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In the risk assessment of work-related mental stress, the use of objective psychophysiological methods could improve the identification of mental stressors. However, mental stressors often reoccur during work, and adaptation processes and individual factors may alter psychophysiological responses over time. In this exploratory study, measures of heart rhythm and skin resistance during recurrent anticipatory stress were examined in two groups with lower and higher neuroticism to provide information on which method is most appropriate for stress detection. In the with-in subject design study participants were required to first anticipate a neutral audio signal during a control condition and then a potential painful electric shock in two subsequent experimental conditions. Heart rate (HR), heart rate variability (HRV), and skin resistance (SR) parameters were extracted during anticipation. Groups with lower and higher neuroticism were formed based on the Big Five Inventory. While SR parameters and the low-frequency HRV responded similarly under both electric shock conditions, the root mean square of successive time differences between heartbeats, and the high-frequency HRV did not respond. HR increased in the 1st electric shock condition in the higher neuroticism group only. Parameters that responded under both electric shock conditions may contribute to more accurately mapping of recurrent anticipatory stressors.

Work-related musculoskeletal disorders (WMSDs) are prevalent in occupations characterised by high repetition and high force demands. Both factors not only evoke inflammatory and degenerative processes in affected musculoskeletal tissue, but also systemic responses identified by biomarkers in blood serum. Clarifying methodological aspects of biomarkers may provide insights into their predictive role in the pathway of developing WMSDs. This study will primarily assess reliability of systemic inflammatory biomarkers (CRP, TNF-α, IL-6, IL-1β) and immune cell reactivity by repeated measures in workers with constant workloads over time. This observational cross-sectional study will include two groups of workers: exposed group including workers exposed to higher upper-extremity physical workloads, especially affecting the elbow/forearm/hand-area; unexposed group, including office workers exposed to lower upper-extremity physical workloads. Recruited persons are screened against eligibility criteria followed by a medical anamnesis and blood analysis. Enrolled participants undergo nine repeated measurements once every two weeks, taking blood among others. Blood analyses will determine values of systemic inflammatory biomarkers and reactivity of immune cells. The absolute test-retest reliability of biomarkers and immune cell reactivity over time is assessed by the intra-class correlation coefficient applying two-way mixed-effects models. The relative test-retest reliability is assessed by the standard error of measurement. Knowledge of and models currently describing the pathological role of systemic inflammatory biomarkers are based on highly-controlled laboratory rat experiments. This study has the strength of assessing a human population under real-life conditions. The major challenge is in participant recruitment given the intensive and complex study design. The results of this study could provide fundamentals for initiating a cohort study and be used for developing work-related stress-recovery concepts for occupations with different physical demands to identify workers who may be at risk for developing WMSDs. German Clinical Trials Register (DRKS00031872, 25 May 2023).

Pathophysiologically, prolonged standing is associated with varicose veins (VV) or pathological venous reflux. Prior work-related epidemiological studies are inconclusive due to crude and imprecise exposure assessments. This cross-sectional field study explored the association between work-related standing time and VV or pathological reflux, assessed using wearables. Daily standing time was tracked by accelerometer and categorized: ≤2 vs. >2 but ≤4 vs. >4 h. Long-term cumulative standing exposure were estimated by combining accelerometer and survey data. Employees underwent CEAP classification and duplex ultrasound to measure lower leg reflux. The associations between standing time and other predictors on VV or reflux were analyzed by multiple logistic regression. 198 employees working ≥30 h and ≥4 days per week for ≥2y in logistics, trade, retail, manufacturing, healthcare, research, and service sectors were included ( n  = 116♀, Ø-age = 40 ± 9y). 18% ( n  = 36) stood ≤2 h, 46% ( n  = 91) >2 but ≤4 h, 36% ( n  = 71) >4 h per day. Long-term cumulative standing exposure was 10,145.0 ± 8,396.0 h. 24% ( n  = 47) were described with VV, 38% ( n  = 74) with reflux. While neither daily nor long-term cumulative standing time were significantly associated with VV or reflux, age and family history were. Our findings partly contradict previous epidemiological studies, highlighting the value of objectively measured activity patterns for future research.

Purpose Primary: To evaluate whether robotic-assisted laparoscopic surgery using the Senhance® Surgical System has the potential to reduce muscular demands compared to conventional laparoscopy. Secondary: To verify that the novel eye-tracking feature for zoom and the selection of functions in the Senhance® System menu is not associated with increased eyestrain or neck strain. Methods In a within-subject design, 2 experienced surgeons performed 11 robot-assisted and 12 conventional laparoscopic procedures. Muscular demands were monitored throughout surgical procedures by assessing the muscle activity via bipolar surface electromyography of seven muscles of the lower back, shoulder–neck, and forearms. Surgeons’ head, arm, and torso posture was assessed by gravimetrical position sensors. Furthermore, musculoskeletal discomfort, mental and physical workload, task difficulty and working precision were rated by the surgeons. In addition, a ten-item eyestrain questionnaire was administered after each surgical procedure. Results Four out of seven muscles were relieved when working with Senhance®. Only in the left shoulder–neck area there was a statistically significant increase in muscle activation associated with robotic-assisted surgery. Changes in surgeons’ posture related to the surgical technique corresponded to the changes in muscle activation. Furthermore, surgeons reported no musculoskeletal discomfort under both conditions and similar levels of workload (mental and physical), and task difficulty. Working precision was subjectively rated to be better during standard laparoscopy. No eyestrain occurred during any of the procedures. Conclusion This exploratory study identified the potential of the Senhance® Surgical System for ergonomic improvements and indicated no impairments by the novel eye-tracking feature on muscle demands and eyestrain. Follow-up studies with larger and more diverse indications are needed that also consider clinical outcomes, which were not part of the present study.

Laparoscopic surgeons are at high risk of experiencing musculoskeletal discomfort, which is considered the result of long-lasting static and awkward body postures. We primarily aimed to evaluate whether passive and active work breaks can reduce ratings of perceived discomfort among laparoscopic surgeons compared with no work breaks. We secondarily aimed to examine potential differences in performance and workload across work break conditions and requested the surgeons evaluate working with passive or active work breaks. Following a balanced, randomized cross-over design, laparoscopic surgeons performed three 90 min laparoscopic simulations without and with 2.5 min passive or active work breaks after 30 min work blocks on separate days. The simulation included the following tasks: a hot wire, peg transfer, pick-and-place, pick-and-tighten, pick-and-thread, and pull-and-stick tasks. Ratings of perceived discomfort (CR10 Borg Scale), performance per subtask, and perceived workload (NASA-TLX) were recorded, and the break interventions were evaluated (self-developed questionnaire). Statistical analyses were performed on the rating of perceived discomfort and a selection of the performance outcomes. Twenty-one participants (9F) were included, with a mean age of 36.6 years (SD 9.7) and an average experience in laparoscopies of 8.5 years (SD 5.6). Ratings of perceived musculoskeletal discomfort slightly increased over time from a mean level of 0.1 to 0.9 but did not statistically significantly differ between conditions (p = 0.439). Performance outcomes of the hot wire and peg transfer tasks did not statistically significantly differ between conditions. The overall evaluation by the participants was slightly in favor regarding the duration and content of active breaks and showed a 65% likelihood of implementing them on their own initiative in ≥90 min-lasting laparoscopic surgeries, compared with passive breaks. Both passive and active breaks did not statistically significantly influence ratings of perceived discomfort or perceived workload in a 90 min simulation of laparoscopic surgery, with an overall low mean level of perceived discomfort of 0.9 (SD 1.4). As work breaks do not lead to performance losses, rest breaks should be tested in real-life situations across a complete working shift, where perceived discomfort may differ from this laboratory situation. However, in this respect, it is crucial to investigate the acceptance and practicality of intraoperative work breaks in feasibility studies in advance of assessing their effectiveness in follow-up longitudinal trials.

Background Osteoarthritis is the most common reason for pain in older adults, and the individual and economic burden of this disease is immense. The chronic character of osteoarthritis requires a long-term therapeutic treatment. In this regard life-style interventions such as physical exercises that can be carried out by the patient himself are recommended as first line treatment. There is evidence for the short-term benefit of exercise therapy in terms of pain reduction and physical functioning. Nonetheless research agendas highlight the need for multifaceted interventions that incorporate exercise strategies into patient care. Studies should be conducted with appropriate sample sizes and should allow statements on long-term effects as well as cost-utility and safety. These open questions are under the scope of this study. Methods/design This is a controlled study in the context of health services research. The study population consists of n  = 1400 subjects with hip or knee osteoarthritis. The intervention group will be recruited from participants of a country-wide health insurance offer for people with hip or knee osteoarthritis. Potential participants for the control group (ratio 10:1 (control vs. intervention) will be filtered out from the insurance data base according to pre-defined matching criteria and asked by letter for their participation. The final statistical twins from the responders (1:1) will be determined via propensity score matching. The progressive training intervention comprises 8 supervised group sessions, supplemented by home exercises (2/week over 11 weeks). Exercises include mobilization, strengthening and training of postural control. Primary outcomes are pain and function measured with the WOMAC Index immediately after the intervention period. Among other things, health related quality of life, self-efficacy, cost utility and safety will be evaluated as secondary outcomes. Participants will be followed up 6, 12 and 24 month after baseline. Discussion Results of this trial will document the effects of clinical as well as economic outcomes in a regular health care setting on the basis of a large sample size. As such, results of this trial might have great impact on future implementations of group- and home-based exercises in hip or knee osteoarthritis. Trail registration German Clinical Trial Register DRKS00009251 . Registered 10 September 2015.

Background Musculoskeletal disorders are more prevalent among women than among men, which may be explained by aspects of motor control, including neuromuscular requirements and motor variability. Using an exploratory approach, this study aimed to evaluate sex differences in neuromuscular responses and motor variability during a repetitive task performed on 3 days. Methods Thirty women and 27 men performed the non-fatiguing, repetitive, 1-h screwing task. For neuromuscular responses, the mean and difference values of static, median, and peak percentile muscle activity levels (normalized to a reference voluntary contraction force) and, for motor variability, the mean and difference values of relative and absolute cycle-to-cycle variability across days were compared between both sexes for each muscle. A mixed-design analysis of variance was used to assess differences between both sexes. Results The non-fatiguing character of the screwing task was confirmed by the absence of decreased force levels in maximal voluntary contractions performed before and after the task and by absence of electromyographic signs of muscle fatigue. The static and median muscle activity levels tended to be higher among women (on average 7.86 and 27.23 %RVE) than men (on average 6.04 and 26.66 %RVE). Relative motor variability of the flexor and biceps muscles and absolute motor variability of both upper arm muscles were lower in women (on average 0.79 and 29.70 %RVE) than in men (on average 0.89 and 37.55 %RVE). The median activity level of both upper arms muscles tended to decrease within days among women (on average - 2.63 %RVE) but increase among men (on average + 1.19 %RVE). Absolute motor variability decreased within days among women (on average - 5.32 to - 0.34%RVE), whereas it tended to decrease less or increase within days among men (on average - 1.21 to + 0.25 %RVE). Conclusion Women showed higher levels of muscle activity and lower initial relative and absolute motor variability than males when performing the same occupational task, implying women may have a higher risk for developing disorders and point to both sexes using different intrinsic motor control strategies in task performance. Clearly, biological aspects alone cannot explain why women would be at higher risk for developing disorders than men. Therefore, a wider range of individual and environmental factors should be taken into account for optimizing work station designs and organizations by taking into account sex differences.

IntroductionCurrently, many countries, affected by the COVID-19 pandemic, discuss how the ‘lockdown-restrictions’ could be lifted to restart the economy and public life after the first wave of the COVID-19 disease has subsided. This study protocol describes an approach designed to provide an in-depth understanding of how companies and their employees in Germany deal with their working conditions during the COVID-19 pandemic. We are also interested in how and why the risk of infection with SARS-CoV-2 could vary across different professional activities, company sites and regions with different epidemiological activity or infection control measures in Germany. We expect the results of this study to contribute to the development of working conditions protecting the health of employees during and beyond the COVID-19 pandemic.Methods and analysisAn explorative multimodal mixed methods approach will be applied. Module 1 comprises a document analysis of prevailing federal and regional laws and regulations at the respective location of the participating company. Module 2 includes qualitative interviews with key actors at different companies. Module 3 is a repeated standardised employee survey designed to capture potential changes in the participants’ experiences and attitudes towards working conditions, occupational safety regulations/measures, and infection control measures during the COVID-19 pandemic. Module 4 comprises SARS-CoV-2 seroprevalence testing. This is carried out by the medical service of the participating company sites as a voluntary offer for employees. Qualitative data will be analysed through document and content analysis. The complexity of the quantitative analysis depends on the response rates of modules 3 and 4.Ethics and disseminationThe approval of the study design was received in June 2020 from the responsible local ethical committee of the Medical Faculty, University of Tübingen and University Hospital Tübingen (No. 423/2020BO). The results will be presented at national and international conferences and published in peer-reviewed journals.

IntroductionLaparoscopy has partially replaced open surgery due to the lower infection rate for the patient and hence better and shorter recovery. However, the surgeon’s physical load is higher due to longer duration static and awkward body postures, increasing the risk for developing work-related musculoskeletal disorders. Interventions of an organisational nature are work breaks, being either passive or active. The primary objectives of this study are to determine whether passive and active work breaks lead to less discomfort than no work breaks and whether active work breaks lead to less discomfort than passive work breaks.Methods and analysisA controlled, randomised cross-over trial will be performed in the laboratory, of which its protocol is described here according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Statement. Recruitment of 21 laparoscopic surgeons started in April 2019 and the study is ongoing. The participating surgeons will perform three 1.5 hour experimental conditions, one without work breaks, one with 2.5 min passive work breaks including rest, and one with 2.5 min active work breaks including mobility and stretching exercises. The work breaks will be taken after 30 and 60 min of work. During the experiments, outcomes will be recorded. The primary outcome is rating of perceived discomfort measured on an 11-point numeric rating scale. The secondary outcomes are performance, muscle activity of selected muscles, upper body angles, heart rate, workload and subjective evaluation of both interventions. The collected data will be tested using a one-way or two-factorial repeated-measures analysis of variance.Ethics and disseminationEthical approval of the study protocol was received by the local medical ethical committee of the University of Tübingen in February 2019 (no 618/2018BO2). The results of this study will be presented at national and international conferences, submitted for publications in peer-reviewed journals and serve as the starting point for a feasibility study.Trial registration numberNCT03715816.

Background Hip osteoarthritis (hip OA) is a disease with a major impact on both national economy and the patients themselves. Patients suffer from pain and functional impairment in activities of daily life which are associated with a decrease in quality of life. Conservative therapeutic interventions such as physical exercises aim at reducing pain and increasing function and health-related quality of life. However, there is only silver level evidence for efficacy of land-based physical exercise in the treatment of hip OA. The purpose of this randomized controlled trial is to determine whether the specific 12-week exercise regime \"Hip School\" can decrease bodily pain and improve physical function and life quality in subjects with hip osteoarthritis. Methods/Design 217 participants with hip OA, confirmed using the clinical score of the American College of Rheumatology, are recruited from the community and randomly allocated to one of the following groups: (1) exercise regime \"Hip School\", n = 70; (2) Non-intervention control group, n = 70; (3) \"Sham\" ultrasound group, n = 70; (4) Ultrasound group, n = 7. The exercise regime combines group exercises (1/week, 60-90') and home-based exercises (2/week, 30-40'). Sham ultrasound and ultrasound are given once a week, 15'. Measures are taken directly prior to (M1) and after (M2) the 12-week intervention period. Two follow-ups are conducted by phone 16 and 40 weeks after the intervention period. The primary outcome measure is the change in the subscale bodily pain of the SF36 from M1 to M2. Secondary outcomes comprise the WOMAC score, SF36, isometric strength of hip muscles, spatial-temporal and discrete measures derived from clinical gait analysis, and the length of the centre of force path in different standing tasks. An intension-to-treat analysis will be performed using multivariate statistics (group × time). Discussion Results from this trial will contribute to the evidence regarding the effect of a hip-specific exercise regime on physical function, pain, and health-related quality of life in patients with hip osteoarthritis. Trial registration German Clinical Trial Register DRKS00000651.