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Background: Infectious diseases during pregnancy can pose a serious health risk for mother and child. Employees with an occupational risk of infection are especially at risk. We investigated the immune status of pregnant employees working in the health service to determine the percentage of women who were adequately protected during pregnancy and the percentage of cases with a pregnancy-relevant risk., Methods: This retrospective data collection was done using the standard records of the Occupational Health Department ( Betriebsärztliche Dienststelle ) of Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany. The data of employees with a pregnancy reported between 1 May 2018 and 31 May 2020 were collected. This resulted in a total study population of 406 cases. We collected data on the respective occupational groups, occupational risk profile, employment bans for expectant mothers, occupational-medical consultations, and immunity status with regards to measles, mumps, rubella, varicella zoster virus, parvovirus B19, CMV, hepatitis A and B, tetanus, diphtheria, pertussis, and poliomyelitis., Results: The investigated employees had attended a mean of three previous occupational-medical consultations; 45.8% had received advice about maternity protection from the occupational physician's office. The immunity rates of the total study population at the time of their last medical consultation prior to their due date varied, depending on the respective disease, from 77.3% (mumps) to 90.9% (varicella zoster virus). 182 cases (44.8%) were prohibited from working during their further pregnancy., Conclusion: Medical advice on infection risks and immunization combined with the offer of vaccinations are decisive in determining the immune status and ensure that immunizations can be carried out in good time. To achieve full immunization before becoming pregnant, girls and women should be advised early on about preventive maternity protection measures., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Positive patch test responses to benzoyl peroxide (BPO) have been reported from patients without and with known exposure. Up to 6.5% were found in the United States and 7.8% in a study including patients from Germany, Austria and Switzerland. We provide an overview of the skin sensitisation potential and potency of BPO based on animal experiments and non-animal methods. BPO tested positive in Guinea Pig Tests and the Local Lymph Node Assay. Application of the current OECD guideline to identify a skin sensitizer by combining non-animal method results gave differing outcomes. Moreover, patch test responses of patients to BPO were considered to determine the importance of BPO as a relevant occupational contact allergen. Another well-known BPO exposure is the topical application to treat acne. Despite widespread use, extensive and long-term skin exposure, we found for this group only studies reporting few positive patch test reactions. Further, occupational handling of BPO and contact allergy is reported by dental technicians. In-depth evaluation of the prevalence of contact allergy in different professions with suspected BPO exposure did not reveal an association with occupational handling of BPO. Consequently, a generally increased risk for those professions is not supported., (© 2025 The Author(s). Contact Dermatitis published by John Wiley & Sons Ltd.)

Introduction: According to the Maternity Protection Act, an occupational risk of infection (e. g. in childcare) - combined with individual immunity gaps - can result in an irresponsible risk for pregnant women in the workplace. If this risk cannot be eliminated by any other means, the employer must impose a prohibition of employment (PE) for the pregnant woman concerned. We classified PE as preventable if the underlying immunity gaps could have been closed by immunisation prior to pregnancy., Methods: From 01.09.2016 to 25.03.2020, 1922 pregnant employees of Bavarian state schools obtained medical counselling on their occupational risk of infection as part of a research project. If the individual combination of occupational-risk profile and immunity status resulted in an irresponsible risk for the pregnancy, a PE was recommended by the attending physician. We determined the proportion of PE that would have theoretically been preventable by full immunisation prior to pregnancy and approximated the resulting - theoretically preventable - loss of working hours and personnel costs., Results: In 425 cases (22%), a PE was deemed necessary by the attending physician, whereby 193 (45%) were retrospectively classified as theoretically preventable. Of these cases, 53 PE (27%) were temporary (valid until the 20th week of pregnancy) and 140 were long-term (valid for the complete duration of the pregnancy). Based on these results, we approximated a loss of 2,746 working weeks for our collective, which entails theoretically preventable personnel costs totalling 5,763,305 € for the observation period of our study (3.6 years). We then extrapolated estimates for all employees of Bavarian state schools and found a loss of 4,260 working weeks and theoretically preventable personnel costs amounting to almost 8,941,000 € per year during our observation period., Conclusion: Theoretically preventable PE caused by immunity gaps can entail a considerable loss of working hours and high personnel costs. Therefore, we should step up measures aimed at improving vaccination rates in women and increasing their willingness to be vaccinated. In view of the changes in legal and regulatory conditions in Germany since 2020, new investigations should be made as soon as there is sufficient data after the general employment prohibitions due to the SARS-CoV-2-pandemic have been lifted., Competing Interests: Finanzielle Unterstützung Das zugrundeliegende Forschungsvorhaben wurde von 2013 bis 2019 durch das Bayerische Staatsministerium für Unterricht und Kultus finanziert (Titel: Entwicklung eines Modells zur dezentralen arbeitsmedizinischen Betreuung von Lehrerinnen und Lehrern sowie von Verwaltungsangestellten im Bereich der Schulverwaltung in Bayern). Von 2020 bis 2022 erfolgte die Anschlussfinanzierung durch das Arbeitsmedizinische Institut für Schulen in Bayern (AMIS-Bayern) am bayerischen Landesamt für Gesundheit und Lebensmittelsicherheit (LGL) zum Zweck der Unterstützung des Aufbaus des AMIS-Bayern. Interessenkonflikt Dr. med. Anna Wolfschmidt-Fietkau, Dr. med. Uta Ochmann, Dr. med. Julia Hiller, Prof. Dr. med. Dennis Nowak, Prof. Dr. med. Hans Drexler: Die Autoren erklären, dass die Arbeitsmedizinischen Institute der Friedrich-Alexander-Universität Erlangen-Nürnberg und des Klinikums der Ludwig-Maximilians-Universität München innerhalb der vergangenen drei Jahre Forschungsunterstützung (Drittmittel) von AMIS-Bayern erhalten haben (vgl. „Finanzielle Unterstützung)., (Thieme. All rights reserved.)

Technical products containing N-Phenyl-beta-naphthylamine (PBNA) are contaminated with beta-naphthylamine (BNA), a known carcinogen. Both amines penetrate the skin to different degrees, but little is known about their dermal-depot formation. This study investigated the dermal penetration of PBNA and its degradation product BNA using a viable human-skin model. PBNA (259 μg) or BNA (0.52 μg) in n-hexane and industrial grease were applied to freshly excised human skin (n = 6, 0.64 cm 2 ) for 2-72 h. After temporary/continuous and single/repeated exposure, samples were taken (stratum corneum, epidermis/dermis, receptor fluid) and analyzed for their amine content by GC-MS. Continuous exposure led to a PBNA dermal depot of ∼47 μg/cm 2 over 72 h. Temporary applications also resulted in lower but consistent PBNA dermal depots. A single 2-h application resulted in a dermal depot of ∼16 μg/cm 2 after 72 h, while this was ∼25 μg/0.64 cm 2 with repeated applications. BNA behaved differently; with repeated 2-h applications, intradermally retained BNA initially increased 3-6 fold, then dropped to ∼200-250 ng/cm 2 . This incomplete decline upon repeated short-term exposure to PBNA suggests that a BNA dermal depot is formed either due to contamination of PBNA with BNA or to enzymatic conversion of PBNA to BNA. Additionally, PBNA dermal depots were saturable under the given conditions. These findings highlight the importance of understanding the dermal-exposure dynamics of potential carcinogenic compounds in industrial settings., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction: Despite a high number of long/post-COVID cases and an enormous psychological strain on the part of the patients, no scientific consensus has yet been reached on a clearly defined disease entity. The comprehensive media coverage has made the public more sensitive to this topic, which makes it more difficult to take an objective perspective., Methods: We report on long/post-COVID symptoms in a hotspot collective of the first SARS-CoV-2 wave of infections in Germany; these infections began in Spring 2020 and therefore preceded the start of an intensive media coverage. In June/July 2021, 122 employees of the Kliniken Nordoberpfalz AG who tested positive for SARS-CoV-2 during the first wave of the pandemic were asked about their infection and its consequences using a standardised questionnaire., Results: 82 participants (67 %) complained of persistent symptoms (post-COVID: 29 %). Long/post-COVID symptoms occurred more frequently in those who had experienced symptoms during the acute phase of the infection. Patients with stomach pain as an acute symptom more frequently reported a symptom duration of > 12 weeks. The probability of symptoms persisting > 12 weeks was reduced if throat pain or sniffling had been reported as an acute symptom. Emergence and duration of symptoms were independent of any demographic or occupational factors or of pre-existing conditions., Discussion: Due to having been infected in a hotspot region during the first wave of the pandemic, the study collective exhibits certain peculiarities which must be considered when interpreting the results. The lack of evidence for many risk factors discussed in the literature, together with the challenges facing scientific studies, seems to suggest a more differentiated approach to dealing with post-COVID., (Copyright © 2024. Published by Elsevier GmbH.)

Background: During the first wave of the SARS-CoV-2 pandemic, Weiden Hospital was a hotspot and was thus in an exceptional medical situation. This study deals with the question of whether the recognized risk factors for a severe course of COVID-19 also apply to the patients treated in Weiden Hospital during this time or whether other factors could have influenced patient outcomes., Methods: In a retrospective analysis, data on 669 patients of Weiden Hospital with proven SARS-CoV-2 infections in the first year of the pandemic were evaluated. Risk factors for a severe case of COVID-19 were determined from medical and demographic information in a univariate analysis and subjected to logistic regression. The logistic regression analysis was performed for the overall collective as well as separately for patients from Wave 1 (3-6/2020) and 2 (7-12/2020)., Results: Looking at all of 2020, significant risk factors for severe COVID-19 included being male, being a smoker, being 71 years or older, and a history of depression. All other commonly recognized risk factors were not applicable for the Weiden collective. When looking at both waves separately, in Wave 1 age was not a significant risk factor, whereas in Wave 2 an age of 61 years or older was associated with an increased risk of severe progression. For patients who were admitted to hospital in Wave 2, the risk of severe progression was reduced almost by half., Conclusion: It can be assumed that patient outcomes in Weiden's hotspot collective were predominantly determined by non-individual factors, like the difficult care situation in a hotspot clinic at the beginning of the pandemic. In preparation for future pandemics, provision of sufficient resources might significantly contribute to better patient outcomes., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Single-use medical gloves achieve their purpose only when properly used. Proper use also helps avoid undesired consequences such as excessive waste and CO2 emissions, as well as inadequate hand hygiene., Methods: In this selective review of the primary scientific literature, we summarize the current state of knowledge on the use of singleuse medical gloves in the health-care sector. We also provide further information from national recommendations, guidelines, and regulatory provisions., Results: Single-use medical gloves mainly serve to protect the health-care professional and are only rarely meant to promote patient safety. For reasons of occupational safety and self-protection, hand hygiene should be performed after single-use medical gloves are removed. In a study of opened glove boxes, human pathogenic bacteria were detected on around 13% of single-use medical gloves. A meta-analysis found that wearing single-use medical gloves can lower the risk of nosocomial infection (incidence rate ratio, IRR: 0.77 [0.67; 0.89]. In a randomized controlled trial, adherence for putting on single-use medical gloves without prior hand disinfection was 87%. On the other hand, where hand disinfection was expected to be performed before putting on gloves, adherence was 41%. Proper use can lower the rate of occupational skin diseases and improve adherence to hand hygiene for the five moments in which it is recommended (before and after patient contact, before aseptic procedures, after contact with potentially infectious material, and after contact with the immediate patient environment)., Conclusion: Limiting the use of single-use medical gloves to its proper indications promotes the safety of health-care professionals and patients and has beneficial ecological and economic effects as well.

Dry reforming of methane is a promising reaction to convert CO 2 and combat climate change. However, the reaction is still not feasible in large-scale industrial applications. The thermodynamic need for high temperatures and the potential of carbon deposition leads to high requirements for potential catalyst materials. As shown in previous publications, the Ni-doped perovskite-oxide Nd 0.6 Ca 0.4 Fe 0.97 Ni 0.03 O 3 is a potential candidate as it can exsolve highly active Ni nanoparticles on its surface. This study focused on controlling the particle size by varying the reduction temperature. We found the optimal temperature that allows the Ni nanoparticles to exsolve while not yet enabling the formation of deactivating CaCO 3 . Furthermore, the exsolution process and the behaviour of the phases during the dry reforming of methane were investigated using in situ XRD measurements at the DESY beamline P02.1 at PETRA III in Hamburg. They revealed that the formed deactivated phases would, at high temperatures, form a brownmillerite phase, thus hinting at a potential self-healing mechanism of these materials., Competing Interests: The authors declare no conflict of interest., (This journal is © The Royal Society of Chemistry.)

Cancer of the skin represents a challenge for radiological protection, as it is very common and involves the largest organ of the human body, which is exposed to environmental stress, including ionizing radiation. The most common subtypes, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) have very low mortality. Current consideration of skin cancer in radiological protection is mainly based on data from the 1990s, which indicate that BCC may be induced by ionizing radiation, SCC is only weakly associated with ionizing radiation, and malignant melanoma (MM) is not considered as ionizing radiation-induced. In a semi-systematic review of the evidence between 1990 and 2023, we snowballed 19 index articles. We identified 29 articles with information on a potential dose-response relationship between skin cancer and ionizing radiation exposure and assessed the evidence for a causal association. Exposure situations included a-bomb survivors, therapeutic and occupational exposure (airlines, nuclear and medical facilities) and residents exposed to radon. There is currently no epidemiological evidence that MM or SCC are caused by ionizing radiation. The only skin cancer type with evidence for a causal relationship is BCC, and evidence is limited to exposures above 0.5 Gy with a wide range of risk levels per dose. Thus, ionizing radiation-inducible skin cancer refers to BCC only and only at levels of exposure beyond those experienced by the vast majority of people exposed today., (© 2024 Society for Radiological Protection. Published on behalf of SRP by IOP Publishing Limited. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Background: Immunization against vaccine-preventable diseases prior to pregnancy is an important measure of primary prevention both for the mother and the unborn child. We analyzed immunity rates against measles, mumps, rubella, varicella, and pertussis in pregnant employees in Germany prior to significant changes in legal conditions in 2020, to provide a basis of comparison for future research., Methods: We analyzed occupational-medical routine data in three collectives of pregnant women with an occupational risk of infection in the years 2018 and 2019: 1: hospital staff with regular access to an in-house company physician (n = 148); 2: employees in childcare with regular access to external occupational-health services (n = 139); 3: teachers with no regular access to occupational healthcare (n = 285). Immune status was assessed by a physician based on vaccination certificates, laboratory results, and medical documentation on prior infections. We compared immunity rates against measles, rubella, varicella, and pertussis as well as full immunity against all targeted vaccine-preventable diseases., Results: Altogether, n = 572 pregnant women were included in our study. Of these women, 96.5 % were immune to rubella, 95.8 % to varicella, 88.3 % to measles, 82.7 % to mumps, and 67.8 % to pertussis. Only 56.2 % of the women had full immunity against all targeted vaccine-preventable diseases. Collective 1 showed the highest immunity rates against measles and pertussis as well as the highest rate of full immunity against all targeted vaccine-preventable diseases. The immunity rates against rubella and varicella did not differ significantly between the collectives. With the exception of rubella, the lowest immunity rates during pregnancy were found in Collective 3., Conclusion: We found pregnancy-relevant immunity gaps in all our study groups with significant differences between the collectives. Considering the potentially devastating consequences of infections during pregnancy, all medical professionals and health-policy makers should be involved in an increased effort to improve vaccination rates prior to pregnancy., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Anna Wolfschmidt-Fietkau, Uta Ochmann, and Hans Drexler report financial support was provided by the Bavarian State Ministry of Education and Cultural Affairs and by the Bavarian Occupational-Medical Institute for Schools (AMIS-Bayern) at the Bavarian Office for Health and Food Safety (Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, LGL). The other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Aluminum (Al) adjuvants have been used in vaccines and subcutaneous immunotherapy (SCIT) for decades. Despite indisputable neurotoxic properties of Al, there is no clear evidence of a causal relationship between their use and any neurotoxic side effects. However, recent rat studies have shown an accumulation of Al from adjuvants in tissues, especially in bones., Objectives: Since the human toxicokinetics of Al-adjuvants are poorly understood, this study aimed to evaluate whether up-dosed or long-term SCIT with Al-coupled extracts leads to increased Al load in humans., Methods: This observational cross-sectional case-control study explored Al excretion in hymenoptera venom allergy patients recruited in 2020 before initiation (n = 10) and during ongoing (n = 12) SCIT with Al-based preparations. Urine samples were collected before and 24 h after the SCIT injections and analyzed for aluminum content by using atomic absorption spectrometry. The cumulative administered Al dose was extracted from patient records. Patients receiving long-term immunotherapy were treated between 2.8 and 13.6 years (mean 7.1). Other potential sources of Al exposure were surveyed., Results: Patients who had received Al-coupled immunotherapy for several years showed significantly (p < 0.001) higher Al excretion than the controls at initiation of immunotherapy (mean 18.2 μg/gC vs. 7.9 μg/gC) and predominantly (73%) were above the 95th percentile of the general populations' exposure (>15 μg/gC), however, without reaching levels of toxicological concern (>50 μg/gC). Taking both groups together excreted Al levels correlated with the cumulative administered Al dose from SCIT (linear regression: Al urine  = 8.258 + 0.133*Al cum ; p = 0.001)., Discussion: These results suggest a relevant iatrogenic contribution of long-term SCIT to human internal Al burden and potential accumulation. Considering the medical benefits of Al-adjuvants and SCIT a differentiated risk-benefit analysis is needed. For certain scenarios of potential toxicological concern in clinical practice biomonitoring might be advisable., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Nicola Wagner reports a relationship with ALK-Abelló, Novartis Pharma GmbH, Allergopharma GmbH & Co KG, Sanofi-Aventis Deutschland GmbH, Shire/Takeda, Blueprint, AbbVie Deutschland GmbH & Co KG and with Biocryst that includes: consulting or advisory, funding grants, and speaking and lecture fees., (Copyright © 2024 The Authors. Published by Elsevier GmbH.. All rights reserved.)

(1) Background: Environmental risks such as air pollutants pose a threat to human health and must be communicated to the affected population to create awareness, such as via health literacy (HL); (2) Methods: We analyzed HL in the context of environmental health risks, including sources of information and prior knowledge, in a sample from the German general population using Kendall's rank correlations, regression analyses, and explorative parallel mediation analysis; (3) Results: The survey included 412 German participants aged between 18 and 77. HL was found to be problematic to inadequate. The internet, family and friends, and newspapers were the most frequently cited sources of information. Mobile apps were mostly unknown but were requested by sample subjects. Although subjects expressed environmental concerns and exhibited rather good levels of knowledge, the majority perceived no risk to human health and rated air quality quite positively. Knowledge on particulate matter, the term "ultrafine particles", and protective measures was found to be rather low. HL was associated with the use of newspapers and commercials as sources of information. The relationship between age and HL is fully mediated by the use of newspapers and information from TV commercials; (4) Conclusions: HL should be promoted by raising awareness of the health effects of environmental pollutants. In particular, the information channels preferred by the affected population should be used and further information opportunities such as apps should be publicized, e.g., through campaigns. An improved HL can assist policy makers in creating a healthier environment by empowering individuals to become more environmentally aware and protect their own health. This, in turn, has the potential to reduce health-related costs.

Background: Environmental factors can play an important role in pathogenesis. However, the understanding of the relationship between environmental risks and health in the general population appears to be poor. The aim of this systematic review is to describe the state of research on the relationship between health literacy (HL) or environmental health literacy (EHL) and environmental risks differentiated by the researched environmental risks, the affected population, the measurement and level of HL or EHL, and their interaction with other variables., Methods: A systematic literature search was conducted using the Pubmed, Scopus, and LIVIVO databases. Original studies in German or English that investigated HL or EHL in the context of an environmental risk or pollutant in a population were included. The Navigation Guide was used to assess the methodological quality of the studies., Results: Twenty-four studies were included in the qualitative analysis. The operationalization of HL or EHL was heterogeneous in 22 studies. Nine studies referred to environmental issues in general, and 15 studies analyzed individual environmental risks. Eleven studies referred to the general population, 12 to specified target groups, and 1 study examined both. The level of HL or EHL proved to be in need of improvement in all populations. Interventions such as trainings were able to increase HL or EHL., Discussion: The heterogeneous operationalizations impede the comparability of the studies. Future work should target the standardization of methodological aspects. Overall, it appears that interventions such as trainings were conducive to improving HL or EHL. In practice, this should therefore be given greater focus in order to increase HL or EHL., (© 2023. The Author(s).)

Background: Outdoor workers are at increased risk of developing skin cancer. Setting-based prevention at the workplace can reduce the UV exposure of outdoor workers through appropriate technical or organizational measures. We explored the implementation of setting-based UV protection at the workplace in Germany from the perspective of outdoor workers., Methods: A Germany-wide sample of 319 outdoor workers from different employment sectors (64.3% male) was surveyed via telephone on different technical and organizational measures for UV protection at the workplace. Bivariate analyses were performed to explore associations with job-related characteristics., Results: In general, 28.0% were rarely or never provided with a place in the shade during working hours, and 27.4% rarely or never provided with a shaded place during breaks. One-third had rarely or never the opportunity to work in the shade on hot summer days. Overall, 51.9% reported receiving protective clothing from their employer, 45.5% were provided with headgear, and 25.1% with sunscreen. About one-third had often or always the option of starting work earlier in the morning on hot summer days to work less in the sun, while 18.6% had to work overtime on such days. One-third (35.4%) had been educated at work about risks of solar radiation and sun protection measures., Conclusions: Our study is among the first to present findings on the implementation of different setting-based UV protection measures at the workplace and provides starting points for employers and policy makers to improve UV protection at the workplace., (© 2023 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)

Background and Purpose: Aluminum can be released into food by aluminum-containing food-contact materials (Al-FCM) during preparation or storage. There is considerable concern that extra aluminum intake may have negative effects on public health, especially with regard to its high background exposure and neurotoxic properties of aluminum in high exposures. Human in-vivo data on the additional aluminum load from Al-FCM, however, are lacking. As such, the objective of this study was to explore whether the consumption of a diet highly exposed to such products leads to an increased systemic Al load in real-world conditions., Materials and Methods: An exploratory, single-arm intervention study with a partially standardized diet was designed and carried out with 11participants. The same 10-day sequence of dishes was repeated three times. Participants were exposed to Al-FCM from Days 11 to 20, whereas control-phase meals were prepared without Al-FCM during the first and last 10-day periods. Spot urine samples were collected each morning and evening and analyzed for their aluminum concentration; appropriate contamination countermeasures were taken., Principal Results: Urinary aluminum excretion showed a strong dependency on the creatinine concentration in urine and required adjustment in further analyses. The creatinine-adjusted aluminum excretion during the exposure phase (median 1.98 µg/g creatinine) was higher than in both control phases (1.78 µg/g creatinine each). Two different mixed-effects regression models showed a significant effect in the exposure phase. Considering a discrete time effect, the creatinine-adjusted mean increase in the exposure phase was estimated to be 0.19 µg/L (95% CI: 0.07-0.31; p = 0.0017)., Major Conclusions: This study demonstrated a measurable but fully reversible additional Al burden in humans from subacute Al-FCM exposure under real-world conditions. The estimated increase from Al-FCM corresponds to 8% of the baseline concentration. These data enable a more robust assessment of human health risks by Al-FCM., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper: [Hans Drexler reports financial support was provided by European Aluminium Foil Association (EAFA) Part of AMS Europe e.V. Hans Drexler reports a relationship with DFG Permanent Senate Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area that includes: board membership. Thomas Goeen reports a relationship with DFG Permanent Senate Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area that includes: board membership.]., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Ultraviolet (UV) exposure during outdoor work increases the risk of developing skin cancer. Therefore, the uptake of recommended sun protection behaviors is important to prevent UV-related skin damage in the population of outdoor workers. To develop targeted prevention campaigns, information on the use of sun protection behaviors in different industries is needed., Methods: A total of 486 outdoor workers were surveyed on the use of several sun protection measures as part of the 7th wave of the National Cancer Aid Monitoring. Furthermore, details on job-related characteristics, sociodemographics, and skin type were assessed. Descriptive analyses stratified by sex were conducted., Results: In general, use of sun protection was insufficient (e.g. 38.4% used sunscreen on the face). Sun protection behavior differed between female and male outdoor workers with females being more likely to use sunscreen and males being more likely to wear sun protective clothes and headgear. For male outdoor workers, we revealed several associations with job-related characteristics. For instance, those who were employed full time were more likely to wear sun protective clothes (e.g. shoulder-covering shirt: 87.1% versus 50.0%, P < 0.001)., Discussion: We identified deficits in sun protection behavior in outdoor workers and differences by sex- and job-related characteristics. These differences offer starting points for targeted prevention measures. In addition, the findings may inspire qualitative research., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Since abolishing the obligation to terminate the harmful professional activity from January 1st, 2021 onwards for some occupational diseases including obstructive respiratory diseases in Germany, the recognition of occupational diseases coded under 4301, 4302 and 1315 according the Occupational Diseases Ordinance has increased significantly. By the time these diseasese are recognized, they are usually already at an advanced stage. Therefore, early detection will play a greater role in the future, as the statutory accident insurance can offer individual preventive measures in order to minimize the consequences of illness and thus also the socio-economic burden. However, precursors of such obstructive airway diseases are often overlooked. For optimizing early detection, the statutory accident insurance worked out an early notification procedure for the respiratory tract - comparable to the already well-established dermatological procedure. "Early cases" from the pilot regions can be reported there; to qualify for being reported as early cases, patients must persue insured professional activity with potential effects on the respiratory tract and suffer from a disease of the upper or lower respiratory tract according to the ICD-10 code (e.g. J31.0 chronic rhinitis)., Competing Interests: Das Autorenteam erklärt, dass es Forschungsunterstützung von der Deutschen Gesetzlichen Unfallversicherung (DGUV, Projekt-Nummer FF-FB0279) erhalten sowie Honorare für Gutachten und Vorträge bezogen hat., (Thieme. All rights reserved.)

Aim of the Study: The measles protection act and the updated recommendations of the permanent commission of vaccination (STIKO) include the obligatory proof of a double vaccination against measles for employees (born after 1970) in childcare. In addition, the standard and professional recommendations for vaccinations should be respected. A retrolective evaluation of vaccination gaps of employees in institutions for preschool childcare was performed., Methods: The database of 2018 and 2019 of the B·A·D-Health center Erlangen have 1300 recorded cases of occupational medical consultations in preschool childcare. Double consultations and consultations with insufficient data were excluded. 1016 contacts were analyzed with regard to vaccination gaps of measles, mumps, rubella, varicella, pertussis, hepatitis A+B and early summer meningoencephalitis. The evaluation was primarily based on the employees' vaccination cards. Vaccination gaps were assumed in case of missing, commenced or incomplete vaccination protection., Results: In this cohort of 1016 employees, the vaccination gap for measles increased from 16.2% to 20.6%, when applying the updated STIKO recommendation and the resulting change of definition of complete vaccination protection from measles. Further gaps were 22.7% for mumps, 18.9% for rubella, 2.3% for varicella, 27.8% for pertussis, 61.1% for hepatitis A and 60.5% and tick-borne encephalitis. The age group <30 years showed less vaccination gaps than the age group ≥30 years., Conclusion: The evaluation of the health center in Erlangen showed considerable age-dependent vaccination gaps in the cohort of employees of preschool childcare. The measles protection act that makes vaccination against measles mandatory contributes to closing this gap. There is room for counselling as well as for action regarding vaccine-preventable diseases in occupational medicine., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenskonflikt besteht., (Thieme. All rights reserved.)

(1) Background: Keratinocyte cancer (KC) is associated with exposure to ultraviolet (UV) radiation. However, data are controversial as to whether chronic UV exposure or high intermittent UV exposure are key drivers of carcinogenesis in cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC). Prolonged sun exposure of the skin causes photo-aging, which is associated with actinic elastosis, a condition characterized by the degeneration of elastin in the upper dermis, which is assessable via conventional histology. In this study, we aimed to compare the degree of actinic elastosis in different types of KC with regard to various patient characteristics. (2) Methods: We defined a semiquantitative score for the degree of actinic elastosis ranging from 0 = none to 3 = total loss of elastic fibers (basophilic degeneration). The extent was measured histometrically by two independent dermatohistopathologists in the immediate vicinity of 353 KC. The scores were merged and matched with tumor types (cSCC and BCC with subtypes), and clinical variables such as body site, sex and age. (3) Results: As expected, the degree of actinic elastosis correlated with age. However, it was significantly higher in cSCC compared to BCC irrespective of age, sex, body site and tumor subtypes. (4): Conclusions: Lifetime sun exposure may be estimated via routine histology using this scoring technique for actinic elastosis as a surrogate marker. cSCCs are more strongly associated with chronic UV exposure than BCCs, even in sun-exposed localizations such as the face.

Purpose: Beryllium is known to have adverse health effects and is classified as carcinogenic to humans. However, data on systemic beryllium exposure in humans are rare and especially human toxicokinetics are largely uncharted. As such, the first reported multi-annual course of blood and urine concentrations after a high exposure scenario provides important new insights., Methods: For a medical follow-up biomonitoring samples were collected for 56 months from a male subject after an accidental and multi-faceted high exposure. Sampling started on day 2 post-exposure for urine and day 147 for blood. The samples were analyzed by inductively coupled mass spectrometry (ICP-MS) and plotted longitudinally as a function of time. Terminal half-lives were calculated assuming a first-order elimination process., Main Findings: Both matrices showed highly increased initial concentrations (about 100-fold), despite the 147-day delay in blood sampling, and a marked decline over time. In urine, a two-phase excretion process was suspected based on the longitudinal data. Calculations gave terminal half-lives of 117.5 days and 666.5 days for phases 1 and 2, respectively. Blood kinetics called for a terminal half-life of 103.5 days. Elimination kinetics in blood and urine were comparable, simultaneously gathered samples showed an excellent correlation (R² = 0.985)., Principal Conclusions: The long-term follow-up after a high initial exposure to beryllium provides the first detailed insights into the elimination course of systemically available beryllium in humans. Conform kinetics of beryllium in urine and blood and the strong correlation between both parameters indicate high data validity and support the good representation of the current systemically available beryllium by urine and blood concentration in humans. The relatively long terminal half-lives in both matrices suggest a possible accumulation in humans in case of repeated exposures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier GmbH. All rights reserved.)

Background: Air pollutants are a health risk for the entire population. Particulate matter (PM) including the smallest fraction, ultra-fine particles (UFP), therefore continue to be the focus of scientific research in this area. To protect the population from the harmful effects of exposure to PM, communication and information of research results are of special relevance as individuals with heightened awareness of the harms of poor air quality are more likely to take action to improve their exposure., Methods: We conducted a scoping review of the scientific literature on science communication of public health information about risks associated with air pollutants to generate an initial over-view of existing research in this field. We searched the PubMed and Scopus databases and analyzed the data using a structured topic modeling (STM) approach., Results: The existing scientific literature dates back to 1958 but increases significantly from the 1990s onwards. Publications are mainly found in the discipline of environmental research and are primarily concerned with health effects. It is often stated that adequate communication of the results to the public would be important, but specific approaches are rare. Overall, the topic of risk communication seems to be underrepresented for both air pollutants and UFP., Conclusions: To protect public health, it is important to conduct more intensive science and risk communication related to scientific findings on the risks of air pollutants. For adequate communication and information, further research is needed to provide specific approaches that also involve the affected population and take different target groups into account. In addition, the effectiveness of communication efforts should also be analyzed., (© 2023. The Author(s).)

Co-doped Au 25 nanoclusters with different numbers of doping atoms were synthesized and supported on CeO 2 . The catalytic properties were studied in the CO oxidation reaction. In all cases, an enhancement in catalytic activity was observed compared to the pure Au 25 nanocluster catalyst. Interestingly, a different catalytic performance was obtained depending on the number of Co atoms within the cluster. This was related to the mobility of atoms within the cluster's structure under pretreatment and reaction conditions, resulting in active CoAu nanoalloy sites. The evolution of the doped Au clusters into nanoalloys with well-distributed Co atoms within the Au cluster structure was revealed by combined XAFS, DRIFTS, and XPS studies. Overall, these studies contribute to a better understanding of the dynamics of doped nanoclusters on supports upon pretreatment and reaction, which is key information for the future development and application of bimetallic nanocluster (nanoalloy) catalysts.

Background: In recent years, the topic of health-oriented leadership (HoL) has often been investigated with health-related outcomes like general health, strain, depression, and anxiety symptoms. In contrast, research which considers the gender of leaders and employees in connection to HoL as well as studies on relationships between HoL and job satisfaction, are scarce. The aim of this paper is to explore the relationships between HoL and health status assessed by employees and leaders, to analyse the relationships between HoL and job satisfaction as a non-health-related outcome for employees and leaders and to examine differences in the assessment of HoL between men and women in a representative dataset of the working population in Germany., Methods: Data were collected via an access panel as a cross-sectional survey. The quota sample included 643 German workers (managers and employees). We focused on staff-care as a core component of HoL. Statistical analyses were performed using Pearson correlations and regression analyses as well as t-tests and Mann-Whitney-U-Tests., Results: The results showed no significant differences between male and female employees or leaders in assessing HoL. Regarding HoL we found relationships between self-rated health status or job satisfaction, both for the self-rated assessment of leaders and employees., Conclusions: Our findings indicate relationships between HoL and well-being as well as job satisfaction at the workplace. For interventions of any kind, the lack of gender effects leaves a wide scope for the implementation of health-promoting measures. In particular, the findings on the relationship between HoL and job satisfaction through leaders' self-assessment could be used for salutogenic approaches to strengthen resources in leadership trainings., (© 2023. The Author(s).)

Squamous cell carcinomas (SCC) of the skin can be induced by occupational exposures to polycyclic aromatic hydrocarbons (PAHs), as in tar and soot, or to UV radiation and can be recognized and compensated as occupational diseases. A possible syncarcinogenic effect of these exposures in the development of SCC in humans is under discussion. For the scientific validation of this question, a systematic literature search was conducted using the databases PubMed, Web of Science, and Scopus. Studies on individuals with SCC of the skin and their precursors as well as occupational, non-occupational, or therapeutic exposure to UV radiation and PAHs were selected. In addition, animal studies with exposure to UV radiation and PAHs were evaluated. After screening the abstracts of 510 identified studies, the full texts of 131 studies were reviewed. None of the epidemiological studies provided robust evidence for a syncarcinogenesis of PAHs and UV radiation in the development of SCC of the skin in humans. Nevertheless, as there are indications for a (super-)additive effect of UV radiation and PAH exposure from animal studies and mechanistic investigations, syncarcinogenesis seems possible. However, quantitative dose-response relationships are lacking which would allow comparison of the onset of an adverse effect between the different exposure levels., (© 2022 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)

Monolayer protected Au nanocluster catalysts are known to undergo structural changes during catalytic reactions, including dissociation and migration of ligands onto the support, which strongly affects their activity and stability. To better understand how the nature of ligands influences the catalytic activity of such catalysts, three types of ceria supported Au nanoclusters with different kinds of ligands (thiolates, phosphines and a mixture thereof) have been studied, employing CO oxidation as model reaction. The thiolate-protected Au 25 /CeO 2 showed significantly higher CO conversion after activation at 250 °C than the cluster catalysts possessing phosphine ligands. Temperature programmed oxidation and in situ infrared spectroscopy revealed that while the phosphine ligands seemed to decompose and free Au surface was exposed, temperatures higher than 250 °C are required to efficiently remove them from the whole catalyst system. Moreover, the presence of residues on the support seemed to have much greater influence on the reactivity than the gold particle size., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. ChemCatChem published by Wiley-VCH GmbH.)

Background: Workplace health promotion (WHP) as a part of workplace health management (WHM) was strengthened in German legislature with the Prevention Act of 2015. However, smaller enterprises often do not offer WHM or WHP. Accordingly, a model-project for improving the uptake and implementation, particularly in micro-, small, and medium-sized enterprises (MSMEs) was carried out. The aim of the study was to determine reasons for non-participation in WHP offers and analyze communication issues, both from the employee's and employer's perspective., Methods: In total, 21 managers or persons responsible for WHP participated in the first online survey between March and April 2020, and 156 employees responded to the second online survey between June and October 2021. The importance of barriers and communication issues was investigated. Based on a principal component analysis on non-participation, differences regarding sociodemographic variables were analyzed., Results: Most employees knew about the offered measures and that the measures were cost free. There was no significant association between having communicated the offers to the employees and considering them suitable for their needs. Most of the managers or persons responsible for WHP rated the measures as sufficiently varied and allowed staff to take part during working-time. Reasons for non-participation from the managers' point of view were travel time to the location of the offers, lack of time, and a missing fit between offers and employees' needs. From the employees' point of view, workload (including working time) was the main barrier to participation., Conclusions: For the practical implementation of model projects in MSMEs, special attention should be paid to ensuring opportunity to participate, which may be easier with in-house offers.

Objectives: Respiratory symptoms at work are common among hairdressers. Various working materials, most notably bleaching ingredients such as ammonium persulfate, have been made responsible. The objective of this study is to achieve a better understanding of work-related respiratory symptoms of hairdressers by describing common features in a large affected collective., Methods: One hundred forty-eight hairdressers with respiratory symptoms at work presenting between 2012 and 2019 were consecutively included in a case series. Anamnestic and diagnostic data including pulmonary function and allergy testing were retrospectively compiled from records and analysed. Additionally, cases were categorised in five groups with respect to occupational causation certainty., Results: 30% of the predominantly female collective had changed jobs or were on longer sick-leave. Besides respiratory symptoms, 10% also reported contact urticaria to blonde dyes. In 60% an obstructive airway disease was confirmed. A specific hypersensitivity reaction to ammonium persulfate was found in 15%. Group 1 with a proven immunological occupational causation showed significantly lower age (p < 0.001) and tenure time (p = 0.001), higher sensitization rates against environmental allergens as well as a higher total IgE (p = 0.015), compared to group 4 (obstructive airway disease, specific occupational causation unlikely)., Conclusions: This case series contributes to a better characterization of work-related respiratory symptoms in hairdressing as one of the largest examined collectives of symptomatic hairdressers. Ammonium persulfate as the most common specific cause showed signs of a type-I-like hypersensitivity reaction with typical risk factors for atopy. Prick testing is recommended in all symptomatic cases. However, a specific occupational causation often cannot be proved., (© 2022. The Author(s).)

Aim: Several studies have pointed out considerable deficits in the implementation of legal requirements regarding occupational safety and health (OSH) as well as company integration management in Germany. The aim of this review was a quantitative analysis of company size and fulfilment of legal requirements in OSH and company integration management in German companies over a period of time., Methods: In October 2019, we performed a systematic literature search of German and English language publications with representative data which include the rates of OSH implementation along with company integration management in Germany. This was done using the databases Pubmed, PsycInfo and WISO. The study was updated in October 2020, while cross-referencing, with grey literature also included in the search. The analysis was carried out by 2 independent reviewers., Results: A total of 16 relevant studies were examined with respect to OSH and company integration management. A slight decline in implementation rates of OSH care was apparent over time. In the care model, an increase in the number of employees resulted in increased need for both regular and demand-oriented care. Regardless of size, all companies were characterized by a steady rise in the implementation rates of risk assessment (including psychosocial risk assessment). In addition, the implementation rates of company inspections and company integration management exhibited an increase over time., Conclusion: Despite moderately increasing implementation rates in almost all sub-areas of OSH and company integration management over the last 20 years, it is evident that an area-wide implementation of legal requirements has not yet been achieved. The results indicate a standardization of methodological aspects for further studies. The implementation of legal requirements is an important factor for maintaining the employability of employees., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Malignant melanoma is an aggressive skin tumor with a good prognosis when treated in an early tumor stage, but has a poor prognosis with distant metastases. The incidence of malignant melanoma has increased continuously over the last decades, with little change in mortality. One explanation for this is that melanomas are increasingly detected in early stages, especially after the establishment of statutory skin cancer screening in 2008, which allows a free skin examination every 2 years for people older than 35 years., Methods: In this study incidence and mortality of malignant melanoma were correlated with the dermatologist density in Bavarian administrative regions. In addition, the incidence data were compared before and after the introduction of statutory skin cancer screening., Results: There was a significant correlation between the incidence of malignant melanoma and dermatologist density (r = 0.258, p = 0.044), but no correlation between mortality and dermatologist density (r = 0.201, p = 0.121). Similarly, the increase of malignant melanoma incidence following the introduction of statutory skin cancer screening in 2008 was independent of dermatologist density (r = 0.021, p = 0.873)., Conclusion: The dermatologist density in Bavaria correlates positively with the incidence of malignant melanoma. Despite an increased incidence, mortality was not elevated in the respective administrative regions., (© 2021. The Author(s).)

Replacement of protecting ligands of gold nanoclusters by ligand exchange has become an established post-synthetic tool for selectively modifying the nanoclusters' properties. Several Au nanoclusters are known to additionally undergo size transformations upon ligand exchange, enabling access to cluster structures that are difficult to obtain by direct synthesis. This work reports on the selective size transformation of Au 15 (SG) 13 (SG: glutathione) nanoclusters to Au 16 (2-PET) 14 (2-PET: 2-phenylethanethiol) nanoclusters through a two-phase ligand exchange process at room temperature. Among several parameters evaluated, the addition of a large excess of exchange thiol (2-PET) to the organic phase was identified as the key factor for the structure conversion. After exchange, the nature of the clusters was determined by UV-vis, electrospray ionization-time of flight mass spectrometry, attenuated total reflection-Fourier transform infrared, and extended x-ray absorption fine-structure spectroscopy. The obtained Au 16 (2-PET) 14 clusters proved to be exceptionally stable in solution, showing only slightly diminished UV-vis absorption features after 3 days, even when exposed to an excess of thiol ligands.

Metals reach humans through food and drinking water intake and inhalation of airborne particles and can have detrimental health effects in particular for children. The metals presented here (lead, cadmium, chromium, and mercury) could lead to toxic effects such as neurotoxicity, mutagenicity, and have been classified as (possible) carcinogens. Using population representative data from the German Environmental Survey 2014-2017 (GerES V) from 3- to 17-year-old children on lead and cadmium in blood (n = 720) and on cadmium, chromium, and mercury in urine (n = 2250) we describe current internal exposure levels, and socio-demographic and substance-specific exposure determinants. Average internal exposure (geometric means) in blood was 9.47 μg/L for lead and below 0.06 μg/L (limit of quantification) for cadmium, and in urine 0.072 μg/L for cadmium, 0.067 μg/L for mercury, and 0.393 μg/L for chromium, respectively. Younger children have higher concentrations of lead and chromium compared to 14-17-year-old adolescents, and boys have slightly higher mercury concentrations than girls. With respect to substance specific determinants, higher lead concentrations emerged in participants with domestic fuel and in non-smoking children with smokers in the household, higher levels of cadmium were associated with smoking and vegetarian diet and higher levels of mercury with the consumption of seafood and amalgam teeth fillings. No specific exposure determinants emerged for chromium. The health based guidance value HBM-I was not exceeded for mercury and for cadmium in urine it was exceeded by 0.6% of the study population. None of the exceedances was related to substantial tobacco smoke exposure. Comparisons to previous GerES cycles (GerES II, 1990-1992; GerES IV, 2003-2006) indicate continuously lower levels., (Copyright © 2021. Published by Elsevier GmbH.)

Navigating animals combine multiple perceptual faculties, learn during exploration, retrieve multi-facetted memory contents, and exhibit goal-directedness as an expression of their current needs and motivations. Navigation in insects has been linked to a variety of underlying strategies such as path integration, view familiarity, visual beaconing, and goal-directed orientation with respect to previously learned ground structures. Most works, however, study navigation either from a field perspective, analyzing purely behavioral observations, or combine computational models with neurophysiological evidence obtained from lab experiments. The honey bee ( Apis mellifera ) has long been a popular model in the search for neural correlates of complex behaviors and exhibits extraordinary navigational capabilities. However, the neural basis for bee navigation has not yet been explored under natural conditions. Here, we propose a novel methodology to record from the brain of a copter-mounted honey bee. This way, the animal experiences natural multimodal sensory inputs in a natural environment that is familiar to her. We have developed a miniaturized electrophysiology recording system which is able to record spikes in the presence of time-varying electric noise from the copter's motors and rotors, and devised an experimental procedure to record from mushroom body extrinsic neurons (MBENs). We analyze the resulting electrophysiological data combined with a reconstruction of the animal's visual perception and find that the neural activity of MBENs is linked to sharp turns, possibly related to the relative motion of visual features. This method is a significant technological step toward recording brain activity of navigating honey bees under natural conditions. By providing all system specifications in an online repository, we hope to close a methodological gap and stimulate further research informing future computational models of insect navigation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Paffhausen, Petrasch, Wild, Meurers, Schülke, Polster, Fuchs, Drexler, Kuriatnyk, Menzel and Landgraf.)

The fluoride ions of the industrially largely irreplaceable, locally corrosive hydrofluoric acid (HF) can scavenge cations in biological tissues, which explains their high toxic potential, and also leads to local acidification through proton release. The influence of three complexing agents, calcium (Ca 2+ ) gluconate (as 2.5% Ca 2+ gel and individually (2.84%) or commercially (10%) formulated Ca 2+ solution), magnesium (Mg 2+ ) gluconate (2.84%) solution and aluminium (Al 3+ ) solution (Hexafluorine®, pure and diluted) on the absorption of fluoride following HF exposure (1-3 min, 100 μl, 30%/0.64 cm 2 ) through human skin was investigated in an ex-vivo diffusion cell model. Fluoride absorption was assessed over 6-24 h and analysed with a fluoride electrode. Decreasing the contamination time reduced the fluoride absorption distinctly which was further reduced by the application of fluoride-binding decontamination agents (Ca 2+ , Mg 2+ , Al 3+ ) or water alone without being significantly different. Ca 2+ appeared slightly more effective than Mg 2+ in reducing fluoride absorption. Moreover, the addition of pH adjusting buffer promoted the decontamination efficacy. Fluoride-binding agents can facilitate the decontamination of dermal HF exposure. However, prompt decontamination appeared to be the key to successful limitation of fluoride absorption and pushes the choice of decontamination agent almost into the background., (Copyright © 2020. Published by Elsevier Ltd.)

Teachers are facing various job demands with psychosocial aspects being fundamental due to the nature of the occupation. Although teachers' work is associated with different psychosocial health risks, little is known on how to identify and tackle those. Thus, a systematic literature search as per the PRISMA statement was conducted via MEDLINE (PubMed), PSYNDEX (PubPsych), and ScienceDirect. Two reviewers independently screened 2261 titles and abstracts and 169 full-texts. According to the inclusion criteria established a priori , articles from peer-reviewed journals (English or German) on psychosocial risk management in teachers were incorporated. Despite a comprehensive and sensitive search, only four publications could be identified, outlining a process to implement risk management and different assessment tools. Taken together, data presented in the articles were scarce. Recommendations for process steps and the assessment of psychosocial risks can be derived from the findings. To implement effective psychosocial risk management in the teaching profession, further research is needed, though. Effective and practicable approaches, which are accepted by the target group, should be further developed and investigated. Relevant causes of occupational strain in the teaching profession must be identified and assessed reliably. Low-threshold interventions should be implemented, and the outcome must be evaluated afterward., Competing Interests: All authors have no conflicts of interest to declare., (© 2020 The Authors.)

Skin temperature plays a certain role in the dermal absorption of substances, but the extent and mechanisms of skin temperatures-induced modulation in ranges caused by physiological thermoregulation or environmental conditions are largely unknown. The influence of dermal temperature on the absorption of the model lipophilic compound (anisole) and the model hydrophilic compounds (1,4-dioxane, ethanol) through human skin was investigated at three dermal temperatures (25, 32 and 39 °C) in an ex-vivo diffusion cell model. The substances were applied to the skin and transdermal penetration was monitored. All substances showed temperature dependent variations in their penetration behavior (3 h: 25-39 °C: 202-275% increase in cumulative, transdermally penetrated amounts). The relative differences in absorption in relation to temperature were greatest within 45 min after exposure (25-39 °C: 347-653% rise in cumulated penetration), although absolute amounts absorbed were small (45 min vs. 3 h: 4.5-14.5%). Regardless of blood circulation, skin temperature significantly influences the amount and kinetics of dermal absorption. Substance-dependent, temperature-related changes of the lipid layer order or the porous pathway may facilitate penetration. The early-stage modulation of transdermal penetration indicates transappendageal absorption, which may be relevant for short-term exposures. For both, toxicological evaluation and perfusion cell studies, it is important to consider the thermal influence on absorption or to perform the latter at a standardized temperature (32±1 °C)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: A two-fold risk increase to develop basal cell carcinoma was seen in outdoor workers exposed to high solar UV radiation compared to controls. However, there is an ongoing discussion whether histopathological subtype, tumor localization and Fitzpatrick phototype may influence the risk estimates., Objectives: To evaluate the influence of histological subtype, tumor localization and Fitzpatrick phototype on the risk to develop basal cell carcinoma in highly UV-exposed cases and controls compared to those with moderate or low solar UV exposure., Methods: Six hundred forty-three participants suffering from incident basal cell carcinoma in commonly sun-exposed anatomic sites (capillitium, face, lip, neck, dorsum of the hands, forearms outside, décolleté) of a population-based, case-control, multicenter study performed from 2013 to 2015 in Germany were matched to controls without skin cancer. Multivariate logistic regression analysis was conducted stratified for histological subtype, phototype 1/2 and 3/4. Dose-response curves adjusted for age, age 2 , sex, phototype and non-occupational UV exposure were calculated., Results: Participants with high versus no (OR 2.08; 95% CI 1.24-3.50; p  = 0.006) or versus moderate (OR 2.05; 95% CI 1.15-3.65; p  = 0.015) occupational UV exposure showed a more than two-fold significantly increased risk to develop BCC in commonly UV-exposed body sites. Multivariate regression analysis did not show an influence of phototype or histological subtype on risk estimates. The restriction of the analysis to BCC cases in commonly sun-exposed body sites did not influence the risk estimates. The occupational UV dosage leading to a 2-fold increased basal cell carcinoma risk was 6126 standard erythema doses., Conclusion: The risk to develop basal cell carcinoma in highly occupationally UV-exposed skin was doubled consistently, independent of histological subtype, tumor localization and Fitzpatrick phototype., Competing Interests: Competing interestsFunds. SJ received funding for educational lectures from the German Social Accident Insurance (DGUV). Outside the scope of this paper, he received institutional funding for investigator-initiated research from Pfizer, Novartis, ALK, and Sanofi. BA received funding for educational lectures, workshops and expert opinions from the German Social Accident Insurance (DGUV). Outside the scope of this paper, she received grants for research paid to the institution, fees for lectures and advisory boards from Novartis, Leo, Sanofi, Biofrontera, Lofarma, Circassia, ALK, Incyte Corporation, Genentech, Shire, and Atopixs Therapeutics Ltd. EP, FM, BT, BR, LB, DGS, SHJ received payments for expert witness for one of the collaborating as well as for other funds. BI, AP, KP, DH, LS, JSM, HL, HE do not declare any COI. Employer. FM and BT declare no conflicts of interest. As staff of the Institute for Prevention and Occupational Medicine (IPA), they are employed at the ‘Berufsgenossenschaft Rohstoffe und chemische Industrie’ (BG RCI), a public body which is a member of the study’s main sponsor, the German Social Accident Insurance. IPA is an independent research institute of the Ruhr-University Bochum. The authors are independent of the German Social Accident Insurance regarding study design, access to the collected data, responsibility for data analysis and interpretation, and the right to publish. The views expressed in this paper are those of the authors and not necessarily those of the sponsor. The other authors declare no potential conflicts of interest., (© The Author(s) 2020.)

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Influenza viruses (IV) exploit a variety of signaling pathways. Previous studies showed that the rapidly accelerated fibrosarcoma/mitogen-activated protein kinase/extracellular signal-regulated kinase (Raf/MEK/ERK) pathway is functionally linked to nuclear export of viral ribonucleoprotein (vRNP) complexes, suggesting that vRNP export is a signaling-induced event. However, the underlying mechanism remained completely enigmatic. Here we have dissected the unknown molecular steps of signaling-driven vRNP export. We identified kinases RSK1/2 as downstream targets of virus-activated ERK signaling. While RSK2 displays an antiviral role, we demonstrate a virus-supportive function of RSK1, migrating to the nucleus to phosphorylate nucleoprotein (NP), the major constituent of vRNPs. This drives association with viral matrix protein 1 (M1) at the chromatin, important for vRNP export. Inhibition or knockdown of MEK, ERK or RSK1 caused impaired vRNP export and reduced progeny virus titers. This work not only expedites the development of anti-influenza strategies, but in addition demonstrates converse actions of different RSK isoforms., Competing Interests: Competing interest statement: S.L. is cofounder and head of the board of Atriva Therapeutics GmbH, Tuebingen, Germany., (Copyright © 2020 the Author(s). Published by PNAS.)

Rare work-related illnesses do not usually meet the requirements to be recognised and compensated as a legal occupational disease. However, common diseases (e.g. ovarian carcinoma) are sometimes caused by occupational influences (e.g. asbestos), making the occupational disease ovarian cancer caused by occupational exposure to asbestos a rare disease. Since in our modern working world the occupational influences that are harmful to health are decreasing qualitatively (substitutes) and quantitatively (limit values), the diseases they cause are also becoming increasingly rare.

Background: The determination of various selenium species in urine enables a specific biomonitoring of the exposure to different selenium compounds., Methods: For this task a coupling of three chromatographic techniques with ICP-MS was developed for the separate quantification of eleven species in urine. The first procedure was based on reverse phase chromatography and was designed for the separate determination of methyl-2-acetamido-2-deoxy-1-seleno-b-d-galactopyranoside (SeSug1), methyl-2-acetamido-2-deoxy-1-seleno-b-d-glucopyranoside (SeSug2), selenomethionine (SeMet), methylselenocysteine (MeSeC), seleno-D,L-ethionine (SeEt), methylselenic acid (MeSeA) and methylselenoglutathione (MeSeG); the second procedure was based on anion exchange chromatography and measured selenate (Se (VI)) and selenite (Se (IV)); the third procedure was based on cationic exchange chromatography and determined methyl-2-amino-2-deoxy-1-seleno-b-d-galactopyranoside (SeSug3) and the trimethylselenium ion (TMSe). A fourth method for the more sensitive determination of TMSe was upgraded by an on-line after-column reaction process., Results: The validation of the methods yielded sensitive detection limits of the species between 0.03 and 0.10 μg Se/L. For TMSe a detection limit of 0.02 μg Se/L resulted by the fourth method. An intra-day precision of 2.7-10.6% and a relative recovery between 87 % and 108 % confirm the robustness of the methods., Conclusion: The developed procedures enable a separate and sensitive determination of eleven selenium species in urine and thus permit the exploring of metabolic factors in the general population and particularly exposed individuals., Competing Interests: Declaration of Competing Interest The authors declare that there is no conflict of interest., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Purpose: Selenium (Se) is an essential trace element, which however, exhibits a narrow safe range of intake. Selenium also occurs at several workplaces, which results in an inhalative selenium exposure of the employees. Thus, an efficient exposure assessment strategy is demanded. The most established parameter, selenium in plasma, mostly consists of protein-bound selenium. This study aimed to investigate urinary total selenium (Se-U) as an additional biomarker of recent human occupational exposure to elemental and inorganic selenium., Methods: Pre- and post-shift urine samples from employees with exposure to selenium-containing dust were analyzed to total selenium and compared with Se levels in urine samples from controls without occupational exposure to selenium as well as correlated with the recent ambient Se exposure by personal air monitoring., Results: Se-U in post-shift samples was considerably increased compared to the levels in pre-shift samples as well as to the controls. However, Se-U in pre-shift urine was elevated compared to the Se-U in controls too. Se-U in post-shift urine and even better the shift increment in Se-U correlated with the air exposure of the present shift. A rough estimation by Se-U shift increment and external exposure accounted for an inhalative resorption rate of about 1%., Conclusion: Our data indicate that Se-U can display the exposure. Pre-shift Se-U levels may be based on previous exposure and indicate a slow urinary elimination kinetics. The results hint for a rather low resorption rate of selenium and inorganic selenium compounds via the lung.

Background: Nickel allergy is the most prevalent contact allergy. It belongs to a different hypersensitivity type to asthma and rhinoconjunctivitis. The aim of this analysis was to assess whether self-reported nickel allergy is associated with incident wheezing, asthma and rhinoconjunctivitis in young German adults, taking into account potential effect modification by sex., Methods: In total, 2051 (70.6%) participants aged 19-24 years took part in the second phase of SOLAR (Study on Occupational Allergy Risks), a follow-up study of ISAAC II (the second phase of the International Study of Asthma and Allergies in Childhood) in Germany. Self-reported nickel allergy, as well as having pierced ears, and the three outcomes incident wheezing, asthma and rhinoconjunctivitis, were analysed stratified for sex. Logistic regression adjusted for potential confounders was performed., Results: An association between self-reported nickel allergy and incident wheezing was observed for men and women, while only in males did pierced ears show a significant association with the outcome (adjusted OR 2.26, 95% CI 1.10-4.62). Also only in males, self-reported nickel allergy was associated with elevated odds for incident asthma (adjusted OR 4.34, 95% CI 1.22-15.41). Neither in men nor in women was a significant association observed for incident rhinoconjunctivitis., Conclusion: Our results suggest that self-reported nickel allergy is associated with incident wheezing. Whether this association is due to environmental or genetic predisposition, or due to an overlap of the mechanisms of type I and type IV hypersensitivity, needs to be elucidated., Competing Interests: Conflict of interest: L. Kolberg has nothing to disclose. Conflict of interest: F. Forster has nothing to disclose. Conflict of interest: J. Gerlich reports grants from German Federal Ministry of Labour, grants from German Research Foundation, during the conduct of the study. Conflict of interest: G. Weinmayr has nothing to disclose. Conflict of interest: J. Genuneit has nothing to disclose. Conflict of interest: D. Windstetter has nothing to disclose. Conflict of interest: C. Vogelberg reports grants from Federal Ministry of Labor and Social Affairs, grants from Federal Office for Occupational Safety and Occupational Medicine and Federal Ministry of Labor and Social Affairs, during the conduct of the study. Conflict of interest: E. von Mutius reports grants from German Research Foundation (DFG – Deutsche Forschungsgemeinschaft), during the conduct of the study; personal fees from OM Pharma, personal fees from Peptinnovate, personal fees from Boehringer Ingelheim International GmbH, personal fees from HAL Allergie GmbH and personal fees from Nestlé Deutschland AG, outside the submitted work. Conflict of interest: D. Nowak has nothing to disclose. Conflict of interest: H. Drexler has nothing to disclose. Conflict of interest: T. Schäfer has nothing to disclose. Conflict of interest: K. Radon has nothing to disclose., (Copyright ©ERS 2020.)

The plasticizer di(2-ethylhexyl)phthalate (DEHP) is often used for PVC medical devices, that are also largely used for intensive care medical treatments, like extracorporeal membrane oxygenation (ECMO) therapy. Due to the toxicological potential of DEHP, the inner exposure of patients with this plasticizer is a strong matter of concern as many studies have shown a high leaching potential of DEHP into blood. In this study, the inner DEHP exposure of patients undergoing ECMO treatment was investigated. The determined DEHP blood levels of ECMO patients and the patients of the control group ranged from 31.5 to 1009 μg/L (median 156.0 μg/L) and from 19.4 to 75.3 μg/L (median 36.4 μg/L), respectively. MEHP blood levels were determined to range from < LOD to 475 μg/L (median 15.9 μg/L) in ECMO patients and from < LOD to 9.9 μg/L (median 3.7 μg/L) in the control group patients, respectively. Increased DEHP exposure was associated with the number of cannulas and membranes of the ECMO setting, whereas residual diuresis decreased the exposure. Due to the suspected toxicological potential of DEHP, its use in medical devices should be further investigated, in particular for ICU patients with long-term exposure to PVC, like in ECMO therapy., Competing Interests: FK received travelling fees from Getinge Deutschland GmbH; PML received travelling fees from Getinge Deutschland GmbH, and speaker fees from Mitsubishi Pharma, and CSL Behring. The other authors declared no conflict of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background and Objectives: Adverse health effects such as neurotoxic and carcinogenic effects through aluminum from cosmetic products have been repeatedly discussed. The dermal uptake and impact on the systemic aluminum load is still poorly understood. Therefore, we investigated the effect of daily antiperspirant use on the systemic aluminum load under real-life conditions., Methods: 21 healthy subjects meeting certain selection criteria to ensure a low systemic aluminum background load were asked to use a commercial aluminum-containing antiperspirant for 14 days. A questionnaire enquired about shaving habits and other sources of aluminum. Aluminum levels were measured before and after the exposure in 24-h urine and plasma using atomic absorption spectroscopy. Urine samples (n = 6) with <700 mg/day creatinine excretion or more than 30% difference in 24-h creatinine excretion were excluded from further analysis., Results: No significant increase in plasma aluminum concentration or total excreted aluminum per day before and after exposure was measurable. No sample exceeded the reference values of the general population (maximum: 9.42 µg/g creatinine and 2.1 µg/L plasma). Shaving habits did not have a significant influence on the systemic aluminum load. Also, no correlation between the total amount of antiperspirant applied and the systemic aluminum level could be demonstrated., Conclusions: No measurable contribution to the overall systemically available aluminum load due to daily use of an antiperspirant for 14 days could be shown, but real-life data concerning long-term use or higher concentrations are still lacking. Considering toxicological occupational exposure data, adverse neurotoxic changes are unlikely in the case of urinary excretion of <50 µg aluminum/g creatinine (= no observed adverse effect level), even following long-term exposure., (© 2019 S. Karger AG, Basel.)

Epicutaneous patch testing is the diagnostic standard for the detection of allergic contact dermatitis. The present guidelines are aimed at residents and board-certified physicians in the fields of dermatology and allergology as well as other medical specialties involved in establishing the indication for patch testing and its execution in patients with contact dermatitis and other forms of delayed-type hypersensitivity. The target audience also includes other health care providers and insurance funds. Based on a systematic literature search and a formal consensus process (S3), the guidelines were developed by dermatologists in collaboration with pediatricians, occupational medicine physicians, nursing staff as well as patient representatives. The systematic methodological approach and appraisal of evidence upon which the recommendations are based are outlined in a separate method report that also contains evidence tables. The guidelines address general aspects of patch testing as well as medicolegal issues. The recommendations given relate to topics such as the indication for patch testing, informed patient consent, as well as the choice of test substances, test chambers and test site, duration of exposure, reading times and interpretation of test reactions. Furthermore, recommendations are provided with respect to endogenous and exogenous factors, specific patient groups (children, pregnant women, immunosuppressed individuals) as well as possible risks and adverse events associated with patch testing using contact allergens., (© 2019 The Authors | Journal compilation © Blackwell Verlag GmbH, Berlin.)

Background: Chemical UV filters are common components in sunscreens and cosmetic products and used to protect the skin against harmful effects of sunlight like sunburn. However, the effectiveness of sunscreens in the prevention of skin cancer is in some parts still controversial. Meanwhile, questions about negative effects of the chemical UV filters on human health arise and request an effective risk assessment. Real-life exposure data in humans after application of these products are still rare. Thus, we explored whether and to what extent UV filters are absorbed through the skin into the human body., Material and Methods: Plasma and urine samples from 20 healthy volunteers were collected before, during and after a real-life exposure scenario (1st application: 2 mg/cm 2 ; 2nd and 3rd (after 2 and 4 h): 1 mg/cm 2 each) using a commercial sunscreen formulation for one day. These samples were analyzed for their content of the currently prominent UV filters octocrylene and avobenzone as well as 2-cyano-3,3-diphenylacrylic acid (CDAA) as the main octocrylene metabolite by using different liquid chromatography electrospray-ionization tandem mass spectrometric procedures., Results: Following dermal sunscreen exposure, avobenzone, octocrylene and CDAA reached concentrations up to 11 μg/L, 25 μg/L and 1352 μg/L in plasma. In urine detection rates of avobenzone and octocrylene were low while CDAA showed a high detection rate and reached up to 5207 μg/g creatinine. Kinetic models could be fitted for octocrylene and CDAA in plasma and CDAA in urine. Concentration peaks were reached between 10 and 16 h after first application and half-life periods were in the range of 1.5 to 2 days. The lipophilic UV filter octocrylene and its metabolite CDAA showed a much slower elimination than other more hydrophilic UV filters. Concordantly, the metabolite CDAA in particular showed a markedly increased renal excretion over the whole sampling period and indicated high internal exposure to OC., Discussion: Real-life sunscreen usage leads to considerable bioavailability of organic UV filters and their metabolites which is rarely seen for other environmental exposures. A combined monitoring of the parent compound and its metabolites is important to fully address internal exposure to the UV filter in humans. Considering the kinetic profiles a prolonged systemic release due to depot formation in skin and a potential accumulation through multi-day exposure is presumed. High in-vivo loads call for a critical toxicological assessment of the UV filters and their metabolites., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)