The Back College for nurses - an evaluation of intermediate effects.

BACKGROUND: Nursing staff and care workers run an increased risk of work related musculoskeletal disorders such as low back pain. The Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) offers its insured persons the opportunity to participate in a three-week Back College with the aim of preventing them having to abandon their profession due to back problems. The aim of the study was to record the effectiveness and sustainability of the Back College on an intermediate basis (6 months). METHODS: As part of a single-group pre-post measurement on three survey dates - at the start (T0) and end (T1) of rehabilitation and 6 months later (T2) - in 2013 all participants in the Back College at three locations were surveyed using a standard questionnaire. Wilcoxon signed-rank tests were performed to evaluate statistically significant changes. RESULTS: For measurement dates T0 to T2 we had 570 complete datasets (response rate 70.81%). There was a significant decrease in reported back pain and the general state of health and quality of life index improved. Participants' emotional strain decreased and they showed an improved understanding of illness as well as of having acquired knowledge-based abilities and skills for dealing with the disease. After training, they recorded back-friendly behaviour in everyday life and opportunities to relieve strain on the spinal column were utilised at work more often. Participants' subjective assessment of their ability to work (Work Ability Index) improved. CONCLUSION: The present study proved the intermediate effectiveness of the Back College curriculum. Whether these effects remain stable in the long term will be tested on the subsequent measurement date (T3, after 24 months).

Smoking behaviour and attitudes among German nursing students.

Tobacco consumption is a major public health threat. Healthcare workers can contribute to the reduction of tobacco use. The principles of intervention need to be provided already during vocational school. This research examines the smoking habits, the personal attitudes towards smoking and the professional beliefs of healthcare trainees. The aim of this study is to ascertain the necessity and the general conditions for multilevel interventions of prevention and health promotion. In 2010, a questionnaire survey was conducted in a Berlin vocational school for healthcare workers. Of 148 students (RR = 49.3%) 41.9% of the students are daily or occasional smokers. The nicotine dependency and the number of cigarettes per day are comparatively low. The majority of smoking students is willing to quit and has already undertaken several attempts. Non-smoking protection is evaluated to be very important and intervention rates in patient care range between 49% and 72%. In both questions, non-smokers and smokers differ significantly. The self-reported smoking prevalence in our population is considerably lower than in previous studies. However, the smoking rate among healthcare trainees is still higher than in the general population. The students' own smoking behaviours and its influences on the treatment of patients should be reflected during school. It is necessary to develop adequate recruitment strategies and attractive interventions for this target group.

Smoking prevention in school students: positive effects of a hospital-based intervention.

BACKGROUND: Adolescents have smoked less in recent years, but 11.7% of 12-to-17-year-olds were still smokers in 2011. The prevalence of smoking has also remained high among 18-to-25-year-olds (36.8%). An intervention program called "Students in the Hospital" was developed in which the health aspects of smoking and its individual and societal consequences were presented in an interactive informational event. In this study, we determine the efficacy of the program. METHODS: From September 2007 to July 2008, we performed an anonymous survey by questionnaire, with a quasi-experimental control-group design, two weeks before (t(1)) and six months after (t(2)) the intervention in a group of 760 participating school students in Berlin. RESULTS: 40.8% of the participants were smokers, among whom 79% stated that they smoked water pipe. Significantly fewer students in the intervention group than in the control group began smoking in the six months after the intervention (p<0.001). The chance of remaining a non-smoker was four times as high in the intervention group (OR, 4.14; CI, 1.66-10.36). Girls benefited from the intervention more than boys (OR 2.56, CI 1.06-6.19). 16.1% of smokers in the intervention group and 17.6% in the control group gave up smoking (p>0.05). CONCLUSION: A clear primary preventive effect of the program was demonstrated, although it apparently did not induce persons who were already smokers to quit.

Analysis and evaluation of geriatricians' working routines in German hospitals.

BACKGROUND: Geriatricians are physicians who work primarily with the elderly and deal with diseases that often accompany old age, such as Alzheimer's disease. In the last few years, data from questionnaires have demonstrated increasing criticism of geriatricians regarding their working conditions in geriatric medicine. Ideally, such rather subjective statements should be compared to data about work strain that is not merely accurate but also evaluated on an objective real-time basis. Therefore, the aim of the current study is to deliver exact data about geriatricians' work in different geriatric departments to evaluate their working routines and afterwards to optimize their working conditions. METHODS: An observational real-time study was conducted by shadowing 15 physicians in geriatric medicine individually during weekday shifts at four hospitals in urban German settings. A total of 368 h of observations were recorded by using an ultra-mobile computer. RESULTS: The average workday lasted 9 h 36 min 14 s (95% CI = 9.07:35-10.01:23 h) with a high amount of elderly patients to deal with (M = 18) every day. Overall, they spent 14.75% of each workday on indirect patient care, 7.29% on direct patient care and 13.19% on administrative work. Communication took up 4.68% of geriatricians' time, breaks and disruptions 7.5%. CONCLUSION: To our knowledge, this is the first real-time analysis on how geriatricians deal with their working demands and how working routines are organized in geriatric hospital departments. Geriatricians' subjective statements on their working conditions have been partially confirmed. Improving geriatricians work flow could increase work efficiency, job satisfaction and quality of care.

Determinants of day care teachers' job satisfaction.

BACKGROUND: Although job satisfaction is among the most widely researched topics, relatively little research has been done on this issue as it relates to early childhood educators. This study was designed to contribute significantly to the deficient body of knowledge about working conditions and job satisfaction of day care teachers, in particular with regard to differences in job satisfaction depending on day care centres' ownership. METHODS: Analyses were based on cross-sectional comparison of 469 questionnaires (42.55% response rate) from day care teachers working at public day care centres with those working at day care centres run by churches or parents' initiatives. RESULTS: A significant difference in job satisfaction was found between these three types. The important interaction between socio-demographic characteristics, psychosocial working conditions, and job satisfaction could be demonstrated. CONCLUSION: The present study is one of the few that examines the impacts of day care centres ownership on pedagogical staffs' job satisfaction and indicates that the type of the centre is a potential factor explaining variations. Results provide a valuable basis for the development of solution-focused approaches to improve pedagogical staff working conditions.

Educators' working conditions in a day care centre on ownership of a non-profit organization.

BACKGROUND: Working conditions of nursery school teachers have not been scrutinized thoroughly in scientific research. Only a few studies have so far examined work-load and strain in this profession. Preferably, subjective perceptions should be corroborated by data that can be quantified more objectively and accurately. The aim of the present observational field study was to evaluate pedagogical staffs' workflow. METHODS: In 2009 eleven educators in a day care centre were observed throughout three complete workdays. A total of 250 working hours were recorded. RESULTS: An educators' workday lasted on average 07:46:59 h (SD = 01:01:10 h). Within this time span, an average of 02:20:46 h (30.14%, SD = 00:28:07 h) were spent on caring, 01:44:18 h on playing (22.33%, SD = 00:54:12 h), 00:49:37 h on educational work (10.62%, SD = 00:40:09), and only 00:05:38 h on individual child contact (1.21%, SD = 00:04:58 h). CONCLUSION: For the first time, educators' workflow in day care centres was studied in real time. Some of the educators' self-reported problems were corroborated. The results of this study form a basis upon which further investigations can be built and measures can be developed for an overall improvement of child care.

Reduced inclination of cervical spine in a novel notebook screen system - implications for rehabilitation.

BACKGROUND: Professional working at computer notebooks is associated with high requirements on the body posture in the seated position. By the high continuous static muscle stress resulting from this position at notebooks, professionals frequently working at notebooks for long hours are exposed to an increased risk of musculoskeletal complaints. Especially in subjects with back pain, new notebooks should be evaluated with a focus on rehabilitative issues. METHODS: In a field study a new notebook design with adjustable screen was analyzed and compared to standard notebook position. RESULTS: There are highly significant differences in the visual axis of individuals who are seated in the novel notebook position in comparison to the standard position. Also, differences are present between further alternative notebook positions. Testing of gender and glasses did not reveal influences. CONCLUSION: This study demonstrates that notebooks with adjustable screen may be used to improve the posture. Future studies may focus on patients with musculoskeletal diseases.

Cardiologists' workflow in small to medium-sized German hospitals: an observational work analysis.

AIMS: Due to recent changes in national health policy and a subsequent increase in clinicians' workload, medical residents in Germany feel that the growing burden of documentation duties leaves too little time for direct patient care. Thus, to describe the daily workflow in cardiology wards with more accuracy, this real-time observational study detailed all tasks performed by resident cardiologists during daily shifts at German hospitals. METHODS: Daily routines of 20 resident cardiologists at four German hospitals were observed and recorded in real time during the study period from September 2009 to January 2010. Each participant was shadowed during three entire day shifts by an observer, who recorded all tasks performed by the cardiologist. RESULTS: During the study period, 60 workdays (512 h) of observation took place. On average, doctors worked 08:31 h per day (SD = 00:32 h). Most time was spent on meetings (2:51 h), on administration duties (1:22 h), on ward rounds and admission to hospital (0:42 h) and on breaks (0:30 h). Doctors were interrupted every 16 min and spent 16.20% of each workday multitasking. CONCLUSION: Ward rounds, meetings and administrative duties took up two-thirds of an average workday. Little time was spent on direct patient care relative to other clinical tasks such as paperwork and management. High rates of interruptions and multitasking were found. As the medical workforce is valuable, changes in the organization of workflow should be made in order to minimize residents' administrative duties and paperwork; thus, cardiologists' job satisfaction might increase.

Cancer care and residents' working hours in oncology and hematology departments: an observational real-time study in German hospitals.

BACKGROUND: Physicians currently working in hematology and oncology wards are often frustrated with their working conditions. They express dissatisfaction with the working hours, poor organization of work and a low salary compared with the burdens of cancer care. However, to date, there have been no real-time observational studies to verify these subjective reports. Therefore, this study is the first to provide objective data about residents' workload. METHODS: A real-time task analysis was conducted by individually observing 21 hematology and oncology residents at German hospitals. A total of 626 h of observation were performed using an Ultra Mobile PC. RESULTS: The residents observed in this study worked an average of 9 h 56 min per day, during which time was divided among the following activities: 31.20% for internal communication, 22.06% for indirect patient care and 10.99% for ward rounds. Per workday residents spent an average 6.20% of their shift time talking to patients. CONCLUSIONS: This study provides the basis for future analyses on physicians' workflow. Some key results may be used to recommend measures to improve physicians' work performance and the quality of cancer care.

Bidirectional Assessment of Stress, job satisfaction and work ability of Educators in day care centres: a real-time observation study - the study protocol (BASE).

BACKGROUND: Occupational demands of educators are not very well researched. Nevertheless their work is subject to several requirements. Whether these demands have an effect on the work ability and the health status of employees has also not been examined. Furthermore it is unclear if the ownership type of day care centres have an influence on job satisfaction and work ability of the pedagogical staff and what kind of resources do exist. Previous studies were mainly based on questionnaire data. Objective data does not exist. Therefore the aim of this investigation is to collect precise data relating to work of educators. METHODS: Effects of different types of ownership of day care centres on job satisfaction and work ability of educators will be assessed with the help of objective real time studies in combination with multi-level psycho diagnostic measurements. DISCUSSION: The present study is the first of its kind. Up to now there are no computer-based real time studies on workflow of pedagogical staff with regard to assess their work-related stress. Following an exhaustive documentation of educators work processes the day-to-day task can be estimated and approaches for prevention can be developed. This can substantially contribute to an overall improvement of child care in Germany.

Mobile Air Quality Studies (MAQS)-an international project.

Due to an increasing awareness of the potential hazardousness of air pollutants, new laws, rules and guidelines have recently been implemented globally. In this respect, numerous studies have addressed traffic-related exposure to particulate matter using stationary technology so far. By contrast, only few studies used the advanced technology of mobile exposure analysis. The Mobile Air Quality Study (MAQS) addresses the issue of air pollutant exposure by combining advanced high-granularity spatial-temporal analysis with vehicle-mounted, person-mounted and roadside sensors. The MAQS-platform will be used by international collaborators in order 1) to assess air pollutant exposure in relation to road structure, 2) to assess air pollutant exposure in relation to traffic density, 3) to assess air pollutant exposure in relation to weather conditions, 4) to compare exposure within vehicles between front and back seat (children) positions, and 5) to evaluate "traffic zone"-exposure in relation to non-"traffic zone"-exposure.Primarily, the MAQS-platform will focus on particulate matter. With the establishment of advanced mobile analysis tools, it is planed to extend the analysis to other pollutants including NO2, SO2, nanoparticles and ozone.

Berlin's medical students' smoking habits, knowledge about smoking and attitudes toward smoking cessation counseling.

BACKGROUND: Diseases associated with smoking are a foremost cause of premature death in the world, both in developed and developing countries. Eliminating smoking can do more to improve health and prolong life than any other measure in the field of preventive medicine. Today's medical students will play a prominent role in future efforts to prevent and control tobacco use. METHODS: A cross-sectional, self-administered, anonymous survey of fifth-year medical students in Berlin, Germany was conducted in November 2007. The study explored the prevalence of smoking among medical students. We assessed their current knowledge regarding tobacco dependence and the effectiveness of smoking cessation methods. Students' perceived competence to counsel smokers and promote smoking cessation treatments was also explored. Analyses were based on responses from 258 students (86.6% response rate). RESULTS: One quarter of the medical students surveyed were current smokers. The smoking rate was 22.1% among women, 32.4% among men. Students underestimated smoking-related mortality and the negative effect of smoking on longevity. A considerable number of subjects erroneously assumed that nicotine causes coronary artery disease. Students' overall knowledge of the effectiveness of smoking cessation methods was inadequate. Only one third of the students indicated that they felt qualified to counsel patients about tobacco dependence. CONCLUSIONS: This study reveals serious deficiencies in knowledge and counseling skills among medical students in our sample. The curriculum of every medical school should include a tobacco module. Thus, by providing comprehensive training in nicotine dependence interventions to medical students, smokers will have access to the professional expertise they need to quit smoking.

Pediatricians' working conditions in German hospitals: a real-time task analysis.

Surveys of pediatricians in Germany report low levels of job satisfaction. Preferably, such subjective reports should be corroborated by objective data regarding physicians' working conditions. However, such data in the field of pediatrics could not be found in the scientific literature. The aim of the present observational field study was to collect exact data about pediatricians' workflow in different pediatric hospital departments to evaluate and to optimize work routines. Data of 697 working hours were collected by using Tablet PCs during weekday shifts at three urban German hospitals. Twenty-five pediatricians were observed separately. A pediatrician's workday lasted on average 9 h and 18 min (SD = 0:53:44 h). The following amount of time was spent on various job tasks within this period: 29.80% (SD = 8.25 %) on meetings, 17.54% (SD = 6.51%) on documentation duties, 12.65% (SD = 3.73%) on indirect patient care, 9.22 % (SD = 5.74%) on hospital admissions and ward rounds and 4.03% (SD = 2.49%) on direct patient care. This is the first objective task analysis of physicians' workflow in pediatric hospital wards. Some of the physicians' self-reported problems were verified. Improvements in work organization and a new allocation of responsibilities among the medical staff may prove helpful in improving the quality of patient care by reducing the burden on pediatricians.

Tobacco control: visualisation of research activity using density-equalizing mapping and scientometric benchmarking procedures.

BACKGROUND: Tobacco smoking continues to be a major preventable cause of death and disease and therefore tobacco control research is extremely important. However, research in this area is often hampered by a lack in funding and there is a need for scientometric techniques to display research efforts. METHODS: The present study combines classical bibliometric tools with novel scientometric and visualizing techniques in order to analyse and categorise research in the field of tobacco control. RESULTS: All studies related to tobacco control and listed in the ISI database since 1900 were identified by the use of defined search terms. Using bibliometric approaches, a continuous increase in qualitative markers such as collaboration numbers or citations were found for tobacco control research. The combination with density equalizing mapping revealed a distinct global pattern of research productivity and citation activity. Radar chart techniques were used to visualize bi- and multilateral research cooperation and institutional cooperation. CONCLUSIONS: The present study supplies a first scientometric approach that visualises research activity in the field of tobacco control. It provides data that can be used for funding policy and the identification of research clusters.