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Objective: The aim of this study was to determine the prevalence and trajectory of persistent symptoms following COVID-19 and to investigate factors influencing these among employees in the health and welfare services in Germany.Methods: This exploratory, mixed retro- and prospective cohort study using paper-and-pencil questionnaires was conducted among insured persons of the German Social Accident Insurance Institution for the health and welfare services with a SARS-CoV-2 infection in 2020. The baseline survey in February 2021 was succeeded by two follow-up surveys after 8 and 13 months. Demographic data, information on the acute illness and persistent symptoms were collected. Kaplan-Meier curves were created to visualize the course of recovery. Factors influencing the time to recovery were analyzed using multivariate Cox regressions.Results: Of the 4,325 people contacted, 2,053 took part in the survey (response rate: 47%). 1,810 people were included in the analysis. The most common persistent symptoms at all three survey time points were fatigue, concentration and memory problems, and dyspnea. After three months, 76.2% (95% CI: 74.2–78.2%) of participants still reported symptoms, after 18 months this dropped to 67.2% (95% CI: 65.0–69.4%). Significant risk factors for persistent symptoms were female sex (HR: 0.72; 95% CI: 0.58–0.88), age over 50 years (HR: 0.63; 95% CI: 0.50–0.78), a higher number of pre-existing illnesses and a higher number of severe acute symptoms. Respiratory and hormone-metabolic pre-existing conditions as well as severe dyspnea, smell or taste disorders, fatigue and memory or concentration problems during the acute COVID-19 illness also reduced the probability of complete recovery. Compared to other professions, working as a doctor had a protective effect (HR: 1.42; 95% CI: 1.11–1.80).Conclusion: More than a year after a COVID-19 illness, two-thirds of the healthcare staff surveyed reported persistent symptoms. This high number emphasizes the importance of long-term consequences of the COVID-19 pandemic for public health and the need for suitable therapy and rehabilitation concepts, especially for healthcare staff with post-COVID syndrome.

Background: Mounting evidence supports an association between the use of personal protective equipment (PPE) and the risk of infection from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in dental healthcare workers (DCW). However, the prevalence and incidence of SARS-CoV-2 infections in the setting of dental care remains poorly characterized.Methods: A systematic review and meta-analysis of studies published prior to Mai 2023 providing epidemiological data for the occurrence of SARS-CoV-2 in DCW was performed. A random-effects model was used to calculate pooled estimates and odds ratios (ORs) with corresponding 95% confidence intervals (CIs). The associated factors were narratively evaluated. Risk of bias was assessed using the Joanna Briggs Institute tool for prevalence studies.Results: Twenty-nine eligible studies were identified including a total of 85,274 DCW at risk; 27 studies met the criteria for the meta-analysis. Among the included DCW, the overall prevalence of SARS-CoV-2 was 11.8% (13,155/85,274; 95%CI, 7.5%–17%), whereby the degree of heterogeneity between the studies was considerable (I=99.7%). The pooled prevalence rate for dentists and dental hygienists alone was 12.7% (1943/20,860; 95%CI, 8.0%–18.0%), showing significantly increased odds of contracting a SARS-CoV-2 infection compared to dental assistant personnel, the prevalence rate for which was less than half, at 5.2% (613/15,066; OR=2.42; 95% CI, 2.2–2.7). In the subgroup of 17 studies from countries with high income there was a significantly lower prevalence rate of 7.3% (95% CI, 5%–10%) in DCW compared to the prevalence rate in low- and middle-income countries, which came to 20.8% (95% CI, 14%–29%; p

Abstract Introduction The effect of using a borderline zone for the interpretation of the interferon-γ release assay (IGRA) on the prediction of progression to active tuberculosis (TB) in healthcare workers (HCW) is analysed. Methods Data from a published study on TB screening in Portuguese HCW is reanalysed using a borderline zone for the interpretation of the IGRA. Testing was performed with the QuantiFERON-TB Gold In-Tube (QFT). The borderline zone for the QFT was defined as interferon (INF) in QFT ≥0.2 to Results The cohort comprised 2,884 HCW with a QFT that could be interpreted. In 1,780 (61.7%) HCW, the QFT was 0.7 IU/mL in 763 (26.3%) HCW. Fifty-seven HCW had a TB in their medical history, eight had a TB at the time of screening and progression to active TB was observed in four HCW. Two out of eight HCW (25%) with active TB at the time of screening had a QFT result falling into the borderline zone. One out of four HCW (25%) who progressed towards active TB after being tested with QFT had QFT results falling into the borderline zone. A second IGRA was performed in 1,199 HCW. In total, 292 (24.4%) HCW had at least one of the two IGRA results pertaining to the borderline zone. Conclusion Using a borderline zone for the QFT from 0.2 to 0.7 IU/mL should be administered with care, as active TB as well as progression to active TB might be overlooked. Therefore, the borderline zone should be restricted to populations with a low TB risk only.

Abstract Background Various procedures, especially minimal invasive techniques using fluoroscopy, pose a risk of radiation exposure to orthopaedic staff. Anatomical sites such as the eyes, thyroid glands and hands are more vulnerable to radiation considering the limited use of personal protective devices in the workplace. The objective of the study is to assess the annual mean cumulative and per procedure radiation dose received at anatomical locations like eyes, thyroid glands and hands in orthopaedic staff using systematic review. Methods The review of literature was conducted using systematic search of the database sources like PUBMED and EMBASE using appropriate keywords. The eligibility criteria and the data extraction of literature were based on study design (cohort or cross-sectional study), study population (orthopaedic surgeons or their assistants), exposure (doses of workplace radiation exposure at hands/fingers, eye/forehead, neck/thyroid), language (German and English). The literature search was conducted using a PRISMA checklist and flow chart. Results Forty-two articles were found eligible and included for the review. The results show that radiation doses for the anatomical locations of eye, thyroid gland and hands were lower than the dose levels recommended. But there is a considerable variation of radiation dose received at all three anatomical locations mainly due to different situations including procedures (open and minimally invasive), work experience (junior and senior surgeons),distance from the primary and secondary radiation, and use of personal protective equipments (PPEs). The surgeons receive higher radiation dose during minimally invasive procedures compared to open procedures. Junior surgeons are at higher risk of radiation exposure compared to seniors. PPEs play a significant role in reduction of radiation dose. Conclusions Although the current radiation precautions appear to be adequate based on the low dose radiation, more in-depth studies are required on the variations of radiation dose in orthopaedic staff, at different anatomical locations and situations.

Abstract Introduction Healthcare workers (HCW) are exposed to infectious agents. Disease surveillance is therefore needed in order to foster prevention. Methods The data of the compensation board that covers HCWs of non-governmental healthcare providers in Germany was analysed for a five-year period. For hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, the period analysed was extended to the last 15 years. The annual rate of occupational infectious diseases (OIDs) per 100,000 employees was calculated. For needlestick injuries (NSI) a rate per 1,000 employees was calculated. Results Within the five years from 2005 to 2009 a total of 384 HCV infections were recognised as OIDs (1.5/100,000 employees). Active TB was the second most frequent cause of an OID. While the numbers of HBV and HCV infections decreased, the numbers for active TB did not follow a clear pattern. Needlestick injuries (NSIs) were reported especially often at hospitals (29.9/1,000 versus 7.4/1,000 employees for all other HCWs). Conclusion Although they are declining, HCV infections remain frequent in HCWs, as do NSIs. Whether the reinforcement of the recommendations for the use of safety devices in Germany will prevent NSIs and therefore HCV infections should be closely observed.

Abstract Background Interferon-gamma release assays (IGRAs) are increasingly used in the tuberculosis (TB) screening of health care workers (HCWs). However, comparatively high rates of conversions and reversion as well as growing evidence of substantial within-subject variability of interferon-gamma responses complicate their interpretation in the serial testing of HCWs. Methods We conducted a systematic review on the repeat use of the two commercial IGRAs, the QuantiFERON-TB Gold or In-Tube version (QFT) and the T-SPOT.TB (T-SPOT), in the serial testing and its with-subject variability among HCWs in order to provide guidance on how to interpret serial testing results in the context of the periodic screening of subjects with an increased occupational risk of latent TB infection (LTBI) in countries with low and intermediate TB incidence rates. The Medline, Embase, and Cochrane databases were searched without restrictions. Retrieved articles were complemented by additional hand searched records. Only studies that used commercial IGRAs among HCWs apart from contact and outbreak investigations and those fulfilling further predefined criteria were included. Results Overall, 20 studies, five using the T-SPOT and 19 using the QFT assay, were included. Fifteen studies met eligibility criteria for serial testing and five studies for within-subject variability. Irrespective of TB incidence rates in the study’s country of origin, reversion rates were consistently higher than conversion rates (range 22–71% vs. 1–14%). Subjects with baseline results around the diagnostic threshold were more likely to show inconsistent results on retesting. The within-subject variability of interferon-gamma responses was considerable across all studies systematically assessing it. Conclusions On the basis of reviewed studies we advocate using a borderline zone from 0.2–0.7 IU/ml for the interpretation of repeat QFT results in the routine screening of HCWs with an increased LTBI risk. Subjects with QFT results within this borderline zone, with suspected fresh infection, and those who are considered for preventive chemotherapy should be retested with the QFT within a period of about four weeks before preventive chemotherapy is recommended. However, the available data regarding the use of the T-SPOT in the serial testing of HCWs is remarkably limited and warrants further research.

Abstract Background Working conditions of nursery school teachers have not been scrutinized thoroughly in scientific research. Only a few studies have so far examined work-load and strain in this profession. Preferably, subjective perceptions should be corroborated by data that can be quantified more objectively and accurately. The aim of the present observational field study was to evaluate pedagogical staffs' workflow. Methods In 2009 eleven educators in a day care centre were observed throughout three complete workdays. A total of 250 working hours were recorded. Results An educators' workday lasted on average 07:46:59 h (SD = 01:01:10 h). Within this time span, an average of 02:20:46 h (30.14%, SD = 00:28:07 h) were spent on caring, 01:44:18 h on playing (22.33%, SD = 00:54:12 h), 00:49:37 h on educational work (10.62%, SD = 00:40:09), and only 00:05:38 h on individual child contact (1.21%, SD = 00:04:58 h). Conclusion For the first time, educators' workflow in day care centres was studied in real time. Some of the educators' self-reported problems were corroborated. The results of this study form a basis upon which further investigations can be built and measures can be developed for an overall improvement of child care.

Abstract Background Interferon-γ release assays (IGRAs) for TB have the potential to replace the tuberculin skin test (TST) in screening for latent tuberculosis infection (LTBI). The higher per-test cost of IGRAs may be compensated for by lower post-screening costs (medical attention, chest x-rays and chemoprevention), given the higher specificity of the new tests as compared to that of the conventional TST. We conducted a systematic review of all publications that have addressed the cost or cost-effectiveness of IGRAs. The objective of this report was to undertake a structured review and critical appraisal of the methods used for the model-based cost-effectiveness analysis of TB screening programmes. Methods Using Medline and Embase, 75 publications that contained the terms "IGRA", "tuberculosis" and "cost" were identified. Of these, 13 were original studies on the costs or cost-effectiveness of IGRAs. Results The 13 relevant studies come from five low-to-medium TB-incidence countries. Five studies took only the costs of screening into consideration, while eight studies analysed the cost-effectiveness of different screening strategies. Screening was performed in high-risk groups: close contacts, immigrants from high-incidence countries and healthcare workers. Two studies used the T-SPOT.TB as an IGRA and the other studies used the QuantiFERON-TB Gold and/or Gold In-Tube test. All 13 studies observed a decrease in costs when the IGRAs were used. Six studies compared the use of an IGRA as a test to confirm a positive TST (TST/IGRA strategy) to the use of an IGRA-only strategy. In four of these studies, the two-step strategy and in two the IGRA-only strategy was more cost-effective. Assumptions about TST specificity and progression risk after a positive test had the greatest influence on determining which IGRA strategy was more cost-effective. Conclusion The available studies on cost-effectiveness provide strong evidence in support of the use of IGRAs in screening risk groups such as HCWs, immigrants from high-incidence countries and close contacts. So far, only two studies provide evidence that the IGRA-only screening strategy is more cost-effective.

Abstract Background Interferon-gamma release assays (IGRA) are used for tuberculosis (TB) screening in healthcare workers (HCWs). However, data on specificity of IGRA in serial testing of HCWs is sparse. Therefore the specificity and the negative predictive value of the IGRA - QuantiFERON-TB Gold In-Tube (QFT) - in German nursing students was investigated. Methods 194 nursing students at the start of their professional career were tested with the QFT. 14 nursing students were excluded from the specificity analysis, due to exposure to mycobacterium tuberculosis. Two of these subjects were QFT- positive. None of them developed disease during the year of follow-up. A study group of 180 students, all with very low risk of prior TB infection, remained in the specificity analysis. Subjects were monitored for at least two years with respect to the development of active TB disease. IGRA was performed at the start of the training and after one year. Results The mean age of the study group (n = 180) was 23 years (range 18-53) with 70.9% female and 99.4% German born. The specificity of QFT was 98.9% (178/180; 95% CI 0.96-0.99); lowering the cut-off from 0.35 IU/ml to 0.1 IU/ml would have decreased specificity only slightly to 97.8% (176/180; 95% CI 0.94-0.99). Of the 154 nursing students available for re-testing, one student who initially scored positive reverted to negative, and one student initially negative converted to positive. None of the monitored group with initially negative QFT results developed TB disease, indicating a high negative predictive value of the IGRA in this population. Conclusions Following our data, QFT can serve as an effective tool in pre-employment TB screenings for HCWs. As its negative results were stable over time, specificity of the QFT in serial testing of HCWs is high. As the risk of acquiring TB infection in the German healthcare system appears to be low, our data supports the recommendation of performing TB screening only in those HCWs with known contact to TB patients or infectious materials.

Abstract Purpose The use of the 2009 H1N1 vaccine has generated much debate concerning safety issues among the general population and physicians. It was questioned if this is a safe vaccine. Therefore, we investigated the safety of an inactivated monovalent H1N1 pandemic influenza vaccine Methods We focused on the H1N1 pandemic influenza vaccine Pandemrix® and applied a self reporting questionnaire in a population of healthcare workers (HCWs) and medical students at a major university hospital. Results In total, 4337 individuals were vaccinated, consisting of 3808 HCWs and 529 medical students. The vaccination rate of the employees was higher than 40%. The majority of individuals were vaccinated in November 2009. In total, 291 of the 4337 vaccinations were reported to lead to one or more adverse reactions (6.7%). Local reactions were reported in 3.8%, myalgia and arthralgia in 3.7%, fatigue in 3.7%, headache in 3.1%. Conclusions Our data together with available data from several national and international institutions points to a safe pandemic influenza vaccine.

Abstract Introduction Results of systematic screening of healthcare workers (HCWs) for tuberculosis (TB) with the tuberculin skin test (TST) and interferon-γ release assays (IGRA) in a Portuguese hospital from 2007 to 2010 are reported. Methods All HCWs are offered screening for TB. Screening is repeated depending on risk assessment. TST and QuantiFERON Gold In-Tube (QFT) are used simultaneously. X-ray is performed when TST is > 10 mm, IGRA is positive or typical symptoms exist. Results The cohort comprises 2,889 HCWs. TST and IGRA were positive in 29.5%, TST-positive but IGRA-negative results were apparent in 43.4%. Active TB was diagnosed in twelve HCWs - eight cases were detected during screening and four cases were predicted by IGRA as well as by TST. However, the progression rate in IGRA-positive was higher than in TST-positive HCWs (0.4% vs. 0.2%, p-value 0.06). Conclusions The TB burden in this cohort was high (129.8 per 100,000 HCWs). However, the progression to active TB after a positive TST or positive IGRA was considerably lower than that reported in literature for close contacts in low-incidence countries. This may indicate that old LTBI prevails in these HCWs.

Abstract Background Helicobacter pylori is a widely spread bacterium that mainly inhabits the gastric mucosa and can lead to serious illnesses such as peptic ulcer disease, gastric carcinoma and gastric MALT lymphoma. The oral-oral route seems to be the main transmission route. The fact that endoscopes are contaminated after being used to perform a gastroscopy leads one to question whether gastroenterologists and endoscopy nurses and assistants run a higher risk of infection. Methods A systematic search for literature was conducted in the MEDLINE and EMBASE databases and further publications were found in reference lists of relevant articles. Epidemiological studies on the occupational exposure of endoscopy personnel were collected and their quality was assessed. Pooled effect estimates were identified in a meta-analysis. Results Of the 24 studies included in the analysis, 15 were considered to be methodologically good. Of these 15 studies, eight single studies showed a statistically significant increased risk of infection for gastroenterologists, and five for their assistants. Meta-analysis across all methodologically good studies found a statistically significant risk of 1.6 (95%CI 1.3-2.0) for doctors. The pooled effect estimates also indicated a statistically significant risk of Helicobacter pylori infection (RR 1.4; 95%CI 1.1-1.8) for assistants too. When studies are stratified by medical and non-medical control groups, statistically significant risks can only be recognised in the comparison with non-medical controls. Conclusions In summary, our results demonstrated an increased risk of Helicobacter pylori infection among gastroenterological personnel. However, the choice of control group is important for making a valid assessment of occupational exposure risks.

Abstract Background During the past two decades, methicillin-resistant Staphylococcus aureus (MRSA) has become increasingly common as a source of nosocomial infections. Most studies of MRSA surveillance were performed during outbreaks, so that results are not applicable to settings in which MRSA is endemic. This paper gives an overview of MRSA prevalence in hospitals and other healthcare institutions in non-outbreak situations in Western Europe. Methods A keyword search was conducted in the Medline database (2000 through June 2010). Titles and abstracts were screened to identify studies on MRSA prevalence in patients in non-outbreak situations in European healthcare facilities. Each study was assessed using seven quality criteria (outcome definition, time unit, target population, participants, observer bias, screening procedure, swabbing sites) and categorized as 'good', 'fair', or 'poor'. Results 31 observational studies were included in the review. Four of the studies were of good quality. Surveillance screening of MRSA was performed in long-term care (11 studies) and acute care (20 studies). Prevalence rates varied over a wide range, from less than 1% to greater than 20%. Prevalence in the acute care and long-term care settings was comparable. The prevalence of MRSA was expressed in various ways - the percentage of MRSA among patients (range between 1% and 24%), the percentage of MRSA among S. aureus isolates (range between 5% and 54%), and as the prevalence density (range between 0.4 and 4 MRSA cases per 1,000 patient days). The screening policy differed with respect to time points (on admission or during hospital stay), selection criteria (all admissions or patients at high risk for MRSA) and anatomical sampling sites. Conclusions This review underlines the methodological differences between studies of MRSA surveillance. For comparisons between different healthcare settings, surveillance methods and outcome calculations should be standardized.

Abstract Background Hairdressers often come into contact with various chemical substances which can be found in hair care products for washing, dyeing, bleaching, styling, spraying and perming. This exposure can impair health and may be present as skin and respiratory diseases. Effects on reproduction have long been discussed in the literature. Method A systematic review has been prepared in which publications from 1990 to 2010 were considered in order to specifically investigate the effects on fertility and pregnancy. The results of the studies were summarised separately in accordance with the type of study and the examined events. Results A total of 2 reviews and 26 original studies on fertility disorders and pregnancy complications in hairdressers were found in the relevant databases, as well as through hand searches of reference lists. Nineteen different outcomes concerning fertility and pregnancy are analysed in the 26 original studies. Most studies looked into malformation (n = 7), particularly orofacial cleft. Two of them found statistically significant increased risks compared to five that did not. Small for gestational age (SGA), low birth weight (LBW) and spontaneous abortions were frequently investigated but found different results. Taken together the studies are inconsistent, so that no clear statements on an association between the exposure as a hairdresser and the effect on reproduction are possible. The different authors describe increased risks of infertility, congenital malformations, SGA, LBW, cancer in childhood, as well as effects from single substances. Conclusion On the basis of the identified epidemiological studies, fertility disorders and pregnancy complications in hairdressers cannot be excluded. Although the evidence for these risks is low, further studies on reproductive risks in hairdressers should be performed as there is a high public health interest.

Abstract Background Data on the performance of Mycobacterium-tuberculosis-specific interferon-(IFN)-γ release assays (IGRAs) in the serial testing of health care workers (HCWs) is limited. The objective of the present study was to determine the frequency of IGRA conversions and reversions and to identify predictors of persistent IGRA positivity among serially tested German HCWs in the absence of recent extensive tuberculosis (TB) exposure. Methods In this observational cohort-study HCWs were prospectively recruited within occupational safety and health measures and underwent a tuberculin skin test (TST) and the IGRA QuantiFERON®-TB Gold In-Tube (QFT-GIT) at baseline. The QFT-GIT was repeated 18 weeks later in the median. QFT-GIT conversions (and reversions) were defined as baseline IFN-γ < 0.35 IU/ml and follow-up IFN-γ ≥ 0.35 IU/ml (and vice versa). Predictors of persistently positive QFT-GIT results were calculated by logistic regression analysis. Results In total, 18 (9.9%) and 15 (8.2%) of 182 analyzed HCWs were QFT-GIT-positive at baseline and at follow-up, respectively. We observed a strong overall agreement between baseline and follow-up QFT-GIT results (κ = 0.70). Reversions (6/18, 33.3%) occurred more frequently than conversions (3/162, 1.9%). Age and positive prior and recent TST results independently predicted persistent QFT-GIT positivity. Furthermore, the chance of having persistently positive QFT-GIT results raised about 3% with each additional 0.1 IU/ml increase in the baseline IFN-γ response (adjusted odds ratio 1.03, 95% confidence interval 1.01-1.04). No active TB cases were detected within an observational period of more than two years. Conclusions The QFT-GIT's utility for the application in serial testing was limited by a substantial proportion of reversions. This shortcoming could be overcome by the implementation of a borderline zone for the interpretation of QFT-GIT results. However, further studies are needed to clearly define the within-subject variability of the QFT-GIT and to confirm that increasing age, concordantly positive TST results, and the extend of baseline IFN-γ responses may predict the persistence of QFT-GIT positivity over time in serially tested HCWs with only a low or medium TB screening risk in a TB low-incidence setting.

Abstract Background Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession. Methods The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain. Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database). Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold. Results In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration). Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity. A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties. Conclusions Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs.

Abstract Introduction The risk of tuberculosis (TB) in healthcare workers (HCWs) is related to its incidence in the general population, and increased by the specific risk as a professional group. The prevalence of latent tuberculosis infection (LTBI) in HCWs in Portugal using the tuberculin skin test (TST) and the interferon-γ release assays (IGRA) was analyzed over a five-year period. Methods A screening programme for LTBI in HCWs was conducted, with clinical evaluations, TST, IGRA, and chest radiography. Putative risk factors for LTBI were assessed by a standardised questionnaire. Results Between September 2005 and June 2009, 5,414 HCWs were screened. The prevalence of LTBI was 55.2% and 25.9% using a TST ≥ 10 mm or an IGRA test result (QuantiFERON-TB Gold In-Tube) INF-γ ≥0.35 IU/mL as a criterion for LTBI, respectively. In 53 HCWs active TB was diagnosed. The number of HCWs with newly detected active TB decreased from 19 in the first year to 6 in 2008. Risk assessment was poorly related to TST diameter. However, physicians (1.7%) and nurses (1.0%) had the highest rates of active TB. Conclusions LTBI and TB burden among HCWs in Portugal is high. The screening of these professionals to identify HCWs with LTBI is essential in order to offer preventive chemotherapy to those with a high risk of future progression to disease. Systematic screening had a positive impact on the rate of active TB in HCWs either by early case detection or by increasing the awareness of HCWs and therefore the precautions taken by them.

Abstract Background Occupational demands of educators are not very well researched. Nevertheless their work is subject to several requirements. Whether these demands have an effect on the work ability and the health status of employees has also not been examined. Furthermore it is unclear if the ownership type of day care centres have an influence on job satisfaction and work ability of the pedagogical staff and what kind of resources do exist. Previous studies were mainly based on questionnaire data. Objective data does not exist. Therefore the aim of this investigation is to collect precise data relating to work of educators. Methods Effects of different types of ownership of day care centres on job satisfaction and work ability of educators will be assessed with the help of objective real time studies in combination with multi-level psycho diagnostic measurements. Discussion The present study is the first of its kind. Up to now there are no computer-based real time studies on workflow of pedagogical staff with regard to assess their work-related stress. Following an exhaustive documentation of educators work processes the day-to-day task can be estimated and approaches for prevention can be developed. This can substantially contribute to an overall improvement of child care in Germany.

Abstract Background Healthcare workers are still recognised as a high-risk group for latent TB infection (LTBI). Therefore, the screening of people employed in the healthcare sector for active and LTBI is fundamental to infection control programmes in German hospitals. It was the aim of the study to determine the prevalence and putative risk factors of LTBI. Methods We tested 2028 employees in the healthcare sector with the QuantiFERON-Gold In-tube (QFT-IT) test between December 2005 and May 2009, either in the course of contact tracing or in serial testing of TB high-risk groups following German OSH legislation. Results A positive IGRA was found in 9.9% of the healthcare workers (HCWs). Nurses and physicians showed similar prevalence rates (9.7% to 9.6%). Analysed by occupational group, the highest prevalence was found in administration staff and ancillary nursing staff (17.4% and 16.7%). None of the individuals in the trainee group showed a positive IGRA result. In the different workplaces the observed prevalence was 14.7% in administration, 12.0% in geriatric care, 14.2% in technicians (radiology, laboratory and pathology), 6.5% in admission ward staff and 8.3% in the staff of pulmonary/infectious disease wards. Putative risk factors for LTBI were age (>55 years: OR14.7, 95% CI 5.1-42.1), being foreign-born (OR 1.99, 95% CI 1.4-2.8), TB in the individual's own history (OR 4.96, 95% CI 1.99-12.3) and previous positive TST results (OR 3.5, 95% CI 2.4-4.98). We observed no statistically significant association with gender, BCG vaccination, workplace or profession. Conclusion The prevalence of LTBI in low-incidence countries depends on age. We found no positive IGRA results among trainees in the healthcare sector. Incidence studies are needed to assess the infection risk. Pre-employment screening might be helpful in this endeavour.

Abstract Background Although international scientific research on health issues has been dealing with the problem of aggression and violence towards those employed in health care, research activities in Germany are still at an early stage. In view of this, the aim of this study was to examine the frequency and consequences of aggressive behaviour towards nurses and health care workers in different health sectors in Germany and to assess the need for preventive measures. Methods We conducted a cross-sectional retrospective survey. Nurses and health care workers from two nursing homes, a psychiatric clinic and a workshop for people with disabilities were interviewed using a standardised questionnaire. The sample covered 123 individuals (response rate 38.8%). The survey assessed the frequency, the type and the consequences of aggressive behaviour, and social support in connection with coping with aggression in the workplace. Odds ratios (OR) and 95% confidence intervals (CI) for putative risk factors which may influence the stress induced by aggression at the workplace were calculated using conditional logistic regression. Results During the previous twelve months 70.7% of the respondents experienced physical and 89.4% verbal aggression. Physical aggression more frequently occurred in nursing homes (83.9% of the employees) and verbal aggression was more common in the psychiatric clinic (96.7% of the employees). The proportion of the individuals affected in the workshop for people with disabilities was lower (41.9% and 77.4% respectively). The incidents impaired the physical (55%) and emotional well-being (77.2%) of the employees. The frequency of incidents (weekly: OR 2.7; 95% CI 1.1-6.4) combined with the lack of social support (OR 2.8; 95% CI 1.2-6.6) increased the probability of higher stress due to aggression. Conclusions This study corroborates previous reports of frequent physical and verbal aggression towards care workers in the various areas of health care. The present study highlights differences between various areas of health care in Germany and the aggravating effect of prevention neglect such as missing social support at the workplace. Therefore our data suggest the need for improved target group specific prevention of aggressive incidents towards care workers and the need for effective aftercare in Germany.

Abstract Background Influenza immunisation for healthcare workers is encouraged to protect their often vulnerable patients but also due to a perceived higher risk for influenza. We aimed to compare the risk of influenza infection in healthcare workers in acute hospital care with that in non-healthcare workers over the same season. Methods We conducted a prospective, multicentre cohort study during the 2006/07 influenza season in Berlin, Germany. Recruited participants gave serum samples before and after the season, and completed questionnaires to determine their relevant exposures and possible confounding factors. The main outcome measure was serologically confirmed influenza infection (SCII), defined as a fourfold or greater rise in haemagglutination inhibition antibody titres to a circulating strain of influenza (with post-season titre at least 1:40). Weekly mobile phone text messages were used to prompt participants to report respiratory illnesses during the influenza season. A logistic regression model was used to assess the influence of potential risk factors. Results We recruited 250 hospital healthcare workers (mean age 35.7 years) and 486 non-healthcare workers (mean age 39.2 years) from administrative centres, blood donors and colleges. Overall SCII attack rate was 10.6%. Being a healthcare worker was not a risk factor for SCII (relative risk 1.1, p = 0.70). The final multivariate model had three significant factors: living with children (odds ratio [OR] 3.7, p = 0.005), immunization (OR 0.50, p = 0.02), and - among persons living in households without children - ownership of a car (OR 3.0, p = 0.02). Living with three or more children (OR 13.8, p < 0.01) was a greater risk than living with one or two children (OR 5.3, p = 0.02). 30% of participants with SCII reported no respiratory illness. Healthcare workers were at slightly higher risk of reporting any respiratory infection than controls (adjusted OR 1.3, p = 0.04, n = 850). Conclusions Our results suggest that healthcare workers in hospitals do not have a higher risk of influenza than non-healthcare workers, although their risk of any respiratory infection is slightly raised. Household contacts seem to be more important than exposure to patients. Car ownership is a surprise finding which needs further exploration. Asymptomatic infections are common, accounting for around a third of serologically confirmed infections.

Abstract Background Back pain is one of the most frequent complaints in the nursing profession. Thus, the 12-month prevalence of pain in the lumbar spine in nursing staff is as high as 76%. Only a few representative studies have assessed the prevalence rates of back pain and its risk factors among nursing staff in nursing homes in comparison to staff in home-based care facilities. The present study accordingly investigates the prevalence in the lumbar and cervical spine and determines the physical workload to lifting and caring in geriatric care. Methods 1390 health care workers in nursing homes and home care participated in this cross sectional survey. The nursing staff members were examined by occupational physicians according to the principals of the multistep diagnosis of musculoskeletal disorders. Occupational exposure to daily care activities with patient transfers was measured by a standardised questionnaire. The lumbar load was calculated with the Mainz-Dortmund dose model. Information on ergonomic conditions were recorded from the management of the nursing homes. Comparisons of all outcome variables were made between both care settings. Results Complete documentation, including the findings from the occupational physicians and the questionnaire, was available for 41%. Staff in nursing homes had more often positive orthopaedic findings than staff in home care. At the same time the values calculated for lumbar load were found to be significant higher in staff in nursing homes than in home-based care: 45% vs. 6% were above the reference value. Nursing homes were well equipped with technical lifting aids, though their provision with assistive advices is unsatisfactory. Situation in home care seems worse, especially as the staff often has to get by without assistance. Conclusions Future interventions should focus on counteracting work-related lumbar load among staff in nursing homes. Equipment and training in handling of assistive devices should be improved especially for staff working in home care.

Abstract Background As a consequence of the disintegration of the state systems and the expansion of the European Union, there have been marked changes in the political and social affiliations of the countries of Eastern Europe. Of the 22 countries in Northeastern, Centraleastern, Southeastern and Eastern Europe, 12 are now members and 10 are "new" neighbours of the European Union. The accident insurance systems and changes in occupational accidents and occupational diseases in eastern European countries are described. Changes since EU and visible differences from non-EU countries are analysed. Special emphasis is given to occupational skin diseases. Methods The available data from the European Union (MISSOC and MISSCEEC Studies on the Social Protection Systems), the database "Social Security Worldwide" (SSW) of the International Social Security Association (ISSA), the International Labour Office Database (LABORSTA), the World Health Organization (WHO) and the annual statistical reports of the different countries were analysed with respect to changes in occupational accidents and occupational diseases. To find missing data, 128 ministries and authorities in the 22 countries in eastern Europe were researched and 165 persons contacted. Results The social insurance systems were very different in the different countries and some were better established than others. Moreover, not all data were available. For these reasons, detailed comparison was not always possible. The occupational accident rates are decreasing in more than half the countries. In contrast, the fatal accident rates have increased in half the countries. The number of newly registered occupational diseases is decreasing in more than half the countries. The rates for occupational skin diseases in 2006 were particularly high in the Czech Republic, Poland and Slovakia. In half the countries (four out of eight), the number of occupational skin diseases is decreasing. A reliable analysis of any correlation between EU membership and the rates of occupational accidents and occupational diseases was not possible, because of missing current data. Conclusion Comparison of the social insurance systems and changes in occupational accidents and occupational diseases in 22 countries in eastern Europe makes it clear that further effort is needed to develop registration and notification procedures. Only then will it be possible to analyse changes, to map successes and problems and perhaps to initiate necessary improvements. Standardisation of the documents must also be improved, to allow international comparisons between the systems.

Abstract Introduction Using French cut-offs for the Tuberculin Skin Test (TST), results of the TST were compared with the results of an Interferon-γ Release Assay (IGRA) in Healthcare Workers (HCW) after contact to AFB-positive TB patients. Methods Between May 2006 and May 2007, a total of 148 HCWs of the University Hospital in Nantes, France were tested simultaneously with IGRA und TST. A TST was considered to indicate recent latent TB infection (LTBI) if an increase of >10 mm or if TST ≥ 15 mm for those with no previous TST result was observed. For those with a positive TST, chest X-ray was performed and preventive chemotherapy was offered. Results All HCWs were BCG-vaccinated. The IGRA was positive in 18.9% and TST ≥ 10 mm was observed in 65.5%. A recent LTBI was believed to be highly probable in 30.4% following TST. Agreement between IGRA and TST was low (kappa 0.041). In 10 (16.7%) out of 60 HCWs who needed chest X-ray following TST the IGRA was positive. In 9 (20%) out of 45 HCWs to whom preventive chemotherapy was offered following TST the IGRA was positive. Of those considered TST-negative following the French guidelines, 20.5% were IGRA-positive. In a two-step strategy - positive TST verified by IGRA - 18 out of 28 (64.3%) IGRA-positive HCWs would not have been detected using French guidelines for TST interpretation. Conclusion The introduction of IGRA in contact tracings of BCG-vaccinated HCWs reduces X-rays and preventive chemotherapies. Increasing the cut-off for a positive TST does not seem to be helpful to overcome the effect of BCG vaccination on TST.

Abstract Background A growing number of German hospitals have been privatized with the intention of increasing cost effectiveness and improving the quality of health care. Numerous studies investigated what possible qualitative and economic consequences these changes issues might have on patient care. However, little is known about how this privatization trend relates to physicians' working conditions and job satisfaction. It was anticipated that different working conditions would be associated with different types of hospital ownership. To that end, this study's purpose is to compare how physicians, working for both public and privatized hospitals, rate their respective psychosocial working conditions and job satisfaction. Methods The study was designed as a cross-sectional comparison using questionnaire data from 203 physicians working at German hospitals of different ownership types (private for-profit, public and private nonprofit). Results The present study shows that several aspects of physicians' perceived working conditions differ significantly depending on hospital ownership. However, results also indicated that physicians' job satisfaction does not vary between different types of hospital ownership. Finally, it was demonstrated that job demands and resources are associated with job satisfaction, while type of ownership is not. Conclusion This study represents one of a few studies that investigate the effect of hospital ownership on physicians work situation and demonstrated that the type of ownership is a potential factor accounting for differences in working conditions. The findings provide an informative basis to find solutions improving physicians' work at German hospitals.

Abstract Background Smear-negative pulmonary tuberculosis (TB) accounts for a considerable proportion of TB transmission, which especially endangers health care workers (HCW). Novel Mycobacterium-tuberculosis-specific interferon-γ release assays (IGRAs) may offer the chance to define the burden of TB in HCW more accurately than the Mantoux tuberculin skin test (TST), but the data that is available regarding their performance in tracing smear-negative TB in the low-incidence, in-hospital setting, is limited. We conducted a large-scale, in-hospital contact investigation among HCW of a German university hospital after exposure to a single case of extensive smear-negative, culture-positive TB with pulmonary involvement. The objective of the present study was to evaluate an IGRA in comparison to the TST and to identify risk factors for test positivity. Methods Contacts were prospectively enrolled, evaluated using a standardized questionnaire, the IGRA QuantiFERON®-TB Gold in Tube (QFT-GIT) and the TST, and followed-up for two years. Active TB was ruled out by chest x-ray in QFT-GIT-positive subjects. Independent predictors of test positivity were established through the use of logistic regression analysis. Results Out of the 143 subjects analyzed, 82 (57.3%) had close contact, but only four (2.8%) experienced cumulative exposure to the index case >40 hours. QFT-GIT results were positive in 13 subjects (9.1%), while TST results were positive in 40 subjects (28.0%) at an induration >5 mm. Overall agreement was poor between both tests (kappa = 0.15). Age was the only predictor of QFT-GIT-positivity (Odds ratio 2.7, 95% confidence interval 1.32–5.46), while TST-positivity was significantly related to Bacillus Calmette-Guérin vaccination and foreign origin. Logistic regression analysis showed no relation between test results and exposure. No secondary cases of active TB were detected over an observational period of two years. Conclusion Our findings suggest a low contagiosity of the particular index case. The frequency of positive QFT-GIT results may in fact reflect the pre-existing prevalence of latent TB infection among the study population. TB transmission seems unlikely and contact tracing not generally warranted after cumulative exposure

Abstract Background In this cross-sectional study the association between psychosocial stress, demoralization and the consumption of psychotropic substances in veterinarians was examined using data from a sample of 1,060 subjects (52.7% response). Methods Multiple logistic regression models were used to determine risk factors for psychosocial stress, demoralization, tobacco consumption (≹ 10 items/day), high-risk alcohol consumption (men > 20 g pure alcohol/day, women > 10 g pure alcohol/day), binge drinking, problem drinking according to CAGE and regular medical drug intake (at least weekly). Results Intense psychosocial stress is a risk factor for binge drinking and for regular drug use. High demoralization values are associated with tobacco consumption, problem drinking and regular drug intake. The probability of a high demoralization value increased with intense psychosocial stress. Practicing veterinarians are more frequently affected by psychosocial stress and have a greater risk of alcohol or drug consumption than veterinarians working in a non-clinical area of work (e.g. Department of Veterinary Services, Industry). Conclusion The findings support the hypothesis of complex interrelationships between psychosocial stress, demoralization and the consumption of psychotropic substances in the veterinary profession and underscore the need of further research.

Abstract Background Little is known about the prevalence of latent tuberculosis infections (LTBI) in health care workers (HCW) in low-incidence countries especially in hospitals for pulmonary diseases. With Interferon-gamma release assays (IGRA), a new method for diagnosis of LTBI is available which is more specific than the tuberculin skin test (TST). Objectives The study was designed to estimate prevalence of LTBI among 270 HCW in a Hospital of Pulmonary Diseases routinely screened for TB. Methods LTBI was assessed by the QuantiFERON-Gold In Tube (QFT-IT). Information on gender, age, workplace, job title, BCG vaccination and history of both TB and TST were collected using a standardised questionnaire. Adjusted odds ratios for potential risk factors for LTBI were calculated. Results The prevalence of LTBI was 7.2%. In HCW younger than 30 years LTBI prevalence was 3.5% and in those older than 50 years 22%. Physicians and nurses showed a higher prevalence rate than other professions (10.8% to 4.5%). The putative risk factors for LTBI were age (>50 year OR 9.3, 95%CI 2.5–33.7), working as physicians/nurses (OR 3. 95%CI 1.2–10.4) and no previous TST in medical history (OR 4.4, 95%CI 1.01–18.9) when compared to those with a negative TST. Conclusion Prevalence of LTBI assessed by QFT-IT is low, this indicates a low infection risk even in hospitals for pulmonary diseases. No statement can be made regarding the occupational risk as compared to the general population because there are no LTBI prevalence data from Germany available. The higher LTBI prevalence rate in older HCWs might be due to the cohort effect or the longer time at risk.

Abstract Background There are several ways to conduct a job task analysis in medical work environments including pencil-paper observations, interviews and questionnaires. However these methods implicate bias problems such as high inter-individual deviations and risks of misjudgement. Computer-based observation helps to reduce these problems. The aim of this paper is to give an overview of the development process of a computer-based job task analysis instrument for real-time observations to quantify the job tasks performed by physicians working in different medical settings. In addition reliability and validity data of this instrument will be demonstrated. Methods This instrument was developed in consequential steps. First, lists comprising tasks performed by physicians in different care settings were classified. Afterwards content validity of task lists was proved. After establishing the final task categories, computer software was programmed and implemented in a mobile personal computer. At least inter-observer reliability was evaluated. Two trained observers recorded simultaneously tasks of the same physician. Results Content validity of the task lists was confirmed by observations and experienced specialists of each medical area. Development process of the job task analysis instrument was completed successfully. Simultaneous records showed adequate interrater reliability. Conclusion Initial results of this analysis supported the validity and reliability of this developed method for assessing physicians' working routines as well as organizational context factors. Based on results using this method, possible improvements for health professionals' work organisation can be identified.

Abstract Background To investigate the occupational risk of tuberculosis (TB) infection in a low-incidence setting, data from a prospective study of patients with culture-confirmed TB conducted in Hamburg, Germany, from 1997 to 2002 were evaluated. Methods M. tuberculosis isolates were genotyped by IS6110 RFLP analysis. Results of contact tracing and additional patient interviews were used for further epidemiological analyses. Results Out of 848 cases included in the cluster analysis, 286 (33.7%) were classified into 76 clusters comprising 2 to 39 patients. In total, two patients in the non-cluster and eight patients in the cluster group were health-care workers. Logistic regression analysis confirmed work in the health-care sector as the strongest predictor for clustering (OR 17.9). However, only two of the eight transmission links among the eight clusters involving health-care workers had been detected previously. Overall, conventional contact tracing performed before genotyping had identified only 26 (25.2%) of the 103 contact persons with the disease among the clustered cases whose transmission links were epidemiologically verified. Conclusion Recent transmission was found to be strongly associated with health-care work in a setting with low incidence of TB. Conventional contact tracing alone was shown to be insufficient to discover recent transmission chains. The data presented also indicate the need for establishing improved TB control strategies in health-care settings.

Background: Children

Background: Healthcare workers (HCWs) are at increased risk of becoming infected with complex (Mtbc). Objective: To assess the magnitude of Mtbc transmission by children under the age of 15 years to HCW. Methods: Medline, Google Scholar and Cochrane library were searched to select primary studies in which a child was the presumed index case and exposed HCW were screened for latent TB infection (LTBI).Results: Of 4,702 abstracts, 15 original case reports covering 16 children with TB were identified. In sum, 1,395 HCW were contact persons and underwent testing. Ten of the studies reported TST conversion, amounting to 35 (2.9%) of the 1,228 HCW tested. In three of the TST-based and both of the studies that used IGRA testing, conversion was absent. 12 of the 15 studies (80%) reported exposure of HCW in neonatal intensive units (NICUs) to premature infants suffering from congenital pulmonary TB. One study including two infants addressed possible pulmonary Mtbc transmission in a general pediatric ward. Extrapulmonary transmission by aerosolized Mtbc was suggested in two patients, an infant with tuberculous peritonitis and a 12-year-old adolescent with pleurisy, and culture-confirmed only after the child had undergone video-assisted thoracoscopic surgery. Routine use of protective facemasks by HCW before exposure was not mentioned in any of the included studies. Conclusions: The results suggest that the risk of Mtbc transmission from children to HCW is low. Particular attention should be paid to infection risk during respiratory manipulations in NICUs. The consistent wearing of facemasks may further reduce the risk of Mtbc transmission.