Physikalische Noxen und ihre Auswirkungen auf die Gesundheit am Beispiel der Exposition gegenüber Umweltlärm

Zusammenfassung Hintergrund: Zahlreiche Studien weisen auf adverse Effekte für die Gesundheit durch Exposition gegenüber Umweltlärm hin. Limitation bisheriger Studien ist jedoch vor allem die teils unzureichende Erfassung der Exposition. Ziel war es daher, die Exposition der Teilnehmer gegenüber Umweltlärm mittels individueller Dosimetermessungen objektiv und summativ zu erfassen und Auswirkungen der Exposition auf den Blutdruck der Probanden zu untersuchen. Im Hinblick auf zukünftige Studien wurde in einer Pilotstudie geprüft, ob Videotelefonate via Skype ein geeignetes neues Erhebungsinstrument sind. Methoden: 628 Kinder (Alter: 8-12 Jahre; Teilnahmebereitschaft: 61%), 632 Jugendliche (Alter: 13-17 Jahre; Teilnahmebereitschaft: 58%) und 482 Erwachsene (Alter: 18-65 Jahre; Teilnahmebereitschaft: 40%) aus vier bayerischen Städten nahmen an einer 24-stündigen Dosimetermessung zur objektiven Erfassung der individuellen Lärmexposition teil. Mittels logistischer Regressionsmodelle wurde ein möglicher Zusammenhang zwischen Lärmexposition und Hypertonie berechnet. Für die Pilotstudie zur Testung von Skype wurden 300 junge Erwachsene (Alter: 18-24 Jahre; Teilnahmebereitschaft 19%) aus Landsberg am Lech randomisiert zu einem Interview per Skype oder per Telefon eingeladen. Die Teilnahmebereitschaft und Dauer der Interviews wurde zwischen beiden Methoden verglichen. Ergebnisse: Es zeigte sich eine sehr hohe Lärmexposition in allen Altersgruppen mit mittleren Schallpegeln am Tag von 80,0 dB(A) (Standardabweichung 5,8 dB(A)) bei den Kindern, 76,0 dB(A) (6,2 dB(A)) bei den Jugendlichen und 72,1 dB(A) (6,1 dB(A)) bei den Erwachsenen. Bei den Jugendlichen und Erwachsenen ergab sich zudem ein statistisch signifikanter Zusammenhang zwischen der nächtlichen Lärmexposition und Hypertonie (Odds Ratio=1,49; 95% Konfidenzintervall=1,04-2,13). Im Rahmen der Pilotstudie nahmen statistisch signifikant weniger Probanden an einem Skype-Interview (10%) als an einem Telefon-Interview (22%) teil (pChi2<0,01). Diskussion: Die objektiv gemessene Exposition gegenüber Umweltlärm ist in den bayerischen Städten sehr hoch. Außerdem wurde ein Zusammenhang zwischen der Lärmexposition und dem kardiovaskulären System beobachtet. Eine genauere Ausdifferenzierung dieses Zusammenhangs beispielsweise unter Berücksichtigung des subjektiven Belästigungserlebnis oder besonderer Fokussierung nächtlicher Lärmexposition sollte in zukünftigen Studien vorgenommen werden. Videotelefonate via Skype sind hierbei noch kein geeignetes Erhebungsinstrument in Deutschland.Abstract Background: Numerous studies indicate adverse health effects of exposure to environmental noise. However, insufficient exposure assessment is a major limitation of studies so far. Aims of these analyses were therefore to achieve an objective and summative assessment of study subjects’ exposure to environmental noise using personal noise dosimeters and to investigate potential cardiovascular effects of noise exposure. With respect to future studies, a pilot study tested if videoconference calls via Skype are a feasible tool for data collection. Methods: 628 children (age: 8-12 years; response: 61%), 632 adolescents (age: 13-17 years; response: 58%) and 482 adults (age: 18-65 years; response: 40%) from four Bavarian towns participated in a 24-h dosimeter measurement to objectively assess individual noise exposure. Logistic regression models were used to estimate the association between noise exposure and hypertension. For the pilot study, 300 young adults (age: 18-24 years; response: 19%) from Landsberg (Bavaria) were randomised and invited to take part in an interview via Skype or phone. Response and duration of interviews were compared between both methods. Results: During daytime mean noise exposure was 80.0 dB(A) (standard deviation 5.8 dB(A)) in children, 76.0 dB(A) (6.2 dB(A)) in adolescents, and 72.1 dB(A) (6.1 dB(A)) in adults. In addition, a statistically significant association between night-time noise exposure and hypertension was observed in the group of adolescents and adults (Odds Ratio=1.49, 95% Confidence Interval=1.04–2.13). Regarding the pilot study, response was statistically significantly lower in Skype interviews (10%) compared to phone interviews (22%) (pChi2<0.01). Discussion: The objectively assessed noise exposure in Bavarian towns is high. Moreover, an association between noise exposure and hypertension was observed. More detailed investigation of this association for example considering subjective annoyance or especially focussing noise exposure during the night should be conducted in upcoming studies. In doing so, Skype calls are not yet a feasible tool for data collection in Germany

Precarious employment and migrant workers' mental health: a protocol for a systematic review of observational studies

Background: Precarious employment has become an urgent public health issue at a global scale with potential consequences for quality of life and health of employees, especially in vulnerable groups such as migrants. The primary aim of this systematic review is thus to analyze and summarize existing research on the association between precarious employment and migrant workers' mental health. Methods: We will search PubMed/MEDLINE, PsycINFO, Web of Science (from January 1970 onwards) for original articles on observational studies (e.g., cohort, case-control and cross-sectional, and qualitative) published in English, German, Turkish, and Spanish. The primary outcome will be depression and anxiety disorders. Secondary outcomes will be burnout, sleeping problems, and occupational stress. Two reviewers will independently screen all citations, full-text articles, and abstract data. Potential conflicts will be resolved through discussion. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. A narrative synthesis will summarize and explain the characteristics and findings of the studies. If feasible, we will conduct random effects meta-analyses where appropriate. Discussion: This systematic review will analyze the ways in which precarious employment affects migrant workers' mental health and the process that underlies this relationship. The results from the systematic review outlined in this protocol will be of interest to labor and health professionals, policy makers, labor unions, and non-governmental organizations. Our findings may encourage and impel related policy makers to establish human-focused, safe and healthy work environments, and workplace conditions

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

INTRODUCTION Flow disruptions (FD) in the operating room (OR) have been found to adversely affect the levels of stress and cognitive workload of the surgical team. It has been concluded that frequent disruptions also lead to impaired technical performance and subsequently pose a risk to patient safety. However, respective studies are scarce. We therefore aimed to determine if surgical performance failures increase after disruptive events during a complete surgical intervention. METHODS We set up a mixed-reality-based OR simulation study within a full-team scenario. Eleven orthopaedic surgeons performed a vertebroplasty procedure from incision to closure. Simulations were audio- and videotaped and key surgical instrument movements were automatically tracked to determine performance failures, i.e. injury of critical tissue. Flow disruptions were identified through retrospective video observation and evaluated according to duration, severity, source, and initiation. We applied a multilevel binary logistic regression model to determine the relationship between FDs and technical performance failures. For this purpose, we compared FDs in one-minute intervals before performance failures with intervals without subsequent performance failures. RESULTS Average simulation duration was 30:02~min (SD = 10:48~min). In 11 simulated cases, 114 flow disruption events were observed with a mean hourly rate of 20.4 (SD = 5.6) and substantial variation across FD sources. Overall, 53 performance failures were recorded. We observed no relationship between FDs and likelihood of immediate performance failures: Adjusted odds ratio = 1.03 (95% CI 0.46-2.30). Likewise, no evidence could be found for different source types of FDs. CONCLUSION Our study advances previous methodological approaches through the utilisation of a mixed-reality simulation environment, automated surgical performance assessments, and expert-rated observations of FD events. Our data do not support the common assumption that FDs adversely affect technical performance. Yet, future studies should focus on the determining factors, mechanisms, and dynamics underlying our findings

Plasminogen activator inhibitor-1 and type 2 diabetes: a systematic review and meta-analysis of observational studies

An emerging body of evidence has implicated plasminogen activator inhibitor-1 (PAI-1) in the development of type 2 diabetes (T2D), though findings have not always been consistent. We systematically reviewed epidemiological studies examining the association of PAI-1 with T2D. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched to identify studies for inclusion. Fifty-two studies (44 cross-sectional with 47 unique analytical comparisons and 8 prospective) were included. In pooled random-effects analyses of prospective studies, a comparison of the top third vs. bottom third of baseline PAI-1 values generated a RR of T2D of 1.67 (95% CI 1.28-2.18) with moderate heterogeneity (I-2 = 38%). Additionally, of 47 cross-sectional comparisons, 34(72%) reported significantly elevated PAI-1 among diabetes cases versus controls, 2(4%) reported significantly elevated PAI-1 among controls, and 11(24%) reported null effects. Results from pooled analyses of prospective studies did not differ substantially by study design, length of follow-up, adjustment for various putative confounding factors, or study quality, and were robust to sensitivity analyses. Findings from this systematic review of the available epidemiological literature support a link between PAI-1 and T2D, independent of established diabetes risk factors. Given the moderate size of the association and heterogeneity across studies, future prospective studies are warranted

Major Depressive Syndrome (MDS) and its association with time of residence among Spanish speaking au-pairs living in Germany - a cross-sectional study

The number of au-pairs in Germany is on the rise. In 2017, about 13,500 au-pairs were living in German families, almost half of them originating from non-EU countries and many of them from Spanish speaking countries. Knowledge about mental health among au-pairs in Germany is limited. Therefore, the main objective of this study was to assess the prevalence of Major Depressive Syndrome (MDS) and its potential association with time of residence among Spanish speaking au-pairs living in Germany. A cross-sectional study was carried out, which included a sample of 409 Spanish speaking au-pairs living in Germany. We classified the au-pairs into those who lived less than three weeks in Germany (newcomer au-pairs) and those who arrived two to ten months prior to the survey (experienced au-pairs). The participants were recruited by an online survey (Facebook and Instagram) from August 2018 to June 2019. Socio-demographic characteristics, time of residence in Germany and the level of education were assessed. MDS was assessed by the Patient Health Questionnaire depression module (PHQ-9). Poisson regression models were calculated to evaluate the association between time of residence in Germany and prevalence of MDS. Most of the participants were female (91%). Almost half of them came from Colombia (48%) and were in the age range between 22-24 years (40%). Prevalence of MDS was 8% among newcomers and 19% among experienced au-pairs (p=0.002). Differences remained statistically significant after adjustment for potential confounders (age, level of education and time of residence in Germany) (Prevalence Ratio 2.25; 95% Confidence Interval: 1.22-4.14). In conclusion, au-pairs may develop mental symptoms during their time abroad. Future prospective studies should aim at identifying potential risk factors and preventive measures

Shift work and cognitive impairment in later life - results of a cross-sectional pilot study testing the feasibility of a large-scale epidemiologic investigation

Background: The effect of shift work on impairment of cognition in later life has not yet been sufficiently investigated. Therefore, we aimed at testing the feasibility of a large-scale epidemiologic study examining this putative association in a pilot study. Methods: Between January and April 2017, a cross-sectional study invited a random sample of 425 former and current employees of a German university hospital aged 55 years and older to undergo a cognitive test battery (including the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test, Letter-Number Span, and Vocabulary Test) and to complete a self-administered questionnaire on socio-demographic characteristics, chronotype, sleep, occupational history including shift work, and medical history. Fifty percent of the invitees were registered in the hospital's occupational records as currently working or having worked in a shift system. The feasibility of a large-scale study was evaluated by the response of the study sample and the completeness of data. In addition, we calculated the prevalence of shift work and cognitive impairment in the study population. Results: Seventy five subjects (18%) completed the questionnaire, of whom 47 (11% of the total sample) participated in cognitive testing. In all but four items assessed in the questionnaire, the proportion of missing data was below 10 %, suggesting that the quality of collected data can be considered as high. Eighty percent of the participants reported that they ever worked in a shift system, indicating selective participation by exposure to shift work. With respect to chronotype, the majority of the study subjects rated themselves as rather evening type, while a quarter considered themselves as definite morning type. All cognitive tests could be carried out completely. We observed slight difficulties in at least one of the cognitive tests in 17 participants (36%) while two participants (4%) showed more pronounced signs of cognitive impairment. Conclusion: The present pilot study only partially supported the feasibility of the planned large-scale study. As response rates were low and depended on exposure to shift work, a better way of sampling and recruitment needs to be identified. The questionnaire and the test battery appear to be viable instruments

Investigating the association between occupational exposure to asbestos and ovarian carcinoma: results from a pilot study in Germany

Background The aim of this pilot study was to assess the feasibility of a large-scale epidemiologic investigation elucidating the quantitative association between occupational exposure to asbestos and ovarian cancer in former German asbestos workers. Methods Between December 2017 and May 2018, a random sample of one thousand insured woman registered at the health service of a German trade association as formerly occupationally exposed to asbestos were invited to participate in a pilot study. Participation included a phone interview using a standardised questionnaire. The feasibility of the project was evaluated using a priori defined criteria. They included response, number of cases, eligibility of the questionnaire data for exact estimation of asbestos fibre-years, and availability of relevant medical documentation (imaging procedures, medical reports, and histologic materials). Results The response (17%) was clearly below the intended number of 60%. With six tumour suspects, of which two could be confirmed by medical documents, the number of cases was within the expected range of two to eleven cases. Exact asbestos fibre-year estimations could be performed for 29% of all interviewees, but only for one suspected case. Medical documentation could be collected for only few participants, while no histology reports could be obtained for all cases. Thus, only the feasibility criterion of the expected number of cases was fulfilled. Conclusion The results of the pilot study indicate that the planned project is feasible only to a very limited extent. For further planning of the study, measures to improve recruitment of participants are necessary

Third Follow-Up of the Study on Occupational Allergy Risks (SOLAR III) in Germany: Design, Methods, and Initial Data Analysis

Introduction: Asthma and allergies are complex diseases affected by genetic and environmental factors, such as occupational and psychosocial factors, as well as interactions between them. Although childhood is a critical phase in the development of asthma and allergies, few cohort studies on occupational outcomes followed up participants from childhood onwards. We present design, methods, and initial data analysis for the third follow-up of SOLAR (Study on Occupational Allergy Risks), a prospective and population-based German asthma and allergy cohort. Methods: The SOLAR cohort was initially recruited in 1995–1996 for Phase II of the German branch of the International Study of Asthma and Allergies in Childhood (ISAAC II) and followed up three times since, in 2002–2003, 2007–2009, and 2017–2018. During the third follow-up (SOLAR III), participants were between 29 and 34 years old. Since SOLAR focuses on occupational exposures, follow-ups were conducted at important points in time of the development of participants' career. To evaluate the potential of selection bias, responders and non-responders were compared based on variables from earlier study phases. In responders, frequency and pattern of missing values were examined and compared within the subsets of paper and online versions of the used questionnaires. Results: In total, 1,359 participants completed the questionnaire of the third follow-up (47.3% of eligible participants). Initially, the cohort started with 6,399 participants from the ISAAC II questionnaire study. A selection process led to a study population that is more female, higher educated, smokes less and has a higher proportion of certain asthma and allergy symptoms (also in their parents) than the initial cohort. Pattern and frequency of missing values were different for paper and online questionnaires. Discussion: The third follow-up of the SOLAR cohort offers the opportunity to analyze the course of asthma and allergies and their associations to environmental, occupational and psychosocial risk factors over more than 20 years from childhood to adulthood. Selection processes within the cohort might lead to bias that needs to be considered in future analyses