[Organization and implementation of occupational health and safety in child day care centers]. / Organisation und Umsetzung des Arbeitsschutzes in Kitas.

Background and research question: Physical and mental stress as well as infection hazards of employees in child day care centers require compliance with governmental occupational health and safety (OHS) regulations. How well OHS is organized and how measures are actually implemented are not yet empirically known. This gap was closed with an epidemiological study on the status quo. Material and methods: In the second half of 2020 a total of 120 managers of day care centers in Germany, mostly church-run, which are member companies of the German Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW), were randomly selected and interviewed. This was done by members of the BGW prevention services using a standardized survey instrument. The surveyed aspects (mostly concerning the OHS organization) were summarized in a standardized sum index between 0 and 1 (worst to best occupational health and safety) and analyzed descriptively. Results: The requirements for the organization of OHS were fulfilled in many cases. There is still some potential left for improvement in the actual implementation of organized OHS requirements. The standardized sum index is 0.82 (standard deviation 0.16). Of the respondents two thirds rated OHS in their day care center as good/very good in a global item. In free texts, the desire for more information on OHS and better communication between the day care center and the respective provider was frequently expressed. Discussion and outlook: The results confirmed a higher formal quality of OHS as found in other cross-sectional studies. To continuously improve the actual implementation of organized measures, OHS management systems, which are still rarely used in day care centers, could have a supporting effect. Corresponding instruments are available and their use should be more strongly promoted in the future. Limitations of the study include possible bias due to responses to representatives of an institution that is also responsible for OHS inspections.

[Implementation of occupational health and safety during the SARS-CoV-2 pandemic in hairdressers' salons]. / Umsetzung des Arbeitsschutzes während der SARS-CoV-2-Pandemie in Friseursalons.

BACKGROUND: There is little empirical evidence with respect to the implementation (adherence) of occupational health and safety guidelines in Germany. Recommendations for the prevention of SARS-CoV­2 infections in hairdressing services were provided by the German Statutory Accident Insurance for the Health and Welfare Services (BGW) in an occupational health and safety (OHS) standard in spring 2020. RESEARCH QUESTION: To what extent are the recommendations adhered to in this service profession as judged by hairdresser's customers after their visits? MATERIAL AND METHODS: The survey was conducted as a covert participant observational study between the beginning of October and the middle of December 2020 as a non-systematic opportunistic sample in three cities. The standardized checklist included three domains: a) measures of general, mainly technical nature, b) in contact with the customer and c) on an individual level for infection prevention.The results on domain and overall level were summarized in a standardized sum index (0-1) of SARS-CoV­2 OHS standard adherence. Nonparametric Wilcoxon tests were used to examine possible differences among the three subindices. RESULTS: The overall adherence index of 162 observations was 0.75 (SD 0.14). The two subindices on infection prevention in contact with the customer (e.g. indications for behavior rules) and on the individual level (e.g. wearing a mouth-nose covering) were significantly better than the one on general measures (e.g., hand cleaning possibility for customers). DISCUSSION: The observed adherence for prevention of SARS-CoV-2-infections in hairdresser salons was higher than experiences of the BGW on OHS adherence suggest. This might be explained by the general public awareness of risks of infection. The results on the adherence are only slightly lower than those resulting from around 400 standardized personal surveys of the BGW prevention services. LIMITATIONS: Given the non-systematic opportunistic sample, a (positive) bias in the adherence results cannot be excluded.

[On Statistical Underreporting of Norovirus-Infections: Insights from Register Data of Two Local Public Health Authorities]. / Zur statistischen Untererfassung von Norovirus-Infektionen: Erkenntnisse aus Daten von zwei Gesundheitsämtern.

BACKGROUND: Only laboratory-confirmed norovirus (NoV) cases have to be notified to the Robert Koch Institute (RKI) since 2011, but not other, e. g. clinical-epidemiological cases. It can be assumed that the extent of underreporting of NoV cases in Germany has significantly increased since then. OBJECTIVES: To discuss the extent of underreporting, we wanted to find out how many laboratory tests were carried out during gastroenteritis outbreaks. Furthermore, the significance of NoV outbreaks in occupational health is discussed. MATERIALS AND METHODS: Of all pseudonymized gastroenteritis outbreak data reported to 2 local health authorities between 2011 and 2015, the proportion of NoV outbreaks and reported cases of infection among employees in hospitals and community facilities (nursing homes for the elderly, day-care centers, schools) confirmed by laboratory tests was calculated retrospectively. RESULTS: Only a few gastroenteritis outbreaks in day-care centers were etiologically diagnosed, so that only 6% and less could be classified as NoV outbreaks. In nursing homes for the elderly, about half of the outbreaks were classified as NoV, in hospitals almost all of them. Employees accounted for up to 23% of those affected in NoV outbreaks. CONCLUSIONS: The low level of laboratory diagnostics carried out during gastroenteritis outbreaks in day-care centers suggests a considerable number of hidden NoV cases. The significant proportion of staff relative to the total number of infected persons during the outbreaks highlights the importance of the burden of NoV outbreaks as a topic in occupational health. Further, large-scale prospective studies are needed to empirically substantiate these initial findings.

Significance of norovirus in occupational health: a review of published norovirus outbreaks in Central and Northern Europe.

OBJECTIVES: Globally, norovirus (NoV) is the leading cause of gastroenteritis infection among all ages. The development of prevention strategies in the field of occupational health requires a detailed knowledge about the impact of the disease on employees. This review article aims not only at evaluating the burden of NoV outbreaks on staff but also at discussing implications for future prevention strategies. METHODS: Published NoV outbreaks in Central and Northern Europe were identified via a systematic literature search. Additionally, published NoV outbreaks in Germany were detected via a manual literature search. Key epidemiological data, as the number of symptomatic staff, was then extracted. The proportion of affected employees was calculated for each dataset (single NoV outbreaks or aggregated data of multiple outbreaks). RESULTS: Overall, 116 datasets were extracted from 72 relevant articles. 144,852 persons were affected by NoV gastroenteritis, 25,408 out of them (17.5%) were employees. 23,874 (94.0%) of them fell sick during outbreaks in hospitals and related settings. NoV cases among personnel in food establishments were reported only sporadically (mean ratio: 0.01). CONCLUSIONS: Employees in hospitals and community facilities seem quantitatively to be most vulnerable towards NoV epidemics. Therefore, high quality of prevention measures in these settings, respective compliance with prevention strategies should have the highest priority. The disease can be considered as an occupational disease, even regularly without long-term consequences. Following work safety rules, a vaccination for vulnerable groups should be recommended if the vaccine development turns out to be successful.

Challenges in Infection Epidemiology: On the Underreporting of Norovirus Gastroenteritis Cases in Germany.

It is commonly accepted that the number of officially reported incidences of norovirus (NoV) according to the German Protection against Infection Act (Infektionsschutzgesetz) does not reflect the 'true' incidence of NoV in Germany. This study aims to reveal the reasons for the underreporting of NoV cases by comparing secondary data. METHODS: NoV incidence (cases per 100,000 reference persons) in the age group 18-65 was derived from register data of four different sources in the German public health system (2011-2015): Statutory health insurance in the federal state of Lower Saxony (AOK; in- and outpatient cases), the Research Institute of Ambulatory Health Care in Germany (ZI; outpatient cases), the German Federal Statistical Office (inpatient cases; DESTATIS), and the Robert Koch Institute (RKI SurvStat; health reporting data). RESULTS: the incidence derived from the AOK in Lower Saxony varied between 49 and 66 NoV cases per 100,000 persons and was thus lower than at the federal level. Incidences of all inpatient and outpatient data were lower than the incidence according to the RKI in the last 2-3 years of the observation period. CONCLUSIONS: the disagreement between NoV incidences calculated from secondary inpatient and outpatient data and the respective numbers published by the RKI can be regarded as an indication that not all NoV cases were reported to public health authorities. This might be due to missed cases during the notification procedure or misclassification of gastroenteritis cases by general practitioners. Considering the limitations associated with analyzing secondary data, the appropriateness of these assumptions should be verified in future studies.

Design and evaluation of an IPE module at the beginning of professional training in medicine, nursing, and physiotherapy.

AIM: Interprofessional education (IPE) is a central feature of modern education in the health care professions. Despite this, empirically founded and systematically structured IPE courses are absent from many curricula. To answer the WHO's call for improved interprofessional collaboration in the health care system, a seminar was designed, implemented and evaluated. The target group consisted of students beginning nursing and medical studies (first and second semesters) and physiotherapy students (first year of training). The aim was to develop a basic IPE module focusing not only on the demands placed by academia and politics, but also the interests of the target group. This module was evaluated on the basis of the modified four-level Kirkpatrick approach. METHOD: Based on focus group interviews analyzed qualitatively using Mayring's content analysis, it was possible to define five learning objectives and develop four practice-oriented modules. The seminar was then implemented and evaluated using written pre- and post-seminar evaluations and group discussions. RESULTS: Analysis confirmed the success of the IPE concept in that the seminar was positively rated by attendees not only in terms of their immediate reactions, but also attitude, knowledge and skills according to Kirkpatrick. CONCLUSION: In the future, it is intended to offer the IPE module on a permanent basis and assess the competencies acquired in the seminar using observation. Courses to ensure sustained learning outcomes would also be desirable.

["Good dying"--definition and current state of research]. / Was ist "gutes Sterben"? Begriffsklärung und Stand der Forschung.

The advances of modern medicine did not only result in prolongation of life expectancy, but also led to a shift from dying at home to dying in public institutions. In western countries most people die at advanced age in medical facilities. Hence, the question regarding the conditions, which should be provided by society and especially medicine, to allow terminally ill people to experience "good dying" is substantial. For this purpose, an examination of patients', family members' and health care providers' understanding of the term " good dying" is required. The present paper aims at shedding light on the term "good dying" and to summarize the current state of research. Therefore, the attributes of "good dying" will be described from the perspectives of patients, family members and health care providers, which are discussed and examined in current medical-sociological research. These attributes can be illustrated on three dimensions: Quality of life at the end of life (e. g. pain relief, mental well-being), quality of dying (e. g. avoiding prolonged dying, autonomy, presence of relatives) and quality of health care at the end of life (e. g. patient-oriented health care, positive communication between health care providers and patients, availability of guidelines). Although the attributes of "good dying" are described in detail in the existing literature, further studies have to clarify the relevance and impact of these attributes as predictors of "good dying".

Perceptions of a good death among German medical students.

The purpose of our study was to examine the perceptions of a good death among medical students, who are future care providers. The authors identified 9 domains that contribute to a good death according to first- and fifth-year medical students (N=432). From their perspective, being free from pain and physical distress is only 1 important component of a good death, and other elements such as psychosocial issues should also be taken into account. A majority of medical students considers psychosocial well-being as a highly relevant aspect of patients' conditions. The results of this study could help to develop concepts for better care and more empathy, which are needed to ensure a good death for all patients.

Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.

Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.

Perceptions of heatwave risks to health: results of an qualitative interview study with older people and their carers in Freiburg, Germany.

AIMS AND OBJECTIVES: Heatwaves can pose a severe threat to health, especially to older people. However, warnings do not necessarily lead to preventive action. This study aims at exploring individual risk perception and adaptive measures of older people and their carers. Their views are explored, taking into account personal backgrounds. METHODS: Questionnaire-based interviews were administered to 20 men and women (64-94 years, living in their own homes or nursing homes) and 13 carers. A qualitative analysis following a framework approach was performed. RESULTS: The majority of respondents stated that older people might be compromised by heatwaves; however, a large proportion of respondents saw themselves as less affected than the average population. Most respondents adopted preventive measures during heatwaves and a majority received warnings or pieces of information. The role of general practitioners in direct warning situations was judged controversial. Survey respondents displayed resistance to the use of technical devices to monitor potentially dangerous situations. In addition, the results support many previous findings. In particular, the relative concepts of ageing, variety of information channels used, and control orientations could be confirmed. CONCLUSIONS: General practitioners hold a position of trust and play a central role in the promotion of preventive action, but there are also limitations to their outreach. Many respondents could be classified as socially active, which has implications for preventive information campaigns. Information campaigns using different channels and targeting a larger audience should be considered. The degree of information of carers can partly be improved.

Mental health and patterns of work-related coping behaviour in a German sample of student teachers: a cross-sectional study.

PURPOSE: The aim of this cross-sectional study was to evaluate the mental health of student teachers, to analyse the extent to which they feel prepared for their profession by the university curriculum and to investigate patterns of coping with occupational stress. METHODS: A sample of 481 German student teachers was investigated using two standardised instruments: GHQ-12 (General Health Questionnaire) and AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster), an occupational stress and coping questionnaire describing four patterns of work-related coping behaviour. In addition, we asked how well the student teachers felt that the curriculum prepared them for their profession. RESULTS: Forty-four per cent of the student teachers report impaired mental health in the second teacher training period, indicated by a GHQ value equal to or over the cut-off of four. The AVEM responses revealed more than 40% showing risk patterns (A or B) compared to only 26.3% displaying a healthy coping style (G), while 32.8% demonstrate an unambitious style (S). These GHQ values are inversely correlated with the extent to which student teachers feel prepared for their work by the university curriculum. CONCLUSIONS: Our data indicate a problematic stress level for student teachers in the second training phase (high exposure to health risks and unfavourable coping styles). Since teaching is clearly an extremely demanding job, it is vital that teacher training systems contribute towards protecting the health of teachers by focusing on fostering healthy personal attitudes and equipping young teachers with coping styles and skills that will better prepare them for the challenges facing them in their daily work. Self-care health management should also be part of the teacher training curriculum.

[Problems of evaluating regional integrated care using the example of "Gesundes Kinzigtal Integrated Care"]. / Probleme der Evaluation einer regionalen integrierten Vollversorgung am Beispiel "Gesundes Kinzigtal"

"Gesundes Kinzigtal Integrated Care" (GKIC) is one of the few population-based integrated care systems in Germany. The external evaluation of GKIC has a modular design and is coordinated by the Department of Medical Sociology of Freiburg University. In this article we will outline the different evaluation modules and address typical problems arising in the evaluation of regional integrated health care systems. One of these problems is the small size of the intervention population in a recently established pilot care system which makes the use of epidemiologic measures (such as incidence figures) difficult. Total population surveys could alleviate this problem, but when the same intervention population is questioned repeatedly for different evaluation modules, the danger of 'over-surveying' arises. This may lead to decreasing participation in further studies. These problems may be managed by using short survey instruments, by conducting surveys successively (not simultaneously) using time shifts, and by analysing claims data from health insurers. Another problem in the evaluation of comparably small systems of care is how to attribute outcomes (effects) to certain health promotion or disease management programmes: Since participants usually take part in more than one programme, the intervention effect is contaminated by multiple programme effects. These will have to be adjusted for in the final evaluation of the data. Finally, randomised controlled study (RCT) designs frequently cannot be used in the evaluation of a region-wide pilot intervention, so the evidence generated by such a (non-randomised) study is weaker than the evidence generated by an RCT.

Measuring psychological stress and strain at work - Evaluation of the COPSOQ Questionnaire in Germany.

The undisputed increase of the relevance of mental work load is confronted with a lack of qualified or at least well documented measuring instruments covering all important aspects.The COPSOQ (Copenhagen Psychosocial Questionnaire), a comprehensive instrument for the assessment of psychosocial factors at work, was tested in a partly modified version in a large German sample (N = 2561 employees). The aims of the study were the detailed investigation of the psychometric measurement properties, and based on these results, the development of an abbreviated version of the instrument.The analysis of objectivity, acceptance, practicability, sensitivity and content validity of the questionnaire as a whole did not show any problematic results - with some limitations regarding the length of the questionnaire.The assessment of the reliability, generalisability, construct validity, criterion validity and diagnostic power of the single scales showed medium to good measuring qualities for the majority of the scales (i.e. Cronbach's alpha mostly >0.7). In addition, the psychometric properties were very similar to those in the Danish COPSOQ-study.Considering all aspects of the measurement quality, a shortened version of the instrument was created. It attempts to combine measuring qualities as high as possible with a number of questions as low as possible.The German COPSOQ questionnaire is a free screening-instrument for the recording of psychosocial work load and strain for all enterprises and organisations interested. The next step is the construction of a "job exposure matrix" for psychosocial factors at work, that means a central database with work load profiles and reference values for as many occupational groups as possible.

Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany.

OBJECTIVES: To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed. METHODS: As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms. RESULTS: The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.