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The transition from school to university has been found to be associated with a decline in physical activity (PA). As regular engagement in PA plays an important role in preventing obesity and various chronic diseases such as type 2 diabetes and cardiovascular diseases, a deeper understanding on barriers that hinder university students from being physically active is necessary. We therefore conducted a mixed-methods study which built, first, on conducting a quantitative online survey across Germany (n = 689; 69.5% female) to examine barriers among university students. Afterwards, we explored these barriers in more detail by conducting 20 in-depth qualitative interviews (65.0% female). While we identified in our quantitative survey that especially time-related and motivational barriers hindered university students to engage in PA, our qualitative interviews indicate that connections between these barriers seem to exist. Moreover, the qualitative interviews enabled us to identify additional transition-related barriers (e.g., missing routines in everyday life, difficulties in finding a new sports club) that were not included in the quantitative questionnaire. Thus, such barriers should be incorporated into quantitative instruments to assess these barriers in larger samples of university students in the future. Moreover, our findings provide potential starting points for promoting PA in German university settings.

ObjectivesThe COVID-19 pandemic has posed great challenges to medical professionals worldwide. Dental assistants (DAs) are at exceptionally high risk of infection with SARS-CoV-2 due to frequent and close patient contact and involvement in various high-risk dental procedures. This study aimed to investigate attitudes, stressors and work outcomes among DAs from all over Germany at the peak of cases in spring 2020.DesignCross-sectional study. Descriptive analysis and logistic regression.SettingDental, maxillofacial surgery and orthodontic practices across Germany, April 2020.ParticipantsParticipants aged 18 years and above and currently working as DAs in Germany.Primary and secondary outcome measuresA self-devised online questionnaire was employed comprising questions on SARS-CoV-2-related attitudes, stressors and work outcomes. Validated scales assessed symptoms of depression and anxiety.ResultsAmong 1481 participating DAs (median age 35 years, 98.4% female, 91.8% working in dental practices), major stressors were uncertainty about the pandemic’s temporal scope (97.9% agreement, n=1450), uncertainty about one’s financial situation (87.8%, n=1301), uncertainty about how to act correctly (87.6%, n=1298) and thoughts about a possible infection during work (83.8%, n=1241). Forty-two per cent of DAs (n=622) felt sufficiently prepared for dealing with patients with SARS-CoV-2. Only 17.5% (n=259) agreed that material for personal protection was sufficiently available. Multivariable logistic regression analyses suggested that working in a dental practice, compared with orthodontic and maxillofacial surgery practices, was significantly associated with uncertainty about one’s financial situation (OR 2.13 (95% CI 1.33 to 3.44)) and with the reported availability of personal protective equipment (PPE) (0.55 (0.36 to 0.84)).ConclusionsTraining about correct behaviour of DAs during future infectious disease outbreaks is needed, especially for DAs working in dental practices. In the future, it will also be necessary to strengthen supply chains to ensure that PPE is sufficiently available in a timely manner.

Background Prior evidence suggests that medical students’ mental health is poor and deteriorates during the course of academic studies. This qualitative study therefore aims to improve our understanding of medical students’ perceptions of i) stressors related to their academic studies, ii) resources that may facilitate coping with those stressors and iii) suggestions to potentially reduce stress. Methods Eight focus groups were conducted with medical students enrolled at a medical school in Germany until thematic saturation was reached. A topic guide was used to facilitate the discussion. Subsequently, focus group discussions were transcribed and content-analyzed using MaxQDA. Results Organizational factors especially related to inadequate information flow as well as exams (e.g. repeat exams, scheduling, perceived unfair grading), poor theoretical and practical teaching quality, time and performance pressure, social interactions and individual characteristics (e.g. self-expectations, fear of failure) emerged as major contributors to stress. Resources perceived to facilitate coping with those stressors pertained to some other organizational aspects (e.g. flexibility, availability of contact persons), career prospects, practical training, social support, personal characteristics (e.g. knowledge base, past experience) and leisure time. Suggestions for improvement related primarily to organizational measures rather than individual-level measures. Conclusions Besides well-known stressors (e.g. exams and high performance pressure), some new aspects emerged from our study including stress related to organizational factors and repeat exams. Accordingly, students’ wishes for organizational-level interventions, including better information systems and better interweaving of practical and theoretical education, could be first target areas for improvement. Electronic supplementary material The online version of this article (10.1186/s12909-019-1747-z) contains supplementary material, which is available to authorized users.

Objective: This study investigates the associations between Effort–Reward–Imbalance (ERI), Overcommitment (OC), Job–Demand–Control (JDC), and Organizational Injustice (OIJ) with employee well-being, absenteeism, and presenteeism, as well as the costs incurred.Methods: Cross-sectional data from 1440 German pharmaceutical company employees assessing job stress, employee well-being, absenteeism, and presenteeism were used. Linear regression and interval regression analyses assessed separate and independent associations and sample-specific costs were estimated.Results: All four stressors were related to employee well-being, presenteeism, and absenteeism when analyzed separately. OIJ showed the strongest independent association with absenteeism (coef. = 0.89; P < 0.01), whereas OC was most strongly independently associated with lower well-being (coef. = −0.44; P < 0.01) and higher presenteeism (coef. = 0.28; P < 0.01). Absenteeism costs per employee/year were higher than presenteeism costs.Conclusions: Occupational health interventions reducing job stress will have strong potential for productivity raise and lower costs.

Ambivalent social ties, i.e., whereby a relationship is evaluated simultaneously in positive and negative terms, are a potential source of distress and can perturb health-relevant biological functions. Social interactions at the workplace, in particular with supervisors, are often described in ambivalent terms, but the psychological and psychobiological impact of such interactions has received little scientific attention. The current study examined associations between ambivalent attitudes towards one's supervisor, perceived distress (general and work-related), and diurnal dynamics of the stress hormone cortisol. 613 employees evaluated their supervisor in terms of positive and negative behaviors, which was combined into an ambivalent index. Higher ambivalence was associated with higher perceived distress and work-related stress (p p

Background The aim was to investigate attitudes and stressors related to the SARS-CoV-2 outbreak among emergency medical services (EMS) workers in Germany. We further aimed to detect possible changes within a 5-week period and potential determinants of attitudes and stressors. Methods We conducted two cross-sectional studies using an online questionnaire in early April 2020 (i.e., the first peak of the SARS-CoV-2 outbreak in Germany) and five weeks later. The study instrument comprised sociodemographic items, self-devised items on pandemic-related attitudes, stressors and work outcomes, and established instruments assessing depressive symptoms and symptoms of anxiety. Logistic regression was performed to identify possible determinants. Results Data of 1537 participants was included in the analysis (April: n = 1124, May: n = 413, 83.1% male, median age 32). Most participants agreed that their personal risk of infection was higher compared to the general population (April: 87.0% agreement, May: 78.9%). The greatest stressor was uncertainty about the pandemic’s temporal scope (82.0 and 80.9%, respectively). Most participants (69.9, 79.7%) felt sufficiently prepared for the pandemic and only few felt burdened by their financial situation (18.8, 13.3%). Agreement to all stressors decreased from April to May except related to the childcare situation. Regression analysis identified subgroups to be burdened more frequently such as older employees, those with SARS-CoV-2 cases among their colleagues, and those with lower paramedic training levels. Conclusions We identified key SARS-CoV-2-related stressors whose levels generally decreased within a 5-week period. Our results indicate that EMS workers are less affected by existential fears and rather worry about their personal infection risk. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06779-5.

BackgroundThe SARS-CoV-2 virus has spread rapidly around the globe since December 2019 creating much uncertainty among medical staff. Due to close patient contact, medical assistants are at increased risk of an infection. Several studies have investigated psychological consequences of the SARS-CoV-2 pandemic on medical staff, yet studies in the outpatient setting are scarce and studies addressing medical assistants are lacking. This study aimed to investigate pandemic-related stressors, attitudes, and work outcomes among medical assistants and to identify possible determinants.MethodsThe population under study were medical assistants across entire Germany. A self-devised online questionnaire was published between April 7th, 2020, and April 14th. including questions on pandemic-related stressors, attitudes and work outcomes. Additionally, symptoms of depression and anxiety disorder were measured by PHQ-2 and GAD-2, respectively. Logistic regression was performed to identify possible determinants.Results2150 medical assistants provided complete data (98.0% female, mean age 37.6 years). Major stressors were uncertainty about the temporal scope of the pandemic (95.1% agreement), about how to act correctly (77.5%), feelings of not being allowed to let patients down (75.9%), uncertainty about one's financial situation (67.4%) and about contact persons for further information (67.1%). One third (29.9%) of the study population screened positively for depression and 42.6% for anxiety disorder. Feeling burdened by one's financial situation was significantly associated with working in specialist practices (1.32 [1.08-1.62]), caring for children (1.51 [1.22-1.87]), depression (1.28 [1.01-1.62]), and anxiety disorder (1.93 [1.55-2.39]). Feeling burdened by thoughts about virus contraction at work was also significantly associated with working in specialist practices (1.33 [1.07-1.64]), caring for children (1.33 [1.07-1.66]), depression (1.54 [1.18-2.00]), and anxiety (4.71 [3.71-5.98]).ConclusionsThis study provides novel evidence regarding major SARS-CoV-2 pandemic-related stressors among medical assistants and suggests need for special support for medical assistants caring for children and working in specialist practices.

The mental health of medical students remains to be a matter of concern. Numerous setting-based and individual-based interventions for student mental health have been proposed in the literature. However, the student perspective on those interventions has been largely neglected. This study aims to explore how medical students perceive different interventions and if they desire any additional changes with regard to their studies. Eight focus groups with 71 participants were conducted at a large German medical school. Focus groups were recorded, transcribed and content-analyzed using MAXQDA 18. We found that medical students prefer setting-based interventions. Most proposed interventions were on a setting-based level. For instance, students asked for more information on the university's psychosocial counseling services and for better information management regarding contact persons. Interventions proposed in the literature received mixed reactions: Several participants did not favour a pass/fail grading system. Students considered a peer-to-peer mentoring program for freshmen very helpful. Students had diverse attitudes towards Balint groups. They approved of several self-management courses, most of them being related to time or stress management. Interestingly, the most urgently wanted interventions appear to be rather easy to implement (e.g. a mentoring program). This study explored the medical student perspective on student mental health interventions. Additionally, our study illustrates the benefit and feasibility of involving students early on in the conception of interventions. Further research with a representative sample is needed to obtain broader information on the acceptance of the suggested interventions.

Common mental disorders (CMDs) are risk factors for long-term sickness absence and unemployment. Therefore, return-to-work (RTW) processes have been introduced to facilitate the return of employees. As the success of RTW processes is considered to be determined by the cooperativeness of the involved stakeholders, we aimed to investigate the views of those stakeholders to disclose potentially diverging expectations. Qualitative interviews were conducted (08/2018-04/2019) among five stakeholder groups: returnees with a diagnosed CMD who were eligible for a RTW process, health care professionals nominated by the returnees, supervisors, colleagues and occupational physicians (the latter three groups were not nominated by the returnees). In total, 24 returnees, 13 health care professionals, 13 occupational physicians, 9 supervisors and 9 colleagues were interviewed (68 interviews in total). Potentially diverging expectations of the stakeholders related to whether diagnoses need to be disclosed by returnees. Agreement existed in terms of the need for a trustful relationship between employees and occupational physicians to initiate a RTW process early. As the understanding of all stakeholders&rsquo, viewpoints is one of the main factors promoting a successful RTW, we explored the expectations of those involved in the RTW process. One implication of our findings is to strengthen the role of occupational physicians, who could coordinate the return process.

Electronic mental health services (eMHSs) offer additional options for the dissemination of psychological interventions for university students. Still, many university students are reluctant to use eMHSs. Narrative messages may help increase the awareness and acceptance of quality-approved programs. However, little is known about the usefulness of narrative messages to improve attitudes towards eMHSs. In this experiment, we thus aimed to explore in how far different ways of targeting information to students affect their attitudes towards eMHSs for stress prevention and therapy, and to identify potential determinants of attitude change. N = 451 students (Mean = 32.6 years, SD = 10.2, 75% female, 7% with eMHS experience) were randomly assigned to one of four study arms involving information designed to induce different levels of perceived similarity. While the active control condition only received general information (arm 1, “information only”, n = 116), the other experimental arms were additionally exposed to testimonials on specific eMHSs either addressing an unspecified audience (arm 2, n = 112), employees (arm 3, n = 115) or working university students (arm 4, n = 108). Two-way ANOVA revealed no impact of information on the alteration of attitudes towards eMHSs for stress coping (d = 0.20). Only a small effect of target-group specific testimonials on attitudes towards online therapies was identified at post-intervention (d = 0.29). Regression analyses demonstrated significant influences of source credibility and perceived similarity on attitudes for preventative eMHSs (ps

The evidence regarding the effects of household air pollution on angina pectoris is limited in low-and middle-income countries (LMICs). We sought to examine the association between household air pollution and angina pectoris across several countries. We analyzed data of individuals from 46 selected countries participating in the cross-sectional World Health Survey (WHS) 2002&ndash, 2003. Pooled and stratified (sex, continent) logistic regression with sampling weights was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to quantify associations between the use of different household fuels with angina pectoris. In the pooled sample, we observed lower odds of angina pectoris with electricity use (OR: 0.68, 95% CI: 0.56&ndash, 0.83) compared to those households reporting the use of gas as a household fuel. Increased odds of angina pectoris were observed with the use of agriculture/dung/shrub/other (OR: 1.65, 95% CI: 1.30&ndash, 2.09), mixed (solid and non-solid fuels) (OR: 1.31, 95% CI: 1.09&ndash, 1.56), and mixed solid fuel use (OR: 1.59, 95% CI: 1.12&ndash, 2.25). Higher odds of angina pectoris were observed mainly with solid fuel use. The results highlight the importance of addressing these issues, especially in regions with a high proportion of solid fuel users and increasing levels of cardiovascular disease.

The HeiDE study (‘‘Heidelberger Langzeitstudie zu Risikofaktoren und Diagnose chronischer Erkrankungen’’) is a longitudinal population-based study that started in the 1990s and, at baseline, assessed an array of health-related personality questionnaires in 5 133 individuals. Five latent personality dimensions (The Heidelberg Five) were identified and interpreted as Emotional Lability (ELAB), Lack of Behavioral Control (LBCN), Type A Behavior (TYAB), Locus of Control over Disease (LOCC), and Psychoticism (PSYC). A subset of participants (n=3 268; after quality control) were genotyped on whole-genome arrays at follow-up. To further characterize The Heidelberg Five, we analyzed genomic underpinnings, their relations to the genetic basis of the Big Five trait Neuroticism, and longitudinal associations with lifetime psychiatric symptoms. SNP-based heritability was significant for ELAB (34%) and LBCN (29%). Five separate genome-wide association studies (GWAS) using factor scores on personality dimensions as phenotypes were conducted, only the phenotype PSYC yielded a genome-wide significant finding (p−8, top SNP rs138223660). Gene-based analyses identified significant findings for ELAB (Integrin Subunit Beta 5), TYAB (Coiled-coil Domain Containing 83), and PSYC (Nuclear Receptor Subfamily 1 Group H Member 4). Polygenic risk scores for Neuroticism, phenotypically related to ELAB, were associated with ELAB, but not with the remaining Heidelberg Five. Longitudinally, all personality dimensions were related to depressive symptoms at follow-up, with ELAB, LBCN, and PSYC also associated with lifetime anxiety symptoms. These results highlight the clinical importance of health-related personality traits, and identify LBCN as a heritable “executive function” personality trait.

BACKGROUND: Previous research suggests that psychosocial working conditions may detrimentally affect diabetes self-management behavior at work, including self-monitoring of glucose levels. We aimed to better understand the potential usefulness of continuous glucose monitoring devices at the workplace according to employees with diabetes. METHODS: We carried out secondary analyses of data from a qualitative study, which sought to explore potential barriers to and solutions for effective diabetes self-management at work. Interviews were carried out in face-to-face contact or by telephone and were transcribed and content-analyzed using MaxQDA. The used topic guide did not specifically inquire after continuous glucose monitoring devices, but views on the suitability of those devices at the workplace repeatedly emerged from the interviews. Data from 25 employed adults with diabetes mellitus type 1 or type 2 on insulin therapy were included. RESULTS: The major perceived improvements associated with the use of continuous glucose monitoring devices pertained to their time-saving application that allowed for an increased frequency of glucose level assessments and for socially covert glucose measurement. The socially less noticeable way of monitoring glucose level was specifically perceived as beneficial, as employees with diabetes believed their illness would thereby attract less attention. Fewer or shorter interruptions as well as the reliability of integrated alarm systems were perceived to increase concentration at work and workability. CONCLUSIONS: Continuous glucose monitoring devices were perceived to facilitate glucose management at the workplace, which may exert positive effects on compliance as well as functioning at work. Further research would be of interest to statistically confirm our findings in occupational samples.

Aims We conducted a qualitative study to expand our current understanding of the potential link between psychosocial working conditions and diabetes self-management at work. Methods Thirty employed adults with diabetes mellitus living in Germany (n = 19 with type 1, n = 11 with type 2, 57% female, aged 24–64 years) were recruited. Using a topic guide, we carried out in-depth interviews in face-to-face contact or by telephone. Interviews were transcribed and content-analyzed using MaxQDA. Results Psychosocial working conditions perceived to detrimentally affect self-management activities included, amongst others, a high workload, poor job control, unhygienic working environments, the requirement to work under high or fluctuating temperature, perceived social norms at the workplace, and the attitude to prioritize work-related demands as opposed to diabetes-related demands. The types of self-management activities considered to be adversely affected related to glucose monitoring, insulin injections, dietary control, the ability to recognize hypoglycemia and health care use. Conclusions Various types of occupational psychosocial factors may determine diabetes self-management practices at the workplace. Quantitative studies are needed to confirm our observations. Subsequently, interventions could be developed and evaluated to improve opportunities to adequately engage into diabetes self-management at work.

Numerous epidemiological studies among health care staff have documented associations of adverse psychosocial working conditions with poorer health-related outcomes, a reduced quality of patient care and intentions to leave the profession. The evidence for physician assistants in Germany remains limited though. We surveyed a total of 994 physician assistants between September 2016 and April 2017. Psychosocial working conditions were measured by the established effort–reward imbalance (ERI) questionnaire and by a questionnaire specifically developed to capture psychosocial working conditions among physicians. Health outcomes (i.e., self-rated health, depression, anxiety), self-rated quality of care and the intention to leave the profession were assessed by established measures. We ran multivariable logistic regression analyses. The prevalence of work stress in terms of ERI equalled 73.77%. Work stress according to the ERI model was associated with significantly poorer self-rated health [odds ratio (OR) 3.62], elevated symptoms of depression (OR 8.83) and anxiety (OR 4.95), poorer quality of care (OR for medical errors 4.04; OR for interference of work with patient care 3.88) and an increased intention to leave one’s current profession (OR 3.74). The PA-specific questionnaire showed similar, albeit weaker, associations (all ORs > 1.22). Our results are in line with previous findings among health care staff and provide specific and novel evidence for physician assistants. Interventions aiming at the improvement of working conditions seem needed given their potential adverse consequences in terms of employee health, quality of care, and personnel policy.

There is ample evidence supporting the link between stress at the workplace and physical and mental health. One of the pathways potentially mediating those associations may involve the hypothalamic-pituitary-adrenal (HPA) axis, with cortisol as an end product. While theoretically plausible, findings on the association of self-reported work stress with hair cortisol concentrations (HCC) are inconclusive, being potentially biased by omitted pertinent factors. This issue can be addressed, among others, by eliminating time-invariant factors through consideration of variation within persons over time. To this end, the present study examined the association between variation in HCC and perceived work stress − as assessed by the Effort-Reward-Imbalance (ERI) model − between two points in time (t1 and t2) over one year in a sample of 40 male factory workers. Neither a cross-sectional association, nor a link between change in ERI and HCC levels at t2 was observed. There was however a robust association of the change in ERI with the change of HCC. This effect was independent of baseline HCC and other confounders (Beta = 0.414, S.E. = 0.155, p = 0.012). Accordingly, this is the first study revealing prospective evidence for the associations of work stress with HCC, while excluding potentially time-stable confounding factors, like genetic factors or phenotypic hair color.

AimEpidemiological studies from high‐income countries show that diabetes is associated with impaired social functioning. As healthcare systems in middle‐ and low‐income countries offer fewer resources to curtail the potential social impact of diabetes, we performed a comparative study on the diabetes–social impairment link in low‐, middle‐ and high‐income countries. MethodsWe use data from the cross‐sectional World Health Survey (n = 235 428 from 10 low‐income, 29 middle‐income and 9 high‐income countries). Diabetes was defined by self‐reports of a diagnosis. Impaired social functioning was considered present if participants reported severe or extreme difficulties with personal relationships or participation in the community. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) in the overall sample and by income regions. ORs were corrected for demographics and health‐related lifestyles, and then additionally adjusted for impairments that may explain any observed association (i.e. impaired vision, mood, cognition and mobility). ResultsIn the overall sample, we confirmed an association between self‐reported diabetes and impaired social functioning (OR = 1.47, 95% CI = 1.18–1.83). The strength of that relationship increased with decreasing country income (e.g. OR in low‐income countries = 2.23, 95% CI = 1.14–4.37). Associations were substantially attenuated by further correction for impairments, in particular mood problems, in the overall sample (OR = 0.92, 95% CI = 0.72–1.16) and all income regions. ConclusionsSelf‐reported diabetes is associated with impaired social functioning in high‐ and middle‐income countries, and this relationship is even stronger in low‐income countries. Associations are largely explained by physical and mental impairments, which may be due to diabetes.

Objective Epidemiological evidence suggests that work stress is associated with suicidal ideation (SI). However, only few studies in this area have drawn on well-established theoretical work stress models (i.e., the job-demand-control [JDC] model, the effort-reward-imbalance [ERI] model, and the model of organizational injustice [OJ]). Utilization of such models allows though for theory-based assessments and workplace interventions. Since evidence on those models' relationship with suicide-related outcomes is currently inconclusive (with regard to JDC), markedly sparse (OJ) or lacking (ERI), we aimed to provide additional or initial evidence. Methods We drew on original data from six cross-sectional studies, which were conducted in four countries (i.e., South Korea, China, Australia, and Germany). Work stress was measured by established questionnaires and was categorized into tertiles. In each study, SI was assessed by either one or two items taken from validated scales. Associations of work stress with SI were estimated for each study and were pooled across studies using multivariate random-effects logistic modeling. Results In the pooled analyses ( n = 12,422) all three work stress models were significantly associated with SI with odds ratios fluctuating around 2. For instance, the pooled odds ratios for highest versus lowest work stress exposure in terms of job strain, OJ, and ERI equalled 1.91 (95% confidence interval [CI] = 1.52, 2.41), 1.98 (95% CI = 1.48, 2.65), and 2.77 (95% CI = 1.57, 4.88), respectively. Patterns of associations were largely consistent across the individual studies. Conclusion Our study provides robust evidence of a positive association between work stress and SI.

Purpose: Research has suggested that psychological stress is associated with reduced lung function and with the development of respiratory disease. Among the major potential sources of stress in adulthood are working conditions. We aimed to examine the relationship of work stress with lung function. Methods: We drew on 4-year prospective data from the Survey of Health, Ageing and Retirement in Europe. The analyzed sample comprised 2627 workers aged 50 years or older who were anamnestically free of respiratory disease. Work stress at baseline was operationalized by abbreviated instruments measuring the well-established effort–reward imbalance model (seven items) and the control component of the job-demand control (two items). Peak expiratory flow (PEF) was determined at baseline and at follow-up. Continuous and categorized (i.e., by the tertile) work stress variables were employed in multivariable linear regression models to predict PEF change. Results: Work stress did not show statistically significant associations with PEF change. For instance, the unstandardized regression coefficient for PEF decline according to high versus low effort–reward imbalance was −1.41 (95% confidence interval = −3.75, 0.94). Conclusions: Our study is the first to examine prospective relationships between work stress and PEF. Overall, we did not observe meaningful associations. Future studies should consider a broader spectrum of spirometric parameters and should expand research to younger and possibly less-selected working populations (i.e., aged

A healthy diet plays a key role in preventing obesity and non-communicable diseases such as type 2 diabetes. This is true for all age groups, including young adults. While unhealthy eating habits among young adults, in particular university students, have been identified in former studies, this group has been neglected in existing health promotion strategies. Our aim was to explore baseline dietary intake, common barriers to healthy eating, and changes in eating behaviour among university students since the time of matriculation. We used data from the quantitative part of the Nutrition and Physical Activity Study (NuPhA), a cross-sectional online survey (data collection: 2014/10/31-2015/01/15). Students were recruited from all over Germany. Overall, 689 university students (30.5% male; mean age: 22.69) from more than 40 universities across Germany participated. We found that there is room for improvement with regard to the consumption of specific food groups, for example, fruits and vegetables. The main barriers to healthy eating were lack of time due to studies, lack of healthy meals at the university canteen, and high prices of healthy foods. Cluster analysis revealed that barriers to healthy eating might affect only specific subgroups, for instance freshmen. Changes in eating behaviour since matriculation were found in the consumption of meat, fish, and regular meals. Future qualitative studies may help to explore why university students change their eating behaviour since the time of matriculation. Such knowledge is necessary to inform health promotion strategies in the university setting.

Cognitive health is a key resource for individuals to nurture their employability. We studied the longitudinal association of cognitive function with changes in stressful working conditions, testing a possible reversed causation. We used a sample of employees (N=1,355) participating in two surveys (2006 and 2011) within a German national representative study (GSOEP). Cognitive function was captured by perceptual speed (Symbol Digit Test) and word fluency (Animal Naming Test). Stressful working conditions were measured by the validated short version of the effort-reward imbalance questionnaire. Multivariate linear regression models assessed the impact of perceptual speed and verbal fluency in 2006 on changes in participants' perceptions of effort, reward, effort-reward ratio, and over-commitment between 2006 and 2011, adjusting for socio-demography, behaviours, physical and mental health at baseline. Neither perceptual speed nor verbal fluency was significantly related to changes in perceived working conditions. Our findings did not support the notion of reversed causation.

Background and aims The diagnosis “Internet Gaming Disorder” (IGD) has been included in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the nine criteria have not been sufficiently reviewed for their diagnostic value. This study focuses on a broader approach of Internet addiction (IA) including other Internet activities. It is not yet clear what the construct of IA is in terms of dimensionality and homogeneity and how the individual criteria contribute to explained variance. Methods Three separate exploratory factor analyses and multinomial logistic regression analyses were carried out based on information collected from a general population-based sample (n = 196), a sample of people recruited at job centers (n = 138), and a student sample (n = 188). Results Both of the adult samples show a distinct single-factor solution. The analysis of the student sample suggests a two-factor solution. Only one item (criterion 8: escape from a negative mood) can be assigned to the second factor. Altogether, high endorsement rates of the eighth criterion in all three samples indicate low discriminatory power. Discussion and conclusions Overall, the analysis shows that the construct of IA is represented one dimensionally by the diagnostic criteria of the IGD. However, the student sample indicates evidence of age-specific performance of the criteria. The criterion “Escape from a negative mood” might be insufficient in discriminating between problematic and non-problematic Internet use. The findings deserve further examination, in particular with respect to the performance of the criteria in different age groups as well as in non-preselected samples.

Background: Medical students have been found to experience considerable stress due to their academic studies. The high demands associated with academic studies may interfere with demands in other domains of life. Conversely, demands in those other domains of life may conflict with academic studies. Objective: We aimed to better understand the potential inter-relationships between the demands related to academic studies and in other domains of life. Design: A total of 68 medical students from a medical school in Germany participate in eight focus groups. Sessions were structured by a topic guide and were recorded, transcribed and content-analyzed. Results: Embarking on one’s medical studies was perceived to be associated with important personal challenges, such as living alone for the first time and finding a new social role in one’s peer group. Permanent stress was perceived to result in emotional exhaustion, which spilled over in other domains of life. Students reported to feel guilty if they did not spend their limited spare time on learning. Consequently, they felt to have little time for leisure time activities and a healthy lifestyle. Feelings of social isolation, especially during exam phases, were reported. Leisure activities were perceived to facilitate recovery from academic stress. Social ties were subjectively able to reduce stress, but also to increase stress due to demands. Side jobs were perceived to increase stress and to be time-consuming and were thus perceived to result in poorer academic performance. Certain personality characteristics seemed to amplify those perceptions. For instance, high levels of conscientiousness were felt to relate to higher expectations regarding one’s academic performance and thus increased stress. Conclusion: The demands associated with medical studies, the demands in private life, lacking resources for recovery and certain personal traits as well as interactions between those domains can contribute to stress among medical students and reduce well-being.

Objective: This study sought to identify psychological resources, which are associated with improved asthma outcomes. Methods: A total of 205 patients who reported physician-diagnosed asthma were surveyed between September 2017 and March 2018. Psychological resources included self-efficacy (i.e. the belief in one's capabilities to organize and execute required behavior [SE]; assessed by the Short Scale for Measuring General Self-Efficacy Beliefs), and internal and external locus of control (i.e. one's beliefs about whether a given event is the result of one's behavior or of forces outside one's control [LoC]; Scale for Internal External Locus of Control-4). Outcome variables included asthma control (Asthma Control Test), asthma-related quality of life (QoL; Asthma Quality of Life Questionnaire-Sydney) and patient needs (Patient Needs in Asthma Treatment Questionnaire). Associations were estimated by linear regressions. Results: We observed that higher self-efficacy and internal LoC scores, but lower scores on the external LoC subscale were associated with improved asthma control (SE: β = 0.19, p = 0.01; internal LoC: β = 0.17, p = 0.02; external LoC: β = -0.18, p = 0.01), better asthma-related QoL (SE: β = -0.38, p < 0.01; internal LoC: β = -0.40, p < 0.01; external LoC: β = 0.46, p < 0.01) and less unmet needs (SE: β = -0.16, p = 0.02; internal LoC: β = -0.18, p < .01; external LoC: β = 0.32, p < 0.01). Conclusions: Our study provides novel evidence on psychological resources among patients with asthma, which are associated with improved asthma outcomes.

Research has suggested that psychological stress is positively associated with asthma morbidity. One major source of stress in adulthood is one's occupation. However, to date, potential links of work stress with asthma control or asthma-specific quality of life have not been examined. We aimed to address this knowledge gap.In 2014/2015, we conducted a cross-sectional study among adults with asthma in Germany (n = 362). For the current analyses that sample was restricted to participants in employment and reporting to have never been diagnosed with chronic obstructive pulmonary disease (n = 94). Work stress was operationalized by the 16-item effort-reward-imbalance (ERI) questionnaire, which measures the subcomponents "effort", "reward" and "overcommitment." Participants further completed the Asthma Control Test and the Asthma Quality of Life Questionnaire-Sydney. Multivariable associations were quantified by linear regression and logistic regression.Effort, reward and their ratio (i.e. ERI ratio) did not show meaningful associations with asthma morbidity. By contrast, increasing levels of overcommitment were associated with poorer asthma control and worse quality of life in both linear regression (ß = -0.26, p = 0.01 and ß = 0.44, p0.01, respectively) and logistic regression (odds ratio [OR] = 1.87, 95% confidence interval [CI] = 1.14-3.07 and OR = 2.34, 95% CI = 1.32-4.15, respectively).The present study provides initial evidence of a positive relationship of work-related overcommitment with asthma control and asthma-specific quality of life. Longitudinal studies with larger samples are needed to confirm our findings and to disentangle the potential causality of associations.

Objective It has been suggested that the relationship between work stress and somatic symptoms (e.g., cardiopulmonary, gastrointestinal complaints, general pain, and fatigue) is particularly pronounced in women. As evidence from China is sparse, we used a large sample of Chinese working women to test those potential associations. Methods Data were obtained from a cross-sectional study of 6826 working women in five urban areas in China who were free from major clinical disease. The sample was drawn from five occupations (physicians, nurses, school teachers, bank employees, and industrial workers). The Effort-Reward Imbalance Questionnaire and Patient Health Questionnaire-15 were used to measure work stress and somatic symptoms, respectively. Multivariate ordinal logistic regression was performed to analyze the associations. Results 52.6% participants reported high work stress in terms of concurrent high effort and low reward. The distribution of severity of somatic symptoms covered the full range from minimal (37.3%) and low (30.6%), to medium (19.7%) and high (12.4%). The adjusted odds ratio of somatic symptoms by high work stress was 2.45 (95% confidence interval = 2.24–2.68), and all single psychosocial work factors (effort, reward, and over-commitment) exerted substantial effects on somatic symptoms (odds ratios > 2.00). Conclusions Work stress is strongly associated with somatic symptoms in Chinese working women. Future longitudinal studies and intervention studies are needed to understand and improve women's psychosocial work environment and their psychosomatic health in China and elsewhere.

The vagus nerve influences the modulation of pain. Chronic pain is associated with disturbance of the descendent inhibitory pathway (DIP). Heart rate variability (HRV) is a proxy measure for vagal activity and may reflect dysfunction of the DIP. We aimed to investigate the association of HRV and pain in individuals with and without chronic pain.Drawing on cross-sectional data from 647 individuals, the present study explores the association of HRV and pain. The root mean square of successive differences (RMSSD), corresponding to parasympathetic regulation of the heart, was derived from 24-hour electrocardiogram recordings. Pain, demographic data, and health behaviors were assessed by self-administered questionnaires. Blood pressure was measured and inflammatory markers (white blood cell count, C-reactive protein, and fibrinogen) were analyzed from fasting blood samples.Those with chronic pain reported lower RMSSD. Results revealed a negative correlation of HRV and pain in multivariate-adjusted analysis only in respondents without chronic pain.Our results suggest that the DIP indexed by vagal activity operationalized as RMSSD is disturbed in persons with chronic pain. Furthermore, the correlations between RMSSD and pain are different between those without and those with chronic pain. The findings are discussed, emphasizing changes in brain activity and the comorbid dysregulation of emotion in patients with chronic pain, to provide implications for the treatment of chronic pain.

BACKGROUND: Building on previous psychometric work, we sought to assess the Patient Needs in Asthma Treatment (NEAT) questionnaire's validity, responsiveness to change and the minimal important change (MIC) over a 3-year period (Study 1) and its reliability and the smallest detectable change (SDC) in a test-retest-study (Study 2) among patients self-reporting physician-diagnosed asthma.METHODS: In Study 1, a total of 207 patients completed a survey which included the NEAT, the Asthma Control Test (ACT), the Asthma Quality of Life Questionnaire-Sydney (AQLQ-S) and a question on treatment satisfaction in 2014 and 2017. In Study 2, a total of 78 patients completed NEAT twice on average four weeks apart in 2018.RESULTS: Concurrent validity: In linear regressions, unmet patient needs were associated with poorer asthma control (β=-0.21; p=0.01), asthma-related Quality of Life (QoL) (β=0.31; pCONCLUSION: NEAT is a promising tool for assessing asthma treatment needs. This article is protected by copyright. All rights reserved.

Psychosocial working conditions—in terms of job decision authority, among others—may influence asthma self-management at work and in leisure time, as recent qualitative research has shown. We sought to statistically investigate potential relationships between job decision authority and two types of self-management behaviours: physical activity (PA) and visits to the general practitioner (GP). We combined data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) for cross-sectional analyses. The sample was restricted to participants who were employed and reported asthma but no other chronic lung disease (n = 387). The three key variables were each measured by one item. We estimated the prevalence ratios of adequate PA (i.e., more than once a week) and regular GP visits (i.e., ≥ 4 per year) according to job decision authority (low vs. high) using Poisson regression with the robust variance. We found no evidence of a relationship between job decision authority and PA. However, employees with low levels of job decision authority had a higher prevalence of reporting that they consulted their GP at least four times per year (prevalence ratio = 1.30; 95% confidence interval = 1.03–1.65). This study was the first to quantitatively investigate the relationship between job decision authority and PA specifically among individuals with asthma. Our results contradict prior epidemiological studies among general working populations, which reported a positive relationship between job decision authority and PA. Our results concerning the association between low job decision authority and more GP visits are inconsistent with our qualitative findings but supported by epidemiological studies among general occupational samples.

Noise annoyance may reflect a pro-participatory attitude towards public information and consultation according to the European Environmental Noise Directive. However, noise annoyance is also indicative of a stress response to perceived uncontrollable noise exposure. Using cross-sectional data on a sample of elderly citizens (n = 1772), we investigated whether the value residents ascribed to being able to control noise exposure at home moderated the potential indirect effect of road traffic noise on annoyance through perceived noise control. Our results confirmed the presence of such a moderated mediation, which may justify studying the impact of residents' valuing perceived noise control on participation readiness.

Medical students are at increased risk of experiencing mental health problems. Certain personality traits may be associated with elevated vulnerability to study-related stress and poor mental health. This study aimed to investigate the relationship between such personality traits and mental health outcomes among medical students. We drew on cross-sectional data from 251 medical students who had been enrolled for one-year at a medical school in Germany. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8) and suicidal ideation was assessed by item 9 from the Patient Health Questionnaire-9 (PHQ-9). Personality traits were captured using the Business-Focused Inventory of Personality 6 Factors (BIP-6F). Multivariable logistic regression analyses were used to quantify the associations between work-related personality factors and mental health outcomes, controlling for demographic and social factors. Odds ratios (ORs) as outcome measures with 95% confidence intervals (CIs) were used. After controlling for important confounders, medical students who scored highly on Stability had lower odds of depressive symptoms (OR: 0.19, 95% CI: 0.09&ndash, 0.42, p &lt, 0.001) and suicidality (OR: 0.38, 95% CI: 0.16&ndash, 0.87, p &lt, 0.05) than those with high scores in other work-related personality factors. Findings also showed that those who scored highly on Dominance had greater odds of depressive symptoms (OR: 2.46, 95% CI: 1.22&ndash, 4.97), p &lt, 0.01). Work-related personality-informed interventions, which promote students&rsquo, mental well-being and reduce academic stress should be considered at various stages of their medical training.

Urban residents’ need to be in control of their home environment can be constrained by perceived uncontrollability of exposure to road traffic noise. Noise annoyance may indicate a psychological stress reaction due to this uncontrollability perception, thereby undermining the restoration process. Environmental resources, such as having access to a quiet side at home and dwelling-related green, may reduce noise annoyance both directly by shielding acoustically and indirectly by enhancing residents’ perceived noise control. We assessed the potential mediating role of perceived noise control in independent and joint associations of road traffic noise exposure (>65 dB Ldₑn) and of an absent dwelling-related environmental resource (three indicators concerning quiet sides and one indicator concerning dwelling-related green) with noise annoyance. In our cross-sectional, questionnaire-based study on elderly urban citizens (N = 1812), we observed a statistically significant indirect effect of noise exposure on noise annoyance through perceived noise control (39%, 95%CI 26-55%). Statistical mediation between indicators of absent environmental resources and noise annoyance was weaker. The potential indirect effect was confirmed for combinations of noise exposure with each of the four indicators of an absent environmental resource. Our findings may call for mitigating noise levels while fostering quietness and green at residents’ homes. CA extern

Although psychosocial stress has been associated with adverse health parameters, little is known about this topic among the variety of university students. We thus examined associations of psychosocial stress due to academic education with self-rated health, and symptoms of depression and anxiety among students from various study disciplines. We used data from the Nutrition and Physical Activity (NuPhA) Study, a cross-sectional online survey among students enrolled across German universities (n = 698). Academic stress was assessed by a newly developed and validated student version of the Effort–Reward Imbalance (ERI-Student) Questionnaire. Depressive and anxiety symptoms were measured by applying the Patient Health Questionnaire-4 (PHQ-4) and using validated cut-offs. Separate multivariate logistic regression analyses run for the different ERI components, the ERI-ratio revealed that high effort, low reward, high over-commitment, and a high ERI-ratio were associated with poor self-rated health, and depressive and anxiety symptoms (odds ratios ≥ 2.43). Separate analyses for medical students and non-medical students largely confirmed these findings for both groups. Associations between all ERI components, the ERI ratio, and both mental health measures were, however, more pronounced among medical students. We were able to show consistent associations between the ERI-Student Questionnaire and self-rated health and mental health across students from different study disciplines. Further research on associations between academic stress and health parameters is necessary to develop effective strategies that prevent students from adverse health outcomes during their academic education.

Objective We sought to investigate whether there are associations between asthma and social functioning in adults from Western and non-Western countries. Methods We analyzed data on individuals (94% aged 20 +, 52% female) from 50 countries participating in the cross-sectional World Health Survey. We used information on self-reports of wheezing and an asthma diagnosis. Social functioning was defined by reports of severe or extreme difficulties related to personal relationships or participation in the community. Logistic regression was used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Wheezing was associated with impaired social functioning both in the overall sample (OR = 2.40, 95%CI = 2.09–2.75) and in Africa, South America and Asia (ORs ≥ 2.47), but not in Europe (aOR = 1.26, 95%CI = 0.90–1.77). Analyses with self-reports of diagnosed asthma yielded similar, albeit weaker, associations (e.g. OR for the overall sample = 1.63, 95%CI = 1.38–1.92). We also combined asthma and wheezing into a single variable (reference group: no asthma diagnosis/no wheezing). We observed that in particular reports of wheezing were associated with impaired social functioning regardless of whether a concomitant asthma diagnosis was reported (OR = 2.19, 95%CI = 1.81–2.64) or not (OR = 2.50, 95%CI = 2.09–2.99). Conclusion Self-reports of wheezing and of diagnosed asthma are associated with impaired social functioning among adults in Africa, South America and Asia, but less so in Europe. These relationships are mainly driven by the experience of respiratory symptoms (i.e. wheezing). Our findings may partly be explained by regional variations in asthma control. Further research should elucidate the determinants and mechanisms of asthma-related impaired social functioning.

Somatic complaints (SC) are highly prevalent in working populations and cause suffering and extensive health-care utilization. Adverse psychosocial working conditions as conceptualized in the Job Demand-Control-Support Model (JDC-S) and adverse working time characteristics (WTC) are potential risk factors. This combination is particularly common in hospital physicians. This study examines associations of JDC-S and WTC with SC in resident physicians from Germany. A cross-sectional study was conducted among 405 physicians at the end of residency training. SC were measured using the Giessen Subjective Complaints List (GBB-24) containing the sub-categories exhaustion, gastrointestinal, musculoskeletal, and cardiovascular complaints. Data on working conditions were collected by a self-report method for work analysis in hospitals (TAA-KH-S) and by questions on WTC (i.e., working hours). Multivariable stepwise regression analyses were applied. Workload showed the most pronounced relationship with all sub-categories of SC except gastrointestinal complaints. Job autonomy was not significantly related to any SC sub-category. Social support at work was inversely associated with all SC sub-categories except for cardiovascular complaints. Free weekends were associated with reduced SC except for exhaustion. Shift work was related to an increased SC total score and musculoskeletal complaints. Working hours showed no association with SC. In resident physicians, high workload and shift work are associated with increased SC, while social support at work and free weekends are associated with decreased SC. These insights may inform the development of preventive measures to improve the health of this professional group. Prospective studies are needed though to corroborate our findings.

To examine the main and interactive effects of effort-reward imbalance (ERI) and selection, optimization, and compensation (SOC) strategy on depressive symptoms among the working population in the City of Kumning, China.We assessed the separate and combined effects of low versus high ERI and good versus poor SOC strategy on depressive symptoms using multivariable logistic regression analyses in a population-based sample (N = 2457).High ERI and poor SOC were significantly associated with depressive symptoms, respectively. In employees with both high ERI and poor SOC, the odds ratio was highly elevated as compared with the reference group (low ERI and good SOC).If our findings are confirmed by prospective studies, health promotion programs in work settings might consider SOC as an integral part to mitigate the adverse mental health effects of ERI.

Objective: Organizational justice refers to perceived fairness at the workplace. Low organizational justice has been identified as a major source of distress and a predictor of poor health. Impaired regulation of immunological and inflammatory pathways may, in part, underlie these health effects. The present study investigated the association of organizational justice with leukocyte glucocorticoid sensitivity in vivo.Methods: Organizational justice was assessed among 541 male factory workers (mean [standard deviation] age = 46 [9] years) by questionnaire. Cortisol release was measured at three time points before blood collection and summed as the area under the curve. Blood was used to assess leukocyte (white blood cell [WBC] count) subsets (neutrophils [%WBC], lymphocytes [%WBC], and the neutrophil/lymphocyte ratio). Glucocorticoid sensitivity was operationalized as the correlation between cortisol release and these hematologic parameters. Associations were adjusted for demographics, work characteristics, and life-style variables.Results: A dose-response relationship between organizational justice and glucocorticoid sensitivity was found. Cortisol and hematologic parameters showed the expected significant association among individuals reporting high (all [beta] values >= |.26|; all p values = |.15|; all p values .10). These regression slopes differed significantly between organizational justice groups (p values for interaction < .050).Conclusions: Low justice at work is associated with an impaired ability of endogenous cortisol to regulate leukocyte distribution in vivo. These findings identify a novel biological pathway by which organizational justice may affect health.

ObjectiveOrganizational justice refers to perceived fairness at the workplace. Individual perceptions of injustice have been linked to reduced mental and physical health. However, perceptions of injustice also exist at the aggregate level of departments, reflecting a shared perception, denoted as justice climate. There is evidence that this shared perception independently predicts individual distress levels (e.g., anxiety, depression), which might negatively affect somatic symptom perception and reporting. Hence, the objective of this study was to examine whether individual perceptions of poor justice as well as a poor justice climate are related to elevated somatic complaints. In addition, this study examined if justice climate moderates the relationship between individual-level justice perceptions and somatic symptom reporting.MethodsCross-sectional data from a large industrial manufacturing company was used, involving 1,102 employees in 31 departments. A validated scale covering interactional and procedural justice assessed individual-level organizational justice. A 19-item symptom checklist measured somatic complaints. Multilevel analyses estimated individual-level associations (within-department effects) with somatic complaints, department-level associations (between-department effects), and the cross-level interaction of both.ResultsIndividual-level justice perceptions were negatively associated with somatic complaints. Collective justice climate was likewise significantly associated with somatic complaints. There was no indication for a moderation effect of justice climate.ConclusionA poor justice climate correlated positively with individual somatic complaints while controlling for individual perceptions, i.e., above and beyond individual justice perceptions. These findings may imply that interventions targeting department-level perceptions of justice may have the potential to reduce individual somatic complaints beyond the effects of individual-level interventions.

Background Research suggests that burnout in physicians is associated with poorer patient care, but evidence is inconclusive. More recently, the concept of work engagement has emerged (i.e. the beneficial counterpart of burnout) and has been associated with better care. Evidence remains markedly sparse however. Aims To examine the associations of burnout and work engagement with physicians' self-perceived quality of care. Methods We drew on cross-sectional data from physicians in Germany. We used a six-item version of the Maslach Burnout Inventory measuring exhaustion and depersonalization. We employed the nine-item Utrecht Work Engagement Scale to assess work engagement and its subcomponents: vigour, dedication and absorption. We measured physicians' own perceptions of their quality of care by a six-item instrument covering practices and attitudes. We used continuous and categorized dependent and independent variables in linear and logistic regression analyses. Results There were 416 participants. In multivariable linear regression analyses, increasing burnout total scores were associated with poorer perceived quality of care [unstandardized regression coefficient (b) = 0.45, 95% confidence interval (CI) 0.37, 0.54]. This association was stronger for depersonalization (b = 0.37, 95% CI 0.29, 0.44) than for exhaustion (b = 0.26, 95% CI 0.18, 0.33). Increasing work engagement was associated with higher perceived quality care (b for the total score = -0.20, 95% CI -0.28, -0.11). This was confirmed for each subcomponent with stronger associations for vigour (b = -0.21, 95% CI -0.29, -0.13) and dedication (b = -0.16, 95% CI -0.24, -0.09) than for absorption (b = -0.12, 95% CI -0.20, -0.04). Logistic regression analyses yielded comparable results. Conclusions Physician burnout was associated with self-perceived poorer patient care, while work engagement related to self-reported better care. Studies are needed to corroborate these findings, particularly for work engagement.

Objective Ample evidence documented the adverse health effects of work stressors, and recent research has increasingly focused on somatic symptoms which are very common and costly. Prospective evidence is however sparse and yielded mixed findings. Furthermore, there is reason to assume that depression and anxiety might mediate the effects of adverse psychosocial work conditions on somatic symptoms. This study aimed to investigate longitudinal effects of work stressors on somatic symptoms and the potential mediation by anxiety and/or depression. Methods Six year follow-up data from 352 individuals – free of potentially stress-related chronic disease – were utilized. Somatic symptoms were assessed by 19 items of an established list of complaints at baseline and follow-up. The effort-reward-imbalance (ERI) model measured adverse psychosocial work conditions and over-commitment (OC). Linear regressions adjusted for socio-demographics, social status, lifestyle, and baseline symptoms estimated the effects of the ERI ratio, effort, reward, OC, and the ERI ratio × OC interaction on somatic symptoms six years later. Furthermore, single and multiple mediation by anxiety and/or depression was investigated. Results There was a strong longitudinal effect of the ERI ratio, as well as of its subcomponents, and OC on somatic symptoms (all Bs ≥ | 0.49 |; p-values ≤ 0.004). Moreover, the ERI ratio × OC interaction was significant (p-value = 0.047). Multiple mediation analyses revealed especially anxiety to mediate the effect of work stressors on somatic symptoms (Sobel test = 0.007). Conclusion Adverse psychosocial work conditions seem to longitudinally affect somatic symptoms, potentially moderated by OC, and mediated by anxiety.

Background Current economic and social change has contributed to increasing job insecurity and traffic-related pollution in residential areas. Both job insecurity and exposure to noise and air pollution are known determinants of population health and can concur in peoples' lives. This may hold true particularly for socially disadvantaged subpopulations. Nevertheless, the potential independent and joint links of those exposures to health have been rarely examined so far. We aimed to contribute to the scarce body of evidence. Methods Information on perceived job insecurity and exposures to noise and air pollution as expressed by annoyance as well as on self-rated health were gathered from 2 waves of the population-based German Socio-Economic Panel (2009 and 2011, N=6544). We performed multivariable Poisson regression to examine the independent and joint risk of poor health in 2011 by perceived job insecurity and annoyance due to noise and air pollution in 2009. Results After the 2-year follow-up in 2011, 571 (8.7%) participants rated their health as poor. The risk of reporting incident poor health was increased by roughly 40% in employees reporting high versus low perceived job insecurity and annoyance due to noise and air pollution, respectively. This risk increased when both exposures were present at higher levels (risk ratio=1.95 (1.49 to 2.55)). Conclusions Work-related and environmental exposures may accumulate and have a joint health impact. Elaboration on the link between occupational and residential exposures is warranted in the light of their concurrence and their implications for health inequities.

Background: Protecting the health of the work force has become an important issue in public health research.Purpose: This study aims to explore potential associations between supportive leadership style (SLS), an aspect of leadership behavior, and self-rated health (SRH) among employees.Method: We drew on cross-sectional data from a cohort of industrial workers (n = 3,331), collected in 2009. We assessed employees' ratings of supportive, employee-oriented leadership behavior at their job, their SRH, and work stress as measured by the effort-reward model and scales measuring demands, control, and social support. Logistic regression estimated odds ratios (ORs) and corresponding 95 % confidence intervals (CIs) for the association between the perception of poor SLS and poor SRH controlling for work-related stress and other confounders. Sensitivity analyses stratified models by sex, age, and managerial position to test the robustness of associations.Results: Perception of poor SLS was associated with poor SRH [OR 2.39 (95 % CI 1.95-2.92)]. Although attenuated following adjustment for measures of work-related stress and other confounders [OR 1.60 (95 % CI 1.26-2.04)], the magnitude, direction, and significance of this association remained robust in stratified models in most subgroups.Conclusion: SLS appears to be relevant to health in the workplace. Leadership behavior may represent a promising area for future research with potential for promoting better health in a large segment of the adult population.

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 (s =-0.33, p< 0.01). Additionally, we found that TL positively affected these resources (s=0.61; p< 0.01) and that absence of resources led to more psychological strain (s=-0.54, p

Comorbid depression predicts poor health outcomes in patients with angina pectoris (AP). However, epidemiological data on the depression-AP comorbidity is limited and largely restricted to studies from Western countries, making generalizability to other regions uncertain. We aimed to provide additional epidemiological data for non-Western as well as Western countries. The present study used population-based data gathered in 47 countries from four continents (Africa, Asia, South America, and Europe) included in the cross-sectional 2002 WHO World Health Survey. Self-reported indicators of depression included: (a) its diagnosis, (b) its treatment, and (c) seven symptom items to determine presence of a major depressive episode. Similarly, information on AP comprised (a) a self-reported diagnosis, (b) self-reported AP treatment, (c) and a definition according to the WHO Rose questionnaire. In primary analyses, we operationalized depression or AP as positive if any of the respective indicators was present. Associations were estimated by multivariate logistic regression. In the entire sample (n = 213,264), the odds of AP were more than doubled among those with depression [odds ratio (OR) = 2.60, 95 % confidence interval = 2.36, 2.87] versus those without depression. These positive associations were replicated across all continents and were observed in both men and women. Likewise, meaningful associations (ORs ≥ 1.5) were observed in virtually all individual countries (46/47). Application of different operationalizations of depression and AP confirmed the above findings, both in the entire sample and in continent-specific analyses. Our study extends the current evidence accrued in Western populations to non-Western populations. The co-occurrence of AP and depression appears to represent a universal phenomenon.Keywords: Angina pectoris, Depression, Epidemiology, World Health Organization

Purpose: The objective of the present study was to validate a German 11-item organizational justice questionnaire (G-OJQ) that consists of two subscales, referred to as "procedural justice" (PJ) and "interactional justice" (IJ) adapted from Moorman’s organizational justice (OJ) questionnaire. A second objective was to determine associations of the G-OJQ with self-rated health.Methods: This study used cross-sectional data from an occupational cohort of 1518 factory workers from Germany (87.7 % male; mean age = 38.8 with SD = 11.9). After splitting the sample in two random subsamples, we assessed structural validity by exploratory factor analyses in one subsample and by confirmatory factor analysis in the other subsample. Internal validity was assessed by Cronbach’s α. Associations with self-reported poor health were estimated by logistic regression.Results: The full scale and its subscales yielded Cronbach’s α’s of ≥0.9, and item-total correlations were ≥0.5. Factor analyses confirmed the expected 2-factor structure, labeled "interactional justice" (IJ, 4 items, λ 0.43-0.94) and "procedural justice" (PJ, 7 items, λ 0.46-0.83), respectively, and showed an acceptable fit to the data (χ 2 = 61; p = .001; CFI = 0.995; RMSEA = 0.037). The OJ total score as well as subscale scores in the lowest quartile, when compared to the highest quartile, was associated with an ≥2.3 increased odds of reporting poor health.Conclusion: The G-OJQ seems to be a valid and useful tool for observational and intervention studies in occupational settings. Future studies may additionally explore longitudinal associations and test the generalizability of the present findings to other populations and health outcomes.

Cytomegalovirus (CMV) is a herpes virus that has been implicated in biological aging and impaired health. Evidence, largely accrued from small-scale studies involving select populations, suggests that stress may promote non-clinical reactivation of this virus. However, absent is evidence from larger studies, which allow better statistical adjustment for confounding and mediating factors, in more representative samples.The present study involved a large occupational cohort (N = 887, mean age = 44, 88% male). Questionnaires assessed psychological (i.e., depression, anxiety, vital exhaustion, SF-12 mental health), demographic, socioeconomic (SES), and lifestyle variables. Plasma samples were analyzed for both the presence and level of CMV-specific IgG antibodies (CMV-IgG), used as markers for infection status and viral reactivation, respectively. Also assessed were potential biological mediators of stress-induced reactivation, such as inflammation (C-reactive protein) and HPA function (awakening and diurnal cortisol). Predictors of CMV infection and CMV-IgG among the infected individuals were analyzed using logistic and linear regression analyses, respectively.Confirming prior reports, lower SES (education and job status) was positively associated with infection status. Among those infected (N = 329), higher CMV-IgG were associated with increased anxiety (β = .14, p < .05), depression (β = .11, p = .06), vital exhaustion (β = .14, p < .05), and decreased SF-12 mental health (β = −.14, p < .05), adjusting for a range of potential confounders. Exploratory analyses showed that these associations were generally stronger in low SES individuals. We found no evidence that elevated inflammation or HPA-function mediated any of the associations.In the largest study to date, we established associations between CMV-IgG levels and multiple indicators of psychological stress. These results demonstrate the robustness of prior findings, and extend these to a general working population. We propose that stress-induced CMV replication warrants further research as a psychobiological mechanism linking stress, aging and health.

Evidence on the association of work stress with cortisol levels is inconsistent and mostly stems from Western countries, with limited generalizability to other regions of the world. These inconsistencies may partly be due to methodological limitations associated with the measurement of cortisol secretion in saliva, serum or urine. The present study set out to explore associations of work stress with long-term integrated cortisol levels in hair among 175 workers of an export oriented ready-made garment (RMG) factory in Dhaka, Bangladesh.Work-related demands (WD), interpersonal resources (IR) and work-related values (WV) were assessed using a psychometrically evaluated interview. WD consisted of four items on physical demands, time pressure, worries about mistakes and exposure to abusive language. IR comprised five items addressing support, recognition, adequate payment, workers’ trust in the management, and the management's trust in workers, as perceived by the workers. WV captured job security, promotion prospects and job latitude by three items. Hair cortisol concentrations (HCC) were analyzed by liquid chromatography-mass spectrometry. Stepwise multivariable linear regression models (backward elimination of predictors) were used to estimate associations of HCC with the three work stress components. For significant work stress component(s), further multivariable linear regression analyses were conducted to explore whether, and if so, which individual item(s) contributed most.The mean HCC equaled 3.27 (SD 2.58) pg/mg. HCC were found to be significantly associated with WV (beta = 0.209, p = 0.021). Additional analyses of the three WV items revealed that this association was largely driven the item on "promotion prospects" (beta = 0.230, p = 0.007) implying that the perception of good promotion prospects was associated with higher HCC.The finding of elevated HCC with good promotion prospects may initially seem counter-intuitive, but is supported by research documenting that job promotion may result in poorer mental well-being. Moreover, being promoted in the Bangladeshi RMG industry may represent a stressful experience: job promotions are rare in this setting and are associated with the need to meet exceptional job-related demands. Further research from ethnic and culturally diverse occupational settings is needed to test this hypothesis, to shed light on the reproducibility of our findings and to improve our understanding of the psychobiological implications of psychosocial working conditions across cultures and contexts.

Medical assistants&rsquo, (MAs) working conditions have been characterized as precarious, and workplace-related intervention needs have been identified. However, strategies to change the MAs adverse working conditions are mostly seen on an individual level, including leaving the employer or even the profession. Since such intentions are antecedents of actual turnover, we aimed to quantify the potential link of reported unmet intervention needs with unfavorable occupational outcomes. Data were collected by means of a nationwide survey among medical assistants (n = 994) in Germany (September 2016&ndash, April 2017). The three subscales working conditions, reward from the supervisor, and task-related independence were derived from a 12-item instrument regarding work-related interventions needs (the independent variables). We used subscale-specific z-scores and a total needs z-score. The four outcome variables (i.e., intention to leave the employer, intention to leave the MA profession, choosing MA profession again, and recommending MA profession to young people) were dichotomized, and logistic regression analyses were performed and limited to MAs in employment (n = 887). We found that increasing needs according to the categorized total needs score were associated with increasing odds of all occupational outcomes. Needs pertaining to working conditions and reward from the supervisor were the strongest determinants of MAs&rsquo, consideration of leaving their employer or profession (Odds ratios: 1.55&ndash, 2.61). In summary, our study identified unmet work-related intervention needs that are associated with unfavorable occupational outcomes. In light of staffing shortage in health care, the identified needs should be addressed to ensure that sufficient recruitment of junior staff in the profession of medical assistants remains feasible and that experienced staff is retained.