Childhood and adolescence factors and multiple sclerosis: results from the German National Cohort (NAKO).

BACKGROUND: Multiple Sclerosis (MS) represents the most common inflammatory neurological disease causing disability in early adulthood. Childhood and adolescence factors might be of relevance in the development of MS. We aimed to investigate the association between various factors (e.g., prematurity, breastfeeding, daycare attendance, weight history) and MS risk. METHODS: Data from the baseline assessment of the German National Cohort (NAKO) were used to calculate adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the association between childhood and adolescence factors and risk of MS. Analyses stratified by sex were conducted. RESULTS: Among a total of 204,273 participants, 858 reported an MS diagnosis. Male sex was associated with a decreased MS risk (HR 0.48; 95% CI 0.41-0.56), while overweight (HR 2.03; 95% CI 1.41-2.94) and obesity (HR 1.89; 95% CI 1.02-3.48) at 18 years of age compared to normal weight were associated with increased MS risk. Having been breastfed for ≤ 4 months was associated with a decreased MS risk in men (HR 0.59; 95% CI 0.40-0.86) compared to no breastfeeding. No association with MS risk was observed for the remaining factors. CONCLUSIONS: Apart from overweight and obesity at the age of 18 years, we did not observe considerable associations with MS risk. The proportion of cases that can be explained by childhood and adolescence factors examined in this study was low. Further investigations of the association between the onset of overweight and obesity in childhood and adolescence and its interaction with physical activity and MS risk seem worthwhile.

"The magic triangle between bed, office, couch": a qualitative exploration of job demands, resources, coping, and the role of leadership in remote work during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has necessitated many employees to work from home with immediate effect for several months, regardless of their workplace preference or situation at home. Against this backdrop, this study explores perceived job demands and resources as well as the role of leadership and coping strategies of employees and managers with little or no prior experience with working from home in the altered work environment. METHODS: Based on the job demands-resources model, we developed an interview guide and conducted thirty-four semi-structured interviews. The interviews were transcribed and analyzed deductively-inductively using qualitative content analysis. RESULTS: Experienced job demands include, e.g., challenging, insufficient digital communication, and lack of social exchange, while greater flexibility and work-life balance were identified as valuable resources. Regarding the role of leadership, signaling trust, keeping regular contact, and supporting employees are important. To cope with the unforeseen yet persistent work situation, participants applied creative strategies by setting up offices at home with what they had at disposal. Differences were observed between employee and managerial perceptions as well as over time during the pandemic. CONCLUSIONS: The results expand our knowledge about healthy remote work by adding specific demands, resources, and coping strategies employees and managers experienced during the extreme situation of the COVID-19 pandemic to the picture as well as specifying the role of leadership. Moreover, our findings provide a foundation for guidelines for healthy remote work design and collaboration in times of abrupt change and crises.

"That was one of my most difficult and biggest challenges": experiences, preconditions and preventive measures of health-oriented leadership in virtual teams - A qualitative study with virtual leaders.

BACKGROUND: Health-oriented leadership (HoL) has a positive impact on health- and work-related outcomes of employees in face-to-face settings. Increased digitization during the COVID-19 pandemic has led to many changes and increased job demands. According to current state of research, HoL in virtual teamwork is insufficiently researched. The aim of the study is to examine the experiences of virtual leaders during the COVID-19 pandemic and to identify preconditions and preventive measures for promoting HoL. METHOD: Using a qualitative study design, semi-structured, guide-based telephone interviews were conducted with 16 German virtual leaders between May and July 2021. The collected data were inductively analyzed and interpreted using qualitative content analysis according to Mayring. Explorative analyses of differences between leaders with and without pre-pandemic experiences with virtual leadership were made. RESULTS: Results indicated that leaders, regardless of pre-pandemic experiences with virtual leadership, faced diverse challenges in implementing HoL in virtual teamwork during the COVID-19 pandemic. Virtual leaders perceived personal preconditions (e.g., leaders' characteristics or behaviors), organizational preconditions (support by management or open-minded corporate culture), social preconditions (e.g., social support by team) and technical preconditions (e.g., sufficient technical equipment) as conducive to implementation of HoL. Almost all leaders with pre-pandemic experience identified a need for structural preventive measures, whereas almost all leaders without pre-pandemic experience reported a need for behavioral preventive measures in order to promote HoL in virtual teams. CONCLUSIONS: This study suggests that implementing HoL in virtual teamwork is challenging, complex and requires adjustments in leadership behavior. Thereby, the study provides initial empirical findings for a holistic approach to HoL implementation in virtual teams, considering beneficial multilevel preconditions. Due to a limited generalization of present results, longitudinal and interventional studies will be necessary for the analysis of causal relationships in future research. In particular, a holistic research perspective in order to understand the complex, contextual interdependencies of leadership is recommended. In practice, based on a differentiated needs analysis, structural preventive measures for a holistic organizational development as well as behavioral preventive measures for ongoing personnel development are recommended.

Changes in physical activity and sedentary behavior during the first COVID-19 pandemic- restrictions in Germany: a nationwide survey : Running head: physical activity during the COVID-19 restrictions.

BACKGROUND: The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups. METHODS: Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions. RESULTS: Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines. CONCLUSIONS: Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany.

BACKGROUND: Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany. METHODS: Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions. RESULTS: Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students). CONCLUSIONS: Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

[Expectations And Motivations Of Young Occupational Medical Physicians: A Quantitative Survey Of Five German Academies]. / Erwartungen und Motive des arbeitsmedizinischen Nachwuchses: eine quantitative Befragung in fünf deutschen Akademien.

STUDY AIM: The aim of this study was to describe the characteristics of future occupational physicians and to evaluate their expectations from and motivations for undertaking postgraduate medical education courses in occupational medicine. This will provide a basis for further increasing the attractiveness of occupational medicine as a discipline in preventive medicine and counteracting the shortage of occupational medical physicians. METHODS: At five locations in Germany, physicians in postgraduate medical education courses in occupational medicine were asked about their expectations from occupational medicine, their reasons for starting postgraduate medical education courses, and their assessment of these courses. The survey took place between 2018 and 2021. The data were analysed descriptively, and a cluster analysis was applied to identify the types of motives for continuing postgraduate medical education courses in occupational medicine. RESULTS: Of the 233 respondents, the majority were female (68.5%) and the mean age was 43.1 years (SD 7.9 years). The response at the State Chamber of Physicians of Saxony was 50% and at the remaining four academies was between 18% and 23%. The analysis revealed four different types of motives: "career & interest", "work & life balance", "self-employment" and "desire for change". Two-thirds of the participants were in favour of a greater integration of occupational medicine into medical school curriculum. CONCLUSIONS: The results suggest that there are different motives that lead physicians to pursue continuing education in occupational medicine. These motives should be considered when recruiting young occupational physicians.

Digital stress perception among German hospital nurses and associations with health-oriented leadership, emotional exhaustion and work-privacy conflict: a cross-sectional study.

BACKGROUND: The use of digital information and communication technologies (ICT) can be accompanied by increased technostress for nursing staff, which in turn can be associated with health consequences. In addition, the use-related constant accessibility through ICT can have a negative impact on health-related recovery and regeneration phases. Health-promoting behaviors of supervisors can influence health complaints and conflicts between employees' work and private lives. The present study investigates whether there is a corresponding relationship between digital stressors (technostressors) as well as health-oriented leadership and health outcomes among nurses. METHODS: In a quantitative online survey, hospital nursing staff (n = 243) was asked about techno-invasion, social environment, emotional exhaustion, work-privacy conflict and on the supervisors' health-oriented staff-care dimensions awareness, value of health and health-oriented leadership behavior (HoL: awareness, value of health and health behavior). The associations of technostress, HoL and health outcomes were tested using regression analyses and performing a correlation. RESULTS: Significant positive associations between techno-invasion and health outcomes had been found. Social environment was not (positively) significantly related to either emotional exhaustion or work-privacy conflict. Health-oriented leadership moderated the association between social environment and work-privacy conflict. CONCLUSIONS: The results confirm the relevance of measures to reduce technostress and the importance of health-oriented leadership as a health-promoting resource. For practice, offers should be implemented for a balanced work and personal life of the nursing staff as well as establishing competence trainings for supervisors to learn and implement health-promoting behaviors. When technology use can't be reduced, options could be created to ensure that nurses' work and private lives become more balanced. These could represent mindfulness practices.

[Statement Paper on the Implementation of a National Organized Program in Germany for the Early Detection of Lung Cancer in Risk Populations Using Low-dose CT Screening Including Management of Screening Findings]. / Positionspapier zur Implementierung eines nationalen organisierten Programms in Deutschland zur Früherkennung von Lungenkrebs in Risikopopulationen mittels Low-Dose-CT-Screening inklusive Management von abklärungsbedürftigen Screening-Befunden.

The process of implementing early detection of lung cancer with low-dose CT (LDCT) in Germany has gained significant momentum in recent years. It is expected that the ordinance of the Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) on early detection of lung cancer, which has been commented on by the professional societies, will come into effect by the end of 2023. Based on this regulation, the Federal Joint Committee (G-BA) will set up a program for early lung cancer detection with LDCT in the near future. In this position paper, the specialist societies involved in lung cancer screening present concrete cornerstones for a uniform, structured and quality-assured early detection program for lung cancer in Germany to make a constructive contribution to this process.

[Statement paper on the implementation of a national organized program in Germany for the early detection of lung cancer in risk populations using low-dose CT screening including management of screening findings]. / Positionspapier zur Implementierung eines nationalen organisierten Programms in Deutschland zur Früherkennung von Lungenkrebs in Risikopopulationen mittels Low-dose-CT-Screening inklusive Management von abklärungsbedürftigen Screeningbefunden.

The process of implementing early detection of lung cancer with low-dose CT (LDCT) in Germany has gained significant momentum in recent years. It is expected that the ordinance of the Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) on early detection of lung cancer, which has been commented on by the professional societies, will come into effect by the end of 2023. Based on this regulation, the Federal Joint Committee (G-BA) will set up a program for early lung cancer detection with LDCT in the near future. In this position paper, the specialist societies involved in lung cancer screening present concrete cornerstones for a uniform, structured and quality-assured early detection program for lung cancer in Germany to make a constructive contribution to this process.

Polymorphisms in genes of melatonin biosynthesis and signaling support the light-at-night hypothesis for breast cancer.

Light-at-night triggers the decline of pineal gland melatonin biosynthesis and secretion and is an IARC-classified probable breast-cancer risk factor. We applied a large-scale molecular epidemiology approach to shed light on the putative role of melatonin in breast cancer. We investigated associations between breast-cancer risk and polymorphisms at genes of melatonin biosynthesis/signaling using a study population of 44,405 women from the Breast Cancer Association Consortium (22,992 cases, 21,413 population-based controls). Genotype data of 97 candidate single nucleotide polymorphisms (SNPs) at 18 defined gene regions were investigated for breast-cancer risk effects. We calculated adjusted odds ratios (ORs) and 95% confidence intervals (CI) by logistic regression for the main-effect analysis as well as stratified analyses by estrogen- and progesterone-receptor (ER, PR) status. SNP-SNP interactions were analyzed via a two-step procedure based on logic regression. The Bayesian false-discovery probability (BFDP) was used for all analyses to account for multiple testing. Noteworthy associations (BFDP < 0.8) included 10 linked SNPs in tryptophan hydroxylase 2 (TPH2) (e.g. rs1386492: OR = 1.07, 95% CI 1.02-1.12), and a SNP in the mitogen-activated protein kinase 8 (MAPK8) (rs10857561: OR = 1.11, 95% CI 1.04-1.18). The SNP-SNP interaction analysis revealed noteworthy interaction terms with TPH2- and MAPK-related SNPs (e.g. rs1386483R ∧ rs1473473D ∧ rs3729931D: OR = 1.20, 95% CI 1.09-1.32). In line with the light-at-night hypothesis that links shift work with elevated breast-cancer risks our results point to SNPs in TPH2 and MAPK-genes that may impact the intricate network of circadian regulation.

Does working in an extremely cold environment affects lung function?: 10 years follow-up.

OBJECTIVE: The aim of this study is to investigate whether there is an association between brief but repeated exposures to extremely cold temperatures over many years and pulmonary function. METHODS: We performed a retrospective analysis of the data collected over 10 years in the context of the extended medical examinations of storeworkers exposed to extremely cold temperatures. We considered forced vital capacity (FVC), forced expiratory volume in one second (FEV1), Tiffeneau-Pinelli index (FEV1/FVC), CO diffusion capacity (DL,CO) and Krogh-factor (CO diffusion capacity relative to recorded alveolar volume, DL,CO/VA) reported as %-predicted. We analysed trends in outcome parameters with linear mixed models. RESULTS: 46 male workers participated in at least two extended medical examinations between 2007 and 2017. Overall 398 measure points were available. All lung function parameters had values above the lower limit of normality at the first examination. In the multivariate model including smoking status and monthly intensity of cold exposure (≤ 16 h/month vs. > 16 h/month) FEV1%-predicted and FVC %-predicted had a statistically significant positive slope (FEV1, 0.32% 95% CI 0.16% to 0.49% p < 0.001; FVC 0.43% 95% CI 0.28% to 0.57% p < 0.001). The other lung function parameters (FEV1/FVC %-predicted, DL,CO %-predicted, DL,CO/VA %-predicted) showed no statistically significant change over time. CONCLUSIONS: Long term intermittent occupational exposure to extreme cold temperatures (-55 °C) does not appear to cause irreversible deleterious changes in lung function in healthy workers, thus the development of obstructive or restrictive lung diseases is not expected.

Accidents, diseases and health complaints among seafarers on German-flagged container ships.

BACKGROUND: For seafarers on the high seas health hazards are various and due to the setting also specific. The spectrum of job-related health impairments and accidents is mainly influenced by the maritime characteristics. The aim of this study is to assess the kind of accidents and the frequency of diseases and health complaints among seafarers on German container ships by evaluating medical log books. METHODS: A systematic analysis of 14,628 medical entries from 95 medical log books of 58 container ships under German flag from 1995 to 2015 was performed. This monocentric retrospective and descriptive study used information on accidents, diseases and health complaints among different occupational groups and medical treatment procedures for the analysis and evaluation. RESULTS: The analysis showed that more than one third of all consultations with the Health Officer on board are related to internal (33.7%) and surgical (31.3%) symptoms. Almost twenty percent of consultations were due to respiratory infections (19.6%) and accidents (17.9%). Accidents represented the most frequent reason for unfitness for sea service (31.2%). Based on occupational categories, most injuries occurred among deck crew (22.5%), followed by ratings working in the engine room (18.9%). In 106 cases, telemedical contact with a physician ashore was necessary. In total, 15 seafarers had to be evacuated from the ship for further medical treatment onshore. Medicine/drug application was the most common therapeutic measure on board, accounting for 77% of all consultations. CONCLUSIONS: The high proportion of health complaints and accidents among seafarers shows that there is a need to optimize medical care at sea and accident prevention, e.g. by standardized treatment algorithms or improving the medical training of Health Officers. The development and introduction of a digital patient file to record medical treatments on the vessels could also improve medical documentation on board.

"I think we still do too little": measures to prevent violence and aggression in German emergency departments - a qualitative study.

BACKGROUND: Healthcare workers employed in emergency departments (EDs) are particularly affected by physical and verbal violence. Violent assaults can be committed by both patients and their attendants. Research on interventions for violence prevention is limited and previous studies report that ED employees feel unprepared for violent incidents. Thus, the current study aims to explore ED staff's perceptions regarding available prevention measures, their effectiveness, barriers, and further needs in terms of violence prevention. METHODS: In accordance with the qualitative study design, 27 semi-structured interviews were conducted via telephone with doctors and nurses working in direct contact with patients in German EDs. Main subjects were advantages and disadvantages of currently available measures, barriers regarding their implementation, their perceived effectiveness, as well as further needs concerning violence prevention. The transcribed interviews were analysed according to Mayring's qualitative content analysis. RESULTS: Participants described environmental (e.g., alarm systems), organisational (e.g., security service), and individual-focused measures (staff training, verbal de-escalation). Measures perceived as effective were, for instance, communication and security service. Both demands and barriers were often related to financial constraints, e.g., staff shortage led to higher workloads and less time to consider violence prevention. In most cases, guidelines or standard operating procedures (SOPs) regarding violence prevention were missing, unknown, or not perceived as helpful in their current form. Furthermore, screening tools were not applied in any of the EDs. CONCLUSIONS: The workload in EDs needs to be decreased in order to enable violence prevention, e.g., by reducing patient inflow or by increasing personnel. In addition, violence prevention guidelines tailored to the requirements of the respective ED need to be developed. Hospitals should supply ED staff with such guidelines, e.g., in the form of SOPs, but more importantly, prevention measures have to be practiced and communicated. Furthermore, there is a need for research on the implementation of screening tools for violent behaviour, so that the focus would shift from managing violence to preventing violence.

[Patient Care in German Outpatient Clinics for Environmental Medicine Illustrated by the Examples of Hamburg and Munich University Hospitals]. / Versorgung von Patient*innen an umweltmedizinischen Ambulanzen in Deutschland am Beispiel der Universitätskliniken in Hamburg und München.

People can be affected by various environmental factors (e. g., odor, noise) which can lead to medical complaints or illnesses. Few adequate contact points are available for patients with suspected environmental complaints in Germany. Illustrated by the outpatient clinics for environmental medicine in Hamburg and Munich, this report shows how patients with suspected environmental medical diseases are cared for in Germany. For the exemplary presentation, the data of the environmental medicine outpatient clinics of both the university hospitals from 01.01.2019 to 31.03.2021 are presented and compared. Overall, more female than male patients were treated at both facilities. Suspected exposure to "heavy metals" was most frequently mentioned by patients as the assumed reason for their complaints. Nonetheless, the suspected exposure or "intoxication" could be ruled out in the majority of cases by appropriate examination methods in accordance to current medical guidelines. The data provided by the environmental medicine outpatient clinics show that there is a continuous demand for environmental medical care. A close cooperation between the private practice sector and the outpatient clinics for environmental medicine providing medical care to patients should therefore be sought.

[Association of oral health literacy and behaviour with physical oral health. What role can dental education play?] / Zusammenhang von Mundgesundheitskompetenz und -verhalten mit physischer Mundgesundheit. Welche Rolle kann die zahnmedizinische Ausbildung spielen?

BACKGROUND: Oral health is an essential component of a person's general health and well-being. It is influenced by many factors. These include individual aspects such as oral health literacy and oral health behaviour. The aim of this study was to investigate the association between oral health literacy and behaviour with physical oral health. METHODS: In this population-based cross-sectional study, data of 5510 subjects enrolled in the Hamburg City Health Study (HCHS) from 2016 to 2018 with a mean age of 62.1 years and 50.7% women were evaluated. Physical oral health was assessed using the 14-item Physical Oral Health Index (PhOX). A newly developed 10-item questionnaire based on the Oral Health Literacy Adult Questionnaire and the 5th German Oral Health Study were used to determine oral health literacy and behaviour. RESULTS: The sum score of the 10 questions related to oral health literacy and behaviour significantly correlated with the PhOX sum score (r = 0.23; p < 0.001). An increase of one point in the total score of oral health literacy and behaviour was associated with an increase in the PhOX sum score of 1.45 points on average. This association decreased only marginally after integrating potential confounders such as age and education. CONCLUSION: Higher oral health literacy and better oral health behaviour are associated with better physical oral health. Oral health literacy and behaviour should be important targets in dental education to efficiently and sustainably improve the oral health of the general population.

[Virtual staff teamwork during the pandemic - development of digital training formats for community emergency response during the coronavirus pandemic]. / Virtuelle Stabsarbeit in Zeiten der Pandemie ­ Entwicklung digitaler Übungsformate in der zivilen Gefahrenabwehr während der Coronapandemie: Erfahrungen am Beispiel des Projekts ARMIHN.

Background: In the event of emergency response to large-scale incidents, such as a mass casualty incident (MCI) or a mass casualty incident-infectious disease (MCI-ID), regular training is essential in order to have experienced emergency personnel available in the event of an incident. Due to the pandemic drills often had to be cancelled or were only possible with small groups of people. It was often not possible to simulate a large-scale emergency with actors, so that the trainees could not be offered realistic scenarios of a mass casualty or disease incident. As part of two research projects, a digital platform for conducting training was used to avoid the risk of infection between participants during the exercises, so that on-site personnel deployment could be reduced to a minimum. The goal of this work was to evaluate end-user acceptance of the digital solution approaches. Methods: Within the framework of the project "Adaptive Resilience Management in Ports" (ARMIHN), a digital exercise platform was applied and evaluated with the help of participant surveys according to the focal points "implementation", "alternative possibilities", "learning effect" and "usability". The participants used the digital platform to exchange information and to communicate. For this purpose, various collaboration tools were embedded in the platform, which enabled simultaneous exchange of information in real time. Constant video communication with in-house and external authorities/teams was also established. Results: The potential of the digital platform as an alternative to on-site exercises was confirmed by the participating end users in the ARMIHN project with 90% agreement. The increase in subjective skills and knowledge gained during a MCI-ID was also predominantly rated approvingly (up to 70%). Participants who rated the implementation of the online format as well performed were significantly more likely to state that subjectively their ability to handle a MCI-ID had improved (p = 0.016). In contrast, virtual staff teamwork in real crisis situations was viewed critically by about half of respondents. Conclusion: Overall, the evaluation results point to the high end-user acceptance of the developed concept. Even though the aim is to evaluate the system over a longer period with a larger number of participants, the studies already conducted confirm the positive experiences in the respective projects.

Restrictions of VC and DLCO in relation to asbestos-related computed tomographic findings quantified by ICOERD-based parameters.

BACKGROUND: Even almost 30 years after the ban on the use of asbestos in Germany, the effects of asbestos are still highly relevant in everyday clinical practice in occupational medicine. The aim of this study was to further investigate the significance of essential parameters of both pulmonary function diagnostics and imaging techniques (low-dose HR-TCT) for the prevention and early detection of asbestos-related morphological and functional lung changes. METHODS: Data from spirometry, body plethysmography and diffusion capacity, as well as CT images of the thorax, were retrospectively studied from 72 patients examined between 2017 and 2019 at the Institute for Occupational and Maritime Medicine (ZfAM), Hamburg, Germany. The subjects were divided into four subgroups according to the presence of comorbidities (concomitant cardiac diseases, obstructive ventilatory disorder, pulmonary function pattern consistent with emphysema, and no other pulmonary or cardiac diseases). These subgroups were analysed in addition to the overall collective. The CT images were evaluated according to the International Classification of Occupational and Environmental Respiratory Diseases (ICOERD) with radiological expertise. In addition, some asbestos-related parameters were newly quantified, and corresponding scores were defined based on ICOERD. Statistical analysis included the use of correlations and fourfold tables with calculation of Spearman's rho (ρ), Cohen's κ, and accuracy. RESULTS: Vital capacity (VC) is slightly reduced in the total collective compared to the normal population (mean 92% of predicted value), while diffusion capacity for CO (DLCO) shows predominantly pathological values, mean 70% of the respective predicted value. The CO transfer coefficient (DLCO/VA), which refers to alveolar volume (VA), also shows slightly decreased values (mean 87% pred.). Seventy-nine percent of patients (n = 57) had signs of pulmonary fibrosis on CT scans, and pleural plaques appeared in 58 of 72 patients (81%). Of the newly quantified additional parameters, particularly frequently described findings are subpleural curvilinear lines (SC, n = 39) and parenchymal bands (PB, n = 29). VC correlates well with the expression of pleural plaques (ρ = - 0.273, P < 0.05), and DLCO measures show a better correlation with fibrosis score (ρ = - 0.315, P < 0.01). A third, newly developed score, which includes the extent of pleural plaques and additional subpleural parameters instead of fibrosis parameters, shows significant correlations for both VC and DLCO (ρ = - 0.283, - 0.274, resp.; both P < 0.05). DISCUSSION: The importance of spirometry (VC) and diffusion capacity measurement (DLCO) as essential diagnostic procedures for the early detection of asbestos-related changes ‒ also including patients with relevant concomitant cardiac or pulmonary diseases ‒ was confirmed. Significant and better correlations between lung function changes (VC and DLCO) and abnormal CT findings are seen when parenchymal bands (PB), subpleural curvilinear lines (SC), and rounded atelectasis (RA) are quantitatively included into the evaluation, in addition to assessing the extent of pleural plaques alone. Therefore, when assessing CT images according to ICOERD, these parameters should also be quantified.

Capturing and analysing the working conditions of employees with disabilities in German social firms using focus groups.

BACKGROUND: Social firms - a type of social enterprise - provide job opportunities to people with mental or intellectual, sensory, physical or multiple disabilities who are disadvantaged on the general labour market. Given the limited number of studies on working conditions of employees in inclusive workplaces, the aim of this study was to explore job demands and resources experienced by employees with disabilities in German social firms. METHODS: Three focus groups were conducted between September and October 2020 with 14 employees with disabilities from social firms in the catering and cleaning sector in Germany. The Job Demands-Resources model was used as a theoretical basis for developing the semi-structured interview guide. Audiotaped data were transcribed verbatim, analysed deductively and inductively using the qualitative content analysis according to Mayring. RESULTS: The results show that employees of social firms experience specific job demands and resources regarding work content, work organisation, social relations and work environment. Job demands were mainly reported with respect to work organisation, e.g. high workload, time pressure or challenges in collaboration, whereas social relationships with colleagues and supervisors were most frequently mentioned as important resources at the workplace. CONCLUSION: First exploratory study results on the working conditions of employees in social firms in Germany were obtained. Given the pivotal importance of employment for people with disabilities, the identified job demands and resources of this study highlight the relevance of a healthy workplace, especially for employees in social firms. Future interventional research is needed regarding the development, implementation and evaluation of workplace health promotion measures in social firms.

Evolution of work ability, quality of life and self-rated health in a police department after remodelling shift schedule.

BACKGROUND: There exists a great diversity of schedules concerning the way shift work is organized and implemented with ample agreement regarding recommendable features of a shift system. In order to adapt the shift schedule of a metropolitan police department to current recommendations, a remodelled shift schedule was introduced in 2015. The aim of this study was to evaluate the potential associations between the remodelled shift schedule and work ability, quality of life and self-rated health after one and five years. METHODS: A controlled before-and- after study was conducted during the piloting phase (2015-2016) as well as a 5-year follow-up using paper questionnaires. Outcome parameters included work ability, quality of life and self-rated health. RESULTS: Work ability, quality of life and self-rated health improved after the first year of the newly implemented shift schedule among police officers working in the piloting police stations compared to those working according to the former schedule. In 5-year follow-up differences between indicators diminished. CONCLUSIONS: The implementation of a remodelled shift schedule including more 12-h shifts accompanied by more days off and a coherent weekend off duty was not associated with detrimental effects to work ability, quality of life or self-reported health among police officers.

Exploring job demands and resources in psychotherapists treating displaced people-A scoping review.

Objective: Little is known about the occupational health of psychotherapists treating displaced people. Therefore, the literature was explored regarding job demands, job resources, as well as work- and health-related outcomes. The Job Demands-Job Resources model (JD-R model) according to Bakker and Demerouti served as theoretical framework. Method: This scoping review followed the methodological framework provided by the Joanna Briggs Institute (JBI). Six databases were searched for qualitative, quantitative and mixed methods studies. Results: Based on 15 included articles, the emotional impact of work, cultural or language barriers, and administrative obstacles were identified as major job demands. Important job resources were related to a politicized conceptualization of the professional identity. Health-related outcomes could mainly be ascribed to empathy-based strain, while work-related outcomes were associated with discrepancies between personal values and asylum regulations. Conclusion: Despite the emotional impact of work, psychotherapists seem to benefit from work engagement arising out of socio-political conviction and the ability to help suffering people. Practitioners need more environmental support like professional networks. Further research is required, as current findings are predominantly based on qualitative and cross-sectional studies.