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Aim: With the COVID-19 pandemic, we witnessed an increase in purchases of certain products, such as toilet paper, disinfectants, or groceries. In the present study, we examined the individual and socio-psychological determinants of stockpiling behavior. For this purpose, we defined an explanatory model based on the Health Belief Model (HBM), which includes threat perceptions, barriers and benefits, and self-efficacy beliefs as main predictors of health-related behaviors, and extended the model to include social norms. Subject and methods: Participants were recruited via social media platforms and data collection was conducted via an online survey. The final sample included 861 German respondents (male = 199, female = 642, mean age = 36.76, SD = 12.38). Results: Perceived barriers of stockpiling, such as financial constraints or regulations in supermarkets, turned out to be the strongest predictors of stockpiling. Regarding the role of threat perception, the perceived severity of the disease in particular was positively related to stockpiling behavior. Finally, our results suggest a significant impact of social cues, showing that descriptive normative beliefs are associated with stockpiling behavior. Conclusion: Based on these findings, we propose targeted interventions to a) reduce perceived benefits of stockpiling and severity beliefs related to COVID-19, b) emphasize disadvantages of stockpiling, and c) reduce media exposure of stockpiling behavior to prevent panic buying. [ABSTRACT FROM AUTHOR]

Aim: The goal of this paper is to analyze the COVID-19 policies of 10 European countries, including Sweden, Finland, Norway, Italy, France, Germany, Poland, Belgium, the Netherlands, and Hungary, with a time-series policy analysis tool. Subject and methods: The results of the COVID-19 policy analysis are based on a single time-series indicator, or daily population mortality rate: the number of COVID-19 daily cumulative deaths divided by the population in millions. The lower the score, the better the policy. Although many experts believe that the COVID-19 policy outcome analysis is premature, time series analysis is an excellent analysis that can provide information on the progress and transition of policy outcomes. In other words, the proposed time series analysis tool allows policymakers to identify and quantify when mistakes were made during the on-going COVID-19 pandemic. Results: The COVID-19 policy analysis discovered many useful facts. Sweden failed due to the herd immunity approach. Hungary made a fundamental mistake in COVID-19 tactics. Countries such as Sweden, Hungary, Belgium, and Poland showed time-series changes that differed from the others. Conclusion: Public health interventions can play a key role in mitigating the COVID-19 pandemic. The proposed policy analysis tool, hiscovid demonstrated the effectiveness of the time-series score behavior for discovering when policymakers made mistakes. [ABSTRACT FROM AUTHOR]

Background: In a global comparison, in 2006 Germany was the first in the world to switch naratriptan to an OTC medication but since then only almotriptan has been switched. Therefore, Germany has fallen behind recently because of the failure to carry out further switches. Objectives: The aim of this extensive evaluation of various surveys among pharmacies, physicians, patients and stakeholders was to investigate whether there is an obvious need for an Rx-to-OTC switch of further triptans. In addition, reasons for or against such a switch should be evaluated. Setting: The surveys were distributed in several ways. Most were based on online tools and were performed in 2017, 2018 and 2019. Methods: Several surveys have been initiated using different methodologies. The pharmacist surveys were only conducted digitally. The physician surveys were first digitally based on an online platform. A paper form could also be edited manually and returned by fax. The respective questionnaires consisted of 5 to 17 questions on the topic of switching and could all be answered in about 5 to 10 min. BAH Health Monitor hosted the patient surveys and included telephone interviews. The stakeholder survey was performed by personal interviews. The surveys on economic calculations among patients were conducted digitally. Main outcome measure: Sumatriptan and other Rx triptans are suitable and should be switched to OTC status. Results: Nine hundred forty pharmacists and pharmaceutical technical assistants took part in the initial pharmacist survey. In the subsequent pharmacist surveys, the volume of participants was even higher and reached almost 4000. For the physician survey, 540 answers were received, and the BAH Health Monitor addressed about 1000 telephone interviews. Within the stakeholder survey, 24 interviews were carried out with 32 participants from a range of professional backgrounds; most are part of the German switch process. Finally, the patient survey related to economic calculations was based on 175 answers. Seventy percent of the participating physicians < 50 years old supported a switch of further triptans. For the question about how safe OTC triptans are, 41% of the 3568 participants from the Marpinion pharmacy survey voted that they are safe. Conclusion: With a Rx-to-OTC switch of further triptans, patients would have an easier, faster and safe way to treat their migraine attacks. Impact of findings on practice statements: The outcome of these surveys and interviews provides information for all participants in the German switch process about their decision-making behaviour. Furthermore, it allows deeper insights into patients' needs and may help to fulfil them. The results can provide information about the German process and German needs worldwide and stimulate discussion about Rx-to-OTC switches. [ABSTRACT FROM AUTHOR]

Aim: Long-term invasively ventilated patients exhibit exceptional and resource-intensive healthcare needs. However, major knowledge gaps in Germany complicate appropriate approaches to best address these demands. This paper evaluates available information on the patient group and their healthcare needs from German data sources and derives implications for healthcare planning and regulation by national/federal self-governing bodies, political decision-makers, and specialized providers. Methods: Based on the concept of needs, we addressed the normative dimension typically characterized by epidemiological data. Based on existing German health system data resources, an explorative approach was utilized to identify and characterize available databases providing information on the patient group and/or their healthcare. Results: To date, no available database provides information on the healthcare needs of this patient group. As of the reporting year 2017, the diagnosis-related groups (DRG) statistics will provide hospital-specific data on home invasive ventilation interventions, but the data do not provide information on long-term care. Claims data may be a promising source for cross-sectoral evaluation of healthcare needs but feature methodological challenges. These results call for efforts to address limited data eligibility, adopt a broader understanding of healthcare needs, and identify actions needed to evidence informed and needs-oriented healthcare. Conclusion: Future approaches on needs-oriented specialized healthcare should close the existing knowledge gap based on reliable data. In addition to normative information, they should consider subjective dimensions on a life course perspective and quantitative and qualitative service performance characteristics across multiple sectors and professions. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study is to analyze the meaning of intergenerational educational transmission and intergenerational educational mobility on adolescents' obesity risk. In particular, the paper investigates if upward social mobility is a protective factor against obesity for children of lower educated parents. Subject and methods: Representative data was derived from a subsample (12-17 years, n = 5,111) of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Body height and weight were measured in a standardized way. Obesity (>97th percentile) was defined due to the national reference system that is based upon percentiles of the body mass index (BMI). Intergenerational educational mobility was defined as: stable high (parents and participant have high education), potentially upwardly mobile (participant's education is higher than parents' education), potentially downwardly mobile (participant's education is lower than parents' education), and stable low (parents and participant have low education). Results: The highest prevalence of obesity was found in adolescents with a stable low education, the lowest prevalence in adolescents with a stable high education. The educational gradient was steeper in girls than in boys. Compared to the 'stable high' reference category, potentially upwardly mobile adolescents had no significant increased risk of obesity, while the risk for potentially downwardly mobile adolescents was only significant in girls (OR 2.32; 95 % CI 1.23 -4.37). The obesity risk in boys and girls with a stable low education was significantly elevated (1.68; 1.04-2.73 and 3.06; 1.89-4.94). Conclusion: Parental education and adolescents' own educational status have cumulative effects on obesity risk. The fact that potentially upwardly mobile boys and girls are not more likely to be obese than adolescents with a stable high education and less often than adolescents with a stable low education can be interpreted as a protective effect of upward social mobility even though health selection might have played a role. [ABSTRACT FROM AUTHOR]

Aim: Knowledge about nurses' error perception is crucial for establishing a sustainable risk management. This paper presents categories and frequencies of errors as identified by nurses. The cross-sectional study results provide further knowledge for professional and organizational development. Subject and methods: Data from 1,100 German nurses working in 30 hospitals and 46 nursing homes were collected using a self-administered questionnaire. This paper firstly presents results from a content analysis of nurses' descriptions of errors and, secondly, results on frequencies of predefined nursing errors (closed-ended, ordinal frequency estimation). Thirdly, it compares the answers of hospital nurses with those of nurses employed in nursing homes and finally it compares answers of participant groups defined by sex or migration background. Results: In the open-ended section, errors described by 60.5 % of the participants concerned medical diagnosis/therapy. 20.7 % had experienced errors in hands-on care, while errors in communication with patients were noted by 3.7 %. In contrast, when offering predefined activities in the questionnaire's closed-ended part, indicated frequencies of errors stressed issues of hands-on care and documentation. Significant differences exist between participants from both settings regarding direct care and relationship building. Sex and migration background were related to frequency estimations. Conclusions: Findings point to shortened professional perspectives in the debates on risk and safety. This might lower nurses' compliance in risk management systems. The influence of health professionals' sex and migration background on their error perception needs further exploration. Field specific approaches for error prevention are needed. [ABSTRACT FROM AUTHOR]

Within Germany, a significant decrease in avoidable mortality from ischemic heart disease (IHD) has been observed since the early 1990s. The objective of this paper is to identify the specific reasons that have led to the decrease in the number of avoidable deaths from IHD in West and East Germany from 1996 to 2004. We analyzed the mortality rate from IHD of the male population aged less than 65 years on the regional level of German counties over the 1996–2004 period. Methodologically, after adjusting for a number of health structure variables, the socioeconomic structure of each region, and yearly time trends in avoidable mortality, we accounted for unobservable differences among regions by using a fixed-effect estimator. Our main result reveals that the number of intracardiac catheter facilities, an important diagnostic tool for IHD, significantly accounts for decreases in avoidable mortality from IHD. This is important, as the modernization of the East German health sector included a considerable catching-up process in the number of IC facilities provided relative to West Germany. Our results suggest that the modernization of the East German health sector may have contributed to saving people from premature deaths. [ABSTRACT FROM AUTHOR]

This paper aims to unobtrusively identify gender patterns in diabetics' adherence to their medication regimen. Non-adherence is a major problem in health care as it affects both the patient’s individual health as well as public health. Seen worldwide, the problem of non-adherence is even more important due to the increasing numbers of the elderly population and of chronic diseases such as diabetes, asthma, HIV, etc. It is estimated that in Germany alone, non-adherence is responsible for costs of €10 billion per year. Finding useful health behaviour patterns could be especially important for the increasing number of patients with chronic diseases such as diabetes, where costs are high and consequences such as retino-, nephro- and neuropathy severe for 180 million diabetics worldwide. This paper analyses the records of two German pharmacies, P1 and P2, regarding gender patterns in adherence to oral antidiabetics as this analysis method has a high specificity. Out of 4,474 (P1) respectively 2,650 (P2) datasets, those were selected that showed the use of medication with oral drugs for diabetes based on ATC code level A10B. The selected medication datasets were fully analysed, also the respective adherence rate for drugs used for hypertension, ATC code level C. Average adherence rates for oral antidiabetic agents varied, with 25.4% (P1 women) and 34.6% (P1 men), and 27.8% (P2 women) and 26.1% (P2 men). In contrast, average adherence rates with drugs for the cardiovascular system were high, with 73.4% (P1 women) and 74.2% (P1 men), and 57.0% (P2 women) and 70.2% (P2 men). Adherence rates for oral antidiabetic agents showed no gender patterns. This finding is supported by varying adherence rates for medication for hypertension. In both cases, the chi-square test showed no significant correlation between gender and adherence classification, and also Cramer’s V only showed a small effect of gender on adherence behaviour. [ABSTRACT FROM AUTHOR]

A Correction to this paper has been published: https://doi.org/10.1007/s10389-020-01470-1 [ABSTRACT FROM AUTHOR]

Aim: To identify literature on safety-relevant handover communication, as operationalized by an adapted Lasswell communication model, and to reveal the extent to which this literature is relevant to patients with dementia (PwD). Furthermore, the study identifies interventions that could be applicable in dementia handover communication. Methods: A systematic review was performed. MEDLINE, EMBASE, Cochrane Library, CINAHL, PsycInfo and GeroLit were searched for publications indexed up to and including April 2011. Forward citation tracking was conducted in January 2012 using the SCOPUS database. The inclusion criteria followed an adapted Lasswell communication model. Evidence was excluded that did not meet more than three-quarters of the critical appraisal's 27 quality criteria. A content analysis and a critical appraisal were performed to eliminate ineligible publications. Results: Out of 3,918 positive search results, a total of 5 publications were ultimately eligible for inclusion. Only one of them included PwD in the intervention group. However, since dementia was not the focus of the study, the paper contained no discussion of the results specifically for PwD. Conclusion: There are several options for improving safety-relevant handover communication between settings, but strong evidence is still lacking, particularly for PwD. Research involving PwD should include topics such as the role of advanced nurse practitioners (APN), the information needs of everyone involved in the handover and appropriate involvement of informal caregivers. Responsibilities in care should be defined and specific communication processes implemented. Further investigation and application of Naylor et al.'s () transitional care model could be particularly helpful in dementia research. [ABSTRACT FROM AUTHOR]

Aim: Nurses constitute an important group in identifying and preventing errors and risks in health care, but research on their perception of errors is scarce. This paper presents results of a representative study on health care errors, focusing on factors causing and influencing the occurrence of errors as perceived by nurses. Subject and methods: The cross-sectional research design comprised descriptive and correlational parts. The sample consisted of 1,100 nurses employed at 30 hospitals and 46 nursing homes in Germany. Data were collected in 2008/2009 using a questionnaire listing 21 factors that can potentially cause or influence errors. Participants could choose up to three factors they deem the most important. Differences between the two settings and variables which might have an influence on the perception of error-causing factors were analyzed using cluster-adjusted methods. Results: High workload, staff shortage and excessive labour topped the list. Hospital nurses more often chose 'workload' and 'interruptions' while nursing home nurses more often ranked 'lack of knowledge' and 'lack of motivation' as the most important. There are some significant variables such as years of professional experience and migration background that could affect nurses' perception. Conclusion: The findings support other studies, pointing to workload issues and below-optimum work processes producing errors. Inter-sectoral differences suggest the necessity of sector-specific support in education and on-going training as well as risk and quality management. [ABSTRACT FROM AUTHOR]

im: Parental depression is a strong risk factor for depression in children and is associated with offspring's behavioral problems. Therefore, prevention measures should aim to reduce the transmission of risk to children of depressed mothers. In this paper, description and evaluation results are reported for EFFEKT-E ( Entwicklungs förderung in Familien: Eltern- und Kinder- Training in emotional belasteten Familien), a prevention program to be used in the setting of mother-child rehabilitation clinics. EFFEKT-E is a family-oriented program including parent training and social skills training for pre-school children. Subjects and methods: The evaluation study contained 375 mothers and their children. The program was evaluated in a quasi-experimental pre-post-follow-up design using instruments on parenting behavior and children's emotional and behavioral problems. Results: Evaluation showed satisfying out reach and implementation of the program. Compared to a treatment-as-usual condition, EFFEKT-E children exhibited less emotional disruption and hyperactivity. Mother's sense of parental competence was promoted, problematic parenting behavior decreased. Conclusion: EFFEKT-E is an evidence-based selective program which has the potential to prevent intergenerational transmission of depression. [ABSTRACT FROM AUTHOR]

im: Disordered eating is a significant social and economic issue in Western societies. Weight and shape concerns are highly prevalent during adolescence and an alarming percentage of adolescents already show disturbed eating patterns. Sociocultural factors like the beauty ideal promoted by the media and social agents are among the main reasons for this trend. Prevention programmes which focus on established protective and risk factors are needed to counteract problematic developments as early as possible. Subject and methods: In this paper we describe the development and the contents of a structured school-based eating disorder prevention programme for adolescents. Results: The POPS programme (POtsdam Prevention at Schools) is an interactive multisession programme and encompasses nine lessons for pupils and one meeting with the parents. The programme is based on current research on risk and protective factors for eating disorders with an emphasis on sociocultural factors. It is designed to enhance resources based on the life skills approach. We included for instance lessons to enhance healthy eating and exercise habits and to reduce unhealthy dieting, to build up resistance through media literacy and strategies to react to social pressure. To further enhance life skills we integrated the impartation of problem-solving techniques and coping strategies which are potential protective factors not only in relation to eating disorders but also other diseases. In contrast to most existing programmes, psychoeducation on eating disorders is not part of the POPS programme for pupils but part of the information session for the parents. Conclusion: POPS is a theory-based, structured prevention programme that can be implemented by teachers as part of regular lessons. [ABSTRACT FROM AUTHOR]

Aim: Sometimes treatment is not necessarily according to guidelines, which is partly due to attitudes rather than lack of knowledge. In Germany, regional differences concerning prevalence rates of ADHD exist without valid explanation. We contribute with our data to the question of attitudes toward ADHD among pediatricians in Germany. Method: A specially designed questionnaire based on the Knowledge of Attention Deficit Disorders Scale and previous surveys was sent to pediatricians. In addition to descriptive statistics, we performed factor analysis and multiple linear regression analysis. Results: The vast majority (85.5%) of 581 respondents have a positive attitude toward ADHD, i.e., ADHD exists and should be treated appropriately. Physicians with positive attitudes were older and more often had a neuropediatric specialization. Conclusion: Most of the pediatricians surveyed in Germany assess ADHD and treatment in line with medical guidelines and treat as part of multimodal therapy. [ABSTRACT FROM AUTHOR]

Aim: The incidence of inflammatory bowel disease (IBD) is increasing worldwide. The Saxon Pediatric IBD Registry was founded in 2000 to describe the epidemiology of pediatric IBD in Germany. The aim of this study was to determinate the completeness of this registry for children and adolescents younger than 15 years and to make this approach transparent. Results of this completeness update have broad implications for further scientific publications from the registry dataset. Method: The capture–recapture method with two data sources was used to ascertain completeness. A second data source was collected in 2019 for the observation period 2008–2014 from all pediatricians, gastroenterologists, and internists working in practices in a predefined region in Saxony, Germany. Results: A total of 23 patients with IBD were reported who fulfilled the inclusion criteria. One of them was not recorded in the registry. Therefore, the completeness of the registry was estimated at 95.7% (95% CI 90.2–100). Initial analysis of the Saxon Pediatric IBD Registry over the 15-year period 2000–2014 includes 532 patients, 312 (58.6%) male and 220 (41.4%) female. The distribution of single IBD diseases in the registry was as follows: Crohn's disease 338 patients (63.5%), ulcerative colitis 176 patients (33.1%), and unclassified IBD 18 patients (3.4%). Evaluations by sex and by disease in age groups and by age at onset were tabulated. Conclusion: This study demonstrates that the completeness level of the Saxon Pediatric IBD Registry is high (95.7%), and thus the epidemiological data of the registry are reliable. [ABSTRACT FROM AUTHOR]

Aim: Even though students attending vocational school are very vulnerable to the development of mental health problems, few studies identify the correlation between suicidal ideations and vocational education. Therefore, this study aimed to identify the prevalence and associated risk factors for suicidal ideations among vocational students in Germany. Methods: We conducted a cross sectional survey with a total of 555 pupils. The pupils received a standardized questionnaire, assessing sociodemographic data, the use of protective factors, possible risk factors, traits for neuroticism and depressive symptoms. For our study, we excluded item 9 from the Beck depression index (BDI-II) to identify the prevalence of suicidal ideation. Results: Our results show that the prevalence of suicidal ideation among students attending vocational school is 23.2%. A combination of feeling lonely, male sex, low importance of religion, little time for hobbies and BMI scores outside the norm show the highest risk for suicidal ideation and can be identified as significant predictors. Conclusion: This cross-sectional study highlights the mental burden vocational students in Germany are confronted with and underlines the necessity of paying special attention to this group of young adults. Furthermore, it emphasizes the necessity of further studies on this topic, especially including larger student populations. The results should be used to decrease the significant loss of life caused by suicidal behavior in young adults. [ABSTRACT FROM AUTHOR]

Aim: Although caring relatives of people with dementia are a mainstay of many care systems, the availability of support services for them within the municipal community shows deficiencies. Adopting the Theoretical Domains Framework (TDF) this study aims to investigate 1) which of the TDF domains adapted to gerontology show up in public dialogue, and 2) the results that public dialogues produce in terms of support services for caring relatives. Subject and methods: The data consists of town hall meetings and focus groups from 14 municipal communities in Germany. Participants were caring relatives and stakeholders of the communities. A qualitative content analysis was conducted, focusing on the assessment of three TDF domains, namely knowledge, goals, and sociopolitical context as well as outcomes of care optimisation. Results: With regard to domain knowledge, it was evident that in every community there were actors aware of the situation and relevance of carers and their relatives. Only some actors mentioned goals for optimising the care of the target group. The sociopolitical context is often addressed through statements about incomplete requirements. Conclusion: Overall, a relation between the discussion about the domains in public dialogues and changes in supporting carers of people with dementia can be assumed. The results indicate that an increased discussion about the domains within town hall meetings influences the actors and their statements with regard to the improvement of support services for caring relatives of people with dementia. Since the domains were not developed exclusively for the outlined context, this approach can also be applied to other areas of care. [ABSTRACT FROM AUTHOR]

Aim: Health literacy has gained increasing importance worldwide. As a result of several studies indicating low health literacy levels in large parts of the population, strategies and action plans promoting health literacy were developed in many countries. The article analyses the origin, development and structure of the German Health Literacy Action Plan. Subject and methods: In 2016, a civil society initiative was formed, aiming at developing a national action plan in an expert-based and collaborative manner. A group of 15 experts elaborated the core elements of the action plan, based on a literature review on existing health literacy approaches, action plans and empirical evidence. These core elements were further developed collaboratively in workshops with key stakeholders, self-help and patient organizations and individual consultation meetings. Afterwards, the National Action Plan was reviewed and previously formulated recommendations were refined before being published. Results and conclusion: The National Action Plan Health Literacy in Germany presents 15 recommendations in four areas of action for promoting health literacy in Germany. This bottom-up strategy and the expert-based yet at the same time collaborative approach have proved to be successful when developing a national action plan. [ABSTRACT FROM AUTHOR]

Aim: The vaccination campaign against SARS-CoV2 in Germany started at the peak of the second wave. An outbreak in an elderly care home occurred in our county at the time of the second vaccination. We describe a package of measures to control the outbreak and to prevent a spill over into the general population. Subjects and methods: After outbreak confirmation, a package of measures such as quarantine of the elderly care home, staff and visitors, and their households was implemented. By sequential testing, quarantine measures were lifted. Surveillance of staff and residents by rapid antigen test and symptom monitoring was used in parallel. Results: The outbreak was on-going for around 17 days until it was noticed by a symptomatic external staff member as index case. A total of 23 out of 96 residents (24.0%) and nine out of 114 staff (7.9%) were infected. Three residents died. Effective first-dose vaccine coverage was 85.4% in residents, 27.4% in internal, and 10.5% in external staff. Given the long latency period, the use of household quarantine prevented a spill over into the public. Already 16 days after notification of the index case the outbreak could be declared over. Conclusions: Interferences between vaccination coverage and outbreak characteristics in regard to an extended latency period were observed. Household quarantine of case as well as contact households is of increased importance in the era of vaccination to prevent further spread into the general population until population-based control measures and lockdowns can be lifted. [ABSTRACT FROM AUTHOR]

Aim: According to estimates by the World Health Organization (WHO), more than 1.9 billion adults were overweight in 2016, of whom 650 million were considered obese. Various studies show that greater physical activity can have positive effects on the job market. This suggests that obesity not only leads to higher health care costs, it also puts those affected at a disadvantage in the labour market. Against this background, the following questions will be investigated in this article: (1) can a connection between a person's body mass index (BMI), income and years of education be identified? and (2) do income and years of education differ as parameters for professional success in terms of their expression depending on the BMI? Subject and methods: To answer these questions, data from the Socio-Economic Panel (reference year 2016) is used, based on a division of the people using the BMI into the groups of normal weight, overweight and obese. Results: It can be shown that people with obesity achieve a lower number of years of education than the other two groups and a lower income than overweight people. Conclusion: Based on this major socio-economic disadvantage of obese people, further preventive and curative approaches to solving obesity need to be developed. [ABSTRACT FROM AUTHOR]

Aim: Waste, including waste from electrical and electronic equipment, has been increasing for many years. This pilot study aims to describe hospital waste management in three European countries (including collection, disposal and recycling). Subject and methods: The survey was carried out in eight hospitals, two in Rome (Italy), three in Dresden (Germany) and three in Belgrade (Serbia). A questionnaire was used to gain more knowledge about hospital waste management, especially regarding electrical and electronic equipment. Results: The survey results show that treatment of electrical and electronic equipment is a difficult and expensive task in all studied hospitals and countries. Only one half of the hospitals have a standardised procedure for waste treatment. While one eighth has a procedure for some equipment, 37.5% do not have one; and whereas one quarter do not have an office of waste management, a waste register is available in 62.5% of the hospitals. Conclusion: Either waste management procedures differ between the eight studied hospitals and countries, or there is no (prescribed) waste management procedure at all. With regard to the two facts, common regulations are necessary to manage waste disposal and treatment in European countries and hospitals. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to test whether the recently developed ALPHA (Instruments for Assessing Levels of Physical Activity and Fitness) environmental questionnaire for Europe is a reliable and valid instrument to assess perceptions of the physical environment in a German population. Subject and methods: We conducted a survey at the University of Stuttgart. One hundred five participants (mean age 27.5 years, SD = 9.7; 68.1% men) were contacted by e-mail and filled in a computer-assisted self-administered version of the ALPHA environmental questionnaire and of the International Physical Activity Questionnaire long version. We calculated bivariate Pearson correlations between environmental sum scores and domain-as well as intensity-specific PA. After 1 week, we contacted all participants a second time by e-mail. All in all, 42 participants answered the German version of the ALPHA environmental questionnaire twice. We calculated intra-class correlations to assess test-retest stability. Results: Most of the scales and items of the ALPHA environmental questionnaire showed a moderate to good test-retest reliability. Domain- and intensity-specific PA correlated with different attributes of the physical environment. The correlations were low, but pointed in the expected direction. Conclusion: The computer-assisted self-administered German version of the ALPHA environmental questionnaire appears to be a recommendable instrument to assess the perceived environment of a neighborhood for young adults. More representative studies across Europe are essential to finally determine the validity and reliability of this questionnaire. [ABSTRACT FROM AUTHOR]

Aim: The goal is to design and, in a next step, establish a scalable, multi-center telemonitoring platform based on existing systems for monitoring COVID-19 patients in home quarantine. In particular, the focus will be on raw data acquisition, integration of sensor data into the hospital system, structured data storage, and interoperability. Subject and methods: Data necessary for monitoring, otherwise provided in various portals, will be continuously queried and integrated into the hospital system via a new interface in this proof-of-concept work. Results: Based on extensive preliminary work at Klinikum rechts der Isar with a structured clinical database, we extend our system's integration of raw data and visualization in dashboards, as well as scientific provision of data from mobile sensors for monitoring patients in home quarantine. Conclusion: Based on existing integrated telemonitoring systems supporting semantic and syntactic interoperability, short-term provision of scientific databases is possible. The integration of different mobile sensors into a clinical system for remote monitoring of patients around the clock is still new and to our knowledge unique. [ABSTRACT FROM AUTHOR]

Aim: We aim to determine the frequency of stressful life events (SLEs) and investigate the association of single and aggregated SLEs with mental health and general subjective health, which has not been reported for an aging representative sample to date. Subjects and methods: A total of 12,947 participants (35–74 years old) of the Gutenberg Health Study (GHS) in Germany were analyzed. SLEs were analyzed at the item and aggregated level with unweighted and weighted sum scores. Additionally, the survey included measures of mental health, general subjective health and demographics. Descriptive analyses were stratified by sex, age and socioeconomic status. Results: Multivariate analyses of variance with SLE at the item level revealed large main effects for sex (ηp2 = 0.30) and age (ηp2 = 0.30); a moderate effect was found for socioeconomic status (ηp2 = 0.08). Interaction effects of sex with age and SES were also significant, but with negligible effect sizes. Regression analyses revealed similar results for unweighted and weighted SLE sum scores controlling for sociodemographic variables, supporting the detrimental relations among cumulated SLEs, depression (β = 0.18/0.19) and anxiety (β =0.17/0.17), but not general health. Mental health indicators showed the highest correlations with single SLEs such as change of sleep habits or personal finances. Severe SLEs according to proposed weight scores showed no or only weak associations with mental health. Conclusion: Representative data support a more distinct impact of SLEs on mental health than on general health. Single SLEs show strong associations with mental health outcome (e.g., change of sleep habits). The low associations between severe single SLEs and mental health merit further attention. [ABSTRACT FROM AUTHOR]

Aim: Corporate social responsibility (CSR) is supposed to play an important part in public health. Critics argue that opposing financial interests can prevent companies from implementing effective CSR programs. We shed light on this discussion by analyzing CSR programs of gambling operators. Subjects and methods: Two data sets are used: (1) seven responsible gambling (RG) programs of German slot machine hall operators and (2) a survey carried out among 512 problem gamblers in treatment who play primarily in slot machines halls. Results: Results show that the RG programs list mostly mandatory measures with one major exception: to approach possible problem gamblers with the intention to help them. However, operators' staff approach only 1% of problem gamblers. Conclusion: We argue that the observed ineffective implementation of voluntary CSR measures is grounded in the strong financial incentive of operators to serve precisely the group they should stop from playing: problem gamblers. We conclude that financial interests reduce the effectiveness of CSR. [ABSTRACT FROM AUTHOR]

Aim: Regular physical activity and low levels of sedentary time have positive health effects on youth, and data are needed to base public health recommendations on. Here, findings of device-based physical activity and sedentary time in sixth graders are presented. Data below are presented as mean (SD). Subject and methods: Three hundred and eight sixth-grade girls [11.6 (0.6) years] from the CReActivity study in Germany wore accelerometers (ActiGraph GT3X) for 7 consecutive days. Moderate to vigorous physical activity (MVPA), light physical activity (LPA), and sedentary time (ST) was obtained during school days with a focus on recess times. Results: Girls spent 79.9 (23.2) minutes in MVPA and 9.4 (1.2) hours in ST during schooldays, of which 20.5 (8.2) minutes and 3.8 (0.4) hours respectively were accumulated during school hours. On average, students had 35.4 (4.5) minutes break, of which 6.3 (3.2) minutes (17.8%) were spent in MVPA activity and 16.5 (6.2) minutes (46.6%) in ST. Conclusion: School setting is an important factor for physical activity and sedentary time. Therefore policy, curriculums, and school environment should promote physical activity und reduce sedentary time during school hours. [ABSTRACT FROM AUTHOR]

Aim: Work engagement is an indicator of work-related well-being. Taking a salutogenic perspective, this study aims to examine work engagement within the effort-reward imbalance (ERI) model. To foster our understanding of work engagement, we analyzed relationships of the ERI model subscales effort, esteem reward, status reward and security reward as well as overcommitment with global work engagement and its subscales (vigor, dedication, absorption). Subjects and methods: Eight hundred eleven police officers participated in a cross-sectional health-monitoring survey in a German police department. Regression analyses were conducted. Results: The ERI ratio was negatively related to measures of work engagement (β = −0.30 to −0.25). Whereas esteem (β = 0.23 to 0.19) and security reward (β = 0.20 to 0.16) positively predicted global work engagement as well as vigor, dedication and absorption, overcommitment showed a negative association with vigor (β = −0.14). The regression models explained up to 23% of the variance in work engagement or its subscales. Conclusion: An imbalance between effort and reward is associated with reduced work engagement in the sample of police officers. While effort is not accountable for reduced work engagement, esteem and security rewards are capable of promoting work engagement. Workplace interventions at the level of the supervisors and the department as well as public image campaigns may promote rewards in police work to foster work engagement. [ABSTRACT FROM AUTHOR]

Background: The consent of community pharmacists is an important factor for the successful implementation of Rx-to-OTC switches but is not part of the official reclassification procedure in Germany. Objective: The aim was to identify potential switch candidates and indications in addition to a basic assessment of new switches in Germany. Setting: The survey was distributed via the online survey tool of the pharmaceutical journal "Deutsche Apotheker Zeitung" within the period from 20 September to 8 October 2017. Methods: The survey comprised 17 questions. Besides some basic parameters, the questionnaire included a list of proposals for new switch candidates, a vote on the general support as well as economic and health professional expectations regarding further switches. Main outcome measure: The highest consent scores were obtained for second-generation antihistamines for treatment of hay fever such as desloratadine, fexofenadine and levocetirizine. Results: Nine hundred forty pharmacy employees participated in the survey. Beside second-generation antihistamines, there are further preferred switches for nasal glucocorticoids, proton pump inhibitors, ocular antibiotics and emergency kits for acute dyspnoea. Conclusion: Pharmacists strongly welcome further switches. This leads to high acceptance rates, especially for a switch of desloratadine, as this was the most named active ingredient possible for a switch within the survey. Impact of findings on practice statements: The outcome of this survey can support pharmaceutical companies in decision-making about which active substances they should submit a switch application for. Additionally, this helps fulfil patient needs, because pharmacists know best what is beneficial for patient self-care. In addition, all other actors involved in this process can see what is required and can rethink their position regarding further switches. [ABSTRACT FROM AUTHOR]

Background: Health systems worldwide are experiencing increasing cost-cutting pressures with more intense competition and rising customer requirements. We aimed to find out and compare the characteristics and successes of two different sustainable business cases in healthcare delivery from an innovation-driven, organizational perspective. Subject and methods: The data for the two cases were collected through structured literature research as well as personal interviews with the founders of the two healthcare business models. Data were analyzed using the business model canvas as a structured framework, as well as by cross-case analysis. Results: The two business models operate successfully, but pursue different approaches to healthcare innovation. We were able to show that one model pursues a very complex, network-based approach that is focused on one specific rural region, while the structure of the other is characterized by a scalable concept. In addition, we observed that the founders had a decisive influence on the development and success of the healthcare business models. Conclusion: Our study highlights the multitude of complex relationships required to build and establish innovative and successful business models for providing high-quality and cost-effective services in two of the world's largest healthcare systems. Moreover, it could be shown that the business model canvas offers a suitable methodological framework to compare and analyze in a structured manner the extent to which innovative care approaches also require an economically successful and sustainable business model. Results give a holistic, structured description of specific organizational features and environments, whch can then serve decision-makers in health and health economics as lessons learned and aid them in decision-making. [ABSTRACT FROM AUTHOR]

Aims: Valid data on the incidence of inflammatory bowel disease (IBD) in children and adolescents in Germany have not yet been published. Unpublished data of the Pediatric IBD Registry of Saxony (primary data source) have shown a decrease in age-specific incidence rates after the 14th year of age; therefore, a second data source was collected from adult gastroenterologists in Leipzig.Methods: All patients up to 25 years of age with a newly diagnosed IBD from adult gastroenterologists in Leipzig between 2005 and 2009 were included in the second data source: a total of 150 young patients with only two patients before age of 16 and 11 patients before age of 18 years.Results: Using a second data source, the incidence of IBD in children and adolescents up to the completion of the 18th year, as determined by IBD Registry, was corrected from 6.6/100,000 (95%-CI 5.4-8.4) to an actual incidence of 11.0/100,000 (95%-CI 9.1-12.9). Age-specific incidence of IBD was also corrected, increasing continuously until the 18th year was completed.Conclusions: Nearly all patients up to 15 years (completeness 87.5%) were recorded by pediatricians to the IBD Registry. The actual incidence up to the age of 18 years for IBD in Leipzig is one of the highest worldwide. To obtain valid epidemiologic data up to the age of 18, the inclusion of adult gastroenterologists are necessary. [ABSTRACT FROM AUTHOR]

Aim: A broad range of self-tests (testing for e.g. HIV, cancer, hepatitis B/C) is available on the Internet and can be conducted by lay consumers without the help of a health professional. However, little is known about the determinants of self-testing. The aims of this study were to investigate whether the use of self-tests can be predicted by (1) factors specified in social-cognitive health behaviour theories; (2) technological affinity; or (3) anticipated affect. Subjects and methods: An online survey was conducted to investigate social-cognitive health concepts, technological affinity, and anticipated affect as predictors of self-testing. Participants were invited in batches, representative of the age and gender distribution in Germany, until similar numbers of completed cases of non-self-testers ( n = 512) and self-testers ( n = 505) were reached. Univariate and multiple hierarchical logistic regression analyses were carried out. Results: Self-testing was significantly associated with self-test-related self-efficacy, perceived severity, perceived susceptibility, and to some degree with outcome expectancy. Technological competence acted as a suppressor variable, tending to enhance the predictive value of self-test-related self-efficacy. Participants who anticipated a positive self-test-related affect were more likely to be self-testers than non-self-testers. Conclusions: Self-testing was predicted by the common health psychological constructs. However, including technological affinity and anticipated affect into the model significantly improved the predictive value of the use of self-tests. Given the current shortage of physicians, especially in rural areas, the need for, and actual use of self-tests could increase in Germany in the future. Thus, follow-up studies investigating the emotional consequences of self-testing are needed. [ABSTRACT FROM AUTHOR]

Aim: Compared to externalizing problem behavior, European and American research has indicated the danger of developing internalizing symptoms, especially in migrant children and adolescents. However, further specific risk factors in relation to internalizing disorders, for example gender aspects, were often found. Subjects and methods: The present study investigates a child and adolescent psychiatric health care population ( N = 6,269) from 2005 to 2011 in Germany. Around 50 % were diagnosed with internalizing disorders ( N = 3,706). Logistic regressions indicated whether migration background, such as ethnicities, or contextual factors could predict internalizing disorders. Results: Ethnicity or migration background had only a minor influence on internalizing disorders, with the exception of those of Asian origin. Generally, the influence of other environments was much stronger than migrant's characteristics such as gender, living in a single-parent family setting, medium educational background of parents, average or above average intelligence level of children, psychopathological problems of family members, abnormal parenting practice or acute burden living conditions. Interactions between migration background and risk factors were only visible in abnormal parenting practice or abnormal environments. Conclusions: Possibly, migrant children are currently not sufficiently supplied with psychiatric health services. Cross-cultural as well as familial aspects should increasingly be considered in psychiatric work with children showing internalizing symptoms. [ABSTRACT FROM AUTHOR]

Aim: Against the backdrop of controversial bioethical and public health debates on the role of age in decisions on healthcare allocation, we examine the perspectives of European lay persons on ethical implications of age and aging for medicine and health care. Subject and methods: The study uses a qualitative approach based on the content analysis of 29 focus group discussions (235 participants) held in 4 European countries (Austria, Germany, the Netherlands, and Sweden) between 2005 and 2012. Results: While lay persons unanimously reject chronological age as a criterion for resource allocation, they acknowledge that age can be an important factor in ethical decision-making processes in many different ways. In the discussions, they articulate biographical concepts and viewpoints (such as age roles, ideas of the course and prime of life, responsibilities between generations), framing questions of resource allocation with regard to a teleological perspective of a good life. Conclusion: Participants introduce a biographical outlook on medical decision making while at the same time articulating different conceptions of aging and the life course. Public health ethics needs to find ways to incorporate this plurality of temporal perspectives on the good life. [ABSTRACT FROM AUTHOR]

Aim: Personal responsibility for one's health is frequently discussed when deciding on health-care allocation and corresponding costs. We address two questions: (1) Which health-related behavior qualifies for private contributions to treatment costs in the view of the German public? (2) Do acceptance rates for copayments depend on specific characteristics of the citizens? Subjects and methods: The findings are part of a larger representative survey from Germany. In a face-to-face interview (CAPI), participants stated their attitudes towards copayments for patients with risky health behaviors. Nonparametric statistics and regression models were applied to analyze the data. Results: The majority of respondents agreed to copayments for smokers, drug users, and patients who took part in extreme sports, consumed higher quantities of alcohol, sunbathed frequently or used a solarium. Copayments for an unhealthy diet or lack of physical exercise were rejected. Older participants, men, and people from East Germany agreed to additional contributions more often. For some health behaviors, attitudes seem to be driven by self-interest. Interestingly, however, smokers and heavy drinkers did not show this behavior. Furthermore, we observed both solidarity and competition between those groups of respondents who would be negatively affected by copayments for different potentially unhealthy lifestyles proposed in the questionnaire. Conclusion: Health policy makers may notice that several but not all unhealthy behaviors described in the survey are criteria that are accepted for the introduction of copayments. Furthermore, some groups of society may be more strongly opposed to respective policy measures than others. [ABSTRACT FROM AUTHOR]

Aims: The population-based incidence of pressure ulcers shows large differences between the 16 federal states in Germany. The present study analyses the association between state-specific pressure ulcer incidence and selected structural variables. Subjects and methods: Based on the Diagnosis Related Groups used for diagnosis-specific hospital billing, the population-based incidence of pressure ulcers as primary and secondary diagnosis was calculated for each German state. Data were also stratified for grade (all pressure ulcers vs. grades 3 and 4 only). Ten variables derived from data collected by the German Federal Statistical Office were used to describe of state-specific healthcare structures. Results: Significant correlations were seen between the state-specific incidence of pressure ulcers as primary and secondary diagnosis per 100,000 and the number of full-time employees in nursing homes per 100,000 ( p < 0.1; correlation factor of -0.43 and -0.44, respectively), the number of patients per doctor in hospitals ( p < 0.05; correlation factor 0.5 and 0.6, respectively) and for the state-specific incidence of pressure ulcers as primary diagnosis and the number of deaths per 100,000 ( p < 0.05; correlation factor of 0.7). Conclusion: Differences in the population-based incidence of pressure ulcers between the 16 German states seem to be influenced by structural differences in patient care. Further examination of these associations could lead to important political approaches for the reduction of pressure ulcers in Germany. [ABSTRACT FROM AUTHOR]

Objective: Single mothers suffer more frequently from chronic diseases, depression, and elevated stress level. Their children display adaptation and behavior problems more often than children of dual-parent families. To prevent these risks, a parental training program (PALME) for single mothers and their preschool children was developed. The concept of PALME is based on attachment theory and psychodynamic-interactional approaches. Subject and methods: The efficacy of the program was evaluated in a randomized control intervention study with 58 single mothers. Outcomes from the revised version of the Symptom Checklist SCL-90-R, SF-12 Health Survey, Psychogenic Impairment Score (BSS), Scales on the Experience of Emotions (SEE) and Strengths and Difficulties Questionnaire SDQ were compared at baseline (t1), post-treatment (t2), and 6 months follow-up (t3) for statistical and clinical significance. Per-protocol analyses of variance were used to examine intervention effects. Results: Statistically significant group x time interaction effects in favor of the intervention group indicated intervention effects on the mothers' psychological symptom load GSI score of SCL-90 R, depression, psychological well-being and psychogenic impairment. Some aspects of maternal emotional competence and behavioral problems of their children improved only in the short term. Conclusion: The results suggest that PALME is an effective prevention program for the reduction of maternal depression and psychological symptom load and the improvement of well-being among single mothers. [ABSTRACT FROM AUTHOR]

Aim: To investigate the nursing home inhabitants' perceptions towards oral health care and to determine the actual level of treatment needs. Subject and methods: All 114 nursing homes in the Federal State of Saarland, Germany were requested to participate in the study. A standardized questionnaire was utilized to assess patient attitudes and satisfaction with their oral health. The state of oral health and dental treatment needs were evaluated in a clinical examination. Results: Facility response rate was 10.5 %. 170 inhabitants from 12 nursing homes (mean age 81.8 years; 71.8 % women) were involved in the study. The mean decayed/missing/filled teeth (DMFT) index was 24.2; the mean number of missing teeth was 22.96. Most of the subjects (80.1 %) had removable dentures, 48.8 % were edentulous. Over 70 % had not been examined by a dentist during the last year. Only about one third of the senior citizens reported problems with their natural teeth (13 %) or dentures (23.8 %), although the caries morbidity among the dentulous was high (87.6 %) and about half of the dentures (50.1 %) were rated as insufficient. Periodontal treatment was necessary in 65.1 % of the cases. Denture-related stomatitis affected 27 %. Unhygienic dentures were worn by 64.1 % of the subjects; dental hygiene was bad in 63.2 % of the cases. Conclusion: The results of this study revealed a large discrepancy between perceived and actual treatment needs among institutionalized elderly people in Saarland. There is an urgent need for the development of a systematic dental care program for elderly people in the Federal State of Saarland. [ABSTRACT FROM AUTHOR]

Aim: We investigate opinions regarding which preventative services should be given priority funding; the importance of primary, secondary and tertiary prevention; and bivariate associations between the respondents’ sociodemographics, health status and lifestyle and their preferences. Subjects and methods: Computer-assisted personal interviews (CAPI) were conducted with participants from a regional quota sampling by sex, age and socioeconomic status (SES) in Germany. Participants were asked to indicate whether they would keep the status quo, expand or reduce health-care provision for eight primary, six secondary and four tertiary preventative services. Furthermore, they stated the importance of primary, secondary and tertiary prevention on a four-point Likert scale. Data were evaluated using contingency analysis and correspondence analyses. Results: One hundred and three people completed the survey. The majority of participants opted for expanding non-medical primary preventative services like health education and counselling and for expanding secondary preventative services like cancer screening. For tertiary prevention, like rehabilitation, the desired service distribution depends on the specific preventative services. There were few differences in answers to the questions on the importance of the provision in primary, secondary and tertiary prevention. Bivariate associations between the respondents’ characteristics like age, SES, health status and lifestyle and their preferences could be observed. Conclusion: Primary preventative services and disease detection should receive more funds. No consistent pattern could be detected for tertiary prevention. Respondents expressed some differences of opinion on the importance of types of prevention. The differences are related to knowledge, personal circumstances and interests of the respondents. [ABSTRACT FROM AUTHOR]

Aim: Sunbed use can have severe health consequences, e.g. skin cancer, especially for children and adolescents. Therefore, our aim was to quantify how many adolescents use tanning beds despite a legal ban in Germany. In addition, we aimed at identifying characteristics of users and at analyzing reasons for use and user behavior. Subjects and methods: The nationwide representative SUN-Study 2012 included a subgroup of 518 minors (14-17 years). Besides calculating the prevalence, we used bivariate statistics to identify user groups and to compare minors with adults in terms of reasons for use, place of last use, and obtained advisory service. Results: Overall, 8.7 % of minors had ever used a sunbed; 5.2 % used it during the last 12 months. Out of these, nearly a half was not aware of the legal ban for minors. Users were mainly smokers, had darker skin, and a migration background. Compared to adults, minors were more likely to use unsupervised sunbeds and were less frequently advised by service personnel. Conclusion: The data showed that minors use tanning beds, although there is a legal ban in Germany. The circumvention of the ban and the widespread use of unsupervised sunbeds underline the importance of education and further legal requirements. [ABSTRACT FROM AUTHOR]

Aim: Winning young health professionals for rural areas is a very important challenge against the background of many retiring physicians in the coming decade and a growing unattractiveness of rural areas for future medical professionals. Through teleconsultation, a bridge can be provided between the single physician in the single practice in terms of professional exchange and second opinions. Teleconsultations between GPs and specialists are already in use in other countries (Lamminen et al. J Telemed Telecare 17(8):412-416, ; Nordal et al. J Telemed Telecare 7:257-265, ) but are not wide spread in Germany. The aim of this investigation is to identify the barriers and success factors for a teleconsultation solution in rural areas of northern Germany. Subject and methods: A qualitative interview study was conducted among 18 experts from the Schleswig-Holstein health care system using a semi-structured interview guide. Seven representatives of health care institutions, six GPs, and five young health professionals were interviewed and the interviews systematically analysed according to predefined categories. Results: The results of this study show that the primary barriers preventing the adoption of teleconsultation are the high time-consumption, the physicians' personality, and the financing possibilities of such solutions. The main factors of a successful adoption of teleconsultation include an easy usability of the system, good training opportunities, voluntary participation, the existence of a model region, and a reasonable financing plan. Conclusion: A consideration of the results when setting up a teleconsultation solution provides a basis for a working teleconsultation system in rural areas that can help attract more physicians to those regions. [ABSTRACT FROM AUTHOR]

Objective: To identify and classify internationally published and applied patient safety indicators (PSIs) and their caracterization as a subgroup of quality indicators. Prioritizing PSIs considering the need for action on patient safety of the German health care and their validation by applying scientific quality criteria. Methods: A systematic review of publications indexed from January 2000 to December 2009 was conducted using Medline and websites of institutions. PSIs were characterized as a subgroup of quality indicators by defined criteria and prioritized using a criteria-based procedure. Results: A total of 2,973 PSIs were identified and classified in a PSI-database. A Medline search resulted in 1,568 PSIs and 1,405 PSIs were identified by analyzing indicator sets of institutions. Finally, 60 PSIs were the result of prioritizing and validating the search outcomes. Discussion: The characterization of PSIs and the criteria-based instrument were suitable to identify appropriate PSIs, so that they can be validated later on using a Delphi-method and a pilot and can be eventually implemented into practice. [ABSTRACT FROM AUTHOR]

Aims: Although work ability has been extensively explored in the occupational setting, this issue is only marginally studied among the unemployed. In the presented study, we examine whether long-term unemployed persons regard themselves as able to work, and we analyse their employability in specific sub-groups as well as compare it with the work ability of the general population. Subjects and method: The data were collected in three European cities, Frankfurt/Main, Warsaw and Graz. The participants were recruited in social institutions that help people find employment. The evaluation instrument of employability was the first dimension of Work Ability Index developed by the Finnish Institute of Occupational Health in Helsinki. Additionally, socio-demographic features were enquired. Results: Compared to the representative Finnish adult population, the study sample has significantly lower work ability scores. The Kruskal-Wallis test shows no significant differences among study samples of the long-term unemployed regarding their experience and evaluation of work ability in relation to their country of origin. Noteworthy, we found significant differences among the analysed groups of the long-term unemployed, e.g. persons with health impairments regarded their work ability significantly lower than other groups. According to the Pearson's correlations, work ability is significantly and negatively associated with length of unemployment and age. Conclusions: There is no single level of work ability among the long-term unemployed. Furthermore, the work ability decreases with the length of unemployment as well as with age. In the context of high rates of unemployment, it is important for health promotion and labour market integrating programmes to maintain and stabilise work ability in due consideration of a need to conceptualise problem-orientated measures for these vulnerable groups. [ABSTRACT FROM AUTHOR]

Aim: Data-protection regulations in German hospitals, based on data-protection laws and internal regulations, must be complied with and taken into account in daily work. However, these regulations are not always respected, as evidenced by the data-protection scandals in Germany of recent years. Subjects and methods: In a 2010 survey, data was collected from 557 individuals including administrative staff, nursing staff, physicians, physicians with scientific/research-based work and other health professionals of 26 hospitals in Germany to analyze the factors of relevance with regard to data-protection compliance. Results: The acceptance of hospital staff concerning data-protection regulations is significantly influenced by subjective values and personal attitudes. Significant differences related to the acceptance of data-protection rules and regulations can be found in gender or type of hospital. The results show that employees consider rules and regulations to be necessary and important. However damage caused by data security breaches and the likelihood that they will occur, are considered to be less significant. A large impact on individual data-protection compliance can be reported in the subjective norm, which is influenced by the effect of close colleagues and superiors. Conclusion: The underlying results of the study at hand demonstrate practical implications which can lead to a high degree of data-protection compliance in the future. The related aspects deserving future investigation of the possible explanations for differences in behavior related to data protection among various occupational groups in hospitals are discussed. Men and women exhibit very different levels of data-protection acceptance, so future efforts to increase sensitivity and awareness of data-protection issues in employees require gender-specific approaches. Another issue that merits investigation is the source of the influence of hospital type on data-protection compliance. [ABSTRACT FROM AUTHOR]

Aim: Since 2007 the GKV in Germany has been able to offer optional deductibles. This work investigates the medium-term effects of this on claims for health benefits. This study also examines whether the size of the deductible influences the volume of claims. Subject and methods: The volumes of claims during the year 2009 were compared between a group whose health insurance tariff carried a deductible and a group with no deductible. Within the group with a deductible, the relationship between the amounts claimed and the chosen size of the deductible was investigated. Results: Comparison of the middle ranks between the group with a deductible and the group without shows that during 2009 the two groups incurred significantly different costs for hospital treatment, drugs and remedies: the amount of health benefits claimed is €707 lower among the group with a deductible. Several non-parametric tests show that the volume of benefits claimed decreases with increasing deductibles. Conclusion: Optional deductible tariffs offered by the GKV can also influence the volume of health benefits claimed in the medium term. The sizes of deductibles can be structured so as to achieve targeted control of the amounts claimed. [ABSTRACT FROM AUTHOR]

Aim: To investigate the spatial distribution of avoidable cancer mortality (ACM) rates in Germany and to identify small areas with exceptionally high rates using districts ( Landkreise/Kreise and kreisfreie Städte) as a unit of analysis. Avoidable cancer mortality reflects deaths from cancer that should not occur in the presence of effective and timely health care. Methods: Age-standardised, average ACM rates were calculated for the period from 2000 through 2004 for each of the 439 districts in Germany using unit-record mortality data. The spatial distribution of ACM was subsequently analysed using country maps, interval estimates and regression analysis. Data on mortality and age distribution were obtained from the German Federal Statistical Office (DESTATIS) and the Federal Office for Building and Regional Planning (INKAR). Results: We found that in women under 70 years, the highest ACM rates were seen for cancer of the breast and for cancer of the trachea, bronchus and lung, whereas in men under 70 years, the highest ACM rates were seen for cancer of the trachea, bronchus and lung, and for cancer of the colon, rectosigmoid junction, rectum, anus and anal canal. The statistically lowest mean ACM rates could be found in the south of Germany for men and women. Although the mean ACM rates in men in former East Germany were significantly higher than elsewhere in the country, they were not substantially higher than those in the west and northwest. The mean ACM rates in women were even lower in the east than in the northwest and west. Conclusion: The spatial distribution of ACM rates in women in Germany showed a north-south gradient rather than the east-west gradient that often appears or, for sociohistorical reasons, is even assumed in the German context. When applying measures of ACM, we suggest using districts with statistically lower ACM rates than the nationwide average as a benchmark for the maximum number of excess deaths that should be considered preventable, whether within the current German context or beyond. [ABSTRACT FROM AUTHOR]

Aim: The study evaluates a community-based intervention programme, using a peer approach. The programme's objective is to improve life opportunities for children from disadvantaged families in a poor district of Berlin by empowering their mothers. Women of varying cultural backgrounds-most of them from immigrant families-are educated in subjects like child development, early education and health in order to work as community mothers (CMs). Their major task is to obtain access to the families, strengthen the mothers' parenting and personal skills, and promote early nursery school attendance and access to social support systems. Community settings are integrated in the programme through the establishment of family cafés in nursery and primary schools. Methods: The evaluation analyses the organisational structure and process determinants of the programme, and its impact on the CMs as well as on the visited family mothers (FMs), identifying the supporting and inhibiting factors. To match the comprehensive programme design, a mixed method approach was chosen, combining primarily qualitative methods with quantitative methods and participatory observation. Target groups for the investigation are the CMs, the FMs, and professionals directly or indirectly involved in the programme. Results: According to preliminary results, the programme has been successful in recruiting women from the community for training as CMs ( n = 67) and in reaching disadvantaged families of German and migrant backgrounds through home visits ( n = 86) as well as in single contacts in various settings ( n = 170). Access to families by home visits and sometimes in family cafés, however, has turned out to be more difficult than expected. The FMs interviewed qualitatively ( n = 15) within the first year after the start of home visits and with a semi-structured questionnaire ( n = 44) after 2.5 years, report increased self-esteem, improved relationships with their children, better access to public services, emotional support and practical assistance. The results also demonstrate a significant gain for the CMs themselves as part of the target group. Professionals ( n = 42) assess the project primarily positively; co-operation with the CMs sometimes presents barriers. Conclusion: Peer-based home visitation programmes are successful in reaching otherwise hard-to-reach populations but also have limits in access to some of the families. The combination of home visits with other forms of activities located in various settings seems promising. [ABSTRACT FROM AUTHOR]

Aim: This investigation aimed to determine whether socially disadvantaged elementary school children profit health-wise from their participation in the mentoring program 'Balu und Du' in which their basic competencies are strengthened and their health-related quality of life is improved. Subjects and methods: For the evaluation study we compared an intervention group of 141 children, or so-called "Mowglis" (treatment group), with a stratified control group of 158 children. The children in both the treatment and control groups were 6 to 10 years old and visited 38 different elementary schools at 12 participating locations in Lower Saxony, Germany. Children were recommended for 'Balu und Du' by their teachers who were worried about their pupils' disadvantaged family backgrounds and their personal and developmental problems. The control group children were also selected by the Mowglis' teachers and were supposed to match the participants closely in the mentioned attributes. With their parents' consents they participated in the evaluation study. Results: The children in the treatment group (Mowglis) can profit from their participation in the project "Balu und Du" in the areas of health-related quality of life. Scholastic achievement and motivation increased in comparison to the control group and the willingness of the children to acquire knowledge and skills that are necessary for current and future problem-solving capacity grew. Conclusion: The project 'Balu und Du' was able to reach elementary school children from socially disadvantaged families and, by strengthening important basic competencies and their health-related quality of life, can prevent hazardous health characteristics. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have demonstrated a positive effect of school-based life skills programmes on the prevention of substance abuse and other health-risk behaviours in children and adolescents. However, the comparison and interpretation of study results is difficult due to methodological problems. In particular, the effectiveness of such programmes within high-risk groups remains uncertain. In this study, we investigated the effects of two school-based life skills programmes on substance abuse and subjective health in a sample with a high proportion of socially disadvantaged pupils. Subjects and methods: We conducted a randomised controlled intervention study with repeated measurements over time. The sample included pupils of secondary schools in northern Germany with an overrepresentation of pupils with low socioeconomic status. We evaluated effects of the programmes on substance abuse and psychosocial outcomes. In addition, we conducted a process evaluation. Results: The sample included 102 classes with a total of 1,561 pupils. Twenty-five per cent of the pupils were of a low socioeconomic status. We found significant positive effects regarding the reduction of smoking and some improvements in the pupils' life skills in the intervention group compared to the control group. Socioeconomic status had no moderating effect on the results. Conclusion: School-based life skills programmes have a positive effect on smoking prevention regardless of socioeconomic status. Socially disadvantaged children benefit from such programmes to a similar extent as other pupils. Pupils and teachers appreciate the programmes. A supportive school environment appears to be an important factor in the successful implementation of school-based life skills programmes. [ABSTRACT FROM AUTHOR]

Aim: The issue of excess weight and obesity among our young people is currently under discussion as one of the most serious problems in public health. Extensive work has been done to analyse the problem, to indicate the drivers, and to create prevention programmes. Much research remains to be done in the field of modelling the complex impact network of familial and societal influences on juvenile obesity. To achieve this, the forecasts and results issued by the various disciplines must be integrated. The aim of our work has been to create a causal-loop model of obesity in socially disadvantaged children and adolescents that allows qualitative simulation, group-specific risk assessment, as well as the identification of key factors for prevention. Subjects and Methods: The model was created in cooperation with 18 experts from the field of obesity research. The participants were drawn from eight different disciplines including medicine, sociology, and prevention. Four expert workshops pinpointed 43 main obesity drivers at the individual, familial, and societal level; these were rated according to their causal interdependence and impact. The computer-based method of cross-impact balance analysis was used to evaluate the model and to produce risk profiles for different societal and individual context situations. Results: The model analysis reveals that there is no one single key factor that can be expected to act as an effective prevention factor for every scenario. Instead, both the risks and the effectiveness of prevention measures depend strongly on the specific characteristics of an individual's own environment. Conclusion: Consequently, it would appear sensible to approach the design of prevention programmes from a group-specific, multi-factor and multi-level perspective. [ABSTRACT FROM AUTHOR]

Aim: Children from socially disadvantaged families are deprived concerning their health status as well as their cognitive and emotional development. They show less positive health-related behaviors and less psycho-social resources. Socially disadvantaged families can hardly be reached by conventional health services and health promoting measures, and even if they are reached, the measures' effectiveness is only limited. Therefore, aim of the BMBF-funded research project 'GO-Healthy in east Leipzig' is to develop a community-based approach for health promotion by which, in particular, the access to the target group of the socially disadvantaged is improved. Subjects and methods: Participatory and low-threshold interventions are integrated with already existing structures within the respective urban district. Multipliers are assigned and impart information as well as their knowledge and experiences to the target group in a manner apt and suitable to their everyday lives. Results: From January 2010 to June 2011, 1,300 women took part in health-promotion measures offered within the scope of the project. Women disposing of a low income (>50%) and having a migration background (70%) were sufficiently reached, in contrast to women with a low educational level (22%). Personal contact proved to be the most important way to access the people (80%). Most frequently, activities carried out by health mediators and enjoyable activities were attended. Social contacts turned out to be an especially important motivation for participation. Conclusion: Strategies such as participation and the assignment of multipliers are suitable approaches to successfully develop and implement health-promotion measures in the community/urban-district setting. To integrate health education with enjoyable, action-oriented activities in a casual manner facilitates accessing socially disadvantaged persons. [ABSTRACT FROM AUTHOR]