Analysis of single nucleotide polymorphisms in chronic beryllium disease.

Sarcoidosis and chronic beryllium disease (CBD) are phenocopies, however the latter one has a clear trigger factor that is beryllium exposure. This study analyses single nucleotide polymorphisms (SNPs) in a large cohort for beryllium-exposed persons. SNPs were chosen for their relevance in sarcoidosis. Even though one of largest cohorts of beryllium-exposed persons was analysed, no statistically relevant association between any SNP and CBD could be verified. Notably, some SNPs exhibit inverse OR for beryllium sensitization and CBD with nominally statistical significance, which allows hypothesizing about pathophysiological role of genes for the disease triggering and development.

Children, care, career - a cross-sectional study on the risk of burnout among German hospital physicians at different career stages.

BACKGROUND: With the increasing number of female medical students physicians' need for work-life balanced hospital jobs rises at all career stages. The Working Time Act (Arbeitszeitgesetz, ArbZG), an implementation of the European Working Time Directive into German law in 2004, should have improved the general conditions for creating flexible work. Nevertheless, the vast majority of female physicians still report an incompatibility of work and family. So far, little is known about mothers working on leading positions in the medical field. The presented study focuses on gender differences in the level of emotional exhaustion between child-rearing junior and senior physicians and different predictors of burnout. METHODS: Three years after the ArbZT-enactment, 994 physicians from the listed hospital physicians in the Medical Register of the city of Hamburg participated in the cross-sectional study and completed a 60-item questionnaire (return rate of 46,5%). The questionnaire included a 22-item version of the German translation of the Maslach Burnout Inventory whereat emotional exhaustion was interpreted as the crucial predictor of burnout. Results of an univariate covariance analysis and regression analyses are reported. RESULTS: In the level of emotional exhaustion no gender differences were found between junior and senior physicians with children in the overall analysis. Support by the superior was the only overall predictor of burnout. Female senior physicians having children presented the highest risk of burnout. Only in this group parenting contributed significantly to the risk of burnout. CONCLUSIONS: Support by the superior and the relationship to colleagues are generally important predictors of burnout among hospital physicians. Parenthood only gets a crucial influence on psychomental health for female senior physicians. Still conservative role models are common in this group, thus dealing with the triple burden of work, leadership responsibility and child rearing seems to be a special female challenge. Innovative approaches of human resource policy need to be implemented to improve the reconciliation of family and working life.

Less work: more burnout? A comparison of working conditions and the risk of burnout by German physicians before and after the implementation of the EU Working Time Directive.

OBJECTIVES: The present study is a 10-year comparison (1997 vs. 2007) of occupational and health aspects before and after the implementation of the European Working Time Directive on German hospital physicians. A major focus is whether the changes in working conditions are accompanied by a lower risk for burnout. METHODS: Three hundred and twenty-eight physicians from the Medical Register of the city of Hamburg completed the survey in 1997 and 994 physicians in 2007. The response rates were 55.4 and 46.5 %, respectively. All participants filled in a 22-item version of the German translation of the Maslach Burnout Inventory. Results of multivariate covariance analyses are reported. RESULTS: The work of physicians has changed significantly within the 10-year period, for example, work time decreased by 4.5 h on average to 55.8 h per week in 2007. Junior physicians profited more from this development, but on-call duties increased for senior physicians in particular. The reduced hours were at the expense of fewer rests. Junior, as well as senior, physicians reported significantly higher rates on the burnout scale for emotional exhaustion (mean 21.8, SD 10.7) in the latter survey and senior physicians also on the depersonalization scale (mean 9.7, SD 6.3). CONCLUSIONS: Changes in working conditions in accordance with the European Working Time Directive are not accompanied by reduced strain and risk of burnout for physicians. Rather, our data argue for greater intensification in work, especially for senior physicians. Further studies are suggested in order to explore interventions for a sustainable improvement in the working conditions of physicians.

Accidental exposure to polychlorinated biphenyls (PCB) in waste cargo after heavy seas. Global waste transport as a source of PCB exposure.

OBJECTIVES: After cargo with PCB-containing transformer oil waste was damaged in heavy seas, the vessel crew exposed to PCB developed itching and acne-form eruption of the skin. The objective of our study was to analyse this work-related incident and its effects on health. METHODS: Air and wipe test samples were taken in the ship for analysis of PCB (28/52/101/138/153/180); clinical investigations of all seafarers (n = 6) included lung function, chest X-ray, clinical chemistry and biomonitoring (plasma PCBs, chlorophenols in urine) measured after a latency of 7 weeks. The biomonitoring data were adjusted according to age-related reference values and validated against controls (n = 96). RESULTS: Biomonitoring showed elevated PCB-28-/52/-102/-138 congeners (mean 1.16/0.91/136, ∑PCB: 5.82 µg/l), which correlates with the dust samples from the cargo hold (∑PCB. 9,440 mg/m(2)) and with 6.1 and 5.0 µg/m(3) in stern and bow cargo air samples. IgE elevation in two seafarers and substantial blood sedimentation rate increase with anaemia or pulmonary emphysema were unlikely to be caused by PCB exposure. Although two members showed slightly elevated airway resistance values, other lung function parameters were normal and reactive airways dysfunction syndrome due to PCBs could be excluded. Elevated chlorophenols in urine could contribute to the manifestation of chloracne. CONCLUSIONS: PCB-52/-101/-138 found in plasma and in air samples confirm exposure to PCB. Acne-form skin eruptions were from occupational exposure to polychlorinated biphenyls in the spilt transformer oil. There were no other abnormal findings in medical and clinical examinations that could be attributed to PCBs. This does not exclude possible long-term effects.

Burnout hazard in teachers results of a clinical-psychological intervention study.

BACKGROUND: The study investigates whether established in-patient therapy for teachers with burnout results in long-acting success and whether gender gaps and differences between teachers of different school levels exist. According to our knowledge, our study is the most extensive inpatient intervention study on the burnout of a defined occupational group, i.e., teachers. METHODS: 200 teachers participated, 150 took part in a later performed katamnestic survey.The Maslach Burnout Inventory (MBI) was used and work-related data were recorded. The days of incapacity for work and the percentage of teachers endangered by burnout decreased, which supports the long-term success of the treatment. RESULTS: Significant differences between males and females and between teacher levels were found. However, the differences between teacher levels only showed up before treatment. Because males only underwent treatment at a more severe stage, further efforts in persuading males to start therapy earlier are needed. CONCLUSIONS: The proven and long-term success of the performed intervention could have greater effects if people, especially males, undergo treatment more frequently. Our results are based on selectively high proposition of teachers of advanced age. Thus it is possible that the long term effect of the intervention, particularly on retirement age, is greater when the intervention is started earlier. Regular burnout tests could help to identify risk cases among teachers at an early stage and to offer a therapeutic intervention.

Severe cobalt intoxication due to prosthesis wear in repeated total hip arthroplasty.

Our study describes a 55-year-old man with a total hip prosthesis (ceramic femoral head and polyethylene [PE] inlay). After a fall, the ceramic head broke into several pieces, and a subsequent revision surgery with metal femoral head and PE inlay was performed. Three months later, the so far healthy patient complained of multiorgan symptoms. The subsequent clinical examinations revealed hypothyroidism, peripheral neuropathy, and cardiomyopathy for the first time. In a second revision surgery, a massive deterioration of the metal femoral head by overlooked particles of the broken ceramic head was found. The cobalt concentration in blood exceeded a never before observed level. After replacement of the scraped femoral head, the cobalt concentration decreased considerably, and most of the symptoms disappeared.

Chlorophenol exposure in harbor workers exposed to river silt aerosols.

OBJECTIVES: While dredging the river Elbe in the harbor of Hamburg, workers are potentially exposed to river silt aerosols containing organic compounds. The aim of this cross-sectional study was to determine the internal load of chlorophenols in exposed workers. METHODS: Eighty-four exposed workers and eighty-four unexposed office workers were examined. Urinary samples were analyzed for dichlorophenols, trichlorophenols, tetrachlorophenols, and pentachlorophenol (PCP). RESULTS: For exposed workers, more than 2/3 of the urinary samples were above detection limit for 2,5-dichlorophenol, 2,4/3,4-dichlorophenol, 2,4,6-trichlorophenol, and PCP. Harbor workers had significantly higher median levels of 2,5-dichlorophenol (0.6 vs. 0.4 microg/g creatinine) and PCP (1.4 vs. 1.0 microg/g creatinine) as compared to unexposed subjects. These differences remained statistically significant after adjustment for age, smoking habits, and fish consumption. CONCLUSION: Harbor workers in the harbor of Hamburg have a statistically significant higher internal load of chlorophenols than the general population. However, the internal load is within the range of exposure reported from the general population. Therefore, even though chlorophenols are found in the river silt these exposures do not seem to be the major source of the internal load among workers in the harbor of Hamburg.

Cotinine excretion (tobacco smoke biomarker) of smokers and non-smokers: comparison of GC/MS and RIA results.

With a validated GC/MS method, the tobacco smoke biomarker cotinine has been estimated in urine for 148 non-smokers (male; 43 +/- 13 years; median 5.0 micrograms/g creatinine; 95th percentile 104 micrograms/g) and 96 smokers (male; 39 +/- 12 years; 1002 micrograms/g; 2993 micrograms/g). For a subgroup of 50 persons, the GC/MS results were compared with those by a commercially available radio immunoassay. Both methods identified the same persons as non-smokers and smokers, respectively, and were closely related. For smokers, the relationship was distinctly closer than for the non-smokers (r = 0.90, p < 0.001, n = 14 vs. r = 0.41, p < 0.02, n = 36). The RIA values were 2.4 times (smokers) and 2.9 times (non-smokers) higher than the GC/MS results. This was probably caused by the cross reactivity of the RIA antibodies against other urinary nicotine metabolites, e.g. trans-3'-hydroxycotinine, and has to be taken into account to correctly compare results of studies obtained with different analytical techniques and for choosing cut-off points to discriminate between active smokers and non-smokers of between non-smokers with higher or lower exposure to environmental tobacco smoke.