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Abstract Background Informal caregivers often experience multiple negative consequences as a result of the informal care they provide. Among other factors, employment status, financial resources, and mental health are related to informal caregiving. This analysis examined the association between informal caregivers’ employment status and their mental health, as well as the moderating effect of net household income on this relationship. Methods The research question was addressed with data from the German Socio-Economic Panel (SOEP) survey, comprising 3,053 informal caregivers (1,007 male; 2,046 female). Data were obtained through self-reports, and mental health was measured with the Summary Scale Mental Score. Stepwise adjusted multiple linear regression models were used to examine the association between employment status and mental health. The moderating effects were tested with interaction terms. All analyses were also stratified for gender. Results Informal caregivers with full-time jobs reported better mental health than unemployed or marginally employed caregivers (β = 0.077, p

Abstract Background Ultraviolet (UV) radiation is the most important risk factor for skin cancer development. Sunlight is the main source of UV radiation in the general population. In addition, tanning beds are a source of artificial UV radiation. Since the incidence of skin cancer is increasing worldwide, it is necessary to monitor UV-related risk behaviors such as intentional indoor and outdoor tanning, as well as sun protection behavior in the general population and specific subgroups and settings. This is the aim of the National Cancer Aid Monitoring online (NCAM-online), a continuation and further development of the NCAM. Methods The NCAM-online is a longitudinal trend study consisting of four annual survey waves. Each year, 4,000 individuals aged 16–65 years living in Germany will be surveyed using online questionnaires. Each year, intentional indoor and outdoor tanning will be assessed. In addition, varying specific topics regarding skin cancer prevention, such as the utilization of skin cancer screening, will be addressed in the questionnaires. Discussion The findings of the NCAM-online will provide an important basis for the German Cancer Aid and Working Group on Dermatologic Prevention (Arbeitsgemeinschaft Dermatologische Prävention, ADP) to develop targeted prevention campaigns and projects aimed at preventing skin cancer. The explorative nature of the NCAM-online allows for the identification of new potential starting points for prevention and education. In addition, the longitudinal design allows for a description of the trend in the prevalence of intentional tanning. For tanning bed use, representative trend data from 2012 are available for Germany, to which NCAM-online will add annual data until 2027.

Abstract Background Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. Methods We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the ‘Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)’ recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. Results Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. Conclusions Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.

Social interactions that are simultaneously characterized by positive and negative aspects—i.e., ambivalent relationships—have been found to be related to distress and poor mental health. As the university setting is also characterized by several social interactions, this study aimed to investigate for the first time to what extent objective and subjective ambivalence towards lecturers or instructors are linked to university students’ distress levels and mental health indicators. A notable relationship of ambivalence with the outcomes was found in 1105 students from Germany. The association with psychological distress was more pronounced for objective than for subjective ambivalence (adjusted betas = 0.342 vs. 0.261, p-values < 0.001), while both also had an independent association. The association with mental health was comparable for both types (adjusted beta = −0.206 vs. −0.191, p-values < 0.001). For paradoxical emotions, the relationship with objective ambivalence was stronger, and only this remained significant in the mutually adjusted model (adjusted beta = 0.376, p-value < 0.001). This study provided evidence of a previously unconsidered stressor at the university—ambivalence towards lecturers—associated with negative health effects among students. Future studies are needed to establish this connection and to create the basis for preventative measures.

In universities, perceived unfairness is associated with negative outcomes, such as dissatisfaction, lower engagement, higher drop-out and stress, and poorer mental health. It is, however, still unclear which aspects constitute perceived unfairness in students. Therefore, this qualitative study explored students’ perceptions of unfairness with twenty semi-structured interviews. The interviews were audiotaped, transcribed verbatim, and analyzed following Mayring’s qualitative content analysis. A set of main codes and subcodes was developed and refined. The identified sources of unfairness can be summarized as organizational aspects, such as the registration and administration processes, the treatment of students, including the behavioural patterns of lecturers and university staff, and the individual situation of students. This study identified different sources of perceived unfairness in the university setting, potentially related to less engagement, higher drop-out rates, and worse mental health of the students. To keep students engaged and healthy, it seems beneficial to address the sources of unfairness.

Nonmelanoma skin cancer (NMSC) is the most common cancer type in Western industrialized countries. However, research into the knowledge and awareness in the general population regarding NMSC is still scarce. This qualitative study aims to fill this research gap. Face-to-face, semi-structured interviews with 20 individuals aged 55–85 years were conducted between February and October 2020. Transcribed interviews were analyzed using qualitative content analysis. The term “white skin cancer”—the German colloquial term of NMSC—was well-known, but the incidence was underestimated. None of the participants could give a precise definition of NMSC, and various alterations in the skin were, partially wrongly, stated as potential signs for NMSC. As risk factors for NMSC, solar radiation, and fair skin type were mentioned most often. The perceived individual risk of developing NMSC and risk compared to individuals of the same age and gender were low in our sample. Own knowledge about NMSC was mostly perceived to be insufficient, and the majority of the sample would like to receive more information on NMSC. Our results emphasize a need to inform about the signs and risks of NMSC not only in the studied older age group but also in younger people.

Abstract Background At the end of secondary education, young people can either start vocational training, enter university, directly transition to employment or become unemployed. Research assumes that post-secondary pathways have immediate and/or long-term impacts on health and well-being, but empirical investigations on this are scarce and restricted to few countries. Therefore, this study traced the development of health and well-being throughout the highly institutionalised school-to-work transition (STWT) in Germany. Methods We used longitudinal data of the National Educational Panel Study (NEPS), a representative sample of 11,098 school-leavers (50.5% girls) repeatedly interviewed between 2011 and 2020. We estimated the effect of post-secondary transitions on self-rated health and subjective well-being by applying fixed-effects (FE) regression, eliminating bias resulting from time-constant confounding and self-selection into different pathways. A multiple-sample strategy was used to account for the increasing diversity of STWTs patterns. Models were controlled for age, as well as household and residential changes to minimise temporal heterogeneity. Results Findings indicate that leaving school was good for health and well-being. Compared with participants who did not find a training position after school, direct transitions to vocational training or university were linked to higher absolute levels of health and well-being, but also to a lower relative decline over time. Furthermore, upward transitions (e.g. to programs leading to better education or from unemployment to employment) were associated with improvements in health and well-being, while downward transitions were followed by deteriorations. Conclusion Findings suggest that school-leave is a sensitive period and that post-secondary pathways provide young people with different abilities to maintain health and well-being. Youth health interventions might benefit when setting a stronger focus on unsuccessful school-leavers.

Abstract Background Necrotizing soft tissue infections (NSTI) require immediate radical debridement, broad-spectrum antibiotics and intensive care. Hyperbaric oxygen therapy (HBOT) may be performed adjunctively, but unequivocal evidence for its benefits is still lacking. Methods We performed a retrospective single-center study including 192 patients with necrotizing fasciitis or Fournier's gangrene to assess in-hospital mortality and outcome dependent on patient, disease and treatment characteristics with or without HBOT. Results The in-hospital mortality rate was 27.6%. Factors associated with increased mortality according to multivariate analysis were higher age, affection of multiple or problem localizations (odds ratio (OR) = 2.88, P = 0.003), ineligibility for HBOT despite clinical indication (OR = 8.59, P = 0.005), pathogens in blood cultures (OR = 3.36, P = 0.002), complications (OR = 10.35, P

Abstract Background The number of obese children is rising worldwide. Many studies have investigated single determinants of children’s body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. Methods Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children’s standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. Results Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 – 25 children; B = -.54; p = 0.022 [ref.: 25 children; B = -.52; p = 0.037 [ref.:

BackgroundOverweight in childhood is considered to be one of the most serious public health challenges. Many studies have investigated individual-level determinants of children's body mass index (BMI), yet studies exploring determinants at the meso-level are sparse. The aim of our study was to examine how a sports focus at early childhood education and care (ECEC) centers moderates the effect of parental socio-economic position (SEP) on children's BMI.MethodsWe used data from the German National Educational Panel Study and included 1,891 children (955 boys and 936 girls) from 224 ECEC centers in our analysis. Linear multilevel regressions were used to estimate the main effects of family SEP and the ECEC center sports focus, as well as their interaction, on children's BMI. All analyses were stratified by sex and adjusted for age, migration background, number of siblings, and employment status of parents.ResultsOur analysis confirmed the wellknown health inequalities in childhood overweight with a social gradient toward a higher BMI for children from lower SEP families. An interactive effect between family SEP and ECEC center sports focus was found. Boys with low family SEP not attending a sports-focused ECEC center had the highest BMI among all boys. In contrast, boys with low family SEP attending a sports-focused ECEC center had the lowest BMI. For girls, no association regarding ECEC center focus or interactive effects emerged. Girls with a high SEP had the lowest BMI, independent of the ECEC center focus.ConclusionWe provided evidence for the gender-specific relevance of sports-focused ECEC centers for the prevention of overweight. Especially boys from low SEP families benefited from a sports focus, whereas for girls the family's SEP was more relevant. As a consequence, gender differences in determinants for BMI at different levels and their interaction should be considered in further research and preventive measures. Our research indicates that ECEC centers may decrease health inequalities by providing opportunities for physical activity.

IntroductionHealth inequalities start early in life. The time of young adulthood, between late teens and early twenties, is especially interesting in this regard. This time of emerging adulthood, the transition from being a child to becoming an adult, is characterized by the detachment from parents and establishing of an own independent life. From a health inequality perspective, the question about the importance of the socio-economic background of parents is important. University students are an especially interesting group. Many students come from a privileged background and the question of health inequality among university students has not yet been properly studied.MethodsBased on the National Educational Panel Study (NEPS), we analyzed health inequalities among 9,000 students in Germany (∅ 20 years in the first year of their studies) over a period of 8 years.ResultsWe found that most university students (92%) in Germany reported a good and very good health. Yet, we still found substantial health inequalities. Students whose parents had a higher occupational status reported less health problems. Additionally, we observed that health inequalities had indirect impact on health via health behavior, psychosocial resources, and material conditions.DiscussionWe believe our study is an important contribution to the understudied subject of students' health. We see the impact of social inequality on health among such a privileged group like university students as an important sign of the importance of health inequality.

Objectives The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16–24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours.Design Scoping review.Study selection Relevant literature was systematically searched following the methodological framework proposed by Arksey and O’Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered.Data extraction To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment).Results A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible.Conclusions This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.

Abstract Background To assess physical activity (PA), a comparative measurement – evaluating one’s own PA compared to others – may be an appropriate method. In previous studies, the use of comparative measurements led to an effect known as unrealistic comparative optimism (UCO) – people being unrealistically optimistic about their behavior. Our aim was to use this comparative measurement in university students to quantify the prevalence of UCO at the group level and to draw conclusions on its validity. Methods We used data from the Nutrition and Physical Activity in Adolescence Study (NuPhA), a cross-sectional online survey that included only self-reports (n = 689). To assess PA among students, they were asked to rate their PA level compared to that of their same-aged fellow students. In addition, we used the Godin-Shephard leisure-time PA questionnaire and other questions on PA for comparisons. We used bivariate and cluster-based analyses to identify potential UCO. Results We found that UCO at the group level led to an uneven distribution, with a higher proportion of students who rated themselves as being more physically active than average. However, the individual assessment of PA with a single and simple comparative question seemed to be valid. Discussion A global single comparative question seems useful for studies where PA is measured as a covariate in university students.

In recent years, millions of citizens all over the world have used digital dating services. It remains unknown to what extent human sexuality will be changed by this. Based on an evolutionary psychological perspective, we assume that sexual selection shaped behavioural tendencies in men and women that are designed to increase the reproductive fitness. These tendencies are referred to as sexual strategies. Males and females sexual strategies differ according to sex-dimorphic reproductive investments. We assume that this inheritance will affect human sexuality also in a digital future. To evaluate this assumption, we conducted a selective review of studies on digital dating services. Based on sexual selection theory, we derived a number of hypotheses regarding how men and women will use digital dating services typically and how the use of digital dating services might affect sexual wellbeing. Out of an initial data set of 2,568 records, we finally reviewed a set of 13 studies. These studies provided support for the notion that men and women act in the digital dating area according to sex-typical strategies. However, sometimes the circumstances of digital dating affect communication flow, e.g., in that men are even more active in establishing contacts than they are in real world conditions. Overall, women appear to accomplish their sexual goals in digital dating arenas more than men do given a surplus of male demand. Our results suggest that future human sexuality will be impacted by an interaction of both: sex-dimorphic ancient sexual strategies and new technologies.

Introduction Although the impact of macrolevel characteristics of health systems on socioeconomic inequity in health has been studied extensively, the impact of access characteristics on a smaller scale of health systems has received less attention. These mesolevel characteristics can influence access to healthcare and might have the potential to moderate or aggravate socioeconomic inequity in healthcare use. This scoping review aims to map the existing evidence of the association of socioeconomic inequity in healthcare use and mesolevel access characteristics of the health system.Methods and analysis In conducting the scoping review, we follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols Extension for Scoping Reviews. The search will be carried out in four scientific databases: MEDLINE (via PubMed), Web of Science, Scopus and PsycINFO. Main eligibility criteria are inclusion in the analysis of a measure of socioeconomic position, a measure of individual healthcare use and a mesolevel determinant of access to healthcare services. The selection process consists of two consecutive screening stages (first: title/abstract; second: full text). At both stages, two reviewers independently assess the eligibility of studies. In case of disagreement, a third reviewer will be involved. Cohen’s kappa will be calculated to report inter-rater agreement between reviewers. Results are synthesised narratively, as a high heterogeneity of studies is expected.Ethics and dissemination No primary data are collected for the presented scoping review. Therefore, ethical approval is not necessary. The scoping review will be published in an international peer-reviewed journal, and findings will be presented on national and international conferences.

Tanning beds have been classified as carcinogenic to humans. As a result, many countries have enacted laws regulating the use of commercial tanning beds, including bans for minors. However, there is no international overview of the current legal status of access restrictions for minors that provides details on their specific design regarding age limits and possible exceptions to the statutory regulation. Therefore, we performed a comprehensive web search of current tanning bed legislation for minors on the three continents North America, Australia, and Europe. Our findings regarding the existence and concrete design of access restrictions are presented graphically, using maps. We found a wide variety of different legislations. In Australia, a total ban on tanning beds exists, while in New Zealand, tanning bed use is banned for minors. In Europe, about half of the countries have implemented a strict ban for minors. In North America, we found differences in the age limit for access restrictions between the states, provinces, and territories for those regions that implemented a ban for minors. In the United States, some states have rather “soft bans” that allow use by minors with different types of parental consent. The patchwork in legislation calls for harmonization. Therefore, our comparison is an important starting point for institutions such as the World Health Organization or the European Commission to advance their goals toward a harmonization of tanning bed legislation in general and for minors in particular.

Solar radiation is one of the driving forces for life on earth [...]

Introduction School-to-work/university transition is a sensitive period that can have a substantial impact on health and health behaviour over the life course. There is some indication that health and health behaviour is socially patterned in the age span of individuals in this transition (16–24 years) and that there are differences by socioeconomic position (SEP). However, evidence regarding this phenomenon has not been systematically mapped. In addition, little is known about the role of institutional characteristics (eg, of universities, workplaces) in the development of health and possible inequalities in health during this transition. Hence, the first objective of this scoping review is to systematically map the existing evidence regarding health and health behaviours (and possible health inequalities, for example, differences by SEP) in the age group of 16–24 years and during school-to-work transition noted in Germany and abroad. The second objective is to summarise the evidence on the potential effects of contextual and compositional characteristics of specific institutions entered during this life stage on health and health behaviours. Third, indicators and measures of these characteristics will be summarised.Methods and analysis We will systematically map the evidence on health inequalities during school-to-work-transitions among young adults (aged 16–24 years), following the methodological framework proposed by Arksey and O’Malley. The literature search is performed in Ovid MEDLINE, Web of Science, International Labour Organization and National Institute for Occupational Safety and Health, using a predetermined search strategy. Articles published between January 2000 and February 2020 in English or German are considered for the review. The selection process follows a two-step approach: (1) screening of titles and abstracts, and (2) screening of full texts, both steps by two independent reviewers. Any discrepancies in the selection process are resolved by a third researcher. Data extraction will be performed using a customised data extraction sheet. The results will be presented in tabular and narrative form.Ethics and dissemination Ethical approval is not required for this scoping review. The results will be published in a peer-reviewed scientific journal and presented at international conferences and project workshops.

Introduction Early childhood is an important life stage which is crucial for determining health and health inequalities in later life. At the meso-level (institutional-level), early childcare facilities (eg, kindergartens, preschools) are the most important agent of socialisation next to families in young children aged 06 years. In recent years, an increasing amount of studies has focused on contextual and compositional characteristics of early childcare facilities and their association with health (eg, self-rated health), health behaviour (eg, physical activity) and well-being (eg, emotional well-being) in this age group. However, as currently no overview of the available literature on this topic exists, we will conduct a scoping review including various study designs (eg, cross-sectional studies, prospective studies, qualitative studies).Methods and analysis We will follow the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A systematic search of the following scientific databases will be conducted: PubMed/Medline, PsycInfo, Sociological Abstracts, Education Resources Information Center and The Cochrane Library. During the selection process, we will follow a two-step process. First, two reviewers will independently screen titles/abstracts of all potentially eligible articles by applying a set of previously defined inclusion and exclusion criteria. After the completion of the title/abstract screening, full texts of the remaining articles will be screened following the same procedure. To determine inter-rater agreement between reviewers, we will calculate Cohen’s Kappa after both steps. Key characteristics (eg, country of origin, sample size, study design) of included articles will be extracted. We will map the evidence available by providing a summary table on the key characteristics extracted and by presenting the associations using various types of illustrations.Ethics and dissemination Since no primary data will be collected for this review, ethical approval is not required. Our findings will be published in an international peer-reviewed journal and presented at national and international conferences.

Treatment paradigms for advanced melanoma have changed fundamentally over recent years. A discrete choice experiment was performed to explore patient preferences regarding outcome (overall response rate, 2-year survival rate, progression-free survival, time to response, type of adverse events, probability of adverse event-related treatment discontinuation) and process attributes (frequency and route of administration, frequency of consultations) of modern treatments for melanoma. Mean preferences of 150 patients with melanoma stage IIC–IV were highest for overall response rate (relative importance score (RIS) 26.8) and 2-year survival (RIS 21.6), followed by type of adverse events (RIS 11.7) and probability of adverse event-related treatment discontinuation (RIS 9.2). Interest in overall response rate and 2-year survival declined with increasing age, whereas process attributes gained importance. Participants who had experienced treatment with immune checkpoint inhibitors valued overall response rate more highly and worried less about the type of adverse events. In conclusion, patients with advanced melanoma consider efficacy of treatment options most important, followed by safety, but preferences vary with individual and disease-related characteristics.

Conservation Agriculture (CA) has been widely promoted in sub-Saharan Africa (SSA) as a sustainable agricultural practice, yet with debatable success. Most authors assume successful adoption, only if all three principles of CA are implemented: (1) minimum or zero tillage, (2) maintenance of a permanent soil cover, and (3) integration of crop rotations. Based on this strict definition, adoption has declined or remained stagnant. Presently, not much attention has been given to context-suited adaptation possibilities, and partial adoption has not been recognized as an entry point to full adoption. Furthermore, isolated success cases have not been analysed sufficiently. By applying the QAToCA approach based on focus group discussions complemented by semi-structured qualitative expert and farmer interviews, we assessed the reasons behind positive CA adaptation and adoption trends in Zambia. Main reasons behind Zambia’s emerging success are (1) a positive institutional influence, (2) a systematic approach towards CA promotion – encouraging a stepwise adaptation and adoption, and (3) mobilization of strong marketing dynamics around CA. These findings could help to eventually adjust or redesign CA promotion activities. We argue for a careful shift from the ‘dogmatic view’ on adoption of CA as a packaged technology, towards adapting its principles to the small-scale farming context of SSA.

Health status and health behavior change during the transition from school to university. However, it is still unclear whether these changes occur at specific points in time, and whether these changes are stable. Therefore, our aim was to conduct a pilot test on biographical mapping (BM) for the first time in this research area in order to map the trajectories of the health status of university students over time. This enabled us to also test the practicability of BM, and to assess the agreement of the findings of BM with those of a standardized questionnaire. We included 30 fourth-year university students. First, they filled in a standardized questionnaire on their sociodemographic information, current health status, and health status compared with that for their final year of school. Second, they filled in a BM grid that allows for drawing the changes in health status that have taken place over the transition period. The health status changed during the transition (e.g., slight decline in general subjective health), and was related to specific events before and after the transition (e.g., examinations), showing that all health variables were not stable over time. The findings of BM were also reflected in the standardized questionnaire. Using BM revealed the changes in health during a six-year-period, including the school–university transition. The identified changes in health during transition and at specific time points underline that not only assistance before the transition, but also psychological support during studies, seems to be important for the health promotion of students. Besides this, BM seems to be a useful, although time-consuming, instrument for which the results were similar to those in the questionnaire.

Seeking shade, the use of textile sun protection and sunscreen, and protecting one’s eyes by wearing sunglasses are recommended sun protection measures in children. We aimed to quantify the use of these measures as well as the prevalence of sunburn in children aged 1 to 10 years in Germany and to identify their determinants. Data collected via telephone interviews in a nationwide sample of 554 parents or caregivers in family were analyzed. Use of sunscreen was the most common measure applied (77.8%), while sunglasses were least frequently used (12.5%). The prevalence of sunburn during the past year was 21.8%, and it was positively associated with children’s age. The use of sun protection measures was significantly associated with the age and skin color of the child, while characteristics and tanning behaviors of the caregivers only played a minor role. The use of sun protection measures was higher when caregivers perceived themselves as a role model (Odds Ratio (OR) = 4.33, p < 0.001). Our nationwide data show that there remains a need for the improved use of sun protection measures, especially in children aged 7 to 10 years. In educational material, parents should be encouraged to become positive role models for their children regarding sun protection.

Abstract Background This conceptual paper aims to illustrate the ways in which communities are able to advance health improvements on a population level. Outcome measures may include increased physical activity and healthier eating habits in particular, as well as an improved health-related quality of life and social cohesion as more generic outcomes. Main body The paper begins by asking initial questions: Why did previous health-specific interventions only show moderate effects on an individual level and mixed effects on a population level? What is the added value of a community-based public health perspective compared to the traditional biomedical perspective when it comes to prevention? Why are we living the way we are living? Why do we eat what we eat? Why do we move the way we move? Subsequently, we illustrate the broad spectrum of contextual interventions available to communities. These can have geographical and technological as well as economic, political, normative and attitude-specific dimensions. It is shown that communities have a strong influence on health-related contexts and decision-making of adults, adolescents and children. In addition contextual characteristics, effects, mediators, moderators and consequences relevant for health can differ greatly between age groups. Both small-scale settings and overarching sectors possess physical, economic, political and sociocultural characteristics that can be proactively influenced by community decision-makers in the sense of a “health in all policies”-strategy. Short conclusion After presenting various interdisciplinary approaches to community-based health interventions, the manuscript closes with the following core message: Successful community-based health promotion strategies consist of multilevel – multicomponent interventions on the micro, meso and macro-level-environments.

In den westlichen Industrienationen gilt gebräunte Haut allgemein als schön und erstrebenswert. Psychologische Studien zeigen, dass Jugendliche und Erwachsene sich häufig natürlicher und künstlicher ultravioletten (UV-) Strahlung (etwa Sonnenbaden oder Solariennutzung) aussetzen, um ihre Attraktivität zu steigern. Ein solches Schönheitsideal birgt jedoch zahlreiche dermatologische und onkologische Risiken (z. B. vorzeitige Hautalterung, Hautkrebs). Im Rahmen des bundesweit repräsentativen Nationalen Krebshilfe-Monitorings (NCAM) wurden im Jahr 2017 3.000 Personen zu den sogenannten attraktivitätsbezogenen Motiven des Bräunungsverhaltens (ABM) befragt. Es zeigte sich, dass ABM eher für Befragte zwischen 18 und 35 Jahren, Befragte mit Migrationshintergrund, Befragte mit mittlerem Bildungsniveau und für Befragte ohne festen Partner relevant waren. Zudem zeigte sich, dass Personen, die sich mit dem Ziel der Attraktivitätssteigerung bräunen, eine geringere Risikowahrnehmung für natürliche und künstliche UV-Strahlung besitzen, aber gleichzeitig ein risikoreicheres Bräunungsverhalten zeigen: Sie bräunen sich häufiger im Solarium und in der Sonne und berichten dabei häufiger von einem Sonnenbrand. Damit haben diese Personen ein erhöhtes Risiko, Hautkrebs zu entwickeln. Diese Ergebnisse sind von Bedeutung für zukünftige Präventionsmaßnahmen. So sollten Präventionskampagnen auch einen Schwerpunkt auf die Reduzierung der positiven Bewertung einer gebräunten Haut und damit auf die Veränderung westlicher Schönheitsideale legen.

The locally occurring mechanisms of hydrogen embrittlement significantly influence the fatigue behavior of a material, which was shown in previous research on two different AISI 300-series austenitic stainless steels with different austenite stabilities. In this preliminary work, an enhanced fatigue crack growth as well as changes in crack initiation sites and morphology caused by hydrogen were observed. To further analyze the results obtained in this previous research, in the present work the local cyclic deformation behavior of the material volume was analyzed by using cyclic indentation testing. Moreover, these results were correlated to the local dislocation structures obtained with transmission electron microscopy (TEM) in the vicinity of fatigue cracks. The cyclic indentation tests show a decreased cyclic hardening potential as well as an increased dislocation mobility for the conditions precharged with hydrogen, which correlates to the TEM analysis, revealing courser dislocation cells in the vicinity of the fatigue crack tip. Consequently, the presented results indicate that the hydrogen enhanced localized plasticity (HELP) mechanism leads to accelerated crack growth and change in crack morphology for the materials investigated. In summary, the cyclic indentation tests show a high potential for an analysis of the effects of hydrogen on the local cyclic deformation behavior.

Apple replant disease (ARD) impacts the economic yield of orchards by physiological and morphological suppression of apple trees on replanted soils. The complexity of replant disease caused by a plethora of biological interactions and physical properties of the soil requires complex management strategies to mitigate these effects. Based on expert recommendations, we selected two management strategies linked to agroecological principles of (a) organic fertilisation with a specific mulch composition (MDK) and (b) biofertilisation with arbuscular mycorrhizal and bacterial strains (AMFbac), applied by a composition of existing products. For both management strategies we provide a proof-of-concept, by pot and field experiments. Both treatments have the potential to mitigate ARD effects on plant vigour. ARD effect was fully mitigated by MDK treatment in the short-term (one year) and was mitigated by up to 29% after seven years of MDK treatment (long-term). MDK provides an additional substrate for root growth. AMFbac has the potential to mitigate ARD effects on plant vigour but with non-replicable plant-beneficial effects in its current form of application. Thereby our results show a principal potential to mitigate economic effects but not to overcome replant disease inducing effects. While the MDK treatment is found resource intensive but reliable, the AMFbac treatment was found more user-friendly.

The soil-borne apple replant disease (ARD) is caused by biotic agents and affected by abiotic properties. There is evidence for the interrelation of the soil fungal population and soil aggregate structure. The aim of this study conducted between March and October 2020 on an orchard in north-east Germany was to detect the correlations of soil fungal density, soil structure and tree vigour under replant conditions in a series of time intervals. By using the replant system as the subject matter of investigation, we found that replanting had an impact on the increase of soil fungal DNA, which correlated with a mass decrease of large macro-aggregates and an increase of small macro- and large micro-aggregates in the late summer. Increased proportions of water-stable aggregates (WS) with binding forces ≤ 50 J mL−1, decreased proportions of WS > 100 J mL−1 and a decrease of the mean weight diameter of aggregates (MWD) emphasised a reduction of aggregate stability in replant soils. Correlation analyses highlighted interactions between replant-sensitive soil fungi (Alternaria-group), the loss of soil structure and suppressed tree vigour, which become obvious only at specific time intervals.

Background. Primary care physicians (PCPs) have a key role in the prevention of cardiovascular diseases (CVD). However, it is not clear whether lifestyle counselling behaviour differs between female and male PCPs. Nonetheless, this information might be helpful to develop need-based advanced training for female and male PCPs. Therefore, our aim was to identify potential gender differences in the implementation of health promotion and the prevention of CVD in primary care. Design and Methods. In a Germany-wide survey called the ÄSP-kardio Study, we collected data from 4074 PCPs (40% female; from October 2011 to March 2012). We compared the provision of prevention measures, the attitude towards counselling, and the potential barriers in counselling among female and male German PCPs. We used chi2 tests, Mann-Whitney U tests, and logistic regression analysis.Results. We found differences in all of the above-mentioned aspects. Female PCPs were less likely to perceive barriers than male and more likely to ask patients about lifestyle, for example, nutrition (OR=1.62, P≤0.001). Additionally, female PCPs were more likely to feel well prepared (84.2% vs. 76.0%, P≤0.001) and successful (75.6% vs. 68.0%, P≤0.001). Male PCPs were more likely to mention barriers in daily practice that hinder lifestyle counselling. Conclusions. Overall, both female and male PCPs had a positive attitude towards lifestyle counselling. Nevertheless, in view of the barriers that they indicated, incentives such as better reimbursement may help output-oriented PCPs to translate their positive attitude into action. Moreover, awareness of gender differences may help PCPs to acquire the specific advanced training that they need for effective lifestyle counselling in CVD.