Ill health and early retirement among school principals in Bavaria.

OBJECTIVES: School principals play an important role in maintaining the performance and health of teachers but often feel over-burdened themselves and suffer illnesses, which not only impairs their health-promoting function but also leads to limitations in their fitness for the occupation. The aim of our study was, therefore, using objective parameters and larger numbers of cases, to obtain a differentiated insight into the morbidity and the health-related early retirement of school principals. METHODS: In a prospective total assessment (the whole of Bavaria, a state in southern Germany) in the period from 1997 to 1999 all medical examinations of school principals performed to decide the question of early retirement were evaluated. The analysis included, e.g., socio-demographic/occupational factors, diagnoses, assessment of performance and rehabilitation. The data were sampled in a standardised, anonymous questionnaire, which provided the database. Evaluation was carried out by means of descriptive statistics. RESULTS: The median age of the 408 school principals included in the evaluation (heads and vice-heads, 30% of whom were women) was 58 years (minimum 41 years, maximum 64 years). The most frequent workplaces were primary schools (63%). A total of 84% (n=342) of the headmasters was assessed to be unfit for work. The main reasons for early retirement were psychiatric/psychosomatic disorders (F-ICD 10) which made up 45% of the cases. The relative frequency was higher in women than in men. Depressive disorders and exhaustion syndromes (burnout) dominated among the psychiatric diagnoses (proportion 57%). The most frequent somatic illnesses were cardiovascular diseases (I-ICD10) in 19% of cases, then muscular/skeletal diseases (M-ICD10) in 10% and malignant tumours (C-ICD 10) in 9% of cases. Cardiovascular diseases, in particular arterial hypertension and ischaemic heart disease, were found in headmasters significantly more frequently than in teachers without a headship function (P

["They'll never come back...""--Expectations and reality of occupational reintegration of teachers unfit for service]. / "They'll never come back ..." -- Anspruch und Wirklichkeit der beruflichen Reintegration dienstunfähiger Lehrkräfte.

AIM OF THE STUDY: The reactivation of teachers with experience of both life and the profession who have become unfit for work is regarded by politicians not only as a suitable measure against the imminent lack of teaching staff, but also as a promising strategy for reducing the cost of health care. The aim of our study was to gather new evidence- based information on the occupational reintegration of teachers who took early retirement and to investigate to what extent official medical reactivation examinations are an effective instrument of tertiary prevention. DATABASE AND METHODS: In a prospective total assessment (the entire state of Bavaria) over the period of 1997 - 1999 all official medical examinations in the public health centres (Gesundheitsamter und Medizinische Untersuchungsstellen der Bezirksregierungen) were evaluated with regard to the reactivation of teachers unfit for work. The analysis included e. g. socio-demographic/occupational factors, the morbidity spectrum, rehabilitation and the assessment of performance. The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics. RESULTS: Of the 1465 teachers studied, 64 % (n = 939) were women and 36 % (n = 526) were men. The median age was 53 years (range: 31 - 63 years), and the proportion of over 60-year-olds was 5.5 %. 22 % of those who took early retirement were recognised as being severely disabled. In 77 % of cases, examination of unfitness for work was carried out at the order of the authorities. 57 % (n = 835) of the teachers had taken part in at least one medical rehabilitation measure, 13 % (n = 190) in at least one occupational rehabilitation measure. Within the morbidity spectrum, psychic and psychosomatic illnesses (F-ICD10) took first place with a share of 59 % the prevalence in female teachers of such illnesses was significantly higher than that in male teachers (p < 0.05). Among the psychiatric diagnoses, depressive illnesses dominated (share: 35 %). The most frequent somatic diseases were muscular/skeletal disorders (M-ICD10) in 12 % of cases, then cardiovascular disorders (I-ICD10) in 7 % and malignant tumours (C-ICD 10) in 5 % of cases. In 33 % of cases multi-morbidity was found. 93 % (n = 1,360) of the teachers investigated in follow-up examinations were again classified as unfit for work. In only 7 % (n = 105) reactivation was recommended by the physician; the lowest reactivation quotas were found among teachers with psychic illnesses and grammar school teachers. In who teachers that returned to work, compared to those still unfit for work, a lower age and lower prevalence of severe disability, multi-morbidity and psychic disturbances were objectified. CONCLUSIONS: Teachers who take early retirement return to the profession only in exceptional cases. The time and expense needed for reactivation examinations should be critically compared with the benefits. The same applies to the quality of the results of intervention and rehabilitation measures for restoring psychological and physical health. In this context problem-oriented disability management appears superfluous.

[School principals--too ill for healthy schools?]. / Führungskräfte im Schuldienst--zu krank für gesunde Schulen?

AIM OF THE STUDY: School principals on the one hand play an important role in maintaining the performance and health of teachers, but on the other hand often feel over-burdened themselves and suffer from illnesses which not only impair their health-promoting function, but also lead to limitations in their fitness for the occupation. The aim of our study was therefore, using objective parameters and larger numbers of cases, to obtain a differentiated insight into the type and extent of morbidity spectrum and the health-related early retirement of school principals. METHODS: In a prospective total assessment (the whole of Bavaria in the period 1997-1999), all the reports about the premature unfitness for work of school directors were evaluated. The analysis included for example socio-demographic/occupational factors, diagnoses, assessment of performance and rehabilitation. The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics. RESULTS: The median age of the 408 school principals included in the evaluation (heads and vice-heads, 30% of whom were women) was 58 (min: 41 years old, max: 64 years old). The most frequent workplaces were primary schools (38%) and secondary schools (25%). 84% (n=342) of the headmasters were assessed to be unfit for work. The main reasons for early retirement were psychic/psychosomatic illnesses (F-ICD 10) which made up 45% of the cases. The relative frequency was higher in women than in men. Depressive disorders and exhaustion syndromes (burnout) dominated among the psychiatric diagnoses (proportion: 57%). The most frequent somatic diseases were cardio-vascular diseases (I-ICD10) in 19% of cases, then muscular/skeletal diseases (M-ICD10) in 10% and malignant tumours (C-ICD 10) in 9% of cases. Cardio-vascular diseases, in particular arterial hypertonia and ischaemic heart disease, were, in addition, found in headmasters significantly more frequently than in teachers without a leadership function (p < or = 0.05). 63% (n=257) of the school principals had participated in at least one medical rehabilitation measure before the proceedings for determining unfitness for work were instigated. The performance of 66% (n=226) of those judged unfit for work was assessed to be so severely impaired that no other employment could be expected of them. CONCLUSIONS: The morbidity spectrum of school principals prematurely unfit for work is characterised by stress-associated illnesses. The health disorders objectified are of considerable relevance for public health. Specific measures of prevention and intervention must, therefore, also include this occupational group. Activity should not be limited to the prevention of behavioural problems, but should also take into account important aspects for preventing adverse circumstances arising at the school workplace.

[Evaluation of the premature unfitness for work among civil servants career--groups and morbidity]. / Evaluation der Dienstunfähigkeit bei Beamtinnen und Beamten--Laufbahn und Morbidität.

Out of the data obtained in a prospective study over 11,528 assessments concerning premature unfitness for work among civil servant over a period of four years the collective groups of those assessed unfit for work (n = 6,861, 2,723 women i. e. 39.7 % and 4,128 men i. e. 60.2 %) were included in this study. The median age was 54 years (women 52, men 55), 4,112 were teachers, in the administration 1,644, in the technical service 386 and in activities with special request (e. g. fire-brigade or law execution service) 483. Career groups: official-legal groups of careers in lower service categories were 266, in medium categories about 29, in elevated service 2,766 and higher service 2,146 woman officials and male officials. In all fields of activity and groups of careers psychic disorders (ICD 10: F) had a prevalence between 30.8 % in lower service and 48.0 % in the elevated service as "Premature Retirement Suffering No. 1". Women in all fields of activity were clearly more frequently concerned than men (differences from 3.1 per cent points to 18.1 per cent points middle service or technical service, p < 0.01). Second place was taken by muscular/skeletal diseases (ICD 10 group M) in 17.4 % of cases (n = 1,630), and third place by cardiovascular diseases (ICD 10 group I) in 10.4 % of cases (n = 972). The altogether lower prevalence of musculoskeletale illnesses (ICD 10: I) showed a dependency on the activity request and was highest in the technical services and in lower service categories. The median of entrance into premature unfitness for health reasons was between 15 and 9 years earlier than the age limit by law and presented itself differently in the groups of careers. Although this analysis only shows the prevalence of illnesses causal for premature retirement and not the health situation of all civil servants, it can give however pointers to emphasis for a necessary prevention.

[Illness related early pensioning of high school teachers]. / Zur Problematik krankheitsbedingter Frühpensionierungen von Gymnasiallehrkräften.

The problem of premature unfitness for work of (grammar school) teachers is of great social and social-medical interest. The possible causes and suitable measures of intervention remain a subject of controversy. The aim of this study was, on the basis of a random sample of a large number of cases, to gain a differentiated overview of the extent and type of early retirement due to illness of grammar school teachers, in order to be able to develop evidence-based strategies for prevention and intervention. In a prospective evaluation, all the assessments of illness-related unfitness for work drawn up for civil servants and teachers between 1.1.1996 and 31.12.1999 in Bavaria were first of all systematically evaluated. In addition, from the total collective a subgroup was formed of grammar school teachers and this was analysed separately. The answers given in a standardized, anonymous questionnaire provided the database. The evaluation included e.g. socio-demographic and occupational factors, the morbidity spectrum, medical judgement, medical rehabilitation and evaluation of performance. The medical diagnoses of the main and accompanying illnesses were classified according to ICD 10 in organ-related groups. Evaluation was carried out by means of descriptive statistics. Of the 655 grammar school teachers assessed, 65% (n = 429) were men, 35% (n = 226) women. The median age for male teachers was 58 years old (range: 30-64 years old), for female teachers 55 years old (range: 32-63 years old). Previous conflicts at the school workplace were reported in 12% of the cases. Among the main medical diagnoses, psychic/psychosomatic complaints (41%) predominated over muscular/skeletal illnesses (14%) and cardio-vascular diseases (12%). 80% of those examined were judged unfit for work. 56% of the grammar school teachers had participated in at least one medical rehabilitation measure before the proceedings for determining unfitness for work were instigated. Psychic and psychosomatic illnesses took first place among the decisive complaints leading to early retirement, and made up 45% of these. Further differentiation revealed the predominance of depressive illnesses and exhaustion (burnout). The main somatic complaints were far less common: muscular/skeletal illnesses (13%), cardio-vascular diseases (12%) and malignant growths (8%). The performance of 70% of the grammar school teachers judged unfit for work was regarded as so severely reduced that even activity outside of the teaching profession was no longer feasible. In this first representative evaluation of illness-related early retirement in grammar school teachers, the high prevalence and great social-medical importance of psychic and psychosomatic illnesses is noteworthy. In Bavaria, almost every second grammar school teacher therefore becomes unfit for work as a result of such complaints long before they reach the normal retiring age. From a social-medical and occupational-medical point of view, there is urgent need for further research into potential illness-inducing occupational and non-occupational stress factors and the development and implementation of effective and efficient strategies for prevention and intervention.

[Illness-related premature unfitness for work among civil servants in Bavaria - an evaluation in the social medical field]. / Krankheitsbedingte vorzeitige Dienstunfähigkeit von Beamtinnen und Beamten im Freistaat Bayern - eine sozialmedizinische Evaluation.

In a prospective study, over a period of four years 11,528 anonymous questionnaires concerning premature unfitness for work among civil servants were evaluated. The questionnaire was devised by the investigators. The main items of interest were: age, sex, career and occupation, main diagnosis and accompanying symptoms, duration of illness, rehabilitation measures, and working capacity including medical assessment of unfitness for work. Included in this study were 9,348 investigations (excluded were reactivations); 40.9 % were from women and 58.9 % from men. The median age was 54 years (women 52, men 55). The range of illnesses among all those investigated included a large number of psychological disorders (43.3 %, n = 4,052) (diagnosis group F of ICD-10). Second place was taken by muscular/skeletal diseases (ICD-10 group M) in 17.4 % of cases (n = 1,630), and third place by cardiovascular diseases (ICD-10 group I) in 10.4 % of cases (n = 972). The median duration of the main disease was 24 months. Classified as no longer fit for work were n = 7,033 persons, corresponding to 75.2 % of those investigated. Among those unfit for work, psychological disorders were the reason in 46.2 % of cases (men 42.6 %, women 53.4 %). In this first prospective study of illness-related premature unfitness for work in civil servants, psychological and psychosomatic illnesses were found to be the 'number one' illness among persons taking early retirement. The median age at which these persons became unfit for work was 52 in women and 55 in men. In view of the high prevalence of psychological disorders, and the increasing tendency towards early retirement and the considerable jump forward in the age this happens compared to in previous studies with small collectives, a preventive strategy must be developed which takes into account the evidence gained in social-medical and occupational-medical practice.

External quality assurance program for biological monitoring in occupational and environmental medicine.

Biological monitoring of chemical exposure in the workplace and in the environment has become increasingly important in assessing health risk. The analysis must be carried out under a quality assurance scheme to guarantee that the results obtained in biological monitoring are comparable with the threshold limit values and results from other laboratories. Since 1982, the German Society for Occupational and Environmental Medicine has offered 28 intercomparison programs. These programs cover 96 analytes in urine, blood, and plasma for 47 substances and cover most parameters that are relevant in occupational and environmental medicine. The data obtained in these programs provide a good overview of the current quality of the determination of analytes that are assessed in occupational and environmental toxicological laboratories. For the analyses of inorganic substances in blood and urine, the tolerable variation ranges from 7.5% to 43.5%. For organic substances in urine, the tolerable variation ranges from 12% to 48%. For organic substances in urine, the tolerable variation ranges from 12% to 48%. The highest variations (36% to 60%) were found for the analysis of organochlorine compounds in plasma. The tolerable variations for determining solvents in blood by head space gas chromatography range from 26% to 57%. The overall average success rates for the participants of the external quality programs range from 65% to 75%.

[The medical dissertation. An assessment from the viewpoint of successful and unsuccessful candidates]. / Die medizinische Dissertation. Eine Bestandsaufnahme aus der Sicht erfolgreicher und gescheiterter Promovenden.

BACKGROUND: The actual value of medical dissertations is under current discussion. Studies concerning medical dissertation focused on successful candidates only. Therefore, data about physicians without "MD" are still lacking. PERSONS AND METHODS: We therefore performed a representative study of both, physicians with and without the "Dr. med." degree. Using an anonymous questionnaire we asked for reasons to perform a doctoral thesis. RESULTS: A total of 321 questionnaires could be evaluated (successful candidates n = 181; unsuccessful candidates n = 140). Nearly 96% have attempted to perform a medical dissertation at the beginning of their studies. Only 4% never had this intention. However, 67% answered that writing a medical dissertation has no relevance in clinical practice. For 80% of the successful physicians, it was the first attempted dissertation, they judged the supervision as very good or good. Physicians who did not write a medical dissertation stated that deficits in planning and supervising were the main reason for prematurely breaking off. 90% of the successful dissertationists thought that it had been personally meaningful and recommended the procedure to younger physicians. However, two-thirds of the practicing physicians without "MD" still intend to write a thesis. CONCLUSION: We conclude that the medical dissertation is highly rated in terms of personal and scientific value and should therefore remain a part of medical studies and science.

[Medical habilitation. Accepted academic qualifications or outdated formalism?]. / Die medizinische Habilitation. Akzeptierter Qualifikationsnachweis oder unzeitgemässer Formalismus?

BACKGROUND: With the changes in the structure of education and society, in recent years also the medical habilitation (German postdoctoral lecturing qualification) has been called into question as an academic qualification. With this in mind, the aim of our study was to discover the current opinion of those who had successfully completed a habilitation on the prerequisites for a habilitation, the habilitation procedure and the status of a habilitation, and to document potential wishes for reform. COLLECTIVE AND METHODS: The target group of our survey were the 616 persons (female: 77, male 539) who successfully completed their habilitation in 1997 at one of the 36 German medical faculties. The database was formed by an anonymous questionnaire (23 items), which included questions on sociodemographic factors and occupational history (general part), and subjective opinions (specific part). Recruitment of the participants in the survey and passing on of the questionnaire were carried out by the office of the medical dean of the various universities, as the names of those who had completed a habilitation were not available to the investigators for reasons of protecting the individual's rights and identity. Evaluation of the returned questionnaires was carried out using descriptive statistics. Subgroups were formed according to sex, age and subject groups. RESULTS: The questionnaire was answered in a useable form by 389 persons (female: 46, male 343) from 35 medical faculties (return quota 63%). 95% of those who took part in the survey were registered doctors; 79% of these came from clinics, 16% from the field of theoretical medicine. 81% were specialist physicians. 5% had studied the natural sciences or humanities. The median age at the time of completing the habilitation was 38 years (minimum 30, maximum 54 years old). At present 93% were assistant professors, 5% were professors. The median interval between the doctoral thesis and habilitation was 10 years. 58% had carried out a period of research abroad. In 90% of cases the persons had written a postdoctoral thesis for their habilitation, 10% qualified cumulatively. 47% had improved their occupational rank within a period of 2 years after completing the habilitation, about 2/3 of these reached senior positions. Among the prerequisites for habilitation, "Humboldt's trias" (research, teaching and caring for patients) was accepted by the great majority. Other prerequisites regarded as important for habilitation were publications, holding talks, specialist status and experience abroad. Impact factors, however, should be regarded as important conditions for habilitation only in combination with other criteria. The value of a habilitation was not called into question; 89% would recommend completing one. 80% of those questioned, however, thought the procedure for completing a habilitation should be optimized. The general abolition of the medical habilitation was, however, not desired by the vast majority. CONCLUSION: The value of completing a medical habilitation is not a point for debate for most of those who successfully completed one. It remains the springboard for occupational advancement. The vast majority do not wish to see it abolished. Also the usual prerequisites for habilitation are accepted by the majority of persons. The procedure for completing a habilitation is, however, regarded as in need of improvement. There is a wide consensus of opinion regarding potential aims for reform.

[Assessment of teaching at the faculties of medicine in Germany]. / Stellenwert der Lehre an den deutschen medizinischen Fakultäten.

BACKGROUND AND OBJECTIVES: The aim of this study was to gather, against the background of a long-discussed deficit in academic teaching, data on the current activities of medical faculties with regard to teaching, and to analyse these findings. Another aim was to obtain suggestions for establishing a consensus on indicators that could be used to assess the quality of teaching. MATERIAL AND METHODS: In March 2000, a written inquiry was addressed to the deans of all 37 medical faculties in Germany. The questionnaire, arranged so that responses could be entered into a data-base, consisted of ten items in three parts. Part 1 concerned the evaluation of teaching, parts 2 and 3 dealt with the place of specific assessment of teaching in the process of choosing lecturers ("habilitation") and appointing senior professors. In addition to providing alternative answers (in some instances, allowing a choice of several alternatives) there was also space for written comments. The answers were analysed by descriptive statistics. RESULTS: All questionnaires were returned in a usable form (response rate 100%). 36 faculties had, at the time of receiving the questionnaire, already instituted teaching assessments, of clinical teaching sessions more often than preclinical ones (97% vs 89%). The most widespread method of assessment consisted of obtaining students' opinion and of using the centralized written examinations of the institute for Medical and Pharmaceutical Examination Questions. In more than half of the faculties (57%) an above-average teaching performance by teachers was acknowledged in special ways (honours/prizes). In 31 faculties (84%) teaching experience counted as an absolute prerequisite for obtaining a lectureship, but as a rule without employing any defined standards. With regard to the selection of senior professors, 27 faculties (73%) explicitly took teaching competence into account. Defined criteria for assessing teaching ability were largely absent. CONCLUSIONS: The assessment of teaching quality can be considered as well established at medical faculties in Germany. However, the methods and models used are highly heterogeneous. Furthermore, numerous activities exist in the various faculties to increase the importance attached to academic teaching. However, despite using diverse indicators of quality, the central problems for assessing teaching ability remain unsolved.

Analytical validity of the determination of mercury in whole blood and urine--results of the German external assurance programme for toxicological analysis in biological materials.

The determination of mercury concentrations in blood and urine is currently the best way of monitoring individual uptake of organic and inorganic mercury. In Germany these determinations must be carried out under the conditions of an external quality assurance programme. The German performance evaluation, based on reference values established by reference laboratories yields success rates in percent for the participants in the intercomparison programme of about 60%. A Canadian evaluation system based on two evaluations scores, yields success rates of 25-50% for "good performance" and of 65-80% for "acceptable performance". The determination of mercury in blood and urine is at present not carried out with the necessary reliability.

["Doctor" without being an M.D.--how do non-graduate MDs view medical dissertations?]. / "Doktor" ohne Dr. med.--wie beurteilen nicht-promovierte Vertragsärzte Medizinische Dissertationen?

Both the ranking and the quality of medical dissertations have for some time been a controversial moot point. Previous studies showed that successful doctorate candidates still regard medical dissertations as a meaningful addition to medical studies. Studies on the views of the value have been placed on a medical dissertation by practising physicians who did not write a dissertation lacking to date. Using an anonymous questionnaire containing 16 questions we carried out a study of all the practising doctors in Mid-Franconia, Germany, who did not write a dissertation (n = 243). We asked about their intentions to write a dissertation, reasons for prematurely breaking off the dissertation and their views on the value of medical dissertations. Evaluation was carried out using descriptive statistics in the sense of an exploratory data analysis. The questionnaire was answered in a usable form by 140 physicians (return quote 58%). The average age of the participants was 44 years (33-89 years). The vast majority (89%) had attempted one or several dissertations, 32% still intended to write a dissertation. 59% regarded writing a dissertation alongside daily practice as very difficult of impossible. Private/family reasons were stated less often than deficits in planning, implementation and supervision for prematurely breaking off the dissertation. 65% of the practising physicians in Mid-Franconia who did not write a dissertation regard medical dissertation today as no longer relevant. 58% are of the opinion that the title "doctor" should be awarded automatically with the final exams. The majority of practising physicians asked had in the meantime given up their intention of writing a dissertation and today tend to disfavour medical dissertations. Nevertheless, one third of those who participated in the study still intend to write a dissertation. In view of this it should be discussed to what extent practising physicians interested in scientific questions can be helped to write a dissertation alongside their daily practice. In particular professors and lecturers of general medicine are called upon to make this possible.

[The path to "Doctor of Medicine"--how do doctoral candidates evaluate their dissertation?]. / Der Weg zum "Dr. med."--wie beurteilen Doktoranden ihre Dissertation?

BACKGROUND AND OBJECTIVE: The value of medical dissertations has for some time been controversial. Critical opinions have, on the one hand, been directed against the effort required, its duration and the concept behind these dissertations, while asserting, on the other hand, that such dissertations hinder studying and lead to unnecessary lengthening of the medical curriculum. PARTICIPANTS AND METHOD: In collaboration with the Medical School in Hanover a questionnaire was sent to all the 189 dissertationists of one year, to be returned anonymously. It contained 16 questions about the dissertation itself, supervision. time spent on it, total duration of medical course and effect of the dissertation on the individual's medical studies. The answers were evaluated statistically by explorative data analysis. RESULTS: 181 questionnaires could be evaluated (96%). Average age of those questioned was 30.5 years, median duration of medical studies to-data was 13 semesters. For 80% it was the first attempted dissertation. 22% had been working on an entirely experimental topic (laboratory or animal experiments). The median time from starting to submitting the dissertation was 4 years, the median time of the experimental phase one year. Two-thirds of students said that work on the dissertation had not prolonged their studies. Supervision during various phases of the dissertation was overwhelmingly judged to have been "very good" or "good". Altogether 90% of dissertationists thought that it had been personally meaningful, and they would recommend it to younger costudents. CONCLUSIONS: The results of this study show that a universal criticism of medical dissertations does not stand up to detailed enquiry. Successful dissertationists highly rated their value both to themselves and to scientific medicine. The medical dissertation should therefore firmly remain as part of medical studies and of research within them.

[Significance of social medicine in the medical contract office]. / Zur Bedeutung von Sozialmedizin in der vertragsärztlichen Praxis.

In the German statutory social security system, the necessity of long-term care for chronically ill persons with multi-morbidity and reduced performance has made the socio-medical management of illness and its consequences an important characteristic of primary medical activity. In routine practice a discrepancy between the practical demands and social-medical insights has often been observed. With this in mind, the aim of our pilot study was to systematically collect data on the state of the art and attitudes towards the relevant spheres of work in a defined group of physicians and analyse this data. The study was carried out in the form of a voluntary questionnaire within the medical association (Arztlicher Kreisverband-AKV) in the area of Erlangen-Hochstadt. The database was a computer-processible, anonymous questionnaire with which first of all general socio-demographic and activity-related data was collected. The following 10 questions included, in addition to an estimation of the participants' own socio-medical knowledge, questions on the general status of socio-medical knowledge and how the individual gained this knowledge and the importance of socio-medical themes in routine practice. The data was evaluated using descriptive statistics in the form of exploratory data analysis. Of the 320 physicians registered at the time of the investigation (4/96), 89 (31 female doctors, 58 male doctors) sent back a questionnaire that proved useful (returns: approx. 28%). Significant sex-related or specialisation-related differences with regard to participation in the study were not observed. The ratio of female to male doctors and of general practitioners to specialists in the study collective corresponded more or less to the distribution in the total group. The participants had a median age of 41 years (minimum 31, maximum 71) and had been in practice for a median of 11 years (maximum 43 years, minimum 1 year). 36% were general practitioners, 64% specialists. 97% regarded sound knowledge in socio-medicine as essential for doctors wishing to set up practice. 70% regarded their own knowledge of socio-medicine as being in need of improvement. 85% regarded their knowledge as having been insufficient at the start of their medical careers. With regard to doctors gaining socio-medical competence, routine practice and their own autodidactic capabilities played an important role. 84% would like to see increased teaching of socio-medical themes during specialist training courses. For over 70% socio-medicine is a part of medical studies as a subject in its own right. The content and aims of New Public Health were known to 45%. Among the areas of socio-medical work the care of chronically ill persons was given highest priority. Preventive measures were also accorded high relevance by the participants, and they were particularly interested in preventive medicine. Taking into consideration conceptional problems (e.g. the size of the random sample/selection effects) it was found that: despite many years of practice in some cases, doctors feel there is a deficit in their socio-medical knowledge--prcctical knowledge is mainly gained autodidactically during routine practice ("learning by doing"). There is a clear wish for increased consideration of socio-medical themes in specialist training courses. The great importance of socio-medical tasks as part of medical practice is undeniable to the study collective. The results underline the necessity for improved communication and co-operation between doctors involved in primary medical activity and in socio-medicine.

[Educational and occupational expectations of tomorrow's generation of physicians]. / Ausbildungs- und Berufserwartungen der Arztegeneration von morgen.

As a result of increased competition on the market for young doctors and the continuing debate on the kind and extent of reforms planned for university courses, it is becoming increasingly difficult for students of human medicine to plan their occupational future. Against this background, the aim of this study was to evaluate the expectations regarding training and occupation of students embarking on their course and to carry out extensive analysis of the results taking socio-demographic variables into consideration. The study was designed as a survey using standardised, anonymous questionnaires, which took place at the beginning of two terms (summer term 95 and winter term 95/96) and was carried out with students attending the lectures on "Occupational opportunities". Sociodemographic factors, the student's educational history, expectations of university training, estimation of occupational opportunities and the medical discipline the student hoped to work in, were all taken into consideration. 212 (female: 110/male: 102) (78%) of the 271 students registered for the course took part in the survey. All the students were in their first term. The median age was 20 (range 18-32). 55% of those taking part in the survey came from academic families, 15% with doctors in the family. On the average, 12 months had elapsed since leaving school and starting university. 21% had taken up another course of study before turning to medicine, 20% had already completed some other occupational training, in particular in non-medical health services. For the great majority (97%) the quality of the course is very important and great emphasis is laid on how knowledge is conveyed in lectures. Correspondingly, 86% regarded personal contact with the lecturers as important. Two-thirds of those taking part in the survey had heard of the concept "problem-oriented learning", 91% could imagine having part of their training abroad. Every second student regarded his own occupational changes skeptically, and 50% of first-term students could imagine their occupational futures outside the classical occupational fields in clinics and general practice. Qualified teaching with personal contact with the lecturers is regarded as particularly important despite the general complaint of mass teaching and anonymity. Bearing this in mind, future reforms should, in particular, aim at strengthening personnel and financial resources. With recognisable occupational flexibility already apparent at the beginning of medical studies, more information should be provided on training for alternative medical occupations.

External and internal antimony exposure in starter battery production.

In the production of lead batteries two antimony compounds occur: in the casting of grids antimony trioxide (Sb2O3), and in the formation of lead plates stibine (SbH3). Seven workers from the grid-casting area and 14 workers from the formation area were examined with regard to the antimony concentration in blood (Sb-B) and urine (Sb-U). Antimony air concentrations (Sb-A) were measured by means of personal air samplers. Urine samples were collected at the end of the working week, at the beginning (U1) and the end (U2) of the shift, and at the beginning of work following a weekend without Sb exposure (U3). At U2 among the casters, the median Sb-A exposure was 4.5 (1.18-6.6) micrograms Sb/m3 and among the formation workers, 12.4 (0.6-41.5) micrograms Sb/m3. The exposure in both groups is more than 10 times lower than the present threshold limit values. The median Sb-B concentrations in the preshift samples was 2.6 (0.5-3.4) micrograms Sb/l for the casters and 10.1 (0.5-17.9) micrograms Sb/l for the formation workers. The average Sb-U values (U2) were 3.9 (2.8-5.6) micrograms Sb/g creatinine in the casting area and 15.2 (3.5-23.4) micrograms Sb/g creatinine in the forming area. Our investigation indicates that the two antimony compounds show virtually equal pulmonary absorption and renal elimination. The statistically significant correlations between Sb-A/Sb-B and Sb-A/Sb-U form the basis for proposals regarding appropriate biological exposure limits for occupational antimony exposure.

Occupational chronic exposure to organic solvents. XIV. Examinations concerning the evaluation of a limit value for 2-ethoxyethanol and 2-ethoxyethyl acetate and the genotoxic effects of these glycol ethers.

Two groups of workers occupationally exposed to glycol ethers in a varnish production plant or the ceramic industry were examined. For 19 persons the external and internal exposure was assessed on the Monday and Tuesday after an exposure-free weekend. In the varnish production area the concentrations of 2-ethoxyethanol (EE), 2-ethoxyethyl acetate (EEAc), and 2-butoxyethanol (BE) in air averaged 2.9, 0.5, and 0.5 ppm, respectively, on the Monday, and 2.1, 0.1, and 0.6 ppm, respectively, on the Tuesday. At the same workplaces the mean urinary 2-ethoxyacetic acid (EAA) and 2-butoxyacetic acid (BAA) concentrations were 53.2 and 0.2 mg/l on Monday preshift and 53.8 and 16.4 mg/l on Tuesday postshift. The results show that glycol ethers are very well absorbed through the skin. Therefore biological monitoring is indispensable. To study the kinetics of the toxic metabolite, 17 persons were examined for their excretion of EAA in urine during an exposure-free weekend. The median values of the calculated half-times were 57.4 and 63.4 h, respectively, which are longer than the values presented in literature until now. According to our calculations the limit value should not exceed 50 mg EAA per liter of urine, which is the current German biological tolerance value (BAT value) for EAA in urine. The maximum concentration value at the workplace (MAK value) for EE and EEAc in air should be revised. Finally, the subjects from the varnish production plant as well as a group of reference persons were studied for cytogenetic effects of glycol ethers (sister chromatid exchange, micronucleus test). Such effects could not be detected.

[Effectiveness and tolerance of genetically engineered vaccines for hepatitis B--a comparative study]. / Wirksamkeit und Verträglichkeit gentechnologisch hergestellter Impfstoffe gegen Hepatitis B--eine vergleichende Gegenüberstellung.

The two hepatitis B vaccines produced by gene technology that are presently available in Germany, were compared in respect of efficacy and tolerance in 80 nurses (female and male) who were under training. Both vaccines proved to be highly effective and well tolerated. In respect of the achieved anti-HBs titer, however, the two vaccines differed significantly from each other. Using the 20 micrograms HBs antigen, the antibody titers obtained were higher by a factor of 1.8. The article gives update recommendations in respect of hepatitis B vaccination as a preventive measure in risk groups.

Neurotoxicity of solvent mixtures in spray painters. I. Study design, workplace exposure, and questionnaire.

A multidisciplinary cross-sectional study was carried out in 105 spray painters with long-term solvent exposure (10-44 years) and in 58 control subjects not exposed to solvents. By means of air monitoring the solvent concentrations in the ambient air during spray painting were determined using charcoal and silicagel tubes with pumps and passive samplers. In general, the air concentrations of the individual compounds did not exceed the current limit values (MAK values). Aromatic hydrocarbons like toluene, xylene, ethylbenzene, trimethylbenzene, aliphatic hydrocarbons (e.g., heptane) and acetates (ethylacetate, butylacetate) were determined to be important components of paint solvents. However, in unfavorable work conditions the "exposure index" could exceed the permissible limits two or three times. To assess the body solvent load at the time of examination, biological monitoring (BM) was performed. The main finding was that there was no evidence of neurotoxicologically relevant solvent exposure. Only in the case of methyl hippuric acid in urine spot samples did the spray painters show a higher mean value (80 mg/l) than control subjects (below 20 mg/l), indicating recent xylene exposure. Elevated urinary chromium concentrations (maximum value 29 micrograms/l) were found in 28 spray painters as a result of using zinc chromate-containing wash primers without taking protective measures. To assess the degree of past solvent exposure a special questionnaire was used. This included variables like duration and amount of solvent exposure, the presence of a technical ventilation system, health complaints during painting, etc. Additionally, three "solvent exposure indices'' (SEI) were calculated and used for evaluation of "dose-effect relationships.''(ABSTRACT TRUNCATED AT 250 WORDS)

Neurotoxicity of solvent mixtures in spray painters. II. Neurologic, psychiatric, psychological, and neuroradiologic findings.

A multidisciplinary cross-sectional study was performed to examine the chronic neurotoxicity of organic solvents. Participating in the study were 105 persons employed as spray painters and having long-term solvent exposure (10-44 years) and a control group consisting of 58 construction workers, electricians, and plumbers without occupational contact to solvents. Samples were matched for age, preexposure intelligence level, occupation, and socioeconomic status. After controlling for potentially non occupational confounding factors (neuropsychiatric diseases, metabolic disorders, high blood pressure, alcohol intake) 83 spray painters and 42 controls were entered finally into the study. The evaluation included work history, self-rating questionnaire, neurologic investigation, psychiatric analysis using the Present State Examination (PSE), psychological testing, and computerized axial tomography (CAT) of the brain. Physical and neurologic examinations demonstrated no case of overt disorders of the central or peripheral nervous system. An important result of the psychiatric analysis was that the syndromes "special features of depression" and "loss of interest and concentration" occurred significantly more frequently among spray painters than among controls. Further analyses demonstrated an association with chronic exposure over 30 years and repeated acute neurotoxic effects during solvent exposures. Neither psychological nor performance tests demonstrated any statistically significant differences in the performance sets after adjustment according to premorbid intelligence level; this finding supports the presumption of only a low grade of mental dysfunction. Correlation analyses indicated a relationship between subjective health complaints and long-term solvent exposure; however, the effect of age cannot be completely ruled out.(ABSTRACT TRUNCATED AT 250 WORDS)