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Background: A large part of the population in Germany makes use of naturopathic, complementary and integrative medical treatments. There are now numerous scientific studies that provide evidence of efficacy for certain indications. At German medical faculties, selected procedures and their application are taught within the cross-sectoral unit called QB 12 and some elective courses, with a focus on specific aspects are offered. So far, however, there has been no structured curriculum that longitudinally anchors teaching across medical studies and enables all students to consider naturopathic and complementary medical options for patient care later on and to integrate them effectively into the diagnostic and treatment process. Objective: The aim of this position paper is to show the relevance of this topic for medical education, to clarify terminology and to present core competencies and possible implementation options for training. Method: The Integrative Medicine and Perspective Pluralism Committee of the German Association for Medical Education developed this position paper in a multi-stage consensual process, in cooperation with the Forum of University Work Groups on Naturopathic Treatment and Complementary Medicine. Results: First, different umbrella terms were discussed and an existing definition of integrative medicine and health was chosen for subsequent use. Building on this step, the status of education and its scientific foundation in Germany was considered in an international context. In the next step, a competency profile for medical training, consisting of seven areas of competency, was developed and described in detail with regard to naturopathic, complementary and integrative medicine. Implementation options were identified using possible starting points in the curriculum and using established examples of best practice. Conclusion: Despite different priorities at each faculty, it was possible to find an agreement on the development of competencies and anchoring them in medical education on the basis of a common definition of terms. Currently, the implementation in the mandatory and elective areas is very heterogeneous. As part of the current revision of the Medical Licensure Act, there are many possible starting points for the integration of naturopathic and complementary medical teaching content, especially in interprofessional and general practice courses. The implementation and accompanying research of targeted teaching settings should lay the foundations for a long-term and binding integration into medical education. Overall, it is clear that medical education in the field of naturopathy and complementary and integrative medicine has the potential to develop comprehensive core medical competencies. [ABSTRACT FROM AUTHOR]

Plastic, plastic waste and marine litter indisputably is one of the key environmental issues of the 21st century. The already existing amount of accumulated marine litter, the high quantity of plastic waste escaping from waste management streams every year in combination with the low recycling rates for plastic and the missing awareness of the consumer for sustainable consumption pose a permanent threat to the ecosystem, biodiversity and human health. What is more, as economic and ecological interests strongly deviate from each other, the transformation of this status quo towards a more sustainable future will take place very slowly. Against this background, this paper will shortly outline the multitude of problems connected to plastic products throughout a product's lifecycle and introduce the idea of a circular economy. On this basis, the paper will critically analyze the strategy papers and the ongoing legislation of the EU introduced to solve these problems and to realize the transformation process of the EU-economy towards a circular economy from a sustainable development point of view. On the one hand, awareness raising is one main strategy of the EU to achieve this transformation, on the other hand, educational institutions are not specifically mentioned by the EU. In order to address this shortcoming, the paper will constitute the teaching principle "global development politics/education for sustainable development" as one measure to increase consumers' awareness and sustainable consumption. In general, this paper will proof that the topical area plastics can fruitfully be implemented at German schools for primary and secondary education in order to strengthen the education for sustainable development.

The increasing number of migrants and refugees arriving in Europe places new demands on European education systems. In this context, the role that free digital learning (FDL) could play in fostering inclusion has attracted renewed interest. While the existing literature highlights some general design principles for developing FDL for migrants and refugees, there is little information on the use of FDL at specific education levels, or for specific learning purposes. This paper presents the results of a qualitative study that was carried out as part of the Moocs4Inclusion project of the Joint Research Centre (JRC) between July and December 2016. The study, which has a European focus, disaggregates the analysis of FDL initiatives by what were identified as its three most common purposes: (a) language learning, (b) civic integration and employment, and (c) higher education. For each of these topics, the study sheds light on the approaches used by a wide sample of initiatives, users' levels of awareness of what is available and take up, and migrants' and refugees' perceptions of the current offer. In order to collect the information needed to cover different approaches and perspectives, semi-structured interviews with 24 representatives of 10 FDL initiatives and four focus groups with 39 migrants and refugees were carried out. The results show that there are indeed overlaps between the purposes of FDL initiatives and their design principles. Specific recommendations on how to better design FDL initiatives for migrants and refugees, taking into account their specific purposes, have also been identified.

The present paper investigates the power of personality to predict important life outcomes in the context of the Programme for the International Assessment of Adult Competencies (PIAAC). On the most global level, personality can be described by the Big Five dimensions, extraversion, agreeableness, conscientiousness, emotional stability, and openness to experience. These five dimensions were assessed in the German PIAAC longitudinal study (N = 4122) and can thus be directly related to the central competence and outcome indicators measured in PIAAC. In a first step, we report the relationships between the Big Five dimensions and the basic competencies literacy and numeracy. In a second step, we investigate the extent to which the five personality dimensions can contribute to explaining six important life outcomes, above and beyond competencies and sociodemographic characteristics. Our results indicate that personality is substantially related to all six life outcomes. The portion of variance explained by personality was similar to, and sometimes larger than, that explained by competencies. After adjusting for competencies, personality was incrementally predictive of life satisfaction and health, in particular, and, to a lesser extent, of educational attainment, employment status, and income. The only outcome of which personality was not incrementally predictive over and above competencies was participation in continuing education. Overall, these findings highlight the merit of including measures for the Big Five personality domains in upcoming cycles of PIAAC.

Heat waves and the consequent heat stress of urban populations have a growing relevance in urban risk management and strategies of urban adaptation to climate change. In this context, social science studies on subjective heat stress of urban citizens are a new emerging field. To contribute to the understanding of subjective heat stress and its major determinants in a daily life perspective, we conducted a questionnaire survey with 323 respondents in Karlsruhe, Germany, after a heat wave in July and August 2013. Statistical data analysis showed that heat stress is an issue permeating everyday activities. It was found that the subjective heat stress at home is lower than at work and in general. Subjective heat stress in general, at home, and at work was determined by the health impairments experienced during the heat and the feeling of being helplessly exposed to the heat. For heat stress at home, additionally characteristics of the residential building and the built environment played a role. Although the rate of implemented coping measures was rather high, coping measures showed no uniform effiect for the subjective heat stress. The results furthermore show that coping with heat is performed within the scopes of action in daily life. We conclude that in terms of urban adaptation strategies, further research is needed to understand how various processes of daily social (work) life enable or limit individual coping and adaptation capacities and that communication strategies are important for building capacities to better cope with future heat waves. [ABSTRACT FROM AUTHOR]

Refugees are perceived as a category of people that are 'vulnerable' per se. However, once they have arrived in (high-income) hosting countries and are supported by a welfare state, vulnerability needs to be rethought, as they face new challenges and potential sources of inequality. In this paper, we have measured vulnerability as the probability of experiencing jointly three interdependent risks: social isolation, financial worries and poor health. For this purpose, we estimated a trivariate logit model to evaluate how individual and household characteristics are associated with vulnerability and also made inferences regarding the residual association between pairs of risks, conditionally to a set of selected covariates. Using the 2016 wave of the IAB-BAMF-SOEP survey of refugees in Germany, we demonstrated the significant correlations between the risks experienced by refugees and assessed a 'propagation effect' that affects vulnerability when the three risks come together. Taking this result into account may be useful in preventing vulnerability among refugees when they are faced with even one of these risks. [ABSTRACT FROM AUTHOR]

The issue of health plays an important role in the German language sports pedagogical discussion and in German curricula. It is also important here that the idea of 'Bildung'—an educational ideal in the German tradition which is still of paramount importance and which stems from the obligation of enlightenment and is intended to enable mature judgment—is a normative idea for school lessons. In terms of health in physical education, this throws up the question of whether PE for young people should not simply be focused towards a healthy lifestyle, but rather towards understanding what and how a healthy lifestyle could be and reflect on the role they want it to play in their lives in an emancipatory manner. Therefore, this paper examines the way in which health and health education are considered in current curricula in Germany. A hermeneutic oriented qualitative text analysis is carried out. Alongside differences between the states, the analysis shows an overall tendency towards narrowing down health education. The paper finally seeks to critically discuss this narrowing from a pedagogical perspective as an exemplary process which might be observed in a similar way in other countries. [ABSTRACT FROM AUTHOR]

The Health Information National Trends Survey (HINTS) is a well-established U.S.-based research program administered by the National Cancer Institute to track the public access to and use of health information. This paper introduces a German research initiative, part of the International Studies to Investigate Global Health Information Trends (INSIGHTS) research consortium. This adaptation of the HINTS is important for initiating analyses of global health communication practices and comparing health information seeking behaviors (HISB) across nations to pinpoint potentials and challenges of health information provision and contribute to a deeper understanding of socio-contextual determinants of HISB. First cross-country comparisons revealed that the share of residents seeking for health information is high in the U.S. (80%) and Germany (74%), but different primary sources are used. Whereas a clear majority of U.S. residents chose the Internet to gather health information (74.9%), Germans most often turn to health professionals (48.0%). Socio-structural and health(care)-related predictors were found to contribute to the explanation of HISB in both countries, whereas information-related predictors were only relevant in Germany. The results indicate the need to engage in patient-provider communication to initiate HISB and to improve the access to information for residents with lower socio-economic backgrounds. [ABSTRACT FROM AUTHOR]

This paper sheds further light on the contextual boundaries in the relationship between high-performance work practices (HPWPs) and employee wellbeing. In particular, we analyze whether this relationship is moderated by health-oriented leadership behavior (i.e., staff care) which describes the extent to which leaders value, are aware of, and protect their followers' health at work. Our analyses are based on employee data (N = 1,345) from Germany, covering two points in time. Findings show positive associations between HPWPs and happiness-related (i.e., engagement, commitment) and health-related (i.e., general health, physical health complaints, mental health complaints, strain) wellbeing outcomes. The positive relationship between HPWPs and employee wellbeing is weaker the more employees experience leadership behavior in terms of staff care. Thus, our results provide further evidence for a substitutive or compensatory effect between HRM and leadership. [ABSTRACT FROM AUTHOR]

Like many OECD countries, Germany is currently facing a shortage of long-term care (LTC) workers. This situation is concerning in the context of the ageing of the German population. A potential reason why Germany fails to recruit and retain LTC workers is that LTC jobs are particularly demanding (physical and psychological strain) which may be harmful to health. However, there is a lack of empirical evidence demonstrating this effect. This article fills the gap in the literature by exploring to what extent LTC jobs reduce workers' health over time. We estimate a dynamic panel data model on the German Socio-Economic Panel (v.35; 1984–2018), which allows adressing selection issues into occupations. Our paper provides innovative findings on the impact of LTC occupations on workers' health. We confirm that LTC jobs have a negative impact on self-reported health. Our results have strong policy implications: we emphasize the need to provide sufficient assistance to LTC workers, who are at risk of facing more health issues than other workers. This issue is key to increase the attractiveness of LTC jobs and reduce turnover in the LTC workforce. [ABSTRACT FROM AUTHOR]

Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Germany played a key role as receiving country during the so-called refugee and displacement crisis with about 5 million asylum seekers arriving in the EU between 2014 and 2020. It is well known that asylum seekers and refugees (ASRs) have a high burden of disease and are particularly prone to mental disorders such as trauma, stress-related and affective disorders. Not much is known about the determinants of health-related quality of life (HrQoL) among ASRs, especially in the context of the flight. Therefore, the aim of this study was to analyze the associations between flight-related characteristics and HrQoL of ASRs in Germany. Methods: The sample of this study was based on five consecutive waves of the Survey of Refugees samples of the German Socio-Economic Panel (n = 8015; 14,314 observations). Mental and physical HrQoL was measured using the mental (MCS) and physical (PCS) component summary scores of the SF-12v2. Associations between flight-related characteristics and HrQoL were examined using multilevel mixed-effects linear regressions. Results: The different countries of birth were associated with varying MCS and PCS scores. The MCS and PCS scores were lower among ASRs with an economic situation below average in their countries of origin. Persecution, discrimination, and poor living conditions as reasons for leaving the county were associated with lower MCS scores. ASRs who were dissatisfied with their own living situation and who were discriminated often due to their origin had both lower MCS and PCS scores. Not feeling welcome in Germany and missing people from one's country of origin were both associated with lower MCS scores. No worries about not being able to stay in Germany or not being able to return to one's country of origin were both associated with higher MCS scores. Conclusions: The economic situation in the country of origin and the presence of persecution, discrimination, and/or poor living conditions as reason for flight may be pre-flight-related determinants of HrQoL of ASRs in Germany. Possible post-flight-related determinants can be the residence status, the satisfaction with one's living situation, discrimination due to one's origin and a feeling of missing people from one's country of origin. With regard to those determinants, the clarity about the residence status, reducing racial discrimination and the mourning of flight-related circumstances must be ensured. [ABSTRACT FROM AUTHOR]

Social comparison has a significant impact on individuals' motivation, affect, and behavior. However, we lack a scale that captures individual differences in attitudes toward social comparison. To address this gap, we developed the Attitudes Toward Social Comparison Inventory (ASCI) drawing on existing scales that tap into metacognitive beliefs about worrying, self-motives, beliefs about emotions, and the general comparative-processing model. We examined the psychometric properties of the ASCI in a longitudinal study (N = 1,084), and a second (N = 550) and third cross-sectional study (N = 306). Through exploratory and confirmatory factor analyses, we identified a 12-item two-factor solution capturing positive and negative attitudes toward social comparison. The ASCI demonstrated measurement invariance across gender and time. The two factors were differentially and longitudinally associated with relevant constructs, including social comparison, metacognitive beliefs about worrying, depression, self-concept clarity, envy, and self-esteem. The ASCI facilitates comprehensive investigations of social comparison processes. [ABSTRACT FROM AUTHOR]

How have differently institutionalized welfare regimes dealt with the Covid-19 crisis? In particular, how have they confronted the social and economic inequalities exposed by the virus? Taking three European countries--Germany, Sweden, and the UK, corresponding broadly to conservative-continental, social democratic, and liberal regime types--this paper tracks the virus response in the areas of income and employment protection and health and residential care. With attention paid to issues of "capacity" and the institutional arrangements in each case, we find that institutional histories in Germany and Sweden permitted a certain recidivistic reliance on established practices in the areas of employment and social protection. In sum, certain social and economic inequalities were mitigated as these countries set aside recent trends toward "liberalization" and mobilized longer-standing institutional capacities to protect some groups, although by no means all. Evidence of this trend is less clear in the health and residential care sectors, where Germany had existing capacity, allowing its older population to weather the crisis in better order than its counterparts in Sweden and the UK. In the UK, welfare liberalization has led to increased social and economic inequalities and funding reductions in health and residential care--all of which have reduced the country's ability to deal with severe crisis. The Covid response in this case was agile, but also chaotic, with little being done to ameliorate the positions of the most vulnerable groups. [ABSTRACT FROM AUTHOR]

Sebastian Kneipp (1821-1897) is seen as a vital link between the European nature cure movement of the 19th century and American naturopathy. He promoted a holistic treatment concept founded on five pillars: hydro- and phytotherapy, exercise, balanced nutrition, and regulative therapy. Kneipp attempted to bridge the gap with allopathic medicine, and many modern treatments that are based on his methods indeed blend wellness elements with naturopathic medicine and biomedicine. Because Kneipp's approach to health and healing today are mainly covered in German literature, this paper aims to provide a broader international audience with insights into his life and his treatment methods and to highlight the profound influence Kneipp has had to this day on natural and preventive medicine. The paper emphasizes in particular the continued popularity of Kneipp's holistic approach to health and well-being, which is evident in the many national and international Kneipp Associations, the globally operating Kneipp Werke, postgraduate qualifications in his treatment methods, and the existence of more than 60 accredited Kneipp spas and health resorts in Germany alone. [ABSTRACT FROM AUTHOR]

This paper analyzes the privatization of German public and charitable hospitals. The subject is examined from financial and social perspective. In the first step, an introduction about health sector is given. In the second part, the German hospitals' situation is described. In the third part of the paper; it is discussed whether privatization is advantageous or risky by consideration of various indications. Lastly, conclusions and recommendations are presented. Until 1985, making profit in hospitals was forbidden by law in Germany. After introduction of DRGs, this law was cancelled. Before 1985, there were no private clinics except a few for rich people. This situation has changed since 90's. The share of private hospitals reaches 36.2% in 2016. It is expected that privatization is going to grow in the presence of DRGs. Due to the financial gap in hospitals, funds for new investments and operational activity are missing. While many of public and charitable hospitals make loss, private hospitals are profitable. [ABSTRACT FROM AUTHOR]

This paper argues that, in general, profit sharing aligns the interests of workers and the firm and that this alignment reduces the extent of conflict between workers and management. This paper also argues that this general result will not carry over to the workers least able to respond to the alignment of interests with greater effort and that it will not apply to supervisors. After describing the German use of profit sharing, we use German data to show that for non-supervisory workers in excellent health, profit sharing reduces conflict but that for those who are not in excellent health and for supervisors, profit sharing does not reduce conflict. We also show that independent from profit sharing, conflict with the boss is greater for the aged and for those not in excellent health. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aimed to review and pilot-test feedback from childbearing women who completed the German short version of the Childbirth Self-Efficacy Inventory (CBSEI-C32), which is widely used and validated in different languages. METHODS Ten pregnant nulliparas, who planned a natural childbirth, completed the German CBSEI-C32 and provided comments about the comprehensibility of the tool. RESULTS When applying the standardized translated German CBSEI-C32, we discovered that women generally gave positive feedback, and reported that the items made them think about coping strategies for labor and birth. Some pregnant woman had problems in understanding two items: 'Mich beherrschen' (original English item: 'Keep myself in control'), and 'Mich ruhig halten' (original English item: 'Keep myself calm'). Some of the items were not comprehensible for pregnant women and might not represent contemporary concepts of childbirth self-efficacy. CONCLUSIONS Two items of the German CBSEI-C32 were interpreted ambiguously by the pilot testers. The CBSEI should be checked to identify which items could serve as the basis for a new questionnaire because there are clear and appropriate coping strategies when dealing with labour pain such as item 3 on breathing. These could be complemented with other coping behaviours that are positively worded and serve to empower rather than restrain women. For measuring self-efficacy beliefs in childbirth nowadays, it appears that health-oriented aspects, such as concentrating on the pauses between contractions or mentally staying in the present moment, are more important for women than focusing on control during childbirth. [ABSTRACT FROM AUTHOR]

Background: Neighborhood characteristics are important determinants of individual health and well-being. For example, characteristics such as noise and pollution affect health directly, while other characteristics affect health and well-being by either providing resources (e.g. social capital in the neighborhood), which individuals can use to cope with health problems, or limiting the use thereof (e.g. crime). This also suggests that there might be age differentials in the impact of these characteristics, since individuals at different stages of life might need different resources. However, there is a lack of empirical evidence on age differentials in associations between well-being, health, and neighborhood characteristics.Objective: This paper studies associations between a wide range of neighborhood characteristics with the health and well-being of residents of the greater Berlin area. In particular, we focus on differences in the effects between younger (aged 20-35) and older (aged 60+) residents.Methods: We used data from the Berlin Aging Study II (312 younger and 993 older residents of the Berlin metropolitan area in Germany). We used survey data on health and well-being, combined these with subjective perceptions of the neighborhood, and geo-referenced indicators on the neighborhood, e.g. amenities (public transport, physicians, and hospitals).Results: The results show that access to public transportation is associated with better outcomes on all measures of health and well-being, and social support is associated with higher life satisfaction and better mental health. There are considerable differences between both age groups: while the associations between access to public transport and health and well-being are similar for both age groups, neighborhood social capital shows stronger associations for older residents. However, the difference is not always statistically significant.Conclusion: Having access to services is associated with better health and well-being regardless of age. Local policy makers should focus on lowering barriers to mobility in order to improve the health and well-being of the population. Since the social capital of a neighborhood is associated with better health and well-being among older residents, investments that increase social capital (e.g. community centers) might be warranted in neighborhoods with higher shares of older residents. [ABSTRACT FROM AUTHOR]

Germany has experienced different forms of immigration for many decades. At the end of and after the Second World War, refugees, displaced persons and German resettlers constituted the largest immigrant group. In the 1950s, labor migration started, followed by family reunification. There has been a constant migration of refugees and asylum seekers reaching peaks in the early 1990s as well as today. Epidemiological research has increasingly considered the health, and the access to health care, of immigrants and people with migration background. In this narrative review we discuss the current knowledge on health of immigrants in Germany. The paper is based on a selective literature research with a focus on studies using representative data from the health reporting system. Our review shows that immigrants in Germany do not suffer from different diseases than non-immigrants, but they differ in their risk for certain diseases, in the resources to cope with theses risk and regarding access to treatment. We also identified the need for differentiation within the immigrant population, considering among others social and legal status, country of origin and duration of stay. Though most of the studies acknowledge the need for differentiation, the lack of data currently rules out analyses accounting for the existing diversity and thus a full understanding of health inequalities related to migration to Germany. [ABSTRACT FROM AUTHOR]

Background: Health of migrants is known to be above-average in the beginning of the migration trajectory. At the same time reports from non-government organisations (NGOs) suggest that undocumented migrants in Germany tend to present late and in poor health at healthcare facilities. In this paper, we explore the health status of undocumented migrants with a mixed method approach including complementary qualitative and quantitative datasets.Methods: Undocumented migrants attending a NGO based in Hamburg, Germany, were asked to fill in the SF-12v2, a standardized questionnaire measuring health-related quality of life (HRQOL). The SF-12v2 was analyzed in comparison to the U.S. American norm sample and a representative German sample. Differences in mean scores for HRQOL were evaluated with a t-test and with a generalized linear model analyzing the impact of living without legal status on HRQOL. The quantitative research was complemented by a qualitative ethnographic study on undocumented migration and health in Berlin, Germany. The study included semi-structured interviews, informal conversations and participant observation with Latin American migrants over the course of three years. The study focused on subjective experiences of illness and health and the impact of illegality on migrants' health and access to health care.Results: HRQOL was significantly worse in the sample of undocumented migrants (n = 96) as compared to the U.S. American sample (p < 0.005). Living without legal status displayed a significant negative effect on subjective mental and physical health (p ≤ 0.003) in the generalized linear model when adjusted for age and gender compared to the representative German population sample. The ethnographic study, which included 35 migrants, identified socio-economic conditions, the subjective experiences of criminalization, and late presentation at healthcare-facilities as the three main factors impacting on health from migrant perspective.Discussion: The present research suggests a high morbidity and mortality in this comparatively young population. The ethnographic research confirms negative impacts on health of social determinants in general and stress associated with living without legal status in particular, both are further aggravated by exclusion from health care services. In addition to the provision of health care it appears to be important to structurally tackle the underlying social conditions which affect undocumented migrants' health.Conclusions: Living without legal status has a negative impact on health and well-being. Limited access to care may further exacerbate physical and mental illness. Possibilities to claim basic rights and protection as well as access to care without legal status appear to be important measures to improve health and well-being. [ABSTRACT FROM AUTHOR]

The objective of this paper is to quantify selection effects related to blood donation behavior and their impact on donors' perceived health status. We rely on data from the 2009 and 2010 survey waves of the German socio-economic panel ( N = 12,000), including information on health-related, demographic and psychographic factors as well as monetary donation behavior and volunteer work. We propose a propensity score matching approach to control for the healthy donor effect related to the health requirements for active blood donations. We estimate two separate models and quantify selection biases between (1) active and inactive blood donors and (2) active donors and non-donors. Our results reveal that active donors are more satisfied with their health status; after controlling for selection effects, however, the differences become non-significant, revealing selection biases of up to 82 % compared with non-donors. These differences also exist between active and inactive donors, but the differences are less distinct. Our methodological approach reveals and quantifies selection biases attributable to the healthy donor effect. These biases are substantial enough to lead to erroneous statistical artifacts, implying that researchers should rigorously control for selection biases when comparing the health outcomes of different blood donor groups. [ABSTRACT FROM AUTHOR]

This paper uses individual-level data from the German Socio-Economic Panel to model trends in population health in terms of cognition, physical fitness, and mental health between 2006 and 2012. The focus is on the population aged 50–90. We use a repeated population-based cross-sectional design. As outcome measures, we use SF-12 measures of physical and mental health and the Symbol-Digit Test (SDT) that captures cognitive processing speed. In line with previous research we find a highly significant Flynn effect on cognition; i.e., SDT scores are higher among those who were tested more recently (at the same age). This result holds for men and women, all age groups, and across all levels of education. While we observe a secular improvement in terms of cognitive functioning, at the same time, average physical and mental health has declined. The decline in average physical health is shown to be stronger for men than for women and found to be strongest for low-educated, young-old men aged 50–64: the decline over the 6-year interval in average physical health is estimated to amount to about 0.37 SD, whereas average fluid cognition improved by about 0.29 SD. This pattern of results at the population-level (trends in average population health) stands in interesting contrast to the positive association of physical health and cognitive functioning at the individual-level. The findings underscore the multi-dimensionality of health and the aging process. [ABSTRACT FROM AUTHOR]

Health-related decisions make use of numeracy skills, for example counting medication dosages, extracting health-related information from food packaging or understanding statistical data. Even though the concept of health literacy is often used to explain health disparities (Freedman et al., in American Journal of Preventive Medicine 36:446–451, 2009), discourses that differentiate between health literacy and health numeracy are emerging. Golbeck et al. (American Journal of Preventive Medicine 29:375–376, 2005) defined health numeracy as "the degree to which individuals have the capacity to access, process, interpret, communicate, and act on numerical, quantitative, graphical, biostatistical, and probabilistic health information needed to make effective health decisions" (p. 375). To determine which numeracy skills impact health and health practices, the present study examines the 2015 German extension of the Programme for the International Assessment of Adult Competencies (PIAAC) survey, which collected data on numeracy skills and numeracy practices and on the perception of health and health practices (as in the socio-economic panel, SOEP). Further, it indicates which numeracy practices (or the lack of these) might play a part in poor health and in (health) vulnerability in Germany. [ABSTRACT FROM AUTHOR]

Background: Intensive care units (ICUs) are often too noisy, exceeding 70–80 dBA, which can have negative effects on staff. The corresponding recommendation of the World Health Organization (average sound pressure level below 35 dBA) is often not achieved. To date there is a lack of intervention studies examining the extent to which unit-based noise management in ICUs contributes to a reduction in noise exposure for the staff. The study therefore aims to provide answers to 1) how unit-based noise management sustainably reduces the subjective noise exposure among staff, and 2) how this intervention affects other noise-related topics. Methods: We performed a monocentric prospective longitudinal study with three measurement points in a German university hospital in three ICUs. We collected data from different healthcare professionals and other professional groups between October 2021 and August 2022 using an online questionnaire. Data were analyzed using descriptive and inference statistics. Results: A total of n = 179 participants took part in the surveys. The majority of participants were nurses or pediatric nurses. Most participants worked more than 75% full-time equivalent. Staff on the three ICUs reported high levels of noise exposure. No significant changes in noise exposure over time were observed. Participants were already aware of the topic and believed that a behavior change could positively influence the noise environment. Conclusions: This study provides an initial insight into how a unit-based noise management could contribute to a reduction in the subjective noise exposure among staff in ICUs. The results of this study highlight the importance of this topic. Future studies should aim to research aspects of adherence and their facilitators or barriers, which promote the sustained implementation of noise-reducing measures by staff. Trial registration: German Clinical Trials Register (DRKS): DRKS00025835; Date of registration: 12.08.2021. [ABSTRACT FROM AUTHOR]

In 2021, the federal government of the United States expanded a set of income transfers that led to strong reductions in child poverty. This research note uses microdata from more than 50 countries and U.S. data spanning more than 50 years to place the 2021 child poverty rate in historical and international perspective. We demonstrate that whether using the Supplemental Poverty Measure (SPM), relative poverty measures, or an absolute poverty measure, the U.S. child poverty rate in 2021 was at its lowest level since at least 1967. The U.S. tax and transfer system reduced the 2021 SPM child poverty rate by more than 75% relative to the pre-tax/transfer child poverty rate; this reduction was three times the mean reduction effect between 1967 and 2019. These policy changes improved the country's standing from having a relative poverty rate twice that of Germany's in 2019 to the same as Germany's in 2021. Moreover, the U.S. progressed from reducing child poverty at less than half the rate of Norway in 2019 to a rate comparable to Norway in 2021. However, the U.S. success was temporary: after the expiration of the 2021 income provisions, the child poverty rate doubled and returned to being higher than in most other high-income countries. [ABSTRACT FROM AUTHOR]

Trans and intersex individuals are often not considered in obstetric care—neither in practice nor in research. This quantitative study used an online survey to compare the experiences of pregnant trans men, non-binary individuals, and intersex people with those of endosex cisgender individuals who received care in obstetrics. Trans men and non-binary individuals reported discrimination during pregnancy and childbirth on the interactional, institutional, and structural level: for example, they reported more unsatisfactory encounters with health care personnel and more barriers in the structure of health care services and facilities. Trans and intersex individuals had less access to information relevant to them concerning pregnancy and birth compared to cisgender endosex individuals. Although it happened less frequently, cisgender endosex individuals also reported negative experiences, such as discrimination or violence during birth in a hospital. Our findings indicate a need for change concerning several aspects of the obstetric care spectrum—especially, but not exclusively, for trans, non-binary, and intersex people. Some suggestions for improvement include the following: On the hospital level, measures should be implemented to reduce structural discrimination and to ascertain one-on-one care during active labor. Inclusive information material should be developed and disseminated and health care institutions should raise awareness among their staff regarding care for their LGBTIQ patients. More studies on obstetric issues concerning queer, trans, and especially intersex people should be conducted and diversity and inclusion should be implemented as core topics in the training curricula for midwives, physicians, and nurses. [ABSTRACT FROM AUTHOR]

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Research into the role of place in shaping inequalities in health has focused largely on examining individual and/or localised drivers, often using a context-composition framing. Whilst this body of work has advanced considerably our understanding of the effects of local environments on health, and re-established an awareness of the importance of place for health, it has done so at the expense of marginalising and minimising the influences of macro political and economic structures on both place and health. In this paper, we argue that: (i) we need to scale up our analysis, moving beyond merely analysing local horizontal drivers to take wider, vertical structural factors into account; and (ii) if we are serious about reducing place-based health inequalities, such analysis needs be overtly linked to appropriate policy levers. Drawing on three case studies (the US mortality disadvantage, Scotland's excess mortality, and regional health divides in England and Germany) we outline the theoretical and empirical value of taking a more political economy approach to understanding geographical inequalities in health. We conclude by outlining the implications for future research and for efforts to influence policy from 'scaling up' geographical research into health inequalities. • Health-place research commonly examines focuses individual and/or localised drivers. • Health geography should 'scale up' analysis of health-place relationships. • Research needs to account for wider, vertical and structural factors. • Political economic approaches add value to insight on geographic health inequalities. • Considers the policy implications of taking a political economy approach. [ABSTRACT FROM AUTHOR]

Meat consumption in high-income countries is increasingly discussed due to its impact on environment and health as well as ethical considerations. The present paper aims to provide information on meat consumption behaviour, sociodemographic factors related to meat consumption and its associations with health and nutritional behaviour, based on the German National Nutrition Survey II. For 12 915 participants aged 18–80 years, food consumption was assessed by two 24-h recalls and further data by interviews. Participants were distinguished in non-meat consumers and meat consumers; meat consumers were further differentiated as low and high meat consumers (<86 g/d and ≥86 g/d). Group differences were analysed using binary logistic and linear regression models. More non-meat consumers were found among women, young and more educated persons. They showed equal or more preferable health characteristics, had a similar energy intake but ate more plant-based foods compared with meat consumers. More high meat consumers were found among men, young and middle-aged and lower-educated persons. Compared with low meat consumers, they showed equal or less preferable health characteristics, had a higher energy intake and ate more potatoes and sauces/spices and less of most other food groups in relation to their energy intake. To conclude, sociodemographic groups differ in their meat consumption and differences in meat consumption go together with differences in health behaviour and other food consumption. [ABSTRACT FROM AUTHOR]

This study aims to compare and contrast how specific information health technologies (IHTs) have been debated, how they have proliferated, and what they have enabled in Germany's and England's healthcare systems. For this a discourse analysis was undertaken that specifically focussed on future-scenarios articulated in policy documents and strategy papers released by relevant actors from both healthcare systems. The study reveals that the way IHTs have been debated and how they have proliferated depends on country-specific regulatory structures, their respective values, actors' and institutions' organized interests, and the status of health professionals. These conditions have enabled IHTs to promote a new and similar concept of patienthood in both countries, although they tend to affect practitioners' practices more dramatically in England. The conclusion is drawn that with the usage of IHTs, healthcare systems reproduced existing patterns of health provision while also enabling a sort of convergence. Future research should investigate whether the new concept of patienthood emerging in both welfare states actually suits patients' and professionals' needs and requirements. [ABSTRACT FROM AUTHOR]

Risk-assessment for environmental odors and the development of an appropriate guideline for protection against undue odor annoyance have long been hampered by the difficulties of assessing odor exposure and community annoyance responses. In recent years, however, dose–response associations between frequency of odor events and odor annoyance level in the affected population were established. However, the influence of hedonic tone (pleasantness–unpleasantness) and perceived odor strength (intensity) on the degree of odor annoyance have long been neglected in such studies and accompanying guidelines. In order to close this gap a pertinent field study was conducted in the vicinity of six odor emitting plants, two with pleasant (sweets production, rusk bakery), with neutral (textile production, seed oil production), and with presumably unpleasant odor emissions (fat refinery, cast iron production). A standardized sensory method was developed (described in Part I in the accompanying paper) to quantify intensity and hedonic tone within the assessment of odor exposure by systematic field inspection with trained observers. Additionally, exposure-information, the degree of annoyance, and the frequency of general health complaints and irritation symptoms were collected from the exposed residents through direct interviews. Multiple logistic regression analysis was used to establish dose–response associations between odor frequency, intensity and hedonic tone as independent variables and annoyance or symptom reporting as the dependent variable. It is shown that exposure-annoyance as well as exposure–symptom associations are strongly influenced by odor hedonic. Whereas pleasant odors induced little to no annoyance, both neutral and unpleasant ones did. Additional inclusion of odor intensity did not improve the prediction of odor annoyance. Frequency of reported symptoms was found to be exclusively mediated by annoyance. The results are discussed in terms of environmental stress emphasizing the WHO-definition of health. Based on these findings the existing German guideline against undue odor annoyance was modified. [ABSTRACT FROM AUTHOR]

After reading the series of articles on a new approach to controlling chemicals, an initiative targeted especially on small and medium-sized businesses, in the Annals of Occupational Hygiene (1998; 42: 355–411), German specialists for health and safety at work realized that problems in this area are very similar in the UK and Germany. Also, in Germany different institutions have developed an array of solutions to help small and medium-sized enterprises during recent years. In this paper, we present these activities and hope to promote an international discussion about practical support for work with chemical substances. [ABSTRACT FROM PUBLISHER]

This article reports the results of an eleven‐wave longitudinal study of personality change conducted between December 2019 and December 2022 with 1328 participants in Germany. Based on theories of personality change, we investigated trajectories of big five personality factors (i.e., extraversion, agreeableness, conscientiousness, emotional stability, and openness) across the COVID‐19 pandemic. In addition, we examined whether demographic characteristics (i.e., age, sex), self‐reported health status (i.e., physical, mental), and socioeconomic status (i.e., education, income, industry) moderated these trajectories. There was evidence for increases in extraversion, conscientiousness, and emotional stability and decreases in openness across time. The magnitude of these effects suggests between d = 0.027 to 0.138 standard deviation changes in these personality characteristics across the 3‐year timeframe of this study. Evidence for moderating effects of age, sex, health, and socioeconomic status was mixed, but indicates differential patterns of personality change for certain individuals. Overall, findings suggest that changes in big five personality factors across the COVID‐19 were present, albeit on average relatively weak, but still higher than anticipated given the timeframe. Moreover, certain demographic and health variables were associated with differential trajectories of personality over time. [ABSTRACT FROM AUTHOR]

Toward the 21st century, subjects and methods of hygiene and public health will be specialized and subdivided. However, practical approaches to human health need an integrated method focusing to a structure of human life. Under these circumstances, the concept of 'health culture' becomes prevalent. The role of hygiene related to the improvement of life style, the development of re-cycle system, and fulfillment of a barrier-free system focussed on the handicapped and the elderly have become increasingly important. Therefore, an increase in the recognition to the concept of 'health culture' is essential to the research of hygiene. The purpose of this paper is to make a historical and theoretical analysis of health culture', in order to promote it as the leading concept of all activities concerned with health in the 21st century. The methods of this paper are mainly historical and theoretical review. 'Health culture' was introduced in American and European societies a hundred years ago. Health culture in the USA involves knowledge and skills applied to actual daily life, refrecting pragmatism as the ideal feature of American society. In Germany, the concept of 'Hygienishe Kultur' was established at the field of social hygiene by Grotjahn and by Fischer in the early 20th century. This concept recognized the importance of the development of culture and independence of life in labour based on the evolution of the concept of 'Hygienishe Kultur'. In Japan, under the influence of German social hygiene, the social hygienic theory flourished. A social hygienist, Tetsuo Hoshino used the term 'hygienic culture' in the context of life creation toward a healthy life. Health culture is the total system concerning knowledge, experience, skill, and norms related to health, which has developed with the development of society. It has fundamental function promotes the creation of culture and self-cultivation of living man, whereas, it contributes to the realization of health based on individuality, in conjunction with the co-operation of medical and health sciences. The contemporary representation of health culture includes new health care activities such as self-care, a self-help movement, and health volunteer activities. It means the basic shift of the function of health culture is from that of life style to life movement. Nowadays, the role of hygiene in the total health care system is seriously considered. The goal, objects, and methods of hygiene should be re-evaluated under the concept of 'health culture', in order to re-define hygiene as the science for people living in a society.

In this paper we examine the longer term outcomes of young people who experienced out of home care (OHC) as children, in Britain, Germany and Finland, countries characterised by different welfare regimes. While there is some evidence on immediate transitions after leaving care (up to age 21), there is less evidence on experiences around age 30, a phase of early adulthood. Drawing on existing longitudinal data for general population samples we focus on outcomes related to education, employment, family, health and receipt of welfare benefits for those who were ever in care and those who were not. We find evidence for continuing disadvantage regarding education and employment for those who were in care as children, but also indications of subjective wellbeing and commitment to family life – possibly a reflection of “normality” and efforts to “fit in” as parents. Surprisingly, despite variations in welfare system and differences in the scope and quality of available data, trends were similar in each of the countries, suggesting that none provide adequately for the needs of care experienced young adults. The findings point towards the need for a revised conceptualisation of the notion of “independence” which has to take into account the manifold and changing relationships between individuals and the state. Instead of a “cliff edge” approach there should be support for a more gradual shift from “dependence” to “independence” enabling those with care experience to develop their full potential. In interpreting the findings, limitations of the available data have to be acknowledged, pointing to the need for generating harmonised and longitudinal data on vulnerable subpopulations to enable effective monitoring of needs and provision. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has led to a flood of—often contradictory—evidence. HCWs had to develop strategies to locate information that supported their work. We investigated the information-seeking of different HCW groups in Germany. Methods: In December 2020, we conducted online surveys on COVID-19 information sources, strategies, assigned trustworthiness, and barriers—and in February 2021, on COVID-19 vaccination information sources. Results were analyzed descriptively; group comparisons were performed using χ 2-tests. Results: For general COVID-19-related medical information (413 participants), non-physicians most often selected official websites (57%), TV (57%), and e-mail/newsletters (46%) as preferred information sources—physicians chose official websites (63%), e-mail/newsletters (56%), and professional journals (55%). Non-physician HCWs used Facebook/YouTube more frequently. The main barriers were insufficient time and access issues. Non-physicians chose abstracts (66%), videos (45%), and webinars (40%) as preferred information strategy; physicians: overviews with algorithms (66%), abstracts (62%), webinars (48%). Information seeking on COVID-19 vaccination (2700 participants) was quite similar, however, with newspapers being more often used by non-physicians (63%) vs. physician HCWs (70%). Conclusion: Non-physician HCWs more often consulted public information sources. Employers/institutions should ensure the supply of professional, targeted COVID-19 information for different HCW groups. [ABSTRACT FROM AUTHOR]

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We identify individuals who set daily intake budgets and examine if an intervention making people estimate their calorie intake up to a certain point in the day helps those setting daily budgets to regulate their calorie intake for the remainder of the day, after high prior consumption. We conducted an online experiment in five countries: Australia, China, Germany, India, and the UK (n = 3,032) using a 2 (setting calorie budget: yes vs. no, measured) x 2 (intervention: intake reminder vs. control, manipulated) between-subjects design, with the amount of prior consumption measured. Participants were contacted in the afternoon. Those in the intervention condition were asked to estimate their prior calorie intake on that day. We measured the individual characteristics of those who set daily calorie budgets and the intended calorie intake for the remainder of the day. Among people who set daily calorie budgets, the intervention reduced intended calorie intake for the remainder of the day by 176 calories if they had already consumed a high amount of calories that day. A timely intervention to estimate one's calorie intake can lower additional intended calorie intake among those who set daily calorie budget. [ABSTRACT FROM AUTHOR]

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Background: The implementation of a personal electronic health record (PHR) is a central objective of digitalization policies in the German health care system. Corresponding legislation was passed with the 2015 Act for Secure Digital Communication and Applications in the Health Sector (eHealth Act). However, compared with other European countries, Germany still lags behind concerning the implementation of a PHR.Objective: In order to explore potential barriers and facilitators for the adoption of a PHR in routine health care in Germany, this paper aims to identify policies, structures, and practices of the German health care system that influence the uptake and use of a PHR.Methods: A total of 33 semistructured interviews were conducted with a purposive sample of experts: 23 interviews with different health care professionals and 10 interviews with key actors of the German health care system who were telematics, eHealth, and information technology experts (eHealth experts). The interviews were transcribed verbatim and subjected to a content analysis.Results: From the expert perspective, a PHR was basically considered desirable and unavoidable. At the same time, a number of challenges for implementation in Germany have been outlined. Three crucial themes emerged: (1) documentation standards: prevailing processes of the analog bureaucratic paper world, (2) interoperability: the plurality of actors and electronic systems, and (3) political structure: the lack of clear political regulations and political incentive structures.Conclusions: With regard to the implementation of a PHR, an important precondition of a successful digitalization will be the precedent reform of the system to be digitized. Whether the recently passed Act for Faster Appointments and Better Care will be a step in the right direction remains to be seen. [ABSTRACT FROM AUTHOR]