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This analysis of longitudinal studies allowed for new evidence with regard to four cause-effect chains between physical exposures at work and the development of shoulder, neck and neck/shoulder complaints. As outcome variables varied greatly among the included studies, harmonization in studies on musculoskeletal research is desirable.

BackgroundApart from objective exam results, the overall feeling of preparedness is important for a successful transition process from being a student to becoming a qualified doctor. This study examines the association between self-assessed deficits in medical skills and knowledge and the feeling of preparedness of junior doctors in order to determine which aspects of medical education need to be addressed in more detail in order to improve the quality of this transition phase and in order to increase patient safety.MethodsA cohort of 637 doctors with up to two years of clinical work experience was included in this analysis and was asked about the overall feeling of preparedness and self-assessed deficits with regard to clinical knowledge and skills. Three logistic regression models were used to identify medical skills which predict the feeling of preparedness.ResultsAll in all, about 60% of the participating doctors felt poorly prepared for post-graduate training. Self-assessed deficits in ECG interpretation (aOR: 4.39; 95% CI: 2.012-9.578), treatment and therapy planning (aOR: 3.42; 95% CI: 1.366-8.555), and intubation (aOR: 2.10; 95% CI: 1.092-4.049) were found to be independently associated with the overall feeling of preparedness in the final regression model.ConclusionsMany junior doctors in Germany felt inadequately prepared for being a doctor. With regard to the contents of medical curricula, our results show that more emphasis on ECG-interpretation, treatment and therapy planning and intubation is required to improve the feeling of preparedness of medical graduates.

While we found evidence for an incremental effect of different psychosocial work factors (in addition to the effect of physical job factors), these results have to be interpreted carefully in order to support the notion that psychological factors can have an independent causal influence on the development of musculoskeletal disorders. Nevertheless, our findings are important for the development of preventive strategies, as they stress the need for preventive approaches that tackle both physical and psychosocial factors. Future research is warranted to consolidate and strengthen the results of this review.

BackgroundThe recent credit crunch will have implications for private households. Low socioeconomic status is associated to various diseases. While income, education and occupational status is frequently used in definitions of socioeconomic status, over-indebtedness of private households is usually not considered. Over-indebtedness is currently increasing in high-income countries. However, its association with health – particularly with obesity – remains unknown. Therefore, the aim of this study was to assess an association between over-indebtedness and overweight or obesity.MethodsA cross-sectional study on over-indebtedness and health including 949 over-indebted subjects from 2006 and 2007 in Rhineland-Palatinate and Mecklenburg-Western Pomerania (Germany) and the telephonic health survey 2003 of the Robert Koch-Institute including 8318 subjects, who are representative for the German population, were analysed with adjusted logistic regression considering overweight (BMI ≥25.0 kg/m2) and obesity (BMI ≥30 kg/m2) as response variable.ResultsAfter adjusting for socio-economic (age, sex, education, income) and health factors (depression, smoking habits) an independent effect of the over-indebt situation on the probability of overweight (aOR 1.97 95%-CI 1.65–2.35) and obesity (aOR 2.56 95%-CI 2.07–3.16) could be identified.ConclusionOver-indebtedness was associated with an increased prevalence of overweight and obesity that was not explained by traditional definitions of socioeconomic status. Over-indebtedness should be additionally considered when assessing health effects of socioeconomic status.

BackgroundThe aim of this review was to synthesize the evidence on the potential relationship between psychosocial work factors from the Areas of Worklife (AW) model (workload, job control, social support, reward, fairness, and values) and chronic low back pain (CLBP; unspecific pain in the lumbar region lasting 3 months or longer).MethodsWe conducted a systematic literature search of studies in Medline, PsycINFO, Web of Science, and CINAHL (1987 to 2018). Three authors independently assessed eligibility and quality of studies. In this meta-analysis, we pooled studies’ effect sizes using a random-effects model approach and report sample size weighted mean Odds Ratios (ORs).ResultsData from 18 studies (N = 19,572) was included in the analyses. We found no studies investigating associations between fairness or values and CLBP. CLBP was significantly positively related to workload (OR = 1.32) and significantly negatively related to overall job control (OR = 0.81), decision authority (OR = 0.72), and two measures of social support (ORs = 0.75 to 0.78), even in prospective studies. Skill discretion and reward did not significantly relate to CLBP. Moderation analyses revealed several variables (e.g., exposure time, mean age and sex) affecting these relationships.ConclusionsOur results support employees’ workload, job control, and social support as predictors of CLBP. In this line, these work factors should be considered when developing programs to prevent chronic low back pain. Future studies should apply measures of CLBP that are more precise, and investigate the full areas of work life (AW) factors in combination.

1,3-Butadiene and acrylonitrile are important industrial chemicals that have a high production volume and are ubiquitous environmental pollutants. The urinary mercapturic acids of 1,3-butadiene and acrylonitrile-N-acetyl-S-(3,4-dihydroxybutyl)cysteine (DHBMA) and MHBMA (an isomeric mixture of N-acetyl-S-((1-hydroxymethyl)-2-propenyl)cysteine and N-acetyl-S-((2-hydroxymethyl)-3-propenyl)cysteine) for the former and N-acetyl-S-2-cyanoethylcysteine (CEMA) for the latter-are specific biomarkers for the determination of individual internal exposure to these chemicals. We have developed and validated a fast, specific, and very sensitive method for the simultaneous determination of DHBMA, MHBMA, and CEMA in human urine using an automated multidimensional LC/MS/MS method that requires no additional sample preparation. Analytes are stripped from urinary matrix by online extraction on a restricted access material, transferred to the analytical column, and subsequently determined by tandem mass spectrometry using labeled internal standards. The limits of quantification (LOQs) for DHBMA, MHBMA, and CEMA were 10 microg/L, 2 microg/L, and 1 microg/L urine, respectively, and were sufficient to quantify the background exposure of the general population. Precision within series and between series for all analytes ranged from 5.4 to 9.9%; mean accuracy was between 95 and 115%. We applied the method on spot urine samples from 210 subjects from the general population with no occupational exposure to 1,3-butadiene or acrylonitrile. A background exposure of the general population to acrylonitrile was discovered that is basically influenced by individual exposure to passive smoke as well as active smoking habits. Smokers showed a significantly higher excretion of MHBMA, whereas DHBMA levels did not differ significantly. Owing to its automation, our method is well suited for application in occupational or environmental studies.

Workplace factors predict the wish for leaving clinical care for junior doctors. Male and female junior doctors seem to have different priorities in the workplace, which should be addressed in order to retain them in patient care.