[Shift Work among Men and Women on the Threshold to Higher Working Age - Working Conditions and Health Status]. / Schichtarbeit bei Männern und Frauen an der Schwelle zum höheren Erwerbsalter ­ Arbeitsumstände und Gesundheitszustand.

Background: The number of older employees in shift and night work has increased significantly in recent years. Furthermore, the proportion of women in shift and night work has increased markedly. This is due to the aging workforce and the expansion of shift work in the tertiary sector. Previous research shows that shift work is often associated with health risks. Against this background, the aim of the present study is to examine the situation of working men and women on the threshold to higher working age with regard to the relationship between shift work and physical health. Methods: We employed data from the study "lidA - leben in der Arbeit" German Cohort Study on Work, Age and Health, a survey of the German baby boom cohorts born in 1959 and 1965 (n=5 637). Linear regression models are used to study the effect of shift work - with and without night work - and of further work exposures on the baby boomers' physical health status. The models control for sleep and health-related behaviour and are stratified by gender. Among women, also the scope of work was taken into account. Results: The results show that male shift workers are burdened by their on average lower occupational status and by physical exposure; female shift workers additionally suffer from high personal effort and low rewards and female part-time shift workers also from overcommitment. Conclusion: Working conditions of shift workers are strongly characterised by work stress. In order to preserve aging shift workers' work ability, some organisational measures seem necessary. In this context, occupational safety and health management as well as opportunities for recovery and encouraging leadership should be considered.

[Psychosocial working conditions and mental health status of the German babyboomer generation]. / Psychosoziale Arbeitsbedingungen und mentale Gesundheit der Babyboomergeneration.

BACKGROUND: The baby boomers are the first to be available to the German labour market up to the age of 67. A crucial premise for a long working life is good health. However, there is evidence that psychosocial working conditions are related to health. More and more employees report psychosocial stress at work. In addition, mental illness has become one of the main reasons for the entry into disability pension. Against this background this study considers the relationship between psychosocial work conditions and mental health exemplarily for two birth cohorts of the German baby boomers. METHODS: For the analysis of the assumed relationships data of the lidA study "lidA - leben in der Arbeit - German Cohort Study on Work, Age and Health" is used (N=6 057). Mental health is assessed by the mental health scale of the SF-12. In addition, the items and the scales quantitative job requirements, work pace and support from colleagues from the Copenhagen Psychosocial Questionnaire (COPSOQ) are used. As further control variables cohort affiliation, level of education, occupational status and partnership are considered. RESULTS: Multivariate analyses of the relations between quantitative job requirements, work pace and the experienced support from colleagues show significant relationship to mental health. The increasing frequency of the requirement to work quickly and increasing quantitative job demands are negatively associated to mental health. However, support of colleagues shows a positive relationship to mental health. These results are similarly observed for women and men. CONCLUSION: For the regarded group of the German babyboomers, employees at the threshold to higher working age, it is clearly shown that psychosocial working conditions are related to mental health. Since this group still has to work up to 18 years given a statutory retirement age of 67, psychosocial working conditions should rather be in the focus of occupational safety.

Using plasma transforming growth factor beta-1 during radiotherapy to select patients for dose escalation.

PURPOSE: The ability to prescribe treatment based on relative risks for normal tissue injury has important implications for oncologists. In non-small-cell lung cancer, increasing the dose of radiation may improve local control and survival. Changes in plasma transforming growth factor beta (TGFbeta) levels during radiotherapy (RT) may identify patients at low risk for complications in whom higher doses of radiation could be safely delivered. PATIENT AND METHODS: Patients with locally advanced or medically inoperable non-small-cell lung cancer received three-dimensional conformal RT to the primary tumor and radiographically involved nodes to a dose of 73.6 Gy (1.6 Gy twice daily). If the plasma TGFbeta level was normal after 73.6 Gy, additional twice daily RT was delivered to successively higher total doses. The maximum-tolerated dose was defined as the highest radiation dose at which < or = one grade 4 (life-threatening) late toxicity and < or = two grade 3 to 4 (severe life-threatening) late toxicities occurred. RESULTS: Thirty-eight patients were enrolled. Median follow-up was 16 months. Twenty-four patients were not eligible for radiation dose escalation beyond 73.6 Gy because of persistently abnormal TGFbeta levels. Fourteen patients whose TGFbeta levels were normal after 73.6 Gy were escalated to 80 Gy (n = 8) and 86.4 Gy (n = 6). In the 86.4-Gy group, dose-limiting toxicity was reached because there were two (33%) grade 3 late toxicities. CONCLUSION: It is feasible to use plasma TGFbeta levels to select patients for RT dose escalation for non-small-cell lung cancer. The maximum-tolerated dose using this approach is 86.4 Gy.

The impact of pre-radiotherapy surgery on radiation-induced lung injury.

AIMS: The use of postoperative radiation therapy (PORT) is predicated by an assessment of the potential benefits and risks, including radiation-induced lung injury. In this study, the risk of radiation-induced lung injury is assessed in patients who received PORT, and compared with a group of patients who received radiation without prior surgery, to determine if surgery increases the risk of radiation pneumonitis. MATERIALS AND METHODS: From 1991 to 2003, 251 patients with lung cancer were enrolled into a prospective study to assess radiation-induced lung injury. All patients received three-dimensional-planned, external-beam radiotherapy. One hundred and seventy-seven patients with over 6-months follow-up were eligible. For the current analysis, 49 patients (28%) had surgical intervention before radiotherapy. The rates of Grade 2 symptomatic pneumonitis in subgroups, based on the type of pre-radiation surgery, were computed and compared using Fisher's Exact Test. To consider the confounding factor of irradiated lung volume, patient subgroups were further defined on the basis of the mean lung dose. RESULTS: Surgical procedures included pneumonectomy (n=9), lobectomy (n=16), wedge resection (n=8) and exploration without resection (n=16). Radiation-induced lung injury occurred in 33 out of 177 (19%) patients, including 18% of the surgical group and 19% of the non-surgical group. Additionally, no statistically significant difference was found in the rate of radiation-induced lung injury based on the extent of resection. CONCLUSIONS: The incidence of pneumonitis is similar in the surgical and non-surgical groups. Thus, PORT may be safely given to selected patients after surgical exploration or resection.