Versorgungsforschung im Gesundheitsamt – eine explorative Interviewstudie zur wissenschaftlichen Methodenkompetenz im ÖGD in Baden-Württemberg

Hintergrund und Ziel der Studie: Ein Ziel des Paktes für den ÖGD (Öffentlicher Gesundheitsdienst) ist die Steigerung der wissenschaftlichen Tätigkeit im ÖGD. Es ist aktuell jedoch unklar, welche wissenschaftlichen Methoden bekannt sind und welche Bedarfe und Bedürfnisse hinsichtlich wissenschaftlicher Kompetenzen bestehen. Diese Arbeit beschäftigt sich mit der Frage, welche Methoden zur Versorgungsforschung im ÖGD in Baden-Württemberg (BW) bekannt sind, angewandt werden und bei welchen Methoden Bedarfe bestehen. Methodik: Es wurden leitfadengestützte Interviews (Fokusgruppen-/Einzelinterviews) mit 12 Personen unterschiedlicher Ebenen (Amtsleitungen, Abteilungsleitungen, Mitarbeitende) aus Gesundheitsämtern in BW geführt, die inhaltsanalytisch in Anlehnung an Kuckartz ausgewertet wurden. Ergebnisse: Die Interviewten nennen heterogene Bedarfe und Kompetenzen. Mitarbeitende äußern häufiger vorhandene Kompetenzen als Leitungspersonen. Kompetenzen, die im Berufsalltag angewandt werden sind z.B. Literaturrecherche oder verschiedene Datenauswertungsmethoden, die vor allem im Bereich der routinemäßig erfassten Daten (z.B. Einschulungsuntersuchung) eingesetzt werden. Bedarfe und Bedürfnisse bestehen vor allem im Bereich der Datenauswertung/-erhebung, werden aber auch im Bereich der Grundlagen geäußert. Vorgaben zur guten wissenschaftlichen Praxis (z.B. Ethikanträge) und zum Publikationsprozess sind eher weniger bekannt. Vielfach wird ein Bedarf nach einem Unterstützungsangebot durch Forschungseinrichtungen oder oberen Behörden genannt. Darüber hinaus werden Aussagen zur Motivation und Hemmnisse für Forschung im ÖGD gemacht. Schlussfolgerung: Diese Studie zeigt heterogene bestehende Methodenkompetenzen sowie Bedarfe und Bedürfnisse auf, die auf die unterschiedlichen Hintergründe und Tätigkeitsbereiche der Befragten zurückzuführen sind. Kompetenzen werden angegeben z.B. im Bereich der Literaturrecherche und der Auswertung vorhandener Daten. Bedarfe gibt es z.B. in Methoden der Datenerhebung/-auswertung sowie in der Grundlagenvermittlung und Vertiefung der vorhandenen Kompetenzen. Es besteht ein Bedarf an Unterstützungsangeboten hinsichtlich wissenschaftlicher Methodenkompetenz für Gesundheitsämter. Es fehlt zudem an Forschungsinfrastruktur (z.B. Software, Literaturzugriff) und gesetzlicher Grundlage für die wissenschaftliche Tätigkeit im ÖGD. Die Ergebnisse können als Grundlage für die Konzeption bedarfsgerechter Fortbildungen für ÖGD-Beschäftigte in BW dienen. Background and aim of the study: One aim of the pact for the Public Health Service (“Pakt für den ÖGD”) is to increase scientific activity in the Public Health Service (PHS). However, it is currently unclear which scientific methods are known and which needs exist regarding scientific competences in local public health departments. This study deals with the question, which methods related to health services research are known and applied in the PHS and which methods are needed by PHS-employees in the federal state Baden-Württemberg in Germany. Methods: Guideline-based interviews (focus group and individual interviews) were conducted with 12 persons from different hierarchy levels from public health departments in Baden-Württemberg. The interviews were analyzed by content analysis following Kuckartz. Results: The interviewees indicate heterogeneous needs as well as existing methodological competences. Staff members express existing competences more frequently than leaders. Various existing competencies were expressed that are used in the everyday work such as literature research or different methods for data analysis. These are mainly used in the field of routinely collected data (e.g., school entry examination). Needs seem to exist primarily in the area of data analysis and collection, but are also expressed in the area of the basic scientific methods. Topics relating to guidelines for good scientific practice (e.g. ethics proposals) and publications are also rather less known. A need for a support from research institutions or higher authorities is frequently mentioned. In addition, statements were made about motivation and barriers for research in public health departments. Conclusion: This study shows heterogeneous existing methodological competencies as well as needs, that can be attributed to the heterogeneous backgrounds and fields of activity of the interviewees. Competencies are indicated for example in literature research and analysis of existing data. There is a need in methods for example of data collection/analysis as well as in basic scientific methods and deepening of existing skills. Furthermore support offers regarding scientific methodological competence for public health departments are required. There is also a lack of research infrastructure (e.g. software, access to literature) and a legal basis. The results can serve as a basis for the design of demand-oriented methodological programs for employees from the PHS in Baden-Württemberg

Correction: Siegel et al. PEN-13: A New Generic 13-Item Questionnaire for Measuring Patient Enablement (German Version). Int. J. Environ. Res. Public Health 2019, 16, 4867

In the original publication [...].

Influence of Intraoperative Active and Passive Breaks in Simulated Minimally Invasive Procedures on Surgeons' Perceived Discomfort, Performance, and Workload

Laparoscopic surgeons are at high risk of experiencing musculoskeletal discomfort, which is considered the result of long-lasting static and awkward body postures. We primarily aimed to evaluate whether passive and active work breaks can reduce ratings of perceived discomfort among laparoscopic surgeons compared with no work breaks. We secondarily aimed to examine potential differences in performance and workload across work break conditions and requested the surgeons evaluate working with passive or active work breaks. Following a balanced, randomized cross-over design, laparoscopic surgeons performed three 90 min laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks on separate days. The simulation included the following tasks: a hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick tasks. Ratings of perceived discomfort (CR10 Borg Scale), performance per subtask, and perceived workload (NASA-TLX) were recorded, and the break interventions were evaluated (self-developed questionnaire). Statistical analyses were performed on the rating of perceived discomfort and a selection of the performance outcomes. Twenty-one participants (9F) were included, with a mean age of 36.6 years (SD 9.7) and an average experience in laparoscopies of 8.5 years (SD 5.6). Ratings of perceived musculoskeletal discomfort slightly increased over time from a mean level of 0.1 to 0.9 but did not statistically significantly differ between conditions (p = 0.439). Performance outcomes of the hot wire and peg transfer tasks did not statistically significantly differ between conditions. The overall evaluation by the participants was slightly in favor regarding the duration and content of active breaks and showed a 65% likelihood of implementing them on their own initiative in ≥90 min-lasting laparoscopic surgeries, compared with passive breaks. Both passive and active breaks did not statistically significantly influence ratings of perceived discomfort or perceived workload in a 90 min simulation of laparoscopic surgery, with an overall low mean level of perceived discomfort of 0.9 (SD 1.4). As work breaks do not lead to performance losses, rest breaks should be tested in real-life situations across a complete working shift, where perceived discomfort may differ from this laboratory situation. However, in this respect, it is crucial to investigate the acceptance and practicality of intraoperative work breaks in feasibility studies in advance of assessing their effectiveness in follow-up longitudinal trials.

[Health Promotion and Prevention of Non-Communicable Diseases by Public Health Departments in Baden-Württemberg during the COVID-19 Pandemic: Results of an Online Survey]

OBJECTIVES

Disease prevention and health promotion are among the core tasks of German public health services (Öffentlicher Gesundheitsdienst - ÖGD), particularly local public health departments (Gesundheitsämter). Little is known about the extent to which the departments were able to continue activities in the field of health promotion and prevention of non-communicable diseases (HPP-NCDs) during the COVID-19 pandemic. Using the example of public health departments in Baden-Württemberg (BW), we therefore investigated how much staff was available to the departments for HPP-NCDs services, how much staff was actually dedicated to HPP-NCDs during the COVID-19 pandemic, which HPP-NCDs activities were carried out during the pandemic, which were cancelled, and which should be resumed as a priority, according to the public health departments.

METHODS

We developed a largely standardized online questionnaire for the survey of the 38 public health departments in BW. Per department one questionnaire was to be completed. The survey took place from 9/1/2022 to 11/4/2022. The data of this explorative cross-sectional study were analyzed in a descriptive-statistical manner using SPSS, version 28.

RESULTS

Of the 38 departments, 34 participated in the survey (89%). Departments had a mean of 2.44 full HPP-NCDs staff as planned (median 2.00; SD 1.41; range 0.20-5.00). Under pandemic conditions, a mean of 1.23 full HPP-NCDs staff were deployed (median 0.95; SD 1.24; range 0.00-4.50). Respondents gave examples of 61 HPP-NCDs activities that were conducted under pandemic conditions, and they described 69 HPP-NCDs activities that had to be cancelled. Of the latter, respondents felt that 40 should be resumed as a matter of highest priority. Analysis of the priority activities to be resumed reveals characteristic differences: e. g., resumption of structural prevention activities was viewed more frequently as a matter of hightest priority than resumption of behavioral prevention activities.

CONCLUSIONS

During the pandemic, local public health departments in BW deployed, on average, actually only half of their full staff allocated as planned to HPP-NCDs. Comparing different categories of HPP-NCDs activities (cancelled during the pandemic) in terms of the relative frequency with which their resumption is viewed as matter of highest priority, characteristic differences can be observed. It remains an open question which conclusions can be drawn from such differences.

Improving Well-Being and Fostering Health-Oriented Leadership among Leaders in Small and Medium-Sized Enterprises (SMEs): A Systematic Review

Leaders of small and medium-sized enterprises (SMEs) are often confronted with specific burdens, which frequently result in increased levels of stress. Leadership behaviour, in turn, has a significant impact on employees' health and performance. Using the Population, Intervention, Comparison, Outcome (PICO) method, we conducted a systematic literature search covering publications from 2002 to 2023 using PubMed, PsycInfo and Business Source Premier on stress-reducing and well-being-improving interventions for SME leaders. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess the methodological quality and risk of bias of the included studies regarding selection bias, study design, confounders, blinding, data collection, withdrawal and drop-out. Of the 3150 identified publications, 6 were included after screening. The studies varied in content (cognitive behavioural therapy [CBT]-based, psychoeducation, and mixed interventions) and approach (individual- and organisation-centred). Not all of the examined interventions provided significant outcomes. However, CBT-based and individualised approaches showed a positive trend in reducing SME leaders' psychosocial stress and improving their well-being. Despite the limited data, it can be concluded that such interventions are beneficial for leaders and their specific needs. Future research should focus on tailored approaches, derived from well-founded theories and integrative interventions addressing SME leaders.

Associations between COVID-19 Pandemic-Related Overtime, Perceived Chronic Stress and Burnout Symptoms in German General Practitioners and Practice Personnel-A Prospective Study

BACKGROUND

The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel.

METHODS

This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods.

RESULTS

Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: -0.08, 0.12), indicating a full mediation.

CONCLUSION

In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel.

The Predominance of the Health-Promoting Patterns of Work Behavior and Experience in General Practice Teams-Results of the IMPROVEjob Study

This study aims to identify the distribution of the "Work-related behavior and experience patterns" (Arbeitsbezogenes Verhaltens-und Erlebnismuster, AVEM) in general practitioners and their teams by using baseline data of the IMPROVEjob study. Members of 60 general practices with 84 physicians in a leadership position, 28 employed physicians, and 254 practice assistants participated in a survey in 2019 and 2020. In this analysis, we focused on AVEM variables. Age, practice years, work experience, and working time were used as control variables in the Spearman Rho correlations and analysis of variance. The majority of the participants (72.1%) revealed a health-promoting pattern (G or S). Three of eleven AVEM dimensions were above the norm for the professional group "employed physicians". The AVEM dimensions "striving for perfection" (p < 0.001), "experience of success at work" (p < 0.001), "satisfaction with life" (p = 0.003), and "experience of social support" (p = 0.019) differed significantly between the groups' practice owners and practice assistants, with the practice owners achieving the higher values, except for experience of social support. Practice affiliation had no effect on almost all AVEM dimensions. We found a high prevalence of AVEM health-promoting patterns in our sample. Nearly half of the participants in all professional groups showed an unambitious pattern (S). Adapted interventions for the represented AVEM patterns are possible and should be utilized for maintaining mental health among general practice teams.

Only the anxious ones? Identifying characteristics of symptom checker app users: a cross-sectional survey

BACKGROUND

Symptom checker applications (SCAs) may help laypeople classify their symptoms and receive recommendations on medically appropriate actions. Further research is necessary to estimate the influence of user characteristics, attitudes and (e)health-related competencies.

OBJECTIVE

The objective of this study is to identify meaningful predictors for SCA use considering user characteristics.

METHODS

An explorative cross-sectional survey was conducted to investigate German citizens' demographics, eHealth literacy, hypochondria, self-efficacy, and affinity for technology using German language-validated questionnaires. A total of 869 participants were eligible for inclusion in the study. As n = 67 SCA users were assessed and matched 1:1 with non-users, a sample of n = 134 participants were assessed in the main analysis. A four-step analysis was conducted involving explorative predictor selection, model comparisons, and parameter estimates for selected predictors, including sensitivity and post hoc analyses.

RESULTS

Hypochondria and self-efficacy were identified as meaningful predictors of SCA use. Hypochondria showed a consistent and significant effect across all analyses OR: 1.24-1.26 (95% CI: 1.1-1.4). Self-efficacy OR: 0.64-0.93 (95% CI: 0.3-1.4) showed inconsistent and nonsignificant results, leaving its role in SCA use unclear. Over half of the SCA users in our sample met the classification for hypochondria (cut-off on the WI of 5).

CONCLUSIONS

Hypochondria has emerged as a significant predictor of SCA use with a consistently stable effect, yet according to the literature, individuals with this trait may be less likely to benefit from SCA despite their greater likelihood of using it. These users could be further unsettled by risk-averse triage and unlikely but serious diagnosis suggestions.

TRIAL REGISTRATION

The study was registered in the German Clinical Trials Register (DRKS) DRKS00022465, DERR1- https://doi.org/10.2196/34026 .

[Information on health promotion and prevention on the websites of Baden-Württemberg's public health services-a first approach]

BACKGROUND

Health promotion and prevention are core tasks of German public health services (Öffentlicher Gesundheitsdienst). Health communication is, among other things, central to their effectiveness. As the Internet has become an important source of health information and public health services are increasingly in the public eye, their websites are gaining more focus. We therefore investigated how public health services present topics on health promotion and prevention of non-communicable diseases (HPP-NCDs) on their websites.

METHODS

The websites of the 38 public health service departments in Baden-Wuerttemberg were examined using qualitative content analysis from June to October 2022. The presentation of the HPP-NCDs topic on the websites as well as the relevant measures were documented. For each measure/activity the addressed target group, the topic, and the type of intervention was collected.

RESULTS

The HPP-NCDs topic is addressed on all websites (n = 38); however, the presentation style is heterogeneous. A total of 243 HPP-NCDs measures/activities were identified across the 38 websites. There was a broad spectrum of topics, target groups, and types of intervention used in the measures/activities presented.

DISCUSSION

The study shows an extensive but heterogeneous presentation of HPP-NCDs on the websites of public health services. In doing so, they are caught between the requirements of public relations and health information. The use of synergy effects through the joint promotion of nationally relevant informational materials and measures could be beneficial for public health services.

Wrist Extensor Muscle Fatigue During a Dual Task With Two Muscular and Cognitive Load Levels in Younger and Older Adults

OBJECTIVE

To examine the effect of concurrent physical and cognitive demands as well as age on indicators of muscle fatigue at the wrist.

BACKGROUND

There are few studies examining risk indicators for musculoskeletal disorders associated with work-related physical and cognitive demands that often occur simultaneously in the workplace.

METHODS

Twenty-four gender-balanced older and 24 gender-balanced younger (mean age 60 and 23 years) participants performed four 30 min dual tasks. Tasks differed by the muscular load level during force tracking: 5% and 10% of maximum voluntary contraction force (MVC) and concurrent cognitive demands on the working memory: easy and difficult. Muscle fatigue was assessed by MVC decline and changes in surface electromyography (increased root mean square: RMS, decreased median frequency: MF) at the extensor digitorum (ED) and extensor carpi ulnaris (EU).

RESULTS

A decline in MVC was found in all participants when tracking was performed at 10% MVC (mean ± SD: 137.9 ± 49.2 - 123.0 ± 45.3 N). Irrespective of age, muscular, or cognitive load, RMS increased (ED 12.3 ± 6.5 - 14.1 ± 7.0% MVE, EU 15.4 ± 7.6 - 16.9 ± 8.6% MVE) and MF decreased (ED 85.4 ± 13.6 - 83.2 ± 12.8 Hz, EU 107.2 ± 17.1 - 104.3 ± 16.7 Hz) in both muscles. However, changes in MF of EU tended to be more pronounced in the older group at higher cognitive and lower muscular load, without reaching statistical significance.

CONCLUSION

Maximum voluntary contraction indicated no interaction between muscle fatigue, cognitive load, or age. However, the tendencies toward altered muscle activity due to an increase in cognitive load and older age suggest muscular adaptations while maintaining tracking performance during the onset of fatigue signs in the sEMG signal.

APPLICATION

If the tendencies in muscle activity are confirmed by further studies, ergonomic assessments in industrial workplaces should consider cognitive load and age when describing the risk of musculoskeletal disorders.

180° view on general practitioners' leadership skills: practice-level comparisons of leader and staff assessments using data from the cluster-randomised controlled IMPROVEjob study

OBJECTIVES

Strong primary care leaders are needed to assure high quality services for patient populations. This study analysed general practitioners' (GP) leadership skills comparing practice-level self and staff assessments based on the full range of leadership model and the leader-member exchange (LMX).

SETTING

The questionnaire survey was conducted among German general practice leaders and their staff participating in the IMPROVEjob trial.

PARTICIPANTS

The study population comprised 60 German general practices with 366 participants: 84 GP practice leaders and 282 employees (28 physicians and 254 practice assistants).

PRIMARY AND SECONDARY OUTCOME MEASURES

Leadership skills of the practice leaders were measured using the Integrative Leadership Questionnaire (German Fragebogen für integrative Führung) and the LMX-7 questionnaire. Leaders rated themselves and practice staff rated their leaders. The data was analysed by paired mean comparisons on the practice level.

RESULTS

For most leadership dimensions, practice leaders rated themselves higher than their employees rated them. Differences were found for transformational leadership (p<0.001, d=0.41), especially for the dimensions 'innovation' (p<0.001, d=0.69) and 'individuality focus' (p<0.001, d=0.50). For transactional leadership, the dimension 'goal setting' differed significantly (p<0.01, d=0.30) but not the other dimensions. Scores for negative leadership were low and showed no differences between leaders and employees. Interestingly, employed physicians' rated their practice leaders higher on the two transformational ('performance development', 'providing a vision') and all transactional dimensions. The LMX-7 scale showed high quality relationships between leaders and employees.

CONCLUSIONS

This 180° analysis of GPs' leadership skills with self and employee ratings indicated good relationships. There is a potential to improve leadership regarding goal-setting, innovation and focusing on individual team members. These results allow for the development of targeted interventions.

TRIAL REGISTRATION NUMBER

German Clinical Trials Register, DRKS00012677. Registered 16 October 2019.

Assessing Attitudes and Participation Regarding a Pilot COVID-19 Workplace Vaccination Program in Southern Germany Considering the Occupational Health Perspective-A Mixed Methods Study

This mixed methods study retrospectively assessed attitudes and participation of employees, occupational health personnel, and key personnel regarding the rollout of a pilot COVID-19 workplace vaccination program in five German companies in May/June 2021 in Baden-Württemberg (Southern Germany) by combining survey data and qualitative interviews. A total of 652 employees completed a standardized questionnaire and we conducted ten interviews with occupational health personnel and key personnel with other professional backgrounds organizing the pilot workplace vaccination program. Survey data were analyzed descriptively and interviews were audio recorded, transcribed verbatim, and analyzed using qualitative content analysis. Employees participated widely in COVID-19 vaccinations at their workplaces, and most employees (n = 608; 93.8%) had a full COVID-19 immunization at the time of the survey. The main advantages of the pilot COVID-19 workplace vaccination program were seen in the flexible and time-saving vaccination offer as well as the trust in and long-standing relationship with occupational health physicians. The main disadvantage of the pilot vaccination offer was increased workload for occupational health personnel, especially during the roll-out phase of the program. The pilot COVID-19 workplace vaccination program was predominantly positively assessed, and the important role of occupational health services in managing the COVID-19 pandemic was highlighted. The main criticisms of the COVID-19 workplace vaccination program related to the high organizational and administrative burden. Findings from our study can support the development of future programs for the administration of generally recommended vaccination in the workplace setting in Germany.

Impacts of Symptom Checkers for Laypersons' Self-diagnosis on Physicians in Primary Care: Scoping Review

BACKGROUND

Symptom checkers (SCs) for laypersons' self-assessment and preliminary self-diagnosis are widely used by the public. Little is known about the impact of these tools on health care professionals (HCPs) in primary care and their work. This is relevant to understanding how technological changes might affect the working world and how this is linked to work-related psychosocial demands and resources for HCPs.

OBJECTIVE

This scoping review aimed to systematically explore the existing publications on the impacts of SCs on HCPs in primary care and to identify knowledge gaps.

METHODS

We used the Arksey and O'Malley framework. We based our search string on the participant, concept, and context scheme and searched PubMed (MEDLINE) and CINAHL in January and June 2021. We performed a reference search in August 2021 and a manual search in November 2021. We included publications of peer-reviewed journals that focused on artificial intelligence- or algorithm-based self-diagnosing apps and tools for laypersons and had primary care or nonclinical settings as a relevant context. The characteristics of these studies were described numerically. We used thematic analysis to identify core themes. We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to report the study.

RESULTS

Of the 2729 publications identified through initial and follow-up database searches, 43 full texts were screened for eligibility, of which 9 were included. Further 8 publications were included through manual search. Two publications were excluded after receiving feedback in the peer-review process. Fifteen publications were included in the final sample, which comprised 5 (33%) commentaries or nonresearch publications, 3 (20%) literature reviews, and 7 (47%) research publications. The earliest publications stemmed from 2015. We identified 5 themes. The theme finding prediagnosis comprised the comparison between SCs and physicians. We identified the performance of the diagnosis and the relevance of human factors as topics. In the theme layperson-technology relationship, we identified potentials for laypersons' empowerment and harm through SCs. Our analysis showed potential disruptions of the physician-patient relationship and uncontested roles of HCPs in the theme (impacts on) physician-patient relationship. In the theme impacts on HCPs' tasks, we described the reduction or increase in HCPs' workload. We identified potential transformations of HCPs' work and impacts on the health care system in the theme future role of SCs in health care.

CONCLUSIONS

The scoping review approach was suitable for this new field of research. The heterogeneity of technologies and wordings was challenging. We identified research gaps in the literature regarding the impact of artificial intelligence- or algorithm-based self-diagnosing apps or tools on the work of HCPs in primary care. Further empirical studies on HCPs' lived experiences are needed, as the current literature depicts expectations rather than empirical findings.

Influence of Face Masks on Physiological and Subjective Response during 130 Min of Simulated Light and Medium Physical Manual Work-An Explorative Study

BACKGROUND

Undesirable side effects from wearing face masks during the ongoing COVID-19 pandemic continue to be discussed and pose a challenge to occupational health and safety when recommending safe application. Only few studies examined the effects of continuously wearing a face mask for more than one hour. Therefore, the influence of wearing a medical mask (MedMask) and a filtering facepiece class II respirator (FFP2) on the physiological and subjective outcomes in the course of 130 min of manual work was exploratively investigated. Physical work load and cardiorespiratory fitness levels were additionally considered as moderating factors.

METHODS

Twenty-four healthy subjects (12 females) from three different cardiorespiratory fitness levels each performed 130 min of simulated manual work with light and medium physical workload using either no mask, a MedMask or FFP2. Heart rate, transcutaneous oxygen and carbon dioxide partial pressure (P_tcO₂, P_tcCO₂) as well as perceived physical exertion and respiratory effort were assessed continuously at discrete time intervals. Wearing comfort of the masks were additionally rated after the working period.

RESULTS

There was no difference in time-dependent changes of physiological outcomes when using either a MedMask or a FFP2 compared to not wearing a mask. A stronger increase over time in perceived respiratory effort occurred when the face masks were worn, being more prominent for FFP2. Physical workload level and cardiorespiratory fitness level were no moderating factors and higher wearing comfort was rated for the MedMask.

CONCLUSION

Our results suggest that using face masks during light and medium physical manual work does not induce detrimental side effects. Prolonged wearing episodes appeared to increase respiratory effort, but without affecting human physiology in a clinically relevant way.

Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial

OBJECTIVE

Investigate the effect of passive, active or no intra-operative work breaks on static, median and peak muscular activity, muscular fatigue, upper body postures, heart rate, and heart rate variability.

BACKGROUND

Although laparoscopic surgery is preferred over open surgery for the benefit of the patient, it puts the surgeons at higher risk for developing musculoskeletal disorders especially due to the less dynamic and awkward working posture. The organizational intervention intraoperative work break is a workplace strategy that has previously demonstrated positive effects in small-scale intervention studies.

METHODS

Twenty-one surgeons were exposed to three 90-min conditions: no breaks, 2.5-min passive (standing rest) or active (targeted stretching and mobilization exercises) breaks after 30-min work blocks. Muscular activity and fatigue of back, shoulder and forearm muscles were assessed by surface electromyography; upper body posture, i.e., spinal curvature, by inclination sensors; and heart rate and variability (HRV) by electrocardiography. Generalized estimating equations were used for statistical analyses. This study (NCT03715816) was conducted from March 2019 to October 2020.

RESULTS

The HRV-metric SDNN tended to be higher, but not statistically significantly, in the intervention conditions compared to the control condition. No statistically significant effects of both interventions were detected for muscular activity, joint angles or heart rate.

CONCLUSION

Intraoperative work breaks, whether passive or active, may counteract shoulder muscular fatigue and increase heart rate variability. This tendency may play a role in a reduced risk for developing work-related musculoskeletal disorders and acute physical stress responses.

Exploring Transfer Potentials of the IMPROVEjob Intervention for Strengthening Workplace Health Management in Micro-, Small-, and Medium-Sized Enterprises in Germany: A Qualitative Study

Micro- and small-sized enterprises (MSE), and small- and medium-sized enterprises (SME) in Germany are often burdened with high levels of psychosocial stressors at work. The IMPROVEjob intervention was originally developed for general practice teams, and aims to promote job satisfaction and reduce psychosocial stressors in the context of workplace health management (WHM). This qualitative study identified challenges and transfer options regarding the transfer of the IMPROVEjob intervention to other MSE/SME settings. Based on previous study results, a comprehensive, qualitative inter- and transdisciplinary approach was developed and conducted between July 2020 and June 2021, also including single interviews and focus group discussion with eleven experts from MSE/SME settings. Data analysis was carried out using a rapid analysis approach. The experts discussed psychosocial topics and didactic formats of the original IMPROVEjob intervention. A lack of access to information on managing work-related psychosocial stressors and inadequate recognition of the importance of psychosocial stressors in the workplace among managers and employees, seemed to be the highest barriers regarding the transfer of the intervention into other MSE/SME settings. The transfer of the IMPROVEjob intervention to other MSE/SME settings requires an adapted intervention format, comprising targeted offers with easy access to information on managing work-related psychosocial stressors and improving WHM in MSE/SME settings.

Using a Back Exoskeleton During Industrial and Functional Tasks-Effects on Muscle Activity, Posture, Performance, Usability, and Wearer Discomfort in a Laboratory Trial

OBJECTIVE

To investigate the effect of using a passive back-support exoskeleton (Laevo V2.56) on muscle activity, posture, heart rate, performance, usability, and wearer comfort during a course of three industrial tasks (COU; exoskeleton worn, turned-on), stair climbing test (SCT; exoskeleton worn, turned-off), timed-up-and-go test (TUG; exoskeleton worn, turned-off) compared to no exoskeleton.

BACKGROUND

Back-support exoskeletons have the potential to reduce work-related physical demands.

METHODS

Thirty-six men participated. Activity of erector spinae (ES), biceps femoris (BF), rectus abdominis (RA), vastus lateralis (VL), gastrocnemius medialis (GM), trapezius descendens (TD) was recorded by electromyography; posture by trunk, hip, knee flexion angles; heart rate by electrocardiography; performance by time-to-task accomplishment (s) and perceived task difficulty (100-mm visual analogue scale; VAS); usability by the System Usability Scale (SUS) and all items belonging to domains skepticism and user-friendliness of the Technology Usage Inventory; wearer comfort by the 100-mm VAS.

RESULTS

During parts of COU, using the exoskeleton decreased ES and BF activity and trunk flexion, and increased RA, GM, and TD activity, knee and hip flexion. Wearing the exoskeleton increased time-to-task accomplishment of SCT, TUG, and COU and perceived difficulty of SCT and TUG. Average SUS was 75.4, skepticism 11.5/28.0, user-friendliness 18.0/21.0, wearer comfort 31.1 mm.

CONCLUSION

Using the exoskeleton modified muscle activity and posture depending on the task applied, slightly impaired performance, and was evaluated mildly uncomfortable.

APPLICATION

These outcomes require investigating the effects of this passive back-supporting exoskeleton in longitudinal studies with longer operating times, providing better insights for guiding their application in real work settings.

Limitations in evaluating COVID-19 protective face masks using open circuit spirometry systems: respiratory measurement mask introduces bias in breathing pressure and perceived respiratory effort

Objective.In response to the COVID-19 pandemic and the resulting widespread use of protective face masks, studies have been and are being conducted to investigate potential side effects of wearing masks on the performance and physiological parameters of wearers. The purpose of the present study is to determine whether and to what extent the use of a respiratory measurement (RM) mask-which is normally used during open-circuit spirometry-influences the results of these types of studies.Approach.34 subjects were involved in this intra-subject study with a cross-over design. Four different protective face masks, Community Mask, medical Mouth-Nose-Protection Mask, Filtering Face Piece Mask Class 2 (FFP2), and FFP2 with exhalation valve (FFP2ex), were tested at rest and during deep breathing by using or not using a RM mask (RM versus noRM). Breathing pressure inside the protective face masks was measured during inhalation and exhalation, and subjects rated breathing effort using an 11-stage Borg scale.Main results.The use of an additional RM mask-worn over the protective face masks-significantly increased inspiratory pressures under all mask conditions. The respiratory pressure rises to a level that substantially distorts the results. Expiratory pressure was also significantly increased except for the FFP2ex mask condition. The perceived respiratory effort was significantly increased by 1.0 to 2.8 steps on the Borgs scale for all mask conditions compared with noRM.Significance.We strongly recommend avoiding the use of RM masks for evaluating the effects of protective face masks on human physiology and subjective perception.

Assessing Differences in Attitudes toward Occupational Safety and Health Measures for Infection Control between Office and Assembly Line Employees during the COVID-19 Pandemic in Germany: A Cross-Sectional Analysis of Baseline Data from a Repeated Employee Survey

In our study, we investigated possible differences across occupational groups regarding employees’ perceived work-related risk of infection with SARS-CoV-2, attitudes toward technical, organisational, and personal occupational safety and health (OSH) measures for infection control, and factors associated with this attitude. We analysed baseline data (10 August to 25 October 2020) from a repeated standardised online survey distributed at a worldwide leading global supplier of technology and services in Germany. 2144 employees (32.4% women; age (mean ± SD): 44 ± 11 years) who worked predominantly remotely (n = 358), at an on-site office (n = 1451), and assembly line/manufacturing (n = 335) were included. The work-related SARS-CoV-2 risk of infection differed between office employees working remotely and on-site (mean ± SD = 2.9 ± 1.5 vs. 3.2 ± 1.5; Mann-Whitney-U-Test: W = 283,346; p < 0.002; ε2 = 0.01) and between on-site office and assembly line/manufacturing employees (3.8 ± 1.7; W = 289,174; p < 0.001; ε2 = 0.02). Attitude scores toward technical OSH-measures differed between remote and on-site office (4.3 ± 0.5 vs. 4.1 ± 0.6; W = 216,787; p < 0.001; ε2 = 0.01), and between on-site office and assembly line/manufacturing employees (3.6 ± 0.9; W = 149,881; p < 0.001; ε2 = 0.07). Findings were similar for organisational and personal measures. Affective risk perception, COVID-19-specific resilience, and information about COVID-19-related risks were associated with the employees’ attitudes. To promote positive attitudes, it seems to be important to consider occupational-group-specific context factors when implementing OSH-measures for infection control.

The association of perceived leadership style and subjective well-being of employees in a tertiary hospital in Germany

BACKGROUND

Professionals in the healthcare sector are a particularly vulnerable group for occupational strain due to high work-related psychological stress. For the implementation of targeted stress-prevention interventions as an important part of a workplace health management programme for all occupational groups and hierarchy levels, information about the current state of their mental health is mandatory. Hence, this study investigated the association of general well-being and different leadership styles among employees in a German tertiary hospital.

METHODS

Via an online survey, 10,101 employees were contacted. The final sample consisted of 1137 employees. Of these, 27.7% described themselves as leaders and 72.3% as followers. Most participants were female (74.8%), more than half were under 41 years old. Besides control variables, general well-being (WHO-5) and leadership style (transactional and transformational, laissez-faire and destructive leadership) were assessed.

RESULTS

Leaders reported higher well-being scores than followers. Physicians without leadership responsibilities had the lowest scores for well-being. Practitioners of both transformational and transactional leadership were associated with higher well-being scores, while those practicing laissez-faire and destructive leadership had lower scores for almost every professional group.

CONCLUSION

Results highlight the necessity for future multimodal health-preventive leadership interventions feature behavioural and organizational intervention modules specifically tailored to hospital professionals at different hierarchical and functional levels to foster the mental health of employees.

Conceptual Framework of a Psychotherapeutic Consultation in the Workplace: A Qualitative Study

(1) Background: A new health care offer called 'psychotherapeutic consultation in the workplace' is an early and effective intervention for employees with common mental disorders. Although cost-effective, it lacks a broader roll-out. This might be attributable to undefined context, mechanisms of change, and a lack of communication; therefore, this study explores how the new model works and where problems occur. (2) Methods: Semi-structured interviews on motivation, expectations and experiences with 20 involved experts. Experts were members of the company health promotion team, service users, and cooperating mental health specialists. Analysis was conducted with ATLAS.ti. (3) Results: The conceptual framework comprises three main topics: (a) structured implementation concept; (b) persons involved, shaping the concept's processes; (c) and meaning and function of the offer within the given context. Concerning (c) we found three potential areas of conflict: (1) intra-corporate conflicts, (2) conflicts between company and employee, (3) and conflicts between the company health promotion and the health care system. Category (c) comprises the offer's core characteristics which were described as low-threshold and preventive. Furthermore, the offer was perceived as convenient in handling, confidential, and having immediate impact on a person's well-being. (4) Conclusions: Here we define structures, address the needs of the involved persons, and communicate foreseeable areas of conflict influences whether the implementation of the intervention succeeds.

Evaluation of measurement properties of the German Work Role Functioning Questionnaire

OBJECTIVE

We assessed the measurement properties of the German Work Role Functioning Questionnaire (WRFQ) after its cross-cultural adaptation of the Dutch version. The WRFQ is a generic role-specific instrument that measures how a particular health status influences the ability to meet work demands.

METHODS

We performed an observational study among German employees assessing the following measurement properties: 1) structural, 2) convergent and 3) discriminant validity, 4) floor and ceiling effects, 5) internal consistency, 6) reproducibility and 7) responsiveness. Participants were recruited from an online access panel sample aged 18 to 64 years having worked more than 12 hours in the last 4 weeks prior to study enrollment (n_(T0) = 653, n_(T1) = 66, n_(T2) = 95).

RESULTS

Measurement properties proved to be good except for structural validity and responsiveness. An exploratory factor analysis showed limited replicability of three of the four original subscales.

CONCLUSION

With the WRFQ German version, the extent can be measured, to which employees with a certain health level experience problems can meet their work demands. This widely used health-related work outcome measurement tool, that helps to identify employees with decreasing work functioning, is now also available in German. This gives researchers and practitioners the opportunity to address work functioning in practice, e.g. in intervention studies in occupational health or rehabilitation. Further research to examine valid subscales is needed.

Effects of a Passive Back-Support Exoskeleton on Knee Joint Loading during Simulated Static Sorting and Dynamic Lifting Tasks

Due to the load shifting mechanism of many back-support exoskeletons (BSEs), this study evaluated possible side effects of using a BSE on knee joint loading. Twenty-nine subjects (25.9 (±4.4) years, 179.0 (±6.5) cm; 73.6 (±9.4) kg) performed simulated static sorting and dynamic lifting tasks, including stoop and squat styles and different trunk rotation postures. Ground reaction force, body posture and the force between the chest and the BSE's contact interface were recorded using a force plate, two-dimensional gravimetric position sensors, and a built-in force sensor of the BSE, respectively. Using these parameters and the subject's anthropometry, median and 90th percentile horizontal (HOR₅₀, HOR₉₀) and vertical (VERT₅₀, VERT₉₀) tibiofemoral forces were calculated via a self-developed inverse quasi-static biomechanical model. BSE use had a variable effect on HOR₅₀ dependent on the working task and body posture. Generally, VERT₅₀ increased without significant interaction effects with posture or task. HOR₉₀ and VERT₉₀ were not affected by using the BSE. In conclusion, utilizing the investigated exoskeleton is likely to induce side effects in terms of changed knee joint loading. This may depend on the applied working task and the user's body posture. The role of these changes in the context of a negative contribution to work-related cumulative knee exposures should be addressed by future research.

Postural Control When Using an Industrial Lower Limb Exoskeleton: Impact of Reaching for a Working Tool and External Perturbation

OBJECTIVE

To investigate postural control related to a lower limb exoskeleton (Chairless Chair) when (a) reaching for a working tool, and (b) an external perturbation occurs.

BACKGROUND

Lower limb exoskeletons aiming to reduce physical load associated with prolonged standing may impair workers' postural control and increase the risk of falling.

METHOD

Forty-five males were reaching for an object (3-kg dumbbell) at the lateral end of their reaching area without the exoskeleton in upright standing (STAND) and with the exoskeleton at a high (EXO_HIGH.SEAT) and low sitting position (EXO_LOW.SEAT). The task was performed with the object placed in three different angles (120°, 150°, and 180°) in the transversal plane. The minimum absolute static postural stability (SS_ABS.MIN) as the shortest distance (mm) of the center of pressure to the base of support border was measured (zero indicates risk of falling). Additionally, eight subjects were standing without the exoskeleton or sitting on it (EXO_HIGH.SEAT and EXO_LOW.SEAT) while being pulled backward. The tilting moment when subjects lost their balance was assessed.

RESULTS

SS_ABS.MIN was lower when using the exoskeleton (p < .05) but still about 17 mm. The location of the object to be reached had no influence. Tilting moments of less than 30 nm were sufficient to let people fall backward when sitting on the exoskeleton (50 nm for STAND).

CONCLUSION

Impairments in postural control by the exoskeleton may not be relevant when reaching laterally for objects up to 3 kg. When an external perturbation occurs, the risk of falling may be much higher; irrespective of factors like uneven or slippery flooring.

APPLICATION

The risk of falling using the exoskeleton seems to be low when reaching laterally for an object of up to 3 kg. In situations where, for example, a collision with coworkers is likely, this exoskeleton is not recommended.

Ethical, Legal, and Social Implications of Symptom Checker Apps in Primary Health Care (CHECK.APP): Protocol for an Interdisciplinary Mixed Methods Study

Background

Symptom checker apps (SCAs) are accessible tools that provide early symptom assessment for users. The ethical, legal, and social implications of SCAs and their impact on the patient-physician relationship, the health care providers, and the health care system have sparsely been examined. This study protocol describes an approach to investigate the possible impacts and implications of SCAs on different levels of health care provision. It considers the perspectives of the users, nonusers, general practitioners (GPs), and health care experts.

Objective

We aim to assess a comprehensive overview of the use of SCAs and address problematic issues, if any. The primary outcomes of this study are empirically informed multi-perspective recommendations for different stakeholders on the ethical, legal, and social implications of SCAs.

Methods

Quantitative and qualitative methods will be used in several overlapping and interconnected study phases. In study phase 1, a comprehensive literature review will be conducted to assess the ethical, legal, social, and systemic impacts of SCAs. Study phase 2 comprises a survey that will be analyzed with a logistic regression. It aims to assess the user degree of SCAs in Germany as well as the predictors for SCA usage. Study phase 3 will investigate self-observational diaries and user interviews, which will be analyzed as integrated cases to assess user perspectives, usage pattern, and arising problems. Study phase 4 will comprise GP interviews to assess their experiences, perspectives, self-image, and concepts and will be analyzed with the basic procedure by Kruse. Moreover, interviews with health care experts will be conducted in study phase 3 and will be analyzed by using the reflexive thematical analysis approach of Braun and Clark.

Results

Study phase 1 will be completed in November 2021. We expect the results of study phase 2 in December 2021 and February 2022. In study phase 3, interviews are currently being conducted. The final study endpoint will be in February 2023.

Conclusions

The possible ethical, legal, social, and systemic impacts of a widespread use of SCAs that affect stakeholders and stakeholder groups on different levels of health care will be identified. The proposed methodological approach provides a multifaceted and diverse empirical basis for a broad discussion on these implications.

Trial Registration

German Clinical Trials Register (DRKS) DRKS00022465; https://tinyurl.com/yx53er67

International Registered Report Identifier (IRRID)

DERR1-10.2196/34026

Quality of life and sleep in individuals with irritable bowel syndrome according to different diagnostic criteria and inflammatory bowel diseases: A comparison using data from a population-based survey

BACKGROUND

A proportion of irritable bowel syndrome (IBS) affected patients does not fulfil Rome criteria despite considerable impairment similarly to that in patients with organic gastrointestinal diseases.This investigation aims to examine differences regarding Mental (MQoL), Physical Quality of Life (PQoL), and sleep between IBS according to Rome III (IBS Rome), clinically defined IBS, inflammatory bowel diseases (IBD), and non-IBS/non-IBD individuals.

METHODS

Data from SHIP-Trend (Study of Health in Pomerania, 2008-2012), a population-based cohort study in Germany, were used.

RESULTS

Response was 50.1% (N = 4420). Prevalence was 3.5% for IBS Rome (95% confidence interval (CI): 3.0 - 4.1%, n = 148), 0.6% for clinically defined IBS (CI: 0.4 - 0.9%, n = 27), and 0.8% for IBD (CI: 0.6 - 1.1%, n = 34). Individuals with IBS Rome (4.54 (CI: -5.92; -3.17)) and clinically defined IBS (4.69 (CI: -7.82; -1.56)) had lower scores for MQoL compared to the non-IBS/non-IBD group. PQoL scores were lowered in IBS Rome (6.39 (CI: -7.89; -4.88)) and IBD (5.37 (CI: -8.51; -2.22)), but not in clinically defined IBS compared to the non-IBS/non-IBD group. IBS Rome was the only gastroenterological condition with higher odds of sleeping problems (odds ratio (OR) "falling asleep": 1.74; CI: 1.29; 2.36; OR "remaining asleep": 1.73; CI: 1.26; 2.38).

CONCLUSIONS

IBS Rome is associated with reduced MQoL, PQoL, and sleep problems. Clinically defined IBS is associated only with reduced MQoL. Heterogeneity within IBS affected patients should be considered in clinical routine and screening for daily life impairment should be performed.

Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital: the results of a mixed-method phase-II study

OBJECTIVES

Hospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership.

DESIGN

This is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants' change in everyday work.

SETTING

A tertiary hospital in Germany.

PARTICIPANTS

N=93 leaders of different professions.

INTERVENTION

An interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource 'team', (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention.

OUTCOME MEASURES

Feasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership.

RESULTS

After the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants' self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work.

CONCLUSIONS

This intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre-randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus).

Social Determinants of Remaining Life Expectancy at Age 60: A District-Level Analysis in Germany

Remaining life expectancy at age 60 (in short: RLE) is an important indicator of the health status of a population's elders. Until now, RLE has not been thoroughly investigated at the district level in Germany. In this study we analyzed, based on recent publicly available data (2015-2017), and for men and women separately, how large the RLE differences were in Germany across the 401 districts. Furthermore, we examined a wide range of potential social determinants in terms of their bivariate and multivariate (i.e., partial) impact on men's and women's RLE. Men's district-level RLE ranged between 19.89 and 24.32 years, women's district-level RLE between 23.67 and 27.16 years. The best single predictor both for men's and women's RLE at district level was 'proportion of employees with academic degree' with standardized partial regression coefficients of 0.42 (men) and 0.51 (women). Second and third in rank were classic economic predictors, such as 'household income' (men), 'proportion of elder with financial elder support' (women), and 'unemployment' (men and women). Indicators expressing the availability of medical services and staffing levels of nursing homes and services had at best a marginal partial impact. This study contributes to the growing body of evidence that a population's educational level is a decisive determinant of population health resp. life expectancy in contemporary industrialized societies.

Reflection on leadership behavior: potentials and limits in the implementation of stress-preventive leadership of middle management in hospitals - a qualitative evaluation of a participatory developed intervention

Background

Mental health and stress prevention aspects related to workplace in hospitals are gaining increasingly more attention in research. The workplace hospital is characterized by high work intensity, high emotional demands, and high levels of stress. These conditions can be a risk for the development of mental disorders. Leadership styles can hinder or foster work-related stress and influence the well-being of employees. Through leadership interventions, leaders may be encouraged to develop a stress-preventive leadership style that addresses both, the well-being of the leaders and of the subordinates. A comprehensive qualitative description of leaders’ experiences with interventions on the topic of stress-preventive leadership is yet missing in the literature. Therefore, we address leaders of middle management regarding the development of stress-preventive leadership styles through supporting interventions. The research questions are: How do leaders of middle management perceive their leadership role in terms of effectiveness in stress prevention? Which potentials and limits in the implementation of stress-preventive leadership are experienced?

Methods

The study follows a qualitative research design and content analysis. We conducted individual interviews with leaders of middle management (n = 30) of a tertiary hospital in Germany for the participatory development of an intervention. This intervention, consisting of five consecutive modules, addressed leaders of middle management in all work areas within one hospital. After participation in the intervention, the leaders were asked to reflect on and evaluate the implementation of the contents learned within focus group discussions. Overall 10 focus group discussions with leaders (n = 60) were conducted.

Results

The results demonstrate that leaders of middle management perceived potentials for a stress-preventive leadership style (e.g., reflection on leadership role and leadership behavior, awareness/mindfulness, and conveying appreciation). However, limits were also mentioned. These can be differentiated into self-referential, subordinate-related, and above all organizational barriers for the implementation of stress-preventive leadership.

Conclusions

Some of the organizational barriers can be addressed by mid-level leadership interventions (e.g., lack of peer-exchange) or possibly by adapted leadership interventions for top management (e.g., lack of stress-preventive leadership styles in top level management). Other organizational limits are working conditions (e.g., staff shortage) that can only be influenced by health policy decisions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00339-7.

A passive back exoskeleton supporting symmetric and asymmetric lifting in stoop and squat posture reduces trunk and hip extensor muscle activity and adjusts body posture - A laboratory study

The influence of a passive exoskeleton was assessed during repetitive lifting with different lifting styles (squat, stoop) and orientations (frontal/symmetric, lateral/asymmetric) on trunk and hip extensor muscle activity (primary outcomes), abdominal, leg, and shoulder muscle activity, joint kinematics, and heart rate (secondary outcomes). Using the exoskeleton significantly and partially clinically relevant reduced median/peak activity of the erector spinae (≤6%), biceps femoris (≤28%), rectus abdominis (≤6%) and increased median/peak activity of the vastus lateralis (≤69%), trapezius descendens (≤19%), and median knee (≤6%) and hip flexion angles (≤11%). Using the exoskeleton had only limited influence on muscular responses. The findings imply the exoskeleton particularly supports hip extension and requires an adjusted body posture during lifting with different styles and orientations. The potential of using exoskeletons for primary/secondary prevention of musculoskeletal disorders should be investigated in future research including a greater diversity of users in terms of age, gender, health status.

Attitudes of Company Executives toward a Comprehensive Workplace Health Management-Results of an Exploratory Cross-Sectional Study in Germany

Workplace health management (WHM) in Germany aims at maintaining and increasing the health and well-being of employees. Little is known about company executives’ attitudes toward WHM. To gain more insight, we conducted a large-scale survey in companies in the German county of Reutlingen in 2017. We sent a standardized questionnaire to 906 companies, containing inter alia 26 self-constructed declarative statements depicting company executives’ opinions on various WHM aspects; 222 questionnaires could be evaluated. By exploratory factor analysis we assigned the 26 items to six factors reflecting different attitudes toward WHM. Factor values were standardized to a scale from 0 to 10. The attitude ‘positive view of general health services in the company’, for example, achieved by far the lowest mean agreement (3.3 points). For the attitude ‘general skepticism toward WHM’, agreement and disagreement were balanced (5.0 points). Using multiple regression analyses, we searched for variables that could partially explain respondents’ agreement with attitudes. In conclusion, a general WHM skepticism was widespread, but not dominant. The idea that general health services should be offered in companies was predominantly rejected. Older respondents and respondents from smaller companies and craft enterprises were more skeptical than average about WHM and its possible extensions.

Psychosocial demands and resources for working time organization in GP practices. Results from a team-based ethnographic study in Germany

Background

General practitioners (GPs) are challenged, e.g. by long working hours, and as employers they are responsible for the creation of working conditions that prevent work-related psychosocial risks. Leadership behaviour plays an important role within the working conditions of employees, thus we focused on two research questions: To what extent and how do GPs fulfil their role as entrepreneurs and leaders responsible for occupational safety and health of the team members in the organization of working time of the employees? What psychosocial factors result from the way of organization of working time for the practice team?

Methods

Data was collected by participant observations, individual interviews with six GPs, and five focus group discussions with 19 members of the practice staff in total. We gained access to five general practices through a teaching network associated with the Institute for General Medicine, University Hospital Essen (Germany). The analysis was carried out according to the Grounded Theory approach.

Results

GPs have several roles and related tasks to fulfil in the organization of working time. This can lead to perceived psychological stress. With regard to the organization of predictable working hours, vacations and sickness absence, the GPs determined the scope of action of the practice assistants. The delegation of these tasks took place to varying degrees and resulted in different work-related resources and stressors.

Conclusion

We described transactional and transformational leadership behaviours which are all related to specific psychosocial demands and resources and may overlap on site. Leadership training seems recommendable as part of the training of GPs and other future leaders of micro-enterprises to promote self-reflection by the entrepreneurs and leaders and strengthen occupational health of leaders and staff.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00336-w.

The Influence of Neuroticism on the Muscle Response in the Trapezius and Frontalis Muscles to Anticipatory Stress

Abstract. Objective quantification of mental stress in the workplace would be beneficial for designing work tasks to avoid the negative consequences of mental stress. Methods such as surface electromyography have proven to be sensitive to mental demands. However, there is little knowledge about the muscle response and moderating factors during anticipatory stress paradigms. This study examined whether the personality dimension neuroticism moderates the muscle response to the expectation of an unpredictable electrical shock. Forty-seven subjects underwent three expectation phases, in which they could expect a pleasant audio signal (NoShock) or an electric shock in two conditions (anticipation of the first: Shock1, and second electric shock: Shock2) at an unpredictable moment. The frontalis muscle activity and the upper and upper/middle parts of the trapezius muscle were recorded using surface electromyography. Neuroticism was surveyed using the Big Five Inventory to assign the subjects to a group with lower or higher neuroticism. Shock1 only induced higher trapezius muscle activity in the higher neuroticism group, which vanished during Shock2, while the frontalis muscle showed no significant effects. The results suggest that neuroticism should be considered a moderating factor in assessing anticipatory stress using surface electromyography at the trapezius muscle.

Work-Related Health Literacy: A Scoping Review to Clarify the Concept

The overall aim of this scoping review is to outline the current state of research on health literacy (HL) in the workplace: the primary objective is to clarify the concept of individual work-related HL; the secondary aims are to report on interventions that promote individual work-related HL and to present respective measurement instruments validated to date. A high level of work-related HL could support work ability and in the longer run employability. These topics are becoming increasingly important in current circumstances and in view of ongoing developments (e.g., digitalization and "new" work). A basic understanding and measurement of HL as an individual competence in the context of working life is necessary to develop future interventions to promote HL among people of working age. According to the participants, concept, and context (PCC) framework, we included articles on health literacy (concept) in the target group of people of working age in the workplace (population and context). Key information sources were the databases PubMed, CINAHL, PsycInfo, and PSYNDEX. A total of 30 articles were included. There are several terms for "health literacy in the workplace" (including individual work-related or occupational HL). The conceptualizations of the individual employee's competence covered all aspects of HL ("access", "understand", "appraise", and "apply" health information). The conceptualizations differed, among others, in the covered time horizon (referring either only to employees' current work situation or additionally to their employability in the lifespan) or whether they referred also to the viability of the respective company. Published interventions attempting to promote individual work-related HL seem mostly to be targeted at the promotion of mental HL. A variety of outcomes have been measured in intervention studies, while specific measurement instruments for individual work-related HL seem to be scarce. We recommend the development of country-specific instruments for the assessment of individual work-related health literacy and to measure mental and physical work-related health literacy.

Job Satisfaction and Chronic Stress of General Practitioners and Their Teams: Baseline Data of a Cluster-Randomised Trial (IMPROVEjob)

Background: A high prevalence of poor job satisfaction and high chronic stress is documented for general practitioners (GPs) and non-physician practice staff from various countries. The reasons are multifactorial and include deficits in leadership, communication and workflows. This publicly funded study evaluates the effectiveness of the newly developed participatory, interdisciplinary, and multimodal IMPROVEjob intervention on improving job satisfaction among GPs and practice personnel. Here, we report the baseline characteristics of the participating GPs and practice assistants, focusing on job satisfaction and perceived chronic stress. Methods: The IMPROVEjob study was performed as a cluster-randomised, controlled trial (cRCT) with German GP practices in the North Rhine Region. The IMPROVEjob intervention comprised two leadership workshops (one for practice leaders only; a second for leaders and practice assistants), a toolbox with supplemental printed and online material, and a nine-month implementation phase supported by IMPROVEjob facilitators. The intervention addressed issues of leadership, communication, and work processes. During study nurse visits, participants completed questionnaires at baseline and after nine months follow up. The primary outcome was the change in job satisfaction as measured by the respective scale of the validated German version of the Copenhagen Psychosocial Questionnaire (German COPSOQ, version 2018). Perceived chronic stress was measured using the Trier Inventory of Chronic Stress (TICS- SSCS). Results: Recruitment of 60 practices was successful: 21 were solo, 39 were group practices. At baseline, n = 84 practice owners, n = 28 employed physicians and n = 254 practice assistants were included. The mean age of all participants was 44.4 (SD = 12.8). At baseline, the job satisfaction score in the total sample was 74.19 of 100 (±14.45) and the perceived chronic stress score was 19.04 of 48 (±8.78). Practice assistants had a significantly lower job satisfaction than practice owners (p < 0.05) and employed physicians (p < 0.05). In the regression analysis, perceived chronic stress was negatively associated with job satisfaction (b= −0.606, SE b = 0.082, p < 0.001, ICC = 0.10). Discussion: The degree of job satisfaction was similar to those in other medical professionals published in studies, while perceived chronic stress was markedly higher compared to the general German population. These findings confirm the need for interventions to improve psychological wellbeing in GP practice personnel.

Challenges arising for older workers from participating in a workplace intervention addressing work ability: a qualitative study from Germany

OBJECTIVE

Studies examining what renders workplace interventions to sustain and promote work ability of older workers successful have largely neglected older workers´ perspective. This paper outlines the results of a study with regard to older workers´ experiences and expectations of a workplace intervention. Based on these findings, some reflections on how to improve the design and the implementation of workplace interventions for older workers are provided.

METHODS

Semi-structured interviews were conducted with older workers (N = 8) participating in a workplace intervention undertaken at one production site of a large manufacturing company in Baden-Wurttemberg/Germany. The interview guide included questions on participants´ experiences with and expectations of the intervention. The interviews were recorded, transcribed verbatim and analyzed using qualitative content analysis according to Mayring (2014).

RESULTS

Older workers´ reported some challenges they face due to their participation in the workplace intervention. These resulted from the work environment (physical challenges), the work process design (new long work cycle), the work organization (tight time allowances, little job rotation, change of teams, age stereotypes) and the management of the workplace intervention (bad information, feeling of occupational insecurity and lack of being valued).

CONCLUSIONS

The study shows that challenges arising for older workers from their participation in the workplace intervention may have counteracted the promotion of work ability. As findings suggest, some of these challenges might have been avoided either by considering workers´ perspective during design and implementation of an intervention or by referring to evidence on aging and work ability.

The influence of using exoskeletons during occupational tasks on acute physical stress and strain compared to no exoskeleton - A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis determined the effects of using an exoskeleton during occupational tasks on physical stress and strain compared to not using an exoskeleton.

METHODS

Systematic electronic database searches were performed and the review was prepared according to the PRISMA guidelines. Treatment effects on the predefined outcomes were calculated using standardized mean differences for continuous outcomes in several meta-analyses using Review Manager 5.3. Registration: PROSPERO (CRD42020168701).

RESULTS

63 articles were included in qualitative syntheses and 52 in quantitative, but most of them did not extensively evaluate musculoskeletal stress and strain and the risk of bias was rated high for all included studies. Statistically significant effects of using back, upper-limb, or lower-limb exoskeletons have been observed in the supported body areas (e.g. reduced muscle activity, joint moments and perceived strain). Studies which did not exclusively focus on the supported body area also showed statistically significant effects in the non-supported areas (e.g. changed muscle activity and perceived strain) and in physiological outcomes (e.g. reduced energy expenditure).

CONCLUSIONS

Using an exoskeleton during occupational tasks seems to reduce user's acute physical stress and strain in the exoskeleton's target area. However, impact on workers' health is still unknown, primarily because of missing long-term evaluations under real working conditions. Furthermore, this systematic review highlights a lack of studies (1) following high quality methodological criteria, (2) evaluating various inter-related stress and strain parameters instead of only focusing on one specific, and (3) evaluating non-target body areas instead of only the directly supported body area.

Influence of Gender, Profession, and Managerial Function on Clinicians' Perceptions of Patient Safety Culture: A Cross-National Cross-Sectional Study

OBJECTIVES

In recent years, several instruments for measuring patient safety culture (PSC) have been developed and implemented. Correct interpretation of survey findings is crucial for understanding PSC locally, for comparisons across settings or time, as well as for planning effective interventions. We aimed to evaluate the influence of gender, profession, and managerial function on perceptions of PSC and on the interplay between various dimensions and perceptions of PSC.

METHODS

We used German and Swiss survey data of frontline physicians and nurses (n = 1786). Data analysis was performed for the two samples separately using multivariate analysis of variance, comparisons of adjusted means, and series of multiple regressions.

RESULTS

Participants' profession and managerial function had significant direct effect on perceptions of PSC. Although there was no significant direct effect of gender for most of the PSC dimensions, it had an indirect effect on PSC dimensions through statistically significant direct effects on profession and managerial function. We identified similarities and differences across participant groups concerning the impact of various PSC dimensions on Overall Perception of Patient Safety. Staffing and Organizational Learning had positive influence in most groups without managerial function, whereas Teamwork Within Unit, Feedback & Communication About Error, and Communication Openness had no significant effect. For female participants without managerial functions, Management Support for Patient Safety had a significant positive effect.

CONCLUSIONS

Participant characteristics have significant effects on perceptions of PSC and thus should be accounted for in reporting, interpreting, and comparing results from different samples.

Can Motivational Interviewing Make a Difference in Supporting Employees to Deal with Elevated Blood Pressure? A Feasibility Study at the Workplace

Background: To overcome the problem of a high prevalence of undiscovered or untreated arterial hypertension in people of working age, the effects of behavioral change counseling in occupational health (OH) services should be investigated. The technique of motivational interviewing (MI) to support health-related lifestyle changes by physicians and/or occupational nurses (‘health coach’) has been shown to be successful in patients with chronic diseases. In 2010, we planned a randomized controlled trial (RCT) with employees who suffer from mild arterial hypertension. A preliminary feasibility study was performed in a large manufacturing company in Germany. Methods: All employees with elevated blood pressure measured by the OH-service were invited to undergo validation by 30 self-measurements. Persons with validated elevated values and without medical treatment received either usual hypertension counseling (control group, CG) or intensified MI-counseling (intervention group, IG) by the occupational health physician. Subsequently, the IG received MI-support from the ‘health coach’ in four telephone counseling sessions. Assessed feasibility factors included organizational processes, the acceptance of the validation procedure and the MI-counseling, and as primary outcome for an RCT the extent to which participants made health-related changes to their lifestyles. Results: Initially, 299 individuals were included in Study Part A (screening). At the end of Study Part B (intervention), out of 34 participants with validated and non-treated mild hypertension, only 7 (IG) and 6 (CG) participants completed the intervention including documentation. The high drop-out rate was due to the frequent lack of willingness to perform the 30 self-measurements at home with their own equipment. Acceptance was little higher when we changed the method to two repeated measurements in the OH service. MI-counseling, especially by the health coach, was evaluated positively. Conclusions: Despite the promising counseling approach, the feasibility study showed that an RCT with previous screening in the operational setting can only be implemented with high financial and personnel effort to reach an appropriate number of subjects. This substantial result could only be achieved through this comprehensive feasibility study, which investigated all aspects of the planned future RCT.

Assessment of work-related hand and elbow workloads using measurement-based TLV for HAL

Direct-measurement-based methods for assessing workloads of the hand or elbow in the field are rare. Aim of the study was to develop such a method based on the Threshold Limit Value for Hand Activity Level (TLV for HAL). Hence, HAL was quantified using kinematic data (mean power frequencies, angular velocities and micro-pauses) and combined with electromyographic data (root-mean-square values) in order to generate a measurement-based TLV for HAL (mTLV for HAL). The multi-sensor system CUELA including inertial sensors, potentiometers and a 4-channel surface electromyography module was used. For wrist and elbow regions, associations between mTLV for HAL and disorders/complaints (quantified by odds ratios (OR [95%-confidence interval])) were tested exploratively within a cross-sectional field study with 500 participants. Higher workloads were frequently significantly associated with arthrosis of distal joints (9.23 [3.29-25.87]), wrist complaints (2.89 [1.63-5.11]) or elbow complaints (1.99 [1.08-3.67]). The new method could extend previous application possibilities.

Addressing future work ability of employees in GP consultations: results of a cross-sectional study

Objectives

In this study we examined to what extent members of a best-practice integrated healthcare model in Germany discussed their subjective future work ability with their general practitioner (GP); furthermore, we examined independent variables which explain whether future work ability is discussed.

Methods

In a cross-sectional survey, 1168 (out of 3218 invited) integrated healthcare members responded to a standardized questionnaire. This study includes n = 475 employed respondents who were at most 65 years old. We determined the (relative) frequency of employed members up to 65 years who had already discussed their subjective future work ability with their GP. By means of logistic regression analysis, explanatory variables were identified which statistically explained the discussion of future work ability with their GP.

Results

N = 80 (16.8%) respondents stated they had discussed their future work ability with their GP. A multiple logistic regression analysis showed the following results: The odds ratio for discussing future work ability is increased the more satisfied respondents are with their general practitioner, the worse they assess their current work ability in relation to the physical demands of the job, and when respondents suffer from one or more chronic diseases (Nagelkerke’s pseudo-R² = 0.13).

Conclusions

Even in this healthcare setting, employees up to the age of 65 rarely discussed their subjective future work ability with their GP. This suggests that the issue ‘future work ability’ is even less commonly discussed in other community-based care settings in Germany. It seems that health care providers involved in acute care only sporadically take this issue into consideration - despite the great importance of maintaining work ability.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12995-021-00299-y.

The effectiveness of health-oriented leadership interventions for the improvement of mental health of employees in the health care sector: a systematic review

PURPOSE

An increasing prevalence of work-related stress and employees' mental health impairments in the health care sector calls for preventive actions. A significant factor in the workplace that is thought to influence employees' mental health is leadership behavior. Hence, effective leadership interventions to foster employees' (leaders' and staff members') mental health might be an important measure to address this pressing issue.

METHODS

We conducted a systematic review according to the PRISMA statement (Liberati et al. 2009) and systematically searched the following databases: PubMed (PMC), Web of Science, PsycINFO (EBSCOhost), EconLit (EBSCOhost), and Business Source Premier (EBSCOhost). In addition, we performed a hand search of the reference lists of relevant articles. We included studies investigating leadership interventions in the health care sector that aimed to maintain/foster employees' mental health.

RESULTS

The systematic search produced 11,221 initial search hits in relevant databases. After the screening process and additional literature search, seven studies were deemed eligible according to the inclusion criteria. All studies showed at least a moderate global validity and four of the included studies showed statistically significant improvements of mental health as a result of the leadership interventions.

CONCLUSIONS

Based on the findings, leadership interventions with reflective and interactive parts in group settings at several seminar days seem to be the most promising strategy to address mental health in health care employees. As the available evidence is limited, efforts to design and scientifically evaluate such interventions should be extended.

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees

Background: Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression). Objective: There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics. Methods: The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models. Results: The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended. Discussion and Conclusions: The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.

Correction to: IMPROVEjob - Participatory intervention to improve job satisfaction of general practice teams: a model for structural and behavioural prevention in small and medium-sized enterprises - a study protocol of a cluster-randomised controlled trial

An amendment to this paper has been published and can be accessed via the original article.

Active and passive work breaks during simulated laparoscopy among laparoscopic surgeons: study protocol for a controlled, randomised cross-over laboratory trial

INTRODUCTION

Laparoscopy has partially replaced open surgery due to the lower infection rate for the patient and hence better and shorter recovery. However, the surgeon's physical load is higher due to longer duration static and awkward body postures, increasing the risk for developing work-related musculoskeletal disorders. Interventions of an organisational nature are work breaks, being either passive or active. The primary objectives of this study are to determine whether passive and active work breaks lead to less discomfort than no work breaks and whether active work breaks lead to less discomfort than passive work breaks.

METHODS AND ANALYSIS

A controlled, randomised cross-over trial will be performed in the laboratory, of which its protocol is described here according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement. Recruitment of 21 laparoscopic surgeons started in April 2019 and the study is ongoing. The participating surgeons will perform three 1.5 hour experimental conditions, one without work breaks, one with 2.5 min passive work breaks including rest, and one with 2.5 min active work breaks including mobility and stretching exercises. The work breaks will be taken after 30 and 60 min of work. During the experiments, outcomes will be recorded. The primary outcome is rating of perceived discomfort measured on an 11-point numeric rating scale. The secondary outcomes are performance, muscle activity of selected muscles, upper body angles, heart rate, workload and subjective evaluation of both interventions. The collected data will be tested using a one-way or two-factorial repeated-measures analysis of variance.

ETHICS AND DISSEMINATION

Ethical approval of the study protocol was received by the local medical ethical committee of the University of Tübingen in February 2019 (no 618/2018BO2). The results of this study will be presented at national and international conferences, submitted for publications in peer-reviewed journals and serve as the starting point for a feasibility study.

TRIAL REGISTRATION NUMBER

NCT03715816.

Adjusting working conditions and evaluating the risk of infection during the COVID-19 pandemic in different workplace settings in Germany: a study protocol for an explorative modular mixed methods approach

INTRODUCTION

Currently, many countries, affected by the COVID-19 pandemic, discuss how the 'lockdown-restrictions' could be lifted to restart the economy and public life after the first wave of the COVID-19 disease has subsided. This study protocol describes an approach designed to provide an in-depth understanding of how companies and their employees in Germany deal with their working conditions during the COVID-19 pandemic. We are also interested in how and why the risk of infection with SARS-CoV-2 could vary across different professional activities, company sites and regions with different epidemiological activity or infection control measures in Germany. We expect the results of this study to contribute to the development of working conditions protecting the health of employees during and beyond the COVID-19 pandemic.

METHODS AND ANALYSIS

An explorative multimodal mixed methods approach will be applied. Module 1 comprises a document analysis of prevailing federal and regional laws and regulations at the respective location of the participating company. Module 2 includes qualitative interviews with key actors at different companies. Module 3 is a repeated standardised employee survey designed to capture potential changes in the participants' experiences and attitudes towards working conditions, occupational safety regulations/measures, and infection control measures during the COVID-19 pandemic. Module 4 comprises SARS-CoV-2 seroprevalence testing. This is carried out by the medical service of the participating company sites as a voluntary offer for employees. Qualitative data will be analysed through document and content analysis. The complexity of the quantitative analysis depends on the response rates of modules 3 and 4.

ETHICS AND DISSEMINATION

The approval of the study design was received in June 2020 from the responsible local ethical committee of the Medical Faculty, University of Tübingen and University Hospital Tübingen (No. 423/2020BO). The results will be presented at national and international conferences and published in peer-reviewed journals.

Work-Related Psychosocial Stress in Small and Medium-Sized Enterprises: An Integrative Review

Background: Work-related psychosocial stress can cause mental and physical illnesses resulting in high costs for the individual, the economy and society. Small and medium-sized enterprises (SMEs) employ the majority of the world’s workforce and often have fewer financial and human resources compared to larger businesses. The aim of this review is to summarize current knowledge on work-related stress in SMEs according to well-established guidelines categorizing psychosocial factors at work. Methods: A systematic database search was carried out in PubMed, PsycINFO, PSYNDEX and Business Source Premiere from March to June 2019, updated in January 2020. Data of included studies were analyzed and mapped into five themes: “work content and task”, “organization of work”, “social relations”, “working environment” and “new forms of work”. Results: After full-text screening, 45 out of 116 studies were included for data extraction. Studies were very heterogeneous and of varying quality, mostly applying a cross-sectional study design. Psychosocial factors in SMEs have been researched with a focus on the work patterns “work organization” and “work content and task”. Conclusions: This review underlines the need for more and better quality research of psychosocial factors in SMEs, particularly in relation to ongoing and new challenges in the workplace, including stressors related to the process of digitalization or the development of safe working conditions during the emerge of new infectious diseases.

Work-Related Psychosocial Demands and Resources in General Practice Teams in Germany. A Team-Based Ethnography

General practices are established microenterprises in Germany providing a variety of preventive and therapeutic health care services and procedures in a challenging working environment. For example, general practice teams are confronted increasingly with work-related demands, which have been associated with poor psychological and physical outcomes. It is therefore important to gain a better understanding of issues related to occupational health and safety for personnel working in the primary care setting. This study aims to gain an in-depth understanding of psychosocial demands and resources in the primary care setting. We applied an ethnographic design, comprising a combination of participating observations, individual interviews with general practitioners (GPs) (N = 6), and focus group discussion with practice assistants and administrative staff (N = 19) in five general practices in Germany. A grounded theory approach was applied to analyze all data. Our results identified psychosocial demands and resources exemplified mainly along two typical tasks in GP practices: the issuing of medical prescriptions and blood sampling. Main psychosocial demands included factors related to work content and tasks, organization of work, and the working environment. For example, daily routines across all practices were characterized by a very high work intensity including disturbances, interruptions, delegation, and the division of labor between GPs and practice staff. Work-related resources comprised the staff’s influence on aspects related to work organization and social support. The triangulation of methods and data formats allowed the disclosure of interconnectedness between these factors. Although work processes in general practices are complex and required to comply with legal regulations, there are opportunities for practice owners and practice teams to establish working procedures in ways that reduce psychosocial risks and strengthen work-related resources.