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Since December 2019, digital health applications (DiGA) have been included in standard care in Germany and are therefore reimbursed by the statutory health insurance funds to support patients in the treatment of diseases or impairments. There are 48 registered DiGA listed in the directory of the Federal Institute of Drugs and Medical Devices (BfArM), mainly in the areas of mental health; hormones and metabolism; and muscles, bones, and joints. In this article, the "Digital Health" specialist group of the German Informatics Society describes the current developments around DiGA as well as the current sentiment on topics such as user-centricity, patient and practitioner acceptance, and innovation potential. In summary, over the past three years, DiGA have experienced a positive development, characterized by a gradually increasing availability of various DiGA and coverage areas as well as prescription numbers. Nevertheless, significant regulatory adjustments are still required in some areas to establish DiGA as a well-established instrument in long-term routine healthcare. Key challenges include user-centeredness and the sustainable use of the applications., (© 2023. The Author(s).)

The National Action Plan for People with Rare Diseases contains 52 concrete actions, including in the fields of care, research, diagnosis, and information management. With the aim of improving the quality and interoperability of national registries in the long term, action 28 proposed the establishment of a "Rare Diseases Registry" strategy group. The strategy group began its work in 2016. In this report, the group takes into account developments at the national and international level in order to develop recommendations for national initiatives.In addition to this, the group reports on consent and implementation as well as on the adaptation of a minimal dataset for use in rare disease registries and mapping the used data elements and schemata in a metadata repository. This position paper was created by the strategy group together with additional authors. The paper reached a consensus within the strategy group and can be seen as a concept paper of the Rare Diseases Registry strategy group.

Digitalization in the healthcare system is a great challenge for rheumatology as for other medical disciplines. The German Society for Rheumatology (DGRh) wants to actively participate in this process and benefit from it. By founding the commission on digital rheumatology, the DGRh has created a committee that deals with the associated tasks, advises the DGRh on questions and positions associated with digital health. For the DGRh, this affects the most diverse areas of digitalization in medicine and rheumatology. This position paper presents the topics and developments currently handled by the commission and the tasks identified.

Increased awareness of the rising antimicrobial resistance problem and impending loss of suitable treatment options for infectious diseases have changed patient care. Antimicrobial/antibiotic stewardship (ABS) activities aiming to optimize antimicrobial treatment were specified in international (WHO, ECDC) and national programmes and evidence-based practice guidelines. In Germany, ABS in hospitals is enshrined in the Infection Protection Act §23 and in a national guideline. The position paper presents the goals and tasks of ABS as well as the necessary organisational and staff requirements.Qualified training and education, mandates and support from hospital directors, and the provision of sufficient resources are essential prerequisites for the successful work of the ABS team. The ABS team should work hospital-wide across clinical services. Their main tasks are developing and implementing an ABS programme tailored to local needs and the conditions of the hospital, taking into account anti-infective drug prescribing, the resistance situation and case mix. Their tasks also include drafting and implementing in-house recommendations for diagnosis, prophylaxis and treatment of important infectious diseases. The ABS team should be interdisciplinary and include specially qualified doctors and pharmacists. Doctors commissioned for ABS should support this team and take the department-specific concerns into account. The document specifies a minimum ABS staff of one full-time equivalent (FTE) per 500 beds. Depending on the case mix and specialties, additional staff may be required. It proposes that there should be 0.1 FTE doctors commissioned for ABS per 100 beds.

From the perspective of patients with rheumatic diseases, the reduction of inflammatory disease activity alone is not a sufficient treatment goal. In addition the functional health and participation also have to be improved. Starting with the first symptoms the empowerment for the self-management of the disease is important for the patients; therefore, the established treat to target-strategy has to be expanded by the functional dimension to treat to participation. The position paper of the German Society for Rheumatology (GSR) summarizes the relevant fields of the multiprofessional action that is frequently necessary. This includes the acquirement of function-related competencies during training, further education and advanced training as well as implementation in the everyday practice of patient care. Furthermore, the GSR acknowledges the need for research related to functional and sociomedical consequences of rheumatic diseases and to individual and combined function-related programs in outpatient and inpatient care in rheumatology.

Background: The incidence for dysphagia amounts to 44-50% in nursing homes. Dysphagia is one of the main reasons for pneumonia in elderly., Method: Consensus paper., Results and Conclusions: For the advisory board consisting of 2 physicians, 2 pharmacists, a speech therapist, and a respresentative of nursing service it is common understanding that for the ideal maintenance and support of patients with dysphagia an interdisciplinary approach is crucial. Despite high clinical relevance of dysphagia the basic knowledge of this field is often underdeveloped. Specific and validated screening procedures for dysphagia have to be developed and implemented into the relevant guidelines. Specifically in this field an active and discipline spanning risk management should find its way into stationary geriatric care and nursing homes. Just as important is the provision of necessary patient information on the progress of the disease, on therapeutic actions and possible diet forms in a dysphagia pass. Additionally, the mentioned disciplines require an online risk screening (for dysphagia) of the pharmacist concerning the overall medication as well as information of galenic properties like facts regarding the possibility of crushing, portioning or tube feeding of the prescribed medication. In this way health risks due to administration errors concerning the medication can be significantly reduced for this patient group. Adequate oral liquids for adapted application of drugs are missing so far.

Background: Dementia is an increasing challenge for care providers in nursing homes and hospitals. Since the 1980s, special acute care units in nursing homes have developed rapidly. In Germany, the first unit in a hospital opened in 1990. In 2013, there were 22 units., Materials and Methods: In the following paper, the German Geriatric Society ("Deutsche Gesellschaft für Geriatrie e. V.") recommends basic standards for these wards., Results: The basic standards for these wards include the following: a maximum of 20 beds, an area physically separated from the geriatric hospital department, their own dayroom and therapy room, a structured daily routine suitable for patients with dementia, the selection of permanent staff on a voluntary basis, specialized training, extended geriatric assessment, and special consideration of the background and social situation of the patients.

The demographic trend towards an ageing society implies increasing numbers of persons well advanced in years. According to a performance-oriented sociocultural frame of reference, the societal acceptance of this group in terms of personal esteem and social integration is no longer self-evident. Based upon generalizing prejudices, disregarding the individual progress of ageing, elderly persons are often perceived as an unproductive burden. By means of detailed theses, problem areas are presented and analysed, linked to a reduction of "useful" social performance and to patterns of reaction against the loss of personal and social acceptance. Potentials for the advancement of a self-determined life practice, aiming at maintaining largely the competence for meaningful personal action, are discussed. A "humanization of well advanced old age" is advocated, combining as long as possible competence for independent living with social integration through active citizenship.

In the 1980s, most Western countries decided to opt for a new public health approach based on learning strategies to fight HIV/AIDS. Within the new public health paradigm, every sexually active person protects him-/herself, whereas it is the infected people that bear the burden of prevention according to old public health. The paper begins with a clear statement for the new public health approach that includes self-protection and the protection of civil rights. It argues that this approach is still valid under the changing circumstances due to combination therapies and the developments related to them, such as the introduction of routine HIV screening in some countries. On this background, the paper examines from an ethical perspective to what extent people with HIV have a responsibility in HIV prevention. The paper argues that a person with HIV has a responsibility to protect his/her partner in the case of a relationship of love. On the other hand, in the case of "purely" sexual encounters, each person is responsible for his/her own security and should not rely on the other. This position also helps to clarify prevention messages. In conclusion, the paper shows how morality evolves into ethical positions and then translates into the law. It finally claims for stronger obligations for sex businesses to support HIV prevention.

Rheumatic diseases in childhood and adolescence differ from those of adulthood according to type, manifestation, treatment and course. A specialized therapy, starting as early as possible, improves the prognosis, can prevent long-term damage and saves the costs of long-term care. Only a specialized pediatric care system can guarantee optimum quality of the processes involved and the results for rheumatology in childhood and adolescence within a global financial system. This requires adequate structural quality of the specialized clinics and departments for pediatric rheumatology. The management of rheumatic diseases in childhood and adolescence is comprehensive and requires a multidisciplinary, specialized and engaged team which can cover the whole spectrum of rheumatic diseases with their various age-dependent aspects. In order to guarantee an adequate, cost-efficient routine, a specialized center which concentrates on inpatient care should treat at least 300 patients with pediatric rheumatic diseases per year. The diagnoses should be divided among the various disease categories with at least 70% of them involving inflammatory rheumatic diseases. For the inpatient care of small children, an accompanying person (parent) is necessary, requiring adequate structures and services. Patient rooms as well as diagnostic (radiography, sonography, etc.) and therapeutic services (physiotherapy, occupational therapy, pool, etc.) must be adequate for small children and school children as well as adolescents. Suitable mother-child units must also be provided and a school for patients is required within the clinic. A pediatric rheumatologist must be available 24 h a day, and it must be possible to reach other specialists within a short time. For painful therapeutic procedures, age-appropriate pain management is obligatory. A continuous adjustment of these recommendations to changing conditions in health politics is intended.

Background: Rheumatology in Germany is facing major challenges. The need for rheumatological care is increasing and can no longer be met in some regions for capacity reasons. Too many people with an inflammatory rheumatic disease (IRD) have to forego appropriate care or receive it too late. The 4th new edition of the memorandum of the German Society for Rheumatology and Clinical Immunology (DGRh) provides information on rheumatological care in Germany. It was produced under the leadership of the DGRh together with the Professional Association of German Rheumatologists (BDRh), the Association of Acute Rheumatology Clinics (VRA), the German Rheumatism League (DRL) and the German Rheumatism Research Center (DRFZ)., Methods: The memorandum describes the current state and development of the following areas: number of people with IRD, outpatient, inpatient and rehabilitative care structures, number of specialists in rheumatology, education and training, quality of care, health economic aspects and digital care concepts. Proposals for health policy measures to safeguard rheumatological care are presented., Results: Prevalence: approximately 1.8 million adults in Germany have an IRD. The prevalence is increasing, due to changes in the demographic structure of the population, improved diagnostics, treatment and longer survival. Care structures: outpatient specialist care (ASV) for rheumatic diseases is developing as a cross-sectoral care model for hospital outpatient clinics and rheumatology practices. Hospitals have been able to be certified as rheumatology centers since 2020, which enables structural developments. Specialists in rheumatology: as of 31 December 2023, there were 1164 specialists in rheumatology working in Germany. This included 715 physicians accredited to work in practices for national health assurance patients, 39% of whom were employees. In hospitals, 39% of doctors worked part-time. At least 2 rheumatology specialists per 100,000 adults are needed, i.e. around 1400, in order to provide adequate care. This means that there is a shortage of around 700 rheumatology specialists in the outpatient sector alone. Of all working specialists, 30% are currently aged 60 years old and over. Medical training: only 10 out of 38 (26%) state universities have an independent chair in rheumatology. In addition, 11 rheumatology departments are subordinate to a nonrheumatology chair. In the rheumatology-integration into student training (RISA) III study, only 16 out of 36 faculties fulfilled the recommended minimum number of compulsory hours of student rheumatology teaching. Continuing education in rheumatology: the annual postgraduate training qualifications do not cover the demand for rheumatology specialists, which is additionally increasing due to intensified workload, reduced capacities through retirement, and part-time work. Quality of care: since the introduction of highly effective medication patients with IRD have a much better chance of achieving remission of their disease. With early initiation of targeted therapy, the lives of many patients are hardly restricted at all: however, waiting times for a first rheumatological visit often last more than 3 months. Quality target is a first consultation within the first 6 weeks after the onset of symptoms. Models for early consultation, delegation of medical services, structured patient training and digital care concepts have been positively evaluated but are not covered financially., Costs: the total annual costs for inflammatory joint diseases alone amount to around 3 billion euros. The direct costs have significantly risen since the introduction of biologics, while the indirect costs for sick leave, disability and hospitalization have fallen., Conclusion: The core demands of this memorandum are a significant and sustainable increase in the number of further training positions in the outpatient and inpatient sector, the creation of chairs or at least independent departments for rheumatology at all universities and the further implementation of new and cross-sectoral forms of care. This will ensure modern needs-based rheumatological care for all patients in the future., (© 2024. Deutsche Gesellschaft für Rheumatologie und Klinische Immunologie e.V. (DGRh) Published by Springer Medizin Verlag GmbH. All rights reserved.)

Background: Earlier mortality in socioeconomically disadvantaged population groups represents an extreme manifestation of health inequity. This study examines the extent, time trends, and mitigation potentials of area-level socioeconomic inequalities in premature mortality in Germany., Methods: Nationwide data from official cause-of-death statistics were linked at the district level with official population data and the German Index of Socioeconomic Deprivation (GISD). Age-standardized mortality rates before the age of 75 were calculated stratified by sex and deprivation quintile. A what-if analysis with counterfactual scenarios was applied to calculate how much lower premature mortality would be overall if socioeconomic mortality inequalities were reduced., Results: Men and women in the highest deprivation quintile had a 43% and 33% higher risk of premature death, respectively, than those in the lowest deprivation quintile of the same age. Higher mortality rates with increasing deprivation were found for cardiovascular and cancer mortality, but also for other causes of death. Socioeconomic mortality inequalities had started to increase before the COVID-19 pandemic and further exacerbated in the first years of the pandemic. If all regions had the same mortality rate as those in the lowest deprivation quintile, premature mortality would be 13% lower overall., Discussion: The widening gap in premature mortality between deprived and affluent regions emphasizes that creating equivalent living conditions across Germany is also an important field of action for reducing health inequity., (© 2024. The Author(s).)

Background: In the next few years many general practitioners and specialists will retire. As in other disciplines the question arises in rheumatology whether sufficient training positions are available to maintain or expand the supply of care according to demand. Therefore, the German Society of Rheumatology (DGRh) has assigned its committee for education and training to review the currently available training opportunities in Germany. The aim of this work is the quantitative survey of the training capacity to become a specialist in internal medicine and rheumatology., Methods: Within the framework of this study, a survey was conducted via the homepages of the 17 state medical associations to determine the postgraduate medical officers, their place of work and the duration of their postgraduate training capabilities. Based on the data, a nationwide survey of training positions was conducted., Results: Specialized rheumatology training is established at 229 training centers in Germany, whereby data from 187 training sites were available for analysis. The training locations are distributed as followed: 52.4% clinical sector and 47.6% outpatient sector. In total, 478.4 training positions are available in Germany (clinical sector: 391.4 and outpatient sector: 87) and 17.2% of the positions (clinical sector: 11.4% and outpatient sector: 43.1%) are not occupied., Conclusion: Based on this study, it can be shown that most of the continuing education positions are available in the clinical sector. In contrast, half of the training positions in the outpatient area are not filled. In order to improve the training situation, it is essential to integrate outpatient colleagues into the training program. This presupposes that further training is supported or financed by the healthcare system. In this context, optimal rheumatological care must be permanently guaranteed throughout Germany in order to provide sufficient care for the approximately 2 million patients with inflammatory rheumatic diseases., (© 2022. The Author(s).)

Since 1995, the Poverty and Health Congress has been organized annually by Gesundheit Berlin-Brandenburg e. V. in cooperation with various partners. It is one of the largest regular public health events in Germany. The congress is a platform for exchange between science, practice, civil society, and politics. In 2022, the motto was "What counts now." Public health and health inequalities were discussed in the light of the SARS-CoV‑2 pandemic and the war in Ukraine. Professional exchange on various topics took place in over 100 digital events with more than 2000 participants, among them around 500 speakers., (© 2022. The Author(s).)

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people., (© 2024. The Author(s).)

Background: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes., Methods: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources., Results: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups., Discussion and Conclusions: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: Loneliness is a widespread phenomenon, and it is associated with a variety of health problems and diseases. Unemployed individuals diagnosed with a mental illness (UMIs) are at a high risk of experiencing loneliness, with serious repercussions for their health and vocational rehabilitation. With this study we wanted to better understand the associations between sociodemographic variables, mental health, and loneliness in UMIs., Methods: We analyzed the data of 526 unemployed individuals that received means-tested benefits as well as at least one psychiatric diagnosis. Data were collected between September 2020 and September 2023. We conducted two robust regressions with loneliness (University of California, Los Angeles, Loneliness Scale, UCLA) as an outcome (N = 526). In the first regression, we used social network as a predictor (Lubben Social Network Scale, LSNS-6); in the second regression we included the additional predictors personal debt (yes/no), depression (Patient Health Questionnaire, PHQ-9), anxiety (Mini-Symptom-Checklist,MSCL), and somatization (MSCL) as well as age, gender, education, and living with a partner as control variables., Results: We found a significant negative association between social network and loneliness, and a significant positive association between a high level of education, depression, anxiety, and loneliness., Conclusions: Unemployed individuals diagnosed with a mental illness in our sample exhibited high levels of depression, anxiety, somatization, and loneliness. The associations between social network, mental health, and loneliness that we found emphasize the importance of psychological screening and/or diagnostics, and they highlight areas for prevention., (© 2024. The Author(s).)

Background: Due to new legal requirements, a patient-relevant benefit for other wound treatment products (sPW) must be demonstrated through clinical studies if reimbursement at the expense of the statutory health insurance is sought in the non-inpatient sector., Method: An interdisciplinary group with expertise in clinical wound care has developed general recommendations for the design of suitable studies. In addition to regulatory documents, previous studies that have already been recognized as proof of benefit in other areas served as a basis., Results: Randomized controlled trials that cover at least the most common types of chronic wounds (arterial, venous, diabetic or pressure sore) are recommended as the best method for gathering evidence. Despite the heterogeneous etiology of chronic wounds, the results should also be transferable to other wound types. The test intervention does not usually consist of the sPW alone, but of a combined wound treatment that follows a treatment plan that is as clearly defined as possible. In the comparison group, all wound treatment options (besides the sPW) must also be available and used according to a similar predefined treatment plan. Depending on the intended purpose and treatment goal, complete wound closure should, if possible, be recorded as the cardinal - although not always as the primary - endpoint. In justified cases, e.g. in the case of intermediate use as part of phase-appropriate wound therapy for chronic wounds, a significant reduction in the wound area can also be considered for benefit assessment. Quality of life (e.g. pain) can also justify a benefit and can therefore be recorded as a primary outcome parameter in clinical trials. The duration of the clinical trial should be adapted to the central endpoints, the medical or nursing goal of wound care and the intended purpose of the sPW. A benefit does not always arise from microbiological, physiological, laboratory or histological parameters or imaging findings., (© 2024. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

For older people, a sufficient mobility offer is an essential prerequisite for participation in social life and a better quality of life. The goal should be self-determined everyday mobility that enables a satisfying and healthy life. Mobility depends on diverse individual abilities and needs. On the other hand, social structures as well as regulatory and spatial framework conditions limit the realisation of mobility services and their transport infrastructure. These framework conditions are characterised by the perception of social roles, the availability of resources and gender-specific attributions. For example, care and caring work is predominantly the responsibility of women in the age group of 50 years plus. The availability of transport infrastructure is geared towards goals that are characterised by the needs of gainful employment and not the goals of care work. Conversely, the availability of flexible means of transport, such as cars, also decreases for women in old age for economic reasons. For this reason, mobility planning should take greater account of specific needs, such as orientation towards care objectives, counselling, and health services and place a greater focus on the local area. For elderly people, especially women, security needs are often an important factor in the decision to become mobile or to forego mobility. This includes perceived subjective safety, accessibility and protection from weather conditions such as slippery surfaces or exposure to excessive heat. If these basic principles are taken into account, more people can be guaranteed self-determined participation in social life., (© 2024. The Author(s).)

Driving is the most important and safest form of mobility for the majority of senior citizens. However, physical and mental performance gradually decline with age, which can lead to more problems, critical situations or even accidents. Vehicle technology innovations such as advanced driver assistance systems (ADAS) have the potential to increase the road safety of older people and maintain their individual mobility for as long as possible.This overview article aims to identify ADAS that have the greatest potential to reduce the number of accidents involving older drivers. For this purpose, the accident and damage occurrence as well as the driving behaviour and compensation strategies of older people are examined in more detail. Suitable ADAS should compensate for typical driver errors, reduce information deficiencies and have a high level of acceptance. For older drivers, emergency braking, parking assistance, navigation, intersection assistance and distance speed control systems as well as systems for detecting blind spots and obstacles appear to be particularly suitable.Some of the disadvantages of ADAS are the lack of market penetration, acceptance problems and interface designs that have not yet been optimally adapted to the needs of older users. For older drivers in particular, it appears to be a priority to develop coherent and integrated solutions in the sense of cooperative assistance instead of pushing ahead with high and full automation with many system limits and exceptions, which can place high demands on attention, for example if the vehicle has to be taken over in a critical situation., (© 2024. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: A diagnosis of dementia places a heavy burden on those affected and their families. Often, difficult decisions must be made. Ideally, people with a new dementia diagnosis make informed decisions together with family members. Digital informational materials can be an important low-threshold resource for making informed decisions. They should provide comprehensive information about dementia, including both primary prevention (risk factors for the onset of dementia) and later treatment options. They should also cover precautionary measures that can make future decisions easier (e.g., advance directives, power of attorney). However, there is currently no comprehensive overview of the various online resources for dementia-related information., Methods: This study explores digital informational materials on dementia for different target groups in the German-speaking area using an innovative systematic search strategy. It examines how these materials are structured in terms of risk factors, treatment options, and decision support. This methodological approach is new, so it is described and discussed in detail., Results: The results show that most materials are intended for people with dementia and their families. Treatment measures are often discussed without explaining the risk factors they are meant to address. There is little focus on preventive measures that could support decision-making., Discussion: The unbalanced presentation could lead to certain measures being difficult to understand (for laypeople) or to misinterpretation of risk factors. Important implications are drawn from these findings., (© 2024. The Author(s).)

Between 2014 and 2022, the 5 German research networks AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus, and SMARTACT are investigating topics of primary prevention and health promotion with the aim of further deepening the evidence base in these areas. The work of the 5 research networks for primary prevention and health promotion is presented, analysed, and discussed from an internal perspective. A model of evidence-based public health serves as a structuring framework.The 5 research networks use a variety of access routes for the generation of evidence with regard to the participation of nonacademic, civil society actors and users. There is a wide range of study designs - from randomised controlled trials and systematic reviews to diverse qualitative designs. The use of models and theories supports the evidence base. Beyond evidence generation, all research networks focus on at least exemplary implementation of new evidence.Due to the diversity of methods, a diversified evidence-based approach can be realised, taking into account network-specific aspects. Structural circumstances limit the further systematic strengthening of the evidence base. In particular, the involvement of nonacademic, civil society actors for the work with hard-to-reach target groups often cannot be financed or is considered too time consuming under the given circumstances. The COVID-19 pandemic highlights the importance of a flexible spectrum of methods, employing both digital and analogue methods in a meaningful way.

Currently, it is becoming alarmingly clear that pharmaceutical companies are continuously withdrawing from antibiotics research and that there is now a market failure. The future decline in the gross domestic product alone is now estimated in the trillions of US dollars. The predicted number of people who could die in 30 years from resistant germs is an urgent call for action. This paper aims to examine the situation on the basis of possible forms of organization and with the help of individual ideas of the principal-agent approach, a theory from economics that can be used to analyze problems between the principal and agent. The result demonstrates the urgent need for action by the state. The longer the alarming proportions of this development is not fully taken into account in the political decision-making process, the more drastic state measures and fewer available options for action there will be at a later point in time.

The concept of digital health literacy can be regarded as the result of the increasing social permeation of digital media and their use in everyday life. Due to increasing accessibility and ubiquity, there is an increasing need not only for searching and finding, but especially for assessing the reliability as well as selecting and applying health information for one's own health concerns. In the context of digitization, it needs to be emphasized that users are not just passive recipients, but rather actively participate in the communication process by interacting with existing content or by sharing their own health-related information.With particular focus on children and adolescents, this paper provides an overview of the current state of research on digital health literacy. In addition to its terminological and conceptual foundations and its links with media literacy, the relationship between digital health literacy and social and health inequality is discussed. Inequalities are not only generated by access to digital media but, above all, by the skills required for their use. After an overview of available instruments is provided, initial reflections on how to promote the individual and structural dimension of digital health literacy with focus on school settings is given.

Background and Aim: Due to its strong economy and a well-developed healthcare system, Germany is well positioned to achieve above-average reductions in mortality. Nevertheless, in terms of life expectancy, Germany is increasingly falling behind Western Europe. We compare mortality trends in Germany with other Western European countries, covering the period from 1960 to 2019. The focus is on long-term trends in Germany's ranking in international mortality trends. In addition, we conduct a detailed mortality analysis by age., Methods: Our analysis is mostly based on mortality data from the Human Mortality Database (HMD). Cause-specific mortality data originate from the database of the World Health Organization (WHO). For the international comparison of mortality trends, we use conventional mortality indicators (age-standardized mortality rate, period life expectancy)., Results: Compared to other Western European countries, Germany has higher mortality in the middle and older age groups. Germany's life expectancy gap compared to Western Europe has grown during the past 20 years. In 2000, Germany was 0.73 years behind for men and 0.74 years behind for women. By 2019, these figures had risen to 1.43 and 1.34 years, respectively. This is mainly due to mortality from non-communicable diseases., Conclusion: For Germany to catch up with other Western European countries, a stronger focus on further reducing mortality at ages 50+ is crucial. This also requires further research to understand the factors behind Germany's disadvantageous position., (© 2024. The Author(s).)

In view of the demographic change, the need for intersectoral care of the aging population has already been identified. The strategies for implementation are diverse and address different approaches, each of which requires different sectors to overlap. This article provides an overview of already completed and ongoing projects for the care of geriatric patients. It becomes apparent that the development of networks as an indispensable basis for intersectoral care cannot be measured in terms of direct intervention effects and therefore makes it difficult to prove the cost-benefit. It is also evident that some research projects fail to be implemented into standard care due to financial and staff shortages.Do we need a rethinking in Germany or less innovation-related funding lines for better implementation and research of existing concepts? International role models such as Japan show that cost reduction for the care of the aging population should be considered in the long term, which requires increased financial volumes in the short term. For a sustainable implementation of cross-sectoral approaches into everyday life, research should therefore reorganize tight and/or entrenched structures, processes, and financing. By linking the countless existing projects and integrating ideas from different sectors, future demands of intersectoral geriatric care may be achieved., (© 2024. The Author(s).)

In Germany, the Standing Committee on Vaccination (STIKO) develops recommendations on vaccinations and other measures of specific prophylaxis against communicable diseases. Myths, wrong assumptions, and conspiracy theories are able to disturb the implementation of vaccination recommendations. Evidence and transparency of recommendations are needed to rationalize the discussion.In November 2011, STIKO adopted a new standard operating procedure (SOP) for the development of evidence-based vaccination recommendations. Following guidance provided by the SOP, a number of new vaccination recommendations have been developed since 2011. Furthermore, existing recommendations were revised or extended accordingly. This article provides an overview on the methodology of the SOP, describes experiences made so far, and characterizes future challenges.

Background: Allergies are frequent and approximately 30% of the general population in Germany are affected. The specific sensitization against an allergen is asymptomatic. On renewed allergen contact the symptoms are indicative of the underlying pathomechanism. A variety of different test procedures are available to identify allergic reactions., Objective and Aim: In this review article the typical clinical symptoms of allergic reactions are assigned to mechanisms and possible test methods are presented and discussed. Current developments in recombinant serum diagnostics and cellular testing methods are presented., (© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

When long-term care insurance was introduced in 1994, a number of conceptual decisions were made that continue to shape the system today. This discussion article examines three of these decisions. In each case, an evaluation standard is formulated against which the current situation is assessed. In the case of a negative assessment, reform options are discussed.In combination with the lack of benefit adjustments, the design of long-term care insurance as a system with capped insurance benefits and unlimited co-payments has led to co-payment levels in nursing homes that the majority of residents cannot cover from their income. Therefore, in order to fulfill its original objectives, long-term care insurance would have be turned upside down - by imposing an absolute limit on the amount and duration of the individual co-payments.The "dual insurance system" consisting of a social insurance for the majority and a private mandatory plan for a minority of the population has also proved to be a "birth defect" of the system. Since the group of privately insured persons has a much more favorable risk structure and higher average incomes, the "equal distribution of burdens" in financing required by the Federal Constitutional Court does not exist. To remedy this inequality, the dual system must be transformed into an integrated long-term care insurance system, or at least a risk structure equalization scheme between the two branches must be implemented.The introduction of long-term care insurance as a separate branch of social insurance, however, can be justified. In order to overcome interface problems, it would nevertheless be necessary to place the financing competence for geriatric rehabilitation with long-term care insurance and that for medical treatment care in nursing homes with health insurance., (© 2023. The Author(s).)

Improving patient safety is key to better health and nursing care. The Association for the Continuous Development of the National Health Target Process, health-targets.de (gesundheitsziele.de), has defined two focus areas, each with six goals, to jointly initiate significant progress in patient safety in Germany and achieve the health target of the same name. It is based on the "Global Patient Safety Action Plan 2021-2030" of the World Health Organization (WHO) and contributes to its implementation on a national level.The national health target addresses all players in healthcare and highlights the role of patients. Strengthening patient safety culture and expanding patient safety competence are at the center of the target process.For patient safety culture, a systemic approach is crucial. Individual-related factors as well as structural and process-oriented variables are looked at. A cooperation that focusses on the wellbeing of patients is essential.Patient safety competence spotlights knowledge on security related aspects in healthcare. At the same time, it focuses on the ability of all those involved to influence care in a positive way-thereby being open to the capabilities of patients., (© 2022. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

Background: Dementia is increasingly perceived as a terminal illness due to disease progression with a shortened life expectancy and often a lack of therapeutic options. In the context of palliative care, the preferred place of death is considered a quality indicator for needs-based patient care. The aim of this study was to describe the distribution of places of death of older patients with dementia., Material and Methods: Death certificates from the years 2001, 2011 and 2017 were evaluated from the most comprehensive study on places of death in Germany to date, conducted in selected regions of Westphalia. Medical information on the cause of death was also analyzed. In this way, deceased patients with dementia ≥ 65 years (ICD-10: F01, F02, F03, G30) were identified and the distribution of their places of death statistically determined., Results: Dementia was present in 4720 out of 31,631 (14.9%; 95% CI: 14.5-15.3%) deceased patients ≥ 65 years. The distribution of places of death was as follows (%; age-standardized; 2001/2011/2017): home environment 24.0/19.7/15.8, hospital 40.4/29.0/24.3, palliative care unit 0.0/0.3/1.8, hospice 0.4/0.9/0.9, nursing home 35.2/49.5/57.1 and other places 0.0/0.0/0.0., Conclusion: The majority of older patients (≥ 65 years) with dementia die in nursing homes, followed by hospitals and the home environment. Palliative care units and hospices play a subordinate role as places of death for patients with dementia., (© 2021. The Author(s).)

Background and Objective: The digital transformation of healthcare requires changed competences in the nursing professions. The reform of nursing education opens up the opportunity to anchor the requisite content in vocational education. The framework curricula of the expert commission ("Rahmenpläne der Fachkommission nach § 53 Pflegeberufegesetz") form the basis for the federal states to create their own framework curricula. This paper examines to what extent and in what form the framework curricula take up digitalisation., Material and Methods: The framework curricula were investigated in an explicative-qualitative content analysis between August and October 2021. First, the frequency of previously defined keywords was determined. This was followed by a systematic context analysis., Results: Merely six federal states had created their own framework curriculum; the others used the federal framework curriculum, which only addresses the acquisition of competences in the field of digitalisation to a small extent. Digitalisation was addressed to varying degrees in the federal state's own framework plans but only selectively overall. Recommendations for practical exercise formats were hardly given., Discussion: The acquisition of competences in the area of digitalisation forms the foundation for later professional life and is an important component of the digital transformation. In the context of the possibility of modifying nursing education until 2024, the topic should be taken into focus more strongly. Improvements can also be made directly at technical and vocational schools as well as universities since the framework curricula are sometimes only of a recommendatory nature., (© 2022. The Author(s).)

Background: Standardised surveillance of COVID-19 infections among healthcare personnel during the current pandemic was and is not available. In particular, the proportion of occupational infections among healthcare personnel and which workers among them are most at risk remains unclear., Objectives: The aim of this study was to analyse the reported COVID-19 cases among healthcare personnel in Frankfurt/Main during the first six months of the pandemic, to determine the number of occupational infections and thus to allow a better interpretation of the data published by the Robert Koch Institute., Methods: Data from the Frankfurt/Main Health Protection Authority was analysed for the period from 1 March to 31 August 2020, and healthcare personnel were recruited for a cross-sectional survey. Three subgroups were defined and analysed according to whether the infectious contact occurred at work, in private or in an unknown setting., Results: Healthcare personnel accounted for 11.8% (319/2700) of all reported COVID-19 cases in Frankfurt/Main during the period studied. In the survey, 47.2% of respondents reported that their infection was acquired in the workplace. There was an association of contact with COVID-19 patients as well as employment in the internal medicine ward and a reported work-related infection. Also apparent was an association between suspected occupational infections and consequently filed reports for alleged occupational disease., Discussion and Conclusion: Health protection authorities are in a position to collect relevant data on work-related transmissions in healthcare occupations and workplaces and should generate standardised data on infected healthcare personnel. This data is necessary to take targeted infection control and prevention measures that protect healthcare personnel and their patients., (© 2022. The Author(s).)

Background and Aim: Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks"., Method: In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated., Previous Results: The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC., Conclusion: Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined., (© 2020. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Ensuring data privacy and information security frequently poses a challenge for manufacturers of digital health applications (DiGA). This is often caused by a low level of maturity of the application development organization and a lack of expertise in the intersection between regulatory requirements and applied information security. As a result, critical mistakes are made during implementation, requirement analysis, and process design. These must be avoided.This paper presents the requirements and solutions derived from and in compliance with the General Data Protection Regulation, the state of the art, other regulations that must be taken into account, the Digital Healthcare Act (DVG), and the corresponding ordinance. In order to derive specific requirements according to the state of the art and considering the identified level of protection with regard to the fundamental objectives of information security, such as confidentiality, integrity and availability, reference is made to important standards and norms. In the spirit of a how-to for manufacturers, the authors then directly address the most important deficiencies regarding authentication, consent, and authorization and give appropriate recommendations.The authors see further support for manufacturers from the Federal Institute for Drugs and Medical Devices (BfArM), for example in the form of specific guidelines, as an important pillar in overcoming the gap between requirements and reality in matters of data protection and information security. At the same time, further maturation of the manufacturer's application development organization is required and expected. At the same time, with the replacement of the Medical Device Directive (MDD) with the Medical Device Regulation (MDR), information security gains more importance., (© 2021. Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature.)

An evidence-based approach is considered a central requirement in the public health system. Five general principles apply in evidence-based medicine as well as in evidence-based public health (EBPH). These comprise a systematic approach, transparency in relation to uncertainty, integration and participation, management of conflicts of interest, and a structured, reflective process. This article aims to promote a common understanding of what taking an evidence-based approach entails in the field of public health.We explored the international understanding of EBPH through systematic literature searches of definitions, concepts, and models regarding an evidence-based approach in public health. In this manner, 20 English sources and one German source were identified and examined using content analysis. Beyond the above-described general principles, characteristics of these perspectives are concerned with a population orientation, the underlying concept of evidence, disciplines, and stakeholder groups to be involved in the process, as well as relevant criteria and necessary competencies for implementing an evidence-based approach.Based on this, and taking into account methodological developments to address complexity, four specific implementation factors of EBPH can be derived. These include theory, interdisciplinarity, context-sensitivity, and complexity as well as general societal aspects.The practical implementation of EBPH requires human and financial resources as well as competencies - among others, for conducting systematic reviews of the effectiveness of measures, examining other relevant questions in a scientific manner, and establishing transparent processes to formulate recommendations.

The challenges posed by the COVID-19 pandemic face different institutional structures and traditions of action in the European health systems. This article uses the example of the public health services in Sweden, France and Austria to address the question of the similarities and differences in the measures taken to combat the pandemic (status: November 2020).Among the countries presented in this article, Austria is the least affected by the pandemic and France is the most affected. In all analysed health systems there is a tension between national and regional responsibilities. France's healthcare system is particularly centralized, while Sweden's is strongly regional and municipal. Governments in the nation states are striving to obtain pandemic containment powers independent of parliamentary decisions. Sweden differs from Austria and France in that its pandemic containment strategy is based primarily on recommendations and appeals rather than directives and bans. The sequences of action during the pandemic and, apart from Sweden, the instruments used to contain the pandemic are similar. The course of the pandemic and the measures taken in Austria and France show clear parallels with those in Germany. The protection of particularly vulnerable groups has not been sufficiently successful in all countries and remains a challenge to be met.

Environmental noise is a great burden for the population in Germany, especially in urban areas. People are often exposed not only to one but several noise sources. Long-term exposure to environmental noise can have several and severe adverse effects on human health, such as noise annoyance, sleep disturbances, ischaemic heart disease and depression. Additional burdens arise from multiple exposure to particulate matter or air pollutants. The current article describes the relevant adverse health effects due to long-term environmental noise exposure, discusses the challenges of environmental noise in urban areas different and introduces measures and instruments to abate environmental noise.

An important prerequisite for the success of the digitisation of the healthcare system are risk-literate users. Risk literacy means the ability to weigh potential benefits and harms of digital technologies and information, to use digital services critically, and to understand statistical evidence. How do people find reliable and comprehensible health information on the Internet? How can they better assess the quality of algorithmic decision systems? This narrative contribution describes two approaches that show how the competence to make informed decisions can be promoted.Evidence-based and reliable health information exists on the Internet but must be distinguished from a large amount of unreliable information. Various institutions in the German-speaking world have therefore provided guidance to help laypersons make informed decisions. The Harding Center for Risk Literacy in Potsdam, for example, has developed a decision tree ("fast-and-frugal tree"). When dealing with algorithms, natural frequency trees (NFTs) can help to assess the quality and fairness of an algorithmic decision system.Independent of reliable and comprehensible digital health services, further tools for laypersons to assess information and algorithms should be developed and provided. These tools can also be included in institutional training programmes for the promotion of digital literacy. This would be an important step towards the success of digitisation in prevention and health promotion.

Digital game-based approaches can be used in the field of prevention and health promotion, for example to promote health-related information or to foster health behavior change. The two most relevant game approaches are "serious games" (games with a serious background) and "gamification" (the application of game-typical elements in nongame contexts). The term serious games is used to describe games that are used to convey serious content, such as health issues. Gamification uses game-design elements such as points, leaderboards, awards, profile design, and team events to increase motivation and performance, for example in learning environments. This narrative article examines the mode of action and study situation as well as the advantages and disadvantages of playful applications in prevention and health promotion and exemplifies some of these applications.Serious games and gamification show great potential in prevention and health promotion. Especially in the case of target groups that are difficult to reach and disinterested, a direct connection to their living environment can be established. The foundations for the effective use of playful approaches in the work and training of health professionals are their already high level of familiarity with the medium of games and that games directly address the basic psychological needs to increase motivation.

In 1986, the Ottawa charter marked a paradigm shift for public health, putting the focus on strengthening community action and on creating supportive environments for health. A key to this is "capacity building" (CB), which we understand as the development and sustainable implementation of structural capacities, e.g. coordinated data collection, collaboration processes across sectors and reliable provision of basic resources in all areas of local health promotion.Many efforts and three and a half decades later we still envisage infrastructure deficits, scattered public health landscapes and restraints to intersectoral cooperation much too often. While agreement on the theoretical insights on what is needed appears to be broad, translating these insights into practice remains a challenge. In this situation, digital public health (DPH) can contribute to overcoming barriers and making knowledge for action more visible and more accessible. With DPH, data can be integrated, structured and disseminated in novel ways.We discuss why CB at the local level could benefit from technological advances and what DPH might do for the provision of information services on public health capacity. Our focus is on the web-based, interactive representation of public health data for use in information, governance or benchmarking processes. As an example from public health practice, the Finnish tool TEAviisari (National Institute for Health and Welfare, Finland) is presented.The 2020 EU Council Presidency of Germany - with the topics of digitalisation and the common European health data space - offers opportunities to decisively advance the development of CB in health promotion in this country.

Background: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA., Material and Methods: Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex., Results: In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated., Conclusion: The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.

Background and Objective: The work environment for rheumatologists has significantly changed over the last years. The healthcare of patients with rheumatic diseases is at risk due to the age structure of specialized rheumatologists in middle Germany and the limited availability of training positions for rheumatologists. In this context, it is important to have detailed information on the resident physicians in rheumatology concerning their own visions regarding their future professional career., Material and Methods: A questionnaire was sent to resident physicians in 25 rheumatology training hospitals in the middle of Germany (Saxony, Saxony-Anhalt and Thuringia). The questionnaire was completed and returned by 27 participants (17 women and 10 men)., Results: Most of the participants (60%) aimed to qualify as a specialist in internal medicine followed by a specialization in rheumatology (altogether training for a minimum of 8 years). After finishing training 44% would prefer to work in an outpatient setting while 30% planned to work in a combined outpatient and clinical setting. Of the participants 48% would prefer to work as part-time rheumatologists and 74% (women 94% and men 40%) were interested in employment in an outpatient medical healthcare center. The compatibility of family and work as well as the work-life balance was considered to be highly relevant for the future professional life., Conclusion: Less than half of the participants intended to work exclusively in an outpatient setting after completing the training in rheumatology. In addition, the participants preferred a part-time employment with compatibility of professional and private life. Consequently, alternative models of employment should be created in rheumatology to be attractive for future physicians. On the other hand, the study revealed that the independent rheumatological practice has a lower priority for the young rheumatologists taking part in this survey.