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39057227_p8
39057227
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1. Introduction
4.105469
biomedical
Study
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The purpose of this study is to provide a preliminary measurement of the effects of ethanol on the expression of the genes linked to ethanol tolerance in honey bees ( Apis mellifera ) using a free-flying paradigm. Specifically, we utilized biomarkers for toxicity and stress by measuring heat shock protein 70 (HSP 70) and big potassium ion channel protein (BKP) . These findings will enhance our understanding of the role of genetic markers in the development of functional ethanol tolerance.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995
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39057227
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1. Introduction
2.861328
biomedical
Study
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In the present experiment, HSP70 and BKP were examined as potential measurements of ethanol toxicity in honey bees. We anticipated that there would be changes in both biomarkers linked to functional ethanol tolerance. The results from this study may provide information on the use of these biomarkers when they are examined at the transcriptional level.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p10
39057227
sec[1]/p[0]
2. Materials and Methods
3.642578
biomedical
Study
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Data for this experiment were collected in summer of 2020 in Stillwater, Oklahoma. Bees ( N = 63) were captured from an artificial feeder containing a 10% sucrose solution using matchboxes. Collecting bees in this manner ensured that all bees were foragers, controlling for individual age within the sample . The matchbox containing the bee was then brought over to a table and placed on a circular platform that contained a drop of 50% sucrose solution. The bee was released from the matchbox with its proboscis extended, which resulted in feeding from the well. Bees were marked while feeding from the well with LBK TM nail polish on the thorax or abdomen when they returned to differentiate them. Once a marked bee returned twice, the test trials started.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p11
39057227
sec[1]/p[1]
2. Materials and Methods
4.046875
biomedical
Study
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Bees were assigned to one of four ethanol groups, consisting of 0%, 2.5%, 5%, and 10% EtOH and sucrose solutions. For the 10% solution, we used a staged procedure where bees were presented with a small drop of 5% ethanol and sucrose and then the 10% sucrose for the first two test trials. The following eleven test trials consisted of the bee only receiving the 10% ethanol and sucrose solution. This procedure was used for the 10% ethanol solution because the bees would not drink the 10% solution without a transition. The return time (leaving time to next landing time), drinking time (length of consumption; there were starts and stops), and the number of interruptions (if the drinking time was interrupted) were observed and recorded for a total of thirteen test trial visits. Bees dropped from the study if they took longer than 20 min to return between trials.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p12
39057227
sec[1]/p[2]
2. Materials and Methods
3.539063
biomedical
Study
[ 0.99462890625, 0.0005674362182617188, 0.0049591064453125 ]
[ 0.95654296875, 0.04254150390625, 0.00054168701171875, 0.00027561187744140625 ]
The circular platform was cleaned and refilled between each visit. Once bees completed the thirteen trials, they were captured in a matchbox on their fourteenth return. The bees were then placed in a −20 °C freezer until fully sedated and were then transferred into a 1.5 mL PCR tube labeled with the bee’s number. The bees were then placed in a liquid nitrogen tank. Every couple of days, the bees in the liquid nitrogen tank were transported to a −80 °C freezer where they were stored until data collection was completed.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
39057227_p13
39057227
sec[1]/p[3]
2. Materials and Methods
3.619141
biomedical
Study
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For analysis of gene expression, a sub-sample ( N = 24) of each treatment group was taken. All treatment groups were analyzed for normality to ensure no outliers were present or included in the sub-sample. Each subject in the subsequent sample was selected randomly from participants within the behavioral sample. An additional subset of naïve bees ( N = 6) was collected as genetic controls. These subjects did not receive any experimental manipulation and were collected from the same research hives as experimental subjects.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p14
39057227
sec[1]/p[4]
2. Materials and Methods
4.074219
biomedical
Study
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Tissue samples were obtained from subjects through brain dissection . Brain tissue was transferred to a 500 µL Trizol solution and homogenized mechanically using a pipette. RNA was obtained from each sample using a Zymo Research Microprep column extraction. Initial concentrations of RNA were assessed using a nanodrop, and all samples were subsequently diluted using RNAse free water to an equivalent starting concentration of 20 ng/µL. Samples were stored at −80 °C until analysis.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
39057227_p15
39057227
sec[1]/p[5]
2. Materials and Methods
4.089844
biomedical
Study
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Cycle threshold data were subject to data transformation following the ddCT method . This method transforms data into the more easily interpreted fold change measure, by comparing expression of genes of interest to that of a housekeeping gene, and to genetically similar subjects that have not undergone experimental manipulation. Data transformation in this way compares expression of genes of interest to a housekeeping gene, which reflects baseline mRNA transcription. For this study, the small ribosomal protein subunit (RS5) was selected as the housekeeping gene. This has been used as a housekeeping gene in past research .
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
39057227_p16
39057227
sec[1]/p[6]
2. Materials and Methods
4.152344
biomedical
Study
[ 0.99951171875, 0.00028896331787109375, 0.00019216537475585938 ]
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In order to quantify relative gene expression, samples were subject to reverse transcriptase quantitative polymerase chain reaction (RT-qPCR). RTqPCR analysis was conducted using a one-step BioRad iTaq Universal SYBR Green qPCR kit . Master mixes containing reaction reagents and primers for either BKP, HSP70, or RS5 were generated following the procedure for a 10 µL final reaction volume. Mixes contained 5 µL SYBR Green reaction mixture, 0.125 µL iScript reverse transcriptase, 0.15 µL of reconstituted RNA primers for both forward and reverse sequences (See Table 1 ), and 0.575 µL of nuclease-free H 2 O. Mixes were introduced into each well in 8 µL aliquots, with 2 µL of the respective sample. Each sample was analyzed in triplicate technical replicates, with averages across replicates used for data analysis. Data were recorded using a using a Bio-Rad CFX Connect Real-Time PCR system (Bio-Rad Laboratories, Hercules, CA, USA). Cycles for each plate followed the same cycling procedure, with an initial reverse transcription reaction for 10 min at 50 °C, a polymerase activation phase of 1 min at 95 °C, followed my 40 amplification cycles of 10 s denaturation at 95 °C and extension of 30 s at 60 °C. Cycle threshold data were recorded for each sample and gene.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p17
39057227
sec[1]/p[7]
2. Materials and Methods
2.685547
biomedical
Study
[ 0.9951171875, 0.0003752708435058594, 0.004459381103515625 ]
[ 0.994140625, 0.005069732666015625, 0.0004119873046875, 0.0001437664031982422 ]
All data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) software (Version 28). Four one-way analysis of variance (ANOVA) tests were conducted. Two of the analyses were conducted on the behavioral data (i.e., return time and drinking time), while the other two analyses were on the gene expression for HSP70 and BKP.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p18
39057227
sec[2]/p[0]
3. Results
4.097656
biomedical
Study
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The first two one-way ANOVA tests were conducted on the behavioral data, with one test for average return time ( F (3,62) = 12.793, p < 0.001) and a second on average drinking time, F (3,62) = 4.127, p = 0.010. Tukey HSD post hoc tests were used to conduct pairwise comparisons. The post hoc tests indicate that there was a significant difference in the average return time between the bees in the 10% condition and those in the 0% ( p < 0.001), 2.5% ( p < 0.001), and 5% ( p < 0.001) EtOH conditions; see Table 2 and Figure 1 for the descriptive statistics. The bees in the 10% condition took significantly longer to return compared to the other groups.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p19
39057227
sec[2]/p[1]
3. Results
3.113281
biomedical
Study
[ 0.97509765625, 0.0007257461547851562, 0.0243988037109375 ]
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There was a significant difference in the average drinking time between the 0% and 5% conditions, p = 0.005; see Table 2 for the descriptive statistics. The bees in the 5% condition spent significantly longer drinking compared to the bees in the 0% condition. There was not a significant difference in drinking time between the bees in the remaining pairs, 0%, 2.5%, 5%, and 10%; see Table 2 and Figure 2 for the descriptive statistics.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
39057227_p20
39057227
sec[2]/p[2]
3. Results
4.082031
biomedical
Study
[ 0.99853515625, 0.0002765655517578125, 0.0009751319885253906 ]
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The one-way ANOVAs for HSP70 ( F (3,20) = 1.82, p = 0.176) and BKP ( F (3,20) = 0.90, p = 0.460) were not significant. The results indicate that there was not a significant difference in the HSP70 expression between the bees in the 0%, 2.5%, 5%, and 10% EtOH conditions; see Table 3 and Figure 3 for the descriptive statistics. There was also not a significant difference in the BKP expression between the bees in the 0%, 2.5%, 5%, and 10% EtOH conditions; see Table 3 and Figure 4 for the descriptive statistics. Combined, these findings suggest that the bees in the different EtOH conditions and the control group (0% EtOH) did not express significantly different levels of HSP70 and BKP; see Table 3 for the descriptive statistics.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p21
39057227
sec[3]/p[0]
4. Discussion
2.691406
biomedical
Study
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Overall, the bees exhibited some significant differences in foraging behavior, as suggested by their return times and drinking times. The bees did not exhibit significant differences in the HSP70 and BKP gene expressions. Combined, these results suggest that, although we observed behavioral changes following some concentrations of EtOH, we did not witness a corresponding change in mRNA expression.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p22
39057227
sec[3]/p[1]
4. Discussion
4.050781
biomedical
Study
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There were significant differences in return time for the bees in the highest EtOH condition (10%) compared to the 0%, 2.5%, and 5% conditions. The bees in the 10% group took significantly more time to return. Similarly, Bozic et al. found that the bees in their 10% EtOH condition visited a feeder less frequently and spent more time in their hive. Additionally, they observed that the bees exhibited difficulty flying . During the study trials, the researchers observed the bees in the 10% condition exhibiting impaired locomotion. The bees in this group had difficulty landing and would sometimes fall over during landing or stumble upon landing. Also, the bees would have difficulty taking off and appeared to have difficulty circling while leaving. Abramson and colleagues also found a significant decrease in locomotion following the consumption of a 10% EtOH solution, providing evidence of motor impairment.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p23
39057227
sec[3]/p[2]
4. Discussion
2.990234
biomedical
Study
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In addition to the differences in return time, the bees differed in their drinking times. Specifically, the bees in the 5% condition spent significantly longer drinking compared to the bees in the 0% condition. It is likely that the bees in the 0% and 2.5% groups did not suffer from locomotor impairments and were able to feed more easily. The bees in the 2.5% group had the quickest average return time, followed by the bees in the control, 5%, and 10% groups, respectively. We believe that the bees in the 2.5% group may have exhibited hyperactivity, as evidenced by their return time.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p24
39057227
sec[3]/p[3]
4. Discussion
3.880859
biomedical
Study
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Exposure to 2.5% EtOH or 5% EtOH has been linked to changes in honey bee flight kinematics . Researchers found that the bees in both the 2.5% and 5% EtOH groups exhibited a frequency decrease and amplitude increase in wing strokes in bees that were hovering in flight . The bees that consumed a 10% EtOH sucrose concentration did not initiate flight during the study. The bees in the 2.5% and 5% EtOH groups were also observed exhibiting erratic locomotion while on the ground .
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p25
39057227
sec[3]/p[4]
4. Discussion
2.080078
biomedical
Study
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The results from our study are similar to some of those that Ahmed and colleagues found. The bees in our study exhibited issues with flight in the 10% group, although they did not fail to take off. The bees in our 2.5% and 5% groups walked around quite a bit during the study but did not exhibit issues with righting themselves like the 10% group.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
39057227_p26
39057227
sec[3]/p[5]
4. Discussion
3.888672
biomedical
Study
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The bees in the 10% condition had difficulty with motor coordination, as evidenced by their return times, which may account for their lack of change in drinking time from the other groups. During the study, the bees in the 10% condition were observed having difficulty landing and would land off balance and be unsteady upon take off at later visits. These changes were not noticed in the bees in the lower alcohol concentration groups. Meanwhile, while the bees in the 5% group did not exhibit decreased motor function, they may have exhibited increased hyperactivity, although not enough to cause a significant difference in return time. Maze and colleagues reported that bees that consumed 5% EtOH showed increases in walking time, suggesting hyperactivity.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p27
39057227
sec[3]/p[6]
4. Discussion
4.246094
biomedical
Study
[ 0.99951171875, 0.00030112266540527344, 0.00035834312438964844 ]
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The results of the RT-qPCR assay indicated that there were no significant differences in the transcriptional expression of either HSP70 or BKP. At first glance, these data appear to be counter to the past literature on both genes, indicating that the expression of both should be altered by the presence of ethanol. Hranitz et al. noted increases in HSP70 expression following ethanol ingestion in honey bees; however, this increase was recorded at the protein level. It is possible that the changes ethanol consumption exerts on HSP70 expression occur at the post-transcriptional level. This would explain the increase in expression observed by Hranitz et al. , while no such change was observed in the present study. Past studies have examined HSP70 as a metric of cellular oxidative stress using RT-qPCR , and have also noted relatively little change in gene expression as a result of experimental manipulation. This corroborates the hypothesis that a change in HSP70 as a result of extra-organismal factors is likely an effect exerted at the post-transcriptional or even post-translational level. Further, Johnston et al. have noted that, in response to external stressors, the expression of mRNA transcription factors can be altered, subsequently altering the transcription, gene splicing, and even protein folding. The particular gene in question, Xbp1 , is linked to the overall changes in the proteins responsible for the cellular immune responses in honey bees. While Johnston et al. did not link this transcription factor directly to HSP70, the role of the protein as a measure of oxidative cellular stress suggests that it could be subject to this, or a similar regulatory factor, triggered by the manipulations present in the present work.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p28
39057227
sec[3]/p[7]
4. Discussion
3.896484
biomedical
Study
[ 0.99853515625, 0.0001850128173828125, 0.0011949539184570312 ]
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In addition to the manipulations present in this study, it is important to note that this is a free-flight paradigm. Such designs enable a wide variety of behavioral outcomes on the part of subjects. While this does generate more generalizable data to real-world scenarios, it also reduces the level of experimental control concerning the amount of ethanol ingested by each individual. This lack of direct ethanol quantification may drive the non-significant results observed in the present experiment. The study by Hranitz et al. made use of a direct feeding methodology, administering a set amount of solution. The methodological differences between these two studies may also contribute to the differences in our results.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
39057227_p29
39057227
sec[3]/p[8]
4. Discussion
4.105469
biomedical
Study
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In the case of BKP, this is the first work examining BKP as an isolated portion of the slo gene within honey bees. The slo gene itself codes for several proteins, including various isoforms of BKP. It is likely that the specific mRNA strand analyzed in this current work is a portion of the slo gene that is not necessary for the development of ethanol tolerance, and as such did not alter the expression following ethanol ingestion. Further, while well-studied in drosophila , there is relatively little research regarding the slo gene within honey bees. Despite their genetic similarity , it is possible that the slo gene’s role within honey bees is more locomotor and less implicated in the development of ethanol tolerance.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
39057227_p30
39057227
sec[3]/p[9]
4. Discussion
4.027344
biomedical
Study
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Further research is necessary regarding the genetic components of ethanol tolerance. We suggest that researchers explore the slo gene in the honey bee to determine whether it plays more of a role in locomotion compared to developing tolerance to ethanol. Further, researchers should conduct studies examining HSP70 and BKP in honey bees following chronic exposure. The bees in our experiment were used in one session, so, while they received alcohol throughout their trials, they did not receive alcohol several days in a row. Overall, our experiment provides information suggesting that both HSP70 and BKP might not play a role in the alcohol tolerance in honey bees at the transcriptional level.
[ "Kiri Li N. Stauch", "Timothy E. Black", "Charles I. Abramson" ]
https://doi.org/10.3390/insects15070494
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
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1. Introduction
1.891602
other
Other
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Digitalization has received tremendous interest in practice and research in recent years, leading to various conceptualizations . In this study, we define it as “the transformation of the socioeconomic environment through processes of digital artifact adoption, application and utilization (p. 17)”. This not only includes the transformation of analogous data into digital ones , but also the intensified use of Information and Communication Technology (ICT) and the restructuring of life domains by the latter . Following Steinmueller’s work on the codification of knowledge , Day et al. define ICT as “any electronic device or technology that has the ability to gather, store, or send information” (p. 473). Due to the high availability and use of devices like mobile phones, smartphones and laptops, and digital technologies like the Internet, emails and artificial intelligence , ICT is paramount in society.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p1
PMC11277318
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1. Introduction
1.584961
other
Other
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[ 0.01309967041015625, 0.98095703125, 0.005725860595703125, 0.0004584789276123047 ]
Increased use of ICT comes with highly interdependent opportunities and risks for individuals and organizations . The (im)balances of ICT chances and challenges at the workplace become very apparent in employee health. This is because organizations influence population health via the working conditions for their employees, the quality and safety of their products and services as well as their socio-ecological effects . Recent research suggests to combine investigations on ICT, health at the workplace and digital efforts to promote the latter .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277318_p2
PMC11277318
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1. Introduction
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other
Other
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While employee health protection is crucial in Organizational Health and Safety Management (OHS, OHSM) in general, health and wellbeing at the workplace comprises much more than complying with health, hygiene and safety regulations. Workplace Health Promotion (WHP) means “the combined efforts of employers, employees and society to improve health and well-being of people at work” (p. 2) by adapting the work setting with its structures and processes to be more health-promoting, increasing employee participation and strengthening individual development . So far, however, WHP in a comprehensive sense is not very common , with small and medium-sized organizations being especially challenged . Initiatives range from comprehensive employee health programs to single activities in specific areas . Both can include interventions and offers, e.g., regarding nutrition, risk behaviors like smoking, physical activity , but also mental health and improvement in the work setting regarding its structures, processes and organizational culture .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p3
PMC11277318
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1. Introduction
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Digitalization can be of great aid in establishing and offering WHP within the organization . Especially Digital Workplace Health Promotion (DWHP), the “use of digital means and tools to create and deliver health interventions for employees” is very promising, due, among others, to its better reachability especially of health-wise easily underserved populations like shift workers , thereby reducing health-related inequalities and working toward reaching the UN’s Sustainable Development Goals . In addition, the personalization of employee health offers is often easier , cost-efficient and spill-over effects toward society are expected . Also, the applicability of DWHP is broad and can cover all aspects of health , e.g., physical activity , medical checks , mental health and eating habits . Offers include apps , wearables, fitness trackers , websites, educational videos, social media, messages, phone calls and a combinations of the above .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p4
PMC11277318
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1. Introduction
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other
Other
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While many aspects of digitalization and sustainability have already been studied , the impact of digital employee health offers is a new research area and its contribution to transforming an organization into a healthier one still warrants investigation . Moreover, investigations regarding the benefits to the workforce are needed . Said workforce should perceive DWHP positively and it should match its requirements . This is also required as most data on employee preferences regarding WHP were collected before the pandemic, making it unclear which topics they would like to see covered , be it in a traditional on-site or digital manner.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p5
PMC11277318
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1. Introduction
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In this study, the focus is twofold: (1) we investigate the perspective of the workforce regarding DWHP and (2) the potentials of DWHP for transforming the organization into a healthier one. For this to be the case, DWHP needs to be used and rated favorably, which requires a positive ratio of benefits over barriers (see Hypotheses in Section 2 and Section 3.2 ).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p6
PMC11277318
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1. Introduction
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An overview of workplace health initiatives, their reasoning and barriers, is given in the following section to contextualize DWHP and its potentials. After this, the setting of the study and the methods employed are described. Section 4 is structured thematically to not only focus on the established hypotheses but also cover the topic of DWHP as perceived by the employees. Together with the discussion of the results, this study outlines future research requirements based on the findings as well as its limitations. Section 6 contextualizes this study and highlights the necessity of discussing the role of organizations for employee and public health.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p7
PMC11277318
sec[1]/p[0]
2. Background and Hypotheses
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Health is assumed to be a basic value and access to healthcare is considered a social right . While human health can be seen as a fundamental need on a societal and individual level, organizations address this differently, using the full continuum from immersion to disregard. Via laws and standards, a certain degree of health protection is mandatory in most states . As Oeij and colleagues put it: “(s)ocial and human values regarding health and wellbeing are seen as conditional to human rights and decent work” (p. 284) which should also apply to digitalization in the work context . When organizations are viewed as agents for producing goods and services for societal needs, demanding health protection and ideally also health creation at work is a rational consequence. The organization’s existence would be endangered should its actions be counterproductive for the need tackled. Moreover, empirical evidence shows the impact of employee wellbeing on positive outcomes for the organization, thus promoting organizational sustainability . Based on these considerations and the societal importance of companies, becoming a health-promoting organization would be sustainable inwardly and outwardly .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p8
PMC11277318
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2. Background and Hypotheses
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Organizational health development is creating and improving health in structures (capacities on the individual and organizational level) and their interactions (processes) in a targeted as well as continuing general way . With the objective being the creation of a healthy, sustainable organization, which operates successfully on the market but also internally regarding employee wellbeing , there are at least four levels to consider for workplace health interventions: the individual, the group, the organization and processes within the latter . This is often achieved via initiatives of WHP. Implementing these successfully depends on management processes being in place , but also on value congruence with health promotion such as internal capacity criteria and evidence for the WHP program elements . In addition, they need to be aligned with the needs and values of the employees . A comprehensive program is suggested that includes offers concerning the salutogenic improvement of the setting and health-related behaviors of the target group . Thus, this can also mean combining offers for all employees with specialized ones . It is important to note here that participation rates can be calculated for behavior-oriented offers, but hardly for setting-oriented offers, as the latter are designed to change the environment for all. This could be healthy food at the canteen or digital ways to prevent mental overload, e.g., by blocking emails during certain times of the day. This means that a health program at the workplace, or at least aspects of it, can reach all employees and highlights the importance of salutogenic processes and structures in organizations. For this, organizational awareness of health impacts for employees and society must be granted.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p9
PMC11277318
sec[1]/p[2]
2. Background and Hypotheses
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other
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A salutogenic orientation, and even health promotion at work, are voluntary for both employer and employees. Due to this, programs are not always ideal , participation rates are often low or attract mainly those who are already trying to lead a healthy lifestyle . Fully reaching the potentials of WHP for employees and organizations, however, would require optimizing the participation rate . Expert advice on this and models are available and require adaptation to the individual organization. Though general implementation science can be drawn upon , aligning a program to specific internal needs and target groups can be laborious. Therefore, having employees participate in setting WHP is often suggested , for example, via health circles , as this can be more efficient.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p10
PMC11277318
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2. Background and Hypotheses
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other
Other
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DWHP can alleviate the issues above for both the employer (see cost-saving options described in the Section 5 ) and employees, who are the focus of this study. Digital offers can increase the range of participants by being available off-site or attracting those who do not want to participate in person . Also, those who are hindered time-wise or by low social support at the workplace can be reached. These considerations lead to the expectation that staff rates the availability of DWHP offers positively, defining H1 as follows:
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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en
0.999996
PMC11277318_p11
PMC11277318
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2. Background and Hypotheses
2.021484
biomedical
Study
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[ 0.82421875, 0.1739501953125, 0.0007200241088867188, 0.001007080078125 ]
This study was conducted in a hospital (the details of which can be found in the next section), as these are among the organizations that could benefit the most from DWHP. Their staff is very interested in health , highly burdened and has irregular working hours. Shifts are common and part-time work is high, plans must be adapted rapidly in case of emergencies, making attending WHP offers very challenging for many employees . This holds true for regular offers, but also one-time events. As hospital staff is thus acutely aware of the barriers towards using WHP, we posit the following:
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p12
PMC11277318
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2. Background and Hypotheses
1.849609
biomedical
Study
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[ 0.87841796875, 0.12005615234375, 0.0008425712585449219, 0.0007276535034179688 ]
Moreover, we assume that, with the current global personnel shortages in healthcare and resulting time pressures and psychological burden , intended future participation in DWHP will be higher than current use. As intention of use has been shown to relate to later participation , we also intend to test the following:
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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https://creativecommons.org/licenses/by/4.0/
en
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PMC11277318_p13
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2. Background and Hypotheses
1.567383
other
Other
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[ 0.370361328125, 0.62646484375, 0.002048492431640625, 0.001049041748046875 ]
As has already been reported for digital applications in the context of WHP, the limitations of regular offers like time barriers are less prevalent while positive attributes like personalization can be enhanced . Moreover, research in Japan found that employees with experience using digital health services (here: mental) were more likely to access these via their employer rather than privately . Therefore, we assume that experience with DWHP has an effect and that
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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0.999995
PMC11277318_p14
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3. Materials and Methods
2.380859
biomedical
Study
[ 0.9013671875, 0.003078460693359375, 0.09552001953125 ]
[ 0.978515625, 0.02093505859375, 0.00031495094299316406, 0.0003058910369873047 ]
As determinants of health are multifaceted , efforts to promote health need to be specified for the respective setting. For this study, we report on a hospital in Austria (~500 employees at the start of the study, currently: 660) with an established WHP program which was supplemented with DWHP. This was achieved as WHP use data show inequalities in opportunities to profit from the offer, mainly due to the very divergent working times of the staff. The organization was chosen based on three considerations: (a) employees needed to be familiar with WHP, and DWHP needed to be a newly introduced, (b) the organization had to be interested in DWHP, and (c) as WHP and DWHP are not mandatory in Austria, there needed to be funding for WHP and DWHP. In addition and to comply with the settings approach of health promotion , the target group for both WHP and DWHP had to be all employees.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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0.999998
PMC11277318_p15
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3. Materials and Methods
1.080078
other
Other
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[ 0.004058837890625, 0.99462890625, 0.0008997917175292969, 0.0005922317504882812 ]
However, being a hierarchical organization, not all staff is extensively trained to use digital appliances or has access to them. Therefore, training needs must be assessed and DWHP offers should be as easy to use as possible and match what people know from other life areas, e.g., video clips as downloads from the intranet. Moreover, digitalization efforts in HR and marketing led to considerations regarding the digital competences of staff. It became clear that digital competences may be unequally distributed and thus the impact of DWHP may be endangered, especially in the case of structural and competence inequalities coinciding.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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en
0.999996
PMC11277318_p16
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3. Materials and Methods
2.421875
biomedical
Other
[ 0.62548828125, 0.00627899169921875, 0.367919921875 ]
[ 0.0035400390625, 0.990234375, 0.006134033203125, 0.00024068355560302734 ]
The sustainable transformation of organizations requires the employees to be integrated as vital stakeholders, especially when digitalization is concerned . Including the target group in the design, implementation and evaluation of a health-promotion program also long been used and is highly advised in order to increase fit and acceptance and to ensure that the offer fits to the target population and the objectives can be reached . Participation is highlighted in implementation guidelines which are typically based on behavioral change models and/or closely linked to change management principles or best practice guidelines . In a stepwise manner, doing a needs assessment, developing the intervention plan and objectives, implementing the intervention and evaluating it are required .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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en
0.999998
PMC11277318_p17
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3. Materials and Methods
1.777344
other
Study
[ 0.109130859375, 0.000774383544921875, 0.89013671875 ]
[ 0.94287109375, 0.0560302734375, 0.0005540847778320312, 0.0005016326904296875 ]
Therefore, we followed this approach in our research process: (1) Before the start of DWPH and to cover the exact needs in the context of digitalization, all employees were asked to fill in a questionnaire in May 2022 regarding their perceptions of the digitalization climate within the organization, the extent to which they felt exposed and ready to work with digital equipment, plus wishes and barriers regarding DWPH (see details in Section 3.1 . and Appendix A ). As they were familiar with WHP, they could be surveyed regarding which offers they wanted in a digital way. In the next step, (2) DWHP elements were designed and introduced. These included behavior-oriented parts like exercise videos and hybrid trainings on mindfulness, as well as an online nutrition workshop, which were all recorded and uploaded to the intranet (employee portal). Moreover, there were setting-oriented parts as, e.g., hardware adaptations, implementing a new digital communication platform (employee portal) and enlarging this with e-learning offers.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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en
0.999996
PMC11277318_p18
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3. Materials and Methods
1.865234
biomedical
Other
[ 0.640625, 0.005523681640625, 0.35400390625 ]
[ 0.0065155029296875, 0.99072265625, 0.0022182464599609375, 0.0003304481506347656 ]
The regular WHP program was also continued, including setting-oriented changes like redesigning a room for relaxing, and behavior-oriented interventions like swimming, health days, eye health checks, back exercises, trainings in de-escalation and leadership, on-site workshops and trips. Covering both setting-related as well as behavior-related aspects is essential in health promotion to ensure a sustainable impact.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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0.999995
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3. Materials and Methods
1.547852
other
Other
[ 0.2279052734375, 0.0018148422241210938, 0.7705078125 ]
[ 0.271728515625, 0.72509765625, 0.00177001953125, 0.0012073516845703125 ]
After the implementation phase, the offer was (3) evaluated (see details in Section 3.2 and Appendix B ). This was achieved by integrating the evaluation of DWHP into the regular evaluation of WHP and the psychological burden at the workplace in November 2023, creating a rich database.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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PMC11277318_p20
PMC11277318
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3.1. First Survey: Wishes, Needs and Attitudes
1.571289
other
Study
[ 0.052001953125, 0.0007505416870117188, 0.947265625 ]
[ 0.97119140625, 0.027801513671875, 0.000522613525390625, 0.0004134178161621094 ]
DWHP is a new topic; therefore, a questionnaire (see Appendix A ) was designed based on the literature and prior research . Items on specific plans and digitalization endeavors of the organization (e.g., an employee portal) were added based on collaborative work of the first author as external scientist and advisor and the second author as internal project lead. This approach was chosen as there is no standardized tool available , not even for WHP . This is because WHP programs need to be targeted to the issues of the employees and thus have different objectives . This makes this study a first suggestion also for other organizations engaging in DWHP as the content can be adapted. To ensure maximum usability, the survey was provided as paper and pencil plus as an online version. All employees were invited to fill in the survey. Participation was completely anonymously and was non-mandatory. The surveys were all completed in German in May 2022. The paper and pencil versions were collected in boxes in the organization and then sent to the university of the first author where they were combined with the online questionnaire data to form a final dataset for analysis. This was done to ensure that the employees knew their data were protected and to accommodate their need for privacy and anonymity and reduce the likelihood of biases like social desirability.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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PMC11277318_p21
PMC11277318
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1.584961
other
Study
[ 0.09393310546875, 0.0011348724365234375, 0.90478515625 ]
[ 0.57177734375, 0.42578125, 0.0014009475708007812, 0.0011014938354492188 ]
The survey comprised three parts (see Appendix A ): General questions about the digital representations of the organization inwardly and outwardly (website, employee portal) and their perception by the employees; the amount of digitalization in the daily work of the employees plus ratings of burden vs. chances; digital competences and wishes for training. DWHP: Rating of current (i.e., online booking of offers) and future offers (i.e., digital offers), comparison of WHP and DWHP; determinants and barriers of using DWHP; wishes regarding DWHP. Ideas for potentially interesting digital offers were derived from a prior project at the hospital . Demographics (age group, occupational group, working times, education).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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0.999996
PMC11277318_p22
PMC11277318
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1.686523
biomedical
Study
[ 0.7001953125, 0.00186920166015625, 0.298095703125 ]
[ 0.58642578125, 0.409423828125, 0.003143310546875, 0.00104522705078125 ]
Most questions were quantitative, those with thematic background (parts 1 and 2) were 5-point Likert-scaled with a neutral option. Items formulated as statements were scaled regarding agreement, questions concerning WHP/DWHP differentiated regarding attractiveness.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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0.999997
PMC11277318_p23
PMC11277318
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3.1. First Survey: Wishes, Needs and Attitudes
0.998047
other
Other
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[ 0.002628326416015625, 0.99609375, 0.000911712646484375, 0.0005702972412109375 ]
Examples: I have so many digital parts in my daily work that I do not want digital WHP offers. (agree/rather agree/neither-nor/rather disagree/disagree) How attractive would digital LIVE-offers of WHP be for you in the following areas? (e.g., dietary habits?) (very attractive/rather attractive/neither-nor/rather not attractive, not attractive)
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
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PMC11277318_p24
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3.1. First Survey: Wishes, Needs and Attitudes
1.222656
other
Other
[ 0.236328125, 0.00439453125, 0.75927734375 ]
[ 0.0293121337890625, 0.9677734375, 0.0020885467529296875, 0.0009822845458984375 ]
Open questions were specific wishes, suggestions or possibilities to further explain something, and available in Parts 1 and 2.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
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PMC11277318_p25
PMC11277318
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1.19043
other
Other
[ 0.0273895263671875, 0.002620697021484375, 0.97021484375 ]
[ 0.00408172607421875, 0.99462890625, 0.0006699562072753906, 0.0005621910095214844 ]
Upon completion of this survey and internal discussion, the hospital continued and adapted its WHP program plus started providing digital offers, mainly videos and hybrid workshops plus hardware adaptations and enlarging the offer available in the employee portal (more details seen above under Section 3 ).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p26
PMC11277318
sec[2]/sec[1]/p[0]
3.2. Second Survey: Evaluation
1.94043
other
Study
[ 0.2451171875, 0.0011138916015625, 0.75390625 ]
[ 0.9716796875, 0.0272674560546875, 0.000637054443359375, 0.0003147125244140625 ]
Contrary to the first survey which was conducted as stand-alone investigation, the evaluation (see Appendix B ) was integrated—as the first part of the questionnaire—into the evaluation of psycho-social burden at the workplace in 2023. This was only offered in the paper and pencil version which again was collected in boxes in the organization and then sent to the university of the first author. This approach had to be taken to avoid biases like social desirability and to prevent a low response rate in case of two separate surveys. As positive side-effect, the dataset allows for more detailed analyses especially since it traditionally also integrates detailed evaluations of WHP, e.g., general satisfaction levels, impact and areas of interest . However, the scaling had to be adapted to a 4-point Likert-scale to fit to the bigger survey for the questions that were repeated from survey 1. Also, the scaling for age was less detailed compared to the first survey to confirm the usual survey on psycho-social burden at the workplace. Questions on frequency were scaled as very often–often–occasionally–seldom–never.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p27
PMC11277318
sec[2]/sec[1]/p[1]
3.2. Second Survey: Evaluation
1.369141
other
Other
[ 0.04742431640625, 0.0009870529174804688, 0.95166015625 ]
[ 0.08837890625, 0.9091796875, 0.0016584396362304688, 0.0008721351623535156 ]
Newly added questions for the project refer to appraisal focused on the comparison of satisfaction levels with WHP vs. DWHP to allow for more detail in the next (D)WHP program cycle. Items that were kept from survey 1 (see items in italics in Appendix B ) refer to difficulties in finding digital information, use and evaluation of this information in the context of DWHP, current and planned use of (D)WHP, benefits and limitations of DWHP and digital information options. The evaluation questionnaire (see Appendix B ) consists of five parts covering WHP and DWHP, their use, interest in specific offers, a general rating and demographics.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p28
PMC11277318
sec[2]/sec[1]/p[2]
3.2. Second Survey: Evaluation
1.066406
other
Study
[ 0.0115509033203125, 0.0006413459777832031, 0.98779296875 ]
[ 0.83447265625, 0.162109375, 0.001800537109375, 0.0016050338745117188 ]
Based on the intentions and design of this study, we aim to answer the research question of whether DWHP does have the potential to contribute to the sustainable transformation of organizations. This is based on employee acceptance and use. Therefore, we will analyze the proxies for this and posit the hypotheses described above.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p29
PMC11277318
sec[3]/p[0]
4. Results
1.467773
other
Study
[ 0.3310546875, 0.00177764892578125, 0.66748046875 ]
[ 0.497314453125, 0.497314453125, 0.00445556640625, 0.0011358261108398438 ]
The presented results we focus on are those of the second survey. This is because the research questions are mainly found here, and more demographics were asked as the intention of the first survey was to gain an overview of the DWHP-related needs. However, data from the first survey are included in square brackets for identical questions and mentioned explicitly in the text. Please note that values shown in figures are rounded.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p30
PMC11277318
sec[3]/sec[0]/p[0]
4.1. Demographics
1.404297
other
Other
[ 0.05535888671875, 0.0014715194702148438, 0.943359375 ]
[ 0.09869384765625, 0.8994140625, 0.0009169578552246094, 0.0009703636169433594 ]
When the project application was submitted, the hospital had 529 employees. The first survey received 241 responses, which regarding the baseline equals 45.56%. At the time of the project’s end, the hospital counted 660 employees. The second survey, the evaluation, was filled in by 254 employees, which based on 660 employees is a response rate of 38.5%. The demographics are listed in Table 1 .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p31
PMC11277318
sec[3]/sec[0]/p[1]
4.1. Demographics
1.8125
other
Study
[ 0.276123046875, 0.0009665489196777344, 0.72265625 ]
[ 0.77001953125, 0.2265625, 0.0025577545166015625, 0.000797271728515625 ]
In the following sections, responses indicating agreement (e.g., agree, rather agree/applies, rather applies) are combined. In case a different scaling was used, this is mentioned in the text. The major demographic elements are tested regarding their influence using Chi2-Tests as most demographic questions were nominally scaled. The Chi2-Tests gives “information not only on the significance of any observed differences, but also provides detailed information on exactly which categories account for any differences found” (p. 143).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p32
PMC11277318
sec[3]/sec[1]/p[0]
4.2. Importance and Knowledge about DWHP
2.419922
biomedical
Study
[ 0.87451171875, 0.00262451171875, 0.1229248046875 ]
[ 0.99609375, 0.0032958984375, 0.00026488304138183594, 0.00012445449829101562 ]
To contextualize the findings, respondents were asked to rate the importance WHP for them and their general perception of the on-site and digital offer. WHP was rated as generally important topic by 95.2% of the respondents. Moreover, 85% stated that it was also personally important. Over 80% (82.6%) [2022: 71.3%] knew where to find information on the WHP offer and over 65% (65.1%) [2022: 50.7%] used the employee portal (intranet). According to the Chi2 test, this also tends to apply primarily to employees over the age of 45 (p = 0.002). Digital information options on occupational health promotion were described as easy to use . This was reported mainly by respondents without patient contact (Chi2 test with p = 0.025).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p33
PMC11277318
sec[3]/sec[1]/p[1]
4.2. Importance and Knowledge about DWHP
1.566406
other
Study
[ 0.119140625, 0.00128173828125, 0.87939453125 ]
[ 0.94873046875, 0.05035400390625, 0.0006146430969238281, 0.0005016326904296875 ]
More than half of respondents knew which DWHP services were available in the company (54.8%). Also, 83.9% stated that they knew where to find information on WHP in the employee portal. However, the latter applies more to people who had been with the company for more than 3 years or were older than 45 (Chi2 test, each at p = 0.000). About 75% stated that DWHP is accessible for everyone, though it becomes apparent that complete agreement stems mainly from participants over 45 years of age ( p = 0.008).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p34
PMC11277318
sec[3]/sec[1]/p[2]
4.2. Importance and Knowledge about DWHP
1.691406
other
Study
[ 0.2724609375, 0.0015125274658203125, 0.72607421875 ]
[ 0.93798828125, 0.06085205078125, 0.0006766319274902344, 0.00041294097900390625 ]
A total of 74.1% stated that the information on WHP offers reached every person in the company. For the latter question, the Chi2 test shows a significant indication that full agreement comes primarily from people over the age of 45 ( p = 0.008).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p35
PMC11277318
sec[3]/sec[1]/p[3]
4.2. Importance and Knowledge about DWHP
1.682617
other
Study
[ 0.43505859375, 0.0035495758056640625, 0.5615234375 ]
[ 0.71044921875, 0.28759765625, 0.0011777877807617188, 0.00095367431640625 ]
General improvements in working conditions due to WHP in the company were felt by 45% of respondents. According to the Chi2 test, people with no patient contact ( p = 0.000) are more likely to say that they do feel improvements due to WHP in the company.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p36
PMC11277318
sec[3]/sec[2]/p[0]
4.3. Personal Rating of (D)WHP
1.464844
other
Other
[ 0.1551513671875, 0.004604339599609375, 0.84033203125 ]
[ 0.204833984375, 0.7919921875, 0.0018987655639648438, 0.0012378692626953125 ]
Overall, three-quarters (75.5%) of people were very or rather satisfied with the WHP offer .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p37
PMC11277318
sec[3]/sec[2]/p[1]
4.3. Personal Rating of (D)WHP
1.845703
biomedical
Study
[ 0.5244140625, 0.003444671630859375, 0.47216796875 ]
[ 0.95849609375, 0.04071044921875, 0.0004987716674804688, 0.0004184246063232422 ]
People over the age of 45 were significantly more likely to be very satisfied (Chi2 test). In the open responses (see below), it was mentioned that an adaptation of the services to younger people and thus higher fitness levels could be beneficial. Just under 22% (21.6%) were rather dissatisfied. Only 2.9% stated that they were not satisfied, with a slight tendency toward shift workers (Chi2 test, p = 0.017).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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en
0.999996
PMC11277318_p38
PMC11277318
sec[3]/sec[2]/p[2]
4.3. Personal Rating of (D)WHP
1.835938
biomedical
Study
[ 0.841796875, 0.06103515625, 0.09722900390625 ]
[ 0.888671875, 0.1075439453125, 0.0017080307006835938, 0.0022945404052734375 ]
Regarding the on-site services , 71.8% were very or rather satisfied, especially if there had no patient contact or if they were over 45 years of age (Chi2 test).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p39
PMC11277318
sec[3]/sec[2]/p[3]
4.3. Personal Rating of (D)WHP
2.019531
biomedical
Study
[ 0.78662109375, 0.004611968994140625, 0.2088623046875 ]
[ 0.98095703125, 0.018218994140625, 0.0004525184631347656, 0.00030684471130371094 ]
At 61.1%, satisfaction with DWHP is around 10 percentage points lower, but still very positive . Moreover, 73.3% [54.8%] saw DWHP as a good addition to WHP, and according to the Chi2 test this tends to be higher among people with on-call duty ( p = 0.049).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p40
PMC11277318
sec[3]/sec[2]/p[4]
4.3. Personal Rating of (D)WHP
1.958984
biomedical
Study
[ 0.88037109375, 0.005706787109375, 0.11376953125 ]
[ 0.97021484375, 0.0279388427734375, 0.00115203857421875, 0.0004839897155761719 ]
Thus, H1—DWHP is rated favorably—is confirmed. Here too, satisfaction tends to be higher among people without patient contact ( p = 0.014).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999994
PMC11277318_p41
PMC11277318
sec[3]/sec[2]/p[5]
4.3. Personal Rating of (D)WHP
1.328125
other
Other
[ 0.0814208984375, 0.0011415481567382812, 0.91748046875 ]
[ 0.2607421875, 0.73681640625, 0.0013360977172851562, 0.001270294189453125 ]
However, 56.8% [26.6%] of respondents were convinced that WHP should only take place live. A total of 48.1% [29.9%] stated that there were so many digital offers in their daily work that they did not want DWHP.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277318_p42
PMC11277318
sec[3]/sec[3]/p[0]
4.4. Use and Opportunity to Use
1.615234
other
Study
[ 0.17626953125, 0.0020809173583984375, 0.82177734375 ]
[ 0.86474609375, 0.1331787109375, 0.0011081695556640625, 0.0007691383361816406 ]
The possibility of using on-site offers is given for 70.3%, and slightly higher for digital offerings at 74.9%. For the latter, complete agreement is more likely to be expressed by people over 45 years of age (Chi2 test, p = 0.011).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p43
PMC11277318
sec[3]/sec[3]/p[1]
4.4. Use and Opportunity to Use
2.607422
biomedical
Study
[ 0.9755859375, 0.0033626556396484375, 0.0211639404296875 ]
[ 0.998046875, 0.0017995834350585938, 0.00017845630645751953, 0.00012171268463134766 ]
A total of 67.1% of participants used WHP offers from very frequently to rarely, with a tendency toward people without patient contact (Chi2 test, p = 0.000). Higher use was reported by 34.5% who used WHP offers between very frequently and occasionally , frequently in particular by people with core working hours (Chi2 test, p = 0.020). It was rarely or never used by around 32% of respondents (32.5% and 32.9%, respectively), and significantly rather never by people working day and night shifts (same Chi2 test). Regarding future plans, 90% stated that they wanted to use WHP.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p44
PMC11277318
sec[3]/sec[3]/p[2]
4.4. Use and Opportunity to Use
1.980469
biomedical
Study
[ 0.92431640625, 0.005336761474609375, 0.070556640625 ]
[ 0.97021484375, 0.0286712646484375, 0.00046634674072265625, 0.0004849433898925781 ]
The usage data on DWHP are currently lower compared to on-site WHP. A total of 44.9% respondents used the offer (including rarely), here too tending to be people without patient contact (Chi2 test, p = 0.002). Between very frequently and occasionally (including three response levels), 17.8% used DWHP . Therefore, H1a—DWHP use is high—is not confirmed.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p45
PMC11277318
sec[3]/sec[3]/p[3]
4.4. Use and Opportunity to Use
2.060547
biomedical
Study
[ 0.8759765625, 0.00286102294921875, 0.12103271484375 ]
[ 0.94775390625, 0.05126953125, 0.0005602836608886719, 0.00043964385986328125 ]
However, the reported rate of future use is rather high: 83.9% planned to use it, confirming H1b—Intended use of DWHP is high: 83.9% stated the intention to use DWHP in the future, with 4% very frequently, 18.1% frequently, 44.4% occasionally and 17.3% seldom .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p46
PMC11277318
sec[3]/sec[3]/p[4]
4.4. Use and Opportunity to Use
2.339844
biomedical
Study
[ 0.556640625, 0.0017547607421875, 0.44140625 ]
[ 0.99365234375, 0.005809783935546875, 0.00023233890533447266, 0.0001366138458251953 ]
Future plans regarding DWHP use are highly connected to working time regimes and current organizational aspects measured in the evaluation of psychosocial burden at the workplace. Those who reported that there was not enough personnel in their work environment (Chi2 test, p = 0.022) and those who could rarely decide when to take a break (Chi2 test, p = 0.037) were likelier to plan for more DWHP use. Also, those who stated that there was not enough time for all tasks were significantly more likely to plan to use DWHP very frequently in the future or to not intend to use it at all (Chi2 test, p = 0.003).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p47
PMC11277318
sec[3]/sec[4]/p[0]
4.5. DWHP: Opportunities and Limitations
1.65918
biomedical
Study
[ 0.89599609375, 0.003520965576171875, 0.10040283203125 ]
[ 0.53466796875, 0.447265625, 0.015777587890625, 0.00202178955078125 ]
Below, the opportunities and limitations of DWHP according to the participants are described.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277318_p48
PMC11277318
sec[3]/sec[4]/p[1]
4.5. DWHP: Opportunities and Limitations
2.28125
biomedical
Study
[ 0.92529296875, 0.0150909423828125, 0.0595703125 ]
[ 0.98974609375, 0.0091400146484375, 0.0004425048828125, 0.00045561790466308594 ]
DWHP services were practical for 67.4% [53.1%] of respondents because they can be used flexibly regarding location. Time-related flexibility was mentioned by 65.7% [53.5%], and according to the Chi2 test this mainly applies to those without patient contact ( p = 0.009). A total of 66.4% said that using DWHP saved time. The Chi2 test shows that this tends to be less important for people without patient contact ( p = 0.038). Moreover, 55% rated DWHP as easier to use than WHP.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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en
0.999998
PMC11277318_p49
PMC11277318
sec[3]/sec[4]/p[2]
4.5. DWHP: Opportunities and Limitations
1.612305
other
Study
[ 0.38134765625, 0.0021209716796875, 0.61669921875 ]
[ 0.67626953125, 0.31787109375, 0.00447845458984375, 0.0012359619140625 ]
In total, this confirms H2 as the perceived benefits are higher in the second survey compared to the first.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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en
0.999997
PMC11277318_p50
PMC11277318
sec[3]/sec[4]/p[3]
4.5. DWHP: Opportunities and Limitations
2.03125
biomedical
Study
[ 0.73291015625, 0.0034275054931640625, 0.263916015625 ]
[ 0.984375, 0.01483917236328125, 0.0002932548522949219, 0.0002684593200683594 ]
In the evaluation survey, 21.1% [19.9%] of respondents stated that they could not participate in DWHP due to their technical equipment. In addition, 15.1% [12.9%] could not participate due to their technical skills. This was stated mainly by people who were older than 45 years (Chi2 text, p = 0.000). The working spaces were an obstacle for 39.5% [38.6%].
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277318_p51
PMC11277318
sec[3]/sec[4]/p[4]
4.5. DWHP: Opportunities and Limitations
1.951172
biomedical
Study
[ 0.8359375, 0.0017652511596679688, 0.1624755859375 ]
[ 0.9423828125, 0.055328369140625, 0.0019779205322265625, 0.0004458427429199219 ]
Taken together, this indicates that H3—The perceived barriers for DWHP use decrease over time—is not confirmed.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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en
0.999995
PMC11277318_p52
PMC11277318
sec[3]/sec[4]/p[5]
4.5. DWHP: Opportunities and Limitations
2.109375
biomedical
Study
[ 0.8828125, 0.0019817352294921875, 0.11517333984375 ]
[ 0.96240234375, 0.03656005859375, 0.0006957054138183594, 0.0003826618194580078 ]
Regarding the limits of DWHP use, men tended to be more optimistic and report fewer problems (Chi2 test, p = 0.044 for working spaces, 0.014 for technical skills, 0.027 for technical equipment). The deviations in the values compared to 2022 are small, but nevertheless noticeable. There appears to be a need for training and support, especially for women.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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0.999998
PMC11277318_p53
PMC11277318
sec[3]/sec[5]/p[0]
4.6. Further Wishes
1.295898
other
Other
[ 0.25244140625, 0.002979278564453125, 0.74462890625 ]
[ 0.023651123046875, 0.97265625, 0.0028133392333984375, 0.0007309913635253906 ]
Regarding interests, all of the provided options received high ratings (general improvement in working conditions, stress management, sports/physical exercise, nutrition, lectures and information events, health day, group activities, spiritual offers).
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
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en
0.999996
PMC11277318_p54
PMC11277318
sec[3]/sec[5]/p[1]
4.6. Further Wishes
1.008789
other
Other
[ 0.0220489501953125, 0.0013418197631835938, 0.9765625 ]
[ 0.0028228759765625, 0.9951171875, 0.001720428466796875, 0.0004930496215820312 ]
Open suggestions for improvement can be clustered in timing aspects, the offer design, specific spatial concerns and related information. Below, only those that are applicable to a broad range of organizations are described.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
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en
0.999997
PMC11277318_p55
PMC11277318
sec[4]/p[0]
5. Discussion
2.052734
biomedical
Study
[ 0.51611328125, 0.00444793701171875, 0.4794921875 ]
[ 0.9931640625, 0.00627899169921875, 0.0002570152282714844, 0.00030994415283203125 ]
This study focused on describing the implementation of DWHP in a hospital in Austria which is already actively engaged in WHP. Digitalization was seen as a general necessity in the HR context, but also to decrease inequalities of access possibilities to WHP. A highly target-group-oriented approach was chosen to ensure the new offer was aligned to the employees’ needs. However, it is important to keep in mind that the setting must be conducive for health, as well . While reporting on the baseline data and the evaluation, the focus was on the latter to test five hypotheses, of which three were confirmed.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p56
PMC11277318
sec[4]/p[1]
5. Discussion
1.124023
other
Other
[ 0.0089569091796875, 0.0006580352783203125, 0.990234375 ]
[ 0.0587158203125, 0.9384765625, 0.001621246337890625, 0.001209259033203125 ]
DWHP is rated favorably by the employees (H1: confirmed), but they are very much more in favor of on-site offers, underlining that digital interventions should only constitute an addition to regular WHP initiatives. This tendency is partly reflected in the currently lower rate of DWHP use (H1a: high use of DWHP is not confirmed) compared to actively engaging in WHP. However, the intended use is pronounced (H1b: high intended future use is confirmed), especially for those who experience high time-related pressure in their daily work. This confirms the initial reasoning for introducing DWHP in the organization.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p57
PMC11277318
sec[4]/p[2]
5. Discussion
3.369141
biomedical
Study
[ 0.896484375, 0.0042266845703125, 0.09930419921875 ]
[ 0.998046875, 0.00144195556640625, 0.00032711029052734375, 0.00011283159255981445 ]
This study shows that the benefits of DWHP were stated by more participants in the second survey, confirming H2. However, barriers to using DWHP did not decrease, which is why H3 was not confirmed. This could be due to a higher awareness of potential barriers, but also highlights the training and assistance needs of employees. Working on barrier reduction should be a major focus to ensure that the benefits of DWHP can be reaped. While the very positive ratings show that there is a significant amount of potential for salutogenetic transformation, the connections to time pressure also require improvements in the general working conditions. Though many of the project targets have been reached, staff with rigid working times and those with direct patient interaction need to be focused on even more. Overall, flexibility (in terms of time and location) appears to be more relevant than saving time. Interestingly, many benefits of DWHP were more relevant for those without patient contact. As these are traditionally seen as those who can better plan for WHP participation, this needs to be further investigated.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p58
PMC11277318
sec[4]/p[3]
5. Discussion
2.199219
biomedical
Other
[ 0.6806640625, 0.0020389556884765625, 0.3173828125 ]
[ 0.39697265625, 0.59033203125, 0.01203155517578125, 0.0008683204650878906 ]
The results show that the demand for DWHP is high and likely to rise further. As Bleier and colleagues highlight, the demand especially for psychological health promotion is high and the offer is likely to be expanded. However, they also raise the issue of high dropout rates in DWHP offers, which may be due to a vicious cycle of lack of time and exhaustion. This may call for increasing precision prevention , e.g., with apps . Recent research indicates that DWHP is not only effective for health promotion and prevention . The use of health apps at the workplace can even improve retention rates . As all health issues can be addressed , it may be advisable to investigate the current state of burdens and resources and to then focus on the major topics. Then, the impact may be even greater. However, internal project and organizational leadership has to be very committed , which is the case for this project. Moreover, data security has to be ensured.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p59
PMC11277318
sec[4]/p[4]
5. Discussion
1.175781
other
Other
[ 0.0115966796875, 0.0012378692626953125, 0.9873046875 ]
[ 0.00244140625, 0.99658203125, 0.00044918060302734375, 0.000347137451171875 ]
Sallinen highlights the importance of stakeholder trust in the context of DWHP. As indicated above, placing health concerns in the hands of the employer (digitally) may involve data security issues . By including third-party applications into the range of options, privacy aspects may be easier to accommodate as the employer is not the one who offers the measure . One way to do so is by creating a pool of DWHP initiatives and sharing them via networks of organizations. When recorded and posted on the intranet or another site, the offers could even be offered for a longer time, which creates a second benefit to cost sharing in a network .
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p60
PMC11277318
sec[4]/p[5]
5. Discussion
1.685547
other
Other
[ 0.0809326171875, 0.0017328262329101562, 0.91748046875 ]
[ 0.005199432373046875, 0.99365234375, 0.0010862350463867188, 0.0002601146697998047 ]
Workplace health initiatives hold the danger of reducing the individual perception of responsibility for health, leading to less autonomy. Even if autonomy is kept, and for example used in the form of not participating in (D)WHP, falling ill may lead to being held even more accountable . This could lead to people opting in even though they would rather not, which again decreases autonomy. The same holds true for information and communication technology and its regular use just as DWHP. While ICT allows for remote work, increasing temporal and spatial autonomy, it can be tied to the expectation of availability, limiting behavioral options and contradicting autonomy . Temporal and spatial autonomy, however, are needed as slack and distancing to make innovation and recovery possible. Therefore, DWHP should also not lead to negative work–home boundary spilling or add pressure.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p61
PMC11277318
sec[4]/sec[0]/p[0]
5.1. Future Research Requirements
3.96875
biomedical
Study
[ 0.986328125, 0.0007128715515136719, 0.01284027099609375 ]
[ 0.67578125, 0.003490447998046875, 0.320556640625, 0.00020682811737060547 ]
Blind spots in WHP research and consequently DWHP are unintended consequences as, for example, creating stress due to WHP participation or reducing additional payments due to demanding working contexts (heat, dust, noise, …) when conditions are improved. Furthermore, unexpected associations like the physical activity paradox must be considered, stating that occupational physical activity is related to higher mortality. This is because higher degrees of physical activity at work are related to lower job qualification levels . Physical activity interventions in (D)WHP would have to take this into account, differentiating between what is required by whom. As Tengland highlights, the type of job needs to be considered, especially in the context of workability, as some lines of work require higher degrees of certain aspects of health, together with relevant competences. A recent systematic review on DWHP underlined that employees’ health literacy is crucial for achieving positive effects . This implicitly calls for targeted workplace health promotion. Moreover, a more detailed analysis of the benefits of DWHP is required, including usability issues (e.g., understandability, applicability, integration into the daily routine), barriers to use DWHP compared to WHP, and employee-perceived health impacts. In this context, the effects of engaging in specific types of DWHP require a detailed analysis. Higher-order statistical analyses like structural equation models could be used to investigate interrelationships of barriers, offers, and impacts. Also, potential unintended effects (e.g., reduction in interaction with colleagues compared to on-site offers) and how to avoid these need to be investigated.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277318_p62
PMC11277318
sec[4]/sec[0]/p[1]
5.1. Future Research Requirements
1.335938
other
Other
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[ 0.01081085205078125, 0.98681640625, 0.0017175674438476562, 0.00044727325439453125 ]
“[T]he question arises as to the chances of realizing an opportunity- and health-oriented design of work. These are characterized by the tension between ethical orientation and economic benefit considerations (…)” (p. 9). Since digital offers are typically much cheaper, this opens new opportunities that organizations should consider. In line with this, future research should evaluate the employer’s perspective on DWHP and analyze reduced costs and impacts on organizational performance data. As the situation during the pandemic highlighted, individual career choices and the staffing and thus existence of entire economic sectors are affected by the degree to which organizations can ensure employee health in a broad sense . Improving the health and safety climate by general setting-oriented initiatives and targeted offers is promising.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277318_p63
PMC11277318
sec[4]/sec[1]/p[0]
5.2. Limitations
2.314453
biomedical
Study
[ 0.62353515625, 0.0016384124755859375, 0.374755859375 ]
[ 0.99462890625, 0.004871368408203125, 0.00043082237243652344, 0.00014352798461914062 ]
This study focused on providing an overview of the demographic differences regarding DWHP perception and does not come without limitations. First, we considered one organization only, and in a very specific sector (healthcare). Moreover, we only investigated employees and no other stakeholders. Nevertheless, this provides the opportunity to survey a population with very diverse educational backgrounds, jobs and working times. Thus, the results are of interest not only for other hospitals, but also large organizations in which employees have very different job types and schedules. However, we highly advise for studies in other sectors, as well, and in different nations. Moreover, we advocate for studies that differentiate in more detail regarding demographic criteria, which was not possible in this case due to ethical concerns, e.g., regarding distinguishing in more detail between age groups. Also, identical scaling should be ensured in case several surveys are used.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277318_p64
PMC11277318
sec[4]/sec[1]/p[1]
5.2. Limitations
1.894531
other
Study
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[ 0.83984375, 0.158447265625, 0.0012378692626953125, 0.0004591941833496094 ]
Second, though we can report on two investigations, we cannot match the answers of the surveys as anonymity concerns did not allow for using personal codes. However, this approach can reduce potential biases like social desirability. Future studies may consider the option of personal codes and provide data on within-person changes using various DWHP offers. Also, group comparisons of WHP and DWHP offers on identical topics and the outcomes regarding statistical twins may be highly interesting. This may also offer the possibility to reduce potential nonresponse bias and people could be matched based on their digital competences. Currently, those interested in WHP and DWHP may have participated in higher numbers, so an analysis of non-respondents may be a fruitful avenue for research.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p65
PMC11277318
sec[4]/sec[1]/p[2]
5.2. Limitations
1.444336
other
Other
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[ 0.225341796875, 0.7724609375, 0.0015802383422851562, 0.0008087158203125 ]
Third, we employed quantitative surveys with only a few open questions. Though the response rate is rather high compared to the sample size, it is very likely that there are patterns that require in-depth interaction with the target group. Therefore, we encourage studies adding qualitative data stemming from interviews or observing employees using DWHP.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999998
PMC11277318_p66
PMC11277318
sec[4]/sec[1]/p[3]
5.2. Limitations
1.115234
other
Other
[ 0.0146331787109375, 0.0005288124084472656, 0.98486328125 ]
[ 0.0889892578125, 0.90869140625, 0.0013685226440429688, 0.0011587142944335938 ]
Fourth, we did not ask about employment history and whether employees had already worked for an employer with a DWHP offer, as this is a very recent development. However, future studies should take this into account.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p67
PMC11277318
sec[5]/p[0]
6. Conclusions
2.255859
other
Other
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[ 0.21435546875, 0.77197265625, 0.01279449462890625, 0.0009713172912597656 ]
Many organizations offer workplace health promotion (WHP) , and increasing stress and strain at the workplace suggests this is much needed. As can be seen from the results of this case study, DWHP does have the potential to contribute to the sustainable development and transformation of organizations via the high interest it generates. Most of the respondents intended to use DWHP in the future, which provides a unique opportunity for organizations to improve the health and wellbeing of their employees via digital health promotion offers. Designing attractive jobs will be crucial for the further development of many industries, as current personnel shortages highlight. Changes regarding how organizations treat employees can thus be expected and are hypothesized to result in advantages for all. Whether this is mainly altruistically or financially motivated, or both, is an open ethical question. Its perceived answer can influence the reaction of the stakeholders due to the importance of credibility of corporate actions regarding health promotion. The latter is improved by providing opportunities for the true co-creation of health programs at the workplace , and evaluated against the ideas held of what organizations should look and be like, provide and stand for. Thus, compliance with laws and societally expected working standards, co-creation, participation and target group orientation must range among the principles for creating a healthy job. Nevertheless, the role of organizations in health needs to be discussed.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277318_p68
PMC11277318
sec[5]/p[1]
6. Conclusions
1.958984
other
Study
[ 0.2266845703125, 0.0012578964233398438, 0.77197265625 ]
[ 0.83447265625, 0.16357421875, 0.0012302398681640625, 0.0007233619689941406 ]
This study is about a project on digital health promotion for employees in a hospital in Austria, thus referring to sustainable HR aided by digitalization. It is important to note here that employees may have a different impression of the WHP offer than employers . Individual capabilities must be considered just as much as motivational issues, together with ensuring the opportunity to participate , which is much improved by digital offers in general and even further profits from investigating the employees’ wishes and needs. The creation of salutogenic structures and processes in organizations requires an intensive dialogue with internal and external stakeholders, just as the choice of (digital) interventions does . In accordance with comprehensive descriptive management models, the topics to be considered include values, concerns and resources . This study can serve as a first basis for organizations interested in supplementing WHP with digital aspects.
[ "Elisabeth Nöhammer", "Michaela Drexel" ]
https://doi.org/10.3390/ijerph21070902
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999999
PMC11277330_p0
PMC11277330
sec[0]/p[0]
1. Introduction
4.195313
biomedical
Study
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[ 0.71630859375, 0.00316619873046875, 0.280029296875, 0.0005311965942382812 ]
In recent years, significant research efforts have been directed towards unravelling the development and progression of glioblastoma (GBM), a grade 4 central nervous system (CNS) cancer noted for its diversity and aggressive nature. Although central nervous system cancers overall have a lower global incidence rate (1.7%) compared to other cancer types, GBM stands out with a relatively higher incidence rate of 3.23 per 100,000 individuals. GBM is recognized as one of the most aggressive and malignant forms of CNS cancer, leading to a high mortality rate with a median survival time of just 8 months and an average survival time of 15–18 months . GBM predominantly arises in the supratentorial region of the brain, with the highest frequency observed in the frontal lobe. It is rarely found in the cerebellum or spinal cord, where it demonstrates unique tumour behaviour .
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277330_p1
PMC11277330
sec[0]/p[1]
1. Introduction
4.28125
biomedical
Study
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[ 0.6083984375, 0.0016765594482421875, 0.38916015625, 0.0006155967712402344 ]
Molecular studies have identified several critical biological pathways and gene expression profiles associated with the stratification and diagnosis of GBM patients . Alterations in the gene expression of PDGFRA-IDH1, EGFR ( ERBB1 ), and NF1 can be used to identify the proneural, classical, and mesenchymal types . New genetic factors involved in the progression of GBM, including the SOX transcription factor family and proteins, have been discovered using CRISPR-Cas9-based studies . Histological studies have revealed that the nature of GBM is heterogeneous in terms of cell types, morphology, and oncogenic changes . These studies may contribute to extending GBM patients’ lifespans and broaden our perspective on understanding the underlying molecular mechanism involved in the progression of GBM. However, GBM remains a significant threat due to recurrence features and its limited treatment approaches.
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277330_p2
PMC11277330
sec[0]/p[2]
1. Introduction
4.082031
biomedical
Review
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[ 0.00746917724609375, 0.00384521484375, 0.98828125, 0.000545501708984375 ]
The current standard of care for GBM treatment involves a comprehensive, multidisciplinary approach that typically includes surgery, radiotherapy, and chemotherapy. The most commonly used chemotherapy agents target a variety of biological processes. These include DNA crosslinking (Temozolomide and its derivatives), VEGF-A inhibition (Bevacizumab and its derivatives), and DNA/RNA damage (Carmustine and its derivatives). Treatment regimens may vary between newly diagnosed patients and those with recurrent GBM. Recent advances in omics technologies have paved the way for personalized therapeutic strategies in GBM treatment. Innovative methods, such as antibody-based drugs, vaccines, growth factor receptor inhibitors, immune checkpoint inhibitors, and modulators of the immune system, are currently under investigation. These emerging treatment alternatives, with their disadvantages, have the potential to enhance patient quality of life and increase the overall survival rates of those with GBM .
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277330_p3
PMC11277330
sec[0]/p[3]
1. Introduction
4.203125
biomedical
Review
[ 0.99853515625, 0.0008687973022460938, 0.0007786750793457031 ]
[ 0.1318359375, 0.004852294921875, 0.86279296875, 0.0006608963012695312 ]
The systems biology approach utilizes a diverse array of experimental and computational methods to examine complex biological systems. This includes analysing high-throughput omics data through statistical analysis, network analysis, and mathematical modelling, providing a comprehensive understanding of biological processes and interactions . This interdisciplinary approach facilitates a thorough understanding of biological systems. Furthermore, it has been successfully applied in drug repositioning, allowing for the repurposing of existing drugs for treating different medical conditions, guided by systems biology methodologies . In addition to these, a recently developed alternative treatment approach, in which glioblastoma cells are exposed to a range of tumour-treating field intensities in combination with standard chemotherapy drugs, has shown potential synergistic anti-tumour effects and received clinical approval from the Food and Drug Administration .
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277330_p4
PMC11277330
sec[0]/p[4]
1. Introduction
4.277344
biomedical
Study
[ 0.99951171875, 0.00042057037353515625, 0.0001392364501953125 ]
[ 0.9970703125, 0.000537872314453125, 0.002185821533203125, 0.00015866756439208984 ]
In this study, we employed a systems biology approach to identify a therapeutic target that can be used for the development of effective treatment strategies for GBM based on the integrative analysis of global gene expression profiling of GBM patients. Specifically, we developed a workflow for the discovery of the potential therapeutic agents for the treatment of GBM patients by performing (i) survival analysis by studying the associations between the survival of GBM patients and global gene expression profiling of tumours obtained from three different GBM cohorts, (ii) differentially expressed gene analysis (DEG) to reveal the altered gene expression, (iii) co-expression analysis to identify the critical gene clusters involved in the occurrence of the disease, and (iv) drug repositioning to discover the drug candidate that can modulate the key genes and clusters involved in the progression of the disease . Employing computational drug repositioning, we explored drug-target interactions and identified potential therapeutic agents that could modulate these target genes in GBM. Our research provides valuable insights into identifying therapeutic drug targets and discovering effective treatment agents for GBM, paving the way for future pre-clinical and clinical trials.
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999997
PMC11277330_p5
PMC11277330
sec[1]/sec[0]/p[0]
2.1. Survival Analysis Identifies Prognostic Genes for GBM
4.085938
biomedical
Study
[ 0.99951171875, 0.0003287792205810547, 0.0002053976058959961 ]
[ 0.99951171875, 0.0001481771469116211, 0.000423431396484375, 0.00007277727127075195 ]
In this study, we performed univariate Cox regression analysis to examine the relationship between the expression levels of protein-coding genes and patients’ survival outcomes in three different cohorts including The Cancer Genome Atlas (TCGA) cohort, CGGA_693 cohort, and CGGA_325 cohort from the Chinese Glioma Genome Atlas (CGGA). Based on our analysis, 1526, 615, and 2232 prognostic genes were identified in these three datasets, respectively . We compared the results from the three datasets to ensure consistency in prognostic genes and found that they significantly overlapped . Notably, most of the overlapped prognostic genes were unfavourable, indicating that high expressions of these genes were associated with poor patients’ survival outcomes.
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999996
PMC11277330_p6
PMC11277330
sec[1]/sec[0]/p[1]
2.1. Survival Analysis Identifies Prognostic Genes for GBM
4.011719
biomedical
Study
[ 0.99951171875, 0.00026726722717285156, 0.0003180503845214844 ]
[ 0.99951171875, 0.0001895427703857422, 0.00022602081298828125, 0.000048041343688964844 ]
To confirm the reproducibility of our findings, we constructed a pool of prognostic genes by including only those that were identified as prognostic in at least two datasets based on Cox regression analysis. This resulted in a consensus pool of 471 overlapped prognostic genes, including 381 unfavourable prognostic gene pool (UPGs) and 90 favourable prognostic gene pool (FPGs) . Comprehensive information regarding significant genes is available in Supplementary File SB .
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995
PMC11277330_p7
PMC11277330
sec[1]/sec[0]/p[2]
2.1. Survival Analysis Identifies Prognostic Genes for GBM
4.265625
biomedical
Study
[ 0.99951171875, 0.0003142356872558594, 0.00022161006927490234 ]
[ 0.9990234375, 0.00017940998077392578, 0.0005927085876464844, 0.00007975101470947266 ]
Functional enrichment analysis revealed that the UPGs were significantly enriched in the biological processes such as extracellular matrix organization, cell migration, blood vessel morphogenesis, angiogenesis, aminoglycan, and glycosaminoglycan (GAG) ( Figure 3 (A.1)). Similarly, we observed supportive results from Kyoto Encyclopaedia of Genes and Genomes (KEGG) pathway analysis showing the functional enrichment of biological processes, including the extracellular matrix (ECM) receptor interaction, GAG degradation, and proteoglycans. Some well-known biological pathway alterations in GBM are phosphatidylinositol-3-OH kinase (PI3K) pathway activation and growth factor signalling defects depending on receptor tyrosine kinase (RTK) activation that are confirmed based on KEGG pathway functional enrichment analysis ( Figure 3 (A.2)). On the other hand, FPGs were only enriched in cytoplasmic translation processes, which are mostly related to RNA metabolism and also confirmed by KEGG pathway functional enrichment analysis. The ribosome pathway that is associated with the altered metabolism regarding the tumorigenic activity was also significantly altered ( Figure 3 (C.1,C.2)).
[ "Ali Kaynar", "Mehmet Ozcan", "Xiangyu Li", "Hasan Turkez", "Cheng Zhang", "Mathias Uhlén", "Saeed Shoaie", "Adil Mardinoglu" ]
https://doi.org/10.3390/ijms25147868
N/A
https://creativecommons.org/licenses/by/4.0/
en
0.999995