Monitoring a cohort of trainees: changes over time and associations between health literacy, health behaviour and health.

BACKGROUND: For many entrants, the initial stages of professional training are a challenge. Demands at work can lead to new physical and psychological stress, as well as new social requirements. These new requirements can influence the health behaviour and the state of health of young employees. In recent years, there have been many studies on health literacy (HL). HL represents resources and potentials that allow individuals to achieve improved control of their health and of factors that influence health. Thus, HL can influence both well-being and health. In the present study, the health of trainees in different branches (health and welfare services, office, sales, technology) is monitored over time ending in the period of the COVID-19 pandemic. Furthermore, the association between health literacy and health or health behaviour has been examined. METHODS: In 2017/18, a baseline survey (T0) was performed on trainees in various sectors (office, sales, teaching, nursing and social welfare, engineering, hairdressers), who had been contacted through vocational colleges in four federal states in north Germany. The trainees were surveyed again in the in the first year after training in 2021 (T3). Demographic data were collected, as well as information on health literacy (HLS-EU-16), health behaviour (physical exercise, nutrition, smoking and alcohol) and state of health (BMI, psychological well-being and subjective state of health). Recognition, satisfaction at work and thoughts of leaving the profession were surveyed with the Copenhagen Psychosocial Questionnaire (COPSOQ). Statistical analysis was performed with tests for paired samples and multivariate regression analysis in SPSS 26. RESULTS: 129 data sets were evaluated, with a follow-up rate of 10.2%. 85% of the trainees were female. The mean age at follow-up was 25.6 years. 56% were employed in the health service or social welfare. 35% worked in the office, sales or engineering. At T3, 47% of the employees exhibited limited health literacy, 67% low levels of exercise and 30% risky alcohol use. 42% exhibited overweight and 42% poor psychological well-being. An association between health literacy (HL) and psychological well-being was only observed in cross-section (HL inadequate vs. HL adequate OR: 3.2 95% CI: 1.07-9.49, p = 0.037). The odds ratio relative to subjective state of health was also increased, although the association was not statistically significant (HL inadequate vs. HL adequate OR: 2.7 95% CI: 0.72-9.78, p = 0.143). In the sector for health service and social welfare, there was statistically significant deterioration over time in all COPSOQ variables (recognition, satisfaction at work, thoughts of leaving the profession). CONCLUSIONS: For a group of trainees in the first year of work during the covid-19 epidemic, the present findings show that there is a need to prevent risky health behaviour, overweight and poor psychological well-being. Health literacy was shown to be a modifiable parameter, that apparently is associated in cross - but not in longitudinal section with the health of young employees. It would appear to be reasonable to modify developing health literacy in the setting of work and school.

Longitudinal SARS-CoV-2 Seroprevalence among Employees in Outpatient Care Services in Hamburg.

The risk of SARS-CoV-2 infection is particularly high for healthcare workers during the pandemic. Home care workers visit many different households per shift. Encounters with mostly elderly patients and their relatives increase the potential for the undetected spread of SARS-CoV-2. In order to gain insight into the seroprevalence of SARS-CoV-2 antibodies and possible transmission risks in outpatient care, this follow-up study was conducted with nursing services in Hamburg. The aim was to estimate the dynamics of seroprevalence in this occupational group over a 12-month period, to identify occupation-specific risk factors, and to collect information on the vaccination status of the surveyed nursing staff. Antibody testing for SARS-CoV-2 IgG against the S1 domain (EUROIMUN Analyser I® Lübeck, Germany) was performed on participating healthcare workers with patient contact at a total of four time points within one year from July 2020 to October 2021 (baseline, follow-up after three, six and twelve months). The data were mostly analysed descriptively. Differences in IgG titres were analysed using variance analysis methods, particularly Tukey's range test. The seroprevalence was 1.2% (8/678) at baseline and 1.5% (9/581) at the three-month follow-up (T1). At the second follow-up (T2) after six months, vaccination against SARS-CoV-2 was available from January 2021 onwards. The prevalence rate of positive IgG antibodies relative to the S1 domain of the spike protein test among unvaccinated individuals was 6.5%. At (T3) after twelve months (July to October 2021), 482 participants were enrolled, and 85.7% of the workers were considered fully vaccinated at this time point, while 51 individuals were unvaccinated. The prevalence was 13.7% (7/51). In our study, a low seroprevalence was found among home care workers, which was lower than in our studies conducted in the clinical setting. Therefore, it can be assumed that the occupational risk of infection is rather low for both the nursing staff and the patients/clients cared for in the outpatient setting. The good provision of protective equipment and the high vaccination rate of the staff probably had a positive influence.

Prevalence of Adverse Skin Reactions in Nursing Staff Due to Personal Protective Equipment during the COVID-19 Pandemic.

In order to prevent the nosocomial transmission of the SARS-CoV-2 virus, it has become necessary for health workers to increase their use of personal protective equipment (PPE). The aim of the study was to investigate the prevalence and influencing factors for adverse skin reactions (ASR) due to occupational PPE use among nursing staff in Germany during the COVID-19 pandemic. The study uses a mixed methods design. A focus group was created with experts from the field of healthcare, and an online survey was then carried out among nursing staff. Influencing factors were identified using multivariate logistic regression via odds ratios (ORs) with 95% confidence intervals (CIs). A total of 2274 nursing staff took part in the survey, with 1967 included in the analysis. The prevalence of ASR was 61%, with 94% affecting at least one area of the face. Statistically significant factors of influence were Filtering Face Peace (FFP) mask wearing duration of ≥4 h, a history of contact allergies, and being female and young. A pre-existing skin disease had a protective effect. The prevalence of PPE-related ASR underlines the necessity for targeted preventive measures for nursing staff during pandemic situation.

Risk of Burnout among Emergency Department Staff as a Result of Violence and Aggression from Patients and Their Relatives.

Emergency department staff are often affected by incidents of violence. The aim of the study was to generate data on the frequency of violence by patients and accompanying relatives and the correlation between experienced aggression, a possible risk of burnout and a high sense of stress. Additionally, the buffering effect of good preventive preparation of care staff by the facility on aggressive visitors and patients was examined. In this cross-sectional study, members of the German Society for Interdisciplinary Emergency and Acute Medicine were surveyed. The investigation of risk factors, particularly experiences of verbal and physical violence, as well as exhaustion and stress, was carried out using ordinal regression models. A total of 349 staff from German emergency departments took part in the survey, 87% of whom had experienced physical violence by patients and 64% by relatives. 97% had been confronted with verbal violence by patients and 94% by relatives. Violence by relatives had a negative effect on perceived stress. High resilience or effective preparation of employees for potential attacks was shown to have a protective effect with regard to the burnout risk and perceived stress. Therefore, management staff play a major role in preventing violence and its impact on employees.

Distribution Patterns of Degeneration of the Lumbar Spine in a Cohort of 200 Patients with an Indication for Lumbar MRI.

Lower back pain is one of the most common causes of a reduced quality of life. Magnetic resonance imaging (MRI) is the best suited imaging technique to detect causes of that pain. We retrospectively evaluated the MRIs of the lumbar spine for 200 patients in order to describe the distribution of signs of degeneration with regard to age, sex, and position of the disc affected. The number of spinal segments affected by degeneration increased with age, as did the number of signs of degeneration per segment. In patients aged between 21 and 30, 38.8% of discs were affected, while for patients aged between 51 and 60, 91.6% of discs were affected. There was no statistically significant gender difference. The lower two segments were most commonly affected by degeneration. The most common were structural changes to the discs, which affected 88.4% of patients over 50. Spondylosis was the most common bone-related change, found in 60.4% of patients over the age of 50. A reduction in disc height increases the likelihood of structural changes to the disc and bone-related changes. When investigating risk factors for developing disc-related diseases, the complex disc degeneration patterns described here should be taken into account.

Cumulative Incidence of SARS-CoV-2 in Healthcare Workers at a General Hospital in Germany during the Pandemic-A Longitudinal Analysis.

Health workers (HW) are at increased risk for SARS-CoV-2 infection. In order to monitor the infection dynamic on the basis of contact with patients, HW at the St. Antonius Hospital (SAH) were tested four times in one year by PCR and serology. The cumulative incidence of infection in HW was calculated. Swab and blood tests were simultaneously performed between April 2020 and April 2021. Risk factors and demographic information were assessed at the beginning of the study. The response rate was above 75% in all rounds of testing. The study comprised 1506 HW, 165 (10.6%) of which tested positive for SARS-CoV-2 infection. Working in an ICU or on wards with patient contact were risk factors (OR 4.4, 95% CI 1.73-13.6 and OR 2.9, 95% CI 1.27-8.49). At the end of the study, the majority of HW (810 of 1363 (59.4%)) had been vaccinated at least once. A total of 29.1% of unvaccinated HW and 5.3% of vaccinated HW showed an immune response typical for natural SARS-CoV-2 infection. Of the 73 HW who provided information on the course of the disease, 31.5% reported that their quality of life continued to be impaired. The cumulative incidence of infection was low in these HW, which may be attributed to vaccination and good hygiene. Nevertheless, a work-related infection risk was identified, highlighting the need to improve protection against infection. A high risk of developing long COVID was found after the infection has subsided. Special rehabilitation programs should be provided and HW should be compensated for reduced work capacity in the case that rehabilitation fails or takes a long time.

Radiation Protection in Interventional Radiology/Cardiology-Is State-of-the-Art Equipment Used?

Interventional radiology/cardiology is one of the fields with the highest radiation doses for workers. For this reason, the International Commission on Radiological Protection (ICRP) published new recommendations in 2018 to shield staff from radiation. This study sets out to establish the extent to which these recommendations are observed in Germany. For the study, areas were selected which are known to have relatively high radiation exposure along with good conditions for radiological protection-interventional cardiology, radiology and vascular surgery. The study was advertised with the aid of an information flyer which was distributed via organisations including the German Cardiac Society (Deutsche Gesellschaft für Kardiologie- Herz- und Kreislaufforschung e. V.). Everyone who participated in our study received a questionnaire to record their occupational medical history, dosimetry, working practices, existing interventional installations and personal protective equipment. The results were compared with international recommendations, especially those of the ICRP, based on state-of-the-art equipment. A total of 104 respondents from eight German clinics took part in the survey. Four participants had been medically diagnosed with cataracts. None of the participants had previously worn an additional dosimeter over their apron to determine partial-body doses. The interventional installations recommended by the ICRP have not been fitted in all examination rooms and, where they have been put in place, they are not always used consistently. Just 31 participants (36.6%) stated that they "always" wore protective lead glasses or a visor. This study revealed considerable deficits in radiological protection-especially in connection with shielding measures and dosimetric practices pertaining to the head and neck-during a range of interventions. Examination rooms without the recommended interventional installations should be upgraded in the future. According to the principle of dose minimization, there is considerable potential for improving radiation protection. Temporary measurements should be taken over the apron to determine the organ-specific equivalent dose to the lens of the eye and the head.

Latent Tuberculosis Infection among Health Workers in Germany-A Retrospective Study on Progression Risk and Use of Preventive Therapy.

Despite the decline in tuberculosis incidence (TB) in Germany, health workers (HW) are at greater risk of becoming infected with Mycobacterium tuberculosis. To date, little is known about the risk of progression of latent tuberculosis infections (LTBI) and the use of Tuberculosis Preventive Therapy (TPT) among HW. Routine data from the German Statutory Institution for Accident Insurance and Prevention for Health and Welfare Services (BGW) were analysed and a retrospective survey was conducted. A self-administered questionnaire was sent to 1711 HW who had received recognition of an LTBI as an occupational disease between the years 2009 and 2018. The response rate was 42.3% after correcting for those with no actual address (20.4%). We included 575 HW in the data analysis of the retrospective survey. The cumulative incidence of progression, the incidence density and the associated 95% confidence interval (95% CI) were calculated. Three progressive cases were identified in the analysis of the routine data. In the survey cohort, three HW developed TB during the observation period of 5.4 years on average (standard deviation: 2.8 years; interquartile range: 5.0 years). The cumulative TB incidence was 0.52% in the survey group (95% CI: 0.14% to 1.65%). The incidence density was 0.97 cases per 1000 person years (95% CI: 0.25 to 3.10). One-third of the respondents underwent TPT. Significant differences were observed between age and activity groups in the use of TPT, but not between the genders, year of diagnosis or the reason for performing the screening. The data indicate that the risk of progression of an LTBI is low for HW. However, one-third of the HW had undergone TPT. Information about the expected progression risk is important so that it can be weighed against the risk of side effects of TPT.

Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors.

Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated.

Tuberculosis among Health Workers-A Secondary Data Analysis of German Social Accident Insurance Data from 2002-2017.

Tuberculosis (TB) is the most common cause of fatal infections worldwide. Recent TB figures in Europe indicate that 30 people were infected with tuberculosis each hour in 2017. Healthcare workers are at particular risk of being infected through patient contact. TB is the second most common occupational infectious disease among German healthcare workers. Routine data from the German Social Accident Insurance were used to examine trends in occupational TB diseases. We analyzed annual cross-sectional data for the years 2002 to 2017. The data underwent descriptive analysis. A total of 4653 TB cases were recognized as occupational diseases (OD) in the period under study. In 2002, 60 TB cases were recognized as OD No. 3101, i.e., transmissions from person to person. Since 2013, the level has settled at around 500 recognized cases per year. This is around eight times the number of cases compared to 2002. The following three groups collectively accounted for the largest share of TB cases (88.5%): nurses (including geriatric nurses), other healthcare employees, and physicians. The upward trend in the number of TB cases recognized as occupational diseases is probably due to improvements in diagnostic tests used to diagnose TB infections. TB in health and welfare workers remains an important issue in the health and welfare sector in Germany, partly due to the long latency period between potential exposure to infectious patients or materials and the recognition of the latent tuberculosis infection (LTBI) or active TB as OD.

Qualitative angiographic and quantitative myocardial perfusion assessment using fluorescent cardiac imaging during graded coronary artery bypass stenosis.

Intraoperative graft assessment in coronary artery bypass (CAB) grafting is important to avoid early graft failure. This study aimed to evaluate the accuracy of fluorescent cardiac imaging (FCI) for intraoperative qualitative angiographic and quantitative myocardial perfusion assessment during graded CAB stenosis compared to coronary angiography (CA). After CAB grafting to the left anterior descending coronary artery, graded distal bypass stenoses were created in ten pigs by 25, 50, 75, and 100% flow reduction assessed by transit-time flow measurement (TTFM). Visual angiographic assessment was performed by FCI and CA during baseline and graded bypass stenoses. Altered myocardial perfusion was assessed by quantitative intraoperative fluorescence intensity (QIFI) derived from FCI and correlated to TTFM. Patent bypass grafts and graft occlusion were visualized successfully by FCI and CA, while discrimination between various graded bypass stenosis was possible in 73.3%. The degree of CAB stenosis was overestimated in 16.7% and underestimated in 10.0% by FCI compared to CA. Graded CAB stenosis reduced regional myocardial perfusion quantified by decreased QIFI value (p < 0.001). Mean QIFI value was 76.8 (95% CI 67.2-86.3) during baseline, 55.6 (95% CI 45.3-65.9) during 25% flow-reduction, 30.6 (95% CI 22.3-39.0) during 50% flow-reduction, 20.3 (95% CI 15.4-25.3) during 75% flow-reduction, and 0 during CAB occlusion (p < 0.001) with a significant correlation to TTFM (r = 0.955; p < 0.0001). Solely visual assessment of CAB quality using FCI is limited as compared to CA. Additional QIFI assessment identified graded CAB stenosis and occlusion with a significant correlation to TTFM.

Aspirin Before Elective Surgery-Stop or Continue?

BACKGROUND: Cessation of long-term aspirin treatment before noncardiac surgery can cause adverse cardiac events in patients at risk, particularly in those with previous percutaneous coronary interventions (PCI) with stent implantation. The factors influencing the clinical decision to stop aspirin treatment are currently unknown. METHODS: In a single-center, cross-sectional study (retrospective registration: NCT03049566) carried out from February to December 2014, we took a survey among patients scheduled for noncardiac surgery who were under long-term aspirin treatment, and among their treating anesthesiologists using standardized questionnaires on preoperative aspirin use, comorbidities, and risk-benefit assessments. The main objective was to identify factors associated with the decision to stop aspirin treatment. The results of multivariable logistic regressions and intraclass correlations are presented. RESULTS: 805 patients were included in the study, and 636 questionnaires were returned (203 of which concerned patients with coronary stents). 46.8% of the patients stopped their long-term aspirin treatment before surgery; 38.7% of these patients stopped it too early (>10 days before surgery) or too late (≤ 3 days before surgery). A prior PCI with stent implantation lowered the probability of aspirin cessation (odds ratio [OR] = 0.47 [0.31; 0.72]; p <0.001). On the other hand, patients were more likely to stop their long-term aspirin treatment if it had already been discontinued once before (OR = 4.58 [3.06; 6.84]; p <0.001), if there was a risk of bleeding into a closed space (OR = 4.54 [2.02; 10.22]; p <0.001), if they did not know why they were supposed to take aspirin (OR = 2.12 [1.05; 4.28]; p = 0.036), or if the preoperative consultation with the anesthesiologist occurred <2 days before surgery (OR = 1.60 [1.08; 2.37]; p = 0.018). Patients often assessed the risks related to aspirin cessation lower than their physicians did. CONCLUSION: This study reveals discordance between guideline recommendations and everyday clinical practice in patients with coronary stents. The early integration of cardiologists and anesthesiologists and a more widespread use of stent implant cards could promote adherence to the guidelines.

The effect of effort-reward imbalance on the health of childcare workers in Hamburg: a longitudinal study.

BACKGROUND: The prevalence of effort-reward imbalance (ERI) among qualified childcare workers in Germany is currently estimated at around 65%. High rates of burnout and musculoskeletal symptoms (MS) have also been reported for this group. Previous longitudinal studies show inconsistent results with regard to the association between ERI and MS. As yet, no longitudinal studies have been conducted to investigate the association between ERI and burnout or MS in childcare workers. This study aims to investigate the extent to which a relationship between ERI and MS or burnout can be observed in childcare workers in Germany on a longitudinal basis. METHODS: In 2014 childcare workers (N = 199, response rate: 57%) of a provider of facilities for children and youth in Hamburg were asked about stress and health effects in the workplace. Follow-up was completed one year later (N = 106, follow-up rate: 53%) For the baseline assessment, ERI was determined as the primary influencing factor. Data on MS was recorded using the Nordic questionnaire, and burnout using the personal burnout scale of the Copenhagen Burnout Inventory (CBI). The statistical analysis was carried out using multivariate linear and logistic regression. RESULTS: At baseline ERI was present in 65% of the sample population. The mean burnout score at the time of follow-up was 53.7 (SD: 20.7); the prevalence of MS was between 19% and 62%. ERI was identified as a statistically significant factor for MS, after adjusting especially for physical stress (lower back: OR 4.2; 95% CI: 1.14 to 15.50, neck: OR 4.3; 95% CI: 1.25 to 15.0, total MS: OR 4.0; 95% CI: 1.20 to 13.49). With regard to burnout, a relative increase of 10% in the ERI ratio score increased the burnout score by 1.1 points (p = 0.034). CONCLUSIONS: ERI was revealed to be a major factor in relation to MS and burnout in childcare workers. Based on this observation worksite interventions on the individual and organizational level should be introduced in order to prevent ERI.

Impact of non-transferrin-bound iron (NTBI) in comparison to serum ferritin on outcome after allogeneic stem cell transplantation (ASCT).

The optimal parameters and time points for the measurement of iron overload (IO) in allogeneic stem cell transplantation (ASCT) patients are still under discussion. Hyperferritinemia and IO are poor prognostic factors in ASCT. We hypothesize that non-transferrin-bound iron (NBTI) is possibly a better marker to predict the effect of IO on the outcome than serum ferritin (SF), which however is not specific for IO. The aim of this prospective observational trial was to evaluate the influence of NBTI in comparison to SF on the outcome of ASCT patients [overall survival, bloodstream infections (BSIs), and invasive fungal infections (IFIs)]. We analyzed daily transferrin saturation (TSAT), SF, and NTBI (if TSAT exceeded 70%) in 100 patients who received ASCT during conditioning, and on day 0, +7, and +14 post-ASCT. After a median NTBI level of 0 µmol/l at baseline, the median of the area under the curve (AUC) of NTBI between conditioning and ASCT (d0) increased to 17 µmol*d/l, and between ASCT and day +14 to 56.3 µmol*d/l. Higher NTBI-AUC d0 resulted in a higher risk of BSI (HR 1.042, p = 0.009) and IFI (HR 1.070, p = 0.001) and showed a trend of inferior 1-year survival (65 vs. 76%, p = 0.09). Baseline SF did not influence BSI, but higher levels resulted in more IFI (HR 1.26, p < 0.001). In conclusion, NTBI possibly better predict for a higher risk of bloodstream infections than SF and needs further investigation.

Prevalence of latent tuberculosis infection among foreign students in Lübeck, Germany tested with QuantiFERON-TB Gold In-Tube and QuantiFERON-TB Gold Plus.

BACKGROUND: The tuberculosis (TB) incidence rate in foreign-born individuals has been increasing in Germany in recent years. Foreign students may be an important source of latent tuberculosis infection (LTBI) in low-incidence countries. In Germany, there are no guidelines for LTBI screening of foreign students. The aim of the study was to estimate LTBI prevalence and evaluate associated risk factors among foreign students in Germany. The second purpose of our study was to compare the results of the new generation of QuantiFERON-TB Gold Plus (QFT-Plus) to those of its predecessor QuantiFERON-TB Gold In-Tube (QFT-GIT). METHODS: This cross-sectional study was conducted between February 2016 and March 2016. Foreign students and young professionals attending the university and higher education institutes in Lübeck, Germany were tested with QFT-Plus and QFT-GIT. Participants filled out a questionnaire for the purpose of LTBI risk assessment and analysis. Variables associated with a positive test result were analyzed using logistic regression. RESULTS: One hundred thirty four students participated in the study. The overall prevalence as regards positive results from both tests, QFT-Plus and QFT-GIT, was 9.7%, and the prevalence of positive QFT-Plus results was 8.2%. The main independent variables associated with a positive QFT-Plus result were a) being born in a high-incidence country (OR = 6.7, 95% CI: 1.3-34.3) and b) previous contact with a person with active TB (OR = 4.5, 95% CI: 1.1-18.3). Higher age (OR = 2.8, 95% CI: 0.7-11.3) and male gender (OR = 1.6, 95% CI: 0.4-6.7) showed a tendency toward positive QFT-Plus results but this was not statistically significant. Agreement between QFT-Plus and QFT-GIT results was κ = 0.85, p < 0.001. CONCLUSIONS: The LTBI prevalence among foreign students was about 10%. We recommend implementing a policy whereby all foreign students are screened by means of a questionnaire about LTBI risk factors, so that only students with present risk factors are tested for LTBI. The agreement between the new QFT-Plus and the QFT-GIT (κ = 0.85) was good. QFT-Plus might be used in the same format as its predecessor.

Reduced frequency of severe hypoglycemia at mild ambient temperatures between 10 and 20 °C: A population-based study under marine west coast climate conditions.

AIMS: To determine the association between ambient temperature and severe hypoglycemia. METHODS: This was a prospective observational study performed in a prehospital setting. Data from the Emergency Medical Service in Hamburg (Germany) and data from the local weather station were evaluated over a 5-year period. Lowess-regression analysis was conducted to assess the relationship between ambient temperature and frequency of severe hypoglycemia. Additionally, three temperature-ranges were defined in order to compare them with each other with regard to frequency of severe hypoglycemia (<10°C vs. 10-20°C vs. >20°C). RESULTS: In 2592 patients severe hypoglycemia was diagnosed and treated by emergency physicians (T1DM: n=829/32%; T2DM: n=1763/68%). The median age of patients was 64 (57-72 [20-85]) years. Compared to mild temperatures (10-20°C) the frequency of severe hypoglycemia increased significantly at temperatures above 20°C (+18% (95%-CI: [7%; 22%], p=0.007) and below 10°C (+15% (95%-CI: [6%; 24%], p<0.001). CONCLUSIONS: The results suggest the existence of a "thermal comfort zone" covering a temperature range from 10 to 20°C in which the frequency of severe hypoglycemia was significantly lower than below 10°C and above 20°C.

Effect of patent ductus arteriosus and patent foramen ovale on left ventricular stroke volume measurement by electrical velocimetry in comparison to transthoracic echocardiography in neonates.

This prospective single-center observational study compared impedance cardiography [electrical velocimetry (EV)] with transthoracic echocardiography (TTE, based on trans-aortic flow) and analyzed the influence of physiological shunts, such as patent ductus arteriosus (PDA) or patent foramen ovale (PFO), on measurement accuracy. Two hundred and ninety-one triplicate simultaneous paired left ventricular stroke volume (LVSV) measurements by EV (LVSVEV) and TTE (LVSVTTE) in 99 spontaneously breathing neonates (mean weight 3270 g; range 1227-4600 g) were included. For the whole cohort, the mean absolute LVSVEV was 5.5 mL, mean LVSVTTE was 4.9 mL, resulting in an absolute Bland-Altman bias of -0.7 mL (limits of agreement LOA -3.0 to 1.7 mL), relative bias -12.8 %; mean percentage error MPE 44.9 %; true precision TPEV 33.4 % (n = 99 aggregated data points). In neonates without shunts (n = 32): mean LVSVEV 5.0 mL, mean LVSVTTE 4.6 mL, Bland-Altman bias -0.4 mL (LOA -2.8 to 2.0 mL), relative bias -8.2 %; MPE 50.7 %; TPEV 40.9 %. In neonates with shunts (PDA and/or PFO; n = 67): mean LVSVEV 5.8 mL, mean LVSVTTE 5.0 mL, bias -0.8 mL (LOA -3.1 to 1.5 mL), relative bias -14.8 %, MPE 41.9 %, TPEV 29.3 %. Accuracy was affected by PDA and/or PFO, with a significant increase in the relative difference in LVSVEV versus LVSVTTE: Subjects without shunts -2.9 % (n = 91), PFO alone -9.6 % (n = 125), PDA alone -14.0 % (n = 12), and PDA and PFO -18.5 % (n = 63). Physiological shunts (PDA and/or PFO) in neonates affect measurement accuracy and cause overestimation of LVSVEV compared with LVSVTTE.

Use of moulded hearing protectors by child care workers - an interventional pilot study.

BACKGROUND: Employees of a multi-site institution for children and adolescents started to wear moulded hearing protectors (MHPs) during working hours, as they were suffering from a high level of noise exposure. It was agreed with the institutional physician and the German Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW) that this presented an opportunity to perform a scientific study to investigate potential beneficial effects on risk of burnout and subjective noise exposure at work when child care workers wear MHPs. METHODS: This was an intervention study which compared the initial values with those after a follow-up of 12 months. All teaching child care workers employed by the multi-site institution were offered the opportunity to take part. Forty-five (45) employees in 16 institutions participated. The subjects were provided with personally adapted MHPs and documented the periods of wear in a diary. At the start and end of the intervention, the subjects had to answer a questionnaire related to subjective noise exposure and burnout risk. In parallel, employees were surveyed who had not taken part in the intervention. RESULTS: Thirty-three (33) subjects took part in the follow-up after 12 months (follow-up rate 73 %). The median period of wear of MHPs was 34.6 h. During the period of observation, the mean subjective noise exposure increased by 2.7 %, and mean burnout risk by 2.5 scale points (baseline: 55.2, follow-up 57.7). Neither difference was statistically significant. 67 % of the participants reported that they were still capable of fulfilling their teaching duties when wearing the MHPs. In the reference group without the intervention, the increase in burnout risk was 3.9 points, which was even less favourable (baseline: 50.6, follow-up: 54.5). CONCLUSIONS: Within the working environment of the child care workers, wearing MHPs did not reduce subjective noise exposure or burnout risk; the satisfaction of the study subjects with wearing MHPs decreased over time. There were however signs that the level of stress increased over time and that this might have been alleviated in the intervention group by wearing MHPs.