Prioritization of diseases for work-related health monitoring by multidimensional ranking

Aim: Although working life issues are subject to European health monitoring schemes, not many routine data sources include information on occupations or working conditions. Additional in-depth analysis is therefore necessary for diseases with high public health impact. The aim of this paper is to introduce a multidimensional ranking procedure for priority setting of diseases based on European and national data. Subject and methods: Multidimensional ranking was carried out on ten disease-specific indicators. First, suitable data sources were identified and information on indicators was retrieved. Second, the diseases were sorted by their ranks according to each indicator. Third, all ranks were added to a rank sum. Finally, the diseases were sorted by their rank sum. Results: Diseases of the circulatory system account for the highest rank sum. The high public health impact is visible in regard to most criteria, particularly to mortality, hospital discharges, and costs. Diseases of the digestive system rank second mainly because of high ranks for hospital discharges and costs. The third place is assigned to diseases of the musculoskeletal system. Conclusion: A multidimensional ranking procedure has advantages when used for priority setting of diseases. The procedure leads to an overall rank as a summary measure for the public health impact but information for each indicator is still retrieved. Furthermore, the procedure uses ranks and is therefore scale invariant. However, ranking procedures do not lead to a selection of diseases but a rank order. So, there is still a decision rule required to determine which diseases are selected e.g. for in-depth health reporting

Struktureller und sozio-demographischer Wandel der Arbeitswelt und Änderung der beruflichen Mobilität in Deutschland 1980-2010

Der Wandel der Arbeitswelt und die Entwicklung der beruflichen Mobilität ist unter gesundheits- und präventionspolitischen Gesichtspunkten wegen einer möglichen Emergenz neuer Belastungsarten und der Einwanderung von Personen in belastungsintensive Berufe von Bedeutung. Bislang fehlt allerdings eine gemeinsame Analyse dieser Einflüsse. Ziel dieses Beitrags ist es, den demographischen und strukturellen Wandel der Arbeitswelt sowie die Änderung der beruflichen Mobilität anhand ausgewählter Indikatoren zu beschreiben. Wir fokussieren dabei auf sozio-demographische Kennzahlen und analysieren die Mobilität interbetrieblich (Wechsel der Arbeitgeber), interberuflich (Wechsel in andere Berufe), intersektoral (Wechsel in andere Branche) sowie interregional (Wechsel in ein anderes Bundesland). Datengrundlage ist die Stichprobe der Integrierten Arbeitsmarktbiografien des Instituts für Arbeits-markt- und Berufsforschung. Bei dem sogenannten Regionalfile handelt sich um eine ca. 2 % Stich-probe aus der Grundgesamtheit der integrierten Erwerbsbiographien. Für den Zeitraum 1980 bis 2010 verdeutlichen die Auswertungen einen durchgreifenden sozio-demographischen und strukturellen Wandel der Arbeitswelt. Während sich in der Mehrzahl der Wirtschaftsgruppen eine Abnahme der Beschäftigung zeigt, gewinnen die ohnehin schon beschäftigungsstarken Branchen wie das Kredit- und Versicherungsgewerbe und die Erziehungs-, Sozial- und Gesundheitseinrichtungen weiter an Bedeutung. Es zeigt sich eine bedeutende Zunahme des Anteils der Frauen, der Teilzeittätigkeit, sowie eine Alterung und Qualifizierung in nahezu allen Wirtschaftsgruppen. Dabei erfasst der Wandel die Wirtschaftsgruppen und besonders die Berufe unterschiedlich stark. Gleichzeitig kann auch 2010 von typischen Frauenberufen mit Beschäftigungsanteilen von über 95 % gesprochen werden, etwa bei KindergärtnerInnen und SprechstundenhelferInnen. Die berufliche Mobilität hat im Hinblick auf alle betrachteten Mobilitätskennziffern zugenommen. Während sozialversicherungspflichtig Beschäftigte im Jahr 1990 rechnerisch in 28 verschiedenen Betrieben arbeiteten (pro 100 Beschäftigungsjahre), waren es 2010 bereits 34. Die Änderungen fallen im Zeitraum 1990 bis 2000 größer aus als von 2000 zu 2010. Altersadjustiert bleibt eine kontinuierliche Zunahme der Betriebs-, Berufs und Branchenwechsel erhalten, während bei der räumlichen Mobilität über Bundesländer kein Trend beobachtet werden kann. Bei allen Kennziffern ist die berufliche Mobilität bei Jüngeren besonders ausgeprägt. Berufsspezifisch finden sich besonders auffällige Änderungen für Frauen mit Schweißer-, Post-, Verkehrs- und Industrieberufe; für Männer bei Kassierern und Friseuren. Diese Berufe sind dadurch gekennzeichnet, dass das Risiko für Betriebswechsel im Jahr 2010 im Vergleich zu 1990 um mindestens 30 % erhöht war. Die erzielten Ergebnisse können durch die Datenbasis beeinflusst sein. Z.B. sind geringfügig Beschäftigte erst seit 1999 in das gesetzliche Meldesystem eingeschlossen. Zudem ist eine Analyse der Ursachen der beruflichen Mobilität - etwa eine erhöhte Wechselbereitschaft oder erzwungene Wechsel - aufgrund der Datengrundlage nicht möglich

Alignment of retention time obtained from multicapillary column gas chromatography used for VOC analysis with ion mobility spectrometry

Multicapillary column (MCC) ion mobility spectrometers (IMS) are increasingly in demand for medical diagnosis, biological applications and process control. In a MCC-IMS, volatile compounds are differentiated by specific retention time and ion mobility when rapid preseparation techniques are applied, e.g. for the analysis of complex and humid samples. Therefore, high accuracy in the determination of both parameters is required for reliable identification of the signals. The retention time in the MCC is the subject of the present investigation because, for such columns, small deviations in temperature and flow velocity may cause significant changes in retention time. Therefore, a universal correction procedure would be a helpful tool to increase the accuracy of the data obtained from a gas-chromatographic preseparation. Although the effect of the carrier gas flow velocity and temperature on retention time is not linear, it could be demonstrated that a linear alignment can compensate for the changes in retention time due to common minor deviations of both the carrier gas flow velocity and the column temperature around the MCC-IMS standard operation conditions. Therefore, an effective linear alignment procedure for the correction of those deviations has been developed from the analyses of defined gas mixtures under various experimental conditions. This procedure was then applied to data sets generated from real breath analyses obtained in clinical studies using different instruments at different measuring sites for validation. The variation in the retention time of known signals, especially for compounds with higher retention times, was significantly improved. The alignment of the retention time—an indispensable procedure to achieve a more precise identification of analytes—using the proposed method reduces the random error caused by small accidental deviations in column temperature and flow velocity significantly

An analysis of sickness absence in chronically ill patients receiving Complementary and Alternative Medicine: A longterm prospective intermittent study

BACKGROUND: The popularity of complementary and alternative medicine (CAM) has led to a growing amount of research in this area. All the same little is known about the effects of these special treatments in every-day practice of primary care, delivered by general practitioners within the health insurance system. From 1994 to 2000 more than 20 German Company health insurances initiated the first model project on CAM according to the German social law. Aim of this contribution is to investigate the effectiveness of multi-modal CAM on chronic diseases within primary health care. METHODS: A long-term prospective intermittent study was conducted including 44 CAM practitioners and 1221 self-selected chronically ill patients (64% women) of whom 441 were employed. Main outcome measure is sick-leave, controlled for secular trends and regression-to-the mean and self-perceived health status. RESULTS: Sick-leave per year of 441 patients at work increased from 22 (SD ± 45.2) to 31 (± 61.0) days within three years prior to intervention, and decreased to 24 (± 55.6) in the second year of treatment, sustaining at this level in the following two years. Detailed statistical analysis show that this development exceeds secular trends and the regression-toward-the-mean effect. Sick-leave reduction was corroborated by data on self-reported improvement of patients' health status. CONCLUSION: Results of this longterm observational study show a reduction of sick leave in chronically ill patients after a complex multimodal CAM intervention. However, as this is an uncontrolled observational study efficacy of any specific CAM treatment can not be proven. The results might indicate an general effectiveness of CAM in primary care, worthwhile further investigations. Future studies should identify the most suitable patients for CAM practices, the most appropriate and safe treatments, provide information on the magnitude of the effects to facilitate subsequent definitive randomised controlled studies that will help to position complementary and alternative medicine in health care

The neutron and its role in cosmology and particle physics

Experiments with cold and ultracold neutrons have reached a level of precision such that problems far beyond the scale of the present Standard Model of particle physics become accessible to experimental investigation. Due to the close links between particle physics and cosmology, these studies also permit a deep look into the very first instances of our universe. First addressed in this article, both in theory and experiment, is the problem of baryogenesis ... The question how baryogenesis could have happened is open to experimental tests, and it turns out that this problem can be curbed by the very stringent limits on an electric dipole moment of the neutron, a quantity that also has deep implications for particle physics. Then we discuss the recent spectacular observation of neutron quantization in the earth's gravitational field and of resonance transitions between such gravitational energy states. These measurements, together with new evaluations of neutron scattering data, set new constraints on deviations from Newton's gravitational law at the picometer scale. Such deviations are predicted in modern theories with extra-dimensions that propose unification of the Planck scale with the scale of the Standard Model ... Another main topic is the weak-interaction parameters in various fields of physics and astrophysics that must all be derived from measured neutron decay data. Up to now, about 10 different neutron decay observables have been measured, much more than needed in the electroweak Standard Model. This allows various precise tests for new physics beyond the Standard Model, competing with or surpassing similar tests at high-energy. The review ends with a discussion of neutron and nuclear data required in the synthesis of the elements during the "first three minutes" and later on in stellar nucleosynthesis.Comment: 91 pages, 30 figures, accepted by Reviews of Modern Physic

Alignment of retention time obtained from multicapillary column gas chromatography used for VOC analysis with ion mobility spectrometry

Multicapillary column (MCC) ion mobility spectrometers (IMS) are increasingly in demand for medical diagnosis, biological applications and process control. In a MCC-IMS, volatile compounds are differentiated by specific retention time and ion mobility when rapid preseparation techniques are applied, e.g. for the analysis of complex and humid samples. Therefore, high accuracy in the determination of both parameters is required for reliable identification of the signals. The retention time in the MCC is the subject of the present investigation because, for such columns, small deviations in temperature and flow velocity may cause significant changes in retention time. Therefore, a universal correction procedure would be a helpful tool to increase the accuracy of the data obtained from a gas-chromatographic preseparation. Although the effect of the carrier gas flow velocity and temperature on retention time is not linear, it could be demonstrated that a linear alignment can compensate for the changes in retention time due to common minor deviations of both the carrier gas flow velocity and the column temperature around the MCC-IMS standard operation conditions. Therefore, an effective linear alignment procedure for the correction of those deviations has been developed from the analyses of defined gas mixtures under various experimental conditions. This procedure was then applied to data sets generated from real breath analyses obtained in clinical studies using different instruments at different measuring sites for validation. The variation in the retention time of known signals, especially for compounds with higher retention times, was significantly improved. The alignment of the retention time—an indispensable procedure to achieve a more precise identification of analytes—using the proposed method reduces the random error caused by small accidental deviations in column temperature and flow velocity significantly