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People can be affected by various environmental factors (e. g., odor, noise) which can lead to medical complaints or illnesses. Few adequate contact points are available for patients with suspected environmental complaints in Germany. Illustrated by the outpatient clinics for environmental medicine in Hamburg and Munich, this report shows how patients with suspected environmental medical diseases are cared for in Germany. For the exemplary presentation, the data of the environmental medicine outpatient clinics of both the university hospitals from 01.01.2019 to 31.03.2021 are presented and compared. Overall, more female than male patients were treated at both facilities. Suspected exposure to "heavy metals" was most frequently mentioned by patients as the assumed reason for their complaints. Nonetheless, the suspected exposure or "intoxication" could be ruled out in the majority of cases by appropriate examination methods in accordance to current medical guidelines. The data provided by the environmental medicine outpatient clinics show that there is a continuous demand for environmental medical care. A close cooperation between the private practice sector and the outpatient clinics for environmental medicine providing medical care to patients should therefore be sought., Competing Interests: SH: Stellvertretende Leiterin des Landesinstitutes arbeits- und umweltbezogener Gesundheitsschutz und Produktsicherheit sowie Leiterin des Sachgebiets Arbeits- und umweltbezogener Gesundheitsschutz am Bayersichen Landesamt für Gesundheit und Lebensmittelsicherheit; Tätigkeit für das Institut und die Poliklinik für Arbeits-, Sozial- und Umweltmedizin am Klinikum der Universität München. CH: Mitglied der Amtsleitung des Bayerischen Landesamtes für Gesundheit und Lebensmittelsicherheit und dadurch entsprechend Kontakt mit Forschungsprojekten mit thematischem Bezug; Brückenprofessur Umweltbezogener Gesundheitsschutz Ludwig-Maximilians-Universität. DN: leitet eine universitäre umweltmedizinische Ambulanz für gesetztlich und privat Versicherte am Klinikum der Universität München., (Thieme. All rights reserved.)

Objective: The aim of this study is to investigate whether there is an association between brief but repeated exposures to extremely cold temperatures over many years and pulmonary function., Methods: We performed a retrospective analysis of the data collected over 10 years in the context of the extended medical examinations of storeworkers exposed to extremely cold temperatures. We considered forced vital capacity (FVC), forced expiratory volume in one second (FEV 1 ), Tiffeneau-Pinelli index (FEV 1 /FVC), CO diffusion capacity (D L,CO ) and Krogh-factor (CO diffusion capacity relative to recorded alveolar volume, D L,CO /VA) reported as %-predicted. We analysed trends in outcome parameters with linear mixed models., Results: 46 male workers participated in at least two extended medical examinations between 2007 and 2017. Overall 398 measure points were available. All lung function parameters had values above the lower limit of normality at the first examination. In the multivariate model including smoking status and monthly intensity of cold exposure (≤ 16 h/month vs. > 16 h/month) FEV1%-predicted and FVC %-predicted had a statistically significant positive slope (FEV1, 0.32% 95% CI 0.16% to 0.49% p < 0.001; FVC 0.43% 95% CI 0.28% to 0.57% p < 0.001). The other lung function parameters (FEV1/FVC %-predicted, DL,CO %-predicted, DL,CO/VA %-predicted) showed no statistically significant change over time., Conclusions: Long term intermittent occupational exposure to extreme cold temperatures (-55 °C) does not appear to cause irreversible deleterious changes in lung function in healthy workers, thus the development of obstructive or restrictive lung diseases is not expected., (© 2023. The Author(s).)

Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The management of asthma has fundamentally changed during the past decades. The present guideline for the diagnosis and treatment of asthma was developed for respiratory specialists who need detailed and evidence-based information on the new diagnostic and therapeutic options in asthma. The guideline shows the new role of biomarkers, especially blood eosinophils and fractional exhaled NO (FeNO), in diagnostic algorithms of asthma. Of note, this guideline is the first worldwide to announce symptom prevention and asthma remission as the ultimate goals of asthma treatment, which can be achieved by using individually tailored, disease-modifying anti-asthmatic drugs such as inhaled steroids, allergen immunotherapy or biologics. In addition, the central role of the treatment of comorbidities is emphasized. Finally, the document addresses several challenges in asthma management, including asthma treatment during pregnancy, treatment of severe asthma or the diagnosis and treatment of work-related asthma., Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://awmf.org; AWMF-Registriernummer 020-009., (Thieme. All rights reserved.)

Background: There exists a great diversity of schedules concerning the way shift work is organized and implemented with ample agreement regarding recommendable features of a shift system. In order to adapt the shift schedule of a metropolitan police department to current recommendations, a remodelled shift schedule was introduced in 2015. The aim of this study was to evaluate the potential associations between the remodelled shift schedule and work ability, quality of life and self-rated health after one and five years., Methods: A controlled before-and- after study was conducted during the piloting phase (2015-2016) as well as a 5-year follow-up using paper questionnaires. Outcome parameters included work ability, quality of life and self-rated health., Results: Work ability, quality of life and self-rated health improved after the first year of the newly implemented shift schedule among police officers working in the piloting police stations compared to those working according to the former schedule. In 5-year follow-up differences between indicators diminished., Conclusions: The implementation of a remodelled shift schedule including more 12-h shifts accompanied by more days off and a coherent weekend off duty was not associated with detrimental effects to work ability, quality of life or self-reported health among police officers., (© 2022. The Author(s).)

Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Erklärung zu finanziellen Interessen Forschungsförderung erhalten: nein; Honorar/geldwerten Vorteil für Referententätigkeit erhalten: nein; Bezahlter Berater/interner Schulungsreferent/Gehaltsempfänger: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an im Bereich der Medizin aktiven Firma: nein; Patent/Geschäftsanteile/Aktien (Autor/Partner, Ehepartner, Kinder) an zu Sponsoren dieser Fortbildung bzw. durch die Fortbildung in ihren Geschäftsinteressen berührten Firma: nein Erklärung zu nichtfinanziellen Interessen Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Not available., (© Dustri-Verlag Dr. K. Feistle.)

The COVID-19 pandemic is changing the requirements for occupational health and safety in the workplace. The aim of the measures implemented nationwide is to reduce the spread of the virus. This applies to all areas of life, including the workplace. The "public service" includes many system-relevant occupational groups: police, fire brigade, judiciary, municipal cleaning, waterworks and administrative bodies at local and state levels. There is a broad diversity of activities in communal and federal state enterprises, especially with regard to internal organisation as well as personnel and spatial conditions. Direct interactions with people are often necessary. Maintaining the functionality of these structures is essential for public life. Education institutions and care facilities for children, people with handicaps and vulnerable groups, institutions for nursing and geriatric care as well as public transport are not covered in this statement due to their special work structures. These recommendations address the professionally accountable in the respective public service institutions. It deals with infection control measures at work in the public service, derived from the risk assessments of various settings. The measures presented can be implemented as part of an operational concept for temporary infection control measures. The aim is to provide general guidance on infection protection with respect to work situations in order to slow down the dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), to protect at-risk groups, and ensure the functioning of the aforementioned structures., (© The Author(s) 2021.)

In order to maintain university teaching while observing the distance rules in accordance with the occupational health and safety standard of the German Federal Ministry of Labour and Social Affairs (BMAS), special regulations and measures must be observed under the conditions of the COVID-19 pandemic when students and teaching staff meet in large groups (lecture hall) and small teaching rooms (seminars, internships). The article gives detailed recommendations for the practical implementation of protective and preventive measures according to the STOP principle, which is customary in occupational health and safety: substitution, technical, organisational and personal protective measures. Responsibilities are named and also difficult situations where physical proximity is necessary (e.g. teaching medical examinations, joint laboratory work, sports and dance seminars) are analysed with regard to the necessary measures; recommendations are formulated., (© The Author(s) 2020.)

Objective: To assess whether there are differences in musculoskeletal pain among different types of occupations offshore and their relationship to ergonomic demands., Methods: We conducted a web-based cross-sectional survey among workers from offshore wind energy companies operating within the German exclusive economic zone. We selected workers with regular offshore commitments and at least 28 days spent offshore in the past year (n = 268). Musculoskeletal pain was assessed using the Subjective Health Complaints inventory (SHC), which considers the past month., Results: Of the 268 male participants eligible for analysis, 54% reported back pain 50.4% neck pain, 40.3% lower back pain, 35.5% shoulder, 23.3% arm and 22.1% leg pain, all of them during the past month. Compared to other offshore occupations, technicians reported more frequently arm (OR 3.13; 95% CI 1.58-6.19), back (OR 1.97; 95% CI 1.15-3.39), shoulder (OR 1.94; 95% CI 1.11-3.40) and neck pain (OR 1.89; 95% CI 1.11-3.22). After adjusting for age and nationality, lifting and carrying heavy loads were associated with all types of pain except leg pain. Overhead work, work in awkward postures, and the use of personal protection equipment and heavy tools was associated with shoulder, back and arm pain., Conclusions: Our findings suggest that occupational health counselling, health promotion and preventive interventions of offshore wind energy workers needs to consider the specific tasks of the employee and be particularly tailored to the ergonomic needs of technicians.

Purpose: Workers on offshore wind turbine installations face a variety of physical and psychological challenges. To prevent potentially dangerous situations or incidents, guidelines for the physical aptitude testing of offshore employees in Germany and other European countries have been developed. However, these criteria have not been previously empirically tested for validity. Although an important component of occupational health and safety, such aptitude testing should not lead to the unjustified exclusion of potential employees., Methods: Heart rate (HR) and oxygen consumption ([Formula: see text]) measurements of 23 male offshore employees and trainers were taken during typical field activities, within the framework of mandatory training exercises. These were evaluated in relation to the individual maximum values of the subjects, determined by cycle spiroergometry., Results: For the training modules, average HR and [Formula: see text] values of approximately 40% and 33-48% of the maximum values, respectively, were found. Furthermore, 65% of the participants achieved average HR values that exceeded 30% of their individual heart rate reserve and 45% had [Formula: see text] values above 35% of their individual [Formula: see text]., Conclusion: Our preliminary results show that offshore work is a form of heavy physical labor, thereby justifying the criteria put forth in the various fitness to work guidelines. We propose that more in-depth investigations should be performed, incorporating task-specific fitness testing as well as higher level aspects of work safety and security, including effective communication skills and teamwork. We also recommend a re-evaluation of the current limits for physical work provided in the literature. The results of such studies could then be applied to other aptitude tests, thereby strengthening the evidence for such measures.

Spiroergometric measurements of persons who require oxygen insufflation due to illness can be performed under conditions of increased inspiratory oxygen concentration (FIO2). This increase in FIO2, however, often leads to errors in the calculation of oxygen consumption ([Formula: see text]). These inconsistencies are due to the application of the Haldane Transformation (HT), an otherwise indispensable correction factor in the calculation of [Formula: see text] that becomes inaccurate at higher FIO2 concentrations. A possible solution to this problem could be the use of the 'Eschenbacher transformation' (ET) as an alternative correction factor. This study examines the concentration of FIO2 at which the HT and the ET are valid, providing plausible data of oxygen consumption corresponding to the wattage achieved during cycle ergometry. Ten healthy volunteers underwent spiroergometric testing under standard conditions (FIO2 = 20.9%), as well as at FIO2 = 40% and 80%. When compared with the predicted values of [Formula: see text], as calculated according to Wasserman et al. (2012), the data obtained show that both the HT and ET are valid under normal conditions and at an increased FIO2 of 40%. At FIO2 concentrations of 80%, however, the [Formula: see text] values provided by the HT begin to lose plausibility, whereas the ET continues to provide credible results. We conclude that the use of the ET in place of the HT in spiroergometric measurements with increased FIO2 allows a reliable evaluation of stress tests in patients requiring high doses of supplemental oxygen., Competing Interests: SL carried out this study. At the time of the study 2016/17, in addition to his Ph.D. student position at the University Medical Center Hamburg-Eppendorf, SL worked as a Product Manager for CareFusion, Höchberg, Germany. This company provided the spiroergometry devices, the used material, and a small compensation for each of the 10 participants of the study. (CareFusion changed to Vyaire medical and is since 2015 part of BD an international medical technology company.) CareFusion as owner of the used CPET-device “Vyntus CPX” did not have any influence on the content and realisation of this study. CareFusion wanted to support SL with his doctoral thesis by providing the CPET-device without direct commercial purpose. This does not alter our adherence to PLOS ONE policies on sharing data and materials. SL does not have any patents on the used technology. RH, AK, VH and AMP declare, to have no conflicts of interest regarding this study.

Background: Employees in the offshore wind industry are exposed to various job demands, increasing the workers' risk of experiencing strain reactions. However, personal and job resources might play a role in the stressor-strain context. The aim of this study was (1) to examine the link between offshore employees' quantitative demands and stress, and (2) to study the role of personal and job resources (psychological detachment from work, social support, and influence at work) in this stressor-strain relationship., Methods: Two hundred fifty offshore wind workers responded to an anonymous web-based survey, assessing the workers' quantitative demands, social support, influence at work, psychological detachment from work, and stress. Descriptive statistical analyses and structural equation modelling were applied to test the hypotheses., Results: Correlation analyses revealed substantial associations between employees' quantitative demands, personal and job resources, and stress. Results of structural equation modelling indicated a good fit of the hypothesized model. Quantitative demands were positively related to stress, and psychological detachment from work partially mediated this relationship. Social support was negatively related to stress, while influence at work was not. Neither social support nor influence at work moderated the stressor-strain or stressor-detachment relationship., Conclusions: The results contribute to the current knowledge on the topic. They can be used to design health promotion interventions aimed at reducing offshore employees' quantitative demands, fostering their ability to mentally detach from work, and enhancing social support at the offshore workplace.

Objectives: To assess the physical strains of employees in the German offshore wind industry, according to job type and phase of the wind farm (under construction or operation)., Design: Web-based cross-sectional survey., Setting: Offshore wind farm companies operating within the German exclusive economic zone., Participants: Male workers with regular offshore commitments and at least 28 days spent offshore in the past year (n=268)., Outcome Measures: Physical strains (eg, climbing, noise, working overhead, with twisted upper body or in confined spaces, vibration, heavy lifting, humidity, odours)., Results: The most frequently mentioned physical strain was 'climbing' with 63.8% of the respondents reporting to be always or frequently confronted with climbing and ascending stairs during offshore work. Work as a technician was associated with a greater exposition to noise, vibrations, humidity, cold, heat, chemical substances, lifting/carrying heavy loads, transport of equipment, working in non-ergonomic positions and in cramped spaces, as well as climbing.Indeed, statistical analyses showed that, after adjusting for phase of the wind farm, age, nationality, offshore experience, work schedule and type of shift, compared with non-technicians, working as a technician was associated with more frequently lifting/carrying of heavy loads (OR 2.58, 95% CI 1.58 to 4.23), transport of equipment (OR 2.06 95% CI 1.27 to 3.33), working with a twisted upper body (OR 2.85 95% CI 1.74 to 4.69), working overhead (OR 2.77 95% CI 1.67 to 4.58) and climbing (OR 2.30 95% CI 1.40 to 3.77). Working in wind farms under construction was strongly associated with increased and decreased exposure to humidity (OR 2.32 95% CI 1.38 to 3.92) and poor air quality (OR 0.58 95% CI 0.35 to 0.95), respectively., Conclusions: Workers on offshore wind farms constitute a heterogeneous group, including a wide variety of occupations. The degree of exposure to detrimental physical strains varies depending on the type of job. Technicians are more exposed to ergonomic challenges than other offshore workers., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Offshore work has been described as demanding and stressful. Despite this, evidence regarding the occupational strain, health, and coping behaviors of workers in the growing offshore wind industry in Germany is still limited. The purpose of our study was to explore offshore wind employees' perceptions of occupational strain and health, and to investigate their strategies for dealing with the demands of offshore work., Methods: We conducted 21 semi-structured telephone interviews with employees in the German offshore wind industry. The interviews were transcribed and analyzed in a deductive-inductive approach following Mayring's qualitative content analysis., Results: Workers generally reported good mental and physical health. However, they also stated perceptions of stress at work, fatigue, difficulties detaching from work, and sleeping problems, all to varying extents. In addition, physical health impairment in relation to offshore work, e.g. musculoskeletal and gastrointestinal complaints, was documented. Employees described different strategies for coping with their job demands. The strategies comprised of both problem and emotion-focused approaches, and were classified as either work-related, health-related, or related to seeking social support., Conclusions: Our study is the first to investigate the occupational strain, health, and coping of workers in the expanding German offshore wind industry. The results offer new insights that can be utilized for future research in this field. In terms of practical implications, the findings suggest that measures should be carried out aimed at reducing occupational strain and health impairment among offshore wind workers. In addition, interventions should be initiated that foster offshore wind workers' health and empower them to further expand on effective coping strategies at their workplace.

Background: Despite the particular demands inherent to offshore work, little is known about the working conditions of employees in the German offshore wind industry. To date, neither offshore employees' job demands and resources, nor their needs for improving the working conditions have been explored. Therefore, the aim of this study was to conduct a qualitative analysis to gain further insight into these topics., Methods: Forty-two semi-structured telephone interviews with German offshore employees ( n  = 21) and offshore experts ( n  = 21) were conducted. Employees and experts were interviewed with regard to their perceptions of their working conditions offshore. In addition, employees were asked to identify areas with potential need for improvement. The interviews were analysed in a deductive-inductive process according to Mayring's qualitative content analysis., Results: Employees and experts reported various demands of offshore work, including challenging physical labour, long shifts, inactive waiting times, and recurrent absences from home. In contrast, the high personal meaning of the work, regular work schedule (14 days offshore, 14 days onshore), and strong comradeship were highlighted as job resources. Interviewees' working conditions varied considerably, e.g. regarding their work tasks and accommodations. Most of the job demands were perceived in terms of the work organization and living conditions offshore. Likewise, employees expressed the majority of needs for improvement in these areas., Conclusions: Our study offers important insight into the working conditions of employees in the German offshore wind industry. The results can provide a basis for further quantitative research in order to generalize the findings. Moreover, they can be utilized to develop needs-based interventions to improve the working conditions offshore.

Purpose: Collecting waste is regarded as a benchmark for "particularly heavy" work. This study aims to determine and compare the workload of refuse workers in the field. We examined heart rate (HR) and oxygen uptake as parameters of workload during their daily work., Methods: Sixty-five refuse collectors from three task-specific groups (residual and organic waste collection, and street sweeping) of the municipal sanitation department in Hamburg, Germany, were included. Performance was determined by cardiopulmonary exercise testing (CPX) under laboratory conditions. Additionally, the oxygen uptake (VO2) and HR under field conditions (1-h morning shift) were recorded with a portable spiroergometry system and a pulse belt., Results: There was a substantial correlation of both absolute HR and VO2 during CPX [HR/VO2 R 0.89 (SD 0.07)] as well as during field measurement [R 0.78 (0.19)]. Compared to reference limits for heavy work, 44% of the total sample had shift values above 30% heart rate reserve (HRR); 34% of the individuals had mean HR during work (HRsh) values that were above the HR corresponding to 30% of individual maximum oxygen uptake (VO2,max). All individuals had a mean oxygen uptake (VO2,1h) above 30% of VO2,max., Conclusion: HR as well as the measurement of VO2 can be valuable tools for investigating physiological workload, not only under laboratory conditions but also under normal working conditions in the field. Both in terms of absolute and relative HR and oxygen consumption, employment as a refuse collector should be classified in the upper range of defined heavy work. The limit of heavy work at about 33% of the individual maximum load at continuous work should be reviewed.

Isocyanates are a well-known and frequent cause of occupational asthma. The implementation of specific inhalation challenges (SICs) is the gold standard in asthma diagnosis supporting occupational case history, lung function testing, specific skin prick tests and the detection of specific IgE. However, the diagnosis is not always definitive. An interesting new approach, analyses of individual genetic susceptibilities, requires discrimination between a positive SIC reaction arising from IgE-mediated immune responses and one from other pathophysiological mechanisms. Hence, additional refinement tools would be helpful in defining sub-classes of occupational asthma and diagnosis. We used total IgE levels, specific IgE and SIC results for sub-classification of 27 symptomatic isocyanate workers studied. Some mutations in glutathione S-transferases (GSTs) are suspected either to enhance or to decrease the individual risk in the development of isocyanate asthma. Our patient groups were assessed for the point mutations GSTP1*I105V and GSTP1*A114V as well as deletions (null mutations) of GSTM1 and GSTT1. There seems to be a higher risk in developing IgE-mediated reactions when GSTM1 is deleted, while GSTT1 deletions were found more frequently in the SIC positive group. Blood samples taken before SIC, 30-60 min and 24h after SIC, were analyzed for histamine and IL-4, classical markers for the IgE-mediated antigen-specific activation of basophils or mast cells. We suggest that the utility of histamine measurements might provide an additional useful marker reflecting isocyanate-induced cellular reactions (although the sampling times require optimization). The promising measurement of IL-4 is not feasible at present due to the lack of a reliable, validated assay., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Introduction: Healthcare workers (HCWs) in low incidence countries with contact to patients with tuberculosis (TB) are considered a high-risk group for latent TB infection (LTBI) and therefore are routinely screened for LTBI. The German Occupational TB Network data is analyzed in order to estimate the prevalence and incidence of LTBI and to evaluate putative risk factors for a positive IGRA and the performance of IGRA in serial testing., Methods: 3,823 HCWs were screened with the Quantiferon Gold in Tube (QFT) at least once; a second QFT was performed on 817 HCWs either in the course of contact tracing or serial examination. Risk factors for a positive QFT were assessed by a questionnaire., Results: We observed a prevalence of LTBI of 8.3%. Putative risk factors for a positive QFT result were age >55 years (OR 6.89), foreign country of birth(OR 2.39), personal history of TB (OR 6.25) and workplace, e.g. infection ward (OR 1.76) or geriatric care (OR 1.99). Of those repeatedly tested, 88.2% (721/817) tested consistently QFT negative and 47 were consistently QFT-positive (5.8%). A conversion was observed in 2.8%(n = 21 of 742 with a negative first QFT) and a reversion occurred in 37.3% (n = 28 of 75 with a positive first QFT). Defining a conversion as an increase of the specific interferon concentration from <0.2 to >0.7 IU/ml, the conversion rate decreased to 1.2% (n = 8). Analogous to this, the reversion rate decreased to 18.8% (n = 9) [corrected]., Discussion: In countries with a low incidence of TB and high hygiene standards, the LTBI infection risk for HCWs seems low. Introducing a borderline zone from 0.2 to ≤ 0.7 IU/ml may help to avoid unnecessary X-rays and preventive chemotherapy. No case of active TB was detected. Therefore, it might be reasonable to further restrict TB screening to HCWs who had unprotected contact with infectious patients or materials.

Introduction: Despite the decline of tuberculosis in the population at large, healthcare workers (HCW) are still at risk of infection., Methods: In a narrative review the TB risk in HCW and preventive measures are described, with the focus on epidemiology and Occupational Safety and Health (OSH) regulations in Germany., Results: There is an increased risk of infection not only in pneumology and laboratories with regular contact with tuberculosis patients or infectious materials. Epidemiological studies have also verified an increased risk of infection from activities that involve close contact with patients' breath (e.g. bronchoscopy, intubation) or close contact with patients in need of care in geriatric medicine or geriatric nursing. In occupational disease claim proceedings on account of tuberculosis, the burden of proof can be eased for insured persons who work in these or other comparable fields. Forgoing evidence of an index person as a source of infection has led to a doubling of the rate of cases of tuberculosis recognised as an occupational disease and has halved the duration of occupational disease claim proceedings in Germany. For several years now, it has been possible to use the new interferon-y release assays (IGRAs) to diagnose a latent tuberculosis infection (LTBI) with significantly greater validity than with the traditional tuberculin skin test (TST). However, variability of the IGRAs around the cut-off poses problems especially in serial testing of HCWs. At around 10%, LTBI prevalence in German healthcare workers is lower than had been assumed. It can make sense to treat a recent LTBI in a young healthcare worker so as to prevent progression into active tuberculosis. If the LTBI is occupational in origin, the provider of statutory accident insurance can cover the costs of preventive treatment. However, little is known about disease progression in HCWs with positive IGRA sofar., Conclusion: TB screening in HCWs will remain an important issue in the near future even in low incidence, high income countries, as active TB in HCWs is often due to workplace exposure. The IGRAs facilitate these screenings. However, variability of IGRA results in serial testing of HCWs need further investigations.

There is a need for a panel of suitable biomarkers for detection of environmental chemical exposure leading to the initiation or progression of degenerative diseases or potentially, to cancer. As the peripheral blood may contain increased levels of circulating cell-free DNA in diseased individuals, we aimed to evaluate this DNA as effect biomarker recognizing vulnerability after exposure to environmental chemicals. We recruited 164 individuals presumably exposed to halo-alkane-based pesticides. Exposure evaluation was based on human biomonitoring analysis; as biomarker of exposure parent halo-methanes, -ethanes and their metabolites, as well as the hemoglobin-adducts methyl valine and hydroxyl ethyl valine in blood were used, complemented by expert evaluation of exposure and clinical intoxication symptoms as well as a questionnaire. Assessment showed exposures to halo alkanes in the concentration range being higher than non-cancer reference doses (RfD) but (mostly) lower than the occupational exposure limits. We quantified circulating DNA in serum from 86 individuals with confirmed exposure to off-gassing halo-alkane pesticides (in storage facilities or in home environment) and 30 non-exposed controls, and found that exposure was significantly associated with elevated serum levels of circulating mitochondrial DNA (in size of 79 bp, mtDNA-79, p = 0.0001). The decreased integrity of mtDNA (mtDNA-230/mtDNA-79) in exposed individuals implicates apoptotic processes (p = 0.015). The relative amounts of mtDNA-79 in serum were positively associated with the lag-time after intoxication to these chemicals (r = 0.99, p<0.0001). Several months of post-exposure the specificity of this biomarker increased from 30% to 97% in patients with intoxication symptoms. Our findings indicate that mitochondrial DNA has a potential to serve as a biomarker recognizing vulnerable risk groups after exposure to toxic/carcinogenic chemicals.

Purpose: Early recognition improves the prognosis of isocyanate asthma. A major unanswered question is whether IgE-dependent mechanisms are of diagnostic value? Our objective was to appraise serological methods using various methylenediphenyl diisocyanate (MDI)-albumin conjugates and weigh up the data versus the outcome of standardized comprehensive clinical diagnostics to evaluate the viability of immunological analysis in supportive MDI-asthma diagnosis (OAI)., Methods: Specific IgE (sIgE) and IgG (sIgG) binding was measured with fluorescence enzyme immunoassay in 43 study subjects (using conjugates prepared in-vapor, in-solution and commercial preparations). The differential clinical diagnosis included standardized measurement of pulmonary function, non-specific bronchial hyper-responsiveness, specific MDI-prick test (MDI-SPT) and specific inhalation challenge (MDI-SIC)., Results: Detailed diagnostic scheme allows the differential OAI and MDI-induced hypersensitivity pneumonitis (PI). The presumed OAI diagnoses were confirmed in 84 % (45 % cases having demonstrable sIgE antibodies) with RR 5.7, P > 0.001, when OAI diagnosis is correlated with MDI-SIC/MDI-SPT (RR 1.28 for MDI-SIC alone); sIgG antibodies were clinically relevant for PI and not for the OA diagnosis. MDI-specific IgE data generated with commercial ImmunoCAP preparations show high correlation with our in-vapor generated MDI conjugates., Conclusions: Isocyanate-specific IgE antibodies are not always detectable but their presence is strongly predictive of OAI and supportive for the diagnosis. MDI-SPT can be a valuable parameter differentiating OAI and PI. We have confirmed and extended published data showing that isocyanate-albumin conjugates perform better in specific antibody assays when prepared with volatile phase formulations and would like to stress additionally the necessity for further refinements and standardization in clinical diagnostics procedures.

Headache, concentration and memory disorders, dizziness and nausea, skin irritation, respiratory distress, and muscle cramps - isolated or in various combinations - may be the result of acute or chronic intoxication by fumigants. The occurrence of these symptoms in workers who are engaged in the opening and unloading of containers, unpacking of imported goods, ventilating of containers, or working on bulk carriers are urgent indications of intoxication by fumigants or other toxic chemical residues in the transported goods. The severity of the disorder depends on the concentration and duration of exposure, distribution and release of the fumigant, its kinetics, the individual susceptibility of the person, as well as any simultaneous exposure to other toxic substances. Physical symptoms, acute and chronic health effects due to contact with fumigants, are complex and difficult to discover. In this article we explain how to identify the guiding symptoms and describe the appropriate diagnostic steps and the prevention of such events on cargo vessels as well as in the logistics and the handling of imported goods.

The fumigation of freight containers to protect transported goods from fungal and pest infestation has increased worldwide in the last five years due to international regulations requiring fumigation or heat treatment of wooden packaging material and dunnage. We have found in 2008 that every sixth container and its contents do retain harmful concentrations of various fumigants and chemicals, representing a significant health risk for port and transport workers, customs officials, warehousemen, store employees and consumers. The shipping documents of these containers did not provide any information about the fumigation procedure or the used fumigant. We report here the cases of 26 patients introduced to our outpatient clinic with presumed intoxication to fumigants, or with symptoms due to inhaling the air out of fumigated containers. All patients were examined from 2007 to 2010 according to a standardized comprehensive diagnostic program. We were able to confirm the diagnosis based on typical symptoms and extensive clinical examination; by laboratory analysis we identified ethylene dichloride, methyl bromide, phosphine and methylene chloride. The predominant symptoms were headaches, concentration and memory problems, dizziness and nausea, irritation of the skin and mucous membranes and a reduced ability to do exercise. In addition to the neurological and neuropsychological impairments our analyses verified the development of reactive airways dysfunction syndrome (RADS) in 14 of 26 patients with long lasting symptoms due to their contact with fumigants. Intoxications with fumigants are serious and could be avoided. These systematical explored cases show the sustainable impact for health and socio-economic wellbeing. These findings also emphasize the necessity for international standards on permitted fumigants, appropriate labeling in the shipping documents and handling of fumigated containers., (Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.)