Night shift work and cardiovascular diseases among employees in Germany: five-year follow-up of the Gutenberg Health Study

OBJECTIVE

This study aimed to determine if there is an increased risk of incident cardiovascular diseases (CVD) resulting from cumulative night shift work in the German population-based Gutenberg Health Study (GHS).

METHODS

We examined working participants of the GHS at baseline and after five years. Cumulative night shift work in the 10 years before baseline was assessed and categorized as low (1-220 nights ≙ up to 1 year), middle (221-660 nights ≙ 1-3 years), and high (>660 nights ≙ more than 3 years) night shift exposure. Hazard ratios (HR) were estimated for incident "quality-assured CVD events" using Cox proportional hazard models.

RESULTS

At baseline, 1092 of 8167 working participants performed night shift work. During the follow-up, 202 incident cardiovascular events occurred. The crude incidence rates for CVD per 1000 person-years were 6.88 [95% confidence interval (CI) 4.80-9.55] for night shift workers and 5.19 (95% CI 4.44-6.04) for day workers. Cumulative incidence curves showed a higher cumulative incidence in workers exposed to night shift work compared to day workers after five years. The adjusted HR for incident CVD events were 1.26 (95% CI 0.68-2.33), 1.37 (95% CI 0.74-2.53) and 1.19 (95% CI 0.67-2.12) for employees in the low, middle and high night shift categories compared to employees without night shift work, respectively.

CONCLUSIONS

The observed tendencies indicate that night shift work might be negatively associated with cardiovascular health. We expect the continued follow-up will clarify the long-term impact of night shift work.

Conditional reciprocal stressor-strain effects in university students: a cross-lagged panel study in Germany

University students worldwide are facing increasing mental health challenges. Traditional stress models, like the Job/Study Demand-Resources Model, link stressors directly to strain. Yet, recent studies suggest the influence of strain on stressors may be even stronger. Our research explored these reciprocal dynamics among university students, considering social support and mindfulness as potential moderators. We conducted a two-wave panel study with 264 university students. We ran separate cross-lagged panel structural equation analyses for three key health outcomes-emotional exhaustion, depression, and well-being-each paired with perceived study stressors, specifically workload and work complexity. Findings revealed significant stressor and strain effects, with social support notably moderating the impact of emotional exhaustion on workload. These insights challenge traditional stress theories and underscore the importance of mental health support and effective stress management strategies for students, emphasizing the need for proactive mental health initiatives in academic environments.

Depression and anxiety in female refugees from East Africa and the Middle East displaced to Germany: cross-sectional results of the female refugee study, taking sociodemographic and migration-related factors into account

At the end of 2022, 108.4 million people around the world were forcibly displaced, the highest number ever recorded. Of these, 50% were women. Despite this situation, little is known about the mental health of female refugees. The first aim of this study was to examine the prevalence of depression and anxiety symptoms among female refugees in Germany. The second aim was to examine which sociodemographic and migration-related variables have an impact on refugees' mental health, and the third aim was to assess the potential predictors of their mental health. A sample of 92 female refugees from East Africa and the Middle East living in Germany were interviewed. Symptoms of depression and anxiety were assessed using the Hopkins Symptom Checklist (HSCL-25). The experience of potentially traumatic events (PTEs) was assessed using the Posttraumatic Diagnostic Scale (PDS) and the Harvard Trauma Questionnaire (HTQ). In our sample of female refugees, 65.2% reported symptoms of depression, and 60.9% reported symptoms of anxiety. Symptoms of depression or anxiety were associated with being from the Middle East, having a higher level of education, and reporting more PTEs. The multiple regression model for anxiety was able to explain 32.4% of the variance in anxiety symptoms. The findings highlight the high burden of mental health problems that female refugees bear. The identified predictors of depressive and anxiety symptoms should sensitize medical and refugee professionals to identify vulnerable individuals and groups, refer them to appropriate psychological treatment, and, where possible, modify the identified predictors.

Cigarette Smoking, Risky Alcohol Consumption, and Marijuana Smoking among University Students in Germany: Identification of Potential Sociodemographic and Study-Related Risk Groups and Predictors of Consumption

(1) Background: Cigarette smoking, risky alcohol consumption, and marijuana smoking are the most common behaviors related to legal and illicit drug use worldwide, including among university students. To plan effective evidence-based programs to prevent the risky consumption of these substances among university students, the present study aimed to identify potential sociodemographic and study-related risk groups and predictors of consumption. (2) Methods: A cross-sectional online health survey with approximately 270 health-related items was conducted among students at the University of Mainz, Germany. Cigarette smoking, risky alcohol consumption (AUDIT-C score: female ≥ 4, male ≥ 5), and marijuana smoking were chosen as dependent variables. Of the 270 health-related items, 56 were chosen as independent variables and collated into five groups (sociodemographic, psychological, study-related psychosocial, general psychosocial and health behavior). The prevalence of cigarette smoking, risky alcohol consumption, and marijuana smoking was assessed using established and validated instruments. Pearson's chi-square test was used to analyze the differences in prevalence between the sociodemographic and study-related groups, and binary logistic regression was used for analyses with stepwise inclusion of the five variable groups. (3) Results: Of the 3991 university students who entered the analyses, 14.9% reported smoking cigarettes, 38.6% reported risky alcohol consumption, and 10.9% reported smoking marijuana. The prevalence of these differed between genders, fields of study, and aspired degree level, among other factors. Binary logistic regression analyses revealed nine significant predictors (p ≤ 0.05) of cigarette smoking (Nagelkerke R2 = 0.314), 18 significant predictors of risky alcohol consumption (Nagelkerke R2 = 0.270), and 16 significant predictors of marijuana smoking (Nagelkerke R2 = 0.239). (4) Conclusions: This study showed cigarette smoking, risky alcohol consumption, and marijuana smoking among university students in Germany to be associated with multiple factors, especially health behaviors. Furthermore, each of the substances was highly associated with each of the two other substances we examined. Other variable groups, such as psychological or psychosocial variables, seemed to play a rather minor role. Therefore, our recommendation for future prevention programs is that substance use among university students should be addressed as a whole, not just in terms of specific substances.

Burnout, self-rated general health and life satisfaction among teachers and other academic occupational groups

Introduction

Teachers work in a job with specific demands that can strain individual coping capabilities and can pose a risk for the development of psychological problems. Prior studies showed that teachers - in comparison with other occupational groups - had high risks of job-related psychological exhaustion. In our study we compared teachers and other occupational groups on burnout, general life satisfaction and self-rated general health. In addition, we analyzed if sociodemographic and job-related factors were relevant predictors of these outcomes.

Methods

We analyzed data from a total of 1,500 subjects arising from the Gutenberg Health Study. Binary logistic regression models and descriptive statistics were calculated to determine potential differences between the occupational group membership and the predictive values of sociodemographic and job-related variables.

Results

The occupational groups did not differ significantly in terms of burnout, self-rated general health and satisfaction with life. Logistic regression models showed which sociodemographic and job-related variables were associated with the outcomes. Female sex, part-time employment as well as work-privacy conflicts showed particular predictive relevance.

Discussion

Job-related interventions for teachers should aim at specific strains, e.g., arising out of work-privacy conflicts where interventions should focus on support of female teachers.

Sociodemographic and work-related differences in teachers' attitude towards and perceived stress from emergency remote teaching during the COVID-19 pandemic

The aim was to investigate the attitude towards and perceived stress from emergency remote teaching (ERT) among teachers during the COVID-19 pandemic. A Germany-wide online survey was conducted among teachers from all school types in March 2021. Data from 31,089 teachers entered analysis. ANOVAs or Welch's t-tests with post-hoc analyses were performed to determine sociodemographic and work-related group differences in teachers' attitude towards and perceived stress from ERT. The mean attitude towards ERT was 3.47 (± .84) out of 5 and the mean perceived stress was 5.03 (± .62) out of 6. Regarding the attitude towards ERT, we revealed significant differences for gender, age groups, number of children, occupational group, school management membership, and employment status (p < .05). Regarding perceived stress, significant differences were obtained for gender, age groups, and employment status (p < .05). A more positive attitude towards ERT seems to be associated with lower stress levels. Being female, a higher age, a higher number of children living in the own household as well as working full-time might hinder an effective implementation of remote teaching in school settings in Germany. Policy-makers and schools should think of strategies to improve the attitude towards and decrease perceived stress from remote teaching. This could include subgroup-specific training on the use of digital media, adapted to the work environment.

Videos using different message strategies to promote the interruption of sedentary behavior in university students during online lectures - A pilot study

Background

Sedentary behavior (SB) is highly prevalent among university students and has increased during COVID-19 pandemic. As SB is associated with negative health outcomes, appropriate prevention measures in the university setting are needed.

Objective

This pilot study aimed at investigating the effects of videos using different message strategies to interrupt SB in the collective of university students during online lectures.

Methods

During online lectures, university students (N = 96) were shown one of three videos on the interruption of SB. The videos differed in their message strategies with regard to evidence type (statistical vs. narrative) and vividness (static vs. animated images). Demographics, health variables (SB intentions, SB attitudes) and selected media reception variables (identification, homophily, counterarguing) were examined as possible influence factors on the interruption of SB evoked by watching the video.

Results

Approximately half of the students interrupted sedentary behavior during watching the videos and students of the older age group (cut-off: median = 22 years) interrupted SB significantly more often (p = 0.046). The interruption of SB was predicted by SB intentions (p < 0.05). Identification with characters significantly predicted the intentions to reduce SB (p < 0.001), with a large effect of the overall regression model (R2corr = 0.47).

Conclusion

Considering the increased digitalization in general and restrictions due to COVID-19 pandemic, videos seem to be a useful tool to interrupt SB among university students during online lectures. Narrative formats could facilitate the intention to reduce SB, which in turn could have a positive impact on the interruption of SB. However, further research on effective communication and message strategies is needed.

Predictors of job satisfaction among teachers in Germany during the SARS-CoV-2 pandemic: cross-sectional results of a nationwide online questionnaire

Introduction

During the SARS-CoV-2 pandemic teaching was changed several times to distance learning. To consider the associated stresses and challenges for teachers a nationwide cross-sectional study was performed in March 2021 in which N = 31,089 teachers from Germany participated.

Methods

A multiple linear regression model with stepwise inclusion of thematically sorted variables (sociodemographic, SARS-CoV-2- and work-related variables) was used to identify relevant predictors of job satisfaction.

Results

The analysis revealed that work-related variables were significant predictors of job satisfaction. In the third regression model, when all variables are included the adjusted R² was 0.364. Overall, the results showed that, e.g., work predictability (b = 0.097), influence at work (b = 0.118), and meaning of work (b = 0.212) increased job satisfaction. In contrast, increased emotional exhaustion (b = -0.016), feelings of unfair treatment (b = -0.048), and work family conflicts (b = -0.154) deteriorated job satisfaction.

Discussion

The results indicate that future research should focus especially the work-related topics in more detail and that job satisfaction is a useful concept for analyzing working conditions from a public health point of view.

Informiert = Geimpft? Das Informationsverhalten und die COVID-19-Impfentscheidung bei Studierenden

Eine zu geringe Impfbereitschaft zählt zu den größten globalen Gesundheitsgefahren und war in der COVID-19-Pandemie auch in Deutschland eine der großen Herausforderungen der öffentlichen Gesundheit. Die Identifikation potenzieller Einflussfaktoren auf das Impfverhalten ist deshalb für eine zielgruppengerechte Gesundheitskommunikation von großer Bedeutung. Studierende sind eine besonders wichtige Zielgruppe der Prävention und Gesundheitsförderung. Der Beitrag geht mit Hilfe einer Online-Befragung der Studierenden einer westdeutschen Universität (n = 1398) im Sommersemester 2021 den Fragen nach, inwieweit sich geimpfte und ungeimpfte Studierende mit hoher bzw. niedrigerer Impfintention hinsichtlich a) ihrer Medien- und Informationsnutzung und b) ihres Vertrauens in Medien und Informationsquellen in der COVID-19-Pandemie unterschieden. Die Ergebnisse zeigen z. T. deutliche Differenzen. Während geimpfte Studierende sich intensiver informierten und hierfür auch stärker auf klassische Medienangebote zurückgriifen, vertrauten insbesondere ungeimpfte Studierende mit niedrigerer Impfintention u. a. mehr auf alternative Nachrichtenseiten und Blogs.

Sedentary time of university students before and during the COVID-19 pandemic: Risk groups and pre-pandemic predictors using cross-sectional and longitudinal data

Background

The present study aimed to (1) assess and compare sedentary time (ST) of university students before and during the COVID-19 pandemic, (2) examine risk groups with regard to ST and the "extent of change" in ST (from before to during the pandemic) in association with sociodemographic (gender, age), study-related (degree aspired to, field of study, semester), and pre-pandemic physical health-related [pre-pandemic physical activity (PA) and ST levels, pre-pandemic BMI class] variables, and (3) investigate whether the change in ST was predicted by these variables.

Methods

Two online surveys were conducted among students at the University of Mainz, Germany-the first in 2019 (before the pandemic) and the second in 2020 (during the pandemic). Participants of both surveys were included in a longitudinal sample. With the longitudinal sample's data, paired t-tests, single factor, and mixed analyses of variances were used to examine group differences in ST and the "extent of change" in ST. A linear regression analysis was computed to investigate the influence of the abovementioned sociodemographic, study-related, and pre-pandemic physical health-related variables on the change in ST.

Results

Of the N = 4,351 (pre-pandemic) and N = 3,066 (in-pandemic) participants of the online surveys, N = 443 entered the longitudinal sample. ST increased by 1.4 h/day to critical levels (≥8 h/day) in all subgroups analyzed-even among students who were highly physically active before the pandemic. Students with a low pre-pandemic ST had the largest increase in ST. Pre-pandemic PA level negatively predicted the change in ST.

Conclusion

Even during a global pandemic lockdown, individuals who were previously more physically active and had less ST showed more health-promoting behavior in terms of ST. Therefore, it can be stated that efforts to promote PA and reduce ST are always valuable. Since ST increased and was worryingly high in all subgroups analyzed, all university students should be targeted by multidimensional approaches to tackle ST and promote their health.

Implementation of occupational safety and health measures at German schools during the SARS-CoV-2 pandemic-cross-sectional results from 31,089 teachers

Background

The SARS-CoV-2 pandemic exacerbated existing health-related challenges in schools and created new ones. Under pandemic conditions, health risks increased, and with them the requirements for occupational safety and health (OSH) measures. The aim of the study was (a) to examine the status quo of OSH measures in German schools, (b) to analyze whether the implementation of OSH measures was associated with preferable outcomes and (c) to identify predictors for the implementation of OSH measures.

Methods

A nationwide cross-sectional online survey was conducted among teachers at all school types in Germany in March 2021. Data on the implementation of OSH measures (risk assessments, infection protection instructions and instructions on occupational safety), associated health-related parameters (e.g., somatic symptoms, PHQ-15) and predictor variables (e.g., gender, age or federal states) were assessed using descriptive statistics, analysis of variance and multiple linear regression analysis.

Results

Less than 10% of surveyed teachers (N = 31,089) reported that their schools met legal requirements for occupational safety and health measures. Beneficial associations became apparent where more measures were implemented, e.g., significantly better somatic and mental health. Predictors for the implementation of OSH measures were found, especially on a systemic level (e.g., federal states schools were located in).

Conclusions

Our study can serve as a basis for future studies. It provides a status quo regarding the implementation of, associations with and predictors for OSH measures in German schools. Our results are best understood as evidence-based arguments to encourage political decision makers to improve the implementation of OSH measures in German schools and thereby foster teachers' health.

Determinants of university students' COVID-19 vaccination intentions and behavior

Vaccination hesitancy has been a major challenge for health authorities and societies during the COVID-19 pandemic. The general determinants of vaccination intentions and behavior include sociodemographic and health-related, psychological, and communication-related factors, with varying relevance for different types of vaccinations, countries, and target groups. The predictors of university students' COVID-19 vaccination behavior have not been sufficiently studied. Using a German university as an example and based on an online survey of 1398 university students, we investigated factors related to (a) the likelihood of vaccination against COVID-19 and (b) vaccination intention among those who had not been vaccinated by summer of 2021. Psychological factors showed high relevance. Field of study, trust in, and use of certain media and information channels were found to be important determinants of students' vaccination decision. Our findings can help better understand university students' vaccination behavior to develop and implement tailored strategies and campaigns.

Predictors of physical activity and smoking among German teachers during the SARS-CoV-2 pandemic

Background

The SARS-CoV-2 pandemic has influenced the social and health-related behavior due to significant changes and constraints in the professional and private life. Especially in the school context, there were considerable changes, which may have promoted positive and negative health behaviors. Therefore, the aim of our study was to identify the predictors of physical activity and smoking of teachers during the SARS-CoV-2 pandemic.

Methods

In March 2021, a nation-wide online survey was conducted among teachers in Germany. A total number of 31,089 participants entered analysis. Data on smoking and physical activity as well as sociodemographic, workplace-related, psychological, SARS-CoV-2-related, and health-related items were collected using established instruments and if necessary self-developed items. Two binary logistic regressions with block wise inclusion of the different variable groups were performed to predict physical activity and smoking.

Results

Among all surveyed teachers, 70.1% did not comply with the WHO recommendation of being physically active for at least 150 minutes per week and 13.9% reported to smoke. The regression analyses revealed significant predictors for physical activity (e.g., time requirement) and smoking (e.g., work schedule).

Conclusions

Recommendations to improve teachers’ health can be derived from the predictors for physical activity and smoking that were identified in our study. Given the alarming result that more than two thirds of the teachers did not comply with the WHO recommendations, a special focus should be placed on improving physical activity, as this is a crucial factor for somatic and mental health.

Key messages

Predictors of job satisfaction among German teachers during the SARS-CoV-2 pandemic

Background

To contribute the containment of the infections during the SARS-COV-2 pandemic, changes in working conditions occurred worldwide. In the school context, teaching was changed several times to distance learning and teachers were forced to work from home. This increasing spatial separation between work and private life increased the potential for conflicts. Based on the theoretical assumption that stressors worsen job satisfaction and resources increase satisfaction, the aim of our study was to identify the predictors of teachers’ job satisfaction during the pandemic. The focus on job satisfaction is interesting because the concept is often related to health-related aspects from a public health perspective.

Methods

A nationwide cross-sectional survey was conducted among German teachers in March 2021. After data cleaning, 31,089 participants were included in the analyses. The survey consisted of established instruments (e.g., COPSOQ) and self-developed items if necessary. A multiple linear regression was performed to predict teachers’ job satisfaction by stepwise inclusion of sociodemographic, work-related and covid-specific variables.

Results

Overall, the regression revealed that especially work-related variables were strong predictors of job satisfaction. The analyses showed that higher levels of meaning of work, autonomy and predictability of work increased job satisfaction. In contrast, increased emotional stress, feelings of unfair treatment, and work-privacy conflicts deteriorated job satisfaction.

Conclusions

The present study identified important predictors of job satisfaction which may be used to derive specific recommendations for improving teachers’ job satisfaction during the SARS-CoV-2 pandemic. The relevance of job satisfaction for the scientific and public discourse becomes apparent because it was closely related to teachers’ somatic and mental health.

Key messages

• Teachers’ job satisfaction during the pandemic can be further improved by making appropriate adjustments, particularly in work-specific requirements.

• Improving job satisfaction significantly contributes to promoting teachers’ health.

Psychological Burdens among Teachers in Germany during the SARS-CoV-2 Pandemic-Subgroup Analysis from a Nationwide Cross-Sectional Online Survey

BACKGROUND

Schools underwent massive changes during the SARS-CoV-2 pandemic worldwide. Besides existing occupational health challenges, teachers had to deal with biological and psychological burdens that had the potential to impact their psychological well-being. The aim of the present study was to (i) assess the current state of psychological burdens in German teachers and (ii) identify highly burdened subgroups to derive and address interventions.

METHODS

A nationwide cross-sectional online survey was conducted among teachers at all school types in Germany in March 2021. Data on psychological strains were assessed using established (e.g., PHQ-4) and new-pandemic-specific-(e.g., COVID-19-associated anxieties) instruments. ANOVAs and Tukey's post hoc tests were used to identify highly burdened subgroups (e.g., gender, age, and number of risk factors for severe courses of COVID-19) of teachers.

RESULTS

Psychological burdens in German teachers (N = 31.089) exceeded the level of the general population, for example, regarding symptoms of depression (PHQ-2, M = 1.93 vs. 1.24) or generalized anxiety (GAD-2, M = 1.72 vs. 1.03). Subgroup analysis revealed that psychological burdens were unevenly distributed among different groups of teachers; for example, younger teachers (18-30 years) showed more depression symptoms compared with their older colleagues (56-67 years) (PHQ-2, M = 2.01 vs. 1.78).

CONCLUSIONS

The online survey was conducted during the "third wave" of SARS-CoV-2 in Germany, which might have influenced risk perception and psychological strains. Future studies at different times, ideally longitudinal monitoring of the mental health of teachers, are recommended. Based on our results, evidence-based subgroup-specific interventions should be implemented to sustain teachers' mental health; for example, younger teachers or teachers with risk factors for a severe course of COVID-19 should receive special attention and support. Teachers from special needs schools whose mental health is, on average, good could also be a starting point for identifying the health promotion structural elements of this school type (e.g., fewer students per teacher). However, beyond the specific pandemic-related psychological burdens, the classic occupational health challenges of physical, biological, and chemical stress and their resulting strains should not be disregarded.

Distinct Patterns of University Students Study Crafting and the Relationships to Exhaustion, Well-Being, and Engagement

Job crafting has been established as a bottom-up work design instrument for promoting health and well-being in the workplace. In recent years, the concepts of job crafting have been applied to the university student context, proving to be positively related to student well-being. Building on person-centered analyses from the employment context, we assessed approach study crafting strategy combinations and the relationships to students’ exhaustion, study engagement, and general well-being. Data from 2,882 German university students were examined, collected online during the summer term in 2020. Using latent profile analysis, we found five distinct crafting groups, which showed discriminate validity with regard to emotional exhaustion, engagement, and well-being. The results underscore the positive role of study crafting for students’ health and well-being. They further indicate a less important role of increasing social resources for emotional exhaustion when combined with a moderate increase in structural resources and a moderate increase in challenging demands. Our findings imply that interventions to promote study crafting should be considered to promote student health and well-being.

Physical Activity and Sedentary Behavior in University Students–The Role of Gender, Age, Field of Study, Targeted Degree, and Study Semester

Background

Physical inactivity and sedentary behavior are modifiable risk factors for an unhealthy lifestyle in university students. The aim of this study was to identify subgroups among German university students with an increased risk for unhealthy behavior. For this purpose, differences in physical activity and sedentary behavior with respect to sociodemographic and study related factors were examined.

Methods

A total of 4,351 students participated in an online survey. The amount of physical activity (metabolic equivalent of task-min/week) and the sitting time (h/day) were assessed using the German short form of the International Physical Activity Questionnaire. Differences in gender and age as well as field of study, targeted degree and study semester were analyzed using a single factorial ANOVA with Tukey correction or a Welch-ANOVA with Games-Howell correction.

Results

For physical activity, significant differences were found for gender (F_{(2, 80.46)} = 17.79, p < 0.001, ηp2 = 0.009), for field of study (F_{(5, 1738.09)} = 7.41, p < 0.001, ηp2 = 0.01), and for study semester (F_{(1, 948.12)} = 5.53, p < 0.05, ηp2 =0.001), but not for age and targeted degree (p > 0.05). For sedentary behavior, significant differences were found for field of study (F_{(5, 3816)} = 5.69, p < 0.001, ηp2 = 0.01) and targeted degree (F_{(3, 3868)} = 3.94, p < 0.01, ηp2 = 0.003), but not for gender, age and study semester (p > 0.05).

Conclusion

Female students, students enrolled in “natural sciences, mathematics and informatics” and first year students appear to have an increased risk of an unhealthy lifestyle. Future research should identify barriers to and incentives of physical activity as well as reasons for high amounts of SB in sub-populations of university students. Suitable prevention and intervention programs are necessary.

The Prevalence of Pharmacological Neuroenhancement Among University Students Before and During the COVID-19-Pandemic: Results of Three Consecutive Cross-Sectional Survey Studies in Germany

Background

According to the literature, the conditions of studying and living as well as the psychological, social and health behavior-related variables, which were strongly related to pharmacological neuroenhancement (PN) before the pandemic, significantly changed during the pandemic. For this reason, it is expected that the prevalence of PN among university students is higher during the pandemic compared to before the pandemic. Therefore, the present study aimed to investigate and compare the prevalence of PN among university students before and during the COVID-19-pandemic.

Methods

Three online surveys assessing the 12-month prevalence of PN were conducted among university students at the University of Mainz, Germany. The first survey took place in summer term 2019 (before the pandemic), the second in summer term 2020 (during the first German lockdown), and the third in summer term 2021 (after the second German lockdown). Pearson's chi-square test was used to test whether the 12-month prevalence of PN differed significantly between the three surveys.

Results

The 12-month prevalence of PN was 10.4% in 2019, 11.3% in 2020, and 8.0% in 2021. Chi-square tests revealed no statistical difference in the prevalence of PN between 2019 and 2020. Overall, the use of PN was lower in 2021 compared to 2019 (p < 0.0001) as well as in comparison to 2020 (p = 0.001). Only the use of cannabis slightly increased from 2019 to 2020 (7.1 vs. 8.3%) and decreased in 2021 (5.4%). At all three time points, cannabis was the most commonly used substance for the purpose of PN. Consequently, the results suggest that the prevalence of PN was highly intertwined with the prevalence of cannabis use for PN.

Discussion

The decrease in the prevalence of PN of around three percentage points in 2021 compared to the previous years was a surprising finding. It may be mainly due to the decrease in the prevalence of cannabis for the purpose of PN. However, the fairly high prevalence of PN of around 8% in 2021 is still an important finding that demonstrates that there is still an urgent need for prevention initiatives among university students to combat the use of PN.

The Gutenberg health study: a five-year prospective analysis of psychosocial working conditions using COPSOQ (Copenhagen psychosocial Questoinnaire) and ERI (effort-reward imbalance)

Background

Psychosocial working conditions were previously analyzed using the first recruitment wave of the Gutenberg Health Study (GHS) cohort (n = 5000). We aimed to confirm the initial analysis using the entire GHS population at baseline (N = 15,010) and at the five-year follow-up. We also aimed to determine the effects of psychosocial working conditions at baseline on self-rated outcomes measured at follow-up.

Methods

At baseline, working GHS participants were assessed with either the Effort-Reward-Imbalance questionnaire (ERI) (n = 4358) or with the Copenhagen Psychosocial Questionnaire (COPSOQ) (n = 4322); participants still working after five years received the same questionnaire again (ERI n = 3142; COPSOQ n = 3091). We analyzed the association between working conditions and the outcomes job satisfaction, general health, burnout, and satisfaction with life at baseline, at follow-up and also prospectively from baseline to follow-up using linear regression models. We examined the outcome variance explained by the models (R²) to estimate the predictive performance of the questionnaires.

Results

The models’ R² was comparable to the original baseline analyses at both t0 and t1 (R² range: ERI 0.10–0.43; COPSOQ 0.10–0.56). However, selected scales of the regression models sometimes changed between assessment times. The prospective analysis showed weaker associations between baseline working conditions and outcomes after five years (R² range: ERI 0.07–0.19; COPSOQ 0.07–0.24). This was particularly true for job satisfaction. After adjusting for the baseline levels of the outcomes, fewer scales still explained some of the variance in the distribution of the outcome variables at follow-up. The models using only data from t₀ or t₁ confirmed the previous baseline analysis. We observed a loss of explained variance in the prospective analysis models. This loss was greatest for job satisfaction, suggesting that this outcome is most influenced by short-term working conditions.

Conclusions

Both the COPSOQ and ERI instruments show good criterion validity and adequately predict contemporaneously measured self-reported measurements of health and (occupational) well-being. However, the COPSOQ provides a more detailed picture of working conditions and might be preferable for improvment strategies in workplaces. Additional prospective research with shorter follow-up times would be beneficial for estimating dose-response relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12240-3.

Comparing SARS-CoV-2 case rates between pupils, teachers and the general population: results from Germany

Given the inconsistent state of research regarding the role of pupils and teachers during the SARS-CoV-2 pandemic in Germany, statewide and nationwide data of infection case rates were analyzed to contribute to the discourse. Infection data from official sources ranging from mid to late 2020 were collected, prepared and analyzed to answer the question if pupils, teachers and general population differed in active case rates or not. The data showed that pupils and teachers case rates didn't exceeded those of the general population. In conclusion, it seems appropriate to appraise school-related measures to mitigate the SARS-CoV-2 pandemic sufficiently. Data-quality is a yet to overcome obstacle to provide good evidence-based recommendations regarding the management around infection cases in schools.

Burdens, resources, health and wellbeing of nurses working in general and specialised palliative care in Germany - results of a nationwide cross-sectional survey study

BACKGROUND

Palliative care in Germany is divided into general (GPC) and specialised palliative care (SPC). Although palliative care will become more important in the care sector in future, there is a large knowledge gab, especially with regard to GPC. The aim of this study was to identify and compare the burdens, resources, health and wellbeing of nurses working in GPC and SPC. Such information will be helpful for developing prevention programs in order to reduce burdens and to strengthen resources of nurses.

METHODS

In 2017, a nationwide cross-sectional survey was conducted. In total, 437 nurses in GPC and 1316 nurses in SPC completed a questionnaire containing parts of standardised instruments, which included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ), the Patient Health Questionnaire (PHQ-2), the Resilience Scale (RS-13) Questionnaire, a single question about back pain from the health survey conducted by the Robert Koch Institute as well as self-developed questions. The differences in the variables between GPC and SPC nurses were compared.

RESULTS

SPC nurses reported higher emotional demands as well as higher burdens due to nursing care and the care of relatives while GPC nurses stated higher quantitative demands, i.e. higher workload. SPC nurses more often reported organisational and social resources that were helpful in dealing with the demands of their work. Regarding health, GPC nurses stated a poorer health status and reported chronic back pain as well as a major depressive disorder more frequently than SPC nurses. Furthermore, GPC nurses reported a higher intention to leave the profession compared to SPC nurses.

CONCLUSIONS

The findings of the present study indicate that SPC could be reviewed as the best practice example for nursing care in Germany. The results may be used for developing target group specific prevention programs for improving health and wellbeing of nurses taking the differences between GPC and SPC into account. Finally, interventional and longitudinal studies should be conducted in future to determine causality in the relationship of burdens, resources, health and wellbeing.

Challenge Accepted! a Critical Reflection on How to Perform a Health Survey Among University Students-An Example of the Healthy Campus Mainz Project

Background: Universities represent an important setting of everyday life for health promotion. The Healthy Campus Mainz project aims to develop an evidence-based and comprehensive student health management program covering physical, mental, and social health promotion. Hence, an initial health survey was performed in order to identify the students' health concerns and resources. Up until now, it remains unclear which topics to choose in a health survey among university students and which strategies can be recommended to receive an acceptable response rate or representative student sample within a university setting. The present paper contributes to the call for the present research topic "Public Health Promotion in University Students" by describing methods for health assessment. Therefore, the current paper aims to give an empirical example on how to perform a health survey among university students, focusing on (1) choosing topics for the survey and (2) methodological considerations of how to reach the target population. Methods: An online questionnaire including around 270 items was developed covering a comprehensive set of health topics. Participants were recruited via the university email. Mixed channels for survey promotion, such as lecture visits and social media, were used, accompanied by different monetary and non-monetary incentives. Descriptive analyses were performed to describe the sample. Results: A total of 5,006 participants (out of 31,213 registered students) viewed the first page of the questionnaire; of whom, 4,714 continued further. After a manual data cleaning according to the predefined criteria, the final sample was 4,351, demonstrating a response rate of 13.9%. Students from different study disciplines participated. However, some study disciplines showed a low participation rate, hence, making the results not free from some bias. Discussion: This survey is exceptional as it integrates a great variety of health aspects. The incentive strategy demonstrated promising results. Future research should try to improve target-group-specific recruitment strategies for the traditionally underrepresented groups, such as males and specific study disciplines. This would not only include advancing marketing strategies, but also refining the incentive strategy.

Antecedents and Moderation Effects of Maladaptive Coping Behaviors Among German University Students

Prolonging working hours and presenteeism have been conceptualized as self-endangering coping behaviors in employees, which are related to health impairment. Drawing upon the self-regulation of behavior model, the goal achievement process, and Warr's vitamin model, we examined the antecedents and moderation effects regarding quantitative demands, autonomy, emotion regulation, and self-motivation competence of university students' self-endangering coping behaviors (showing prolonging working hours and presenteeism). Results from a cross-sectional survey of 3,546 German university students indicate that quantitative demands are positively related and autonomy has a u-shape connection with self-endangering coping. Emotion regulation was shown to be a protective factor for prolonging working hours. Moreover, self-motivation moderated the relationship between quantitative demands and prolonging of working hours, but not in the assumed direction. Self-motivation showed a systematic positive relationship with prolonging of working hours, but no relationship with presenteeism. Autonomy moderated the relationship of quantitative demands with both self-endangering behaviors. We found no moderating effects for emotion regulation of quantitative demands or autonomy and self-endangering behaviors. Besides further practical implications, the results suggest that lecturers should design their courses accordingly with less time pressure and university students should be trained in the use of autonomy.

Work-life conflict and cardiovascular health: 5-year follow-up of the Gutenberg Health Study

INTRODUCTION

Work-life conflicts (WLC) may impact health, but few studies prospectively consider the impact of WLC on objective outcomes such as cardiovascular disease. Using data from the Gutenberg Health Study (GHS), we examined if WLC at baseline was associated with an increased five-year incidence of cardiovascular events (myocardial infarct, stroke, atrial fibrillation, peripheral artery disease, coronary artery disease, chronic heart failure, sudden cardiac death). We also considered if WLC was associated with incident hypertension and arterial stiffness and if the effects of WLC on cardiovascular health differ for men and women.

METHODS

A working subsample of the 15,010 GHS cohort participants completed the Copenhagen Psychosocial Questionnaire, which included five "work-privacy conflict" questions at baseline and at the five-year follow-up. Relative risks for incident hypertension due to increased WLC at baseline (WLC scores exceeding 60 out of 100) were estimated with Poisson regression in the subgroup of participants without hypertension at baseline (n = 2426). Categories of WLC at baseline and follow-up were also used to examine the risk of hypertension due to chronic/recurrent WLC. In this subgroup, we also examined the association between WLC as a continuous score ranging from 0 to 100 with change to arterial stiffness after five years using linear regression. Hazard ratios were estimated for incident cardiovascular events in a larger subsample of participants without prevalent cardiovascular disease at baseline (n = 3698) using Cox regression. We used various multivariable regression models to adjust for sex, age, socioeconomic status, occupational, household, and cardiovascular risk factors.

RESULTS

We found no association between WLC and incident hypertension or increased arterial stiffness. The fully-adjusted relative risk for WLC >60 at baseline and hypertension was 0.93 (95% 0.74-1.17). The risk of hypertension due to chronic/recurrent WLC >60 was increased but not statistically significant (RR = 1.13, 95% CI 0.83-1.54). Overall, hazard ratios for incident cardiovascular events were also not increased. However, stratifying the results by sex resulted in a hazard ratio of 1.47 (95% CI 0.54-3.98) for incident cardiovascular disease among women in the fully adjusted model.

CONCLUSIONS

Although our results were not statistically significant, they indicate that WLC is negatively impacting the cardiovascular health of women. While these results need to be confirmed with additional research and a longer follow-up, interventions to prevent WLC will promote health and could be especially beneficial for women.

Arbeitsbedingungen von Pflegekräften in der allgemeinen Palliativversorgung in Deutschland

Working conditions of nurses in general palliative care in Germany - A cross-sectional survey Abstract. Background: Most terminally ill people are treated within general palliative care including outpatient care, nursing homes and hospitals. In contrast, only a small number is treated within specialised palliative care. Nursing research within the framework of palliative care focuses on the latter.

AIM

To investigate the working conditions of nurses working in general palliative care and to analyse potential differences between nurses in outpatient care, in nursing homes and in hospitals.

METHODS

A cross-sectional survey was conducted among nurses working in outpatient care, in nursing homes and in hospitals. The questionnaire included questions about working conditions, parts of the Copenhagen Psychosocial Questionnaire and self-developed questions. Descriptive and bivariate analyses were conducted.

RESULTS

437 questionnaires entered final analyses (response rate 16.7 %). On average, nurses spend 20 % of their working time with palliative care. Every fourth nurse (n = 104) express the wish for an additional qualification in palliative care. The following demands are reported: confrontation with pain, death and dying, as well as care of relatives. 59 % (n = 249) of the nurses evaluate the quality of palliative care as good / very good.

CONCLUSIONS

Nurses are faced with demands, which so far had only been a subject of discussion within the framework of the specialised palliative care. Further steps for action, in particular the additional qualification in palliative care for nurses, should be discussed.

Health Information Seeking Among University Students Before and During the Corona Crisis-Findings From Germany

Health information-seeking behavior is the process of gathering information about health and disease and can be influential for health-related perception and behavior. University students are an important target group for prevention and health promotion and largely belong to an age group that is considered to play a leading role in propagating the SARS-CoV-2 epidemic in Germany. The paper deals with students' health information-seeking behavior before and during the corona crisis, aiming to give insights into its determinants and implications. Using the example of a large German comprehensive university and based on two cross-sectional surveys in the summer of 2019 (n = 4,351) and 2020 (n = 3,066), we investigate which information channels students use for health information, how information seeking changes during the course of the pandemic, and to what extent information seeking is associated with risk perception and risk behavior. For a subsample of participants that participated in both surveys (n = 443), we also trace developments at the individual level through a longitudinal analysis. The results show that students' health information seeking takes place primarily online and changed markedly during the corona crisis. The comparatively high relevance of sources that are largely based on unchecked user-generated content raises the concern whether students' health information-seeking behavior guarantees the necessary quality and reliability of health information. Significant correlations between the intensity of corona-related information seeking, risk perception, and actual risk behavior were found.

The relationship between workload and burnout among nurses: The buffering role of personal, social and organisational resources

Workload in the nursing profession is high, which is associated with poor health. Thus, it is important to get a proper understanding of the working situation and to analyse factors which might be able to mitigate the negative effects of such a high workload. In Germany, many people with serious or life-threatening illnesses are treated in non-specialized palliative care settings such as nursing homes, hospitals and outpatient care. The purpose of the present study was to investigate the buffering role of resources on the relationship between workload and burnout among nurses. A nationwide cross-sectional survey was applied. The questionnaire included parts of the Copenhagen Psychosocial Questionnaire (COPSOQ) (scale 'quantitative demands' measuring workload, scale 'burnout', various scales to resources), the resilience questionnaire RS-13 and single self-developed questions. Bivariate and moderator analyses were performed. Palliative care aspects, such as the 'extent of palliative care', were incorporated to the analyses as covariates. 497 nurses participated. Nurses who reported 'workplace commitment', a 'good working team' and 'recognition from supervisor' conveyed a weaker association between 'quantitative demands' and 'burnout' than those who did not. On average, nurses spend 20% of their working time with palliative care. Spending more time than this was associated with 'burnout'. The results of our study imply a buffering role of different resources on burnout. Additionally, the study reveals that the 'extent of palliative care' may have an impact on nurse burnout, and should be considered in future studies.

Self-reported cardiovascular health of teachers: results from the 5-year follow-up of the Gutenberg Health Study cohort

Objectives

Following an exploratory approach, we examined cardiovascular disease risk factors at baseline and the 5-year incidence proportion of self-reported doctor-diagnosed cardiovascular diseases (CVD) in teachers and other occupational groups of the Gutenberg Health Study.

Methods

Study participants lived in the region of Mainz, Germany. Data from 6510 working participants without prevalent CVD at baseline (2007–2012) were analyzed. Participants were teachers (n = 215), other professionals from the health, social or educational (HSE) fields (n = 1061) or worked outside the HSE fields (n = 5234). For occupational comparisons, we estimated prevalence ratios (PR) for each CVD risk factor at baseline with robust Poisson regression analyses. We calculated crude CVD incidence rates based on the observed 5-year CVD cumulative incidence at follow-up and estimated age-weighted incidence proportions. All analyses were stratified by sex.

Results

Male non-HSE workers showed a higher prevalence of smoking and physical inactivity than male teachers (PR 2.26; 95%-CI: 1.06–4.82/PR 1.89; 95%-CI: 1.24–2.87). In contrast, non-HSE workers and other HSE professionals were less likely to have reported an unhealthy alcohol intake than teachers. Differences were attenuated after SES-adjustment. We did not detect occupational group-specific differences in CVD incidence. However, there were only two cases of CVD among the teachers.

Conclusion

Particularly male teachers showed a healthier lifestyle regarding physical inactivity and smoking. Nevertheless, occupational-medical care practitioners and researchers need to be aware of the relatively heightened prevalence of unhealthy alcohol intake in female and male teachers, and in absolute terms, the high hypertension prevalence in male teachers.

Basal cell carcinoma risk and solar UV exposure in occupationally relevant anatomic sites: do histological subtype, tumor localization and Fitzpatrick phototype play a role? A population-based case-control study

Background

A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates.

Objectives

To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure.

Methods

Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age², sex, phototype and non-occupational UV exposure were calculated.

Results

Participants with high versus no (OR 2.08; 95% CI 1.24–3.50; p = 0.006) or versus moderate (OR 2.05; 95% CI 1.15–3.65; p = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses.

Conclusion

The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype.

Health and intention to leave the profession of nursing - which individual, social and organisational resources buffer the impact of quantitative demands? A cross-sectional study

Background

The aim of this study was to analyse the buffering effect of individual, social and organisational resources on health and intention to leave the profession in the context of burden due to quantitative job demands.

Methods

In 2017, a cross-sectional survey was carried out anonymously among nurses in palliative care in Germany. One thousand three hundred sixteen nurses responded to the questionnaire (response rate 38.7%), which contained, amongst others, questions from the German version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Moderator analyses were conducted to investigate the buffering effect of different resources on health (‘self-rated health’ and ‘burnout’) and ‘intention to leave’ in the context of quantitative demands.

Results

‘Self-rated health’ was significantly buffered by the resources ‘recognition through salary’ (p = 0.001) and ‘good working team’ (p = 0.004). Additionally, buffering effects of the resources ‘workplace commitment’ and ‘good working team’ on ‘burnout’ (p = 0.001 and p = 0.006, respectively) as well as of the resources ‘degree of freedom’, ‘meeting relatives after death of patients’, ‘recognition from supervisor’ and ‘possibilities for development’ on ‘intention to leave’ (p = 0.014, p = 0.012, p = 0.007 and p = 0.036, respectively) were observed.

Conclusions

The results of our study can be used to develop and implement job (re) design interventions with the goal of reducing the risk of burnout and enhancing job satisfaction among nurses in palliative care. This includes for example adequate payment, communication training and team activities or team events to strengthen the team as well as the implementation of some rituals (such as meeting relatives after the death of patients). As our study was exploratory, the results should be confirmed in further studies.

Cardiovascular health outcomes of mobbing at work: results of the population-based, five-year follow-up of the Gutenberg health study

Background

The aim of this study was to determine if there is an increased risk of incident cardiovascular disease (CVD) resulting from workplace mobbing measured with two mobbing instruments in the Gutenberg Health Study.

Methods

In this prospective study, we examined working persons younger than 65 years for the presence of mobbing at baseline and at a 5-year follow-up using a single-item and a 5-item instrument. We used multivariate models to investigate the association between mobbing and incident CVD, hypertension, and change in arterial stiffness and further stratified the models by sex.

Results

After adjustment for confounders, mobbed workers appeared to have a higher risk of incident CVD than those not mobbed (single-item HR = 1.28, 95% CI 0.73–2.24; 5-item HR = 1.57, 95% CI 0.96–2.54). With the 5-item instrument, men who reported mobbing had a higher risk of incident CVD (HR = 1.77, 95% CI 1.01–3.09), while no association was observed for women (HR = 1.05, 95% CI 0.38–2.91). There was no difference in risks between men and women with the single-item instrument. No association between mobbing and incident hypertension and arterial stiffness was seen.

Conclusions

Our results show an indication of an increased risk of incident CVD for those mobbed at baseline when using the whole study population. Differences in risks between men and women when using the five-item instrument may be due to the instrument itself. Still, it is essential to detect or prevent workplace mobbing, and if present, to apply an intervention to halt it in order to minimize its adverse effects on CVD.

A Systematic Umbrella Review on the Epidemiology of Modifiable Health Influencing Factors and on Health Promoting Interventions Among University Students

Background: Universities represent an important setting for health promotion. The unique collective of university students is of particular relevance since they are the leaders, decision-makers, and parents of tomorrow. In this context, modifiable health influencing factors as well as interventions to prevent these, play a crucial role. Therefore, the present umbrella review aims to (i) provide an overview of review articles addressing epidemiological issues (prevalence and determinants) of modifiable health influencing factors in university students and (ii) to provide an overview of review articles addressing the evidence of interventions to promote/enhance modifiable health influencing factors in university students.

Methods: A systematic literature search was performed in the databases PubMed, Cochrane Reviews Library und Web of Science according to the PRISMA guidelines. Only systematic reviews and meta-analyses were included. The AMSTAR-2-Tool was used for the quality assessment.

Result: The initial search resulted in 10,726 records of which 81 fulfilled the inclusion criteria, with a further distinction in articles with an epidemiological focus (n = 39) and in articles with interventional approaches (n = 42). Topics of the different review articles ranged from physical activity over mental health, substance use, sleep, diet and nutrition, and media consumption. Many review articles had a specific focus on medical and nursing students and originated from the U.S.A., U.K., or China.

Discussion: This umbrella review provides an overview of review articles on the epidemiology of modifiable health influencing factors and on the evidence of interventions targeting these factors among university students. Thereby, experts as well as stakeholders in the field could gain insights into crucial target points for health promotion. It identifies research gaps in terms of study region and groups of students.

Belastungen und Ressourcen von Pflegekräften der spezialisierten Palliativversorgung - Eine explorative Querschnittstudie

Zusammenfassung. Hintergrund: In Deutschland gibt es keine Studie, die Belastungen und Ressourcen von Pflegekräften der spezialisierten Palliativversorgung vergleichend erhebt. Ziel: Ziel waren die Erhebung und der Vergleich von Belastungen und Ressourcen von Pflegekräften in Palliativstationen, Hospizen und der spezialisierten ambulanten Palliativversorgung (SAPV). Methode: Pflegekräfte aus den genannten Settings in Rheinland-Pfalz, wurden 2015 mittels eines selbst entwickelten Fragebogens zu Belastungen und Ressourcen befragt. Es wurden Kontingenz- und Gruppenanalysen sowie Regressionen durchgeführt. Ergebnisse: 149 Pflegekräfte (Rücklauf 34,5 %) nahmen an der Befragung teil. Pflegekräfte auf Palliativstationen gaben in allen Belastungsbereichen höhere Werte an als Pflegekräfte in Hospizen und der SAPV. Pflegekräfte in Palliativstationen und Hospizen nannten emotionale Belastungen als stärksten belastenden Faktor, Pflegekräfte der SAPV patientenbezogene Belastungen. Es wurde ein Zusammenhang zwischen dem Belastungserleben und einer Zusatzqualifikation in Palliative Care festgestellt (adjustierte Odds Ratio (aOR) für Belastung durch organisatorische Rahmenbedingungen: 2,56, KI: 1,06 – 6,19; aOR für Belastung durch Betreuung von Angehörigen: 2,99, KI: 1,06 – 8,46). Bei den Ressourcen Familie, Gruppensupervision und Zusatzqualifikation unterschieden sich die Settings. Schlussfolgerungen: Die Studie gibt einen Einblick in das Belastungserleben und mögliche Ressourcen von Pflegekräften in Palliativstationen, Hospizen und der SAPV in Rheinland-Pfalz. Künftige Präventionsmaßnahmen sollten auf die jeweiligen Settings zugeschnitten sein.

Urinary excretion of heptanones, heptanoles and 2,5-heptanedione after controlled acute exposure of volunteers to n-heptane

A lack of well-established parameters and assessment values currently impairs biomonitoring of n-heptane exposure. Using controlled inhalation experiments, we collected information on urinary n-heptane metabolite concentrations and the time course of metabolite excretion. Relationships between external and internal exposure were analysed to investigate the suitability of selected metabolites to reflect n-heptane uptake. Twenty healthy, non-smoking males (aged 19-38 years, median 25.5) were exposed for 3 h to 167, 333 and 500 ppm n-heptane, each. Spot urine samples of the volunteers, collected before exposure and during the following 24 h, were analysed for heptane-2-one, 3-one, 4-one, 2,5-dione, 1-ol, 2-ol, 3-ol, and 4-ol using headspace solid phase dynamic extraction gas chromatography/mass spectrometry (HS-SPDE-GC/MS). Starting from median pre-exposure concentrations between <0.5 (3-one) and 82.9 μg/L (4-one), exposure increased the concentrations for all parameters except for 4-one. Median post-exposure concentrations ranged up to 840.4 μg/L (2-ol) and decreased with half-lifes <3 h after exposure. Non-parametric correlation analyses (n = 47, p < 0.05) revealed weak to moderate associations of volume related metabolite excretion with external exposure for 2-one, 3-one and 2,5-dione (R = 0.332-0.753). Heptanol excretion was moderately associated with exposure (R ≥ 0.509) only after creatinine adjustment. Lacking association with external exposure impedes the use of 4-one as heptane biomarker, whereas 2-ol and 3-ol turned out to be sensitive indicators of exposure if creatinine correction is applied. By providing fundamental data on a panel of eight potential heptane metabolites, our study can help to promote biological monitoring of n-heptane exposure.

An acute exposure to ozone impairs human olfactory functioning

INTRODUCTION

Ozone is a ubiquitous and irritant gas. We questioned whether an acute exposure to 0.2 ppm ozone impaired olfactory functioning.

METHODS

Healthy, normosmic subjects were exposed according to a parallel group design either to 0.2 ppm ozone (n = 15) or to sham (n = 13) in an exposure chamber for two hours. Possible irritating effects were assessed by questionnaire (range 0-5). The detection threshold of n-butanol was measured with the Sniffin' Sticks test before and after exposure. Olfactory thresholds were logarithmized and a two-way analysis of variance (ANOVA) with repeated measurements was carried out to test the effects of exposure (ozone vs. sham) and time (before vs. after exposure). Additionally, nasal secretions were taken at a preliminary examination and after exposure to determine interleukins 1ß and 8.

RESULTS

No irritating effects to the upper airways were observed. In the ozone group, the median score for cough increased from 0 to 2 at the end of exposure (sham group 0 and 0, respectively, p < 0.001). The ANOVA showed a main effect for ozone exposure (F (1, 26) = 27.6, p = 0.0002), indicating higher olfactory thresholds in the ozone group. Concentrations of interleukins in nasal secretions did not increase following ozone exposure.

CONCLUSIONS

This study shows a clear impairment of olfactory functioning following an acute exposure to 0.2 ppm ozone.

Belastungsfaktoren von Pflegekräften in der spezialisierten Palliativversorgung – Ergebnisse einer qualitativen Studie

Hintergrund Für Deutschland liegen keine Studien und kein Erhebungsinstrument vor, welches die Belastungen von Pflegekräften in der spezialisierten Palliativversorgung auf Palliativstationen, Hospizen und der spezialisierten ambulanten Palliativversorgung (SAPV) vergleichend erhebt. Ziel der vorliegenden Arbeit war es, die gemeinsamen Belastungen dieser Pflegekräfte zu explorieren.

Methode Es wurden 10 Interviews mit Fachleuten unterschiedlicher Disziplinen in der Palliativversorgung durchgeführt und mittels qualitativer Inhaltsanalyse ausgewertet.

Ergebnisse Es wurden Belastungen, die aufgrund einer mangelhaften flächendeckenden Versorgung der SAPV in Rheinland-Pfalz entstehen, und Belastungen, die aus der Betreuung von Angehörigen sowie dem Zeitaufwand zum Informationsaustausch mit anderen (Fach-)Kräften hervorgehen, berichtet. Zudem wurden physische Belastungen genannt.

Schlussfolgerungen Durch die Interviews konnten Belastungen aufgedeckt werden, die in bisherigen Studien nicht bzw. nicht in ausreichendem Maße untersucht wurden. Neben psychischen sollten zukünftig physische Belastungen erhoben werden.

Who is the gate keeper for treatment in a fertility clinic in Germany? -baseline results of a prospective cohort study (PinK study)

BACKGROUND

It is estimated that 5-15% of all couples in industrialised nations are infertile. A perceived unfulfilled desire for a child or self-identification as infertile can lead to psychological strain and social isolation. About 53.000 women underwent assisted reproduction treatments in Germany in 2014. Little is known about the first medical consultation and patient needs prior to the first visit in a fertility clinic in Germany. The baseline survey of the prospective cohort study on couples undergoing fertility treatment in Germany (PinK Study) provides first results on this topic for Germany.

METHODS

The baseline survey was conducted between 2012 and 2013. Self-administered questionnaires were handed out to patients of six fertility clinics at the beginning of treatment by clinic staff. At a participation rate of 31.0%, we were able to analyse data on 323 women and 242 men.

RESULTS

92.6% of the women had their initial medical consultation on their unfulfilled desire for a child with a gynaecologist. After the urologist (44.2%), the general practitioner (12.0%) was the second most approached initial contact person for men. 36.4% of all men had no medical consultation on the unfulfilled desire for a child before visiting a fertility clinic. 46.9% of the respondents expressed the wish that the conversation about infertility should be initiated by a physician. Prior to their first visit to a fertility clinic, 11.2% of the men and 24.8% of the women were informed by a physician that infertility treatment can cause emotional strain.

CONCLUSION

While almost all women consult a gynaecologist prior to the first visit in a fertility centre, one out of three men do not consult any physician at that stage. For the remaining group of men, urologists and general practitioners are the most important contact persons. Gender-specific health care needs are evident. In order to close the health care gap for men in Germany, more opportunities for discreet access to consultation should be offered. Due to its low threshold and family-oriented approach, general practice could make an important contribution to this effect.