Die Fahrradergometrie in der arbeitsmedizinischen Vorsorge

A sufficiently high level of physical performance is of elementary importance for many occupational groups for coping with the daily work requirements. These include the fire brigade, police, military and also those employed in the construction industry, mining and agriculture. For the examination of the physical performance (bicycle) ergometry is available to the occupational physician as a standardized investigation, which is feasible under practical conditions. Taking the national and international guidelines and current scientific literature into consideration, the knowledge, prerequisites, indications and contraindications of ergometry that are necessary for the occupational physician are summarized. The recommendations for implementation are presented. Abort criteria in cases of pathological abnormalities or when the maximum workload is reached are listed. The advantages and disadvantages of gradual vs. ramp loading are shown. In addition to the physiologically expected reactions in this stress test, the limited sensitivity and specificity of ergometry for the diagnostics of coronary heart disease are discussed using examples of false positive and false negative ergometry examinations for men and women aged 50–59 years with unclear chest pains. Moreover, the different forms of ergometry and the partially limited comparability with each other and with real working conditions make the validity of bicycle ergometry for assessing the physical performance of a test person more difficult, since only the specific bicycle ergometric performance is tested. Therefore, despite the low complication rates in healthy and young volunteers, the use of bicycle ergometry in preventive occupational healthcare should not automatically be used in the assessment of physical performance for a subject’s employment in a particular workplace

Risk factors for musculoskeletal injuries in the military : a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

Funding Information: The authors would like to thank LTC Dr. Damien Van Tiggelen (Belgium) and Ms. Beatriz Sanz-Bustillo Aguirre (Spain) for their participation and input in the discussion during the HFM-283 meeting in Cologne (Germany) in January 2020. Publisher Copyright: © 2021, The Author(s).Background: Musculoskeletal injuries (MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training, operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available. Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed (using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made. Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/non-modifiable, as well as extrinsic/intrinsic risk factors. Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.publishersversionPeer reviewe

Electrocardiographic abnormalities in medically screened German military aircrew

Background!#!A resting electrocardiogram (ECG) is a well-tolerated, non-invasive, and inexpensive test for overt electrical signs of cardiac pathology and is widely used in the screening of aircrew and other high-hazard occupations. Given the low number of pathological results leading to disqualification or restriction however, there is an ongoing debate as to how often screening ECGs should be performed in different age groups.!##!Methods!#!We restrospectively analyzed 8275 resting 12-lead ECGs registered between 2007 and 2020 in the German Air Force Centre of Aerospace Medicine. Findings were categorized according to consensus recommendations published by the NATO Working Group on Occupational Cardiology in Military Aircrew, based on ECG screening criteria published for athletes which were used at the time of registration. Age, sex, height, weight, and body mass index of the probands were also captured. Additionally, 4839 pilot and non-pilot aircrew members were analyzed longitudinally over a maximum period of 13.4 years.!##!Results!#!Out of all the ECGs only 18 revealed findings requiring further investigation, and only one individual was temporarily disqualified because of a ventricular pre-excitation (delta wave) as a sign of an antegrade conducting accessory pathway. The longitudinal analysis of 25,829 ECGs revealed 28 abnormalities requiring further investigation, and only two ECG findings (in probands aged 48.8 and 59.1 years) led to temporary, or permanent disqualification. In a third case, the ECG showed signs of a myocardial infarction, which was already known from the proband's history.!##!Conclusions!#!Initial ECG screening for asymptomatic aircrew revealed extremely low numbers of individuals requiring further investigation in our cohort. This would appear to justify an initial screening ECG and follow-up ECGs at certain intervals starting at a certain age, but routine ECG screening of applicants in professions with a higher risk tolerance or frequent, e.g. annual, follow-up ECGs in younger aircrew is not supported by our data because of the minimal yield of ECG findings requiring further investigation

Factors Influencing Heart Rate Variability

The measurement and analysis of heart rate variability (HRV), which is based on the variation between consecutive NN intervals, has become an established procedure over the past two decades. A decrease in HRV has been shown to correlate with an increase in mortality. HRV is influenced by a number of physiological factors such as various diseases. Awareness of these mediators or confounders is of great importance in the analysis and assessment of HRV both in scientific studies and in clinical practice. This document, which is based on a selective survey of references and supplemented by information from national and international guidelines, presents the main endogenous, exogenous and constitutional factors. A decrease in HRV has been observed not only in connection with non-influenceable physiological factors such as age, gender and ethnic origin, but also in conjunction with a large number of acute and chronic diseases. Numerous lifestyle factors have both a positive and a negative influence on HRV. There are also physical influences that affect HRV. They must on no account be disregarded. Although the list of the factors is long and not all of them have yet been fully studied, awareness of them is of crucial importance in the measurement of HRV (both under laboratory conditions and during medical practice), its analysis and its assessment. More research also needs to be carried out to close knowledge gaps

Soldiers’ physical activity of daily life: a systematic literature review

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Purpose</jats:title> <jats:p>High physical fitness and good health are not only essential for the civilian population but also for persons working in physically and psychologically demanding professions, such as armed forces personnel. To date there is no scientific summary of studies dealing with the physical activity of daily life in armed forces personnel, but this is necessary for a targeted intervention.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>A systematic review was performed in the PubMed database (target date: 24 May 2020), using the search terms “military personnel” and “exercise” or “(physical) activity of daily life” including the assigned MESH words.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>Seven original papers have focused on the daily physical activity of military personal, and they were all conducted in different countries. The activity of daily life was on average 11,540 steps per day.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>It could be shown that soldiers performed more physical activity than the civilian population and that the recommended 10,000 steps per day were slightly exceeded on average. However, the number of steps performed was very low in fields of activity with limited physical activity options, such as on board a ship. Altogether, it thus seems that additional health-promoting physical activity programs are not required for most of the soldiers, but that, in contrast, corresponding offers for physical activity alternatives, e.g., in the form of fitness equipment, are urgently required in specific task areas (e.g., on board ships).</jats:p> </jats:sec&gt

Unbemannte Systeme im FCAS-Wirkverbund – Die Bedeutung des Piloten als limitierender Faktor der Leistungsfähigkeit des Waffensystems

Unbemannte Systeme im FCAS-Wirkverbund – Die Bedeutung des Piloten als limitierender Faktor der Leistungsfähigkeit des Waffensystem

Randomised Controlled Study on Measures to Increase Vaccination Rates among German Armed Forces Soldiers

Vaccination is one of the most effective medical measures for preventing infectious diseases. Even though there are recommendations for specific occupational groups that have an increased risk of infection, e.g., armed forces personnel, there are gaps in the vaccination rates of this personal. We conducted a randomised and controlled cohort study to examine whether a computerised reminder system would increase the vaccination rates of active soldiers over a period of twelve months. A total of 506 soldiers with a mean age of 27.7 ± 6.5 years (experimental group (EG)) and 27.9 ± 6.3 years (control group (CG)) were included in our study. Only 26.2% of the EG and 31.3% of the CG had received the required vaccinations at the beginning of our study. The vaccination rates for influenza (50.5% and 49.1%) and tick-borne encephalitis (57.1% and 60.7%) were particularly low, for measles, mumps, and rubella they were high (94.3% and 97.8%). A highly significant increase (p < 0.001) in vaccination rates was observed for both groups during our study. The results revealed considerable vaccination gaps among German armed forces soldiers. Despite a highly significant increase in vaccination rates during the study, there is still a clear need for action

Ein holistischer Ansatz für die Dimension Luft - Erschließen bisher ungenutzter Potentiale

Ein holistischer Ansatz für die Dimension Luft - Erschließen bisher ungenutzter Potential

Vaccination coverage rates of military personnel worldwide: a systematic review of the literature

Objectives!#!Due to the professionally specific risk of infection in the armed forces, recommendations for vaccination are usually adapted for soldiers and are subject to special regulations. Little data is available on scientifically measured vaccination coverage of soldiers.!##!Methods!#!A systematic literature research was carried out in the PubMed database using the search terms 'army' or 'military' or 'Bundeswehr' and 'vaccination' or 'vaccine'. Studies covering the period from 1990 to 2018 that contain statements on vaccination coverage rates of soldiers were identified. Twenty-two out of the initially found 1801 results were used.!##!Results!#!The studies found were conducted in nine different countries with eight out of the 22 studies originating from the USA. The size of study was between 180 and 32,502 subjects. On average, the vaccination rates determined in the studies were between 26.8 and 94.7%. Hepatitis A coverage was lowest (a minimum of 11.3%) and tetanus vaccination coverage was highest (with a maximum of 94.7%). Vaccination rates decreased with increasing age and coverage tended to be lower for men than for women. The term of service did not have a significant effect on vaccination rates.!##!Conclusions!#!On the whole, most studies referred to recruits. They showed high vaccination rates for standard vaccinations and lower vaccination rates for indication and seasonal vaccinations. However, there were also vaccination gaps of temporary-career volunteers. This leads to a considerable effort at the armed forces to complete vaccine protection in case of a short-term operational commitment