Special Issue "Proceedings of ICOH Occupational Health for Health Worker (OHHW2019) Conference"

Special Issue Editors

Prof. Dr. Albert Nienhaus
Website
Guest Editor
1. Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
2. Department for Occupational Medicine, Hazardous Substances and Health Science, Institution for Accident Insurance and Prevention in the Health and Welfare Services (BGW), 22089 Hamburg, Germany
Interests: occupational health; tuberculosis in health workers; violence against health workers; leadership and workers’ health; low back pain in health workers; psycho-social exposure in health workers
Special Issues and Collections in MDPI journals
Dr. Gwen Brachman

Guest Editor
Dr. Brachman graduated from Boston University School of Medicine, completed a residency in Internal Medicine (Pacific Medical Center), a fellowship in Rheumatology (UMDNJ-Rutgers) and a residency in Occupational Medicine (UMDNJ-Rutgers). She was an Assistant Clinical Professor of Medicine and worked in the Occupational Medicine Service at UMDNJ-Rutgers University – New Jersey Medical School in Newark, NJ for 20 years. She is currently retired but remains active in ACOEM (American College of Occupational and Environmental Medicine) and ICOH (International Commission on Occupational Health) where she is the Chair of the Scientific Committee on Occupational Health for Health Workers.
Dr. Antoon De Schryver

Guest Editor
Dr. De Schryver received an MD and a PhD with a doctoral thesis in Medical Sciences from Ghent University, Belgium. Dr. De Schryver is a certified specialist in Occupational Medicine and in Epidemiology and is a Professor in the Department of Epidemiology and Social Medicine at the University of Antwerp, since 2005. He has been an occupational physician with IDEWE Occupational Health Services since 1997. Occupational Health Memberships: ICOH since 1993, Belgian Association of occupational physicians since 1995 Publications: In total 100 publications in listed journals. Most publications concern studies on epidemiology and infectious diseases in healthcare and non-health care workers.
Interests: epidemiology; particularly occupational and infectious diseases epidemiology; Hepatitis B; vaccinations

Special Issue Information

Dear Colleagues,

You are invited to submit papers to be presented at the ICOH Occupational Health for Health Workers (OHHW2019) Conference (https://www.ohhw2019.org), for publication in IJERPH (Impact Factor 2.468). This Special Issue will be guest edited by Dr. Albert Nienhaus, Dr. Gwen Brachman, and Dr. Antoon De Schryver. Manuscripts should be submitted by 31 May 2020. See the Special Issue website for further details and submission instructions. Participants of this conference will receive a 20% discount on the Article Processing Charges.

Papers submitted to this Special Issue of IJERPH will undergo the standard peer-review procedure. Published papers will be indexed by the SCIE (Web of Science) and PubMed.

Prof. Dr. Nienhaus Albert
Dr. Gwen Brachman
Dr. Antoon De Schryver
Guest Editors

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Published Papers (40 papers)

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Open AccessArticle
Preventing Occupational Tuberculosis in Health Workers: An Analysis of State Responsibilities and Worker Rights in Mozambique
Int. J. Environ. Res. Public Health 2020, 17(20), 7546; https://doi.org/10.3390/ijerph17207546 - 16 Oct 2020
Abstract
Given the very high incidence of tuberculosis (TB) among health workers in Mozambique, a low-income country in Southern Africa, implementation of measures to protect health workers from occupational TB remains a major challenge. This study explores how Mozambique’s legal framework and health system [...] Read more.
Given the very high incidence of tuberculosis (TB) among health workers in Mozambique, a low-income country in Southern Africa, implementation of measures to protect health workers from occupational TB remains a major challenge. This study explores how Mozambique’s legal framework and health system governance facilitate—or hinder—implementation of protective measures in its public (state-provided) healthcare sector. Using a mixed-methods approach, we examined international, constitutional, regulatory, and policy frameworks. We also recorded and analysed the content of a workshop and policy discussion group on the topic to elicit the perspectives of health workers and of officials responsible for implementing workplace TB policies. We found that despite a well-developed legal framework and national infection prevention and control policy, a number of implementation barrier persisted: lack of legal codification of TB as an occupational disease; absence of regulations assigning specific responsibilities to employers; failure to deal with privacy and stigma fears among health workers; and limited awareness among health workers of their legal rights, including that of collective action. While all these elements require attention to protect health workers from occupational TB, a stronger emphasis on their human and labour rights is needed alongside their perceived responsibilities as caregivers. Full article
Open AccessArticle
Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand
Int. J. Environ. Res. Public Health 2020, 17(18), 6876; https://doi.org/10.3390/ijerph17186876 - 21 Sep 2020
Abstract
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study [...] Read more.
Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB—94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01–3.58, p = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50–4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04–3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65–5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role. Full article
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Open AccessArticle
Tuberculosis Infection Screening in 5468 Italian Healthcare Students: Investigation of a Borderline Zone Value for the QFT-Test
Int. J. Environ. Res. Public Health 2020, 17(18), 6773; https://doi.org/10.3390/ijerph17186773 - 17 Sep 2020
Abstract
Healthcare workers are at an increased risk of contracting Mycobacterium tuberculosis infection. Tuberculin skin test (TST) and interferon gamma release assay (IGRA) represent the available tests most used for the diagnosis of latent tuberculosis infection (LTBI). Different borderline zones have been proposed for [...] Read more.
Healthcare workers are at an increased risk of contracting Mycobacterium tuberculosis infection. Tuberculin skin test (TST) and interferon gamma release assay (IGRA) represent the available tests most used for the diagnosis of latent tuberculosis infection (LTBI). Different borderline zones have been proposed for defining conversions and reversions to improve the interpretation of the IGRA test results as part of serial testing. From 2012 to 2017, 5468 health students of an Italian University Hospital were screened for tuberculosis infection through the execution of the TST and, in case of positivity, of the QuantiFERON-TB® Gold In-Tube assay (QFT–GIT). The QFT–GIT is considered “borderline” with values from 0.35 to 0.99 IU/mL. Among the students who performed the QFT–GIT assay, 27 subjects presented a range of values defined as borderline. The QFT–GIT was repeated after 90 days on 19 subjects with borderline values and showed a negativization of the values in 14 students and a positive conversion in three cases, while for two students, a borderline value was also found for the second test, with a 74% regression of the borderline cases. The introduction of QuantiFERON borderline values is a useful assessment tool to bring out LTBI case candidates for chemoprophylaxis. Full article
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Open AccessArticle
DANGER! Crisis Health Workers at Risk
Int. J. Environ. Res. Public Health 2020, 17(15), 5270; https://doi.org/10.3390/ijerph17155270 - 22 Jul 2020
Abstract
The occupational hazards of health workers (HWs) in standard work environments have been well defined in both the developed and developing world during routine working conditions. Less defined are the hazards to HWs during pandemics, epidemics, natural disasters, wars, conflicts, and other crises. [...] Read more.
The occupational hazards of health workers (HWs) in standard work environments have been well defined in both the developed and developing world during routine working conditions. Less defined are the hazards to HWs during pandemics, epidemics, natural disasters, wars, conflicts, and other crises. How do crises affect the infrastructure of medical systems? What are the distinct needs of the patient population during crises? What are the peculiarities of the Crisis Health Worker (CHW)? What are the known CHWs’ occupational risks? What are the protective factors? By means of a PubMed search, we synthesized the most relevant publications to try to answer these questions. Failures of healthcare infrastructure and institutions include CHW shortages, insufficient medical supplies, medications, transportation, poorly paid health workers, security concerns, and the absence of firm guidance in health policy. Healthcare needs affecting the patient population and CHWs include crisis-induced injury and illness, hazardous exposures, communicable diseases, mental healthcare, and continuity of care for pre-crisis medical conditions. CHWs’ occupational hazards include supply deficiencies, infectious disease transmission, long working hours, staff shortages, financial reimbursements, mental fatigue, physical exhaustion, and inconsistent access to clean water, electricity, and Internet. CHWs suffer from injuries and illnesses that range from immediate, debilitating injuries to chronic, unforeseen effects like mental fatigue, physical exhaustion, anxiety, burnout, and even post-traumatic stress syndrome (PTSD). Protective factors include personal traits such as adaptability and resilience as well as skills learned through structured education and training. Success will be achieved by constructively collaborating with local authorities, local health workers, national military, foreign military, and aid organizations. Full article
Open AccessArticle
Biomechanical Model-Based Development of an Active Occupational Upper-Limb Exoskeleton to Support Healthcare Workers in the Surgery Waiting Room
Int. J. Environ. Res. Public Health 2020, 17(14), 5140; https://doi.org/10.3390/ijerph17145140 - 16 Jul 2020
Abstract
Occupational ergonomics in healthcare is an increasing challenge we have to handle in the near future. Physical assistive systems, so-called exoskeletons, are promising solutions to prevent work-related musculoskeletal disorders (WMSDs). Manual handling like pushing, pulling, holding and lifting during healthcare activities require practical [...] Read more.
Occupational ergonomics in healthcare is an increasing challenge we have to handle in the near future. Physical assistive systems, so-called exoskeletons, are promising solutions to prevent work-related musculoskeletal disorders (WMSDs). Manual handling like pushing, pulling, holding and lifting during healthcare activities require practical and biomechanical effective assistive devices. In this article, a musculoskeletal-model-based development of an assistive exoskeleton is described for manual patient transfer in the surgery waiting room. For that purpose, kinematic data collected with an experimental set-up reproducing real patient transfer conditions are first used to define the kinetic boundary conditions for the model-based development approach. Model-based analysis reveals significant relief potential in the lower back and shoulder area of the musculoskeletal apparatus. This is corroborated by subjective feedback collected during measurements with real surgery assistants. A shoulder–arm exoskeleton design is then proposed, optimized and evaluated within the same simulation framework. The presented results illustrate the potential for the proposed design to reduce significantly joint compressions and muscle activities in the shoulder complex in the considered patient transfer scenarios. Full article
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Open AccessArticle
Hospital Medical and Nursing Managers’ Perspective on the Mental Stressors of Employees
Int. J. Environ. Res. Public Health 2020, 17(14), 5041; https://doi.org/10.3390/ijerph17145041 - 13 Jul 2020
Cited by 1
Abstract
Working conditions in hospitals are characterized by occupational stressors, which lead to potentially harmful psychosocial stress reactions for medical and nursing staff. Representative surveys showed that almost every second hospital physician or nurse is affected by burnout and that there is a strong [...] Read more.
Working conditions in hospitals are characterized by occupational stressors, which lead to potentially harmful psychosocial stress reactions for medical and nursing staff. Representative surveys showed that almost every second hospital physician or nurse is affected by burnout and that there is a strong association between leadership behavior and employee health. Workplace health promotion programs can only be successful and sustainable if managers support them. However, it is still unclear whether hospital managers are aware of the working conditions and perceive them as an influence on the health of their employees. Therefore, the aim of this qualitative study was to explore the hospital medical and nursing managers’ perspective on the mental stress of their employees. Semi-standardized interviews with 37 chief physicians (CP), senior physicians (SP) and senior nurses (SN) in total were carried out in one German hospital. The interviews were content-analyzed based on the guideline for the mental risk assessment of the ‘Gemeinsame Deutsche Arbeitsschutzstrategie’ (GDA). Most reported work characteristics related to work organization, work task, and social factors. Staff shortage could be identified as an underlying stressor for several other burdens. Social support by managers and among colleagues was mentioned as main resource. The findings indicate that managers strive to reduce the burden on their staff, especially through their personal support. Nevertheless, it seemed that managers need additional resources to counteract stressors. Full article
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Open AccessArticle
Healthcare Workers and Manual Patient Handling: A Pilot Study for Interdisciplinary Training
Int. J. Environ. Res. Public Health 2020, 17(14), 4971; https://doi.org/10.3390/ijerph17144971 - 10 Jul 2020
Abstract
Manual patient handling (MPH) is a major occupational risk in healthcare settings. The aim of this study was to propose an MPH training model involving interdisciplinary aspects. A scheduled training program was performed with 60 healthcare workers (HCWs) from a hospital in Naples, [...] Read more.
Manual patient handling (MPH) is a major occupational risk in healthcare settings. The aim of this study was to propose an MPH training model involving interdisciplinary aspects. A scheduled training program was performed with 60 healthcare workers (HCWs) from a hospital in Naples, Italy, providing training divided into three sections (occupational health—section one; physical therapy—section two; psychosocial section—section three) and lasting six hours. Fifty-two HCWs performed the training session. In section one, a questionnaire about risk perception related to specific working tasks was administered. Section two provided specific exercises for the postural discharge of the anatomical areas most involved in MPH. The last section provided teamwork consolidation through a role-playing exercise. The training program could also be useful for risk assessment itself, as they can examine the perceptions of the specific risk of the various workers and incorrect attitudes and therefore correct any incorrect procedures, reducing exposure to specific risks in the field. This pilot study proposes a training model that explores all aspects related to MPH risk exposure and also underlines the need for standardization of this formative model, which could represent a useful tool for studying the real effectiveness of training in workplaces. Full article
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Open AccessArticle
COVID-19 among Health Workers in Germany and Malaysia
Int. J. Environ. Res. Public Health 2020, 17(13), 4881; https://doi.org/10.3390/ijerph17134881 - 07 Jul 2020
Cited by 4
Abstract
We report on the suspected case reports filed for SARS-CoV-2 infections and COVID-19 illnesses among health and social welfare workers in Germany. In addition, we report about COVID-19 in health workers in Malaysia. Claims for occupational diseases caused by SARS-CoV-2 are recorded separately [...] Read more.
We report on the suspected case reports filed for SARS-CoV-2 infections and COVID-19 illnesses among health and social welfare workers in Germany. In addition, we report about COVID-19 in health workers in Malaysia. Claims for occupational diseases caused by SARS-CoV-2 are recorded separately in a database of the Statutory Accident Insurance and Prevention in the Health and Welfare Services (BGW). This database is analyzed according to its content as of May 22, 2020. In addition, the notifiable cases of SARS-CoV-2 infections from personnel in medical institutions (e.g., clinics and doctor’s office) and social welfare institutions (e.g., nursing homes, shelters and refugee camps) following the German Infection Protection Act are analyzed. The report from Malaysia is based on personal experience and publications of the government. In Germany at present, 4398 suspected case reports for the diagnosis of SARS-CoV-2 infections among health and social workers have been filed. This figure is four times the number of all reported infections normally received per year. The majority of claims, regardless of being a confirmed infection, concerned nurses (n = 6927, 63.9%). The mortality rate for workers infected with SARS-CoV-2 is 0.2% to 0.5%. Doctors are affected by severe illness more frequently than other occupational groups (8.1% vs. 4.1%). In Malaysia, work-related infection of health workers (HW) occurred mainly when COVID-19 was not suspected in patients and no adequate personal protective equipment (PPE) was worn. Although knowledge on the spread of SARS-CoV-2 infections among workers remains limited, the impact appears to be substantial. This is supported by the mortality rate among infected workers. Occupational health check-ups carried out at the present time should be systematically analyzed in order to gain more information on the epidemiology of COVID-19 among HW. Since the supply and use of PPE improved, the infection risk of HW in Malaysia seems to have decreased. Full article
Open AccessArticle
Seeing the Finish Line? Retirement Perceptions and Wellbeing among Social Workers
Int. J. Environ. Res. Public Health 2020, 17(13), 4722; https://doi.org/10.3390/ijerph17134722 - 30 Jun 2020
Abstract
Planning for future health and social services (HSS) workforces must be informed by an understanding of how workers view their work within the context of their life and the challenges they will face across the course of life. There is a range of [...] Read more.
Planning for future health and social services (HSS) workforces must be informed by an understanding of how workers view their work within the context of their life and the challenges they will face across the course of life. There is a range of policies and provisions that states and organisations can adopt to create sustainable careers, support wellbeing at work, and extend working lives where appropriate, but the potential impact of these policies on the make-up of the workforce remains under investigation. This paper makes the case that service planners need to appreciate complex interplay between wellbeing and career decisions when planning the future workforce. It makes use of a recent survey of United Kingdom (UK) social workers (n = 1434) to illustrate this interplay in two ways. First, we present the analysis of how social workers’ perception of retirement and extended working lives are associated with dimensions of Work-Related Quality of Life (WRQL). We find that social workers who agreed that a flexible working policy would encourage them to delay their retirement scored lower on the Home-Work Interface and Control at Work dimensions of WRQL, while social workers who indicated a perception that their employer would not wish them to work beyond a certain age had lower Job and Career Satisfaction scores. Second, we propose a new typology of retirement outlooks using latent class analysis of these attitudinal measures. An 8-class solution is proposed, and we demonstrate the predictive utility of this scheme. Results are discussed in terms of the challenges for ageing Western populations and the usefulness of analysis such as this in estimating the potential uptake and impact of age-friendly policies and provisions. Full article
Open AccessArticle
How Do Hospital Medical and Nursing Managers Perceive Work-Related Strain on Their Employees?
Int. J. Environ. Res. Public Health 2020, 17(13), 4660; https://doi.org/10.3390/ijerph17134660 - 28 Jun 2020
Abstract
Health-oriented supportive leadership behavior is a key factor in reducing work stress and promoting health. Employees in the health sector are subject to a heavy workload, and it has been shown that 40% of them show permanent health problems. A supportive leadership behavior [...] Read more.
Health-oriented supportive leadership behavior is a key factor in reducing work stress and promoting health. Employees in the health sector are subject to a heavy workload, and it has been shown that 40% of them show permanent health problems. A supportive leadership behavior requires the manager’s awareness of the employees’ well-being. However, little is yet known about how medical and nursing managers perceive the well-being of their staff. To explore this issue, we conducted a total of 37 semi-standardized interviews with 37 chief physicians (CPs), senior physicians (SPs), and senior nurses (SNs) in one German hospital. The interviews were content-analyzed based on the definitions of strain of the ‘Federal Institute for Occupational Safety and Health’. Results show that hospital managers are aware of fatigue and further consequences such as deterioration of the team atmosphere, work ethics, treatment quality, and an increased feeling of injustice among employees. Most managers reported sick leaves as a result of psychosomatic complaints due to the permanent overstrain situation at work in the hospital. Results of this qualitative study are discussed in the light of health-oriented management relating to relevant stress models and to findings concerning staff shortages. Full article
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Open AccessArticle
Risk Analysis of Latent Tuberculosis Infection among Health Workers Compared to Employees in Other Sectors
Int. J. Environ. Res. Public Health 2020, 17(13), 4643; https://doi.org/10.3390/ijerph17134643 - 28 Jun 2020
Abstract
Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in [...] Read more.
Latent tuberculosis infection (LTBI) represents a work-related risk for health workers (HWs). Tuberculosis remains the second most common occupational infectious disease among HWs in Germany. Comparative figures on LTBI prevalence in the general population are missing because testing is only carried out in the context of an outbreak situation. The objective of this study is to investigate whether HWs are at greater risk of LTBI than workers in other sectors. This study is based on two samples. The first sample is a database of HWs who were examined by the German Occupational Physicians Network using an interferon-gamma release assay (IGRA). The second sample consists of general employees (non-health workers, non-HWs) from Hamburg who had no professional contact with the health care system. Propensity score matching (PS matching) was performed to ensure better comparability of the groups. The differences in the prevalence of positive test results from IGRAs were examined using univariate and multivariate analyses. After the PS matching of 1:10, 100 test subjects in the non-HW group and 1000 HWs remained to form the analysis collective. The HWs tended to exhibit higher IGRA values than non-HWs. The univariate analysis showed an odds ratio (OR) of 3.86 for the HWs (95% confidence interval (CI): 0.99 to 32.5; p = 0.056) with respect to a positive test result. The multivariate analysis produced an OR of 4.92, (95% CI: 1.3 to 43.7; p = 0.013) for HWs born in Germany. Despite the declining tuberculosis incidence rates in Germany, a comparison with non-exposed professional groups showed that HWs are at greater risk of LTBI. Preventive medical check-ups still seem to be indicated. Full article
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Open AccessArticle
Empowering Health Workers to Protect their Own Health: A Study of Enabling Factors and Barriers to Implementing HealthWISE in Mozambique, South Africa, and Zimbabwe
Int. J. Environ. Res. Public Health 2020, 17(12), 4519; https://doi.org/10.3390/ijerph17124519 - 23 Jun 2020
Cited by 1
Abstract
Ways to address the increasing global health workforce shortage include improving the occupational health and safety of health workers, particularly those in high-risk, low-resource settings. The World Health Organization and International Labour Organization designed HealthWISE, a quality improvement tool to help health workers [...] Read more.
Ways to address the increasing global health workforce shortage include improving the occupational health and safety of health workers, particularly those in high-risk, low-resource settings. The World Health Organization and International Labour Organization designed HealthWISE, a quality improvement tool to help health workers identify workplace hazards to find and apply low-cost solutions. However, its implementation had never been systematically evaluated. We, therefore, studied the implementation of HealthWISE in seven hospitals in three countries: Mozambique, South Africa, and Zimbabwe. Through a multiple-case study and thematic analysis of data collected primarily from focus group discussions and questionnaires, we examined the enabling factors and barriers to the implementation of HealthWISE by applying the integrated Promoting Action on Research Implementation in Health Services (i-PARiHS) framework. Enabling factors included the willingness of workers to engage in the implementation, diverse teams that championed the process, and supportive senior leadership. Barriers included lack of clarity about how to use HealthWISE, insufficient funds, stretched human resources, older buildings, and lack of incident reporting infrastructure. Overall, successful implementation of HealthWISE required dedicated local team members who helped facilitate the process by adapting HealthWISE to the workers’ occupational health and safety (OHS) knowledge and skill levels and the cultures and needs of their hospitals, cutting across all constructs of the i-PARiHS framework. Full article
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Open AccessArticle
The Effects of Multifaceted Ergonomic Interventions on Musculoskeletal Complaints in Intensive Care Units
Int. J. Environ. Res. Public Health 2020, 17(10), 3719; https://doi.org/10.3390/ijerph17103719 - 25 May 2020
Cited by 1
Abstract
Working at intensive care units (ICUs) is considered a risk factor for developing musculoskeletal complaints (MSC). This study was conducted between January 2017 and June 2019 in two ICUs of a university hospital. It was designed as a pre- and post-assessment of the [...] Read more.
Working at intensive care units (ICUs) is considered a risk factor for developing musculoskeletal complaints (MSC). This study was conducted between January 2017 and June 2019 in two ICUs of a university hospital. It was designed as a pre- and post-assessment of the intervention group (IG) (N = 27) compared with a control group (CG) (N = 23) to determine the effects of a multifaceted ergonomics intervention program in reducing MSC. The IG (N: 35) received a multifaceted ergonomic intervention program, which was implemented by an ERGO team over an 18 month period. Four ergonomic interventions were planned as follows: individual level interventions such as training; stretching exercises and motivation meetings; administrative intervention such as a daily 10 min stretching exercises break; engineering interventions such as lifting and usage of auxiliary devices. The CG (N:29) did not receive any intervention. Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) was used to assess MSC in both groups. At the start of the intervention, both groups were similar concerning the number of visits to doctors due to MSC, the number of sick leave days, and total CMDQ scores (p > 0.05 for all). Two factor repeated ANOVA measures were performed for between-groups and within-group analyses. The mean of the initial CMSDQ total scores in both groups increased significantly in the 18th month (p < 0.001). However, the interaction effect of group and time (between and within factors) was not significant (p = 0.992). Work-related MSC is a common occupational health problem among nurses. This study showed that individual-level interventions are not likely to succeed in eliminating manual patient lifting by nurses. Our results suggested that interventions without administrative measures might have limited success Full article
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Open AccessArticle
Prevalence of Muscular Skeletal Disorders among Qualified Dental Assistants
Int. J. Environ. Res. Public Health 2020, 17(10), 3490; https://doi.org/10.3390/ijerph17103490 - 16 May 2020
Cited by 1
Abstract
The occupation of dental assistants (DAs) involves many health risks of the musculoskeletal system due to static and prolonged work, which can lead to musculoskeletal disorders (MSDs). The aim of the study was to investigate the prevalence of MSDs in DAs in Germany. [...] Read more.
The occupation of dental assistants (DAs) involves many health risks of the musculoskeletal system due to static and prolonged work, which can lead to musculoskeletal disorders (MSDs). The aim of the study was to investigate the prevalence of MSDs in DAs in Germany. Methods: For this purpose, an online questionnaire analyzed 406 (401 female participants and 5 male participants, 401w/5m) DAs. It was based on the Nordic Questionnaire (lifetime, 12-month, and seven-day MSDs’ prevalence separated into neck, shoulder, elbow, wrist, upper back, lower back, hip, knee, and ankle), and occupational and sociodemographic questions as well as questions about specific medical conditions. Results: 98.5% of the participants reported complaints of at least one body region in their lives, 97.5% reported at least one complaint in the last 12 months and 86.9% affirmed at least one complaint in the last seven days. For lifetime, 12-month and seven-day prevalence, the neck was the region that was most affected followed by the shoulder, the upper back and the lower back. Conclusion: The prevalence of MSDs among German (female) DAs was very high. The most affected area is the neck, followed by the shoulder, the lower back, and the upper back. It, therefore, seems necessary to devote more attention to ergonomics at the working practice of DAs as well in education and in dental work. Full article
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Open AccessArticle
Workplace Aggression and Burnout in Nursing—The Moderating Role of Follow-Up Counseling
Int. J. Environ. Res. Public Health 2020, 17(9), 3152; https://doi.org/10.3390/ijerph17093152 - 01 May 2020
Abstract
The aim of this study is to obtain a better understanding of the association between the frequency of nurses’ exposure to workplace aggression from patients and their levels of burnout. In particular, we seek to shed light on the role of the availability [...] Read more.
The aim of this study is to obtain a better understanding of the association between the frequency of nurses’ exposure to workplace aggression from patients and their levels of burnout. In particular, we seek to shed light on the role of the availability of follow-up counseling in organizations after critical incidents in mitigating the adverse relationships between physical and verbal aggression and nurses’ burnout. A total of 582 nurses reported how frequently they had experienced physical and verbal aggression from patients in the last 12 months and whether they had the opportunity to receive follow-up counseling in their organization. In addition, nurses rated the extent to which they experienced each of the three dimensions of burnout (i.e., emotional exhaustion, depersonalization, and personal accomplishment). The results showed that both physical and verbal aggression were substantially related to the burnout dimensions. Furthermore, we found that the availability of follow-up counseling in organizations attenuated the relationships between physical aggression and all three burnout dimensions. While we found that the availability of follow-up counseling moderated the relationship between verbal aggression depersonalization, the moderating effects were not significant for emotional exhaustion and personal accomplishment. The findings indicate that the availability of follow-up counseling might help minimize the adverse impact of exposure to aggression from patients on nurses’ mental health. Full article
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Open AccessArticle
Burnout in Gastroenterology Unit Nurses
Int. J. Environ. Res. Public Health 2020, 17(9), 3115; https://doi.org/10.3390/ijerph17093115 - 30 Apr 2020
Abstract
(1) Background: Burnout syndrome is a significant problem in nursing professionals but may be dependent on the type of care that they provide. The objectives of our study are to identify and explore risk factors associated with burnout among gastroenterology nurses. Identifying the [...] Read more.
(1) Background: Burnout syndrome is a significant problem in nursing professionals but may be dependent on the type of care that they provide. The objectives of our study are to identify and explore risk factors associated with burnout among gastroenterology nurses. Identifying the risk factors involved is an essential element for prevention programs. (2) Methods: We performed an analytical descriptive cross-sectional study. Burnout was measured using an adapted version of the Maslach Burnout Inventory (MBI) questionnaire. Strength of association between burnout scores and risk factors was calculated using Fischer’s exact test; (3) Results: Our subjects were all female nurses. Work-related risk factors, such as an increased workload and a large number of night shifts have been associated with burnout in nurses, together with a lack of physical activity. We found no significant associations with sociodemographic factors; (4) Conclusions: Gastroenterology nurses are affected by high levels of emotional exhaustion. Work-related risk factors and a sedentary lifestyle result in a greater prevalence of burnout. In this category of healthcare workers, preventive actions are needed. The physical activity outside work could be a protective factor for burnout, and an exercise program could contribute to the effectiveness of well-established burnout intervention programs. Full article
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Open AccessArticle
Commuting Accidents among Non-Physician Staff of a Large University Hospital Center from 2012 to 2016: A Case-Control Study
Int. J. Environ. Res. Public Health 2020, 17(9), 2982; https://doi.org/10.3390/ijerph17092982 - 25 Apr 2020
Abstract
Road risks (commuting and on-duty accidents) have been responsible for 44% of work-related fatalities compensated by the French system of Social Security in 2012 and still represented 37% in 2018. Our objective was to assess risk factors for commuting accidents among the non-physician [...] Read more.
Road risks (commuting and on-duty accidents) have been responsible for 44% of work-related fatalities compensated by the French system of Social Security in 2012 and still represented 37% in 2018. Our objective was to assess risk factors for commuting accidents among the non-physician staff in a French university hospital. We conducted a case-control study of commuting accidents from 2012 to 2016. Cases were identified and controls were randomly selected from the hospital’s personnel file with matches by year of the accident, gender and age. Risk factors were assessed using conditional logistic regression analysis. An increased risk was observed for 2 × 8 hour shifts, crude OR = 1.40 (95% CI = 1.05–1.86) compared to daytime schedules, but not confirmed in the multiple model. Being a duty officer and not working the day before the accident were associated with increased risk of accidents with adjusted OR = 1.9 (95% CI = 1.1; 3.3) and OR = 1.5, (95% CI = 1.1; 2.1), respectively. The risk increased as the distance between home and work increased, such as adjusted OR = 2.2 (95% CI = 1.4; 3.4) for a distance of >3.6 to 9 km, OR = 2.6, (95% CI = 1.7; 4.0) for a distance of >9 km to 19 km, and OR = 4.2, (95% CI = 2.8; 6.2) for >19 km vs. <3.6 km. The distance between home and work, not working the day before the accident, and certain categories of personnel were related to commuting accidents. Full article
Open AccessArticle
Analysis of Job-Related Demands and Resources in Ambulatory Youth Welfare Services: A Qualitative and Quantitative Approach
Int. J. Environ. Res. Public Health 2020, 17(8), 2941; https://doi.org/10.3390/ijerph17082941 - 24 Apr 2020
Abstract
In this study, we investigated health-relevant job characteristics of social workers in ambulatory youth welfare services, combining qualitative and quantitative methods. Based on a systematic literature review, expert workshops, and focus group discussions with 9 experts of the target group, we identified target [...] Read more.
In this study, we investigated health-relevant job characteristics of social workers in ambulatory youth welfare services, combining qualitative and quantitative methods. Based on a systematic literature review, expert workshops, and focus group discussions with 9 experts of the target group, we identified target group-specific job demands and job resources, which we compiled into a questionnaire using content-valid scales. The target group-specific survey tool comprises 9 scales for assessing job demands and 10 scales for assessing job resources. Analyses of data from 209 social workers demonstrated desirable psychometric properties and substantial correlations of the scales with coping behaviours and indicators of employee well-being. The scales for assessing job demands were negatively related to psychological well-being and job satisfaction and positively related to burnout and depressiveness. The scales for assessing job resources showed positive correlations with indicators of positive well-being and negative correlations with indicators of impaired well-being. Regression analyses revealed that job resources explained a higher amount of variance in the positive well-being indicators compared to job demands. The study identified a broad range of health-relevant job characteristics for social workers in ambulatory youth welfare. Applying the target group-specific survey tool allows organisations to derive suitable implications for the design of health promotion programs. Full article
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Open AccessArticle
Beyond Mistreatment at the Relationship Level: Abusive Supervision and Illegitimate Tasks
Int. J. Environ. Res. Public Health 2020, 17(8), 2722; https://doi.org/10.3390/ijerph17082722 - 15 Apr 2020
Cited by 2
Abstract
According to the concept of abusive supervision, abusive supervisors display hostility towards their employees by humiliating and ridiculing them, giving them the silent treatment, and breaking promises. In this study, we argue that abusive supervision may not be limited to mistreatment at the [...] Read more.
According to the concept of abusive supervision, abusive supervisors display hostility towards their employees by humiliating and ridiculing them, giving them the silent treatment, and breaking promises. In this study, we argue that abusive supervision may not be limited to mistreatment at the relationship level and that the abuse is likely to extend to employees’ work tasks. Drawing upon the notion that supervisors play a key role in assigning work tasks to employees, we propose that abusive supervisors may display disrespect and devaluation towards their employees through assigning illegitimate (i.e., unnecessary and unreasonable) tasks. Survey data were obtained from 268 healthcare and social services workers. The results showed that abusive supervision was strongly and positively related to illegitimate tasks. Moreover, we found that the relationship between abusive supervision and unreasonable tasks was stronger for nonsupervisory employees at the lowest hierarchical level than for supervisory employees at higher hierarchical levels. The findings indicate that abusive supervision may go beyond relatively overt forms of hostility at the relationship level. Task-level stressors may be an important additional source of stress for employees with abusive supervisors that should be considered to fully understand the devastating effects of abusive supervision on employee functioning and well-being. Full article
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Open AccessArticle
How Perceived Quality of Care and Job Satisfaction Are Associated with Intention to Leave the Profession in Young Nurses and Physicians
Int. J. Environ. Res. Public Health 2020, 17(8), 2714; https://doi.org/10.3390/ijerph17082714 - 15 Apr 2020
Abstract
German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was [...] Read more.
German hospitals are now confronted with major challenges from both shortages and fluctuations in the numbers of physicians and nurses. This makes it even more important that physicians and nurses do not prematurely leave patient care. The objective of the present study was to improve our understanding of the factors that trigger intentions to leave the profession. For this purpose, data from 1060 young physicians and nurses in hospital care were analysed. Intentions to leave the profession was assessed with the Copenhagen Psychosocial Questionnaire (COPSOQ). In the first step, the association was determined between intention to leave the profession and the factors of perceived quality of care and job satisfaction. In a second step, a mediation analysis was performed to determine the effect of perceived quality of care after correction for the possible mediator of job satisfaction. There were statistically significant negative associations between perceived quality of care and intention to leave the profession (beta: −2.9, 95% CI: −4.48–−1.39) and job satisfaction and intention to leave the profession (beta: −0.5, 95% CI: −0.64–−0.44). The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions. Full article
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Open AccessArticle
Sexually Harassing Behaviors from Patients or Clients and Care Workers’ Mental Health: Development and Validation of a Measure
Int. J. Environ. Res. Public Health 2020, 17(7), 2570; https://doi.org/10.3390/ijerph17072570 - 09 Apr 2020
Abstract
Although evidence reveals severe effects of sexual harassment on care workers’ mental health, there is a scarcity of studies that investigate care workers’ experiences of sexually inappropriate behavior from patients or clients. One reason for this lack of research is that validated measures [...] Read more.
Although evidence reveals severe effects of sexual harassment on care workers’ mental health, there is a scarcity of studies that investigate care workers’ experiences of sexually inappropriate behavior from patients or clients. One reason for this lack of research is that validated measures that assess different types of sexual harassment experienced by employees working with patients or clients are lacking. In this study, we seek to establish a conceptual framework for investigating extraorganizational sexual harassment in healthcare work. Based on this theoretical framework, we developed and validated a measure for assessing sexually harassing behaviors from patients or clients. Data were gathered from heterogeneous samples of employees working in a variety of settings in healthcare. To evaluate the factorial structure of the measure, we conducted exploratory factor analysis (EFA) using a calibration sample (N = 179) and confirmatory factor analysis (CFA) using a cross-validation sample (N = 305). The construct validity of the measure was demonstrated by investigating relationships with indicators of care workers’ mental health. EFA revealed three factors, namely, nonverbal, verbal, and physical acts of sexual harassment. Examination of the measure comprising 14 items revealed acceptable internal consistencies and substantial correlations with indicators of care workers’ mental health. This study provides a useful and sound measure for assessing sexual harassment from patients or clients and paves the way for the development of a comprehensive theoretical framework for the assessment of sexual harassment. Furthermore, it facilitates future investigations of risk factors for sexual harassment and protective factors helping healthcare workers cope with sexual harassment from patients or clients. Full article
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Open AccessArticle
Discrimination in In-Patient Geriatric Care: A Qualitative Study on the Experiences of Employees with a Turkish Migration Background
Int. J. Environ. Res. Public Health 2020, 17(7), 2205; https://doi.org/10.3390/ijerph17072205 - 25 Mar 2020
Abstract
In most studies, nurses with a migrant background report experiences of interpersonal discrimination. These often occur in interaction with those in need of care. However, in Germany this topic has remained largely unexplored, although a large proportion of the employees in geriatric care [...] Read more.
In most studies, nurses with a migrant background report experiences of interpersonal discrimination. These often occur in interaction with those in need of care. However, in Germany this topic has remained largely unexplored, although a large proportion of the employees in geriatric care have a migration background. The aim of the study was to investigate whether care workers with Turkish migration background in in-patient geriatric care are exposed to discrimination from residents. Furthermore, the reasons for discrimination, handling of discrimination and recommendations for in-patient geriatric facilities to avoid/reduce discrimination were examined. In a qualitative, explorative study, 24 employees with Turkish migrant background working in in-patient geriatric care were interviewed in 2017. The semi-structured interviews were evaluated using a qualitative content analysis according to Mayring. The majority (N = 20) experienced or observed discrimination. This occurred mainly in the form of xenophobic insults and rejections. They perceived visible traits (dark hair and eye color, clothing) as potential reasons. To deal with the discrimination, most of them temporarily left the scene. They recommend that institutions should primarily make the diversity of the workforce transparent to avoid/reduce discrimination. More research is needed about discrimination against care workers with migration background because discrimination may have serious psychological effects that impact employee retention and the quality of care. Full article
Open AccessArticle
The Extent of Psychosocial Distress among Immigrant and Non-Immigrant Homecare Nurses—A Comparative cross Sectional Survey
Int. J. Environ. Res. Public Health 2020, 17(5), 1635; https://doi.org/10.3390/ijerph17051635 - 03 Mar 2020
Abstract
In times of demographic change, most developed countries are increasingly looking to cover the growing domestic demand for healthcare by hiring nurses from abroad. The evidence concerning the health of immigrant care workers is inconsistent since studies report that it is either better [...] Read more.
In times of demographic change, most developed countries are increasingly looking to cover the growing domestic demand for healthcare by hiring nurses from abroad. The evidence concerning the health of immigrant care workers is inconsistent since studies report that it is either better or more impaired than that of their non-immigrant counterparts. This study compared the extent of occupational psychosocial stressors and resources affecting immigrant and non-immigrant homecare nurses. The cross-sectional survey was conducted in the homecare nursing service sector in Hamburg. Psychosocial distress, depressive symptomatology, generalized anxiety, somatic symptom burdens, homecare-specific qualitative stressors, as well as resources, have been measured using a standardized questionnaire. There was no significant difference in the extent of psychosocial distress experienced by immigrant and non-immigrant homecare nurses. Somatic symptom burdens most strongly predicted nurses’ psychosocial distress, in general. For immigrant nurses, greater influence and freedom at work, as well as fixed-term employment, was related to increased levels of distress, while age, working full time, and working overtime predicted distress in non-immigrant nurses. A functioning relationship with colleagues and superiors had a declining effect on immigrant nurses’ psychosocial distress, while shift work arrangements benefitted non-immigrant nurses. Even though the extent of psychosocial distress experienced by immigrant and non-immigrant nurses did not significantly differ, the nurse’s individual explanatory model of psychosocial health should be considered in every occupational and political context. Full article
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Open AccessArticle
Validation of the Brief Thai Version of the Work-Related Quality of Life Scale (Brief THWRQLS)
Int. J. Environ. Res. Public Health 2020, 17(5), 1503; https://doi.org/10.3390/ijerph17051503 - 26 Feb 2020
Abstract
The Work-Related Quality of Life Scale (WRQLS) was developed by Van Laar et al. The Thai version was developed and could be completed in 13.4 min on average with some items having a factor loading of less than 0.4. The aims of this [...] Read more.
The Work-Related Quality of Life Scale (WRQLS) was developed by Van Laar et al. The Thai version was developed and could be completed in 13.4 min on average with some items having a factor loading of less than 0.4. The aims of this study were (a) to develop a brief Thai version of the WRQLS (brief THWRQLS), and (b) to assess its validity and reliability. A descriptive correlation study was performed with the components of THWRQLS selected based on statistical and judgmental criteria. The statistical criteria were developed using secondary data from 320 physicians identifying discrimination, internal consistency and exploratory factor analysis (EFA). The judgmental criteria included content validity and agreement by five experts. The web-based brief THWRQLS was then used by 250 health personnel, and confirmatory factor analysis (CFA) was conducted and internal consistency assessed. The brief THWRQLS consisted of seven dimensions, encompassing 25 of the original 32 items. The CFA revealed that most of the standardized factor loadings were greater than 0.5. The χ2goodness of fit was 268.772 (p < 0.01), the comparative fit index was 0.971, the root mean square error of approximation was 0.039, and the standardized root mean square residual was 0.049. The Cronbach’s alpha coefficient of the scale was 0.94, and almost all dimensions were greater than 0.7 except for that of “stress at work,” which was 0.53. In conclusion, the brief THWRQLS appeared to be valid, and the reliability was acceptable, except in the dimension of “stress at work.” Full article
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Open AccessArticle
Stress of Dialysis Nurses—Analyzing the Buffering Role of Influence at Work and Feedback
Int. J. Environ. Res. Public Health 2020, 17(3), 802; https://doi.org/10.3390/ijerph17030802 - 28 Jan 2020
Abstract
Dialysis nurses face complex and demanding working conditions. Due to demographic changes, the number of dialysis patients has increased, while the number of skilled personnel is expected to decrease, leading to tremendous increases in quantitative demands in the near future. Against the background [...] Read more.
Dialysis nurses face complex and demanding working conditions. Due to demographic changes, the number of dialysis patients has increased, while the number of skilled personnel is expected to decrease, leading to tremendous increases in quantitative demands in the near future. Against the background of increasing workload, focusing on the provision of job resources is considered a promising approach because resources can buffer the negative effects of job demands. The aim of this study is to investigate whether different job resources—in particular influence at work and feedback—play a buffering role in the relationship between job demands and employee well-being. The study used a cross-sectional paper–pencil survey design. Data were collected from 951 dialysis nurses working in dialysis facilities in Germany between October 2010 and March 2012 using validated measures of quantitative job demands, job-related resources (influence at work and feedback), and cognitive stress symptoms. To test the moderating role of resources, we applied hierarchical regression analyses. The findings indicate that feedback buffers the relationship between quantitative demands and well-being; that is, the positive relationship between quantitative demands and cognitive stress symptoms was weaker when feedback was high. However, we found no buffering role of influence at work. The results suggest that feedback is a promising resource that may buffer the negative impact of quantitative demands on well-being of dialysis nurses. The findings offer new approaches for training nurses and implementing a feedback culture. Full article
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Open AccessArticle
(Un)bounded Social Work?—Analysis of Working Conditions in Refugee and Homeless Aid in Relation to Perceived Job Stress and Job Satisfaction
Int. J. Environ. Res. Public Health 2020, 17(2), 601; https://doi.org/10.3390/ijerph17020601 - 17 Jan 2020
Abstract
Little is known about working conditions of social workers providing help in homeless and refugee aid. Therefore, the present study examined their work-related demands, job and personal resources as well as workplace violence, domain-specific demands, and gender-related differences. Job demands and resources were [...] Read more.
Little is known about working conditions of social workers providing help in homeless and refugee aid. Therefore, the present study examined their work-related demands, job and personal resources as well as workplace violence, domain-specific demands, and gender-related differences. Job demands and resources were analyzed with regard to their association with job stress and job satisfaction. Two hundred and fifty-three social workers (69.2% female, 30.8% male) from four federal states in Germany (Berlin, Hamburg, Schleswig-Holstein, and Mecklenburg-Western Pomerania) took part in the cross-sectional quantitative online survey that included validated scales and exploratory items especially developed for the target group. Multiple regression analysis showed that resilience as a personal resource was a significant negative predictor of perceived job stress. Emotional demands were positively related with perceived job stress. Meaning of work and social support were strongly associated with job satisfaction. Language and bureaucratic barriers as well as being affected by clients’ experiences were the domain-specific demands named most often. The study offers insights into the work-related demands and resources and their respective impact on perceived job stress and job satisfaction experienced by social workers in refugee and homeless aid. In order to ensure health and safety for this occupational group, health promotion measures focusing on structural aspects are recommended. Full article
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Open AccessArticle
Surgical Smoke—Hazard Perceptions and Protective Measures in German Operating Rooms
Int. J. Environ. Res. Public Health 2020, 17(2), 515; https://doi.org/10.3390/ijerph17020515 - 14 Jan 2020
Cited by 4
Abstract
(1) Background: Hazardous substances in surgical smoke that is generated during laser or electrosurgery pose a potential health hazard. In Germany, the Technical Rules for Hazardous Substances (TRGS 525) have included recommendations for appropriate protective measures since 2014. Up to now, no empirical [...] Read more.
(1) Background: Hazardous substances in surgical smoke that is generated during laser or electrosurgery pose a potential health hazard. In Germany, the Technical Rules for Hazardous Substances (TRGS 525) have included recommendations for appropriate protective measures since 2014. Up to now, no empirical data has been available on the extent to which recommendations have been implemented in practice. (2) Methods: In 2018, 7089 surgeons in hospitals and outpatient practices were invited by email to participate in an online survey. In addition, 219 technical assistants were interviewed. The questionnaire dealt with knowledge of, and attitudes toward, the hazard potential of surgical smoke, as well as the availability and actual use of protective measures. Furthermore, manufacturers and distributors of smoke extraction devices were asked to give their assessment of the development of prevention in recent years. (3) Results: The survey response rate was 5% (surgeons) and 65% (technical assistant staff). Half of all surgeons assumed that there were high health hazards of surgical smoke without taking protective measures. Operating room nurses were more often concerned (88%). Only a few felt properly informed about the topic. The TRGS recommendations had been read by a minority of the respondents. In total, 52% of hospital respondents and 65% of the respondents in outpatient facilities reported any type of special suction system to capture surgical smoke. One-fifth of respondents from hospitals reported that technical measures had improved since the introduction of the TRGS 525. Fifty-one percent of the surgeons in hospitals and 70% of the surgeons in outpatient facilities “mostly” or “always” paid attention to avoiding surgical smoke. The most important reason for non-compliance with recommendations was a lack of problem awareness or thoughtlessness. Twelve industrial interviewees who assessed the situation and the development of prevention in practice largely confirmed the prevention gaps observed; only slight developments were observed in recent years. (4) Conclusions: The low response rate among surgeons and the survey results both indicate a major lack of interest and knowledge. Among other measures, team interventions with advanced training are needed in the future. Full article
Open AccessArticle
Cost-Effectiveness Analysis of Direct-Acting Antiviral Agents for Occupational Hepatitis C Infections in Germany
Int. J. Environ. Res. Public Health 2020, 17(2), 440; https://doi.org/10.3390/ijerph17020440 - 09 Jan 2020
Abstract
Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel [...] Read more.
Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs. Full article
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Open AccessArticle
Culture of Blame—An Ongoing Burden for Doctors and Patient Safety
Int. J. Environ. Res. Public Health 2019, 16(23), 4826; https://doi.org/10.3390/ijerph16234826 - 01 Dec 2019
Cited by 1
Abstract
Introduction: Every procedure in healthcare carries a certain degree of inherent unsafety resulting from problems in practice, which might lead to a healthcare adverse event (HAE). It is very important, and even mandatory, to report HAE. The point of HAE reporting is not [...] Read more.
Introduction: Every procedure in healthcare carries a certain degree of inherent unsafety resulting from problems in practice, which might lead to a healthcare adverse event (HAE). It is very important, and even mandatory, to report HAE. The point of HAE reporting is not to blame the person, but to learn from the HAE in order to prevent future HAEs. Study question: Our aim was to examine the prevalence and the impact of culture of blame on health workers’ health. Methods: A cross-sectional study on healthcare workers at two Croatian hospitals was conducted using the Hospital Survey on Patient Safety Culture (PSC). Results: The majority of PSC dimensions in both hospitals were high. Among the dimensions, Hospital Handoffs and Transitions and Overall Perceptions of Safety had the highest values. The Nonpunitive Response to Error dimension had low values, indicating the ongoing culture of blame. The Staffing dimension had low values, indicating the ongoing shortage of doctors and nurses. Discussion: We found inconsistencies between a single-item measure and PSC dimensions. It was expected that Frequency of Events Reported (PSC dimension) relates to Number of Events Reported (single-item measure). However, in our study, the relations between these pairs of measures were different between hospitals. Our results indicate the ongoing culture of blame. Healthcare workers do not report HAE because they fear they will be punished by management or by law. Full article
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Open AccessArticle
To Be or Not to Be Vaccinated? The Ethical Aspects of Influenza Vaccination among Healthcare Workers
Int. J. Environ. Res. Public Health 2019, 16(20), 3981; https://doi.org/10.3390/ijerph16203981 - 18 Oct 2019
Cited by 1
Abstract
Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. [...] Read more.
Influenza is a highly contagious airborne disease with a significant morbidity and mortality burden. Seasonal influenza (SI) vaccination has been recommended for healthcare workers (HCWs) for many years. Despite many efforts to encourage HCWs to be immunized against influenza, vaccination uptake remains suboptimal. Sometimes there is a significant sign of improvement, only if numerous measures are taken. Is ‘the evidence’ and ‘rationale’ sufficient enough to support mandatory influenza vaccination policies? Most voluntary policies to increase vaccination rates among HCWs have not been very effective. How to close the gap between desired and current vaccination rates? Whether (semi)mandatory policies are justified is an ethical issue. By means of a MEDLINE search, we synthesized the most relevant publications to try to answer these questions. Neither the ‘clinical’ Hippocratic ethics (the Georgetown Mantra: autonomy, beneficence, non-maleficence, and justice), nor the ‘public health’ ethics frameworks resolve the question completely. Therefore, recently the ‘components of justice’ framework was added to the ethical debate. Most options to increase the uptake arouse little ethical controversy, except mandatory policies. The success of vaccination will largely depend upon the way the ethical challenges like professional duty and ethics (deontology), self-determination, vaccine hesitance, and refusal (‘conscientious objector’) are dealt with. Full article
Open AccessArticle
Quality of Life and Work Ability among Healthcare Personnel with Chronic Viral Hepatitis. Evaluation of the Inpatient Rehabilitation Program of the Wartenberg Clinic
Int. J. Environ. Res. Public Health 2019, 16(20), 3874; https://doi.org/10.3390/ijerph16203874 - 12 Oct 2019
Cited by 1
Abstract
The aim of this study was to research the impact of inpatient rehabilitation on work ability and health-related quality of life factors for healthcare personnel (HP) with chronic hepatitis B and C virus (HBV and HCV) infection. A prospective evaluation study with three [...] Read more.
The aim of this study was to research the impact of inpatient rehabilitation on work ability and health-related quality of life factors for healthcare personnel (HP) with chronic hepatitis B and C virus (HBV and HCV) infection. A prospective evaluation study with three data collection times without an external control group was conducted. HP (n = 163) with an occupational acquired chronic hepatitis B/C infection who participated in an inpatient rehabilitation program were surveyed. Information was collected on work ability (WAI—Work Ability Index), quality of life (SF-36—Short Form-36 Health Survey), and anxiety and depression-related symptoms (HADS-D—Hospital Anxiety and Depression Scale). The majority of participants had HCV infection. Work ability was poor, improved significantly until the end of treatment, and remained at a moderate level six months later. The SF-36 showed no change in physical health over the study period, the results regarding mental health were in the average range with a significant improvement directly after intervention. The HADS-D results indicate noteworthy anxiety and depression symptoms during the study period. The inpatient rehabilitation program proved to be effective in the short term regarding mental health (SF-36) and WAI. To ensure long lasting positive results, services aimed at enhancing physical and mental health should be provided as early as possible and on a recurring basis. Full article
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Open AccessArticle
Radiation Dose to the Eye Lens through Radiological Imaging Procedures at the Surgical Workplace during Trauma Surgery
Int. J. Environ. Res. Public Health 2019, 16(20), 3850; https://doi.org/10.3390/ijerph16203850 - 11 Oct 2019
Abstract
Background: Due to the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year since 2018, the prospective investigation of the estimated dose of the eye lens by radiological imaging procedures at the surgical [...] Read more.
Background: Due to the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year since 2018, the prospective investigation of the estimated dose of the eye lens by radiological imaging procedures at the surgical site during trauma surgery in the daily work process was carried out. This was also necessary because, as experience shows, with changes in surgical techniques, there are also changes in the use of radiological procedures, and thus an up-to-date inventory can provide valuable information for the assessment of occupationally induced radiation exposure of surgical personnel under the current conditions. Methods: The eye lens radiation exposure was measured over three months for five trauma surgeons, four hand surgeons and four surgical assistants with personalized LPS-TLD-TD 07 partial body dosimeters Hp (0.07). A reference dosimeter was deposited at the surgery changing room. The dosimeters were sent to the LPS (Landesanstalt für Personendosimetrie und Strahlenschutzausbildung) measuring institute (National Institute for Personal Dosimetry and Radiation Protection Training, Berlin) for evaluation after 3 months. The duration of the operation, occupation (assistant, surgeon, etc.), type of surgery (procedure, diagnosis), designation of the X-ray unit, total duration of radiation exposure per operation and dose area product per operation were recorded. Results: Both the evaluation of the dosimeters by the trauma surgeons and the evaluation of the dosimeters by the hand surgeons and the surgical assistants revealed no significant radiation exposure of the eye lens in comparison to the respective measured reference dosimeters. Conclusions: Despite the drastic reduction of the eye lens dose limit from 150 mSv per year to 20 mSv per year, the limit for orthopedic, trauma and hand surgery operations is well below the limit in this setting. Full article
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Open AccessArticle
MRSA Point Prevalence among Health Care Workers in German Rehabilitation Centers: A Multi-Center, Cross-Sectional Study in a Non-Outbreak Setting
Int. J. Environ. Res. Public Health 2019, 16(9), 1660; https://doi.org/10.3390/ijerph16091660 - 13 May 2019
Abstract
People working in health care services have an increased risk of being infected with methicillin-resistant Staphylococcus aureus (MRSA), though little is known about the prevalence in rehabilitation centers. This cross-sectional study investigated the MRSA prevalence in employees from different rehabilitation centers and aimed [...] Read more.
People working in health care services have an increased risk of being infected with methicillin-resistant Staphylococcus aureus (MRSA), though little is known about the prevalence in rehabilitation centers. This cross-sectional study investigated the MRSA prevalence in employees from different rehabilitation centers and aimed to identify risk factors for MRSA transmission. We invited all staff (i.e., with and without patient contact from 22 participating rehabilitation centers; n = 2499) to participate. Study participation included a questionnaire on personal characteristics, lifestyle, personal and occupational risk factors for MRSA and nasal swabs taken by the study team. In total, 1005 persons participated in the study (response: 40.2%). Only four participants carried MRSA (0.40 (95% CI 0.00–1.00) per 100). MRSA carriage did not seem to be occupationally related, as it was found in different occupations with and without direct contact with MRSA patients, as well as in different clinics with different indications and patient clientele. We could not find a clear association between MRSA carriage and potential risk factors due to the low number of cases found. Genotyping revealed the spa types t032 (Barnim epidemic strain) and t1223. Our results suggest a low point prevalence of nasal MRSA colonization in a non-outbreak setting in employees from rehabilitation centers. Full article

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Open AccessReview
Anti-X Apron Wearing and Musculoskeletal Problems Among Healthcare Workers: A Systematic Scoping Review
Int. J. Environ. Res. Public Health 2020, 17(16), 5877; https://doi.org/10.3390/ijerph17165877 - 13 Aug 2020
Abstract
Interventional radiology activities and other medical practices using ionising radiation have become increasingly prevalent. In this context, the use of anti-X aprons, in association with awkward postures and non-ergonomic working conditions, might cause the onset of musculoskeletal disorders (MSDs). This research aims to [...] Read more.
Interventional radiology activities and other medical practices using ionising radiation have become increasingly prevalent. In this context, the use of anti-X aprons, in association with awkward postures and non-ergonomic working conditions, might cause the onset of musculoskeletal disorders (MSDs). This research aims to evaluate the evidence about the correlation between wearing anti-X aprons and work-related MSDs. A systematic scoping review of articles published between 1990 and 2020 was conducted by searching the PubMed, Scopus, Embase, and Web of Science databases. Twelve cross-sectional studies, conducted among interventional physicians, nurses, and technicians, were finally included. Five studies primarily investigated the association between use of anti-X aprons and MSDs, showing that a higher prevalence of disorders was not always associated with the use of protective aprons. No studies investigated the impact of anti-X aprons on fitness for work assessment, particularly in subjects with MSDs. There is no complete agreement about the correlation between anti-X apron-wearing and the occurrence of MSDs, although the possible discomfort of workers using anti-X aprons appears more evident. Further studies are needed to objectify the role of these protective devices in the genesis of MSDs and to offer specific ergonomic solutions for healthcare workers. Full article
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Open AccessReview
Intervertebral Disc Disease of the Lumbar Spine in Health Personnel with Occupational Exposure to Patient Handling—A Systematic Literature Review and Meta-Analysis
Int. J. Environ. Res. Public Health 2020, 17(13), 4832; https://doi.org/10.3390/ijerph17134832 - 04 Jul 2020
Abstract
Lifting or carrying loads or working while the trunk is in a bent position are well established risk factors for the development of disc disease of the lumbar spine (LDD). Patient handling is associated with certain hazardous activities, which can result in exposure [...] Read more.
Lifting or carrying loads or working while the trunk is in a bent position are well established risk factors for the development of disc disease of the lumbar spine (LDD). Patient handling is associated with certain hazardous activities, which can result in exposure to heavy loads and high pressure for the discs of the lumbar spine of the nurses performing these tasks. The purpose of this review was to examine the occurrence of work-related LDD among health personnel (HP) with occupational exposure to patient handling activities in comparison to un-exposed workers. A systematic literature search was conducted using the following databases: PubMed, CINAHL, Scopus, and Web of Science. A meta-analysis of odds ratios (OR) was conducted by stratifying for various factors. Five studies reported a higher prevalence for LDD among nurses and geriatric nurses (11.3–96.3%) compared to all controls (3.78–76.47%). Results of the meta-analysis showed a significantly increased OR for LDD among HP compared to all controls (OR 2.45; 95% confidence interval (CI) 1.41, 4.26). In particular, the results of this review suggest that nurses have a higher probability of developing disc herniation than office workers. Full article
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Open AccessReview
Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review
Int. J. Environ. Res. Public Health 2020, 17(12), 4331; https://doi.org/10.3390/ijerph17124331 - 17 Jun 2020
Abstract
The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in [...] Read more.
The occupational health literature has established that sex and gender are associated with all dimensions of the workplace. Sex and/or gender (sex/gender) factors play an important role in shaping the experiences, exposures, and health outcomes of male and female healthcare providers working in war and conflict settings. This study aims to (1) assess how sex/gender is considered in the occupational health literature on healthcare workers in conflict settings, and (2) identify the gaps in incorporating sex/gender concepts in this literature. A scoping review was carried out and nine electronic databases were searched using a comprehensive search strategy. Two reviewers screened the titles/abstracts and full-texts of the studies using specific inclusion and exclusion criteria. Key information was extracted from the studies and four themes were identified. Of 7679 identified records, 47 were included for final review. The findings underlined the harsh working conditions of healthcare workers practicing in conflict zones and showed sex/gender similarities and differences in experiences, exposures and health outcomes. This review revealed a dearth of articles with adequate consideration of sex/gender in the study design. Sex/gender-sensitive research in occupational health is necessary to develop effective occupational health and safety policies to protect men and women healthcare workers in conflict settings. Full article
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Open AccessReview
Prevention of Musculoskeletal Diseases and Pain among Dental Professionals through Ergonomic Interventions: A Systematic Literature Review
Int. J. Environ. Res. Public Health 2020, 17(10), 3482; https://doi.org/10.3390/ijerph17103482 - 16 May 2020
Cited by 4
Abstract
Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus, the objective of this review was to summarize the evidence of ergonomic interventions for the prevention of MSDs among [...] Read more.
Musculoskeletal diseases and pain (MSDs) are prevalent among dental professionals. They cause a growing inability to work and premature leaving of the occupation. Thus, the objective of this review was to summarize the evidence of ergonomic interventions for the prevention of MSDs among dental professionals. This review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The literature search was carried out in May 2018, with an update in April 2019. Scientific databases such as MEDLINE, CINAHL, PubMed and Web of Science as well as reference lists of the included studies were used. Relevant data were extracted from the studies and summarized. The quality assessment was performed using a validated standardized instrument. Eleven studies were included in this review, of which four are of high quality. Eight studies focused on setting prevention strategies. Of those, in five studies, magnification loupes or prismatic spectacles were the subject of ergonomic interventions. Further subjects were the dental chair (n = 2) and dental instruments (n = 1). Three studies evaluated ergonomic training. In all studies, the ergonomic interventions had positive effects on the study outcome. Several ergonomic interventions to prevent MSDs among dental professionals were found to exert a positive effect on the prevalence of MSDs or working posture. This systematic review adds current evidence for the use of prismatic spectacles in order to prevent MSDs among dental professionals. Further intervention studies about the role of ergonomics for the prevention of MSDs among dental professionals are warranted. Full article
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Open AccessReview
Occupational Infection Risk with Multidrug-Resistant Organisms in Health Personnel—A Systematic Review
Int. J. Environ. Res. Public Health 2019, 16(11), 1983; https://doi.org/10.3390/ijerph16111983 - 04 Jun 2019
Cited by 1
Abstract
The increase in multi-drug-resistant organisms (MDROs) in the last years has become a public health problem. MDROs are partially responsible for numerous nosocomial infections, extended hospital stays, high costs, and high mortality. In addition to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), [...] Read more.
The increase in multi-drug-resistant organisms (MDROs) in the last years has become a public health problem. MDROs are partially responsible for numerous nosocomial infections, extended hospital stays, high costs, and high mortality. In addition to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), Gram-negative bacteria are also a key area of focus. The knowledge of MDROs among the medical staff in the occupational context is limited, with the exception of MRSA. Therefore, a systematic review was carried out to determine the occupational risk for employees posed by MDROs. The search included studies from the year 2000 onwards among personnel who had contact with MDROs. A total of 22 primarily cross-sectional studies in hospital or geriatric care settings were found, with large differences regarding number of participants, examination method, inclusion of a control group, and study quality. The most frequently examined pathogens were extended-spectrum ß-lactamase (ESBL)-producing bacteria with a prevalence of 2.6–48.5%, VRE (0–9.6%), and MRSA (0.9–14.5%). There are only few qualitatively good studies available on MDROs’ risk infection for employees in the health service. Any comparison of the results was limited by data heterogeneity. More research is required to describe the occupational risk of infection with MDROs. Full article
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Open AccessCommentary
Doctors’ Extended Shifts as Risk to Practitioner and Patient: South Africa as a Case Study
Int. J. Environ. Res. Public Health 2020, 17(16), 5853; https://doi.org/10.3390/ijerph17165853 - 12 Aug 2020
Abstract
Extended shifts are common in medical practice. This is when doctors are required to work continuously for more than 16 h, with little or no rest, often without a maximum limit. These shifts have been a part of medical practice for more than [...] Read more.
Extended shifts are common in medical practice. This is when doctors are required to work continuously for more than 16 h, with little or no rest, often without a maximum limit. These shifts have been a part of medical practice for more than a century. Research on the impact of fatigue presents compelling evidence that extended shifts increase the risk of harm to patients and practitioners. However, where the number of doctors is limited and their workloads are not easily reduced, there are numerous barriers to reform. Some of these include a perceived lack of safer alternatives, concerns about continuity of care, trainee education, and doctors’ preferences. As such, working hour reorganisation has been contentious globally. South Africa, a middle-income country where extended shifts are unregulated for most doctors, offers a useful case study of reform efforts. The South African Safe Working Hours campaign has promoted working hour reorganization through multi-level advocacy efforts, although extended shifts remain common. We propose that extended shifts should be regarded as an occupational hazard under health and safety legislation. We suggest options for managing the risks of extended shifts by adapting the hierarchy of controls for occupational hazards. Despite the challenges reform pose, the practice of unregulated extended shifts should not continue. Full article
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Open AccessCase Report
Work-Related Tuberculosis among Health Workers Employed in a Tertiary Hospital in Northeastern Thailand: A Report of Nine Cases
Int. J. Environ. Res. Public Health 2020, 17(14), 5156; https://doi.org/10.3390/ijerph17145156 - 17 Jul 2020
Abstract
Between October 2016 and September 2018, fifteen health workers were diagnosed with tuberculosis (TB) at a tertiary hospital in northeastern Thailand. However, the cases could not be diagnosed as occupational TB according to international standards because of hospital limitations. The use of occupational [...] Read more.
Between October 2016 and September 2018, fifteen health workers were diagnosed with tuberculosis (TB) at a tertiary hospital in northeastern Thailand. However, the cases could not be diagnosed as occupational TB according to international standards because of hospital limitations. The use of occupational epidemiological information provides a more effective work-related TB diagnosis. This study aims to provide a report of work-related TB using individual case investigation methods. We collected secondary data from the Occupational Health and Safety Office of the hospital in question, including baseline characteristics for the health workers, occupational history, source of TB infection and occupational exposure, and working environmental measurements. We found that nine of the fifteen cases were diagnosable as work-related TB due to two important factors: daily prolonged exposure time to an infected TB patient, and aerosol-generating procedures without adequate respiratory protection. The other six cases were not diagnosable as work-related TB because of inadequate evidence of activities related to the TB infection. The diagnosis of work-related TB thus requires occupational epidemiological information in order to complete the differentiation process. Full article
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