[Effects of Wearing Face Masks to Prevent Infectious Diseases On Children's and Adolescents' Well-Being and Behavior: An Interview Study]. / Auswirkungen des Tragens von Gesichtsmasken zur Prävention von Infektionskrankheiten auf das Befinden und Verhalten von Kindern und Jugendlichen: Eine Interviewstudie.

AIM: To investigate the effects of wearing masks in terms of well-being, behavior and psychosocial development on children and adolescents during the COVID-19 pandemic. METHODS: Expert interviews were conducted with educators (n=2), teachers from primary and secondary education (n=9), adolescent student representatives (n=5) as well as paediatricians from primary care (n=3) and the public health service (n=1), transcribed and subjected to thematic analysis using MAXQDA 2020. RESULTS: The most frequently reported short- and medium-term direct effects of mask-wearing were primarily in terms of limited communication due to a reduction in hearing and facial expressions. These restrictions in communication had consequences for social interaction and teaching quality. It is assumed that there will be effects on language development and social-emotional development in the future. A reported increase in psychosomatic complaints as well as anxiety, depression and eating disorders was attributed more to the conglomerate of distancing interventions than to just wearing of masks. Vulnerable groups were children with developmental difficulties, those with German as a foreign language, younger children, and shy and quiet children and adolescents. CONCLUSION: While the consequences of mask-wearing for children and adolescents can be described quite well for different aspects of communication and interaction, effects on aspects of psychosocial development cannot be clearly identified yet. Recommendations are made primarily for dealing with the limitations in the school setting.

CAT HPPR: a critical appraisal tool to assess the quality of systematic, rapid, and scoping reviews investigating interventions in health promotion and prevention.

BACKGROUND: For over three decades researchers have developed critical appraisal tools (CATs) for assessing the scientific quality of research overviews. Most established CATs for reviews in evidence-based medicine and evidence-based public health (EBPH) focus on systematic reviews (SRs) with studies on experimental interventions or exposure included. EBPH- and implementation-oriented organisations and decision-makers, however, often seek access to rapid reviews (RRs) or scoping reviews (ScRs) for rapid evidence synthesis and research field exploration. Until now, no CAT is available to assess the quality of SRs, RRs, and ScRs following a unified approach. We set out to develop such a CAT. METHODS: The development process of the Critical Appraisal Tool for Health Promotion and Prevention Reviews (CAT HPPR) included six phases: (i) the definition of important review formats and complementary approaches, (ii) the identification of relevant CATs, (iii) prioritisation, selection and adaptation of quality criteria using a consensus approach, (iv) development of the rating system and bilingual guidance documents, (v) engaging with experts in the field for piloting/optimising the CAT, and (vi) approval of the final CAT. We used a pragmatic search approach to identify reporting guidelines/standards (n = 3; e.g. PRISMA, MECIR) as well as guidance documents (n = 17; e.g. for reviews with mixed-methods approach) to develop working definitions for SRs, RRs, ScRs, and other review types (esp. those defined by statistical methods or included data sources). RESULTS: We successfully identified 14 relevant CATs, predominantly for SRs (e.g. AMSTAR 2), and extracted 46 items. Following consensual discussions 15 individual criteria were included in our CAT and tailored to the review types of interest. The CAT was piloted with 14 different reviews which were eligible to be included in a new German database looking at interventions in health promotion and prevention in different implementation settings. CONCLUSIONS: The newly developed CAT HPPR follows a unique uniformed approach to assess a set of heterogeneous reviews (e.g. reviews from problem identification to policy evaluations) to assist end-users needs. Feedback of external experts showed general feasibility and satisfaction with the tool. Future studies should further formally test the validity of CAT HPPR using larger sets of reviews.

Psychosocial Occupational Exposures and Mental Illness.

BACKGROUND: The purpose of this study is to investigate the exposure-risk relationship between psychosocial occupational stress and mental illness. METHODS: We conducted a systematic review with meta-analyses as an update of a systematic review published in 2014. The study protocol was registered in PROSPERO (CRD42020170032). Literature searches were carried out in the MEDLINE, PsycINFO, and Embase databases. All procedural steps were performed independently by two reviewers; discordances were solved by consensus. All of the included full texts were subject to a methodological appraisal. Certainty of evidence was determined with the GRADE procedure. RESULTS: The pooled risk of depression was found to be approximately doubled in workers exposed to high job strain, which is defined as high work demands combined with low job control (effect estimate [EE] = 1.99, 95% CI [1.68; 2.35], heterogeneity [I2] = 24.7%, n = 8). In particular, high work demands are associated with incident depression (ES = 13.8 [1.19; 1.61], I2 = 69.0%, n = 9) and with incident anxiety disorder (ES = 1.79 [1.44; 2.23], I2 = 48.1%, n = 5). There were only a small number of methodologically adequate studies available on burnout, somatoform disorders, suicidal ideation, and suicide. Thus, no pooled risk estimates were calculated, although some individual studies showed a considerably increased risk. CONCLUSION: Psychosocial occupational stress is clearly associated with depression and anxiety disorders.

[Impact of wearing face masks in public to prevent infectious diseases on the psychosocial development in children and adolescents: a systematic review]. / Beeinflussung der psychosozialen Entwicklung von Kindern und Jugendlichen durch das Tragen von Gesichtsmasken im öffentlichen Raum zur Prävention von Infektionskrankheiten: Ein systematischer Review.

BACKGROUND: Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. AIM: The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents. METHODS: A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. RESULTS: Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the "mask" and "no mask" conditions. DISCUSSION: Only little evidence can be derived on the effects of wearing mouth-nose protection on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behavior, school success, and participation. Further qualitative studies and epidemiological studies are required.

A Rapid Review on the Influence of COVID-19 Lockdown and Quarantine Measures on Modifiable Cardiovascular Risk Factors in the General Population.

Preceding coronavirus outbreaks resulted in social isolation, which in turn is associated with cardiovascular consequences. Whether the current COVID-19 pandemic negatively impacts cardiovascular health is unclear. The aim of the rapid review was to investigate, whether COVID-19 lockdown influences modifiable cardiovascular risk factors (i.e., physical inactivity, sedentary behaviour, smoking, alcohol use, unhealthy diet, obesity, bad blood lipids, and hypertension) in the general population. Medline and EMBASE were searched until March 2021. Title, abstracts, and full texts were screened by one reviewer and 20% by a second reviewer. Only studies using probability sampling were included in order to ensure the representativeness of the target population. Data extraction and critical appraisal were done by one reviewer and double-checked by another reviewer. We identified 32 studies that fulfilled our inclusion criteria. Findings show that physical activity decreased, and sedentary behaviour increased among all age groups during the COVID-19 lockdown. Among adults, alcohol consumption increased, dietary quality worsened, and the amount of food intake increased. Some adults reported weight gain. Studies on children and adolescents were sparse. This rapid review found a high number of epidemiological studies on the impact of COVID-19 lockdown measures on modifiable cardiovascular risk factors, but only a few used probability sampling methods.

Stigmatization from Work-Related COVID-19 Exposure: A Systematic Review with Meta-Analysis.

Stigmatization from work-related COVID-19 exposure has not been investigated in detail yet. Therefore, we systematically searched three databases: Medline, Embase, and PsychInfo (until October 2020), and performed a grey literature search (until February 2021). We identified 46 suitable articles from 24 quantitative and 11 qualitative studies, 6 systematic reviews, 3 study protocols and 1 intervention. The assessment of stigmatization varied widely, ranging from a single-item question to a 22-item questionnaire. Studies mostly considered perceived self-stigma (27 of 35 original studies) in healthcare workers (HCWs) or hospital-related jobs (29 of 35). All articles reported on stigmatization as a result of work-related COVID-19 exposure. However, most quantitative studies were characterized by convenience sampling (17 of 24), and all studies-also those with an adequate sampling design-were considered of low methodological quality. Therefore, it is not possible to determine prevalence of stigmatization in defined occupational groups. Nevertheless, the work-related stigmatization of occupational groups with or without suspected contact to COVID-19 is a relevant problem and increases the risk for depression (odds ratio (OR) = 1.74; 95% confidence interval CI 1.29-2.36) and anxiety (OR = 1.75; 95% CI 1.29-2.37). For promoting workers' health, anti-stigma strategies and support should be implemented in the workplace.

The Risk of Knee Osteoarthritis in Professional Soccer Players­a Systematic Review With Meta-Analyses

BACKGROUND: We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis. METHODS: A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria. RESULTS: The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%). CONCLUSION: A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.

Reply to Seafarers' Occupational Noise Exposure and Cardiovascular Risk. Comments to Bolm-Audorff, U.; et al. Occupational Noise and Hypertension Risk: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 6281.

We are grateful for the insightful comments in [...].

Occupational Noise and Hypertension Risk: A Systematic Review and Meta-Analysis.

A number of epidemiological studies report an association between occupational noise exposure and arterial hypertension. Existing systematic reviews report conflicting results, so we conducted an updated systematic review with meta-analysis. We registered the review protocol with PROSPERO (registration no.: CRD 42019147923) and searched for observational epidemiological studies in literature databases (Medline, Embase, Scopus, Web of Science). Two independent reviewers screened the titles/abstracts and full texts of the studies. Two reviewers also did the quality assessment and data extraction. Studies without adequate information on recruitment, response, or without a comparison group that was exposed to occupational noise under 80 dB(A) were excluded. The literature search yielded 4583 studies, and 58 studies were found through hand searching. Twenty-four studies were included in the review. The meta-analysis found a pooled effect size (ES) for hypertension (systolic/diastolic blood pressure ≥140/90 mmHg) due to noise exposures ≥80 dB(A) of 1.81 (95% CI 1.51-2.18). There is no substantial risk difference between men and women, but data concerning this question are limited. We found a positive dose-response-relationship: ES = 1.21 (95% CI 0.78-1.87) ≤ 80 dB(A), ES = 1.77 (95% CI 1.36-2.29) >80-≤85 dB(A), and ES = 3.50 (95% CI 1.56-7.86) >85-≤90 dB(A). We found high quality of evidence that occupational noise exposure increases the risk of hypertension.

Vaccine-Preventable Infections in Childcare Workers.

BACKGROUND: Adequate immunity to so-called childhood diseases can lower the occupational risk of vaccine-preventable infectious diseases in persons who work in day-care centers for children. METHODS: A systematic literature survey was carried out in PubMed and Embase for the period January 2000 to February 2019. Studies on immune status and vaccination status were included. In addition, data from the first wave of the German Health Interview and Examination Survey for Adults (Studie zur Gesundheit Erwachsener in Deutschland, DEGS1) and surveillance data on notifiable infections in Germany were evaluated. RESULTS: Six studies and the DEGS1 analysis of vaccination or immune status for varicella zoster, rubella, hepatitis A (HAV), pertussis, measles, and mumps in persons caring for children in day-care centers, most of whom are women, were included in this review. According to DEGS1, childcare workers are more commonly vaccinated against HAV and pertussis than the general female population (prevalence ratios [PR]: 1.46 [1.12; 1.90] and 1.57 [1.05; 2.36]), yet 57% had not been vaccinated against HAV and 77% had not been vaccinated against pertussis. Childcare workers were found to be less commonly vaccinated against rubella than the general female population, although the difference was not statistically significant (PR: 0.87 [0.71; 1.07]). In a Canadian study, positive HAV serology was found to be correlated with the duration of activity as a childcare worker. In the DEGS1 study, large proportions of the younger childcare workers in particular were seronegative against measles (16%), mumps (19%), and HAV (37%). Notifiable disease statistics show that those working in community facilities had a markedly higher risk of mumps, pertussis, and varicella (relative risk [RR]: 1.8-2.6) and a somewhat higher risk of rubella and HAV (RR: 1.47 and 1.21, respectively). CONCLUSION: Childcare workers have a higher occupational risk of infection but do not always receive the appropriate vaccinations. In particular, women of child-bearing age working in day-care centers should be made more aware of the need for vaccination.

Traffic Noise and Mental Health: A Systematic Review and Meta-Analysis.

Recent evidence suggests that traffic noise may negatively impact mental health. However, existing systematic reviews provide an incomplete overview of the effects of all traffic noise sources on mental health. We conducted a systematic literature search and summarized the evidence for road, railway, or aircraft noise-related risks of depression, anxiety, cognitive decline, and dementia among adults. We included 31 studies (26 on depression and/or anxiety disorders, 5 on dementia). The meta-analysis of five aircraft noise studies found that depression risk increased significantly by 12% per 10 dB LDEN (Effect Size = 1.12, 95% CI 1.02-1.23). The meta-analyses of road (11 studies) and railway traffic noise (3 studies) indicated 2-3% (not statistically significant) increases in depression risk per 10 dB LDEN. Results for road traffic noise related anxiety were similar. We did not find enough studies to meta-analyze anxiety and railway or aircraft noise, and dementia/ cognitive impairment and any traffic noise. In conclusion, aircraft noise exposure increases the risk for depression. Otherwise, we did not detect statistically significant risk increases due to road and railway traffic noise or for anxiety. More research on the association of cognitive disorders and traffic noise is required. Public policies to reduce environmental traffic noise might not only increase wellness (by reducing noise-induced annoyance), but might contribute to the prevention of depression and anxiety disorders.

Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis.

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4-41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases-particularly rotator cuff lesions-should be recognized as an occupational disease.

The risk of cytomegalovirus infection in daycare workers: a systematic review and meta-analysis.

PURPOSE: The primary aim of this review was to summarize the evidence on the relationship between being a daycare worker working with children and the possible increased risk of cytomegalovirus infection. METHODS: We searched the Medline and Embase databases using search strings defined according to the population, exposure, comparison, and outcomes (PECO) applicable to our research questions in order to find studies published since 2000. Two independent reviewers evaluated the search hits using predefined inclusion and exclusion criteria. A manual search was performed to identify additional relevant literature. We extracted the resulting studies and assessed them in eight domains of bias. The pooled CMV seroprevalence for daycare workers compared to the general population was calculated. RESULTS: After evaluating the 6879 records, six methodologically adequate studies were identified: five cross-sectional studies and one cohort study. The pooled seroprevalence of daycare workers was 59.3% (95% CI 47.6-70.9). The four studies investigating risk of infection indicated an increased seroprevalence for daycare workers compared to a reference population (prevalence ratio, PR = 1.54, 95% CI 1.33-1.77). No study evaluated CMV seroconversions for daycare workers. CONCLUSIONS: Our findings suggest a higher CMV seroprevalence for daycare workers compared to the general population. Notwithstanding the need for longitudinal and intervention studies, preventative efforts are needed. A pooled PR of 1.54 is compatible with a doubled seroconversion risk corresponding to a vocational probability of 50% if the substantial underestimation of the actual occupational seroconversion risk by prevalence-based estimators is considered.

Behavioral and Emotional Disorders and Transportation Noise among Children and Adolescents: A Systematic Review and Meta-Analysis.

Children and adolescents may be particularly vulnerable to environmental influences such as noise which can affect mental well-being. The aim of this systematic review was to evaluate the effect of transportation noise on behavioral and emotional disorders in children and adolescents using a meta-analytic approach. Therefore, we searched four databases (Pubmed, Embase, PsychINFO, and PSYNDEX) and grey literature until February of 2019. We identified 14 articles from 10 studies examining the effect of transportation noise exposure on the mental health of children. These studies predominately used the Strength and Difficulties Questionnaire (SDQ) and mainly focused on schoolchildren and adolescents aged 9-10 years and 15-17 years in Europe. Three studies could be included in the meta-analysis. In sum, the odds for hyperactivity/inattention and total difficulties was significantly increased by 11% (Odds Ratio, OR = 1.11 (95% Confidence Interval, CI 1.04-1.19), respectively 9% (95% CI 1.02-1.16) per 10 dB road traffic noise. Thus, we obtained evidence for an effect of road traffic noise on hyperactivity/inattention and total difficulties, although we could consider few studies. Future studies are needed that use similar techniques to assess outcomes and exposures at schools and in homes. This would make it possible to conduct an individual participant data pooled analysis of the data.

Are Daycare Workers at a Higher Risk of Parvovirus B19 Infection? A Systematic Review and Meta-Analysis.

Objective: In this systematic review, we aimed to summarize the evidence on the association between being a daycare educator working with children and the possible increased risk of parvovirus B19 infection compared to the general population. Methods: The Medline and Embase databases were searched using a defined search to find studies published since 2000. Two reviewers evaluated the search hits using predefined inclusion and exclusion criteria. The resulting studies were extracted and were assessed in eight domains of bias. A pooled relative risk (RR) of parvovirus infection for daycare workers compared to the general population was calculated. Results: After evaluating the 7781 search hits and manual search, four methodologically-adequate studies were identified: three cross-sectional studies and one retrospective cohort study. Of the three studies investigating the risk of infection, one evaluated parvovirus B19 seroconversion rates for daycare workers. There was an indication for an increased risk for daycare workers compared to the unexposed population (RR = 1.12, 95% CI 0.98-1.27) using prevalence estimators. Furthermore, daycare workers had a higher seroconversion rate compared to the unexposed population (RR = 2.63, 95% 1.27-5.45) in the low risk of bias study. Conclusions: Our findings suggest a higher risk of parvovirus B19 infection for daycare workers compared to an unexposed comparison population, which necessitate preventative efforts. Considering the underestimation of the occupational seroconversion risk by prevalence-based estimators, parvovirus B19 infections among daycare workers might mostly be occupationally acquired.

The influence of wind turbine visibility on the health of local residents: a systematic review.

PURPOSE: The health effects of visible wind turbine features on residents were investigated. Further, it was examined, if visual annoyance has an influence on residents' health, and if wind turbine visibility impacts residents' health independently of or in combination with acoustical aspects. METHODS: Medical databases, Google Scholar, public health institutions, and reference lists were searched systematically (PROSPERO registry number: CRD42016041737). Two independent reviewers screened titles/abstract and full texts, extracted data, and critically appraised the methodology of included studies. Study findings were analyzed qualitatively and quantitatively. RESULTS: Seventeen studies from 19 publications of varying methodological quality were included (two cohort studies, fifteen cross-sectional studies). The pooled prevalence of high annoyance due to altered views and shadow flicker was 6% each. The results of other health effects were inconsistent, with some indications showing that direct wind turbine visibility increases sleep disturbance. Annoyance by direct visibility, shadow flicker, and blinking lights was significantly associated with an increased risk for sleep disorders. One study indicated reactions to visual wind turbine features may be influenced by acoustical exposures. CONCLUSIONS: In interpreting the results, the differing methodological quality of the included studies needs to be considered. Direct and indirect wind turbine visibility may affect residents' health, and reactions may differ in combination with noise. Further, annoyance by wind turbine visibility may interact as mediator between visual exposures and the health of local residents. To confirm the results, more high-quality research is needed.

Health effects of wind turbines on humans in residential settings: Results of a scoping review.

INTRODUCTION: As the global number of wind turbines has increased steadily in recent years, as has the number of studies about putative health effects in residential settings, it is the review purpose to give an overview of the characteristics and methodologies of the scientific literature around the topic in order to identify research gaps and to derive implications for research and practice. Additionally, study findings from higher-quality observational studies as well as results that seem to be of interest for the scientific and political debate are presented. METHODS: The scoping review was conducted following systematic review methods. Comprehensive literature searches were carried out in several databases, and with extensive hand searches. All review steps were carried out in parallel by two reviewers or by one reviewer and in duplicate checked by another reviewer. The following important methodological criteria were investigated: Reporting, ethical aspects, generalization, selection bias, information bias, confounder bias. Findings from observational studies without a selection bias, information bias, and confounder bias are presented. RESULTS: 84 articles, that varied significantly in methods and outcomes assessed, met the inclusion criteria. Multiple cross-sectional studies reported that wind turbine noise is associated with noise annoyance, which is moderated by several variables such as noise sensitivity, attitude towards wind turbines, or economic benefit. Wind turbine noise is not associated with stress effects and biophysiological variables of sleep. Results on the impact of wind turbine noise on sleep disburbance, quality of life, and mental health problems differed among cross-sectional studies. There were few studies that addressed the potential impact of turbine noise on clinically apparent health outcomes. There were also few studies on visual risk factors or infrasound exposure. No literature was identified regarding low-frequency noise, electromagnetic radiation, and ice throw. CONCLUSIONS: There is an extensive and diverse body of evidence around health impacts of wind turbines in residential settings, that increased sharply since 2010, showing particularly noise consequences concerning increased noise annoyance with its complex pathways; no relationship between wind turbine noise and stress effects and biophysiological variables of sleep; and heterogeneous findings concerning sleep disturbance, quality of life, as well as mental health problems. Research gaps concern the complex pathways of annoyance, the examination of clinically apparent health outcomes in comparison with non-exposed residents, an objective investigation of visual wind turbine features, the interaction between all wind turbine exposures, and epidemiological observational studies on field low-frequency and infrasound from wind turbines. Future research needs thorough high-quality and prospective study designs.

Dose-response relationship between cumulative physical workload and osteoarthritis of the hip - a meta-analysis applying an external reference population for exposure assignment.

BACKGROUND: There is consistent evidence from observational studies of an association between occupational lifting and carrying of heavy loads and the diagnosis of hip osteoarthritis. However, due to the heterogeneity of exposure estimates considered in single studies, a dose-response relationship between cumulative physical workload and hip osteoarthritis could not be determined so far. METHODS: This study aimed to analyze the dose-response relationship between cumulative physical workload and hip osteoarthritis by replacing the exposure categories of the included studies with cumulative exposure values of an external reference population. Our meta-regression analysis was based on a recently conducted systematic review (Bergmann A, Bolm-Audorff U, Krone D, Seidler A, Liebers F, Haerting J, Freiberg A, Unverzagt S, Dtsch Arztebl Int 114:581-8, 2017). The main analysis of our meta-regression comprised six case-control studies for men and five for women. The population control subjects of a German multicentre case-control study (Seidler A, Bergmann A, Jäger M, Ellegast R, Ditchen D, Elsner G, Grifka J, Haerting J, Hofmann F, Linhardt O, Luttmann A, Michaelis M, Petereit-Haack G, Schumann B, Bolm-Audorff U, BMC Musculoskelet Disord 10:48, 2009) served as the reference population. Based on the sex-specific cumulative exposure percentiles of the reference population, we assigned exposure values to each category of the included studies using three different cumulative exposure parameters. To estimate the doubling dose (the amount of physical workload to double the risk of hip osteoarthritis) on the basis of all available case-control-studies, meta-regression analyses were conducted based on the linear association between exposure values of the reference population and the logarithm of reported odds ratios (ORs) from the included studies. RESULTS: In men, the risk to develop hip osteoarthritis was increased by an OR of 1.98 (95% CI 1.20-3.29) per 10,000 tons of weights ≥20 kg handled, 2.08 (95% CI 1.22-3.53) per 10,000 tons handled > 10 times per day and 8.64 (95% CI 1.87-39.91) per 106 operations. These estimations result in doubling dosages of 10,100 tons of weights ≥20 kg handled, 9500 tons ≥20 kg handled > 10 times per day and 321,400 operations of weights ≥20 kg. There was no linear association between manual handling of weights at work and risk to develop hip osteoarthritis in women. CONCLUSIONS: Under specific conditions, the application of an external reference population allows for the derivation of a dose-response relationship despite high exposure heterogeneities in the pooled studies.

Do Technical Aids for Patient Handling Prevent Musculoskeletal Complaints in Health Care Workers?-A Systematic Review of Intervention Studies.

The physical load ensuing from the repositioning and moving of patients puts health care workers at risk of musculoskeletal complaints. Technical equipment developed to aid with patient handling should reduce physical strain and workload; however, the efficacy of these aids in preventing musculoskeletal disorders and complaints is still unclear. A systematic review of controlled intervention studies was conducted to examine if the risk of musculoskeletal complaints and disorders is reduced by technical patient handling equipment. MEDLINE®/PubMed®, EMBASE®, Allied and Complementary Medicine Database (AMED), and Cumulative Index of Nursing and Allied Health Literature (CINAHL®) were searched using terms for nursing, caregiving, technical aids, musculoskeletal injuries, and complaints. Randomized controlled trials and controlled before-after studies of interventions including technical patient handling equipment were included. The titles and abstracts of 9554 publications and 97 full-texts were screened by two reviewers. The qualitative synthesis included one randomized controlled trial (RCT) and ten controlled before-after studies. A meta-analysis of four studies resulted in a pooled risk ratio for musculoskeletal injury claims (post-intervention) of 0.78 (95% confidence interval 0.68-0.90). Overall, the methodological quality of the studies was poor and the results often based on administrative injury claim data, introducing potential selection bias. Interventions with technical patient handling aids appear to prevent musculoskeletal complaints, but the certainty of the evidence according to GRADE approach ranged from low to very low.