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Objective: This study examines the association between irritation and demands of long-term care managers during the COVID-19 pandemic, as well as the role of workplace health promotion (WHP)., Methods: Findings were derived from an online survey investigating long-term care managers as part of the employees in the COVID-19 pandemic (N = 207). Data analyses were performed with linear regression and interaction analyses., Results: For managers in long-term care, there was found a significant positive association between pandemic-related and general demands and irritation. The irritation level was significantly lower among managers in facilities where WHP was offered whereas the association between irritation and demands did not significantly vary by WHP., Conclusions: The presence of WHP was associated with lower average irritation levels among managers during the COVID-19 pandemic. Thus, the implementation of WHP can contribute to maintain the well-being of long-term care managers., Competing Interests: Conflict of interest: None declared., (Copyright © 2023 American College of Occupational and Environmental Medicine.)

Aims: The aim of the present study was to examine whether the prevalence of the operational integration management programme in Germany (BEM) is associated with selected structural characteristics of companies and variables from the field of social resources., Methods: The study was based on the representative 2018 BIBB/BAuA employment survey. An assumption was made of the existence of an association between BEM and characteristics of companies, indicating a prioritisation of health and social resources. Furthermore, the same variables were considered with the acceptance of BEM, complemented by person-related characteristics., Results: About forty percent of employees on long-term sick leave were offered BEM, of which about seventy percent accepted the offer. BEM was more likely to be offered in companies where employees were aware of workplace health promotion (WHP) measures, where supervisors often gave praise and recognition, where there was often a sense of community in the workplace, and where there was a works or staff council. In smaller companies, in service and craft enterprises, the BEM offer was accepted more frequently than in larger companies, the public sector, and in companies in the industry. Of the personal characteristics, only a longer incapacity to work was associated with the acceptance of BEM., Conclusions: The association with WHP and appreciative supervisor behaviour suggest that companies in which good and health-promoting work is given higher priority are more likely to implement the legal requirements for BEM. At the same time, it is also conceivable that the opposite effect exists and that companies have taken the introduction of BEM as an opportunity to review their other commitment to the health of their employees because of the cases that have occurred., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim of the Study: This secondary analysis aims to investigate the prevalence and uptake of workplace health promotion (WHP) in Germany., Methods: Our data base was the 2018 BIBB-/BAuA Survey in Germany, which is a randomized representative CATI survey of 20,012 employed persons aged 15 and older. Proportions were compared among different groups and a binary logistic regression model was estimated., Results: 47% of the employees reported that WHP interventions had been implemented in their company in the last two years. 25% of the employees had taken up the offer of WHP. The proportion of employees who confirmed that WHP was offered in their company increased sharply with the company size, but the take-up rates decreased. Employees in companies with a works/staff council stated a disproportionately high rate of implementation of WHP. However, employees with a low socioeconomic status reported WHP offer to a relatively small extent. In particular, employees without a vocational qualification, in a fixed-term employment, at risk of dismissal and temporary agency workers reported a relatively low implementation of WHP in their company. Logistic regression analyses aimed to identify predictors for the WHP offer. Compared to small companies, workers in medium-sized companies were more than twice as likely (OR=2.17) to have a WHP offer in their company and more than five times as likely (OR=5.64) in large companies. In the public sector, the chances of employees having WHP in their company were significantly better than in industry, crafts, trade or other sectors. Compared to German employees, employees with a foreign citizenship had a significantly lower chance of WHP being offered in their company (OR=0.78). A very good or excellent health status was associated with a slightly increased OR of 1.15 for WHP in the company. In companies in which employees were very satisfied with their work overall, the probability of a WHP offer was significantly increased (OR=1.70)., Conclusion: The analysis reveals large disparities in the WHP. There is a need for WHP strategies for targeting the small companies and the employees with a low socioeconomic status within the companies., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht, (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Health is an increasingly important issue in the workplace, but the dissemination of health-promoting interventions in companies, especially in small and medium-sized enterprises (SMEs), remains limited. Inter-organizational networks seem to be a promising approach to promote and implement workplace health management (WHM) in SMEs. This study analyses the establishment and coordination of the network 'ERZgesund-Healthy Companies in the Ore Mountains' for WHM in SMEs in a rural area of Germany. The case study, which builds on a mixed method approach (expert interviews, participant observations and document analysis), finds that ERZgesund evolved from a top-down approach (politically initiated, regionally anchored and financed from promotional funds). The network's hierarchy is disproportionately vertical, and the project group has limited decision-taking power and limited opportunities to act, which has reduced their overall engagement in the network. We conclude that although long and stable relationships are important for successful networks, change-especially at the leadership level-can lead to increased engagement of network participants if the hierarchy within the network is horizontally aligned. The findings of this explorative case study contribute to the planning process, the development and implementation of network structures, and successful WHM interventions., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Workers' health surveillance is considered essential for employees' health and protection against hazardous working conditions. It is one part of occupational health care and thus one of four pillars of holistic workplace health management. In Germany, employers are obliged to provide mandatory and voluntary occupational health care (OHC) to employees, dependent on the defined occupational hazards. However, employees are not obliged to make use of voluntary OHC. No empirical information is available about the uptake of voluntary OHC by employees and the influencing factors in Germany. Thus, we carried out an explorative multi-perspective study with qualitative and quantitative elements to get insights from the view of occupational health physicians (OHPs) and employees. We conducted a survey among OHPs based on prior statements from two focus group discussions. A multivariate logistic regression analysis was performed to detect enablers and barriers regarding employee uptake of the offered voluntary OHC. We used extended qualitative methods among employees instead of an analogous survey. In total, 460 OHPs participated in the survey (response rate 29.1%), and 25 employees took part in interviews. Most of the employees had not heard the term voluntary OHC before, and only a few remembered respective occupational health care after explanatory request. In total, 78% of the OHPs assessed that employees always/mostly take up voluntary OHC. The most important attributed reason for non-uptake was that employees see no need for occupational health care when they feel healthy. The most important enabler for the perceived high uptake of voluntary OHC in the regression analysis was a positive attitude of the OHP toward voluntary OHC. While OHPs perceived that voluntary OHC was accepted by a majority of employees, this was not confirmed by the interviews with selected employees. This could indicate that the OHP respondents overestimated the amount of uptake. Since it became clear that employees are often unfamiliar with the terminology itself, we see a need for more and better information regarding the objectives and content of occupational health care to improve this important pillar of workplace health management.

Background: Rural and urban areas hold different health challenges and resources for resident small and medium-sized enterprises (SMEs) and their employees. Additionally, residents of urban and rural areas differ in individual characteristics. This study aims at investigating potential rural-urban differences (1) in the participation rate in workplace health promotion (WHP) and (2) in the relationship of WHP and health relevant outcomes in residents living in rural or urban German areas and working in SMEs., Methods: Data of a large German Employee Survey in 2018 were used and analyzed by chi-square and t-tests and regression analyses regarding job satisfaction, sick days, and psychosomatic complaints. A total of 10,763 SME employees was included in analyses (23.9% living in rural, 76.1% living in urban areas)., Results: Analyses revealed higher participation rates for SME employees living in rural areas. SME employees living in urban areas reported more often the existence of WHP. Results showed (a) significance of existence of WHP for psychosomatic complaints and (b) significance of participation in WHP for job satisfaction in SME employees living in urban but not for those living in rural areas., Conclusion: The revealed disparities of (1) higher participation rates in SME employees living in rural areas and in (2) the relationship of WHP aspects with health relevant outcomes are of special interest for practitioners (, e.g. human resource managers), politicians, and researchers by providing new indications for planning and evaluating WHP measures., (© 2022. The Author(s).)

Hazardous substances are ubiquitous in the world of work. Employees from all sectors are exposed to different risks when working with hazardous substances. This also applies to people who do not directly handle hazardous substances (bystanders). Risk communication in occupational safety and health takes place at different levels. The spectrum ranges from large to small companies, safety experts, company physicians, works and staff council representatives to employees and the general public. Risk communication in occupational safety and health along the supply chain aims to create risk awareness among manufacturers, employers and employees to reduce risky behaviour and to encourage risk-reducing behaviour.Instruments of risk communication are explained in this article and considered with regard to their effectiveness. This affects binding instruments in the European internal market such as the hazard label or the safety data sheet (SDS). At the level of the Hazardous Substances Ordinance, they are the Technical Rules for Hazardous Substances (TRGS), limit values, the Easy-to-use Workplace Control Scheme for Hazardous Substances (EMKG) and, as a creative instrument, objects of the "DASA Working World Exhibition" in Dortmund, Germany. The results of the paper show that an adaptation of the instruments is necessary, especially for small and micro-enterprises, in order to find the appropriate entry point into risk assessment. Often, the existing instruments are not known, too extensive or difficult to understand. Recommendations for action are necessary that make it easy to get started with risk assessment. Existing scientific studies tend to focus on the deficits in risk assessment rather than on the development of efficient ways to communicate risks. Further analyses of the needs of the different target groups are necessary for appropriate risk communication., (© 2022. The Author(s).)

Background: Micro, small and medium-sized enterprises (SMEs) represent the majority of businesses in the EU. Little is known about psychosocial demands faced by company owners, managers, and employees in SMEs, especially in the health and service sector. The current study aimed to identify which psychosocial demands related to work organization are reported by managers and employees in the health and service sector, and if managers and employees differ in their perspective on these psychosocial demands., Methods: We conducted nine single interviews and two focus group discussions with seven company owners and managers as well as eleven employees from six different German companies between January and February 2020. The psychosocial factors of the psychosocial risk assessment of the Joint German Occupational Safety and Health Strategy (GDA) served as a framework for data collection and analysis. The interview material was analysed using Mayring's method of qualitative content analysis., Results: We identified four prevailing work-related psychosocial demands related to work organization among managers and employees: (1) possibilities and time for recovery after work, (2) communication and cooperation, (3) work intensity, and (4) interruptions, and prioritization. According to the managers, they were confronted with a lack of possibilities and time for recovery after work. They report issues related to inadequate communication and cooperation affecting the entire company team, and also face high work intensity and frequent interruptions and prioritization. Employees reported a clearer division between work and private life. However, they also face periods of high work intensity, frequent interruptions and the need for prioritization., Conclusion: Managers and employees in SMEs in the health and service sector would benefit from evidence-based and evaluated tailored interventions and approaches for improved work organization. Further studies are needed to support managers and employees in SMEs in the health and service sector in facing and handling work-related psychosocial demands like lack of possibilities and time for recovery after work, high work intensity or frequent interruptions., (© 2022. The Author(s).)

On the general labor market, social firms provide 30-50% of people with different types of disabilities the opportunity to gain employment. However, the topic of workplace health promotion (WHP), needs for improvement and accompanied challenges are neglected in the current research and were the focus of the present study. Therefore, data triangulation was used between July and December 2020 by combining three focus groups with employees ( n = 14 employees) with 16 interviews with supervisors from several social firms in Northern Germany (e.g., from catering, cleaning or bicycle repair sectors). 17 semi-structured telephone interviews with experts in the field of WHP or social firms were added. All approaches were audio-taped, transcribed and anonymized. To analyze the data, Mayring's qualitative content analysis was used. The results indicated that several offers for WHP, including sport, nutrition and relaxation, were offered, as well as those on smoking cessation, cooperation with external organizations or training and education offers. Needs for improvement were stated referring to additional sport offers, support for implementing a healthy diet, offers for relaxation, financial incentives or collaborations with external organizations. A low take-up of offers; a lack of resources, structures or management support; compatibility of offers with work time and organization; challenges with available trainings or the consideration of individual needs and capacities were highlighted as challenges. Overall, there is a need for further interventional and longitudinal research on WHP in social firms.

Aim: The aim of the study was to investigate compliance with occupational health and safety (OHS) among pregnant surgeons., Methods: All female surgeons in Saxony up to 45 years of age received a written questionnaire about their work environment during pregnancy. Predefined and expert-based criteria of OHS were analyzed descriptively. Poor compliance with OSH was defined as meeting a maximum of half of the criteria. Using logistic regression, professional factors (i. e. "operating due to lack of staff") and personal factors (i. e. "operating due to residency") were investigated for poor compliance with OSH., Results: Of the participating female specialists, 55% (response=39%) had performed surgery during pregnancy. On average, 7.4 of the 16 occupational health and safety measures were fulfilled (median=8; range 1-13). In none of the cases were all predefined OSH criteria fulfilled. Two-thirds of the women who worked in non-operative areas took on invasive activities. When the women were working outside the operating theatre, an average of 4.1 of 13 predefined OSH criteria was fulfilled (median=4; range 0-8). "Lack of staff" was related to poor OSH compliance in the multivariate analysis (OR=5.9 (95% CI 1.7-20.0))., Conclusion: The results of the study show a great need for improvement in the occupational safety of pregnant surgeons., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Working conditions in the care sector, especially under the increased strain during COVID-19, make it difficult for outpatient caregivers to adhere to health-promoting behaviours. Research on workplace health promotion (WHP) and COVID-19 support measures in outpatient care services is limited. The aim of this pilot study was to characterise the current situation of WHP and COVID-19 support measures in outpatient care services and to explore how to offer WHP support measures targeted for a specific group. A web-based cross-sectional survey was conducted with outpatient caregivers ( N = 171) in northern Germany. The results showed that 60.2% of the study participants were offered WHP support measures, with significantly higher work engagement when WHP support measures were available ( Z = 4279.50, p < 0.01) and that 77.2% received specific support from their employer during the COVID-19 pandemic. Although spending a break in a break room was significantly associated with longer breaks as compared with being in a car ( Z = 39.10, p adj. = 0.01), a break room was neither available in all outpatient care services, nor did it appear to be feasible. Overall, WHP in outpatient care services is insufficiently covered. In order to be able to offer WHP support measures that are targeted to outpatient caregivers, cooperation among local care services, feasibility, and digital measures should be examined.

Workplace health management (WHM) in Germany aims at maintaining and increasing the health and well-being of employees. Little is known about company executives' attitudes toward WHM. To gain more insight, we conducted a large-scale survey in companies in the German county of Reutlingen in 2017. We sent a standardized questionnaire to 906 companies, containing inter alia 26 self-constructed declarative statements depicting company executives' opinions on various WHM aspects; 222 questionnaires could be evaluated. By exploratory factor analysis we assigned the 26 items to six factors reflecting different attitudes toward WHM. Factor values were standardized to a scale from 0 to 10. The attitude 'positive view of general health services in the company', for example, achieved by far the lowest mean agreement (3.3 points). For the attitude 'general skepticism toward WHM', agreement and disagreement were balanced (5.0 points). Using multiple regression analyses, we searched for variables that could partially explain respondents' agreement with attitudes. In conclusion, a general WHM skepticism was widespread, but not dominant. The idea that general health services should be offered in companies was predominantly rejected. Older respondents and respondents from smaller companies and craft enterprises were more skeptical than average about WHM and its possible extensions.

Background: The negative effect of unfavorable working conditions and long-term work stress on health has been demonstrated in previous research. To address these challenges, systematic approaches such as psychosocial risk assessments (PRA) have been developed in many countries worldwide. Despite legal obligations, psychosocial risk assessments are rarely carried out in micro and small-sized enterprises (MSE). Even though those enterprises constitute a large proportion of the general workforce, this area remains largely untouched by research. In order to enable starting points for a greater dissemination in organizational practice, the present study explores barriers and drivers of psychosocial risk assessments in micro and small-sized enterprises., Methods: A total of 18 owners and managers from 15 micro and small-sized enterprises in North-Rhine Westphalia, Germany, were interviewed. The interviews were audio-recorded, transcribed, and analyzed. A qualitative approach was applied: Content analysis was used to analyze the data, using deductive as well as inductive coding techniques., Results: The following barriers emerged from the interviews: Negative PRA image, stigmatization of mental health, lacking acceptance of employees, fear of excessive authority interference, ignorance of PRA, not understanding the necessity, inappropriate approach, and limited resources. The identified drivers were: Easy access to PRA material, external support from experts, renaming the term "workplace risk assessment", understanding content and benefit of PRA, simplify and revise PRA process, and noticeable consequences of PRA execution and non-execution. The results are comparable with those in larger companies. They emphasize the importance of mental health education, improving the process of psychosocial risk assessments, and the ongoing support in overcoming limited financial as well as human resources., Conclusions: To improve implementation of PRA in organizational practice, a simplification of the process is proposed, accompanied by information campaigns and an improvement in the health literacy of owners and managers of MSE. In view of the results, the full revision of the PRA approach should also be considered., (© 2021. The Author(s).)

Cross-company networking and counseling is considered to be a promising approach for workplace health promotion in small and medium-sized enterprises. However, a systematic and empirical approach on how such networks can be developed is lacking. The aims of the present paper are to describe the approach of a social network analysis supporting the development of a cross-company network promoting physical activity and to present first results. In the process of developing the methodological approach, a common understanding of the nodes and edges within the project was elaborated. Based on the BIG-model as the theoretical framework of the project, five measuring points and an application-oriented data collection table were determined. Using Gephi, network size, degree, and distance measures, as well as density and clustering measures, were calculated and visualized in the course of the time. First results showed a continuous expansion and densification of the network. The application experience showed that the application of social network analysis in practical cross-company network development is promising but currently still very resource intensive. In order to address the current major challenges and enable routine application, the development of an application-oriented and feasible tool could make an essential contribution.

There is great potential for the implementation of physical-activity measures at the workplace, especially in smaller companies. The present paper describes the study protocol for evaluating an impact-model-based multicomponent intervention promoting physical activity at the workplace within a cross-company network. The evaluation is based on a logic model focusing on outputs and short-term outcomes for the purpose of physical-activity promotion, physical-activity-related health competence, and knowledge about physical activity. A mixed-methods approach is applied. The quantitative evaluation is conducted as a natural design, and combines a retrospective evaluation of the acceptance, usage, and satisfaction (output) at the end of the measures, and two surveys that capture physical activity, knowledge about physical activity, and physical-activity-related health competence (outcome) of the employees in the form of a trend study. The qualitative evaluation comprises semistructured interviews to investigate knowledge of the existence of and attitude towards the content of the multicomponent intervention and the study. The challenges evaluating complex interventions are widely debated. Through an impact-model-based approach, the study will provide a promising framework for the systematic evaluation of a multicomponent intervention promoting physical activity.

Background: The workplace has been identified as a priority setting for health promotion. There are potential advantages of systematically integrating Occupational Health Management (OHM) and Corporate Social Responsibility (CSR). However, OHM and CSR are usually overseen by different management branches with different sets of values, and there is a lack of empirical research regarding interfaces between OHM and CSR. Germany offers a particularly useful setting due to legislation requiring health to be promoted in the workplace. This study aims to examine key stakeholders' views and experiences regarding interfaces between OHM and CSR in German companies., Methods: Individual semi-structured qualitative interviews were conducted with a sample of 77 German stakeholders from three different groups: experts in occupational health and corporate social responsibility from various companies (n = 35), business partners (n = 19), and various non-business partners (n = 23). Transcripts were analysed using qualitative content analysis., Results: Participants identified several areas in which OHM and CSR are already interacting at strategic, structural and cultural levels, but also highlighted several barriers that undermine a more meaningful interaction. Participants reported difficulties in articulating the underlying ethical values relevant to both OHM and CSR at the strategic level. Several structural barriers were also highlighted, including a lack of resources (both financial and knowledge), and OHM and CSR departments not being fully developed or undertaken at entirely different operational levels. Finally, the missing practical implementation of corporate philosophy was identified as a critical cultural barrier to interfaces between OHM and CSR, with existing guidelines and companies' philosophies that already connect OHM and CSR not being embraced by employees and managers., Conclusions: There is already significant overlap in the focus of OHM and CSR, at the structural, strategic and cultural levels in many German companies. The potential is there, both in theory and practice, for the systematic combination of OHM and CSR. The insights from this study will be useful to ensure that closer integration between both management branches is set up in a socially sustainable and ethical manner.

The standard workplace addiction prevention and addiction counselling programmes for preventing alcohol problems in the workplace and helping those at risk of addiction have been proven to be successful. The key elements are, firstly, information and education; secondly, early intervention if conspicuous behaviour in the workplace is identified; thirdly, qualification and counselling by human resources staff; and, finally, assistance for employees with alcohol or other substance addiction problems.In the 1970s, corporate addiction prevention programs based on the American model were established in Germany. In 2006 the German Centre for Addiction Issues (DHS) published for the first time the "Guidelines on Addiction Prevention and Assistance Programs in Companies" as a quality standard. Since then, all companies or public administrations have had open access to specialised knowledge and current legal materials. This is important in order to regulate and reduce alcohol consumption in the workplace. The prevention mandate of managers includes instructing employees on how to avoid health hazards. As soon as there are occupational safety violations, superiors are obliged to intervene. In general, they should intervene as early as possible in the case of irregularities caused by alcohol consumption. In the case of high-risk drug use and risk of addiction, the procedure is based on a tiered sequence of interviews. Support offers from internal or external advice centres are recommended.Alcohol and addiction prevention is part of occupational health management. It has a particularly lasting effect where the program has been written in a company or service agreement and is implemented in a binding manner.

Background/objectives: Workplace health promotion (WHP) interventions can reach a large part of the population. They are designed to improve work organisation and conditions and to promote the personal competencies of employees. Here the aim was to describe the use of WHP interventions based on individual factors and factors related to the size and branch of the companies., Materials and Methods: In the representative population-based study "German Health Update" (GEDA 2014/15-EHIS) conducted by the Robert Koch Institute, 14,389 employees aged between 18 and 64 years were asked about their knowledge and use of workplace measures in their companies during the last 12 months regarding back health, stress management/relaxation and a canteen with healthy food. In addition to socio-demographic factors, health awareness and self-rated health on the use of WHP interventions was analysed., Results: A canteen with healthy food is used by 64.6% of women (F) and 66.2% of men (M); offers for back health (F: 26.2%; M: 18.7%) and stress/relaxation (F: 35.2%; M: 25.6%) are used significantly less. Employees with more pronounced health awareness use the offers more frequently than employees with a less pronounced awareness of health. Men with poor self-rated health make more use of offers for back health and stress/relaxation than men with good self-rated health., Conclusions: In order to reach a larger part of the working population, WHP measures should take the needs of specific target groups into account including sex/gender and age aspects as well as the extent of employment, health awareness and self-rated health status.

The untapped potential of workplace health promotion (WHP) in smaller companies and the promising approach to promote physical activity in the workplace requires application-oriented approaches. This study describes the participatory, theory-based development of a cross-company network with a multicomponent intervention for promoting physical activity in smaller companies. The BIG-Manual (from the "Movement as an Investment for Health" project, German-BIG) was the theoretical framework for developing the cross-company network. Qualitative and quantitative data sources were used to identify the requests and requirements of stakeholders (employees on site, local exercise providers, company representatives and network partners) regarding measures promoting physical activity and the cross-company network. The methods applied included two workshops (n = 13; n = 15), individual semi-structured interviews (n = 8) and a survey (n = 285). The analysis revealed that a large number of stakeholders must be taken into consideration for physical activity promotion in cross-company networks. Many similarities between the requests of employees and further stakeholders concerning a multicomponent intervention for promoting physical activity could be identified. Present gender-specific and physical activity-related differences show the importance of target group-specific intervention planning in the context of WHP. This study makes an important contribution for the development of future cross-company networks promoting physical activity and yields valuable information for the design of a multicomponent intervention promoting physical activity.

Occupational physicians (OPs) are key figures for advising employees and employers about prevention and health at the workplace. However, knowledge of their views on participation in health promotion measures is sparse. This qualitative study aims to explore occupational physicians' experiences with employee participation in a randomized controlled workplace measure for musculoskeletal disorders (MSDs) in Germany. We conducted eight semi-structured telephone interviews with occupational physicians. Interviews were transcribed verbatim and analyzed using a combination of conventional and directed content analysis. Findings were mapped based on Andersen's behavioral model of health services use, resulting in four categories and 10 subcategories. (a) Contextual factors of the measure comprised impacts of the healthcare system and company environment, (b) individual factors of measure participation comprised demographic, social, belief, and MSD need characteristics, (c) health behavior during the measure included OPs' communication, employees' personal practices and measure participation, and (d) outcomes of participation included health status, satisfaction, and dissatisfaction with the measure. Findings imply occupational physicians' and employees' views should be investigated on a broader scale. Researchers should use present statements for the development of intervention studies, while political and managerial authorities can improve organizational conditions of prevention based on these findings.

Aim: Health risks of prolonged periods of sitting at work are a matter of concern. Solutions are needed based on interdisciplinary collaborations of research experts and practitioners in occupational safety and health areas., Methods: In February 2019, at a workshop in Berlin of experts from different fields, issues of scientific evidence on the health risks of sedentary behaviour at work were presented in 6 lectures and solutions for the workplace were discussed. The workshop is documented here in 2 parts. Gender relevant aspects are distinguished where possible., Results: Part II describes solution approaches for practice in the workplace. The results of a recent evaluation of dynamic workplaces are presented. Two examples provide insight into ongoing workplace health promotion measures addressing sedentary behavior in Germany which currently mainly target measures to increase physical activity rather than measures to interrupt long sedentary bouts. The documentation of the plenary discussion summarizes how interventions addressing sedentary behaviour at the workplace can be successful., Conclusions: Decision makers increasingly realize that there is a trend in the 21st century towards low physical demands due to increasingly sedentary tasks in the workplace. Despite research gaps, there is a need for evidence-based decisions in policy and workplace practices. Germany can learn from the experiences of other countries., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Aim of Study: An occupational health management system was initiated at 11 departments under the German Ministry of Defense (MoD) at the beginning of 2015. The departments were characterized by the heterogeneity of employees and the tasks of the departments. The aim of this pilot phase was to get experience and knowledge for implementation of this system in other departments. At the beginning of the pilot phase, an employee attitude survey was conducted to examine the situation., Methods: The survey included all 9,267 employees of the eleven departments. A combination of a web-based online survey and a paper-pencil survey was used., Results: In total, 2,076 (22.4%) of all employees took part in the survey. There were significant difference between the departments in all topics assessed ("leadership behaviour/social issues", "work habits", "job design", "work equipment", "environment conditions", "mental health", "stress", "diet", "exercise", "job responsibility") but not in "health behavior"., Conclusion: This study shows clearly that a department-based analysis is necessary for a goal-oriented meaningful occupational health management system, especially if only limited resources are available., Competing Interests: Sammito ist aktiver Sanitätsoffizier der Bundeswehr. Rose und das Institut für Arbeits-, Sozial- und Umweltmedizin erhalten Forschungsmittel aus dem BMVg., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objectives: Diversity is increasing, including among workers. Traditional approaches in occupational safety and health are no longer sufficient to meet the emerging challenges in the workplace. Currently, knowledge about specific needs of workers with a migrant background is insufficient to develop suitable interventions under participatory methods. The aim of this work is to gain knowledge about diversity in the workplace and discuss considerations for suitable prevention and health promotion., Materials and Methods: Research in reports, analyses of the German Socio-Economic Panel, as well as a review of the literature in relevant databases served to collate current findings about health indicators, stress and strain, structural conditions, and occupational prevention and health promotion., Results: Differentiated results about health in the workplace and stress and strain could be identified. In particular, workers with a migrant background are more often exposed to physical stress and harsh environmental conditions. Furthermore, structural conditions are worse for these workers, e.g. due to lower employment rates, as well as enhanced atypical employment among the target group., Conclusion: Plausible explanations for the reported differences are discussed and useful implications are given. However, the overall lack of data and challenges in data collection must be considered.

Holistic approaches to workplace health promotion (WHP) within the military setting are challenging. In 2015, the German Ministry of Defense initiated a 6-month pilot study of WHP in the Federal Armed Forces. The pilot study was to identify organizational challenges that should be addressed before the Ministry implemented a comprehensive occupational health management policy in all departments. Eleven diverse departments were selected to participate in a WHP program that addressed physical activity, diet, stress management and addiction prevention. As part of the evaluation concept, we interviewed coordinators, and department heads focusing on transfer factors from the perspective of the implementers. All coordinators and their department heads or deputies participated in semi-structured face-to-face on-site interviews. The data were analyzed based on qualitative content analysis. The coordinators (officers with sports science degree) seemed fully prepared and capable to master the new task. They experienced difficulties in adapting WHP activities to local structures and needs, and complications in administering modular activities. Department heads described conflict regarding human resources between the military mission and the implementation of WHP. Commitment to WHP was a strong facilitator. The interviews identified various barriers related to support by middle management (supervisors) and specific work conditions (e.g. shift work). If occupational health management is to be successfully implemented on a large scale, conceptional and practically collaboration is necessary between WHP and occupational safety and health, and organization and leadership, respectively. Supervisors will benefit from open communication about compensation for the release time of their subordinates to attend WHP.

Objectives: To investigate the awareness and use of health promotion offers among offshore wind workers and to study associations with demographic and workplace characteristics. To examine employees' reasons for (non-)participation and their wishes for health promotion activities offshore., Design: Mixed-methods study presenting the results from semistructured telephone interviews and a web-based cross-sectional survey., Setting: Offshore wind parks in the German exclusive economic zone in the North and Baltic Seas., Participants: 21 offshore workers in the qualitative study (19 male/2 female; all German). 303 offshore workers in the quantitative study (287 male/13 female; 275 German/24 other nationalities)., Outcome Measures: Awareness and use of workplace health promotion offers and associations with demographic and workplace characteristics (age, work schedule and wind park phase); reasons for (non-)participation; needs and wishes for health promotion offers., Results: Few workers indicated being aware of health promotion programmes at their workplace. Single offers were reported, with fitness facilities being the most common offer employees recognised and had used (n=168, 55.6%). Employees with a regular work schedule were more likely to have used fitness facilities offshore (adjusted OR (AOR)=3.22, 95% CI 1.53 to 6.80). Workers in the construction phase were more likely to have used massages (AOR=8.19, 95% CI 2.82 to 23.77). Younger workers were less likely to belong to the group of those who were aware of fitness facilities but had not used them (AOR=0.43, 95% CI 0.19 to 0.98). Employees expressed various needs and wishes for behavioural and environmental preventive measures offshore., Conclusions: The results demonstrate a perceived need among the workers for the development of health promotion programmes offshore. Since the awareness and use of offers may partly depend on personal and organisational characteristics, this should be taken into account in the planning of health promotion activities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The purpose of the study was to analyze if 2 regional networks of small and medium enterprises (SME) for workplace health promotion are sustainable, and to find out the motivation of the enterprises to join the network. It was also examined if there is a stable culture of cooperation 6 -10 years after the founding of the network. Additionally, the study checked the current work and suggestions for improvement to the network structure, so that in the future, promotion of workplace health can be further improved., Method: 2 regional networks, founded in 2005 and 2009, were studied. Standardized telephone interviews carried out between September 2013 and January 2014 enabled data collection for this cross-sectional study. 42 interviews with 6 open questions were organized with the managers of the companies or the person responsible for workplace health promotion., Results: The results of the study show that 88.1% (n=37) of the network company members profited from the exchange of experiences. 50.0% (n=21) benefited from shared activities and 28.6% (n=12) from making new contacts. 9.5% (n=4) of the respondents expressed concerns about excessive bureaucracy resulting in too much effort for too little benefit and 7.1% (n=3) were also missing comprehensive structural measures. Suggestions for improvement were enhancement of practical work (26.2%, n=11) and the wish for stronger commitment (11.9%, n=5). 90.5% (n=38) considered their expectations as fulfilled and 66.7% (n=28) evaluated the current work as being quite positive., Conclusion: The networks have turned out to be sustainable, proven by the fact that the companies still are members of the networks for 6 and 10 years, respectively and are still satisfied with the network. The study shows that the majority of the members profits from the membership of these regional networks. Networks can help them to implement permanent workplace health promotion. To further improve the work of the network, a systematic and scientific workplace health promotion scheme is recommended., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: To assess whether a structured employee protection program for pregnant workers at a chemical company has an impact on pregnancy outcomes., Methods: Reported pregnancies (n = 1402) between 2003 and 2010 and their outcomes were documented using questionnaires at the time of pregnancy report, end of pregnancy, and 1 year later. Potential maternal exposures were assessed using job histories, workplace inspections, and questionnaires., Results: Participation was 86% overall and was consistently high across subgroups.Pregnancy losses (10.9%), pregnancy complications, and preterm births (8.1%) were in agreement with rates in the general population and were independent of type of work and maternal exposure category., Conclusions: Pregnancy complication rates in this chemical company are not statistically elevated than that in the general population, as suggested in a previous study. The protection program may play a role in preventing complications that may have occurred.

Background: Organizational justice (OJ), involving transparent workplace procedures and treating staff members with respect, has been of growing concern in recent epidemiological research as a determinant of health-related outcomes., Aims: To examine the factorial validity of the German version of Moorman's Organizational Justice Questionnaire (OJQ), to investigate the direct cross-sectional effect of OJ on self-rated work ability and to analyse if there is an additional indirect effect of OJ on work ability mediated by effort-reward imbalance., Methods: An analysis of cross-sectional data from the Second German Sociomedical Panel of Employees, involving white-collar workers employed at least half time. We performed confirmatory factor analyses to test the factorial validity of the OJQ and analysed the direct and indirect associations of OJ and self-rated work ability by path model analysis., Results: Of the 1217 participants (47% female; mean age: 51) 36% had poor work ability. Factor analyses confirmed the two-factor structure of the German OJQ. Work ability was explained directly by OJ (β = 0.30) and effort-reward imbalance (β = -0.27). Additionally, we identified an indirect effect of OJ that was mediated by effort-reward imbalance (β = 0.14). The total effect of OJ on work ability was remarkably strong (β = 0.44). Associations remained unchanged after adjustment for socio-demographic parameters., Conclusions: This study showed the importance of considering additional indirect pathways when examining the impact of OJ on the work ability of employees., (© The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

This article examines the concept of wellness through a comparative political economy and legal framework. It asks whether wellness, an increasingly defined term within US federal and state legislative instruments including, for example, the Patient Protection and Affordable Care Act, is primarily a US-centric phenomenon. Or is wellness, in its various different guises, a worldwide phenomenon? By focusing on three distinctly different jurisdictions - the United States, Germany, and Australia - this article examines wellness through the lens of employers, the health care system, employment and tort law, and the greater political economy. It notes that while improving employee health, well-being, and productivity is common across the three countries and their respective cultures, the focus on wellness as a distinct legal concept is unique to the United States., (Copyright © 2014 by Duke University Press.)

Background: Leadership behavior may both serve as a supportive resource or as a source of psychological distress in the workplace., Objective: Transformational leadership (TL), a behavior of superiors that fosters motivation, empowerment and a sense of teamness, has been associated with employee well-being, but the mechanisms that underlie these effects are unclear. We therefore explored the relationship between TL and stress by examining potential mediating roles for established organizational and personal resources., Methods: We used cross-sectional data on TL, psychosocial resources and employee strain from a company wide survey. Linear regression and structural equation modeling assessed potential mediation following the method outlined by Baron and Kenny., Results: In a convenience sample consisting of mostly white-collar employees (n=320, 42.6% male), we observed a relationship between TL and employees' perceived work-related stress that was fully mediated by protective psychosocial resources (ß =-0.33, p< 0.01). Additionally, we found that TL positively affected these resources (ß=0.61; p< 0.01) and that absence of resources led to more psychological strain (ß=-0.54, p<0.01)., Conclusions: Transformational leadership seems to be associated with lower stress among employees and a perception of more available psychosocial resources. These findings indicate that TL might serve as a valuable focus for tailored interventions to improve employee health.

Objective: The present study aims to measure the determinants of the innovative climate in German banks with a focus on workplace health management (WHM)., Methods: We analyze the determinants of innovative climate with multiple regressions using a dataset based on standardized telephone interviews conducted with health promotion experts from 198 randomly selected German banks., Results: The regression analysis provided a good explanation of the variance in the dependent variable (R² = 55%). Communication climate (β = 0.55; p < 0.001), social capital (β = 0.21; p < 0.01), the establishment of a WHM program (β = 0.13; p < 0.05) as well as company size (β = 0.15; p < 0.01) were found to have a significant impact on an organization's innovative climate., Conclusions: In order to foster an innovation-friendly climate, organizations should establish shared values. An active step in this direction involves strengthening the organizations' social capital and communication climate through trustworthy management decisions such as the implementation of a WHM program.

Objective: In 1983, global chemical company BASF SE implemented a supplemental health protection program to help its employees cope with the stressors associated with shift work. The program included comprehensive medical examinations and health promotion activities targeted at shift workers., Methods: To assess the possible long-term health impacts of the program, cohorts of 14,128 male rotating shift and 17,218 male day wage employees were established via electronic job history searches. Health examination and mortality records were linked to job histories and studied over an 11-year period., Results: Between 1996 and 2006, there were 414 and 463 deaths among rotating shift and day work employees, respectively. Mortality risks were marginally lower among shift working employees when taking age and job level into consideration, and remained so when cigarette smoking, alcohol intake, and existing chronic disease conditions were included as explanatory factors. The incidence of obesity, diabetes, and diseases of the circulatory and digestive system, as diagnosed or reported during health examinations, was higher among shift work employees, possibly as a consequence of enhanced medical surveillance or a direct effect of shift work., Conclusion: Incorporation of extensive occupational medical examinations, health seminars, and other intervention programs may help mitigate the long-term health consequences of shift work.

The submitted model of working time transposes and interprets german industrial law. The result of this interpretation is a high level of acceptance of the employees, a fast education that is high qualified with costs that are still affordable. The advantage of this model compared with the shift-model that runs after the EuGH-decision is obvious if you look at the reality of our health care system. This is why it is important to have an efficient interpretation of the existing law. Of course it will be a necessity also in the future to create new models of working time and to adapt these models in a way that it fits into the structure of a hospital. It would be the wrong way to force a juridical and political decision, how it was done by the german government that gave a deadline to put the EuGH decision into operation, without the possibility of an interpretation that fulfils the demand of the hospital.

Although gastrointestinal (GI) illnesses account for considerable sick absenteeism, there have been few workplace studies of GI disorders. We determined the prevalence of Helicobacter pylori infection by serology and assessed its relation to upper GI tract complaints, personal ulcer history, and family history of stomach cancer in 6,143 employees (mean age, 40.4 years) at BASF's main chemical production facilities in Ludwigshafen, Germany. Employees were recruited during occupational health clinic visits (n = 4,488) and through broad communications efforts (n = 1,655). Participation among clinic attendees was 66%, and this recruitment method was particularly effective in reaching shift employees. Positive immunoglobulin G (IgG) serology (38.2%), ulcers (4.9%), nonulcer dyspepsia (20.4%), and a family history of stomach cancer (6.1%) were common occurrences in this work setting. Further diagnostic evaluation and eradication therapy was recommended for 795 employees (12.9%), based on a combination of positive serology and either upper GI tract complaints or family stomach cancer history, and has been completed for 541 employees. A weak but consistent association was seen between positive serology and cigarette smoking, and shift work was found to be associated with positive serology, but not with ulcer or nonulcer dyspepsia occurrence.

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Background: Psychotherapeutic consultation at work (PT-A) provides employees with mental illnesses or subclinical symptoms a short-term and low-threshold access to psychotherapeutic care. However, practical experience shows that the utilisation rate seems low compared to expected demand. Therefore, this study aimed to identify determinants of utilisation by exploring associations between sociodemographic characteristics, psychological well-being, stigma-related barriers and psychosocial safety climate and the intention to seek PT-A. Methods: Within a cross-sectional study, 658 participants were recruited via various social media channels in Germany. Participants answered an online questionnaire on potential determinants of (1) intention to seek PT-A in general and of intention to seek PT-A to specifically discuss (2) occupational burden and (3) private burden. Multiple ordinal regression analyses were conducted for the whole study sample and for the subgroups of participants screened positive and negative for current depression. Results: Lower stigma-related barriers were associated with higher general intention to seek PT-A among all study groups. Lower psychological well-being was associated with higher general intention to seek PT-A and with higher intention to seek PT-A to discuss occupational and private burden, but only so in the subgroup of employees who were screened negative for current depression. Treatment experience was associated with higher intention to seek PT-A for occupational burden among participants screened negative but not among participants screened positive for current depression. No associations were found between age, gender, education or psychosocial safety climate and any variable of intention to seek PT-A. Conclusion: Those results give an overview on potential determinants for the intention to seek PT-A, but future research with longitudinal designs is needed to confirm that those factors also determine actual utilisation of PT-A. Based on the results, practical implications might include antistigma campaigns and promotion of PT-A adapted to the aims of the consultation. [ABSTRACT FROM AUTHOR]

Background: Common mental disorders affect a significant proportion of the population worldwide at any given time. Psychotherapeutic consultation at work offers employees with mental distress short-term and low-threshold access to psychotherapeutic treatment. However, this offer is only accepted by one to two percent of the employees to whom it is offered. Taking into account employees ' preferences regarding organisational aspects might increase the use of psychotherapeutic consultation at work. This study therefore aimed to identify preferences on organisational aspects of psychotherapeutic consultation at work among employees of diverse occupational areas, company sizes, supervisor functions and job requirement levels. Methods: A total of 755 employees were recruited via advertisements on social media (Instagram, Facebook and LinkedIn). Participants rated on a 5-point Likert scale their agreement to different implementation options of psychotherapeutic consultation at work: type (in-person/video/telephone), location (on/outside company premises), time (within/outside working hours), scope (diagnostic/diagnostic + treatment) and purpose (private/occupational). Additionally, the maximum accepted distance to the location of consultation was assessed. Various analyses of variances (ANOVA) were conducted to determine differences in agreement to implementation options within each organisational aspect and to analyse differences between occupational areas, company sizes, requirement levels and between employees with and without supervisor function. Results: Participants indicated a preference for in-person psychotherapeutic consultation that takes places outside company premises and outside working hours. Furthermore, they preferred offers including diagnostic and treatment sessions compared to offers including diagnostic sessions only. Even though participants agreed that consultation should be offered for all purposes, agreement for occupational issues was stronger than for private issues. For some implementation options, the level of agreement varied according to occupational field, company size, supervisor function and level of requirement. However, these differences did not affect the key findings mentioned above. Conclusion: Those findings give practical indications on the organisational design of psychotherapeutic consultation at work. The results suggest that in-person consultation outside company premises and working hours combining diagnostic and treatment sessions will be accepted by employees regardless of their occupational area, company size, supervisor function and requirement level. [ABSTRACT FROM AUTHOR]

This article examines the scientific and medical objectification of workers' bodies in mining on the Ruhr as an integral part of the formation of a modern care and control regime. This specific control regime had been established with the modernisation of health insurance for miners at the end of the nineteenth century. The central thesis of this article is that in the German Empire new knowledge about the miner's body arose within the scope of the categories and paradigms of the hygiene movement. Above all this means that the miner's body, in particular his productivity and health, was analysed and categorised in relation to his working and everyday life environment. This specific form of hygienic objectification of the miner aimed at the production of a healthy environment as well as at the production of a hygienic subject. Indeed, this environmental-hygienic approach was to be complemented by a new scientific discipline at the turn of the century, namely bacteriology or more precisely, bacteriology-oriented hygiene. The fight against hookworm disease around 1900 and the extension of the medical infrastructure of the health insurance for miners will be taken as examples of this important turning point for biopolitics in industrialised Germany. [ABSTRACT FROM PUBLISHER]