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Background: During their training, pre-professional ballet students are confronted with physical stresses comparable to those of competitive sports. In competitive sports, there are mandatory and binding aptitude tests to ensure that the growing athlete meets the requirements. In ballet, there are no such mandatory examinations preceding the start of training. For adult professional dancers, musculoskeletal ideals could be isolated from the dance medicine literature. However, only a few studies describe musculoskeletal characteristics of pre-professional ballet students. It is neither known at what age a student should meet the ideal measurements for an adult nor what deviations from the ideal can be considered normal. This study aims to describe sociodemographic and musculoskeletal characteristics of pre-professional ballet students and discusses to what extent they already meet or deviate from dance-specific eligibility criteria for adult professional ballet dancers., Material and Methods: In this study, n = 414 female and n = 192 male students of John Cranko School (JCS) were seen by an experienced orthopaedist and dance physician. Mean age was 13.9 years (SD 3.5, range 5-22 years). Their medical history was taken (age; nationality; start of ballet/training) and a physical examination was performed (height/weight; symmetry of shoulder girdle, spine, waist triangles; pelvic tilt; tibial torsion; range of motion of base of index finger joint, spine, hips, ankle and base of great toe joint). Subsequently, the results of this study were compared with suitability criteria for adult professional ballet dancers that had been isolated from the dance medicine literature for a previous article., Results: Examinees were from 49 different nations. 34.6% of the female subjects (≥16 years) were between 165 and 170 cm and 33.3% of the male subjects (≥18 years) were between 178 and 185 cm tall. 45.0% of those examined showed low body weight (<10th percentile, BMI <18.5 kg/m²). The trunk of 61.0-84.8% of those examined was erect and symmetrical. 25.2% had scoliosis. Half (53.5%) were found to have a bilateral external rotation of the hips of at least 60°, and 68.7% had a bilateral internal rotation between 20 and 50°. 87.3% exhibited a bilateral tibial torsion between 15 and 40°. A bilateral en dehors of 90° was calculated for 25.0%. In 9.1% of those examined, the upper ankle joints presented a dorsiflexion of at least 25°, and in 70.2%, a plantarflexion of at least 70° was seen. In 88.0%, the metatarsophalangeal joint of the great toe was 90° (f) and 80° (m) on both sides., Conclusion: The results of this study showed that pre-professional ballet students fulfil many characteristics of adult professional ballet dancers. High values already among young age groups suggest a ballet-specific selection. Nevertheless, not all students fulfil the theoretical "ideal measurements" for professional classical ballet. These anatomical limits should be considered individually in training to protect the growing pre-professional ballet dancer. The high ballet-specific anatomical demands, but especially the large number of students with a low body weight, underline the necessity of mandatory aptitude tests at the beginning and regular check-ups in the course of training to avert compensatory mechanisms and their consequential damage and to screen for eating disorders and disorders of eating behaviour., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: Mental comorbidity plays an increasingly important role in determining the specific rehabilitation needs of patients in Germany in the context of other personal, social and occupational factors. In order to make the DRV's list of criteria more meaningful when assigning patients to one type of rehabilitation, this retrospective analysis is intended to determine from which of the two rehabilitation concepts examined (orthopedic rehabilitation or healing procedures (HV)/behavioral-medical orthopedic rehabilitation (BMOR)) patients with mental comorbidity (taking into account gender, employment status of the main orthopedic diagnosis) benefit more., Methods: Using the screening questionnaires HADS‑A, HADS‑D, SIMBO and BPI as well as a hospital questionnaire at the beginning of rehabilitation, data from 913 subjects (529 m/384 w) were collected and evaluated. Of these, 43% were assigned to HV and 57% to BMOR. Thus, in addition to the main orthopedic diagnosis, the frequency distribution of the factors psychological comorbidity, sex and, employment status (in the sense of unemployment) was determined. Using HADS, the benefit was determined at the end of the therapy by comparing the score medians., Results: Frequency distributions and the development of HADS scores show that the prior classification according to psychological comorbidity was correct. Women were more often affected by mental comorbidity and women achieved greater success in BMOR. Regarding the main orthopedic diagnosis, a high prevalence of cervical and lumbar spine complaints was found. According to logistic regression with model decomposition, the variables gender, HADS‑A and -D at the beginning of rehabilitation and the psychological comorbidity (yes/no) are suitable to correctly allocate the patients with 76.86% to one of the two types of therapy., Conclusions: The presence of mental comorbidity appears to be a useful indicator that should be retained in the DRV's criteria catalog as one of the main criteria for allocation to BMOR. Female gender in connection with the presence of mental co-morbidity can also be considered a conclusive criterion. With regard to the main orthopedic diagnosis, cervical spine complaints may be particularly suitable as an allocation criterion., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Background: The dance teacher's own body is considered to be the central working instrument within the movement mediation. Up to now there is a lack of knowledge about the subjective perception of one's own occupationally associated health and satisfaction as well as the identification of occupational characteristics that are detrimental to health., Material and Methods: Within the framework of a questionnaire-based cross-sectional survey, a cohort of dance teachers in Germany were investigated about dimensions of their own health and general job satisfaction in connection with their profession as a dance teacher. Likert scales were primarily used for these assessments. Additionally, general anthropometric and sociodemographic characteristics were recorded. Beside examining the overall cohort, gender-specific differences were tested. The statistical analysis included n  = 232 dance teachers (male 51/female 181) aged 43.1 ± 11.0 years., Results: The general state of health was rated as satisfactory (26.1%) to very good (14.7%) by 85.3% of those surveyed. Of the dance teachers 59.2% even rated their health as good (35.3%) to very good. There was a high degree of satisfaction with their own professional practice for 80% of the participants. Most of the dance teachers felt that they were able to deal with the physical (75.7%) and psychological demands of their profession (70.3%). In addition to fears about the future (51.5%), the main burdensome professional characteristics on dance teachers' self-perception were organizational aspects of work (lack of time for family and friends in 28.4%) and economic aspects (income insecurity in 61.0% and lack of old age security in 65.7%)., Conclusion: The profession as a dance teacher is accompanied by a high level of general satisfaction and a positive perception of one's own state of health. A confirmation of these positive results by injury and illness statistics is still pending. In addition, an improvement in work organization and economic aspects would be desirable., (© The Author(s) 2021.)

Background:  Pain in sport occurs both as a result of acute injuries and in the form of chronic pain due to overuse or misuse. Pain often occurs in dance and is associated with the high specific strain on the musculoskeletal system caused by dance techniques. There is a lack of data on pain-relevant aspects in semi-professional and ambitious popular sports. This applies to dancers and (professional) dance teachers alike. This study aimed to determine pain with regard to prevalence, localisation and development over time in female dancers (T) and dance teachers (TP) engaged in non-professional dance., Methods:  This descriptive quantitative cross-sectional observational study was conducted with semi-professional dancers (n = 153) and professional dance teachers (n = 149) in the context of a fully structured anonymous online survey., Results:  More than 70 % of the respondents reported pain in the musculoskeletal system occurring in the context of dancing both within the last 3 and 12 months, with the lower back and knee joints being most frequently and strongly affected. Regarding the development over time, both T and TP predominantly suffered from pain that lasted for more than six months and occurred frequently. In TP, the pain lasted longer, was more likely to occur at rest and was more often associated with limited mobility and resilience compared with the T group., Discussion:  Regarding prevalence and localisation of pain, the available results are comparable with previous study results from the professional field, both in the TP and T areas. Health risks and (professional) restrictions associated with them are mainly caused by chronic pain development in TP. Therefore, the treatment and management of chronic pain conditions in the healthcare of TP can be very important with regard to their professional participation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Classical dance (ballet) is often compared to high-performance sport in terms of its demands on the body and psyche. During the last century, the physical requirements have increased to such an extent that artistic aptitude alone is no longer sufficient to start a professional training. If a professional training is started although the necessary musculoskeletal criteria are not fully met, the risk of injury, overload damage and associated drop-out of training increases. However, initial medical examinations and checkups accompanying the professional training are only optional and therefore not available in all professional training institutions. The role of a medical doctor in the qualifying examination is merely advisory for the institution. Regarding musculoskeletal eligibility, a distinction can be made between absolute (= not modifiable: e. g. fixed back stiffening, limited en dehors capability, rigid hollow foot) and relative (= up to individual decision: e. g. hyperflexibility, scoliosis, hip extension deficit) contraindications. At the same time, criteria can be defined that support aptitude. A standardised, mandatory medical fitness examination for the training of professional dance could help to protect adolescents from acute injuries and the consequences of chronic misuse or overload., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective:  The study aims to elucidate the state of gender equality in high-impact medical research, analyzing the representation of female authorships from January, 2008 to September, 2017., Methods:  133 893 male and female authorships from seven high-impact medical journals were analyzed. The key methodology was the combined analysis of the relative frequency, odds ratio and citations of female authorships. The Prestige Index measures the distribution of prestigious authorships between the two genders., Results:  35.0 % of all authorships and 34.3 % of the first, 36.1 % of the co- and 24.2 % of the last authorships were held by women. Female authors have an odds ratio of 0.97 (KI: 0.93 - 1.01) for first, 1.36 (KI: 1.32 - 1.40) for co- und 0.57 (KI: 0.54 - 0.60) for last authorships compared to male authors. The proportion of female authorships exhibits an annual growth of 1.3 % overall, with 0.5 % for first, 1.2 % for co-, and 0.8 % for last authorships. Women are underrepresented at prestigious authorship compared to men (Prestige Index = -0.38). The underrepresentation accentuates in highly competitive articles attracting the highest citation rates, namely, articles with many authors and articles that were published in highest-impact journals. Multi-author articles with male key authors are more frequently cited than articles with female key authors. The gender-specific differences in citation rates increase the more authors contribute to an article. Women publish fewer articles compared to men (39.6 % female authors are responsible for 35.0 % of the authorships) and are underrepresented at productivity levels of more than 1 article per author. Distinct differences at the country level were revealed., Conclusion:  High impact medical research is characterized by few female group leaders as last authors and many female researchers being first or co-authors early in their career. It is very likely that this gender-specific career dichotomy will persistent in the next decade., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Hantaviruses belong to the Bunyaviridae family. A large number of different subtypes are known worldwide that show a host-specific geographical distribution. Humans may become infected through contact with rodent urine, saliva or feces. In humans, hantavirus infections are an important and worldwide emerging zoonotic disease that may result in a variety of potentially life-threatening diseases, e. g. hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). There are various aspects of major occupational importance, particularly for agriculturists, veterinarians and forestry workers. This article reviews the current knowledge about epidemiology, pathology, diagnostics, therapy and prevention of human hantavirus infections worldwide., (© Springer Medizin Verlag GmbH 2017.)

Background: Access to primary care plays an important role in medical care provision in Germany. Therefore, current health care planning aims at providing equal access for every patient in Germany no matter where they live., Objective: This study examined accessibility of primary care and compared the result with current primary care planning data., Materials and Methods: Spatial accessibility to primary care was measured by the integrated Floating Catchment Area method ("accessibility index") using a geographical information system at the level of square kilometers cells (hectare grid cells for major urban areas)., Results: The analysis of 649 million generated records showed considerable geographical variations of accessibility: 4.7 % of the total population lived in areas with significantly lower primary care accessibility (z-score = -3.4), whereas 48.0 % of the population lived in areas with significantly higher primary care accessibility (z-score = 9.7). The average accessibility index was 0.14 (SD = 0.15) and increased the more urban (r = 0.64; p < 0.001) and the less deprived (r = -0.37; p < 0.001) the area was. Within health care planning regions, the accessibility index varied by an average of Δ = 0.23 (SD = 0.19) and was not correlated with the degree of care provision (r = -0.04; p = 0.28)., Conclusion: With regard to primary care, there are urban-rural disparities and regional social inequalities in Germany. Therefore, health care planning should take greater account of spatial accessibility in the future., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background Stress with negative influence on health (distress) is highly prevalent among surgeons. Especially the physicians' own perception of working conditions plays an important role in an evaluation of the stress potential of working conditions. Thus, this study is intended to examine and evaluate the working conditions of surgeons in German hospitals. Material and Methods This web-based study is methodically based on the theoretical stress models of Siegrist (Effort-Reward-Imbalance Model) and Karasek (Job-Demand-Control Model). The questionnaire designed for this survey consists of items from two validated questionnaires. Thus it is possible to draw a conclusion about the job satisfaction and distress prevalence among surgeons concerning working conditions in German hospitals. Results In this study 58.2% (95% CI: 55.6 - 61.5) of respondents showed unfavourable working conditions (ER/JDC ratio > 1). Meanwhile 52.2% (95% CI: 49.3 - 55.1) were satisfied with their job. The distress prevalence among female surgeons was six percent points higher (95% CI: 0.1 - 12.0) at 62.4% with an odds ratio compared to male surgeons of 1.29 (95% CI: 1.01 - 1.65; p < 0.05). Chief residents, in comparison to functional positions, showed with 22.0% the lowest distress prevalence of all positions. The highest prevalence was shown by fellows with 66.7% (OR: 7.11; 95% CI: 3.26 - 15.48; p < 0.001). Furthermore 43.4% of fellows said that they were very satisfied with their job. Among attendings 61.5% stated this (OR: 2.08; 95% CI: 1.52 - 2.84; p < 0.001). Conclusions The outlined data emphasise a high stress-potential among surgeons in hospitals concerning working conditions. According to the ERI/JDC model emphasis should be put on the balance between effort and reward or, respectively, job demands and control., Competing Interests: Interessenkonflikt: Nein., (Georg Thieme Verlag KG Stuttgart · New York.)

Aims and Scope: Diabetic retinopathy (DR) is of major scientific and socioeconomic interest in most of the industrialized countries due to increasing prevalence. This interest is reflected by a marked increase in the number of publications since the 1990 s. It is therefore difficult for a single author to obtain an overview of the topic. Material and Methods: The total number of published items on DR was determined in the Web of Science database. All bibliometric data were collected for the period 1900 to 2008 (search term:"diabet* retinopath*" and "diabet* macul*"). A number of different scientometric methods were applied in accordance with the NewQIS protocol, e.g. state of the art visualisation techniques such as density equalising maps and network diagrams. Results: A total of 15,624 publications were identified. The U. S. A. leads in the overall number of publications (4,689). The most productive and the most prolific institutions, authors and publications are all in the U. S. A. The University of Wisconsin (i.e. Ronald Klein and his wife Barbara Eden Kobrin Klein) have established an international network with a large number of institutions publishing important work. Nevertheless, many other important institutions can be identified, e.g. the Joslin Diabetes Center, which has published many articles on VEGF. Conclusion: The results reveal that the scientific interest on the topic DR is continuously increasing. International collaboration is of growing importance in this field., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Bladder cancer (BC) is one of the most common forms of cancer world-wide. This underestimated disease can cause severe morbidity and mortality in individuals. Increasing awareness can be depicted by the increasing numbers of publications since the 1990s. Hence, it is challenging for a scientist to obtain an overview of the topic. To quantify the global research activity in this field, a scientometric investigation was conducted., Material and Methods: Using the database Web of Science, the bibliometric data of publications on the topic of BC was acquired for the period 1900-2007. According to the NewQIS protocol, different visualization techniques and scientometric methods were applied., Results: A total of 19,651 publications were evaluated. The USA takes a leading position in terms of the overall number of publications, institutions, and collaborations. International collaboration on BC has changed considerably in terms of quantity during the past 20 years. The largest number of articles and the highest number of citations regarding BC are found in the Journal of Urology. Thus, it is considered the most prolific journal. Furthermore, the productivity (i. e., publication numbers) of authors and scientific impact (i. e., citation rates) vary greatly., Conclusion: The field of BC continues to progress, whereby the influence of international co-operation on scientific progress is of increasing importance. New evaluation factors/tools have to be established for a more reliable evaluation of scientific work.

Objective: This study aims to examine work related distress in the specialty of psychiatry and psychotherapy., Methods: With an online survey based on validated stress theories distress prevalence and job satisfaction was examined., Results: 39.4 % (95 %-CI: 35.4 - 44.3) of all respondents (n = 508) showed signs of distress. At the same time 58.5 % (95 %-CI: 53.7 - 63.4) claimed to be satisfied with their job., Conclusion: High job satisfaction paired with high distress prevalence can be a sign of a high intrinsic motivation among physicians in the specialty of psychiatry. To prevent this situation to become harmful to one's health, successful coping strategies have to be put in place., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The number of sick leaves due to job strain is increasing., Objective: This study's scope is to examine working conditions of neurologists in hospitals in regard to job strain and job satisfaction., Methods: This study is part of the iCEPT-Study. The iCEPT-Study was conducted as a web based survey among physicians (n = 7090) in German hospitals. The focus was on working conditions regarding job strain. Job strain was measured by a questionnaire consisting of items and scales from the short version of the Effort-Reward-Imbalance (ERI) questionnaire and the short questionnaire for working analysis (KFZA). By calculation ratios of distinct scales according to validated stress models a conclusion could be drawn as to whether or not job strain was present., Results: The total number of n = 354 neurologists were analyzed. The response rate was at 18.2 %. Job strain was encountered by 52.0 % (95 %-KI: 46.7|57.2) of all neurologists and no significant gender difference was present. However, resident neurologists were significantly more often exposed to job strain than attending neurologists (OR = 2.9; 95 %-KI: 1.6-4.7; p < 0.001). Regarding job satisfaction, 59.6 % (95 %-KI: 54.5-64.7) of all respondents stated to be satisfied with their job. Significantly more men were satisfied than women (OR = 1.5; 95 %-KI: 1.0-2.4; p < 0.05). Putting the focus on different occupational positions revealed that significantly more attendings were satisfied with their job than residents (OR = 2.9; 95 %-KI: 1.7-4.8; p < 0.001)., Conclusion: The results of this study showed high prevalence of job strain among neurologists in German hospitals. Keeping the negative implications of mental and physical health in mind, the working conditions of neurologists must be improved. As shown in this study, a possible way to do so is to increase job control in order to decrease a major stressor at work.

Aims and Scope: Sarcoidosis continues to be an underestimated disease that can cause severe morbidity and mortality in individuals. There has, however, been an increasing awareness of this disease as shown by the increasing number of publications since the 1990  s. The large number of available publications makes it challenging for a single scientist to provide an overview of the topic. To quantify the global research activity in this field, a scientometric investigation was conducted., Material and Methods: The total number of publications on sarcoidosis was determined in the Web of Science to obtain their bibliometric data for the period 1900-2008. According to the NewQIS-protocol, different visualisation techniques and scientometric methods were applied., Results: A total of 14,190 published items were evaluated. The U.S. takes a leading position in terms of the overall number of publications and collaborations. Prolific institutions and authors are of U.S. origin. Only a relatively small number of international co-operations were identified. The most intensive network is between the "University of Colorado" and the "National Jewish Medical Research Center". "Semenzato, G" has the highest citation rate of all authors. The most productive co-operative author is "du Bois, RM"., Conclusion: The scientific interest in the topic sarcoidosis is growing steadily. The influence of international co-operation on scientific progress in this area is of increasing importance., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Despite the great medical importance, there is still no comprehensive scientometric analysis regarding the results of magnetic resonance imaging (MRI) and the development of the importance for the healthcare system., Aims: This paper evaluated and analyzed the entire research publication results on the topic of MRI for the period 1981-2007 based on scientometric methods and parameters., Material and Methods: A scientometric analysis (database: ISI Web of Science 1981-2007, search terms MRI and magnetic resonance imaging) was performed. The following parameters were analyzed: number of publications, countries of publication, number of citations, citation rate and collaborations, using various analytical and display techniques, including density equalizing map projections., Results: Most of the 49,122 publications on MRI could be attributed to the USA (32.5 %), which also has the most cooperative collaborations. Within Europe, Germany (10.3 %) is the country with the highest number of publications followed by the UK (9.3 %). The western industrialized nations dominate over the rest of the world in terms of scientific developments of MRI. The thematic focus of the publications lies in the fields of radiology and neuroscience. In addition to the journal Neurology most scientific articles were published in Magnetic Resonance in Medicine and Circulation., Discussion: The results show that the current trend is continuing and the scientific interest in MRI is continuously increasing.

Introduction: The purpose of this study was to examine the linkage between the musculoskeletal and the craniomandibular system in competitive athletes. Therefore the upper body posture and lower jaw position were investigated while a temporarily induced leg length discrepancy (LLD) during standing was induced., Material and Methods: In this study 34 competitive athletes (2 women/32 men) who had no signs of temporomandibular dysfunction according to their own statements were investigated. The measurement of the upper part of the body posture was performed with a three-dimensional back scanner. Afterwards the condylar position was registered by using a homologated and approved electronic registration device. In order to induce the leg length discrepancy, wooden panels measuring 1 and 3 cm thickness were placed unilaterally under one foot., Results: The statistical analysis of the three-dimensional back measurement was carried out using the Friedman and Wilcoxon matched pairs tests with Bonferroni-Holm correction. The results showed in comparisons of the lateral trunk a decline (p ≤ 0.05), of the height of the shoulder girdle (p ≤ 0.05) and, in every pair comparison, of the height of the pelvis area significant correlations between the body posture and the experimentally induced leg length discrepancy. The biggest changes can be observed in the area of the height of the pelvis in the transverse plane. The alterations in statics can be found at the ipsilateral as well as the contralateral side of the body, whereby changes are dependent of the parameter. Moreover, the position of the left condyle in space changes significantly (p ≤ 0.05)., Discussion: The results illustrate functional correlations of the musculoskeletal system through muscular, neurological and fascia based processes. Furthermore, they show that athletes who have a distinctive supporting and postural musculature possess a good body demeanor as well as a fast musculoskeletal compensation by way of the sensorimotor system correspondent to the heightened side of the body. The theory of the ascendant chain spanning from limb to shoulder girdle and further to mandibular condyles can be demonstrated. Athletes with strong postural muscles can quickly compensate through the use of the somatic nervous system., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: In the context of the iCept-Study several medical specialties have been examined for their stress related working conditions. This study contrasts the different medical specialties., Methods: The iCept-Study was designed as a web based survey in which altogether 7.090 respondents took part. The published data concerning the iCept-Study was systematically analyzed focusing on distress and job satisfaction., Results: 53,9% of respondents showed unfavorable working conditions with an ER/JDC-Ratio > 1 (distress). Especially surgical specialties showed a higher prevalence: The odds ratio of surgery to anesthesiology was at 1,59 (95%-CI: 1,35|1,86; p < 0,001). On the other hand specialties like occupational medicine showed a lower prevalence in comparison with the average: The odds ratio was here at 0,37 (95%CI: 0,19|0,71; p < 0,01). Furthermore 55,8% of respondents stated that they were very satisfied with their job., Consequences: Surgical specialties encountered distress the most. Moreover there was a positive correlation between high job satisfaction and lack of distress evident. Therefore it seems that distress and job satisfaction are two dependent characteristics of a changing work environment. Especially surgical specialties need to catch up with today's demand of improved working conditions and thus reducing distress and increasing satisfaction., (© Georg Thieme Verlag KG Stuttgart · New York.)

Obesity is a chronic disease whose origin is determined by genetic factors as well as environmental influences. The prevalence has rapidly increased worldwide in the recent decades. This paper evaluated the research on obesity in the period of 1900 - 2009 in the ISI "Web of Science" by Thomson Reuters. For this purpose scientometric methods were used and the results were graphically illustrated by "Density Equalizing Map Projections". From 1900 till 2009 94.987 published items are the basis for the present qualitative and quantitative data analysis. The publication rates show an exponential growth indicating a pronounced research activity. Concerning the country comparison the United States has the highest number of publications and citations, the highest modified h-index and most academic institutions. This manuscript shows the first comprehensive scientometric data on obesity. In this research area, the United States is a leader and is located at the center of global collaborations., (© Georg Thieme Verlag KG Stuttgart · New York.)

The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered for the first time in Saudi Arabia in 2012. On a global scale 1200 infections have been registered with approximately 50 % resulting in a fatal outcome. It is currently not fully clear how MERS-CoV is transmitted and insufficient research has so far been carried out. Taking the sudden increase of cases in South Korea into consideration, this article discusses which preventive measures should be recommended for international travelers in order to prevent infections. A literature search of the most recent publications indicated that appropriate standard hygiene measures are sufficient and no travel restrictions are therefore necessary., (© Springer-Verlag Berlin Heidelberg 2015.)

Background: In industrialized nations, arthrosis is one of the most frequent causes of physical disability and impaired quality of life in older people., Objectives: There are still no direct and curative therapies. In addition, the causative mechanisms of this disease have not been sufficiently deciphered and investigated so far., Materials and Methods: For the present article, publications from 1900-2013 in the ISI Web of Science were reviewed. Quantitative and qualitative aspects are taken into account and are examined based on scientometric analysis methods. The illustrations demonstrate the global structure of the research and citation activity by Density Equalizing Map Projection. In addition, the radar charts illustrate the bi- and multilateral research and institutional cooperation., Results: On the basis of the search criteria, a total of 46,212 publications were identified. Approximately 95 % of the publications date back to the last 25 years. In addition to the number of publications, the number of citations has increased continuously. The analysis of the country collaborations as well as the number of institutions indicates a predominance of the United States. Most articles about arthrosis concern the subject areas of rheumatology, orthopedics, and surgery., Conclusion: This study provides the first comprehensive, scientometric findings and illustrates corresponding representations of research activities, geographical contexts as well as research cooperation. It shows a great scientific interest, especially by North American and European scientists. The steady growth of research is explained by the high prevalence of arthrosis.

Introduction: The growing numbers of members aged over 35 years in the German Dancesport Association indicate that not only physical activity but also sporting success is gaining significance with increasing age. Investigations on health hazards are still lacking. Aim of this study is the analysis of dance sport-related health hazards in the classifications Seniors I-III., Methods: A total of n = 124 (m: n = 67, f: n = 57) senior ballroom dancers participated in this retrospective cross-sectional investigation., Results: There were 0.9 (m)/1.0 (f) traumatic injuries/year (m: 0.03/1000 h, f: 0.04/1000 h). Gender specific differences as to localisation, type and factors could be observed. The most common injury localisations were the spine (22.2 %), followed by upper and lower leg (15.9 %) in males with foot (incl. ankle joint) (35.6 %), followed by spine (25.4 %), hip (15.3 %) and knee joint (23.8 %) in females. Chronic sports damages/complaints were more common in dancers (m: 1.6, f: 1.9) than traumatic injuries (m: 0.05/1000 h, w: 007/1000 h). The number of traumatic injuries and chronic sports damages rose according to the extent of training and age in males, with females only according to age. Knee problems (arthrosis/gonalgia/meniscal damage) were the most common sports damages (m: 30 %, f: 19.4 %), followed by degenerative spine diseases (m: 9.1 %, f: 9.7 %) and complaints not yet diagnosed (m: 14.6 %, f: 16 %). Intrinsic factors predominated (m: 64.7 %, f: 53.6 %)., Conclusion/discussion: The injury risk in competitive senior ballroom dancers is low. An increase of jeopardising with age and extent of training could only be observed in males. That raises the issue of an optimal and gender-specific amount of training and the preventive significance of dance sport in the elderly. Localisation and type of injury reflect the characteristic movement elements in dance sport. There is a need for additional qualitative and quantitative investigations in order to create differentiated suggestions as to the planning of training and injury prevention., (© Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: How physicians within the specialty of internal medicine perceive their stress-related working conditions, especially due to a changing health system with an impact on workflows and working hours, is examined in this study., Methods: A total of 1696 online questionnaires completed by internists were analyzed. The questionnaire was based upon the Effort-Reward Imbalance (ERI) model by Siegrist et al. and the Job-Demand-Control model (JDC) by Karasek et al., Results: Working conditions in the specialty of internal medicine seem to have a high risk of leading to distress. As a result 62.1 % [95 % confidence interval (CI): 59.8-64.5] of the respondents described working conditions with unfavorable stress (distress). Analyzing the distress prevalence in subgroups, there were significant differences between gender (65.9 % of female physicians and 58.6 % of male physicians; p = 0.002; odds ratio (OR): 1.37; 95 % CI: 1.12-1.66), age (69.3 % of under 35-year-old to 56.6 % of 35- to 59-year-old), and functional position (38.3 % of chief physician to 69.1 % of junior physicians; OR: 7.17; 95 % CI: 3.91-13.16). Regarding job satisfaction 48.1 % of respondents said, they were very satisfied with their job., Conclusion: This study should be a cause for concern, since current data suggest a future shortage of qualified employers in the specialty of internal medicine. Taking this into account, working conditions in hospitals should be improved in order to bind current employees and attract new employees.

Background: Latin American formation dancing ranks among the technical-compositional types of sport and represents a discipline of dance sport due to its performance- and competition-orientated mode. Despite its high degree of popularity and a movement profile favouring injuries, there has been a lack of studies as to health hazards and damage in Latin American formation dancing. The aim of this study is to analyse formation dance-related health hazards and their causes., Methods: A total of n = 100 (m: n = 52, f: n = 48) Latin American dancers of the German top-level league participated in this anonymised retrospective cross-sectional investigation., Results: Mean weights of the male dancers were 75.2 kg and respectively 58.2 kg for the females, mean body height/size were 1.82 m (m) and 1.67 m (f) and mean BMI 22.2 (m) and 20.0 (f), respectively. At least one each traumatic injury/chronic damage was sustained by 69.3 % (m) and 77.6 % (f) of the dancers in the course of their dance sport activities. Almost all (97.9 %) injuries occurred during the training. A total of 409 injuries/overuse damages (= 4.1 injuries/athlete) was reported with 80.4 % traumatic injuries and 19.5 % chronic damages. Female dancers were more often injured than their male counterparts. The lower extremity was the most commonly affected body region [64.5 % (m) and, respectively, 71.2 % (f)], followed by upper extremity (m: 21.2 %, f: 17.6 %) and spinal column/trunk region (m: 12.0 %, f: 8.5 %). Blockages and pulled muscles were the most common complaints reported by males with contusions and pulled muscles being reported by females. Chondropathy/osteoarthrosis were the most frequent chronic diseases. Of all injuries sustained, circa two thirds were caused by extrinsic and circa one third by intrinsic factors., Conclusion: The injury profiles/patterns in Latin American formation dancing show on the one hand parallels to the individual partner dances. On the other hand, typical and gender-specific movement elements seem to reflect in the injuries and chronic damages/diseases of formation dancers. This is to be taken into account when injury prevention measures are considered. There is also a need for further studies to allow a more differentiated analysis., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: It is not known/is disputed whether introduction of low emission zones (LEZs) leads to a reduction of fine dust pollutants., Methods: Data on PM10 concentrations obtained from measurement stations within and outside of LEZs from 19 German cities (Augsburg, Berlin, Dortmund, Duisburg, Düsseldorf, Essen, Frankfurt a. M., Hannover, Herrenberg, Ilsfeld, Karlsruhe, Köln, Ludwigsburg, Mannheim, München, Reutlingen, Stuttgart, Tübingen, Wuppertal) were analyzed in order to investigate the effect of banning vehicles ("tier 1") of the pollutant group 1 (without stickers) on the pollutant concentration, i.e, this study focused on LEZs that restricted cars of EURO 1 standard without appropriate retrofitting systems from entering these zones. For the period from about 2005 until the end of 2009, data from continuous half-hour measurements as well as gravimetrically determined daily measurements of PM10 were collected. The analysis consisted of four pairwise corresponding measurement values as matched quadruples of two index and two reference values (index stations are inside, and reference stations are outside the LEZs). One index value and the simultaneous reference value were measured during the active LEZ period, and the other pair of values was measured before the LEZ was introduced. The pairs of values had a difference in time of 364 days or a multiple of 364 days keeping the season, weekday and time of day constant within the quadruple. Differences in index values were regressed on differences in reference values while meteorological parameters (height of the inversion base, amount of precipitation, wind velocity), school holidays, period of environmental bonus paid, periods when trucks were banned as well as baseline data at index and reference stations were taken into account as covariates in so-called "fixed effects" regression analyses of the quadruples (difference score method in the two-period case). The statistical approach was successfully validated prior to this study in an analysis of simulated data from FU Berlin., Results: 2,110,803 quadruples of continuous PM10 and 15,735 gravimetric quadruples were identified leading to 61,169 quadruples based on daily PM10 averages. The analyses showed that best LEZ effect estimates for fine dust reduction were (at all index stations) ≤ 0.2 μg/m3, i. e., a relative PM10 reduction ≤ 1 %. Best estimates at all index stations near traffic (excluding urban background and industry index stations) were below 1 μg/m3 (less than 5 %, respectively)., Conclusions: Effects were smaller than predicted prior to the introduction of LEZs. This study is the first that investigated comprehensively the effectiveness of "tier 1" LEZs in Germany on PM10 reduction with a homogeneous approach in data collection and analysis and taking into account the most relevant confounding factors., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: How do physicians in the specialty of anesthesiology perceive the working conditions regarding stress and job satisfaction? The health system in Germany has been confronted with a rapidly changing framework over the last 20 years: For example, an increased influence of economic patterns on the workflow and the medical decision of physicians has been established forcing them to always take the economic aspects into account. Moreover, a new generation (generation Y) of physicians with other requirements of the work place, meaning mainly a demand for a better work-life balance, has gained a foothold in hospitals. These changes make it very important to investigate the status quo of current working conditions., Aim: Working conditions in hospitals in the specialty of anesthesiology is the main issue investigated in this study., Methods: For this study 1,321 completed online-questionnaires from physicians in hospitals with the specialty of anesthesiology were analyzed. The questionnaire was based on the stress theory, the effort-reward-imbalance model (ERI) and the job-demand-control model (JDC).The items used in the questionnaire were taken from the ERI questionnaire and the short questionnaire on work analysis (KFZA). By calculating a certain ratio of several items (according to the stress theory), the prevalence of distress could be measured. In addition the overall job satisfaction in the field of anesthesiology was measured and analyzed., Results: In this study 47.0 % (95 %-CI: 44.3-49.7 %) of all respondents showed signs of distress. Simultaneously, 61.8 % (95 %-CI: 59.2-64.5 %) were very satisfied with the job situation. Regarding gender, female physicians perceived a lower control of the work situation whereas male physicians perceived a much higher decision level. This led to a higher prevalence of distress in the group of female physicians regarding the JDC model (odds ratio, OR: 1.54, 95 %-CI: 1.19-2.01). Regarding age, the prevalence of distress increased from 36.5 % in the respondents under 35 years old to 50.7 % in those 35-59 years old (OR: 1.79, 95 %-CI: 1.38-2.32). Looking at the different functional positions in the hospital, senior doctors showed a much higher prevalence of distress (52.8 %) than junior doctors (OR: 1.57, 95 %-CI: 1.21-2.05). Analyzing job satisfaction with respect to the functional position, the highest significant proportion was shown by senior doctors (65.8 %)., Consequences: This study revealed a high prevalence of unfavorable working conditions for anesthetists in hospitals. Taking the forthcoming shortage of qualified physicians in German hospitals into account, these results have to be considered as a cause for concern. Constant unfavorable working conditions have a negative effect on the mental and physical health of employees. Sooner or later a migration of qualified physicians abroad could be the consequence. To prevent a future shortage of qualified physicians and to make the hospital work place more appealing, working conditions have to be adapted to current needs and expectations of employees. The focus should be put on balanced working conditions according to stress models shown in this study.

Background: Current working conditions of physicians in hospitals display characteristics, which on the long term are harmful for the physicians mental and physical health (distress). There are problems concerning the work flow and the organization of working time which finally leads to gratification crises. How physicians perceive their stress-related working conditions is the issue this study wants to investigate., Methods: In this study 12 062 physicians in hospitals were invited to an anonymized online-survey. 2064 physicians took part. The basis of this investigation is built by 2 theoretical stress models: The effort-reward-imbalance models of Siegrist and the job-demand-control model of Karasek. Through these theoretical models distress is measured., Results: The study revealed a high prevalence (55,5 %) of distress among physicians in hospitals. Furthermore there were significant differences between gender (59,7 % of female and 51,5 % of male physicians; OR 1,40; 95 %-CI 1,17‑1,66; p < 0,001), between age (61,9 % of under 35-year-old and 49,4 % of over 59-year-old; OR 1,67; 95 %-CI 1,06-2,62; p < 0,001) and between the functional position (24,6 % of chief physician and 63,8 % of junior doctors; OR 5,40; 95 %-CI 3,03-9,65; p < 0,001). An additional analysis of the psychosocial aspects of the working conditions showed that these aspects are rated positively by this sample., Consequences: These results have to be considered as a cause for concern, because this high prevalence of distress will lead sooner or later to a migration of qualified physicians abroad or to other (less stressful) jobs. In order to prevent a future shortage of qualified physicians, the working conditions have to be adapted to current needs and expectations of the younger generation., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Parkour sport is the playfully breaching of obstacles originally not created to get from A to B in the fastest manner. There have been only few publications on injuries in this young and trendy sport mainly performed in urban areas. The aim of this study is to analyse parkour-related acute injuries and their factors., Methods: For the retrospective cross-sectional study, a total of n = 266 traceurs (m: n = 255, w: n = 11) completed anonymized online questionnaires., Results: On average, each traceur sustained 1.9 injuries per sport career/year, or 5.5 injuries/1000 h training, respectively. The upper extremity was the most affected body region (58 %), followed by the lower extremity (27 %), head and the back. An increase of injuries from proximal to distal was observed in the upper extremity. However, for the lower extremity it was the opposite. Of all injuries, the most common were skin abrasions (70.3 %). Muscle injuries were observed in 13.1 % of the traceurs, followed by dislocations (6.1 %), and soft tissue (e. g., ligaments, tendons) injuries (5.3 %). Passive precautionary measures were abandoned by the majority of the traceurs (88 %). Landing belonged to the movement elements resulting in most of the injuries (61 %), followed by supportive and static efforts of the arms (10.7 %). Overestimation (23 %) as well as misjudging the situation (20 %) were the most common causes., Conclusion: Other than expected, parkour is an urban movement style with most of the injuries being neither severe nor common despite the lack of precautionary measures. Localisation and type of injuries reflect the characteristic movement elements. There is a need for further investigations to allow a more differentiated analysis in order to develop injury prevention concepts., (© Georg Thieme Verlag KG Stuttgart · New York.)

Tobacco consumption is a major public health threat. Midwives can contribute to the reduction of tobacco use among pregnant women and young families. It can be assumed that personal smoking behaviour and knowledge of harmful effects influences counselling activities. The aim of this study was to assess smoking status, nicotine dependency and the will to change of midwifery students in german-speaking countries. Broad data on this population is not available so far. In 2010, a self-administered questionnaire survey was conducted among Austrian, German and Swiss midwifery schools. Sociodemographic characteristics, smoking habits, personal attitudes towards smoking, knowledge of cessation strategies, perceived self-efficacy and competence to counsel pregnant women regarding their smoking habits of midwifery trainees were examined. 1 126 students and 38 teaching midwives answered this questionnaire (RR=61.8%). 22.7% are daily or occasional smokers. 6.8% have to be considered as medium and heavy smokers. 98.1% consider cessation counselling for pregnant and breast-feeding women as a midwife's task, while 76.5% feel competent enough to do so. 75.5% rate cessation counselling through midwives as effective stop-smoking procedures compared to blurry knowledge on related health risks and effective stop-smoking strategies. The self-reported smoking prevalence is considerably lower than in previous studies and other populations. Knowledge of harmful effects and of effective treatment options needs improvement. Counselling competence needs to be included in a broader way in midwifery curricula., (© Georg Thieme Verlag KG Stuttgart · New York.)

Smoking is still one of the most dangerous and avoidable health risks. This study "Healthy air at work" analysed smoking habits, state of change, the influence of the diagnosis F.17.0 in patient treatment and estimation of subjective workloads and personal resources in health-care workers. Almost 2 000 questionnaires were analysed. 19.9% of this study population were smokers, while 26.4% were considered to be heavy or very heavy smokers. Half of the current smokers were willing to change, while the majority had already tried to quit multiple times. The most important motive to stop smoking was fear of consequences (44.4%), followed by other reasons (42.3%) (e. g., pregnancy) and expenses (33.9%). Protection against second-hand smoke was estimated mostly as very relevant, especially for patients. Being a role model in terms of tobacco consumption seems to be important for health-care workers. 61.3% of all health-care workers stated that patients' nicotine dependency had been diagnosed and out of these 46.5% say it is a relevant factor in therapy. 60% of all interviewed employees evaluated themselves as working quantitatively under heavy and very heavy workloads, while 20% had to deal with high qualitative challenges. In terms of future work ability and personal resources 75% were considerably optimistic. We did not find any relation in terms of workloads and smoking habits. Rather few health-care workers used nicotine replacement therapy during former cessation trials. Health-care workers could play an important role in the treatment and prevention of smoking dependency. This potential is not used to its full extent up to now., (© Georg Thieme Verlag KG Stuttgart · New York.)

An unknown Coronavirus (hCoV-EMC) was first isolated retrospectively in September 2012 from sputum of a 60 year old Saudi Arabian patient, who suffered from acute respiratory failure followed by renal failure and died already in June 2012. The clinical findings were highly similar to those presented in the severe diseases seen in the SARS pandemic in 2003. Also the hCoV-E M C is genetically related to animal Coronaviruses (in bats) and caused 9 affirmed severe human infections leading to 5 deaths by now.The following article should give a short overview concerning the current knowledge about the new human Coronavirus as well as information about the official disease definition and registration procedures in Germany (Robert Koch-Institut)., (© Springer 2013.)

Introduction: The perennial training and education to become a professional dancer is associated with maximum physical and psychic stress. These challenges fall into a period of utmost changes caused by adolescence. As a consequence, acute injuries may occur that - depending on the degree of severity - could endanger the education. The aim of this study was to analyse acute injuries, their causes and mechanisms with regard to gender-specific aspects in students of a state ballet school. These data may provide the basis to work out individual institution-centred injury prevention concepts., Methods: The data for the evaluation were obtained from occupational accident reports, accident documentations of various Berlin theatres as well as case records of a State Ballet School (n = 480, m: 120, w: 360) of the Berlin State Accident Insurance (UKB). Evaluation and descriptive statistics were conducted with Excel 2007 and PASW Statistics 18., Results: One of three dance students is injured at least once a year. One out of ten accidents is classified as severe. The lower extremity is the most frequent localisation (67.8 %; m: 57.6 %, w: 73.0 %). There are age- and gender-specific particularities. The main acute injured body structures are joints and ligaments (69.5 %). Contusions (23 %), distorsions (33 %) and muscular strains (20 %) are the most frequent types of injuries. There is a correlation between the time of the day and the incidence of injuries. Acute injuries in both genders are more frequently caused by multifactorial (70 %; f: 71.6 %, m: 64.5 %) than by exogenous factors (30 %; f: 28.4 %, m: 35.5 %). Exogenous objects initiating an accident are 'corridors/stairs' (f: 8.8 %, m: 13.7 %), followed by 'human being' (f: 7.5 %, m: 13.2 %) and 'dance floor' (f: 7.5 %, m: 5.7 %)., Discussion: With due regard to gender, the results can be compared in many respects with those of professional dancers. There are various gender-specific differences in the acute injuries, reasons of which are numerous (e. g., the monospecific education/training, early specialisation, gender-specific differences concerning work contents). Incipient stages of injury prevention are as complex as the versatility of dance movements., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: A dance teacher teaches in various professional and amateur genres. The physical load depends on the target group and is partly submaximal or even higher. The only tool of dance teachers is their own body. There are only few other tools to facilitate such work. Therefore, keeping the body in a good health status is of great significance. Up to the present, there have been little or no data on the health status of persons teaching dance. The aim of this study is to examine the health status of persons who teach dance in order to initiate a data base for the development of further projects with a preventive medical focus., Methods: A total of 165 (f: 154, m: 11) average aged (46.1 years) dance teachers in Germany responded to a cross-section questionnaire survey., Results: Teaching dance is for 96.6 % "the job of their dreams". Of all dance teachers 89.4 % continue to work while in pain and 85.5 % cannot afford a "longer down-time". 78.2 % state that they have paused due to a work-related disease, although 56.9 % of the respondents consider their occupation to be the cause for a disease with the answer only, seldom (44.4 %) or never (12.5 %). 4.5 % consult a medical doctor only after the self-treatment has failed. The lower extremity is the most common anatomic region in acute injuries (57.6 %) as well as in chronic complaints (58.3 %). The causes are multiple and comprise physical as well as psychic factors such as a high pressure of expectation (64.8 %) or a tight schedule/time table (43 %). 29 % of all dance teachers suffer from internal and 58 % from orthopaedic complaints. 43.1 % of them state that these complaints result from their occupation. 80.5 % make an acute injury responsible for compulsary breaks., Discussion: The discrepancies between the self-perception and the findings of this investigation clearly show that the psychic and physical load in this occupation should not be underestimated. Here, further research on the social, psychic and physical health status of dance teachers is required. The results of this investigation warrant further research in the field of activity of the variable and up to now unprotected dance teacher profession in Germany., (© Georg Thieme Verlag KG Stuttgart · New York.)

An injury of cruciate ligament is one the most common knee injuries. This accident happens mostly without external impact and towards the end of training and competition sessions. Women, especially athletes playing team sports ball games such as soccer or disciplines such as tennis, are affected 2 to 8 times more often than men. Anatomic, biomechanical and endocrinological differences are currently discussed as potential risk factors. In terms of prevention, biomechanical impact is of greatest importance given its influenceability through various training opportunities. Training programs including endurance aspects, strengthening knee musculature, balance as well as plyometric trainings were most effective. Further studies should focus more on concomitants of course of injuries., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Specific requirements in the Musical field such as the versatility of abilities in dancing, singing and acting, the aspiration for perfection as well as the high number of performances, lead to a high amount of occupational accidents not yet evaluated. Aim of this study is, therefore, to analyze and evaluate occupational accidents in Musical performers and to suggest preventive concepts., Methods: The data of this evaluation comprise occupational accident reports of consultants, accident reports of various Berlin theatres as well as case records of all Berlin State Theatres (n = 89, m: 58, f: 31) of the Berlin State Accident Insurance covering a period 12-year period., Results: A total of 60.3 % of the accidents happen during performances, 24.4 % during rehearsals, and 6.7 % during the training. Lower extremity injuries (m: 61.1 %, f: 58.2 %) are the most common for performers. The majority of injuries (m: 46.3 %, f: 50.0 %) happens during ordinary dance movements. Altogether 66.7 % of the injuries have a uniquely defined exogenous cause. The dance partner is with 17.9 % the most common exogenous cause, followed by props (15.4 %) and dance floor (11.6 %). 66.3 % of all accidents happen in the first three hours after starting work with an incidence in the evenings. There are gender specific differences., Discussion: Parallels can be drawn (e. g. injured structures, type of injuries) to the professional dance and the dance theatre, however, there are also differences (e. g. age, injury location) Due to the results and the work specific requirements the Musical is to be considered as an autonomous field among the performing arts. Above all, the majority of injuries are - compared to other dance styles - caused by exogenous factors. Modifications may here reduce the incidence. At that, an early interaction in the planning progress of a production, an optimal selection of physical and psychic qualified performers as well as an improvement of training conditions are primary steps towards an injury prevention., (© Georg Thieme Verlag KG Stuttgart · New York.)

Economic restructuring processes in Germany require changes within all social and health care systems regarding night shiftwork. The aim of this paper was to analyse research results referring to shift- and nightwork using scientometric methods. A total of 3092 items could be detected. A constant increase in the number of publications per year since 1977, especially since 1990' was obvious. One third of the research results, a total of 884 articles could be assigned to the USA. Great Britain could be identified with 365 articles and France with 244 published articles. Sleep, Ergonomics and Chronobiology International are the most prolific journals. The Swedish scientist Torbjörn Akerstedt is to this date the most acclaimed researcher referring to his issue. He has written 105 articles about shift- and nightwork. He is not only a most efficient author, but also has the highest h-index [30]. Self-citations and multiple co-authorships distort parameters like impact factor and h-index enormously and should be regarded from a critical point of view.

For many diseases, tobacco smoke is the most important risk factor. To understand the different risks concerning both quality and severity of the possible diseases, the differentiation between mainstream smoke, sidestream smoke and environmental tobacco smoke (ETS) is indispensable, since the different types of smoke are associated with different diseases. Before anything else, tobacco smoke is the main risk factor for the development of lung cancer and with restrictions for laryngeal and pharyngeal carcinomas as well. Moreover, the inhalation of tobacco smoke is of great importance in the genesis of chronic obstructive lung diseases (COPD). During recent years it has generally been acknowledged that ETS, besides a general activity in cancerogenesis also, seems to induce other morbidities. Nevertheless, when looking at the risks of smoking it has to be mentioned that the difficulty of gaining reliable information concerning quality and quantity of the smoking and the exposure to ETS is significant. That is why in many cases the relation between the dose of tobacco smoke and its effect is hard to make out. Not to be denied is the fact that both active and passive smoking has a great impact on the respiratory tract, which should be considered carefully when it comes to children being exposed to ETS. The age of children when exposed to regular ETS for the first time plays a key role concerning their disposition to later developing a COPD or a bronchial asthma. This subject of ETS is especially of great interest in the work of company doctors because there are many people exposed to ETS for many hours every day in their work environment. This problem is most obvious in the gastronomic work sector.