Eva Münster

The incremental effect of psychosocial workplace factors on the development of neck and shoulder disorders: a systematic review of longitudinal studies

BackgroundTo systematically analyse evidence on the incremental effect of work-related psychosocial risk factors on the development of neck and shoulder disorders, as reported in longitudinal studies.MethodsA systematic literature search was conducted in three data bases (MEDLINE, EMBASE, and PsychINFO) until May 2009. The quality assessment leading to a methodological quality score of the included studies was conducted by two independent reviewers using a standardised checklist. Criteria for the evaluation of evidence were established. Heterogeneity analyses were conducted.ResultsAltogether 18 prospective longitudinal studies were included in the analysis. Potential psychosocial risk factors were mainly based on the job demand control (support) model by Karasek (1998). Study results were too heterogeneous to deduce pooled risk estimates. But the weight of evidence was strong for an incremental effect of job demands, job control, social support, and job strain, on the development of neck and/or shoulder disorders.ConclusionWhile 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.

History of allergic disease and epilepsy and risk of glioma and meningioma (INTERPHONE study group, Germany)

The aim of the present analysis was to examine the association of a medical history of asthma, hay fever, eczema, or epilepsy with the risk of glioma and meningioma. Data of a German population-based case–control study included 381 meningioma cases, 366 glioma cases, and 1,494 controls. Participants’ histories of asthma, hay fever, eczema, and epilepsy and the respective ages at onset were asked during a personal interview. A small inverse association between allergic condition and both glioma (odds ratio: 0.92; 95% CI: 0.70–1.22) and meningioma (odd ratio: 0.87; 95% CI: 0.66–1.14) was found. For glioma, this inverse association was more pronounced in persons reporting to have asthma compared to other allergic conditions. The positive association between epilepsy and particularly glioma suggests that epilepsy is an early symptom of the disease. As the association was seen also for epilepsies occurring more than a decade before the diagnosis of glioma, this might indicate either an aetiological role of epilepsy, or a relatively long preclinical phase. In conclusion our study confirms previous findings of case control studies but not those from cohort studies. However, possible selection bias in case control studies might not explain the different results in its entirety.

Over-indebtedness as a marker of socioeconomic status and its association with obesity: a cross-sectional study

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.

Factors influencing place of death in Germany.

CONTEXT Knowledge about factors influencing the place of death may be very useful for the planning of public health strategies to improve the situation of terminally ill patients. OBJECTIVES The aim of our study was to determine where people died in the German federal state of Rhineland-Palatinate in 2008. We further wanted to detect which factors had an influence on the place of death. METHODS Our cross-sectional survey was based on a random sample of 5000 inhabitants of Rhineland-Palatinate who had died between May 25, 2008 and August 24, 2008. Relatives of these randomly drawn deceased persons were interviewed by means of a written survey. RESULTS After removing duplicates, 4967 questionnaires were sent out. In total, 3832 questionnaires were delivered and 1378 completed, leading to a response rate of 36.0%. Of this group, 38.2% of the deceased died at home, 39.3% in a hospital, 13.4% in a nursing home, 7.5% in a palliative care facility, and 1.6% elsewhere. Suffering from cancer (adjusted odds ratio [AOR]: 1.30; 95% confidence interval [CI]: 1.01-1.68), social support (AOR being married: 1.33; 95% CI: 1.04-1.70; AOR having a nonworking relative: 1.71; 95% CI: 1.28-2.29), a high care level (AOR Care Level II: 2.79; 95% CI: 2.06-3.79, AOR Care Level III: 4.96; 95% CI: 3.40-7.24), and living in a rural municipality (AOR: 1.36; 95% CI: 1.01-1.84) were major factors favoring home death compared with institutional death. CONCLUSION Compared with other European countries, home death is still a frequent event in the federal state of Rhineland-Palatinate. Regional health policy should consider the actual distribution of place of death and corresponding predicting factors when establishing specialized palliative care home services as designed by recent German health legislation.

[Mental illness and over-indebtedness. Mental illness, social networks and financial strain in over-indebted persons].

In Germany, over-indebtedness of private households has been steadily increasing and is currently estimated to affect about 3 million private households. It is almost unknown in the German-speaking part, to what extent financial strain due to excessive debts is accompanied by mental health problems in affected persons. A cross-sectional study including over-indebted persons was conducted between July 2006 and March 2007 in Rhineland-Palatinate by an anonymously filled-in questionnaire of clients of debt counselling services. Altogether 666 persons (51% women) aged between 18-79 years took part (participation rate: 35.5%). 40% of the collective reported a current mental disorder. Especially persons experiencing over-indebtedness as a threat and cannot rely on a functioning social network are in danger of experiencing mental illnesses. When treating mental illnesses, the financial situation of the diseased person should be taken into account and the support of debt counselling services should be used at an early stage.

Sind gehörlose Patienten in Deutschland über ihren gesetzlichen Dolmetscheranspruch informiert

Deaf citizens are confronted with barriers in a health-care system shaped by hearing people. Therefore the German legislature provides a supply with sign language interpreters at the expense of the health insurances. The present study initially examines in how far the deaf are informed about this and use said interpreters. Traditional surveys are based on spoken and written language and therefore are unsuitable for the target audience. Because of this, a cross-sectional online study was performed using sign language videos and visually oriented answers to allow a barrier-free participation. With a multivariate analysis, factors increasing deaf peoples risks not to be informed of the supply with interpreters were identified: Of 841 deaf participants, 31.4% were not informed of their rights. 41.3% have experience with an interpreter at the doctors and report a mainly trouble-free reimbursement of costs. Young and modestly educated deaf have a higher risk of not being informed of the interpreter supply. Further information is necessary to provide equality of opportunities to deaf patients utilising medical benefits.

Feasibility of a cohort study on health risks caused by occupational exposure to radiofrequency electromagnetic fields

BackgroundThe aim of this study was to examine the feasibility of performing a cohort study on health risks from occupational exposure to radiofrequency electromagnetic fields (RF-EMF) in Germany.MethodsA set of criteria was developed to evaluate the feasibility of such a cohort study. The criteria aimed at conditions of exposure and exposure assessment (level, duration, preferably on an individual basis), the possibility to assemble a cohort and the feasibility of ascertaining various disease endpoints.ResultsTwenty occupational settings with workers potentially exposed to RF-EMF and, in addition, a cohort of amateur radio operators were considered. Based on expert ratings, literature reviews and our set of predefined criteria, three of the cohorts were identified as promising for further evaluation: the personnel (technicians) of medium/short wave broadcasting stations, amateur radio operators, and workers on dielectric heat sealers. After further analyses, the cohort of workers on dielectric heat sealers seems not to be feasible due to the small number of exposed workers available and to the difficulty of assessing exposure (exposure depends heavily on the respective working process and mixture of exposures, e.g. plastic vapours), although exposure was highest in this occupational setting. The advantage of the cohort of amateur radio operators was the large number of persons it includes, while the advantage of the cohort of personnel working at broadcasting stations was the quality of retrospective exposure assessment. However, in the cohort of amateur radio operators the exposure assessment was limited, and the cohort of technicians was hampered by the small number of persons working in this profession.ConclusionThe majority of occupational groups exposed to RF-EMF are not practicable for setting up an occupational cohort study due to the small numbers of exposed subjects or due to exposure levels being only marginally higher than those of the general public.

Überschuldung und Zuzahlungen im deutschen Gesundheitssystem – Benachteiligung bei Ausgabenarmut

AIM OF THE STUDY In the past few years, the number of over-indebted private households in Germany has steadily increased and is currently estimated to have reached 3.13 million. Financial difficulties culminating in private insolvencies of the persons concerned may lead to a restrained usage of health-care services that require additional payment. For the first time ever this study has examined whether over-indebted individuals refrain from seeking medical treatment or from buying prescribed medicine because of their financial situation. METHODS The cross-sectional study covered over-indebted persons in Rhineland-Palatinate and was conducted between July 2006 and March 2007. In cooperation with 53 debt counselling agencies in Rhineland-Palatinate and in cooperation with the specialized debtor counselling centre of the Johannes Gutenberg-University of Mainz a singular, anonymous questionnaire-based survey in written form was conducted. RESULTS Altogether 666 persons (51% female) between 18 and 79 years old (mean value: 41,0 years, standard deviation: 11,2 years; median: 41 years) participated in this evaluation, which amounts to a participation rate of 35.5%. The majority of participants stated to refrain from buying prescribed medication (65.2%) as well as from seeking medical advice and paying euro 10.00 own contribution (60.8%) because of their financial situation. The multivariate, binary logistic end-model showed age, family situation, insolvency proceedings, medical conditions and the self-reported attitude towards health alertness to be relevant factors of influence for both target variables. CONCLUSION The enacted own financial contribution when seeking health care or when receiving medication in Germany might cause a discrimination of indebted persons or households with regard to health care and medical treatment. Because of the obligation of additional payment, health services are not independent of an individuals financial resources, meaning that especially destitution in expenditure affects equal opportunities in the health care system.

[Gender-specific risk factors for acute low back pain: starting points for target-group-specific prevention].

ZusammenfassungHintergrundFrauen geben häufiger akute Rückenschmerzen an als Männer. Es stellte sich die Frage, ob sich geschlechtsspezifische Risikoprofile aufzeigen lassen.MethodeEine Sekundärdatenanalyse des telefonischen Gesundheitssurveys 2003 des Robert-Koch-Instituts wurde durchgeführt (n=7829). Es wurden bivariate (χ2) und geschlechtsstratifizierte multivariate Tests durchgeführt („odd‘s ratios“, 95%-Konfidenzintervalle).ErgebnisseFrauen (28,5%) gaben signifikant häufiger als Männer (18%) akute Rückenschmerzen an (p<0,001). In der multivariaten Analyse ergaben sich geschlechtsspezifische Risikoschätzer für folgende Faktoren: Alter, degenerative Gelenkerkrankungen, Osteoporose, Depression, Raucherstatus, Anstellungsverhältnis, Gemeindegröße und Beeinträchtigung der täglichen Arbeit durch körperliche Beschwerden.SchlussfolgerungDie vorliegende Untersuchung stellt einen Versuch dar, Erkenntnisse abzuleiten, nach denen Geschlechtsunterschiede in der Versorgung von Rückenschmerzpatienten berücksichtigt werden sollten. Präventionsmaßnahmen und Therapieansätze könnten dadurch beeinflusst werden. Zukünftige Analysen, sollten besonders psychosoziale Faktoren einschließen, um sich dem Problem adäquat zu nähern.AbstractBackgroundWomen complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified.MethodsSecondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (χ2) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals).ResultsWomen (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment.ConclusionThe present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.BACKGROUND Women complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified. METHODS Secondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (chi(2)) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals). RESULTS Women (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment. CONCLUSION The present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.

Geschlechtsspezifische Risikofaktoren akuter Rückenschmerzen

ZusammenfassungHintergrundFrauen geben häufiger akute Rückenschmerzen an als Männer. Es stellte sich die Frage, ob sich geschlechtsspezifische Risikoprofile aufzeigen lassen.MethodeEine Sekundärdatenanalyse des telefonischen Gesundheitssurveys 2003 des Robert-Koch-Instituts wurde durchgeführt (n=7829). Es wurden bivariate (χ2) und geschlechtsstratifizierte multivariate Tests durchgeführt („odd‘s ratios“, 95%-Konfidenzintervalle).ErgebnisseFrauen (28,5%) gaben signifikant häufiger als Männer (18%) akute Rückenschmerzen an (p<0,001). In der multivariaten Analyse ergaben sich geschlechtsspezifische Risikoschätzer für folgende Faktoren: Alter, degenerative Gelenkerkrankungen, Osteoporose, Depression, Raucherstatus, Anstellungsverhältnis, Gemeindegröße und Beeinträchtigung der täglichen Arbeit durch körperliche Beschwerden.SchlussfolgerungDie vorliegende Untersuchung stellt einen Versuch dar, Erkenntnisse abzuleiten, nach denen Geschlechtsunterschiede in der Versorgung von Rückenschmerzpatienten berücksichtigt werden sollten. Präventionsmaßnahmen und Therapieansätze könnten dadurch beeinflusst werden. Zukünftige Analysen, sollten besonders psychosoziale Faktoren einschließen, um sich dem Problem adäquat zu nähern.AbstractBackgroundWomen complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified.MethodsSecondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (χ2) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals).ResultsWomen (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment.ConclusionThe present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.BACKGROUND Women complain about back pain more often than men, giving rise to the question of whether gender-specific risk profiles could be identified. METHODS Secondary data analysis was done of the telephone health survey conducted by the Robert Koch Institute in 2003 (n=7,829). Bivariate (chi(2)) and gender-stratified multivariate tests were conducted (odds ratio, 95% confidence intervals). RESULTS Women (28.5%) complained about acute low back pain significantly more often than men did (18%; p<0.001). The multivariate analysis found gender-specific risk estimates for the following factors: age, degenerative diseases of the joints, osteoporosis, depression, smoking, employment, municipality size, and impairment of daily work because of physical impairment. CONCLUSION The present examination is an attempt to deduce factors to be taken into account for gender-specific care of patients with acute low back pain. Preventive measures and therapy approaches could be influenced by these findings. To adequately address the problem, future analyses should specifically include psychosocial factors.