Dismissing the idea that basketball is a "contactless" sport: quantifying contacts during professional gameplay.

Introduction: Basketball, introduced by Naismith as a contactless and indoor alternative to sports such as American football, now frequently involves physical contact among players, challenging the traditional notion. Up to date, a thorough understanding of these contacts and their implications remains limited. This study aims to analyze player contacts, embedding it within overall load monitoring to optimize performance and reduce injury risk. Methods: Using a mixed-method design, video-based observations and quantitative analysis were employed to study contact characteristics during ten professional male basketball matches. Fisher exact tests and chi-squared tests (p < .05) were conducted to examine positional variations across different contact variables. Results: A total of 2,069 player contacts were examined, showing centers had the most contacts at 40.5%, followed by power forwards (19.6%), point guards (17.7%), shooting guards (12.9%), and small forwards (9.3%). Notably, half-court defense (46.1%) and set offense (48.9%) emerged as the primary game phases associated with the majority of contacts across all playing positions. Key play actions leading to physical contact included screening/picking (25.7%), box outs (22.9%), and fights for position (FFP) (18%). Post hoc analyses identified significant associations between centers (32.6%, 5.93) and point guards (21.5%, -1.98) during screening/picking maneuvers. Moreover, the torso/upper body (48.1%) and upper extremities (38.2%) were identified as the most affected contact points, while lower extremities and the head/neck exhibited minimal impact. Additionally, 81.4% (n = 1,684) of contacts resulted in kinematic displacement, whereas 18.6% (n = 385) exhibited no change. Post hoc analyses indicated significant associations of physical contacts against opposing counterparts for each playing position. Discussion: Basketball entails frequent physical contacts across all playing positions, with distinct patterns observed for each playing position. Integrating contact monitoring alongside traditional load metrics offers a more comprehensive understanding of physical demands in professional basketball. Practical implications include the developing of tailored training strategies based on playing position-specific contact profiles and recognizing the physiological and biomechanical impacts of contacts. Future research should consider whether the number of contacts between players has increased over the years, and it should acknowledge the impact of player contacts on performance in basketball in order to refine training strategies and enhance player well-being.

[Factors influencing patient competency and health care of service members of the German armed forces with deployment-related mental illness: A patient interview study]. / Einflussfaktoren auf die Patientenkompetenz und die Versorgung einsatzgeschädigter, psychisch erkrankter Soldat*innen der Bundeswehr: eine Interviewstudie mit Betroffenen.

BACKGROUND: The number of service members of the German armed forces suffering from deployment-related mental health problems is steadily rising. Preliminary studies have shown that less than 50 % seek professional help. There is little knowledge about the factors influencing the development of an adequate level of patient competence to cope with the complexity of the clinical picture and the care of people with operational disabilities in the interprofessional network. METHODS: The article presents data gathered by semi-structured, guided interviews from 14 affected individuals analyzing salient beliefs about the perceived factors influencing their patient competence and care through the interprofessional network of supporters inside and outside the German armed forces. Data evaluation was carried out by means of content-structuring, qualitative content analysis using the method of deductive-inductive category formation. FINDINGS: Based on the interviews conducted, we identified four groups of salient beliefs having an influence on patient competence: identify changes and limitations, recognize illness, redirect one's life, help shape one's life again, and four groups of salient beliefs having an influence on care: intangible / material support, medical supplies, psychosocial support, third-party support. All main topics could be assigned to three levels of influence (individual, individual-contextual, contextual) and stored with a total of 70 topics (codes). INTERPRETATION: The development of an effective "social structure" was named by those affected as an important influencing factor. Family members, comrades, superiors, and military GPs appear to have a significant impact on patient competence and care. The respondents' opinions about the importance of internal factors such as the soldier's self-image and fear of stigmatization are consistent with previous findings. Structural factors like supply procedures were mentioned as specific German armed forces phenomena.

First steps of learning analytics in a blended learning general practice curriculum at Saarland University - a quantitative approach.

Objectives: Medical education has been revolutionized by the growing importance of digital learning. Little is known about students' online study behaviour and its relationship with exam performance. This quantitative study analyses and describes students' digital learning behaviours in a blended learning curriculum for General practice at Saarland University, Germany. It also examines the relationship between digital learning behaviour and exam performance. Methods: Cohort and individualized AMBOSS® user data from 195 students at Saarland University was analysed quantitatively. Performance in course-specific multiple-choice question sessions and user data of the integrated online learning activities were correlated with each other and with General practice exam grades. Anonymized data from 10,534 students from 35 other German universities served as the reference cohort. Differences in digital learning behaviour between the groups were calculated using Mann-Whitney-U-Test for non-normally distributed data. Results: Students in the blended learning course used integrated content more frequently than the reference cohort (U=48777, p<0.001). The number of digital learning cards read correlated moderately with digital formative assessment performance (ρ=0.331, p=0.005 and ρ=0.217, p=0.034). Formative assessment scores and exam results correlated strongly in the summer semester cohort (ρ=0.505, p<0.001), and moderately in the winter semester cohort (ρ=0.381, p<0.001). Conclusion: There is a difference in the usage of online learning activities when they are purposefully integrated into a curriculum. Digital learning activities including formative assessment may serve as valuable, constructively aligned exam preparation. This is relevant for medical educators when planning future blended learning curricula and portfolio systems, as it may save financial and human resources.

Can a Family Medicine Curriculum Increase the Attraction of Family Medicine as a Career Choice?

Hintergrund: An der Universität des Saarlandes wurde ein neu strukturierter, kompetenzbasierter Blended-learning-Pflichtkurs Allgemeinmedizin im 5. Studienjahr implementiert. In Anbetracht des drohenden Hausarztmangels untersucht diese Studie, ob ein universitärer Kurs die Studierenden in dem Wunsch, eine Weiterbildung im Fach Allgemeinmedizin zu wählen, beeinflussen kann. Es wird untersucht, welche Aspekte des Allgemeinmedizinkurses besonders motivierend sind. Methoden: Zwei Online-Fragebögen wurden verwendet, um die Motivation für eine Weiterbildung im Fach Allgemeinmedizin vor und nach Belegen des Kurses im Sommersemester 2021 zu vergleichen. Basierend auf den Ergebnissen der Academic Motivation Scale wurde mittels Clusteranalyse das Motivationslernverhalten von Studierenden im Kurs analysiert. Motivierende Aspekte des Kurses wurden deskriptiv anhand quantitativer Daten identifiziert. Für die Datenanalyse wurden die Statistikprogramme JASP (Version 0.14.1) und Jamovi (Version 1.6) benutzt. Ergebnisse: 109 von 111 im Kurs eingeschriebenen Studierenden nahmen am ersten Fragebogen, 103 am zweiten Fragebogen teil. Studierende konnten sich nach Belegen des Kurses signifikant besser vorstellen, eine Weiterbildung im Fach Allgemeinmedizin zu wählen (p = 0,016). Vier sich in ihrer Motivation unterscheidende Cluster an Studierenden konnten identifiziert werden. Studierende empfanden die Eingrenzung auf relevante Themen, das Alignment zwischen Kurs- und Klausurinhalten, die Abstimmung der Inhalte mit mit staatsexamensrelevanten Inhalten, die symptomorientierte Lehre, die Kommunikation auf Augenhöhe und das Gefühl, mit alltäglichen Krankheiten souveräner umgehen zu können, als besonders motivierend. Schlussfolgerungen: Ein Pflichtkurs Allgemeinmedizin kann die Wahl einer späteren Spezialisierung in der Allgemeinmedizin möglicherweise beeinflussen. Die identifizierten motivierenden Aspekte können für zukünftige Kursentwicklungen in der Allgemeinmedizin hilfreich sein.

Streptococcus equi subsp. zooepidemicus and 'Neighbourhood syndrome' -extra-orbitocranial rhinosinusitis with reversible sudden loss of vision- a case report.

BACKGROUND: Rhinosinusitis is a common condition which may present with complications commonly involving the orbit and the intracranial space. Loss of vision in the absence of clinical or radiological signs of involvement of the orbit and intracranium is rare and carries a high morbidity rate. Streptococcus equi subspecies zooepidemicus is not a well-documented cause of paranasal sinus infection. CASE PRESENTATION: We present a case of a 16 year old female patient who had unilateral loss of vision with signs of retrobulbar optic neuritis and no other neurological signs. We isolated an unusual organism- Streptococcus equi subspecies zooepidemicus from the maxillary sinus. Emergency endoscopic sinus surgery and antibiotic treatment resulted in complete reversal of the loss of vision. CONCLUSION: The presence of paranasal sinus disease in association with loss of vision even in the absence of a clear link between the two should be treated as an emergency with surgical drainage and or appropriate antibiotic therapy. In patients presenting with suspected inflammatory orbital involvement, imaging of the orbit and paranasal sinuses should be considered early.

[Evaluation of Abnormal Liver Chemistries in General Practitioner Care - The Reality of Primary Care in Germany]. / Abklärung von Leberwerterhöhungen in der hausärztlichen Praxis ­ Versorgungsrealität in Deutschland.

BACKGROUND: In general practitioner care, abnormal liver chemistries are often being diagnosed unintentionally. So far, there is no evidence-based, structured diagnostic pathway for classifying and evaluating elevated liver enzymes, especially with regard to the early detection of patients at increased risk for liver fibrosis or liver cirrhosis. Accordingly, dealing with elevated liver values which are noticed in the course of a general blood examination is a diagnostic challenge that strongly depends on the doctor's approach. METHODS AND PARTICIPANTS: In the course of a survey, 391 general practitioners in Rhineland-Palatinate and Saarland were interviewed between March and June 2017. The focus was on behavior and strategies with regard to the clarification of elevated liver values as well as the identification of challenges and training interests. In addition to the descriptive analysis, a factor analysis was performed. RESULTS: The determination of liver values such as γ-GT, AST and ALT is frequently performed in general practitioner care without the existence of any particular cause. There are strongly different clusters of liver values that are being analyzed in the course of a liver function test. In the case of increased liver values, a majority of the physicians surveyed generally prefer a controlled waiting (58 %). Due to the absence of an established diagnosis and treatment pathway, challenges arise in everyday practice which relate to controlled waiting, cooperation with gastroenterological specialists, as well as orientation to predefined laboratory value portfolios. DISCUSSION: In addition to the introduction of an evidence-based diagnosis and treatment pathway, it should be considered to optimize the flow of information between general practitioners and gastroenterological specialists. Last but not least, it would be desirable if more training courses for general practitioners could be offered in this subject area.

Extraction of medium chain fatty acids from organic municipal waste and subsequent production of bio-based fuels.

This paper provides an overview on investigations for a new technology to generate bio-based fuel additives from bio-waste. The investigations are taking place at the composting plant in Darmstadt-Kranichstein (Germany). The aim is to explore the potential of bio-waste as feedstock in producing different bio-based products (or bio-based fuels). For this investigation, a facultative anaerobic process is to be integrated into the normal aerobic waste treatment process for composting. The bio-waste is to be treated in four steps to produce biofuels. The first step is the facultative anaerobic treatment of the waste in a rotting box namely percolate to generate a fatty-acid rich liquid fraction. The Hydrolysis takes place in the rotting box during the waste treatment. The organic compounds are then dissolved and transferred into the waste liquid phase. Browne et al. (2013) describes the hydrolysis as an enzymatically degradation of high solid substrates to soluble products which are further degraded to volatile fatty acids (VFA). This is confirmed by analytical tests done on the liquid fraction. After the percolation, volatile and medium chain fatty acids are found in the liquid phase. Concentrations of fatty acids between 8.0 and 31.5 were detected depending on the nature of the input material. In the second step, a fermentation process will be initiated to produce additional fatty acids. Existing microorganism mass is activated to degrade the organic components that are still remaining in the percolate. After fermentation the quantity of fatty acids in four investigated reactors increased 3-5 times. While fermentation mainly non-polar fatty acids (pentanoic to octanoic acid) are build. Next to the fermentation process, a chain-elongation step is arranged by adding ethanol to the fatty acid rich percolate. While these investigations a chain-elongation of mainly fatty acids with pair numbers of carbon atoms (acetate, butanoic and hexanoic acid) are demonstrated. After these three pre-treatments, the percolate is brought to a refinery to extract the non-polar fatty acids using bio-diesel, which was generated from used kitchen oil at the refinery. The extraction tests in the lab have proved that the efficiency of the liquid-liquid-extraction is directly linked with the chain length and polarity of the fatty acids. By using a non-polar bio-diesel mainly the non-polar fatty acids, like pentanoic to octanoic acid, are extracted. After extraction, the bio-diesel enriched with the fatty acids is esterified. As a result bio-diesel with a lower viscosity than usual is produced. The fatty acids remaining in the percolate after the extraction can be used in another fermentation process to generate biogas.

Compound-specific chlorine isotope analysis: a comparison of gas chromatography/isotope ratio mass spectrometry and gas chromatography/quadrupole mass spectrometry methods in an interlaboratory study.

Chlorine isotope analysis of chlorinated hydrocarbons like trichloroethylene (TCE) is of emerging demand because these species are important environmental pollutants. Continuous flow analysis of noncombusted TCE molecules, either by gas chromatography/isotope ratio mass spectrometry (GC/IRMS) or by GC/quadrupole mass spectrometry (GC/qMS), was recently brought forward as innovative analytical solution. Despite early implementations, a benchmark for routine applications has been missing. This study systematically compared the performance of GC/qMS versus GC/IRMS in six laboratories involving eight different instruments (GC/IRMS, Isoprime and Thermo MAT-253; GC/qMS, Agilent 5973N, two Agilent 5975C, two Thermo DSQII, and one Thermo DSQI). Calibrations of (37)Cl/(35)Cl instrument data against the international SMOC scale (Standard Mean Ocean Chloride) deviated between instruments and over time. Therefore, at least two calibration standards are required to obtain true differences between samples. Amount dependency of δ(37)Cl was pronounced for some instruments, but could be eliminated by corrections, or by adjusting amplitudes of standards and samples. Precision decreased in the order GC/IRMS (1σ ≈ 0.1‰), to GC/qMS (1σ ≈ 0.2-0.5‰ for Agilent GC/qMS and 1σ ≈ 0.2-0.9‰ for Thermo GC/qMS). Nonetheless, δ(37)Cl values between laboratories showed good agreement when the same external standards were used. These results lend confidence to the methods and may serve as a benchmark for future applications.

Improving the aeration of critical fine-grained landfill top cover material by vegetation to increase the microbial methane oxidation efficiency.

The natural methane oxidation potential of methanotrophic bacteria in landfill top covers is a sustainable and inexpensive method to reduce methane emissions to the atmosphere. Basically, the activity of methanotrophic bacteria is limited by the availability of oxygen in the soil. A column study was carried out to determine whether and to what extent vegetation can improve soil aeration and maintain the methane oxidation process. Tested soils were clayey silt and mature compost. The first soil is critical in light of surface crusting due to vertical erosion of an integral part of fine-grained material, blocking pores required for the gas exchange. The second soil, mature compost, is known for its good methane oxidation characteristics, due to high air-filled porosity, favorable water retention capacity and high nutrient supply. The assortment of plants consisted of a grass mixture, Canadian goldenrod and a mixture of leguminous plants. The compost offered an excellent methane oxidation potential of 100% up to a CH(4)-input of 5.6l CH(4)m(-2)h(-1). Whereas the oxidation potential was strongly diminished in the bare control column filled with clayey silt even at low CH(4)-loads. By contrast the planted clayey silt showed an increased methane oxidation potential compared to the bare column. The spreading root system forms secondary macro-pores, and hence amplifies the air diffusivity and sustain the oxygen supply to the methanotrophic bacteria. Water is produced during methane oxidation, causing leachate. Vegetation reduces the leachate by evapotranspiration. Furthermore, leguminous plants support the enrichment of soil with nitrogen compounds and thus improving the methane oxidation process. In conclusion, vegetation is relevant for the increase of oxygen diffusion into the soil and subsequently enhances effective methane oxidation in landfill cover soils.

Monitoring and evaluation of dechlorination processes using compound-specific chlorine isotope analysis.

A simple, quick and sensitive method for the compound-specific stable chlorine isotope analysis of chlorinated solvents by conventional quadrupole gas chromatography/mass spectrometry (GC/MS) is presented. With this method, compound-specific stable chlorine isotope ratios of typical chlorinated solvents like tetrachloroethene (PCE) and trichloroethene (TCE) can be determined quantitatively within 30 min by direct injection. The chlorine isotope ratios of target substances are calculated from the peak areas of several selected molecular ions and fragment ions of the substances, using a set of unique mathematical equations. The precision of the method was demonstrated through reproducibility tests. An internal precision of +/-0.4 per thousand to +/-1.1 per thousand was obtained when analyzing PCE and TCE in the 10-1000 pmol range. The validity of the method was further demonstrated by determining the chlorine isotopic fractionation factor during the reductive dechlorination of TCE in a batch experiment using zero-valent iron. The chlorine isotopic fractionation factor was calculated as 0.9976 +/- 0.0011 with a correlation coefficient of 0.9469 (n = 38). The high correlation coefficient indicates that compound-specific stable chlorine isotope analysis can be performed with sufficient accuracy using conventional quadrupole GC/MS when significant fractionation takes place during a reaction. For the first time, the chlorine isotope fractionation factor of TCE during an abiotic anaerobic dechlorination process was determined using quadrupole GC/MS, without offline sample preparation.

Report: environmental assessment of Darmstadt (Germany) municipal waste incineration plant.

The focus of this study was the emissions from waste incineration plants using Darmstadt (Germany) waste incineration plant as an example. In the study the emissions generated by incineration of the waste were considered using three different approaches. Initially the emissions from the waste incineration plant were assessed as part of the impact of waste management systems on the environment by using a Municipal Solid Waste Management System (MSWMS) assessment tool (also called: LCA-IWM assessment tool). This was followed by a comparison between the optimal waste incineration process and the real situation. Finally a comparison was made between the emissions from the incineration plant and the emissions from a vehicle.

Inhibition of photosystem II electron transport by acyl derivatives of 2,2-dimethyl-1,3-dioxane-4,6-dione (Meldrum's acid).

In the course of the synthesis of gamma-pyrones, well-known inhibitors of photosystem II electron transport, it turned out that the starting material, acyl derivatives of 2,2-dimethyl-1,3-dioxane-5,6-dione (Meldrum's acid) are potent inhibitors of photosystem II electron transport. Thus, in a simple one-step synthesis from commercial available substances, highly potent photosystem II inhibitors are generated. The biological activity of the acyl derivatives is in a parabolic fashion dependent from the length of the alkyl side chain.

Reversal of the inhibition of photosynthesis by herbicides affecting hydroxyphenylpyruvate dioxygenase by plastoquinone and tocopheryl derivatives in Chlamydomonas reinhardtii.

Isoxaflutole or pyrazolate inhibition of tocopherol and plastoquinone biosynthesis in the green alga Chlamydomonas reinhardtii Dang leads to the inactivation of photosystem II and the degradation of its reaction centre D1 protein when exposed to strong light. Cell-permeable short-chain derivatives of plastoquinone and tocopherol were tested in the reversal. Addition of decyl-plastoquinone reverses herbicide-induced inhibition of photosynthesis and inactivation of photosystem II in short-time (1 h) exposure of the algae to high light. In high light longer than 1 h, decyl-plastoquinone alone loses effectiveness, but a synthetic permeable tocopheryl derivative retards the inhibitory effects on photosystem II and on the degradation of the D1 protein. This indicates that tocopherol deficiency induced by the herbicides makes a major contribution to their secondary mode of action in high light stress.

Formation of chlorinated and brominated dioxins and other organohalogen compounds at the pilot incineration plant VERONA.

Experiments were conducted at the VERONA pilot plant, an incineration plant with stationary grate and separate post-combustion chamber, using wood and propane as basic combustible materials and with controlled dosage of various bromine-, chlorine- and copper-containing compounds. The behaviour of the following compounds was studied in the combustion chamber, after the post-combustion chamber and after the heat exchanger: polychlorinated phenols (PCPh), polybrominated phenols (PBrPh), polychlorinated benzenes (PCBz), polybrominated benzenes (PBrBz), polychlorinated dioxins and furans (PCDD/F) and polybrominated dioxins and furans (PBDD/F). The bromine co-incineration leaded to very high bromophenol concentrations after the post-combustion chamber. The formation of brominated and mixed-halogenated phenols and the further reaction to halogenated dioxins is apparently a relevant reaction mechanism for dioxin formation in processes involving bromine. This assumption is supported by the high formation rates of PBDD/F found in the heat exchanger, which were 4-20 times higher than those of PCDD/F. Moreover, the strong correlations found between the formation rates of PCPh, PCBz and PCDD/F in the heat exchanger indicate that in addition considerable new formation of dioxins takes place through de novo synthesis. Experiments involving the variation of primary operational parameters and fuel properties have shown that the quality of post-combustion plays a much greater role than the other parameters. Furthermore, it became apparent that the congeners of the chlorophenols and of the chlorobenzenes, measured in various incineration stages, do not correlate closely with the dioxin concentrations after the heat exchanger.

Pandemic influenza and healthcare demand in the Netherlands: scenario analysis.

In accordance with World Health Organization guidelines, the Dutch Ministry of Health, Welfare and Sports designed a national plan to minimize effects of pandemic influenza. Within the scope of the Dutch pandemic preparedness plan, we were asked to estimate the magnitude of the problem in terms of the number of hospitalizations and deaths during an influenza pandemic. Using scenario analysis, we also examined the potential effects of intervention options. We describe and compare the scenarios developed to understand the potential impact of a pandemic (i.e., illness, hospitalizations, deaths), various interventions, and critical model parameters. Scenario analysis is a helpful tool for making policy decisions about the design and planning of outbreak control management on a national, regional, or local level.

Pharmacoeconomics of elderly vaccination against invasive pneumococcal infections: cost-effectiveness analyses and implications for The Netherlands.

We performed a review of cost-effectiveness of elderly pneumococcal vaccination to prevent invasive disease. It concerns studies in the USA, Canada, Netherlands and Spain and a multinational study of five European countries. Cost-effectiveness of elderly vaccination against invasive pneumococcal infections varies from cost-saving to EUR 33,000 per life-year gained. The Dutch study estimates cost-effectiveness at EUR 10,100 per life-year gained (price level: 1995). This is below the level that has recently been defined for treatment of high cholesterol (EUR 20,000 per life-year gained) and may therefore be considered as favorable. Almost all studies base their estimate of vaccine efficacy on the same case-control study from the USA. We identify a need for a systematic review on the efficacy of the pneumococcal vaccine. Also, we suggest further analysis with respect to potential effects on cost-effectiveness of extended influenza vaccination for the Dutch elderly in recent years and inclusion of pneumococcal re-vaccination. Pending this additional information, we conclude that cost-effectiveness of vaccination against invasive pneumococcal infections for Dutch elderly is favorable (as in several other countries) and justifies implementation from a pharmacoeconomic point of view.

Cost effectiveness of guideline advice for children with asthma: a literature review.

Asthma is an important chronic disease among children. This study reviews the cost effectiveness of interventions in the long-term care of asthmatic children and compares these results with treatment advice in four current guidelines. Cost-effectiveness studies were searched for in Medline, Embase, Healthstar, Biosis, and the Office of Health Economics-Health Economic Evaluations Database (OHE-HEED), and the Cochrane Library was searched for meta-analyses of clinical trials. In the four reviewed guidelines, cost effectiveness is not explicitly used as a criterion. The cost-effectiveness studies show sufficient evidence for the cost effectiveness of treatment with inhaled steroids and for self-management programs for severe asthmatic patients. Inclusion of these results in the guidelines would not lead to significant changes in current treatment advice. The effectiveness of various measures for trigger avoidance is not fully proven, and hence neither is their cost effectiveness. Available information on the cost effectiveness of cromolyn could be used to focus the guidelines. Finally, evidence exists that organizational interventions, e.g., the employment of asthma nurses, can result in cost savings, but it is unclear to what extent these results can be generalized. More cost-effectiveness studies are needed, especially on long-acting bronchodilators and self-management programs for mild and moderate asthma, in order to help make the guidelines more informative and reduce the differences between them.

Pharmacoeconomics of influenza vaccination for healthy working adults: reviewing the available evidence.

A favourable pharmacoeconomic profile has been well established for influenza vaccination in the elderly. For employers relevant benefits seem to exist for vaccinating healthy working adults to avert absenteeism and related production losses. From a pharmacoeconomic point of view it is relevant to consider whether societal benefits of vaccination for healthy working adults is worthwhile given the costs of vaccination for the community. We searched Medline and Embase using the key words influenza (vaccination) in combination with cost, cost-benefit, cost-effectiveness, efficiency, economic evaluation, health-policy and pharmacoeconomics. From this primary search, we selected 11 studies concerned with the group of healthy working adults. We reviewed these studies according to several criteria: benefit-to-cost (B/C) ratio;vaccine effectiveness, influenza incidence, number of days of work absence due to illness; and relative cost of the vaccine. Three studies on vaccinating healthy working adults found costs exceeding the benefits (B/C-ratio <1). The remaining eight pharmacoeconomic studies found a B/C-ratio of almost two or more. Cost savings are strongly related to the inclusion of indirect benefits related to averted production losses. After exclusion of indirect costs and benefits of production gains/losses, only one of the eight studies remains cost saving. Considering the available pharmacoeconomic evidence, vaccination of healthy working adults in Western countries may be an intervention with favourable cost-effectiveness and cost-saving potentials if indirect benefits of averted production losses are included. Excluding indirect benefits and costs of production losses/gains, cost-saving potentials are limited. Recent international guidelines for pharmacoeconomic research advise the inclusion of production gains and losses in the preferred societal perspective. Hence, on the basis of the available evidence, influenza vaccination of healthy working adults may be recommended from pharmacoeconomic point of view. Pharmacoeconomics do, however, present only one argument for consideration aside from ethical issues, budgetary limits and psychosocial aspects.