are needed. It might be misleading to adjust associations between work and health by age, because age might moderate this relationship.

[Work, age, health, and work participation. A theoretical model]. / Arbeit, Alter, Gesundheit und Erwerbsteilhabe : Ein Modell.

Research into the associations between work, age, and health and the impact of these associations on employment status has focused on health as a crucial determinant of staying on the job. In our paper, we ask whether concentrating on health is still feasible, particularly when considering the change in demographics and the increasing proportion of older people in the workplace. We introduce a theoretical model describing health as a variable that indirectly influences leaving employment. According to our model, the immediate decision to leave employment is due to work motivation and work ability. These two factors may require intervention activities different from those needed to improve health. Our model explains employment participation as a result of complex associations between work, socioeconomic status, lifestyle, and health especially with work ability and work motivation. The complexity of these processes should be considered in studies by conducting longitudinal investigations like the German lidA study (http://www.lida-studie.de). If the model is verified in scientific studies like lidA, it can be used as a basis for preventive and intervening activities in practice, i.e., in politics, enterprises, and science.

The impact of social support upon intention to leave among female nurses in Europe: secondary analysis of data from the NEXT survey.

OBJECTIVES: This study examined the importance of one's social work environment in the light of prevention of premature leave from the nursing profession. A research model with social support (from direct supervisor and close colleagues) as predictor and intention to leave as the dependent variable has been tested, while controlling for job satisfaction and age. Moreover, we have studied the impact of nurses' age upon the prevalence of social support from both parties. PARTICIPANTS: Data were obtained from 17,524 registered female nurses working in hospitals throughout Europe (Belgium, Germany, Finland, France, Italy, The Netherlands, Poland, and Slovakia). RESULTS: Our findings indicated that a lack of job satisfaction is an important risk factor in the light of nurses' turnover as for most countries the intention to leave cannot be buffered by social support from one's close colleagues. However, in general, social support from one's direct superior appeared to contribute negatively to the intention to leave the profession, over and above job satisfaction and age. As regards age effects, in line with our expectation, we have found a significant negative relationship between age and social support from close colleagues, while the hypothesis regarding the relationship between age and supervisory support could not be confirmed. CONCLUSIONS: Given its importance in the light of preventing premature leave, we advocate not to neglect the possible positive effects of social support from important key figures like nurses' direct supervisor and close colleagues. It is necessary for health care institutions to carefully pay attention to finding opportunities to obtain more social support for all staff members. In Section 5, limitations and practical implications of this study are dealt with.

Back or neck-pain-related disability of nursing staff in hospitals, nursing homes and home care in seven countries--results from the European NEXT-Study.

BACKGROUND: Musculoskeletal disorders are a widespread affliction in the nursing profession. Back or neck-pain-related disability of nursing staff is mainly attributed to physical and psychosocial risk factors. OBJECTIVES: To investigate which-and to what extent-physical and psychosocial risk factors are associated with neck/back-pain-related disability in nursing, and to assess the role of the type of health care institution (hospitals, nursing homes and home care institutions) within different countries in this problem. DESIGN: Cross-sectional secondary analysis of multinational data of nurses and auxiliary staff in hospitals (n=16,770), nursing homes (n=2140) and home care institutions (n=2606) in seven countries from the European NEXT-Study. METHODS: Multinomial logistic regression analysis with raw models for each factor and mutually adjusted with all analysed variables. RESULTS: Analysis of the pooled data revealed effort-reward imbalance as the predominant risk factor for disability in all settings (odds ratios for high disability by effort-reward ratio: hospital 5.05 [4.30-5.93]; nursing home 6.52 [4.04-10.52] and home care 6.4 [3.83-10.70] [after mutual adjustment of psychosocial and physical risk factors]). In contrast, physical exposure to lifting and bending showed only limited associations with odds ratios below 1.6; the availability and use of lifting aids was-after mutual adjustment-not or only marginally associated with disability. These findings were basically confirmed in separate analyses for all seven countries and types of institutions. CONCLUSIONS: The findings show a pronounced association between psychosocial factors and back or neck-pain-related disability. Further research should consider psychosocial factors and should take the setting where nurses work into account.

Explaining young registered Finnish nurses' intention to leave the profession: a questionnaire survey.

BACKGROUND: Regardless of the current global nursing shortage, many nurses are planning to leave their profession. According to previous research, young nurses in particular are the most eager to leave-there is, however, no research available as to why this is. OBJECTIVES: The aim of this survey study was to discover what proportion of young nurses intends to leave the profession in Finland and what the reasons behind this are. DESIGN: Quantitative, survey study. SETTINGS: Six hospital districts in Finland. PARTICIPANTS: A total of 147 Registered Nurses, under the age of 30, working mainly in hospitals. METHOD: Data was collected as part of the NEXT (Nurses Early Exit)--Study. A structured postal questionnaire, BQ-12, was used to collect the data in autumn 2003. Quantitative data were analysed using chi(2), the Fisher exact-test and Mann-Whitney U-test, and qualitative data were analysed using quasi-statistics. RESULTS: During the course of the past year, 26% of young nurses have often thought of giving up nursing. This was associated with personal burnout, poor opportunities for development, lack of affective professional commitment, low job satisfaction, work-family conflicts and higher quantitative work demands. In open-ended question, nurses stated that the main reasons for them considering leaving the profession included dissatisfaction with salary, the demands of nursing work, the inconvenience of shift work/working hours and uncertain work status. CONCLUSIONS: Findings illustrate that there were several factors influencing the young nurses' intentions. By identifying the factors responsible, it could be possible to retain young nurses in the field.

Nurses' health, age and the wish to leave the profession--findings from the European NEXT-Study.

BACKGROUND AND OBJECTIVES: In many industrialised countries the number of workers with low health is expected to increase in the nursing profession. This will have implications for occupational health work in health care. The European NEXT-Study (www. next-study. net, funded by EU) investigates working conditions of nurses in ten European countries and provides the opportunity to evaluate the role of health with respect to age and the consideration of leaving nursing. METHODS: 26,263 female registered nurses from Belgium, Germany, Finland, France, England, Italy, Netherlands, Poland and Slovakia were eligible for analysis. RESULTS: In most countries, older nurses considered leaving the profession more frequently than younger nurses. 'Health' was--next to 'professional opportunities' and 'work organisational factors'--strongly associated with the consideration of leaving nursing. However, more than half of all nurses with low health wanted to remain in the profession. This group reported rather positive psychosocial working conditions--but also the highest fear for unemployment. CONCLUSIONS: The findings indicate that 'the nurse with low health' is reality in many health care settings. Both positive supporting working conditions but also lack of occupational alternatives and fear of unemployment may contribute to this. Current economic, political and demographic trends implicate that the number of active nurses with low health will increase. Occupational health surveillance will be challenged by this. But NEXT findings implicate that prevention also will have to regard work organisational factors if the aim is to sustain nurses' health and to enable nurses to remain healthy in their profession until retirement age.

Effect of a diphtheria booster vaccination in adults with a documented history of an incomplete primary series vaccination.

BACKGROUND: An incomplete series of diphtheria vaccination is frequently found in the vaccination documents of adult patients. This paper investigates the effect of a booster vaccination in adults with an incomplete series of primary vaccination. MATERIALS AND METHODS: The effect of one diphtheria booster vaccination in adults with a documented history of only two childhood vaccinations has been investigated in 21 adults. Before the vaccination and 4 to 8 weeks thereafter, blood samples were taken and analyzed with an in vitro neutralization assay. RESULTS: None of the participants had prevaccinal full protective diphtheria antitoxin levels (AT) > or = 0.1 IU/ml and four (19%) had limited serological protection (AT 0.01 to 0.1 IU/ml). After the vaccination, 14 individuals (67%) had protective LeveLs and six (29%) had limited protective levels. The risk for post-booster non-protection (AT < 0.1 IU/ml) was 7.7 times higher in comparison with a group of 170 adults with a history of at least one booster vaccination. CONCLUSION: A specific immunologic memory exists in adults with a history of only two previous diphtheria vaccinations. However, our results also indicate the need for a second booster vaccination in this group if long-term protection is to be achieved.

[Premature departure from nursing in Germany as a growing problem for the health care system -- a review]. / Vorzeitiger Berufsausstieg aus der Pflege in Deutschland als zunehmendes Problem für den Gesundheitsdienst -- eine Ubersichtsarbeit.

There is a shortage of nursing staff in almost all of the countries in the European Union. This problem is expected to increase within the next decades as a result of demographic changes. Efforts to improve training or recruiting nurses from other countries such as future EU member states are unlikely to solve the problem. Premature departure from the nursing profession occurs more frequently than in other professional fields in Germany. There is little known about the underlying reasons of this. The authors present data regarding the early departure of nursing staff from the profession. They propose that a lengthened stay in nursing could help solve the above problem. In order for specific measures to take place (to solve this), more knowledge is needed regarding the causes and circumstances surrounding the early departure of nursing staff. This is the object of the European NEXT-Study ( http://www.next-study.net ), in which research groups from 10 European countries are taking part. Starting in Autumn 2002, between 5000 and 8000 nurses will be questioned in each of the 9 countries, in this longitudinal study. The first findings will be submitted in Summer 2003.

[Prevention of diphtheria in Germany: yesterday, today, tomorrow - an overview]. / Diphtherieprävention in Deutschland: gestern, heute und morgen - eine Ubersichtsarbeit.

The year 2000 was the first without the registration of any cases of diphtheria in Germany. However, serologic protection against diphtheria amongst the population is very low, especially among young and middle-aged adults, where over 50 % are not or only minimally protected. In a review of the diphtheria cases of the last 7 years (n = 18), three factors were associated with the disease: adult age (14 cases between 18 and 50 years of age), travelling (in 14 of 18 cases travelling to or from endemic areas played a role) and occupational exposure (suspected in 6 of 18 cases). In Germany, the official guidelines which suggest a booster vaccination every ten years are followed very insufficiently. Should vaccination habits fail to improve, population immunity will further decrease and a resurgence of diphtheria will become more likely. Measures for future preventive activities are being discussed.

Endocrine and immunologic parameters indicative of 6-month prognosis after the onset of low back pain or neck/shoulder pain.

STUDY DESIGN: Prospective study. OBJECTIVES: To evaluate the prognosis of spine disease by investigating biologic parameters reflecting different physiologic or psychophysiological systems in men and women with acute onset of low back or neck/shoulder complaints. SUMMARY OF BACKGROUND DATA: Psychosocial factors may be of importance to the etiology and prognosis of musculoskeletal disorders. The possible mechanisms, however, remain unclear. Stress-induced long-lasting energy mobilization resulting in inhibited anabolism has been discussed. Using a theoretical framework within stress physiology, such psychophysiological processes were recorded by measures of substances representing the anabolic, catabolic, immunologic, and opioid systems. METHODS: The study comprised 67 working men and women 21 to 59 years of age seeking care by any caregiver for acute low back and/or neck/shoulder pain. Blood samples were taken and analyzed for 3 methyl 5hydroxy phenylethylene glycol (MHPG, reflecting sympathoadrenomedullary activity), DHEA-s (anabolism), immunoglobulin E, interleukin 6 (immune activity), and beta-endorphin (pain regulation). The participants were followed up for 6 months after the blood samples had been drawn. RESULTS: In women, low MHPG, low DHEA-s, and low beta-endorphin predicted persistent disability due to low back complaints. Few significant findings were made for self-reported pain, for neck/shoulder complaints, and for men. CONCLUSION: Disturbances of the regulation of certain biologic parameters might be indicators of a prolonged course of low back disease in women. Prospective studies are necessary to enable causal conclusions.

[Transmission of HBV, HCV and HIV by infectious medical personnel--presentation of an overview]. / Ubertragung von HBV, HCV und HIV durch infektiöses medizinisches Personal--eine Ubersichtsdarstellung.

This report analyzes 46 cases of personnel-to-patient transmissions of hepatitis B (HB), hepatitis C (HC) and HIV in health care settings. Similar circumstances were found for transmission of HB (40 cases, 404 infected patients), HC (4 cases, 224 infected patients) and HIV (2 cases, 7 infected patients). Cases with the highest number of transmissions (one anesthesiologist with 217 HC transmissions, and one EEG technologist with 75 HB transmissions) were attributed to poor infection control practices. As long as infected health care workers (HCW) adhere to general infection control measures, a risk for transmission to patients exists only from infected surgeons who perform 'exposure-prone invasive procedures'. Whether changes in duties of infected HCW are necessary should be decided on an individual basis. Often, the infected personnel were assumed to have acquired the disease occupationally. Medical practices and devices bearing a risk of infection should constantly be reviewed with regard to risk for patients and personnel.

[European and North American regulations on employing HBV-, HCV- and HIV-infected persons in health care]. / Europäische und nordamerikanische Regelungen zur Beschäftigung von HBV-, HCV- und HIV-infektiösen Personen im Gesundheitsdienst.

In the United States of America (1991), in Canada (1998), in the UK (1993, 1994) and in Germany (1999) recommendations have been published concerning performance of "exposure-prone procedures" (EPP) by persons infected with Hepatitis-B virus (HBV), Hepatitis-C virus (HCV) or HIV. This review summarises the definition of EPP, methods to reduce the transmission of blood-borne pathogens, immunisation and screening policies, constitution of an advisory panel and the question of trace-back investigations described in these regulations.

[Nosocomial hepatitis B virus, hepatitis C virus and HIV infections by infectious medial personnel]. / Nosokomiale Hepatitis B-Virus-, Hepatitis C-Virus- und HIV-Infektionen durch infektiöses medizinisches Personal.

Transmission of Hepatitis-B virus (HBV), Hepatitis-C virus (HCV) and Human immunodeficiency virus (HIV) from medical personnel to patients has been observed by many authors. In Germany, however, neither this type of nosocomial infection nor preventive measures have been discussed to date. This review deals with 302 cases documented in national and international journals (HBV 289, HCV 6, HIV 7). Methods of prevention (especially in surgery) are discussed.

Factors influencing immunity against diphtheria in adults.

In about 50% of all adult Germans, serological immunity to diphtheria is lacking even though a vaccination history exists in most cases. In this study, the factors contributing to diphtheria immunity, up to 43 years after the last diphtheria vaccination, were analysed. Serum samples were taken from 287 adults whose complete vaccination history was available, and who had received a standard primary vaccination. The sera were tested by tissue culture neutralization assay for diphtheria antitoxin levels. The time lapse since the last diphtheria vaccination proved to be the most important factor influencing the protection rate. Secondly, the factor last vaccination within the first 3 years of life and, finally, female gender were found to correlate significantly with a low protection rate. No direct effect could be established for age, number of previous vaccinations, occupational contact with patients or travel within any endemic region during the last 10 years. Since diphtheritic infection can occur among previously vaccinated persons, the immunity gap observed among adults should be closed by regular diphtheria boosters. Special attention should be paid to the three groups mentioned. Further investigation is required to determine whether or not a single booster vaccination is sufficient to provide long-term protection for those in the risk groups indicated above.