Effects of increased recirculation air rate and aircraft cabin occupancy on passengers' health and well-being - Results from a randomized controlled trial

BACKGROUND

Aircraft cabins are special environments. Passengers sit in close proximity in a space with low pressure that they cannot leave. The cabin is ventilated with a mixture of outside and recirculated air. The volume of outside air impacts the carbon footprint of flying. Higher recirculation air rates could be considered to save energy and divert less kerosene from producing thrust.

OBJECTIVES

To investigate whether higher recirculation air rates in aircraft cabins negatively affect passengers' health and well-being and if occupancy plays a role in this.

METHODS

In a 2 (occupancy: full and half-occupied) X 4 (ventilation regime) factorial design with stratified randomization, participants were exposed in an aircraft segment in a low-pressure tube during a 4-h simulated flight. Ventilation regimes consisted of increasing proportions of recirculated air up to a maximum CO₂ concentration of 4200 ppm. Participants rated comfort, health symptoms, and sleepiness multiple times. Heart rate (variability), as stress marker, was measured continuously.

RESULTS

559 persons representative of flight passengers regarding age (M = 42.7, SD = 15.9) and sex (283 men) participated. ANCOVA results showed hardly any effect of both factors on self-reported health symptoms, strong main effects of occupancy on comfort measures, and interaction effects for sleepiness and physiological stress parameters: Participants in the half-occupied cabin hardly reacted to increased recirculation air rates and show overall more favorable responses. Participants in the fully occupied cabin reported higher sleepiness and had stress reactions when the recirculation air rate was high.

DISCUSSION

This large-scale RCT shows the importance of occupancy, a previously neglected factor in indoor air research. The proximity of other people seems to increase stress and exacerbate reactions to air quality. Further studies on causal pathways are needed to determine if recirculation air rates can be increased to reduce the carbon footprint of flying without detrimental effects on passengers.

Traffic safety knowledge gain of ambulance drivers after simulator-based training

BACKGROUND

Compared to other road users, ambulance drivers are at a higher accident risk while driving with warning lights and sirens. No standard exists for training or education for emergency medical service employees driving ambulances. Training programs should positively influence knowledge. However, knowledge gain can be influenced by several different factors. This study developed a knowledge test for ambulance drivers to determine influencing factors on knowledge and its gain by simulator-based training.

METHODS

Two parallel knowledge test forms with 20 questions each were designed in several steps and tested on up to 174 participants. Questionnaires were used to study associated and influencing factors, such as objective experience, subjective attitudes, personality, motivation and demographic data.

RESULTS

Test construction showed good overall parallelism of the two tests as well as reliability and sensitivity. There was no correlation between subjective and objective knowledge gain, but participants with higher subjective knowledge gain showed a higher variation in objective knowledge. Younger age, higher qualification, higher number of license classes, fewer traffic violations, and more traffic safety trainings were positively associated with knowledge, whereas less yearly driving mileage, more traffic safety trainings, and higher risk sensitivity positively influenced knowledge gain through the training.

CONCLUSION

Knowledge and its gain through training are very low. Reasons for the lack of predictive power of some variables, such as motivation, personality and attitudes, are discussed. This study presents a new tool for testing knowledge on driving with warning lights and sirens. It shows the need for objective testing and for further research in this special area.

Potentially Critical Driving Situations During "Blue-light" Driving: A Video Analysis

INTRODUCTION

Driving with warning lights and sirens is highly demanding for ambulance drivers, and the crash risk is much higher than that during normal driving. In this study our goals were to establish a coding protocol to observe how often and how long potentially critical driving situations (PCDS) occur during "blue-light" driving (driving with emergency response lights) and to describe traffic and environmental conditions preceding and accompanying the PCDS.

METHODS

We collected randomly drawn video data of real ambulance driving between 2014-2017 in two German federal states. A coding protocol was developed to categorize PCDS into four types ("right of way," "crosswalks," "overtaking" [passing], and "other") and to describe them within the context of road characteristics, incident type, traffic, weather conditions, and driving style.

RESULTS

A total of 172 videos of 71 different drivers were chosen randomly covering 1125 minutes of driving with warning lights and sirens. The drivers had a mean age of 33.7 years, and 25.4% were female. A total of 2048 PCDS occurred with a mean duration of five seconds (range of 1-66), amounting to one PCDS every 33 seconds. Twenty percent of the driving time involved PCDS. The rapid driving style (10.5%) showed more PCDS (one every 28.5 seconds), and the defensive driving style showed fewer PCDS (one every 49.6 seconds). Of all detected PCDS, "right of way" situations (57.5%) were most frequent, followed by "overtaking" [passing] maneuvers (30.2%).

CONCLUSION

This study used a detailed coding protocol to describe driving with warning lights and sirens. The PCDS occurred less frequently than anticipated, although they were still common events when driving an ambulance, representing significant potential for crashes or near-crashes. These results can be used for insight training programs to raise ambulance drivers' awareness of typical PCDS and associated potential crash risk.

Digitally connected work and its consequences for strain - a systematic review

Background

Evolving digitization has an impact not only on the organization of work, but also on the health of employees. Dealing with new technologies, integrating new processes and requirements into work, and restructuring tasks among others are demands that can be stressful and impair health.

Objectives

Our aim was to identify (clusters of) working conditions associated with digitally connected work and to analyze their relations with strain, that is, health and well-being outcomes.

Methods

Between May and October 2019, a search string was used to systematically search six databases (EMBASE, Medline, PSYNDEX, PsycInfo, SocIndex, WISO) for German and English texts according to the PEO scheme. The methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Design.

Results

14 studies were identified. Despite the search string containing latest technologies, we identified mostly studies from the 1980s/90s. To aggregate findings, a categorization of work factors (cognitive demands, social factors, organizational factors, environmental factors) and health factors (motivation/satisfaction, reduced well-being/affective symptoms, physiological parameters/somatic complaints) is introduced. The most frequently identified work factors belong to the category of cognitive demands. For health factors, motivation/satisfaction was identified most often. 475 associations were found in total.

Conclusions

This systematic review provides an overview of work and health factors that have been studied between 1981 and 2019. Recent texts frequently study individualized health factors (e.g., life satisfaction) whereas objective physiological measurement data and objective survey methods such as workplace analysis are not used. This latter approach was predominantly found in the older studies. In order to obtain a comprehensive picture, however, it is worthwhile to use a combination of these subjective and objective approaches for future studies in this field.

Cabin air quality on non-smoking commercial flights: A review of published data on airborne pollutants

We reviewed 47 documents published 1967-2019 that reported measurements of volatile organic compounds (VOCs) on commercial aircraft. We compared the measurements with the air quality standards and guidelines for aircraft cabins and in some cases buildings. Average levels of VOCs for which limits exist were lower than the permissible levels except for benzene with average concentration at 5.9 ± 5.5 μg/m³ . Toluene, benzene, ethylbenzene, formaldehyde, acetaldehyde, limonene, nonanal, hexanal, decanal, octanal, acetic acid, acetone, ethanol, butanal, acrolein, isoprene and menthol were the most frequently measured compounds. The concentrations of semi-volatile organic compounds (SVOCs) and other contaminants did not exceed standards and guidelines in buildings except for the average NO₂ concentration at 12 ppb. Although the focus was on VOCs, we also retrieved the data on other parameters characterizing cabin environment. Ozone concentration averaged 38 ppb below the upper limit recommended for aircraft. The outdoor air supply rate ranged from 1.7 to 39.5 L/s per person and averaged 6.0 ± 0.8 L/s/p (median 5.8 L/s/p), higher than the minimum level recommended for commercial aircraft. Carbon dioxide concentration averaged 1315 ± 232 ppm, lower than what is permitted in aircraft and close to what is permitted in buildings. Measured temperatures averaged 23.5 ± 0.8°C and were generally within the ranges recommended for avoiding thermal discomfort. Relative humidity averaged 16% ± 5%, lower than what is recommended in buildings.

Evaluating the effects of a simulator-based training on knowledge, attitudes and driving profiles of German ambulance drivers

INTRODUCTION

Accident risk is increased for emergency responders driving with warning lights and sirens compared to other road users' driving. Currently no standards for education of ambulance drivers exist. Research shows that high order understanding trainings focusing on insight to avoid critical driving situations might be more helpful than trainings focusing on car handling. The present controlled intervention study evaluates a one-day simulator-based high order training program specifically designed for ambulance drivers.

METHODS

In a longitudinal design with three measurement times multiple methods were used to evaluate the training holistically targeting the levels of reaction to training, learning, behavior and results of training. Questionnaire, knowledge test and driving profile data were analyzed with repeated measures analysis of variance controlling for age and sex. Data of two intervention groups and one control-waiting group was collected between 2014 and 2017 in two German federal states.

RESULTS

183 German paramedics (age: M = 33.1, SD = 9.4, 21.9 % female) participated in the study. 147 participants (80.3 %) completed post-training tests, and 30 participants (16.4 %) completed follow-up measurements six months after training. Participants' reaction to training was positive directly after the training, and dropped slightly over time. Intervention group participants gained traffic-relevant knowledge compared to control group participants. Risk sensitivity of regular driving situations was the only attitude variable positively affected by training. This effect was not sustained six months after training. Training led to a decrease of average and maximum speed in short- as well as long-term measurements but did not affect drivers' acceleration. Although speed was lower in post-tests, emergency response times did not differ.

CONCLUSION

The simulator-based training for paramedics has small but notable effects on drivers' knowledge, attitudes and real driving behavior. Although only very few measured variables showed positive training effects, no negative training effects were found. Speed was reduced in the long term which underlines the importance of such a training. More research is needed to determine effects on different types of participants and to elicit framework conditions for training integration in formal education.

A training intervention for home care nurses in cross-cultural communication: An evaluation study of changes in attitudes, knowledge and behaviour

AIMS

To assess whether a training intervention in cross-cultural communication can positively impact attitudes, knowledge and behaviour and to investigate possible dependencies between these components.

DESIGN

(Controlled) longitudinal multimethod evaluation.

METHODS

A training based on theoretical considerations and informed by semi-standardized interviews with home care nurses was developed and evaluated. Participants rated their cross-cultural attitudes, knowledge and behaviour and answered case vignettes assessing their knowledge before and after this training. Shift observations assessed behaviourial aspects at t1 and t2. Data were collected between June 2016-March 2017 and between April 2017-November 2017. Analyses of variance and multiple linear regression models were employed.

RESULTS

The training showed promising tendencies with cross-cultural attitudes, knowledge and behaviour with diverging results for initially quite high self-reports showing positive but mostly not significant developments and objective assessments mostly showing significant positive changes. There were significant associations between self-reported cross-cultural behaviour at t1 and objective cross-cultural knowledge at t2, whereas self-rated and objectively assessed knowledge showed no significant associations. Shift observations showed significant positive developments in participants' communication behaviour.

CONCLUSION

Our study shows the importance of using different methods and targeting different outcomes areas to rate impacts of (cross-cultural) training interventions. Future studies should consider challenging conditions in home care nursing affecting the success of interventions and investigate mechanisms of skill acquisition in nursing.

IMPACT

This is one of very few studies using multi-method approach to evaluate a cross-cultural competency intervention and simultaneously assess cross-cultural attitudes, knowledge and behaviour including possible dependencies between these aspects.

Occupational Stress in Helicopter Emergency Service Pilots From 4 European Countries

OBJECTIVE

Working conditions are known to affect motivation, well-being, and ultimately work performance. Helicopter emergency medical services (HEMS) pilots' work is highly demanding and safety critical, but virtually no published data on occupational stress and strain symptoms in HEMS pilots are available. We investigated work stressors and resources and their association with work engagement, subjective well-being, and energy levels in European HEMS pilots.

METHODS

Cross-sectional questionnaire data were collected consecutively from 72 European HEMS pilots (24 Western European and 48 Eastern European, mean age = 51.9 years). We examined the stressor, resource, and strain symptom levels by age group and region of origin and the association of stressors and resources with work engagement, well-being, and energy.

RESULTS

Although the responses differed notably between the Eastern and Western European pilots, their overall profile was quite favorable. At the same time, those stressor/resource variables, which on average had the most favorable ratings, were the most strongly associated with (reduced) well-being and energy.

CONCLUSION

On the whole, the HEMS pilots' perception of their work situation appears to be positive, and they are highly engaged in their work. The pilots' strong identification with their work should be taken into account in pilot mental health support systems.

Effect of COPD severity and comorbidities on the result of the PHQ-9 tool for the diagnosis of depression: results from the COSYCONET cohort study

The diagnosis of depression, a frequent comorbidity of chronic obstructive pulmonary disease (COPD), is often supported by questionnaires, such as the Patient Health Questionnaire 9 (PHQ-9). It is unknown to which extent its single questions are affected by the clinical characteristics of COPD patients.

We addressed this question in 2255 GOLD grade 1–4 patients from the COSYCONET (COPD and Systemic Consequences - Comorbidities Network) COPD cohort. The dependence on COPD severity was assessed using symptoms, exacerbation risk (GOLD A-D; modified Medical Research Council dyspnoea scale (mMRC)), and frequent comorbidities as predictors of PHQ-9 results, while including age, gender, body mass index (BMI) and smoking habits as covariates.

Symptoms and exacerbation risk were associated with depression in an additive manner, with mean elevations in the PHQ-9 sum score by 2.75 and 1.44 points, respectively. Asthma, sleep apnoea, gastrointestinal disorders, osteoporosis and arthritis were linked to increases by 0.8 to 1.3 points. Overall, the COPD characteristics contributed to the mean PHQ-9 score by increases from 4.5 or 5.2 to 6.3 points, respectively, when either taking GOLD A as reference or the absence of comorbidities. This finding was independent of the diagnosis of mental disorder or the intake of antidepressants. The presence of COPD led to an increase in the proportion of scores indicating depression from 12 to 22%. Single item analysis revealed homogenous effects regarding GOLD groups, but heterogeneous effects regarding GOLD grades.

These findings indicate specific effects of COPD severity on the PHQ-9 depression score, especially symptoms and exacerbation risk, explaining the high prevalence of depression in COPD. Alternative explanations like an overlap of COPD severity and PHQ-9 items are discussed. Of note, we also found COPD treatment effects on depression scores.

Helicopter Simulator Performance Prediction Using the Random Forest Method

INTRODUCTION: Different aspects of the aviation system, such as pilot's fitness, supervision, and working conditions, interact to produce or protect against flight safety hazards. Machine learning methods such as Random Forests may help identify system characteristics with the potential to affect flight safety from the large number of candidate predictors that results when multiple system levels are considered simultaneously.METHODS: There were 54 pilot-related and occupational candidate predictors of simulator flight performance in 2 malfunction scenarios completed by 51 male European helicopter emergency medical services pilots derived from pilots' self-report questionnaires and aeromedical examination records. In a cross-sectional explorative analysis, the Random Forest method was used to screen for informative predictors. Predictors scoring above the critical threshold for the conditional permutation variable importance (VI) statistic were selected.RESULTS: In five predictors, the VI statistic averaged across 2000 Random Forest runs exceeded the selection threshold: higher perceived rewards (VI = 0.0691) and predictability (VI = 0.0501) at work were associated with higher performance scores, and higher physiological dysregulation (VI = 0.0495) and alanine aminotransferase (VI = 0.0224) with lower scores. Performance also differed between the simulators at the two training sites (VI = 0.0298).DISCUSSION: Random Forests may usefully complement previously applied methods for the identification of human factors safety hazards. The identified performance predictors suggest further areas with potential for safety improvements.Bauer H, Nowak D, Herbig B. Helicopter simulator performance prediction using the Random Forest method. Aerosp Med Hum Perform. 2018; 89(11):967-975.

Aging and Cardiometabolic Risk in European HEMS Pilots: An Assessment of Occupational Old-Age Limits as a Regulatory Risk Management Strategy

Old-age limits are imposed in some occupations in an effort to ensure public safety. In aviation, the "Age 60 Rule" limits permissible flight operations conducted by pilots aged 60 and over. Using a retrospective cohort design, we assessed this rule's validity by comparing age-related change rates of cardiometabolic incapacitation risk markers in European helicopter emergency medical service (HEMS) pilots near age 60 with those in younger pilots. Specifically, individual clinical, laboratory, and electrocardiogram (ECG)-based risk markers and an overall cardiovascular event risk score were determined from aeromedical examination records of 66 German, Austrian, Polish, and Czech HEMS pilots (average follow-up 8.52 years). Risk marker change rates were assessed using linear mixed models and generalized additive models. Body mass index increases over time were slower in pilots near age 60 compared to younger pilots, and fasting glucose levels increased only in the latter. Whereas the lipid profile remained unchanged in the latter, it improved in the former. An ECG-based arrhythmia risk marker increased in younger pilots, which persisted in the older pilots. Six-month risk of a fatal cardiovascular event (in or out of cockpit) was estimated between 0% and 0.3%. Between 41% and 95% of risk marker variability was due to unexplained time-stable between-person differences. To conclude, the cardiometabolic risk marker profile of HEMS pilots appears to improve over time in pilots near age 60, compared to younger pilots. Given large stable interindividual differences, we recommend individualized risk assessment of HEMS pilots near age 60 instead of general grounding.

The Care Information System PIK – the Fit between User and System

Objectives: The presented laboratory study explores the relationship between the care information system PIK and its users, focusing on intuitive program usage, occurring errors, the usefulness of the evaluation method, and the role of person related variables.

Methods: Three studies were conducted. While thinking aloud, a sample of 26 participants performed certain tasks, which were recorded in protocols. In addition, the occurring errors were rated in an error taxonomy.

Results: While the actual use of the program proved quite easy, conceptual structuring caused the participants difficulties. These difficulties stemmed mainly from problems encountered in generating a clear mental picture of the system, and the consequences of the actions. Over time, the program showed a positive development.

Conclusions: Discussion of the results focuses on implementation processes in the context of usability research. The need to train users in the conceptual structure of the program and to build realistic expectations are the focus of our outline.

Effectiveness of Interventions Teaching Cross-Cultural Competencies to Health-Related Professionals With Work Experience: A Systematic Review

INTRODUCTION

Because of the increasing diversity in society, health professionals are working with patients from many different cultural backgrounds. Interventions to improve culture-specific competencies in health care have been shown to be successful. However, there is an increasing demand for continuing professional development in general cross-cultural competencies that do not focus on specific cultures. Previous reviews do not differentiate between general cross-cultural and culturally specific competencies. This review assesses the effectiveness of interventions that aim to increase cross-cultural competencies in health professionals.

METHODS

Databases were searched systematically to identify quantitative and qualitative studies that focus on cross-cultural competencies in health care professions. Two independent raters used an assessment tool (Quality Assessment Tool for Studies with Diverse Designs, QATSDD) to rate the quality of the results.

RESULTS

Thirty-one of 34 identified studies described cross-cultural competency interventions to be effective in terms of participants' satisfaction with the interventions and self-rated knowledge improvement. Nineteen studies relied exclusively on subjective assessment methods. Most of them reported significant findings, whereas results from five studies with independent ratings or objective assessments were mostly not significant. Many studies lacked in providing sufficient data on intervention descriptions.

DISCUSSION

Cross-cultural competency interventions seem to be effective-according to self-ratings by participants. However, the definitions of cultural competency, the objectiveness of measurements, and the types of study outcomes were varied. To evaluate the success of cross-cultural competency interventions, more evidence from objective, behavioral assessments is needed. Studies should investigate the differential impact of various intervention types and need to provide detailed reporting on methods and outcomes.

Psychological and cognitive effects of laser printer emissions: A controlled exposure study

The possible impact of ultrafine particles from laser printers on human health is controversially discussed although there are persons reporting substantial symptoms in relation to these emissions. A randomized, single-blinded, cross-over experimental design with two exposure conditions (high-level and low-level exposure) was conducted with 23 healthy subjects, 14 subjects with mild asthma, and 15 persons reporting symptoms associated with laser printer emissions. To separate physiological and psychological effects, a secondary physiologically based categorization of susceptibility to particle effects was used. In line with results from physiological and biochemical assessments, we found no coherent, differential, or clinically relevant effects of different exposure conditions on subjective complaints and cognitive performance in terms of attention, short-term memory, and psychomotor performance. However, results regarding the psychological characteristics of participants and their situational perception confirm differences between the participants groups: Subjects reporting symptoms associated with laser printer emissions showed a higher psychological susceptibility for adverse reactions in line with previous results on persons with multiple chemical sensitivity or idiopathic environmental intolerance. In conclusion, acute psychological and cognitive effects of laser printer emissions were small and could be attributed only to different participant groups but not to differences in exposure conditions in terms of particle number concentrations.

Health effects of laser printer emissions: a controlled exposure study

Ultrafine particles emitted from laser printers are suspected to elicit adverse health effects. We performed 75-minute exposures to emissions of laser printing devices (LPDs) in a standardized, randomized, cross-over manner in 23 healthy subjects, 14 mild, stable asthmatics, and 15 persons reporting symptoms associated with LPD emissions. Low-level exposures (LLE) ranged at the particle background (3000 cm^-3 ) and high-level exposures (HLE) at 100 000 cm^-3 . Examinations before and after exposures included spirometry, body plethysmography, transfer factors for CO and NO (TLCO, TLNO), bronchial and alveolar NO, cytokines in serum and nasal secretions (IL-1β, IL-5, IL-6, IL-8, GM-CSF, IFNγ, TNFα), serum ECP, and IgE. Across all participants, no statistically significant changes occurred for lung mechanics and NO. There was a decrease in volume-related TLNO that was more pronounced in HLE, but the difference to LLE was not significant. ECP and IgE increased in the same way after exposures. Nasal IL-6 showed a higher increase after LLE. There was no coherent pattern regarding the responses in the participant subgroups or single sets of variables. In conclusion, the experimental acute responses to short but very high-level LPD exposures were small and did not indicate clinically relevant effects compared to low particle number concentrations.

[Drawing up a Guideline for Handling Information and Communication Technology, Flexibility and Availability in Small and Medium Enterprises]

BACKGROUND

Within the last decades the world of work has changed enormously. Due to new Information and Communication Technologies (ICT), working at any time from any place has become possible. Flexibility, availability and the dissolution of boundaries between work and private life are the possible results of this development. The spread of this development and possible consequences on the affected employee's health and wellbeing have been examined so far especially in big companies. Small and medium-sized enterprises (SME) are rarely subjects of scientific studies in this context.

OBJECTIVE OF THIS PAPER

The aim of this work was to develop a guideline based on experiences and results of a study regarding flexibility in the business world (FlexA), as well as a systematic literature research. The target populations of this guideline are SMEs, focusing on integrating a health promoting way in dealing with ICT, flexibility and availability within the corporate culture.

METHODS

In order to delineate the current state in of research in ICT-related work interventions, a systematic review in data bases e. g. PsycINFO, EconLit and Medline was carried out. The search strategy used the key words "work", "intervention", "ICT", "mental strain", "flexibility" and "availability". In addition, grey literature and findings from the FlexA study were used to formulate the current guideline.

RESULTS

Based on the exclusion criteria, all studies from the systematic literature search were excluded after title and abstract screening. Within grey literature research, 4 relevant publications could be identified. The measures, developed during the corporate workshops of the FlexA study, e. g. the implementation of collective regulations in the company, were included in the guideline.

CONCLUSION

Due to the ongoing development of ICT and flexibility in daily business life, it is getting more and more important to follow this progress. Executives and corporate management are responsible to actively shape this trend in a health-promoting way in their enterprises. The current guideline was made to support the corporate management in this task and it is an important instrument for a health-promoting use of ICT in daily business life taking in to consideration flexibility and availability.

Does office space occupation matter? The role of the number of persons per enclosed office space, psychosocial work characteristics, and environmental satisfaction in the physical and mental health of employees

The study examined the effects of office space occupation, psychosocial work characteristics, and environmental satisfaction on physical and mental health of office workers in small-sized and open-plan offices as well as possible underlying mechanisms. Office space occupation was characterized as number of persons per one enclosed office space. A total of 207 office employees with similar jobs in offices with different space occupation were surveyed regarding their work situation (psychosocial work characteristics, satisfaction with privacy, acoustics, and control) and health (psychosomatic complaints, irritation, mental well-being, and work ability). Binary logistic and linear regression analyses as well as bootstrapped mediation analyses were used to determine associations and underlying mechanisms. Employee health was significantly associated with all work characteristics. Psychosocial work stressors had the strongest relation to physical and mental health (OR range: 1.66-3.72). The effect of office space occupation on employee health was mediated by stressors and environmental satisfaction, but not by psychosocial work resources. As assumed by sociotechnical approaches, a higher number of persons per enclosed office space was associated with adverse health effects. However, the strongest associations were found with psychosocial work stressors. When revising office design, a holistic approach to work (re)design is needed.

Job strain, bullying and violence at work and asthma in Peruvian cleaners-a cross-sectional analysis

OBJECTIVES

An increased asthma prevalence was found in cleaners. Many of them work in precarious employment conditions, potentially leading to stress, a known risk factor for asthma. We aimed to analyze whether asthma in cleaners might partly be explained by psychosocial working conditions.

METHODS

The study population of this cross-sectional study included 199 cleaners employed at regional public health services in Puno Province (Peru). They were compared to 79 unexposed workers from Lima, Peru (response 83%). Both groups answered the short version of the European Working Condition Survey and a modified version of the European Community Respiratory Health screening questionnaire. After multiple imputation, the association between psychosocial working conditions and asthma (wheeze without cold or use of asthma medication) was assessed.

RESULTS

The 12-months prevalence of asthma was 22% among cleaners versus 5% among unexposed workers (pChi(2) = .001). Cleaners were more likely than unexposed workers to work with temporary or sub-contracts, have a high employment insecurity, high strain working conditions and low social support (all pChi(2) < .05). Twenty-six percent vs. 10% reported a high bullying score; 39% vs. 8% had experienced violence at work (both pChi(2) < .001). High bullying score (adjusted Odds Ratio 5.6; 95% Confidence Interval 1.5-21.4) and violence (2.4; 1.1-5.4) were the main predictors of asthma. Taking these factors into account, being a cleaner was not statistically significantly associated with the outcome (3.5; 0.9-13.8).

CONCLUSIONS

Poor psychosocial working conditions of cleaners may partly explain the high prevalence of asthma. The underlying mechanism might be a stress-induced inflammatory immune response.

Improving well-being at work: A randomized controlled intervention based on selection, optimization, and compensation

This study aimed to develop, implement, and evaluate an occupational health intervention that is based on the theoretical model of selection, optimization, and compensation (SOC). We conducted a stratified randomized controlled intervention with 70 nurses of a community hospital in Germany (94% women; mean age 43.7 years). Altogether, the training consisted of 6 sessions (16.5 hours) over a period of 9 months. The training took place in groups of 6-8 employees. Participants were familiarized with the SOC model and developed and implemented a personal project based on SOC to cope effectively with 1 important job demand or to activate a job resource. Consistent with our hypotheses, we observed a meaningful trend that the proposed SOC training enhanced mental well-being, particularly in employees with a strong commitment to the intervention. While highly committed training participants reported higher levels of job control at follow-up, the effects were not statistical significant. Additional analyses of moderation effects showed that the training is particularly effective to enhance mental well-being when job control is low. Contrary to our assumptions, perceived work ability was not improved by the training. Our study provides first indications that SOC training might be a promising approach to occupational health and stress prevention. Moreover, it identifies critical success factors of occupational interventions based on SOC. However, additional studies are needed to corroborate the effectiveness of SOC trainings in the occupational contexts.

The Impact of Learning Demands, Work-Related Resources, and Job Stressors on Creative Performance and Health

We propose an integrated model of learning demands, work-related resources, and job stressors that incorporates core assumptions of work design in predicting processes of learning and performance as well as health impairment. The model was tested in a heterogeneous sample of 830 employees using structural equation modeling. Empirical results largely support theoretical assumptions. Learning demands and work-related resources were positively related to intrinsic motivation and creative performance. Job stressors and low work-related resources were predictive for health impairment. The suggested tripartite taxonomy reconciles inconsistent research findings on the impact of work characteristics. The model provides practical guidance for work analysis and design by clarifying relationships between established work characteristics, job performance, and worker health.

Health in the long-term unemployed

BACKGROUND

Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons' state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy.

METHODS

This article is based on a selective review of pertinent literature in the PubMed database.

RESULTS

Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions.

CONCLUSION

The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions.

Selection, optimization, and compensation in nursing: exploration of job-specific strategies, scale development, and age-specific associations to work ability

AIMS

(1) To explore 'successful ageing' strategies in terms of selection, optimization and compensation in nursing; (2) To develop a scale that measures these strategies in nursing; (3) To investigate the association between these strategies in nursing and work ability of nurses and the moderating effects of age on this relationship.

BACKGROUND

Studies indicate impaired work ability of older nurses. Research is needed to examine if 'successful ageing' strategies can promote the work ability especially in older nurses.

DESIGN

The investigation applied a mixed method design: Study (1) Semi-structured interviews were conducted to explore selection, optimization and compensation in nursing; (Study 2) A cross-sectional survey was used to test the association between selection, optimization and compensation in nursing and work ability.

METHODS

Data were collected in 2010 and 2011. Study 1: 17 nurses ≥45 years were interviewed; Study 2: 438 nurses (21-63 years) participated. A selection, optimization and compensation-in-nursing-scale was applied that was developed on the basis of study 1. Work ability was measured with the Work Ability Index (Dimension 1).

RESULTS

Study 1, the majority of reported ageing strategies were identified as selection, optimization and compensation in nursing. Study 2, selection, optimization, and compensation in nursing was positively related with work ability. The positive relationship was stronger for older nurses.

CONCLUSION

Selection, optimization and compensation in nursing contributes positively to work ability, particularly in older nurses. This finding is relevant for the development of measures that promote work ability of nurses over the course of their professional careers.

Evidence of thromboembolism prophylaxis in bariatric surgery-results of a quality assurance trial in bariatric surgery in Germany from 2005 to 2007 and review of the literature

BACKGROUND

Since January 1st, 2005, the current situation for bariatric surgery has been examined by means of a voluntary quality assurance study in Germany with a multicenter design in which 38 hospitals and surgical departments participated. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).

METHODS

Data describing peri-interventional characteristics were prospectively documented in an internet online data registry. All primary bariatric procedures performed since January 1st, 2005, were registered. In addition, reoperations in patients who had previously undergone primary surgical intervention were included. As a representative excerpt from the overall prospective multicenter observational study on obesity surgery, data on the type, regimen, and time course of deep venous thrombosis (DVT) prophylaxis were documented. From the number and spectrum of complications, the incidences of clinically manifest DVT or pulmonary embolism (PE) were derived during the in-hospital course and follow-up in conjunction with the type of surgical procedure and body mass index (BMI).

RESULTS

Overall, 3,122 bariatric procedures were performed at 38 German hospitals between January 2005 and December 2007. These procedures were subdivided into 2,869 primary operations and 253 revisions (sex ratio, male to female = 25.6:74.4%). The average BMI of all patients was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. In 2005 and 2006, gastric banding (GB) was the most commonly performed operation, followed by Roux-en-Y gastric bypass (RYGBP). In 2007, RYGBP was carried out in 42.1% of all bariatric procedures. Interestingly, the incidence of deep venous thrombosis (DVT) was only 0.06%, whereas PE occurred in 0.06% of patients only after hospital discharge. The DVT prophylaxis protocol used has been changed for the last 2 years: the majority of patients with a BMI above 50 kg/m(2) received low-molecular-weight heparin twice a day.

CONCLUSION

In Germany, a trend from GB to sleeve gastrectomy (SG) and malabsorptive approach has been evaluated. This trend is associated with differences of the DVT prophylaxis regimen in the profile of bariatric surgical patients depending on BMI and the type of bariatric procedure. Despite the low incidence of DVT and pulmonary embolism (PE) detected, there is a lack of evidence on a reasonable regimen for sufficient DVT prophylaxis in bariatric surgery; instead, there are only recommendations from the guidelines and statements of a specific medical society. Therefore, prospective studies are necessary to determine the optimal DVT prophylaxis for bariatric surgical patients as well as obese patients undergoing surgery.

The Explication of Implicit Team Knowledge and Its Supporting Effect on Team Processes and Technical Innovations

A framework for the analysis of implicit team knowledge is developed based on action regulation theory and concepts of individual implicit knowledge. We argue that the explication and reflection on implicit knowledge in and of teams supports an individual understanding and a shared mental model of the task which in turn should enhance team innovation. In an experimental study, 48 students of mechanical engineering in 16 groups worked on a product development task. Experimental conditions were explication versus no explication and individual versus collective explication. Individual as well as collective explication enhanced the overall outcome quality, but not the originality of solutions. The positive effects of collective explication were stronger than the effects of individual explication. Group processes and contents of explication were in line with the assumption from action regulation theory that reflecting on goals and strategies facilitates performance of complex tasks.

A nationwide survey on bariatric surgery in Germany--results 2005-2007

BACKGROUND

Most studies on bariatric surgery outcomes are performed as clinical trials or reflect the clinical experience in single centers. The status of bariatric surgery in Germany has been examined since January 1st, 2005 with the cooperation of clinics and hospitals at the Institute of Quality Assurance in Surgery at the Otto-von-Guericke University of Magdeburg (Germany).

METHODS

In this prospective multicenter observational study, the data obtained for all primary bariatric procedures, including all repeated operations, performed on consecutive patients with morbid obesity at participating hospitals from 2005 to 2007 were prospectively collected using an Internet online data registry. In particular, perioperative characteristics, such as the spectrum of diagnostic measurements, type of surgical procedures, and short- and long-term outcomes, were investigated.

RESULTS

During the study period, 629 surgical procedures were performed at 21 hospitals in 2005, 828 procedures at 32 hospitals in 2006, and 1,666 procedures at 35 hospitals in 2007. In 2005 and 2006, gastric banding was the most frequently performed operation, followed by the Roux-en-Y gastric bypass (RYGBP). In 2007, a RYGBP was carried out in 42.1% of all bariatric procedures. Among all patients, 74.4% were female. The mean body mass index (BMI) was 48.5 kg/m(2) in 2005, 48.4 kg/m(2) in 2006, and 48.0 kg/m(2) in 2007. Follow-up data after 12 months were available for 63.8% of the patients in 2005 and 2006; these data showed greater reduction of BMI after malabsorptive rather than restrictive bariatric procedures. The mortality was 0.1% (30 days) and 0.16% (overall).

CONCLUSION

As indicated by the worldwide trend, there is an ongoing change from restrictive bariatric procedures to malabsorptive procedures and sleeve gastrectomy. Although the BMIs of German patients undergoing bariatric surgery appear to be substantially higher than those of patients from most other countries, there were no differences in intraoperative and short-term complications or in overall outcomes during follow-up when compared with published studies.

[Quality assurance in bariatric surgery in Germany--results of the German multicentre trial 2005 and 2006]

BACKGROUND

Since January 1st 2005, the situation of bariatric surgery in Germany has been examined. The data are registered in cooperation with the Institute of Quality Assurance in Surgery at the Otto-von-Guericke-University Magdeburg.

METHODS

The data registration took place prospectively in an internet online data base. All primary bariatric procedures performed since January 1st 2005 were detected as well as re-operations in patients who had been operated before.

RESULTS

629 patients underwent bariatric surgery in 21 hospitals in 2005 and 828 patients were operated in 32 hospitals in 2006. The mostly performed operation was gastric banding with 46.8 %, followed by Roux-Y gastric bypass with 38.5 %. 74.4 % of the patients were female. The medium BMI of all patients was 48.5 kg/m2 in 2005 and 48.4 kg/m2 in 2006. Follow-up data were available for 71.2 % of the patients operated in 2005. These data show a higher reduction of BMI after malabsorptive than after restrictive bariatric procedures.

CONCLUSION

A trend from restrictive bariatric procedures to a malabsorptive approach could be observed. In Germany the BMI of patients undergoing bariatric surgery is higher than in most countries world-wide. No differences could be detected in intraoperative and short-term complications as well in the complication rate in the first year of follow-up in comparison with the literature.

Experiences of two centers of bariatric surgery in the treatment of intragastrale band migration after gastric banding-the importance of the German multicenter observational study for quality assurance in obesity surgery 2005 and 2006

BACKGROUND

Adjustable silicone gastric banding (ASGB) is an effective treatment in morbid obesity. Band migration is a long-term complication. Causes, clinical symptoms, timing and incidence are investigated in single centres only. In Germany, since January 1st, 2005, practice in bariatric surgery has been investigated in German prospective multicenter trial for quality assurance in obesity surgery.

MATERIALS AND METHODS

All patients underwent ASGB in two centres of bariatric surgery in Germany were prospectively registered using a computer-based data form. Patients with band migration were retrospectively evaluated, in particular, causes and characteristics of its management. The results were correlated with data obtained from the German prospective multicentre trial.

RESULTS

In total, 493 patients were enrolled in the study from February 1995 to February 2007. The follow-up rate was 79.9% (mean follow-up time period, 78.7 months; range, 2-148 months). Fifteen patients (3.0%) developed migration. In 14 cases, migration occurred within the range of 30-86 months after implantation. In one case, migration occurred 10 months after repositioning of the band. In the German multicentre trial, 629 patients underwent surgery during 2005 and 827 patients in 2006. In both periods, 74.4% of the patients were female and 25.6% male. The most frequently performed operation was ASGB (46.8%) followed by Roux-en-Y gastric bypass (38.5%).

CONCLUSION

Band migration requires band removal. Different symptoms and complications influence the kind of band removal. Multicentre data were evident in the case of high long-term complication rate after ASGB. Data of the German multicentre trial show the trend from restrictive bariatric procedures to malabsorptive approach.

Primary perineal hernia: a case report and review of the literature

Pelvic floor hernias are extremely rare. This study presents a successfully treated case of primary perineal hernia and takes a look at the existing literature.

CASE

The case of a 75-year-old female patient with a great perineal hernia is presented. Diagnosis was secured by magnetic resonance tomography. The pelvic defect was successfully treated by primary suture with Prolene.

DISCUSSION

The literature shows many different approaches for treatment of perineal hernia, such as open or laparoscopic mesh repair, and perineal, abdominal or combined access. Our case confirms that primary closure of the hernial orifice through an abdominal approach is also feasible.

[Implicit theories--the problems of thought economy]

Based upon the presentation of the concept of naive implicit theories the article relates experience and action-guiding knowledge in critical nursing situations. Nineteen experienced and inexperienced nurses had to deal with two simulated nursing situations. Thereafter their implicit knowledge was explicated. Separate analyses for experienced and inexperienced persons regarding the adequacy of this knowledge and naive theories were performed. The results show for example, that in both groups naive theories can be found which relate especially to the perception of the patient. They led to inadequate action even though adequate knowledge was also represented. Finally, it is discussed how such (often not consciously used) naive theories can be changed in practice and which processes play a role in this change.

The care information system PIK--the fit between user and system

OBJECTIVES

The presented laboratory study explores the relationship between the care information system PIK and its users, focusing on intuitive program usage, occurring errors, the usefulness of the evaluation method, and the role of person related variables.

METHODS

Three studies were conducted. While thinking aloud, a sample of 26 participants performed certain tasks, which were recorded in protocols. In addition, the occurring errors were rated in an error taxonomy.

RESULTS

While the actual use of the program proved quite easy, conceptual structuring caused the participants difficulties. These difficulties stemmed mainly from problems encountered in generating a clear mental picture of the system, and the consequences of the actions. Over time, the program showed a positive development.

CONCLUSIONS

Discussion of the results focuses on implementation processes in the context of usability research. The need to train users in the conceptual structure of the program and to build realistic expectations are the focus of our outline.

Implizites Wissen und erfahrungsgeleitetes Arbeitshandeln

Zusammenfassung. Ausgehend von der Integration der bisherigen Befunde zu implizitem Wissen und erfahrungsgeleitetem Handeln wird die Entwicklung einer Methode zur Explikation impliziten Wissens in der Domäne der Krankenpflege dargestellt. Mit Hilfe von Expertinnen und Experten wurde eine kritische Situation erarbeitet, die bestimmte Kriterien erfüllen musste, um die Verwendung impliziten Wissens und erfahrungsgeleiteten Handelns zu ermöglichen. Sechzehn Pflegekräfte bearbeiteten diese kritische Situation in einem experimentellen Setting. Im Anschluss wurde das handlungsleitende explizite und implizite Wissen mit der neuen Methode erhoben. Zur Validierung der Methode wird die ökologische Validität der kritischen Situation bestimmt und eine Kontrastierung der explizierten Wissensinhalte mit einem vorher erhobenen Wissenstest vorgenommen. Weiterhin wird exemplarisch die Auswertung einer Versuchsperson mit Hilfe der Korrespondenzanalyse herangezogen, um Zusammenhänge zwischen explizitem und implizitem handlungsleitendem Wissen sowie dessen kommunikative Validierung aufzuzeigen. Abschließend werden die Ergebnisse diskutiert und ein Ausblick auf mögliche praktische Einsatzmöglichkeiten der Methode gegeben.

The role of tacit knowledge in the work context of nursing

AIMS OF THE STUDY

Previous research on the role of tacit knowledge is ambiguous. Some studies show the superiority of expertise, while other studies found experts would not be better than laymen. This paper aims at clarifying the contribution of tacit knowledge to expertise in the domain of nursing.

BACKGROUND

Two important concepts for dealing with critical situations are outlined - tacit knowledge and experience-guided working. The framework of tacit knowledge and experience-guided working can contribute to an explanation of the ambiguous results. Tacit knowledge is acquired implicitly in the course of working and is therefore not subject to reflection. For this reason it can contain erroneous or problematic contents.

METHODS

A method for the explication of tacit knowledge was developed and a laboratory study with 16 experienced nurses conducted. In the laboratory study the nurses had to deal with a critical nursing situation that was developed in co-operation with nursing experts. The explicit knowledge of the nurses was tested before the laboratory study.

RESULTS

No systematic differences in explicit knowledge could be observed, i.e. differences in performance could not be attributed to this knowledge mode. Results from multidimensional scaling procedures illustrate differences in the tacit knowledge of nurses who successfully accomplished the critical situation and those who did not.

CONCLUSIONS

The findings are in line with the assumption that experience-guided working is of the utmost importance for dealing with critical situations. Consequences of these results for nursing and person-related services in general are discussed and the aim of future research is outlined.

[Intuition as implicite knowledge]

The article relates the terms intuition, tacit knowledge and experience and describes their meaning for nursing. An empirical study with 16 experienced nurses is presented whereby the nurses had to deal with a simulated critical nursing situation. Basing on their actions a method for explication of action-guiding tacit knowledge was developed so that a closer scrutinizing of this type of knowledge became possible. Results underline the assumption of many practitioners that intuition as a resource in nursing activities is not to underestimate. At the same time a warning is given: Intuition and tacit knowledge is not always and at all times to evaluate positively. Finally, this differentiated point of view is discussed regarding consequences for nursing practice.

Formen von Arbeitszufriedenheit im Experiment: Differentielle Auswirkungen auf die Beziehung von Wissen und Handeln

Zusammenfassung. Der Einfluß verschiedener Formen von Arbeitszufriedenheit (hier. resignative Zufriedenheit, konstruktive Unzufriedenheit) und unterschiedlicher Tätigkeitsspielräume auf die Beziehung von Wissen und Handeln wird in einem experimentellen 2×2-Design untersucht. In einem computergestützten Szenario hatten 18 examinierte Krankenpflegekräfte neun typische Situationen aus dem Pflegealltag einer Inneren Station zu bearbeiten. Das berichtete Handeln in den Situationen wurde mit ergebnis- und bearbeitungsbezogenen Indikatoren auf der Basis verschiedener Datenquellen (verbale Daten, Log-file-Dateien) analysiert. Die quantitativen und qualitativen Ergebnisse zeigen, daß die konstruktiv Unzufriedenen stärker mit Handlungen auf unterschiedliche Tätigkeitsspielräume reagieren als die resignativ Zufriedenen. Entgegen den Hypothesen tritt diese differentielle Wirkung jedoch bei niedrigeren Tätigkeitsspielräumen auf. Weiterhin zeigte sich, daß, obwohl beide AZ-Formen sich weder bei der Informationsaufnahme und -verwendung im Pflege-Szenario noch im pflegerischen Fach- und Methodenwissen unterscheiden, die konstruktiv Unzufriedenen ihr Wissen im Unterschied zu den resignativ Zufriedenen deutlich stärker in Handeln umsetzen. Implikationen dieser Ergebnisse etwa für das Personalmanagement werden diskutiert.

The challenges of a care information system reflecting holistic nursing care

In this article two recent developments in the German health care system are outlined. On one side, an increasing economic pressure and legal changes on the German health care system lead to growing computerization in German hospitals. On the other side, a shift from functional to holistic nursing is observed. The question is raised if within the paradigm of holistic nursing computer support is an adequate way to organize and design work. The newly developed German care information system, PIK (Pflegedienst im Krankenhaus--Nursing service in hospital), serves as an example for a program that is structured according to the nursing process. On the grounds of this exemplification it is argued that within the concept of "technology as an option" not only is the design of a program important but also its basic work organization and design. The authors come to the conclusion that computer support of holistic nursing is possible. However, it is shown that some aspects of nursing (for example, intuitive knowledge, which has been identified as an integral part of expert nursing) cannot be formalized and thus cannot be supported by computer systems.

Recent developments of care information systems in Germany

The authors describe recent developments in the German health care system. A taking stock of the current state of hospital information system implementations in Germany leads to the conclusion that up to now no integrated hospital information system can be found, but that the awareness for the necessity of such a system is growing. Anticipated challenges and risks of care information systems are examined on grounds of an exemplification by the German care information system PIK (Pflegedienst im Krankenhaus--Nursing service in hospital). With regard to the shift from functional to holistic nursing in Germany it is argued that the consequences of the implementation of a care information system are intertwined closely with the nursing model.