Dispositional and performance-specific music performance anxiety in young amateur musicians.

Introduction: Research on Music Performance Anxiety (MPA) among amateur musicians is of great interest due to inconsistent results in literature. In addition, amateur music represents an important part of musical culture in Germany. Accordingly, the performance experiences of young wind players represent a relevant issue for research and musical practice. Methods: In the present study, 67 young amateur musicians of a brass choir were examined. Using two different questionnaires, both the dispositional MPA (K-MPAI) and the performance-specific MPA during a joint concert (Performance-specific Questionnaire for Musicians, PQM) were assessed. The PQM measures the symptoms of MPA, functional coping with MPA and self-efficacy before, during and after a specific performance. The PQM was completed by the musicians via an app directly after the concert. Results: Results showed that about 90% of the young amateur musicians had a low dispositional MPA, but about 10% showed high values. For the concrete performance, however, musicians with high dispositional MPA also experienced a very moderate to low MPA in the concert. On average, the musicians were quite nervous before the performance. After the performance, they showed low levels of MPA. Three types of MPA found in previous studies could be confirmed among the amateur musicians, with three quarters being assigned to the positive type, showing low levels of symptoms associated with consistently high levels of self-efficacy and positive functional coping. Discussion: The results provide a differentiated picture of different expressions of MPA in young amateur musicians. They also raise further questions about the correlation between dispositional and performance-specific assessment of MPA in musicians in general.

A coupled experimental and statistical approach for an assessment of SARS-CoV-2 infection risk at indoor event locations.

Indoor event locations are particularly affected by the SARS-CoV-2 pandemic. At large venues, only incomplete risk assessments exist, whereby no suitable measures can be derived. In this study, a physical and data-driven statistical model for a comprehensive infection risk assessment has been developed. At venues displacement ventilation concepts are often implemented. Here simplified theoretical assumptions fail for the prediction of relevant airflows for airborne transmission processes. Thus, with locally resolving trace gas measurements infection risks are computed more detailed. Coupled with epidemiological data such as incidences, vaccination rates, test sensitivities, and audience characteristics such as masks and age distribution, predictions of new infections (mean), situational R-values (mean), and individual risks on- and off-seat can be achieved for the first time. Using the Stuttgart State Opera as an example, the functioning of the model and its plausibility are tested and a sensitivity analysis is performed with regard to masks and tests. Besides a reference scenario on 2022-11-29, a maximum safety scenario with an obligation of FFP2 masks and rapid antigen tests as well as a minimum safety scenario without masks and tests are investigated. For these scenarios the new infections (mean) are 10.6, 0.25 and 13.0, respectively. The situational R-values (mean) - number of new infections caused by a single infectious person in a certain situation - are 2.75, 0.32 and 3.39, respectively. Besides these results a clustered consideration divided by age, masks and whether infections occur on-seat or off-seat are presented. In conclusion this provides an instrument that can enable policymakers and operators to take appropriate measures to control pandemics despite ongoing mass gathering events.

Social contact, practice, organization and technical knowledge: Experiences of music students in the course of the COVID-19 pandemic.

For music students, the COVID-19 pandemic has had a great impact, forcing them to adapt to certain coronavirus regulations laid down by the state. In this study, the experiences of music students in three consecutive semesters under different coronavirus-related conditions are investigated. At the end of three semesters, the lockdown semester [SS (Summer Semester) 2020: April - July], a partially opened semester [WS (Winter Semester) 2020/21: October - February] and a mostly opened semester (SS 2021), a total of 152 music students at the University of Music Freiburg were asked to fill in an online survey. A mixed-methods approach was used, with results showing that the qualitative statements of the students support the quantitative data. The results of the cross-sectional study demonstrate that self-regulated learning improved during the lockdown semester, through new time management and focused practice with regular breaks. During the partially opened semester, the use of blended learning formats led to organizational problems, such as travel time and change of locations. Furthermore, music students were challenged by the social distancing, which improved during the partially opened, and mostly opened semester. New technologies regarding digital communication formats were emerged, which have evolved over the course of the three semesters. Concerning the overall experience, students stated that the partially-opened semester was most challenging, since distances and change of locations had to be combined with quickly changing public COVID-19-regulations. These findings during different stages of the COVID-19 pandemic provide constructive starting points for future teaching.

Associations Between Ancillary Body Movements and Acoustic Parameters of Pitch, Dynamics and Timbre in Clarinet Playing.

When playing an instrument, there are two main categories of body movements: instrumental movements, which are necessary for the sound production, and ancillary movements, which are associated with individual musical intentions and expressions. In this study, the particular purpose of ancillary movements of clarinet player was investigated especially in respect to how these movements were related to the musical structure of the piece and to specific audio parameters. 3D motion capture data of 19 clarinet players performing the same piece were analyzed regarding common motion patterns during the performance and in accordance with acoustic features related to pitch, dynamics (RMS energy) and timbre (spectral centroid and flux). A focus of the body movements was on the arms and the knees. The results showed that there were certain motion patterns performed by the players depending on specific musical structures. When playing a melodic part, the players often did so by bending their knees. At musical transitions, however, the knees were mainly stretched. Similarly, arm movements were more pronounced during playing melodious parts. At transitions, the arms were put closer to the torso. Considering the connection with the acoustics, a larger range of knee motions was correlated with a larger variation of the timbre. Moreover, at specific moments during the performance, when some players strongly bent their knees or lifted the arms, the RMS energy of the signal was significantly higher. The correlations of the body movements and the acoustic features showed that some players synchronized their movements with particular audio parameters more than others did. In summary, the ancillary movements of the clarinetists pursued both musical expressive intentions and physiologically necessary movements and tended to be performed with individual differences in terms of visual and auditory expression.

Coronavirus vaccination rates in cultural areas in Germany.

Vaccination is a significant preventive measure to contain the coronavirus disease-2019 (COVID-19) pandemic. Vaccination rates can provide useful information on the potential spread of infection in a given population. In this study, vaccination rates and attitudes towards vaccination in cultural sectors, specifically the music sector, have been investigated. In total, 4341 persons in four different areas, including visitors to performances of classical music and musicals, as well as professional and amateur musicians, have participated in this survey. Results show rates of 86% recovered from the COVID-19 virus or vaccinated at least once, with 54.5% fully vaccinated. These vaccination rates were considerably higher compared to the general population. An attitude of hesitation towards vaccination found in 6.4% of those sampled was half that of the general population. These findings drawn from a large sample indicate that in the field of music a high vaccination rate is to be found, as well as a low rejection rate of vaccination on the part of the audience and performers. The results can be used to provide insights into the vaccination status to be found at cultural events and, importantly, to assist in consideration of whether cultural events should be permitted to continue under pandemic circumstances.

Live Music Performance: The Relationship Between Flow and Music Performance Anxiety.

Most studies exploring the relation between flow and Music Performance Anxiety (MPA) have focused on the disposition of generally experiencing flow and the occurrence of MPA. Little is known about the connection between experiencing flow and MPA as it relates to a specific performance. In this study, flow and MPA have been investigated in 363 orchestral musicians in relation to a particular live music performance. The musicians were asked to fill out a questionnaire immediately after a concert. Flow experience during the performance was measured using the Flow Short Scale. The Performance-specific Questionnaire on MPA (PQM) was used for MPA. The PQM addresses particular aspects of MPA and refers retrospectively to the time before and during the performance as well as to the moment of filling out the questionnaire after the performance. Using three scales, the functional coping, the perceived symptoms of MPA and self-efficacy were determined for each time point of the performance. The results showed that experiencing flow was on average higher among orchestral musicians compared to a sample of the general population. However, there were differences between the professional and non-professional musicians. All PQM scales showed significant correlations with the global flow scale. Regression analysis on the global flow score found that regarding the time before the performance the PQM scale symptoms of MPA were diametrically connected with the flow experience. The PQM scale functional coping was shown to be positively related to the flow during the performance. Moreover, high self-efficacy was found to be closely related with stronger flow experience. Furthermore, flow seems to have positive effects on functionally coping with MPA and the self-efficacy after the performance. These findings confirm the negative relationship between flow and symptoms of MPA, offering further approaches in understanding the relationship especially for live music performances.

The spread of breathing air from wind instruments and singers using schlieren techniques.

The spread of breathing air when playing wind instruments and singing was investigated and visualized using two methods: (1) schlieren imaging with a schlieren mirror and (2) background-oriented schlieren (BOS). These methods visualize airflow by visualizing density gradients in transparent media. The playing of professional woodwind and brass instrument players, as well as professional classical trained singers were investigated to estimate the spread distances of the breathing air. For a better comparison and consistent measurement series, a single high note, a single low note, and an extract of a musical piece were investigated. Additionally, anemometry was used to determine the velocity of the spreading breathing air and the extent to which it was quantifiable. The results showed that the ejected airflow from the examined instruments and singers did not exceed a spreading range of 1.2 m into the room. However, differences in the various instruments have to be considered to assess properly the spread of the breathing air. The findings discussed below help to estimate the risk of cross-infection for wind instrument players and singers and to develop efficacious safety precautions, which is essential during critical health periods such as the current COVID-19 pandemic.

Airflow and Air Velocity Measurements While Playing Wind Instruments, with Respect to Risk Assessment of a SARS-CoV-2 Infection.

Due to airborne transmission of the coronavirus, the question arose as to how high the risk of spreading infectious particles can be while playing a wind instrument. To examine this question and to help clarify the possible risk, we analyzed 14 wind instruments, first qualitatively by making airflows visible while playing, and second quantitatively by measuring air velocity at three distances (1, 1.5, 2 m) in the direction of the instruments' bells. Measurements took place with wind instrumentalists of the Bamberg Symphony in their concert hall. Our findings highlight that while playing, no airflows escaping from any of the wind instruments-from the bell with brass instruments or from the mouthpiece, keyholes or bell with woodwinds-were measurable beyond a distance of 1.5 m, regardless of volume, pitch or what was played. With that, air velocity while playing corresponded to the usual value of 1 m/s in hall-like rooms. For air-jet woodwinds, alto flute and piccolo, significant air movements were seen close to the mouthpiece, which escaped directly into the room.

Musical Practice in Music Students During COVID-19 Lockdown.

The pandemic situation has forced students in higher education to use alternative learning routines due to reduced activities at universities and educational facilities. Especially music students needed to adapt their musical learning to this particular situation. Mostly affected by the lockdown was the musical practicing behavior, especially when practicing at the University of Music was not possible. In this study, music students in their second and third semesters were asked to provide information on their practicing situations during the coronavirus disease 2019 (COVID-19) lockdown. They were required to fill in questionnaires about the practicing time and concepts of self-efficacy and self-regulation for musical learning. The data of 18 music students were collected. For the analysis, they were compared with the answers of 15 music students who were asked the same questions half a year earlier before the pandemic situation occurred. The results showed that the music students relocated mostly to their parents' homes for practicing during the lockdown. In the amount of practicing, the bachelor of music students practiced less during lockdown compared with before the lockdown. The mean self-efficacy for musical learning did not differ between before and during the lockdown. For the self-regulated musical learning, the music students showed significantly higher values in the subscale on reflecting and creating a framework for the progress of musical learning during the lockdown. The findings indicate that the music students developed certain self-regulated learning skills during the lockdown and managed to find suitable solutions in continuing with their musical learning without reservation.

Classifying Different Types of Music Performance Anxiety.

Music performance anxiety (MPA) is a commonly present topic among musicians. Most studies on MPA investigated effects of a more general occurrence of MPA on performances. Less is known about individual variations of MPA within a performance, more specifically at the times before, during, and after the performance. This study used a questionnaire to investigate these performance times in order to find out if there occur different types in the variation of the perceived MPA across the performance. The study was performed with 532 musicians; 27% of them being professional orchestra musicians, 45% non-professional orchestra musicians, and 28% non-professional choir singers. The musicians were asked to fill in the Performance-specific Questionnaire for Musicians (PQM) immediately after a performance. The questionnaire contains three scales regarding symptoms of MPA, functional coping with MPA and performance-related self-efficacy. A cluster analysis was performed on the PQM scales to identify systematic variations. Findings indicate that there are three different types of MPA in the sample studied. Type 1 describes musicians who have few symptoms of MPA throughout the performance, show functional coping with MPA, and have a stable and well-developed self-efficacy. Type 2 describes musicians who begin their performance with rather high symptoms of MPA but can positively reduce these by the end of the performance and show high values in self-efficacy and in functional coping. Type 3 contains musicians who begin their performance with some symptoms of MPA, which increase to the end of the performance. The values of self-efficacy and functional coping in this type are rather low. Of the total sample, half of the musicians were assigned to Type 1 and approximately a quarter each to Type 2 (27%) and Type 3 (23%). In accordance with the literature, the results confirm the importance of self-efficacy and functional coping for a positive performance experience.

[Aerosols and SARS-CoV-2: Statement of the "Expert Group Aerosols" on the development, infectivity, spread and reduction of airborne, virus-containing particles in the air]. / Stellungnahme des "Expertenkreises Aerosole": Aerosole und SARS-CoV-2 ­ Entstehung, Infektiosität, Ausbreitung und Minderung luftgetragener, virenhaltiger Teilchen in der Atemluft.

Aerosols are currently seen as one of the main transmission routes for SARS-CoV-2, but a comprehensive understanding of the processes and appropriate action/adaptation of protection concepts requires the exchange of information across interdisciplinary boundaries. Against this background, the Baden-Württemberg state government launched in October 2020 a multidisciplinary "Expert Group Aerosols" comprising engineers, natural scientists and medical professionals. In its statement, the group has compiled the current state of knowledge in all relevant disciplines in the context of airborne SARS-CoV-2 infection. In addition to the well-known hygiene and social distancing rules, the importance of the correct use of effective masks is emphasized. Furthermore, the necessity for dynamic and correct ventilation is pointed out and illustrated with ventilation intervals and periods for different scenarios as examples. The effectiveness of stationary or mobile cabin air filters as an important component in the protection concept is discussed. The first opinion of the expert group makes it clear that the existing hygiene and social distancing rules offer the best possible protection against SARS-CoV-2 infection only when correctly applied in combination.

Long-Term Effects of a Voice Training Program for Teachers on Vocal and Mental Health.

OBJECTIVES: The voice is an important occupational tool for teachers. Voice training programs have been shown to help strengthen the voice health and endurance. However, longitudinal studies on voice trainings are sparse. In this study, long-term effects nearly 2 years after a voice training program have been investigated. METHODS: The acoustic voice quality (Dysphonia Severity Index [DSI]), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the health-related quality of life (SF-12) of 55 teachers who participated in a prior voice training program of ten 90 minutes sessions were compared to 33 teachers without voice training. The participants were measured at three times: in a pre- and a post-training survey and in a 2-years follow-up survey. RESULTS: The trained teachers increased in DSI over all three surveys while the nontrained teachers decreased in DSI with a significant interaction effect. Also the trained teachers significantly increased the awareness of voice use and their mental health compared to the nontrained group. CONCLUSIONS: The positive effects of the voice training, which have been found between pre- and post-training and in comparison with the control group, clearly sustained in long-term 2 years after the end of the training. This finding emphasizes the importance of voice training for teachers as a long-term investment for a voice-related healthy working life.

Comparison of Postural Stability and Balance Between Musicians and Non-musicians.

Good postural stability and balance provide a basis for optimal movement. For instrumental musicians, particular postures are demanded during long periods of playing and practicing. These postures can potentially also affect the postural control system even in situations when the musician is not playing the instrument. The goal of this exploratory study was to measure the postural stability and balance of instrument musicians in non-instrumental situations. By comparing these measures with a control group of non-musicians, postural differences were identified which can be ascribed to certain playing positions arising from playing the instrument. The measurement technique used was a pressure platform (Zebris force plate) to record static posturography. The postural sway of the center of pressure (COP) and the postural balance (body weight distribution) in a standing position were measured in 390 students including music students (n = 346) and a control group (n = 44). The analyses revealed significant differences for specific instrumental groups. Around 23% of the pianists, 25% of the upper strings players, and 33% of the guitar players showed a weight distribution significantly shifted more to the left compared to the control group (9%). In contrast, 23% of the lower strings players and 33% of the percussionists were found to stand more to the right side than the control group (5%). The results indicate that there are certain unbalanced postural patterns in musicians, outside of the music performance situation, which can be provoked by instrumental playing postures. As postural misalignments can lead to severe postural disorders in older age, preventive activities to improve postural stability and balance should be considered in instrumental education, not only during, but also outside of instrumental playing situations.

Vocal Health, Voice Self-concept and Quality of Life in German School Teachers.

OBJECTIVES: For school teachers, the voice is a mandatory occupational tool during teaching. Several studies, however, proved that teachers are at high risk of developing voice disorders. The aim of this study was to investigate the voice health, voice self-concept, and quality of life in German teachers. METHODS: In a cross-sectional study 536 German school teachers had a laryngeal examination, acoustic voice measurements to determine the Dysphonia Severity Index and filled in a self-reporting questionnaire with the Voice Handicap Index-12), the voice self-concept (Fragebogen zur Erfassung des Stimmlichen Selbstkonzepts), and the general quality of life (SF-12). RESULTS: A total of 58.3% of the teachers reported that they had experienced a voice problem at least once in their career. Female teachers had more often experienced voice problems than male teachers. Twenty-five percent showed a current considerable voice abnormality of vocal fold oscillation pattern. Such voice abnormalities were observed more in male teachers than female teachers. The Dysphonia Severity Index also differed between gender with higher values in the female teachers and a steadily decreasing value over age. The voice self-concept showed differences between gender and age of the teachers. Teachers who experienced a voice problem had higher Voice Handicap Index and lower voice self-concept values compared to those without experienced voice problems. Teachers with voice abnormalities had lower values in the quality of life scales. CONCLUSIONS: The findings confirm the high risk of voice health problems among German teachers and illustrate the complexity of vocal health and quality of life issues in teachers associated with gender, age, and the history of experienced voice problems. This study strengthens the necessity for vocal training programs to prepare teachers for a professional and healthy voice use to maintain vocal health.

Dipeptidyl-Peptidase Activity of Meprin ß Links N-truncation of Aß with Glutaminyl Cyclase-Catalyzed pGlu-Aß Formation.

The formation of amyloid-ß (Aß) peptides is causally involved in the development of Alzheimer's disease (AD). A significant proportion of deposited Aß is N-terminally truncated and modified at the N-terminus by a pGlu-residue (pGlu-Aß). These forms show enhanced neurotoxicity compared to full-length Aß. Although the truncation may occur by aminopeptidases after formation of Aß, recently discovered processing pathways of amyloid-ß protein precursor (AßPP) by proteases such as meprin ß may also be involved. Here, we assessed a role of meprin ß in forming Aß3-40/42, which is the precursor of pGlu-Aß3-40/42 generated by glutaminyl cyclase (QC). Similar to QC, meprin ß mRNA is significantly upregulated in postmortem brain from AD patients. A histochemical analysis supports the presence of meprin ß in neurons and astrocytes in the vicinity of pGlu-Aß containing deposits. Cleavage of AßPP-derived peptides by meprin ß in vitro results in peptides Aß1-x, Aß2-x, and Aß3-x. The formation of N-truncated Aß by meprin ß was also corroborated in cell culture. A subset of the generated peptides was converted into pGlu-Aß3-40 by an addition of glutaminyl cyclase, supporting the preceding formation of Aß3-40. Further analysis of the meprin ß cleavage revealed a yet unknown dipeptidyl-peptidase-like activity specific for the N-terminus of Aß1-x. Thus, our data suggest that meprin ß contributes to the formation of N-truncated Aß by endopeptidase and exopeptidase activity to generate the substrate for QC-catalyzed pGlu-Aß formation.

[An across-scales analysis of the voice self-concept questionnaire (FESS)]. / Skalenübergreifende Auswertung des Fragebogens zur Erfassung des stimmlichen Selbstkonzepts (FESS).

BACKGROUND: The questionnaire for the assessment of the voice selfconcept (FESS) contains three sub-scales indicating the personal relation with the own voice. The scales address the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. A comprehensive approach across the three scales supporting a simplified interpretation of the results was still missing. MATERIAL AND METHOD: The FESS questionnaire was used in a sample of 536 German teachers. With a discrimination analysis, commonalities in the scale characteristics were investigated. For a comparative validation with voice health and psychological and physiological wellbeing, the Voice Handicap Index (VHI), the questionnaire for Work-related Behavior and Experience Patterns (AVEM), and the questionnaire for Health-related Quality of Life (SF-12) were additionally collected. RESULTS: The analysis provided four different groups of voice self-concept: group 1 with healthy values in the voice self-concept and wellbeing scales, group 2 with a low voice self-concept and mean wellbeing values, group 3 with a high awareness of the voice use and mean wellbeing values and group 4 with low values in all scales. CONCLUSION: The results show that a combined approach across all scales of the questionnaire for the assessment of the voice self-concept enables a more detailed interpretation of the characteristics in the voice self-concept. The presented groups provide an applicable use supporting medical diagnoses.

Analysing the vocal behaviour of teachers during classroom teaching using a portable voice accumulator.

PURPOSE: Teachers are at a considerable risk of developing vocal health problems due to intensive voice use during teaching. This study investigated factors related to the teacher's voice during a teaching situation. METHODS: Overall, 113 teachers were recorded during a typical class lesson, lasting on average 48 min. A portable voice dosimeter (VoxLog System) was used to measure the sound pressure level (SPL) of the noise in the classroom, the teacher's voice SPL, the fundamental frequency (fo) and the phonation time. General conditions of each lesson such as number of pupils, lesson subject and the educational level of the class were also collected. For the analysis, vocal loading doses and correlations between teacher's voice and noise SPL were calculated. RESULTS: Voice and noise SPL values varied across the lesson subjects, with highest levels measured in sports lessons. The mean noise SPL changed throughout a lesson with highest values at the beginning and at the end of the lessons. The correlation analysis of voice and noise SPL identified two groups of teachers with different vocal SPL behaviours. For some teachers, the voice SPL varied with the noise SPL. For others, voice SPL was constantly high. A regression model on the teacher's voice SPL yielded a strong correlation with fo, the classroom noise SPL, and the individual vocal SPL behaviour. CONCLUSIONS: Classroom noise SPL and individual vocal SPL behaviour were significantly associated with teachers' voice SPL during teaching. Addressing these factors could be important steps in reducing the vocal load in teachers.

Purification of recombinant Aß(1-42) and pGlu-Aß(3-42) using preparative SDS-PAGE.

Recombinant expression and purification of amyloid peptides represents a common basis for investigating the molecular mechanisms of amyloid formation and toxicity. However, the isolation of the recombinant peptides is hampered by inefficient separation from contaminants such as the fusion protein required for efficient expression in E. coli. Here, we present a new approach for the isolation of highly purified Aß(1-42) and pGlu-Aß(3-42), which is based on a separation using preparative SDS-PAGE. The method relies on the purification of the Aß fusion protein by affinity chromatography followed by preparative SDS-PAGE under reducing conditions and subsequent removal of detergents by precipitation. The application of preparative SDS-PAGE represents the key step to isolate highly pure recombinant Aß, which has been applied for characterization of aggregation and toxicity. Thereby, the yield of the purification strategy was  >60%. To the best of our knowledge, this is the first description of an electrophoresis-based method for purification of a recombinant Aß peptide. Therefore, the method might be of interest for isolation of other amyloid peptides, which are critical for conventional purification strategies due to their aggregation propensity.

Factors for and against establishing and working in private practice correlated with work-related behavior and experience patterns of Ferman physicians in Schleswig-Holstein: A 2-year longitudinal study.

OBJECTIVES: To identify factors in favor of or against establishing and working in private practice, to determine the quality of life and work-related behavior and experience patterns of German physicians working in private practice, and to analyze the correlation of those factors. MATERIAL AND METHODS: A representative sample of physicians in private practice in Schleswig-Holstein, Germany, was surveyed according to a 2-year longitudinal design (T1 - 2008, N = 549 and T2 - 2010, N = 414). The study included 22 items regarding the attractiveness of establishing and working in private practice, and the questionnaires: the Short Form-12 Health Survey (SF-12), and Work-related Behavior and Experience Pattern (Arbeitsbezogenes Verhaltens- und Erlebensmuster - AVEM). RESULTS: Job satisfaction among those private practitioners decreased over time but their willingness to choose the profession once again remained unchanged. Patient care and the continuity of physician-patient relationship encouraged establishing and working in private practice; state regulation, financial risk, and administrative effort weighed against it. At both T1 and T2, physicians scored significantly lower for mental health than general population. About 20% of physicians showed a healthy behavior and experience pattern but 40% of them showed the pattern of reduced working motivation. About 20% of participants were at elevated risk for overexertion and for burnout. Physical and mental health as well as the total distribution of patterns did not change significantly during the 2-year observation period. Physicians at higher burnout risk rated tasks related to patient care considerably less positively than those with healthy pattern. CONCLUSIONS: In order to improve job satisfaction and quality of life, and to make private practice more attractive, those German physicians require a) improved legislation, b) educational programs that promote the attractiveness of private practice, and c) highly accessible counseling services for the prevention and treatment of stress, overexertion, and burnout. Int J Occup Med Environ Health 2017;30(3):485-498.

Effectiveness of a Voice Training Program for Student Teachers on Vocal Health.

OBJECTIVES: The effectiveness of a preventive training program on vocal health for German student teachers was investigated on specific vocal parameters. METHODS: The voice quality as described by the Dysphonia Severity Index of 204 student teachers (training group: n = 123; control group: n = 81) was measured at the beginning and at the end of the student teachers training period (duration 1.5 years). Additionally, for investigating the voice-carrying capacity, a vocal loading test (VLT) was performed. Finally, participants had to provide a subjective judgment of a possible Voice Handicap Index. RESULTS: The training program improved the voice quality of the trained group compared with that of the control group, whose voice quality declined. The trained group was also able to better sustain their voice quality across the VLT than the control group. Both groups, however, reported a similar increase in subjective vocal strain. CONCLUSIONS: The presented training program clearly showed a positive impact on the voice quality and the vocal capacity. The results maintain the importance of such a training program to be integrated in the education and occupational routine of teachers.