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Abstract Background Many palliative cancer patients require inpatient hospital treatment for medical reasons, which contrasts their frequent desire to be at home. Virtual reality (VR) could be a way of bringing the home environment closer to them. First observations have shown benefits from VR for inpatients in palliative care. The aim of this qualitative, descriptive study was to explore the expectations of in-patients suffering from incurable cancer and their relatives about VR, in particular individualized VR images of the patients’ own home. Methods Semi-structured interviews with inpatients suffering from incurable cancers and their relatives in three medical settings (palliative care, hematology, radiotherapy) of a German university hospital. Qualitative content analysis about expected benefits and concerns regarding VR-videos showing their private home; defining the main topics deductively and the subcategories inductively. We also assessed the patients’ subjective perspective on their remaining time to live to estimate the impact of double awareness on the results. The Patient Advisory Board informed the study protocol and conduct. Results We interviewed 15 patients (8 men; age M = 63.4, SD = 11.34; range 39–82) under palliative care, and four relatives. We organized the interview content in 6 themes (general interest, desired content, non-desired content, expected benefits, concerns, and irregularities) and 26 sub-themes. Most patients and relatives were interested in using VR during hospital treatment. They often preferred viewing nature or tourist sites over seeing their home or family. Reasons could be linked to privacy concerns and the general desire for distraction from the current situation that they specified with their expectation of well-being, a break from the patient-experience, the pursue of curiosity, and the VR evoking fond memories. Conclusion VR seems to be of interest for palliative cancer patients, especially as distraction and relief from their illness. The desired content can be very different, so a choice from a selection of VR-content should be made available. If patients want to see videos of their own home, recordings by relatives instead of study or hospital staff seem to meet the need for privacy. Trial registration Registered at Deutsches Register Klinischer Studien; registration number: DRKS00032172; registration date: 11/07/2023. https://drks.de/search/de/trial/DRKS00032172.

Abstract Background Low back pain (LBP) is a common health problem in workers that contributes to work disability and reduces quality of life. However, studies examining vulnerable groups in relation to sociodemographic differences in LBP remain scarce. Therefore, the current study investigates which sociodemographic groups of workers are most affected by LBP. Methods Data from the 2018 BIBB/BAuA employment survey were used (N = 16252). Age, education, occupational group, income, working hours, atypical working time, relationship status, and having children were used as sociodemographic predictors. Gender-stratified logistic regression analyses and intersectional classification tree analyses were conducted. Results A higher prevalence of LBP was observed for women compared to men. Significant differences in LBP emerged for age, working hours, atypical working time, occupational group and education, with some gender differences in the importance of predictors: Age was a significant predictor mostly in men as compared to women, atypical working hours had a slightly greater effect in women, whereas differences in LBP according to the occupational group were more pronounced for men. Vulnerable groups were found to be women who work in occupations other than professionals or managers, work atypical hours and have an intermediate or low educational level as well as men who work as skilled agricultural workers, craft workers, machine operators, or elementary occupations and are between 35 and 64 years old. Conclusions Thus, workers with certain occupations and lower levels of education, middle-aged men and women with unfavourable working time characteristics are most affected by low back pain. These groups should be focused on to potentially increase healthy working life and prevent work disability.

Abstract Background Cancer patients benefit from Virtual Reality (VR) in burdensome situations, but evidence is scarce for palliative situations. Based on earlier work in palliative care, individualized VR interventions like seeing the patient’s home may address a patient’s wish to be at home and thus have a greater effect compared to standard VR content. Yet, some patients and relatives may be concerned about their privacy. Also, patient stakeholders raised concerns about triggering depressed mood or homesickness. Aim To test the feasibility and safety of individualized vs. standard 360°video VR interventions in palliative cancer inpatients. Methods Prospective observational study with patient-reported outcome measurement using validated instruments of well-being (MDBF), symptoms and psychosocial burden (IPOS), cybersickness (SSQ), presence experience (SPES), subjective benefit (2 items), content analysis of interviews, and field notes. Individualized VR content was recorded with action camcorder-technology to protect the patients’ privacy. Results Seventeen patients participated, median age 65 years (range 20–82), 9 women (53%), 8 single or widowed (47%), 4 childless (23.5%), 4 academics (23.5%), with a median length of stay of 9 days (1–75) in the hematology (10), palliative care (3), or radiotherapy (2) unit of a German university hospital. Eight patients (53.3%) chose their own home environments or family for individualized VR-content. All participants enjoyed the intervention. Compared to standard VR content the individualized VR tended to have a stronger effect on well-being and emotional touch. It was not inferior in terms of psychosocial burden and cybersickness. No subjective and relevant side effects occurred. The patients well tolerated the assessments. However, most patients demanded a lighter headset and a desire for more interactivity. Conclusions Individualization of VR content shows potential for enhancement of immersion, which improves the VR experience and does not harm in terms of depressed mood or worsening of symptoms. The patients’ and family desire for privacy is feasible with the support of family members who recorded the individualized videos, which is easily manageable today. We suggest a pragmatic randomized clinical trial to compare the effects of individualized vs. standard VR-content. Trial registration Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023.

Panton-Valentine leucocidin (PVL)-producing Staphylococcus aureus (PVL-SA) is typically associated with skin and soft tissue infections, such as abscesses (1). Transmission occurs between persons in close contact, often causing clusters of [...]

Abstract Background Against the backdrop of the debate on extending working life, it is important to identify vulnerable occupational groups by analysing inequalities in healthy life years. The aim of the study is to analyse partial life expectancy (age 30–65) [1] free of musculoskeletal diseases (MSD) and [2] free of cardiovascular diseases (CVD) in occupational groups with different levels of physical and psychosocial exposures. Methods The study is based on German health insurance claims data from 2015 to 2018. The study population comprises all employed insured persons aged 18 to 65 years (N = 1,528,523). Occupational exposures were assessed using a Job Exposure Matrix. Life years free of MSD / CVD and life years with MSD /CVD during working age were estimated using multistate life tables. Results We found inequalities in MSD-free and CVD-free life years, with less disease-free years among men and women having jobs with high levels of physical and psychosocial exposures. Men with low physical exposures had 2.4 more MSD-free and 0.7 more CVD-free years than men with high physical exposures. Women with low psychosocial exposures had 1.7 MSD-free and 1.0 CVD-free years more than women with high psychosocial exposures. Conclusions Employees in occupations with high physical and psychosocial demands constitute vulnerable groups for reduced life expectancy free of MSD and CVD. Given the inequalities and high numbers of disease-affected life years during working age, the prevention potential of occupational health care and workplace health promotion should be used more extensively.

Abstract Background Artificial intelligence (AI) has revolutionized various healthcare domains, where AI algorithms sometimes even outperform human specialists. However, the field of clinical ethics has remained largely untouched by AI advances. This study explores the attitudes of anesthesiologists and internists towards the use of AI-driven preference prediction tools to support ethical decision-making for incapacitated patients. Methods A questionnaire was developed and pretested among medical students. The questionnaire was distributed to 200 German anesthesiologists and 200 German internists, thereby focusing on physicians who often encounter patients lacking decision-making capacity. The questionnaire covered attitudes toward AI-driven preference prediction, availability and utilization of Clinical Ethics Support Services (CESS), and experiences with ethically challenging situations. Descriptive statistics and bivariate analysis was performed. Qualitative responses were analyzed using content analysis in a mixed inductive-deductive approach. Results Participants were predominantly male (69.3%), with ages ranging from 27 to 77. Most worked in nonacademic hospitals (82%). Physicians generally showed hesitance toward AI-driven preference prediction, citing concerns about the loss of individuality and humanity, lack of explicability in AI results, and doubts about AI’s ability to encompass the ethical deliberation process. In contrast, physicians had a more positive opinion of CESS. Availability of CESS varied, with 81.8% of participants reporting access. Among those without access, 91.8% expressed a desire for CESS. Physicians' reluctance toward AI-driven preference prediction aligns with concerns about transparency, individuality, and human-machine interaction. While AI could enhance the accuracy of predictions and reduce surrogate burden, concerns about potential biases, de-humanisation, and lack of explicability persist. Conclusions German physicians frequently encountering incapacitated patients exhibit hesitance toward AI-driven preference prediction but hold a higher esteem for CESS. Addressing concerns about individuality, explicability, and human-machine roles may facilitate the acceptance of AI in clinical ethics. Further research into patient and surrogate perspectives is needed to ensure AI aligns with patient preferences and values in complex medical decisions.

Continued detection of Panton-Valentine leukocidin–positive Staphylococcus aureus in samples from a family with severe repeated skin infections and their pet cat suggests transmission between the family and the cat. Decolonizing the pet led to successful elimination of the bacteria from the household. Clinicians should consider pet cats as possible reinfection sources.

Abstract Background Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle and sedentary behavior, little is known on T2D prevalence and trends among different occupational groups. This study aims to examine occupational sector differences in T2D prevalence and trends thereof between 2012 and 2019. Methods The study was done on 1.683.644 employed individuals using data from the German statutory health insurance provider in Lower Saxony, the “Allgemeine Ortskrankenkasse Niedersachsen” (AOKN). Predicted probabilities for T2D prevalence in four two-year periods between 2012 and 2019 were estimated based on logistic regression analyses for nine occupational sectors. Prevalence ratios were calculated to illustrate the effect of time period on the prevalence of T2D among the nine occupational sectors. Analyses were stratified by gender and two age groups. Results Results showed differences among occupational sectors in the predicted probabilities for T2D. The occupational sectors “Transport, logistics, protection and security” and “Health sector, social work, teaching & education” had the highest predicted probabilities, while those working in the sector “Agriculture” had by far the lowest predicted probabilities for T2D. Over all, there appeared to be a rising trend in T2D prevalence among younger employed individuals, with gender differences among occupational sectors. Conclusion The study displayed different vulnerability levels among occupational sectors with respect to T2D prevalence overall and for its rising trend among the younger age group. Specific occupations within the vulnerable sectors need to be focused upon in further research to define specific target groups to which T2D prevention interventions should be tailored.

Abstract Musculoskeletal diseases (MSDs) are a major predictor of early retirement. Against the backdrop of the extension of working life, we investigated time trends and educational inequalities in years spent in the labour market free of MSD. Based on German statutory health insurance data (N = 3,405,673), total life years free of MSD (Healthy Life Expectancy, HLE) and years spent in the labour force free of MSD (Healthy Working Life Expectancy, HWLE) were estimated for three periods (2006–2008, 2011–2013, 2016–2018) using multistate analyses. Educational inequalities (8 to 11 vs. 12 or more years of schooling) are reported for 2011–2013. HLE decreased slightly over time in all genders. HWLE in women increased, while it remained rather constant in men. Over time, the share of years in the labour force spent free of MSD declined continuously. People with lower education had lower HLE and HWLE than individuals with higher education. With respect to musculoskeletal diseases, the increase in disease-free working life years cannot keep pace with the extension of working life, resulting in an increasing proportion of years spent in impaired musculoskeletal health in the labour market. Effective prevention strategies are needed, focusing especially on individuals with lower educational attainment.