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BACKGROUND: Demographic change is a driving force of disease burden. The German population is aging and simultaneously shrinking, due to a rising life expectancy and a declining fertility rate. North Rhine-Westphalia (NRW) is the most populous federal state of Germany including the Ruhr metropolitan area. The NRW population is expected to shrink by 2.5% until 2025, the population of the Ruhr area by 9.5%. At the same time, the population forecast predicts a growth of 30% in the age group > or =55 years for NRW. METHODS: The 'burden of disease' approach of the World Health Organisation (WHO) summarizes the health status of populations. This approach was used to predict the regional disease burden in 2025 by calculating disability adjusted life years (DALY) as the sum of life years lost due to premature death and years lived with disability due to selected diseases. Our projection included selected tumours, myocardial infarction (MI) and dementia. RESULTS: For the Ruhr area, increases in DALYs are expected for all causes studied, i.e. selected tumours (20%), MI (17%) and dementia (36%). The increase in the Ruhr area was estimated to be proportionally lower than in NRW in total, but the disease burden per inhabitant is higher. CONCLUSION: The population shrinking is no cure for 'Ruhr City'. The projection of disease burden shows that health status will decrease due to the demographic change. DALY estimates show the potential health gains, which can be won by implementing measures to reduce premature deaths and to prevent new cases. [ABSTRACT FROM AUTHOR]

This article presents information on the difficulties in the quantification of radiofrequency (RF) exposure from appliances in analytical epidemiological studies. In 1997-2000, the Northern Germany Leukaemia and lymphoma Study, recorded lifetime use of a pre-selected array of RF emitting appliances like cellular and cordless phones, baby monitors, and TV headphones in standardised, face to face computer assisted interviews. Exposure assessment comprised three levels of precision: ever use, gross/net appliance years, and lifelong cumulative exposure hours.

The usage of smart glasses in goods logistics and order picking has mainly been studied through cross-sectional experimental studies. Our longitudinal field study investigated the effects of smart glasses on the eyesight of 43 employees at two German companies. We combined ophthalmological examinations and questionnaire surveys at two points in time, six months apart. The vision of the employees was examined before and after each work shift. Mixed effects logistic regression was conducted to determine the associations between smart glasses use and effects on visual acuity. In the baseline examination, differences in eyesight before and after shifts were small and not statistically significant. However, some individuals experienced deteriorations, especially in visual acuity at near distances ( n = 7 for the right eye, n = 6 for the left). Participants over 40 years of age had 16.1 times higher odds of deterioration compared to those under 40 years (95% CI: 2.7-95.9, p = 0.002). The most commonly reported eye strains were eye fatigue ( n = 32), rubbing ( n = 25), and burning ( n = 24). If smart glasses are to be implemented in logistics companies, it is recommended to offer employees eye tests with an industrial physician in advance.

Study Objectives: The association of shift work (SW) and disrupted circadian rhythm with markers of large artery atherosclerosis and cerebral small vessel disease is uncertain. We aimed to study the separate association of current and former SW with these markers., Methods: We included participants from the population-based Hamburg City Health Study. SW was defined by monthly working hours between 06:00 pm and 07:00 am containing night shifts for at least 12 months. Cross-sectional data were obtained from structured questionnaires, laboratory analyses, physical examinations, brain magnetic resonance imaging, and carotid ultrasound. We performed multivariable regression analysis with carotid intima-media thickness (CIMT), and peak-width skeletonized mean diffusivity (PSMD) as dependent variables., Results: Three hundred and forty-four current, 238 former, and 7162 never-shift workers were included. The median age was 60 years for both current and former shift workers, and total duration of SW was comparable for the two groups. Current shift workers were less frequently female (27.3% vs. 44.5%; p  < .001), had more frequent hyperlipidemia (31.5% vs. 22.3%; p  = .024), and diabetes (16.2% vs. 3.2%; p  < .001). After adjustment for age and sex, reduced quality of sleep (β = 1.61, p  = .001) and low education (β = 2.63, p  < .001) were associated with current but not former SW. Adjusted for age and sex, the current SW was associated with higher CIMT (β = 0.02, p  = .001) and PSMD (β = 9.06e-06, p  = .006), whereas former SW was not. Adjusted for risk factors, current SW remained associated with PSMD (β = 9.91e-06, p  = .006) but not with CIMT., Conclusions: Current SW was associated with CIMT and with PSMD, with the latter association remaining after adjustment for risk factors. Former SW showed no associations with CIMT or PSMD. This may indicate that current SW is linked with increased neurovascular risk through disrupted circadian rhythms., Trial Registration Information: The trial was submitted at http://www.clinicaltrials.gov, under NCT03934957 on January 4, 2019. The first participant was enrolled in February 2016., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Light-at-night triggers the decline of pineal gland melatonin biosynthesis and secretion and is an IARC-classified probable breast-cancer risk factor. We applied a large-scale molecular epidemiology approach to shed light on the putative role of melatonin in breast cancer. We investigated associations between breast-cancer risk and polymorphisms at genes of melatonin biosynthesis/signaling using a study population of 44,405 women from the Breast Cancer Association Consortium (22,992 cases, 21,413 population-based controls). Genotype data of 97 candidate single nucleotide polymorphisms (SNPs) at 18 defined gene regions were investigated for breast-cancer risk effects. We calculated adjusted odds ratios (ORs) and 95% confidence intervals (CI) by logistic regression for the main-effect analysis as well as stratified analyses by estrogen- and progesterone-receptor (ER, PR) status. SNP-SNP interactions were analyzed via a two-step procedure based on logic regression. The Bayesian false-discovery probability (BFDP) was used for all analyses to account for multiple testing. Noteworthy associations (BFDP < 0.8) included 10 linked SNPs in tryptophan hydroxylase 2 (TPH2) (e.g. rs1386492: OR = 1.07, 95% CI 1.02-1.12), and a SNP in the mitogen-activated protein kinase 8 (MAPK8) (rs10857561: OR = 1.11, 95% CI 1.04-1.18). The SNP-SNP interaction analysis revealed noteworthy interaction terms with TPH2- and MAPK-related SNPs (e.g. rs1386483 R ∧ rs1473473 D ∧ rs3729931 D : OR = 1.20, 95% CI 1.09-1.32). In line with the light-at-night hypothesis that links shift work with elevated breast-cancer risks our results point to SNPs in TPH2 and MAPK-genes that may impact the intricate network of circadian regulation., (© 2023. The Author(s).)

Background: For seafarers on the high seas health hazards are various and due to the setting also specific. The spectrum of job-related health impairments and accidents is mainly influenced by the maritime characteristics. The aim of this study is to assess the kind of accidents and the frequency of diseases and health complaints among seafarers on German container ships by evaluating medical log books., Methods: A systematic analysis of 14,628 medical entries from 95 medical log books of 58 container ships under German flag from 1995 to 2015 was performed. This monocentric retrospective and descriptive study used information on accidents, diseases and health complaints among different occupational groups and medical treatment procedures for the analysis and evaluation., Results: The analysis showed that more than one third of all consultations with the Health Officer on board are related to internal (33.7%) and surgical (31.3%) symptoms. Almost twenty percent of consultations were due to respiratory infections (19.6%) and accidents (17.9%). Accidents represented the most frequent reason for unfitness for sea service (31.2%). Based on occupational categories, most injuries occurred among deck crew (22.5%), followed by ratings working in the engine room (18.9%). In 106 cases, telemedical contact with a physician ashore was necessary. In total, 15 seafarers had to be evacuated from the ship for further medical treatment onshore. Medicine/drug application was the most common therapeutic measure on board, accounting for 77% of all consultations., Conclusions: The high proportion of health complaints and accidents among seafarers shows that there is a need to optimize medical care at sea and accident prevention, e.g. by standardized treatment algorithms or improving the medical training of Health Officers. The development and introduction of a digital patient file to record medical treatments on the vessels could also improve medical documentation on board., (© 2023. The Author(s).)

The risk of SARS-CoV-2 infection is particularly high for healthcare workers during the pandemic. Home care workers visit many different households per shift. Encounters with mostly elderly patients and their relatives increase the potential for the undetected spread of SARS-CoV-2. In order to gain insight into the seroprevalence of SARS-CoV-2 antibodies and possible transmission risks in outpatient care, this follow-up study was conducted with nursing services in Hamburg. The aim was to estimate the dynamics of seroprevalence in this occupational group over a 12-month period, to identify occupation-specific risk factors, and to collect information on the vaccination status of the surveyed nursing staff. Antibody testing for SARS-CoV-2 IgG against the S1 domain (EUROIMUN Analyser I ® Lübeck, Germany) was performed on participating healthcare workers with patient contact at a total of four time points within one year from July 2020 to October 2021 (baseline, follow-up after three, six and twelve months). The data were mostly analysed descriptively. Differences in IgG titres were analysed using variance analysis methods, particularly Tukey's range test. The seroprevalence was 1.2% (8/678) at baseline and 1.5% (9/581) at the three-month follow-up (T1). At the second follow-up (T2) after six months, vaccination against SARS-CoV-2 was available from January 2021 onwards. The prevalence rate of positive IgG antibodies relative to the S1 domain of the spike protein test among unvaccinated individuals was 6.5%. At (T3) after twelve months (July to October 2021), 482 participants were enrolled, and 85.7% of the workers were considered fully vaccinated at this time point, while 51 individuals were unvaccinated. The prevalence was 13.7% (7/51). In our study, a low seroprevalence was found among home care workers, which was lower than in our studies conducted in the clinical setting. Therefore, it can be assumed that the occupational risk of infection is rather low for both the nursing staff and the patients/clients cared for in the outpatient setting. The good provision of protective equipment and the high vaccination rate of the staff probably had a positive influence.

Head worn displays have become increasingly popular at workplaces in logistics and assembly lines in recent years. Such displays are expected to improve productivity and safety at the workplace. However, their impact on balance in the workforce is still an open research question. Therefore, we investigated the influence of the Vuzix M400 and Realwear HMT1 smart glasses on postural control. A laboratory study was conducted with eleven participants. Balance parameters were recorded during bilateral quiet stance, together with parameters of cognitive load. The two different smart glasses used in this study were compared with a monitor and a tablet under single-task conditions and while performing a spatial 2-back task. As balance parameters, the prediction ellipse and sample entropy in anteroposterior as well as mediolateral direction of the center-of-pressure data were examined. No significant differences were observed in the cognitive task performance between the devices. The prediction ellipse of the smart glasses was smaller than the tablets but larger than the smartboard. The dynamic of sample entropy data suggests that the use of the spatial 2-back task induces postural sway in the participants. This effect was most profound when looking at the monitor and least recognizable in the data of the tablet., (© 2023 Walter de Gruyter GmbH, Berlin/Boston.)

Hypertension is a global public health concern and an important contributor to cardiovascular disease. It remains disputed how important life circumstances are for the etiology of hypertension. Thus, the aim of this study is to assess the spatial variation of hypertension within an urban population and to investigate the association with the quality of life of city dwellers and their subjective evaluation of their residential district, as well as their home environment, using the example of Hamburg, Germany. In this cross-sectional study, the first 10,000 participants from the Hamburg City Health Study (HCHS) were analysed. Only participants who had resided at the current address for a minimum of five years were considered. In the descriptive analysis, participants with and without arterial hypertension were compared considering various parameters. The subjective quality of the living environment was obtained using an appropriate subjective living environment index. Quality of life was mapped using the EuroQol Group quality of life questionnaire (EQ-5D) score and the two (mental and physical health) scores of the Short Form Health Questionnaire SF-8. The Gini-coefficient was used to quantify the regional economic variation within Hamburg. Linear and logistic regression analyses were performed. Regional levels were 68 city district clusters in Hamburg. The analysis included n = 8192 participants living at least five years in Hamburg at the time of participation in the HCHS. There was a spatial variation in the prevalence of arterial hypertension within Hamburg. Prevalence rates between city district clusters ranged from 50.0% to 88.5%. The results showed that city district clusters with a worse subjective perception of the living environment were partly associated with an increased prevalence of arterial hypertension. Furthermore, a negative association was observed between arterial hypertension prevalence and the sociodemographic status of participants in the city district clusters. Thus, participants with a high level of education suffered less frequently from arterial hypertension than participants with a rather low level of education. The subjective living environment index and quality of life were significantly related to the occurrence of arterial hypertension; however, more extensive and detailed studies are necessary to derive possible clinical implications.

Objectives: To evaluate mental health-related outcomes of police officers 5.5 years after implementing a new alternating shift schedule which was supposed to improve their health and work-life balance., Design: Pre-post study design with a baseline survey at the beginning of the piloting of the new shift schedule in 2015 and another survey 5.5 years later in 2020., Setting: Police departments of a German metropolitan police force piloting the new shift schedule., Participants: 116 shift-working police officers out of a population of 1673 police officers at the follow-up date., Interventions: New shift schedule based on occupational health recommendations., Outcomes Measures: Work-life balance, job satisfaction and quality of life., Methods: Mixed analyses of variances were used to test the hypotheses of within-subject and between-subject differences regarding time and gender., Results: We found partly significant differences between the baseline and follow-up survey for work-life balance ( F (1, 114) = 6.168, p=0.014, η p ² = 0.051), job satisfaction ( F (1, 114) = 9.921, p=0.002, η p ² = 0.080) and quality of life ( F (1, 114) = 0.593, p=0.443, η p ² = 0.005). Neither significant differences between male and female police officers nor interaction effects of time and gender were found., Conclusion: An increase was found for each of the three outcomes 5.5 years after implementing the new shift schedule. The results contribute to the current state of research on mental health-related outcomes of working conditions in shift work. On this basis, recommendations for designing shift schedules can be deduced to promote mental health and job satisfaction for employees in shift work., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Healthcare workers bear a high risk of infection during epidemics and pandemics such as the current SARS-CoV-2 pandemic. Various new vaccines have been approved. We investigated the influence of the time elapsed since vaccination, as well as of vaccination schema, on health workers' spike antibody levels following their second vaccination. Blood samples were obtained from employees working at a German hospital between August 2021 and December 2021 on average half a year (range 130-280 days) after their second vaccination. Levels of SARS-CoV-2-IgG antibodies (spike and nucleocapsid protein) were qualitatively detected via chemiluminescent immunoassays (CLIAs). A previous infection with SARS-CoV-2 was an exclusion criterion. In total, 545 persons were included in this cross-sectional study. Most participants (97.8%) showed elevated anti-spike concentrations. Anti-spike levels differed significantly among vaccination schemas. Repeated vector vaccinations resulted in lower protective antibody levels. Higher age levels, immunosuppression and a longer time period since the second vaccination resulted in lower anti-spike levels. Women's antibody levels were higher, but not significantly. Since anti-spike levels drop after vaccination, further boosters are required to increase immunoreactivity. If two vector vaccines have been administered, it is possible that an mRNA booster might increase the anti-spike level.

Objective: Large-scale population-based studies regarding the role of education in periodontitis are lacking. Thus, the aim of the current study was to analyze the potential association between education and periodontitis with state of the art measured clinical phenotypes within a large population-based sample from northern Germany., Material & Methods: The Hamburg City Health Study (HCHS) is a population-based cohort study registered at ClinicalTrial.gov (NCT03934957). Oral health was assessed via plaque-index, probing depth, gingival recession and gingival bleeding. Periodontitis was classified according to Eke & Page. Education level was determined using the International Standard Classification of Education (ISCED-97) further categorized in "low, medium or high" education. Analyses for descriptive models were stratified by periodontitis severity. Ordinal logistic regression models were stepwise constructed to test for hypotheses., Results: Within the first cohort of 10,000 participants, we identified 1,453 with none/mild, 3,580 with moderate, and 1,176 with severe periodontitis. Ordinal regression analyses adjusted for co-variables (age, sex, smoking, diabetes, hypertension and migration) showed that the education level (low vs. high) was significantly associated with periodontitis (OR: 1.33, 95% CI: 1.18;1.47)., Conclusion: In conclusion, the current study revealed a significant association between the education level and periodontitis after adjustments for a set of confounders. Further research is needed to develop strategies to overcome education related deficits in oral and periodontal health., (© 2022. The Author(s).)

The functionality of smart glasses includes the possibility of wireless communication. For this purpose, WiFi or Bluetooth modules are integrated into the glasses. They emit electromagnetic radiation in the vicinity of the user's head. This simulation study investigates the impact of varying positions, frequencies, and antenna types of the embedded WiFi or Bluetooth modules on different tissue types in the human head. The absorption of electromagnetic energy causes the main impact on the tissue in the head. This physical process is best described by the specific absorption rate SAR. To investigate the effects of position, frequency, and antenna type on the simulated SAR values multiple simulations have been carried out considering real-world applications of smart glasses. The results show that the type of antenna has little effect on the SAR values of the different tissues. The maximum regulated output powers explain the frequencies' impact on the exposure. According to our findings, the greatest influence on the SAR values can be attributed to the placement of the antenna. Finally, our study reveals that positioning the antenna at the front side of the head is optimal for most tissues because of its maximal distance to the head tissues., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

In aging populations, the increasing prevalence of metabolic syndrome and the resulting elevated risk of developing non-communicable diseases is a major challenge for worldwide health care. The elderly population-based Hamburg City Health Study (HCHS) allows investigating the association in the relevant age group 45-74 years. For 3513 of 10,000 participants, self-reported information on dietary patterns (DASH, MEDAS), chronotype, lifestyle, and data on metabolic syndrome parameters was available. Overall, having a "low" DASH score was a statistically significant risk factor (OR 1.23; 95% CI 1.01-1.48). Only for "late" chronotype, a slightly elevated OR (1.06) was found, but no statistically significant effect on the outcome of metabolic syndrome. Still, considering chronotype vastly improved the model. However, a trend of an increasing predicted probability from early to late chronotype was found for participants with low adherence to the DASH diet. Future research should focus on options for prevention in persons with late chronotype, so they can be supported better in adherence to, e.g., DASH diet to lower their risk.

The Lufthansa Prevention Study (LUPS) study is a prospective observation of a healthy worker cohort to identify early changes in metabolism leading to the Metabolic Syndrome (MetS) and to analyze their relation to behavioral factors like nutrition, physical activity, psychological status, and to underlying genetic conditions. The LUPS study recruited a sample of 1.962 non-diabetic healthy adults between 25-60 years, employed at a flight base of Lufthansa Technik GmbH in Hamburg, Germany. Baseline assessments included anthropometric measures, blood and urine samples and medical history. Psychosocial variables, dietary habits and life-style risk factors were assessed via self-reported questionnaires.In this report we describe the study design and present baseline parameters including the prevalence of the MetS using different classification criteria. The MetS was present in 20% of male and 12% of female subjects according to the 'Harmonizing the metabolic syndrome' definition. The prevalence varies between 2.6% in male and 2.3% in female subjects up to 48% in male and 41% in female subjects according to different classification criteria of MetS.In conclusion, this first cross-sectional view on the LUPS data confirms the expectation that this cohort is rather healthy and thus provides the opportunity to analyze early changes associated with the development of the MetS. The LUPS study is registered as a clinical trial NCT01313156., Competing Interests: No conflict of interest has been declared by the authors., (Thieme. All rights reserved.)

Background: Asbestos-related lung diseases are one of the leading diagnoses of the recognized occupational diseases in Germany, both in terms of their number and their socio-economic costs. The aim of this study was to determine whether pulmonary function testing (spirometry and CO diffusion measurement (D LCO )) and computed tomography of the thorax (TCT) are relevant for the early detection of asbestos-related pleural and pulmonary fibrosis and the assessment of the functional deficiency., Methods: The records of 111 formerly asbestos-exposed workers who had been examined at the Institute for Occupational and Maritime Medicine, Hamburg, Germany, with data on spirometry, D LCO and TCT were reviewed. Workers with substantial comorbidities (cardiac, malignant, silicosis) and/or pulmonary emphysema (pulmonary hyperinflation and/or TCT findings), which, like asbestosis, can lead to a diffusion disorder were excluded. The remaining data of 41 male workers (mean 69.8 years ±6.9) were evaluated. The TCT changes were coded according to the International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) by radiologists and ICOERD-scores for pleural and pulmonary changes were determined. Correlations (ρ), Cohens κ and accuracy were calculated., Results: In all 41 males the vital capacity (VC in % of the predicted value (% pred.)) showed only minor limitations (mean 96.5 ± 18.0%). The D LCO (in % pred.) was slightly reduced (mean 76.4 ± 16.6%; median 80.1%); the alveolar volume related value (D LCO /VA) was within reference value (mean 102 ± 22%). In the TCT of 27 workers pleural asbestos-related findings were diagnosed whereof 24 were classified as pulmonary fibrosis (only one case with honey-combing). Statistical analysis provided low correlations of VC ( ρ  = - 0.12) and moderate correlations of D LCO (- 0.25) with pleural plaque extension. The ICOERD-score for pulmonary fibrosis correlated low with VC (0.10) and moderate with D LCO (- 0.23); D LCO had the highest accuracy with 73.2% and Cohens κ with 0.45. D LCO /VA showed no correlations to the ICOERD-score. The newly developed score, which takes into account the diffuse pleural thickening, shows a moderate correlation with the D LCO ( ρ  = - 0.35, p  < 0.05)., Conclusions: In formerly asbestos-exposed workers, lung function alterations and TCT findings correlated moderate, but significant using D LCO and ICOERD-score considering parenchymal ligaments, subpleural curvilinear lines, round atelectases and pleural effusion in addition to pleural plaque extension. D LCO also showed highest accuracy in regard to pulmonary findings. However, VC showed only weaker correlations although being well established for early detection. Besides TCT the determination of both lung function parameters (VC and D LCO ) is mandatory for the early detection and assessment of functional deficiencies in workers formerly exposed to asbestos., Competing Interests: Competing interestsThe authors report no conflicts of interest in this work., (© The Author(s) 2020.)

The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.