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Social work in the German rehabilitation sector is practiced with great variation and its interventions lack research evidence. The SWIMMER project aims to develop a program theory of social work in rehabilitation to explain this variation and to discuss possible conditions. The dealing with ethical dilemmas by social workers is one possible influence and the focus of this paper. The social workers' practice was analyzed using the triple mandate, a German-Swiss concept that describes three possible, sometimes simultaneous directives without a concrete call to action from society, the client or the profession. This qualitative, case-comparative research project collected data from interviews with social workers and managers, participant observation and counseling sessions in ten German rehabilitation facilities. Social workers were confronted with all three mandates. They prioritized either the societal mandate or the client mandate. A consequence for social work practice was the limitation of options under social law (mandate by society). Social workers relied on their professional experience to reflect on the mandates. They used a variety of strategies when faced with conflicting mandates. The research project has succeeded in systematizing the orientations of social workers in goal conflicts. Further investigation on this topic on a broader basis would be beneficial. [ABSTRACT FROM AUTHOR]

In this paper, we estimate the causal effects of a set of active labor market programs for male unemployed refugees on welfare who entered Germany between, 2013 and September, 2016. Using rich administrative data, we employ covariate balancing propensity scores combined with inverse probability weighting to estimate effects up to 33 months after the start of treatment. Our results show that relatively short-term training in the form of Schemes by Providers and In-Firm Training, as well as longer-term Further Vocational Training programs have a positive impact on both the employment chances as well as labor market earnings of refugees in the medium run. So-called "One Euro Jobs", a public employment program, does not yield positive effects on employment or earnings. Sensitivity analyses confirm that our results are unlikely to be driven by unobserved confounding. [ABSTRACT FROM AUTHOR]

Introduction: The digitalisation of the German healthcare system enables a wide range of opportunities to utilize healthcare data. The implementation of the EHR in January 2021 was a significant step, but compared to other European countries, the implementation of the EHR in the German healthcare system is still at an early stage. The aim of this paper is to characterise the structural factors relating to the adoption of the EHR in more detail from the perspective of representatives of stakeholders working in the German healthcare system and to identify existing barriers to implementation and the need for change. Methods: Qualitative expert interviews were conducted with one representative from each of the stakeholder groups health insurance, pharmacies, healthcare research, EHR development and panel doctors. Results: The interviews with the various stakeholders revealed that the implementation process of the EHR is being delayed by a lack of a viable basis for decision-making, existing conflicts of interest and insufficient consideration of the needs of patients and service providers, among other things. Discussion: The current status of EHR implementation is due to deficiency in legal regulations as well as structural problems and the timing of the introduction. For instance, the access rights of various stakeholders to the EHR data and the procedure in the event of a technical failure of the telematics infrastructure are remain unclear. In addition, insufficient information and communication measures have not led to the desired acceptance of EHR use among patients and service providers. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [ABSTRACT FROM AUTHOR]

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Background: People with aphasia (PWA) frequently experience difficulties in understanding longer written content such as paragraphs or books. Reading strategies are a promising approach to treat text‐level reading comprehension deficits in PWA. Nevertheless, empirical evidence for their efficacy remains rare. Aims: The primary objective of this study was to analyse the efficacy of a strategy‐based intervention on text‐level reading comprehension in PWA. Secondary objectives were to compare the effects of two strategy‐based intervention components and to explore potential moderator effects. Methods & Procedures: A protocol was published prior to data acquisition. In a repeated measures trial, 26 German participants with chronic, post‐stroke aphasia participated in a waiting period without aphasia treatment (control condition) followed by a strategy‐based intervention called 'Strategiebasierte Textverständnis‐Therapie bei Aphasie' (StraTexT, 14 face‐to‐face‐sessions, twice per week, 60 min each). Two strategy combinations, Intervention Micro targeting microstructure and Intervention Macro targeting macrostructure, were applied to newspaper and magazine articles. Participants were randomly allocated to two parallel groups that received these strategy combinations in interchanged sequences. Assessments were implemented before and after each period as well as 3 and 6 months after the intervention. The primary outcome measure was text‐level reading comprehension measured with the total score of a German version of the Test de Compréhension de Textes (TCT‐D). Secondary outcome measures addressed the self‐reported perception of reading abilities, reading activities and feelings about reading (German version of the Comprehensive Assessment of Reading in Aphasia CARA reading questionnaire) as well as selected cognitive functions. Outcomes & Results: The per‐protocol‐analysis included data from 22 participants. We found significant small improvements up to 6 months post‐intervention compared to pre‐intervention in the TCT‐D Total (d = 0.35–0.46) as well as medium to large improvements in the CARA questionnaire (d = 0.68–0.96). Up to 3 months after the intervention, treatment‐induced improvements in the TCT‐D Total were significantly larger than change without treatment during the control condition. There was no evidence of moderator effects. Furthermore, we found improvements in several cognitive functions. Conclusions & Implications: Reading strategies can lead to long‐term improvements in text‐level reading comprehension and in self‐reported reading abilities, feelings about reading and reading activities in aphasia. In regular clinical settings, it seems reasonable to implement both Intervention Micro and Intervention Macro. It remains important to investigate participant characteristics that contribute to treatment success. WHAT THIS PAPER ADDS: What is already known on the subject: Systematic reviews and multiple case studies suggest that reading strategies are a promising approach to treat text‐level reading comprehension in aphasia. The efficacy of reading strategies has been demonstrated for different populations. However, to date no group study has evaluated the efficacy of reading strategies on text‐level reading comprehension in people with aphasia. What this study adds: This study provides the first group‐level evidence about the efficacy of a systematic strategy‐based intervention in 22 people with post‐stroke chronic aphasia. During 14 treatment sessions, participants applied four reading strategies to newspaper and magazine articles within two intervention components called Intervention Micro and Intervention Macro (two strategies per intervention component). We found improvements in text‐level reading comprehension for at least 3 months post‐intervention, as well as effects on selected cognitive functions and self‐reported reading abilities, thoughts and feelings about reading and the ability to engage in reading activities. What are the clinical implications of this work?: The strategies and materials evaluated in this study could be used in clinical practice with people with aphasia. In order to replicate treatment effects in clinical practice, we suggest applying the strategy combination with the same protocol features (e.g., frequency, duration, homework, product orientation) as in this study, implementing Intervention Micro and Intervention Macro sequentially in either order. As treatment response was not equal in all individuals, it seems important to investigate individual features that contribute to treatment success. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

To reduce smoking uptake in adolescents, the medical students' network Education Against Tobacco (EAT) has developed a school-based intervention involving a face-aging mobile app (Smokerface). A two-arm cluster-randomized controlled trial was conducted, evaluating the 2016 EAT intervention, which employed the mobile app Smokerface and which was delivered by medical students. Schools were randomized to intervention or control group. Surveys were conducted at baseline (pre-intervention) and at 9, 16, and 24 months post-intervention via paper & pencil questionnaires. The primary outcome was the difference in within-group changes in smoking prevalence between intervention and control group at 24 months. Overall, 144 German secondary schools comprising 11,286 pupils participated in the baseline survey, of which 100 schools participated in the baseline and at least one of the follow-up surveys, yielding 7437 pupils in the analysis sample. After 24 months, smoking prevalence was numerically lower in the intervention group compared to control group (12.9 % vs. 14.3 %); however, between-group differences in change in smoking prevalence between baseline and 24-months follow-up (OR=0.83, 95 %-CI: 0.64–1.09) were not statistically significant (p = 0.176). Intention to start smoking among baseline non-smokers declined non-significantly in the intervention group (p = 0.064), and remained essentially unchanged in the control group, but between-group differences in changes at the 24-months follow-up (OR=0.88, 0.64–1.21) were not statistically significant (p = 0.417). While a trend towards beneficial effects of the intervention regarding smoking prevalence as well as intention to start smoking among baseline non-smokers was observed, our smoking prevention trial demonstrated no significant effect of the intervention. • A face-aging app intervention aimed to reduce adolescent smoking uptake. • Two-arm cluster-randomized controlled trial with 144 German secondary schools. • No significant difference in smoking prevalence change at 24 months (p = 0.176). • Subgroup analyses showed a tendency towards benefits among boys and grammar school pupils. • Intention to start smoking declined non-significantly in the intervention group (p = 0.064). [ABSTRACT FROM AUTHOR]

Aim: Individual experiences shape perceptions of illness. Post-Soviet migrants have different expectations of chronic disease treatment than German patients. This study aimed to delve into perceptions of diabetes mellitus, a topic of increasing importance in global migration. Design: Qualitative, semi-structured interviews were conducted with 26 post-Soviet migrants with diabetes and three Russian-speaking diabetes counselors, mainly recruited through a snowball system. Methods: The research data were analyzed using a hermeneutic approach. The categories of the common-sense self-regulation model and developed subcategories were scrutinized by means of content analysis, ensuring a comprehensive understanding of the data. Results: The perception of diabetes mellitus varied depending on the country where the diagnosis was made. This included the individual recording of symptoms, the expected time course, and the allocation of different competencies. Opportunities for access to the local healthcare system in the former Soviet Union influenced these expectations. Conclusion: The study’s findings underscore the importance of healthcare access in the country of origin and the patient’s knowledge of diabetes mellitus in shaping their perception and treatment. These factors, influenced by the social environment and the patient’s level of education, continue to play a role even after immigration to Germany. [ABSTRACT FROM AUTHOR]

Background/Objectives: Early childhood can be a stressful period for families with a significant impact on parents' mental health, the child's healthy development, and the development of a secure mother–child attachment. The goal of the cross-sectional study part of SKKIPPI was to assess the occurrence of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions. Methods: Based on random samples from three residents' registration offices, parents with infants aged up to 12 months were invited to participate. An online screening questionnaire was developed in four languages to assess common psychosocial stressors and mental health problems of parents with small children. Results: The study enrolled 4984 mothers and 962 fathers. The most common potential psychosocial stressors were professional problems (mothers 22%, fathers 33%), lack of social support (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obsessive–compulsive thoughts (21%, 16%) and depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory problems of the child were reported by between 1.5% and 5.1% of parents. Conclusions: The study showed that a substantial proportion of parents are burdened by psychosocial problems and suffer from mental health problems in the first years after the birth of their children. Early preventive and low-threshold support measures should be available in the health and social care system. Low-threshold questionnaires, which cover a wide range of possible stress factors, should be further developed for the practical healthcare of this group of people. [ABSTRACT FROM AUTHOR]

Background: The aim is to estimate age- and sex-specific direct medical costs related to diagnosed type 1 and type 2 diabetes in Germany between 2010 and 2040. Methods: Based on nationwide representative epidemiological routine data from 2010 from the statutory health insurance in Germany (almost 80% of the population's insurance) we projected age- and sex-specific healthcare expenses for type 1 and 2 diabetes considering future demographic, disease-specific and cost trends. We combine per capita healthcare cost data (obtained from aggregated claims data from an almost 7% random sample of all German people with statutory health insurance) together with the demographic structure of the German population (obtained from the Federal Statictical Office), diabetes prevalence, incidence and mortality. Direct per capita costs, total annual costs, cost ratios for people with versus without diabetes and attributable costs were estimated. The source code for running the analysis is publicly available in the open-access repository Zenodo. Results: In 2010, total healthcare costs amounted to more than €1 billion for type 1 and €28 billion for type 2 diabetes. Depending on the scenario, total annual expenses were projected to rise remarkably until 2040 compared to 2010, by 1–281% for type 1 (€1 to €4 billion) and by 8–364% for type 2 diabetes (€30 to €131 billion). In a relatively probable scenario total costs amount to about €2 and €79 billion for type 1 and type 2 diabetes in 2040, respectively. Depending on annual cost growth (1% p.a. as realistic scenario vs. 5% p.a. as very extreme setting), we estimated annual per capita costs of €6,581 to €12,057 for type 1 and €5,245 to €8,999 for type 2 diabetes in 2040. Conclusions: Diabetes imposes a large economic burden on Germany which is projected to increase substantially until 2040. Temporal trends in the incidence and cost growth are main drivers of this increase. This highlight the need for urgent action to prepare for the potential development and mitigate its consequences. [ABSTRACT FROM AUTHOR]

Aim: To investigate nursing/midwifery students, Clinical Mentors, Link Teachers and Head Nurses experiences within "Dedicated Education Unit" model in 6 European clinical placements and analyse the necessary elements for a powerful clinical learning environment. Design: A multi‐country, phenomenological, qualitative study. Methods: Focus group interviews were performed to identify the personal and organizational factors of importance for students and nurses/midwives. Results: Data analysis produced 4 main themes (1) Clinical placement organization, (2) students' clinical knowledge and skill acquisition, (3) students, and nurses/midwives' experiences within the DEU model and (4) factors for creating an effective learning environment. Conclusions: A close educational‐service collaboration, a realistic clinical placement planning, a focus on student learning process and an investment in professionals' education and development among others, are elements to set up a powerful clinical learning environment. Implications for the profession: It is considered advisable and urgent to improve the working conditions of nurses/midwives and the learning environments of students as a strategy to alleviate the global shortage of nurses and respond to the increasingly demanding health needs of the population. Impact: Due to the close relationship between students' learning and features of the clinical environment nurse educators seek innovative models which allow students to manage patient care and their transition to professional practice. To implement new learning strategies, identifying students, nurses and midwives perceptions and suggestions is a powerful information to evaluate implementation process and outcomes. Public Contribution: Our findings could help academic and clinical managers to meet the human and organizational requirements to create a successful learning environment in every student placement. [ABSTRACT FROM AUTHOR]

Introduction: With advancements in communication technologies and internet connectivity, avatar robots for children who cannot attend school in person due to illness or disabilities have become more widespread. Introducing these technologies to the classroom aims to offer possibilities of social and educational inclusion. While implementation is still at an experimental level, several of these avatars have already been introduced as a marketable service. However, various obstacles impede widespread acceptance. Methods: In our explorative qualitative case study we conducted semistructured interviews with eight individuals involved in the implementation of the avatar robots AV1 in Germany and eleven participants involved with implementing OriHime in Japan. We analyzed and compared implementation processes, application areas, access and eligibility, and the potential and limitations of avatars at schools. Results: We identified structural similarities and differences in both countries. In the German cases the target is defined as temporary use for children who cannot attend school in person because of childhood illness, with the clear goal of returning to school. Whereas in Japan OriHime is also implemented for children with physical or developmental disabilities, or who cannot attend school in person for other reasons. Discussion: Our study suggests that avatar technologies bear high potential for children to stay socially and educationally connected. Yet, structures need establishing that grant equal access to avatar technologies. These include educational board regulations, budgets for funding avatar technologies and making them accessible to the public, and privacy protection standards that are adequate, yet do not create implementation hurdles that are too high. Furthermore, guidelines or training sessions on technical, educational and psychosocial aspects of including avatar technologies in the classroom for teachers are important for successful implementation. Since our Japanese cases suggest that expanding the area of application beyond childhood illness is promising, further research on the benefits for different groups is needed. [ABSTRACT FROM AUTHOR]

Background: Caring for parents continuing pregnancy after learning about a severe life-limiting condition in their unborn is challenging. Most existing studies focus on affected families, whereas research on the subjective experience of care professionals is scarce. Aim: We aimed to (1) explore experiences and needs of involved care professionals, (2) obtain information about existing care structures, and (3) identify requirements for a structured perinatal palliative care program. Design: Grounded Theory study using theoretical sampling. Data was collected by semi-structured interviews and analyzed following the principles of grounded theory coding and situational analysis. Setting: A total of 18 professionals from 12 different services in Munich and surroundings participated in the study: 8 physicians, 3 midwives, 2 nurses, 1 each pregnancy counselor, grief counselor, chaplain, clinical psychologist, and undertaker. Results: Several organizations provide support for affected parents, but inter-institutional communication is scarce. Due to the lack of a dedicated perinatal palliative care program, professionals make immense and partly unpaid efforts to support concerned parents. Providers experience "collateral beauty" in their work despite all the suffering and grief. This includes the development of a humble attitude and feelings of gratitude toward life, the feeling of having a meaningful task and professional as well as personal growth. Requirements for a structured perinatal palliative care program include: fostering peer support, ensuring regular supervision, and enhancing interdisciplinary exchange. Conclusions: Perinatal palliative care demands a high level of personal engagement but is experienced as highly rewarding by care professionals. [ABSTRACT FROM AUTHOR]

Stratification is an important design feature of many studies using complex sampling designs and it is often used in large-scale assessment (LSA) studies, such as the Programme for International Student Assessment (PISA), for two main reasons. First, stratification variables that achieve a high between and low within strata variance can improve the efficiency of a survey design. Second, stratification allows one to, explicitly or implicitly, control for sample sizes across subpopulations. It ensures that some parts of a population are in the sample in predetermined proportions. In this study, we determine through simulation which stratification scheme is best for PISA in Germany. For this, we consider the constraints imposed by the international sampling design, the available information about schools, and specific national characteristics of the German educational system. We examine seven different stratification designs selected based on scenarios used in past LSAs in Germany and theoretical considerations for future implementations. The chosen scenarios were compared with two reference scenarios: (1) an unstratified design and (2) a synthetic optimal stratification design. The simulation study reveals that the stratification design currently applied in PISA produces satisfactory results regarding sampling precision. The present stratification design is based on Germany's federal states and school types. However, this approach leads to small strata, which has been problematic for estimating sampling variance in previous cycles. Therefore, alternative stratification scenarios were considered and, in addition to overcoming the small-strata problem, also led to smaller standard errors for estimates of student mean performance in mathematics, science, and reading. As a result of this study, we recommend considering three different stratification designs for Germany in future cycles of PISA. These recommendations aim to: (1) improve the sampling efficiency while keeping the sample size constant, (2) follow a sound methodological approach, and (3) make conservative and cautious changes while maintaining a reflection of the structure of the German federal school system with different school types. These suggestions include a reinvented stratification of grouped German federal states and designs with school types as explicit stratifiers and federal states as implicit stratifiers. [ABSTRACT FROM AUTHOR]

Objective: Smart sensing has the potential to make psychotherapeutic treatments more effective. It involves the passive analysis and collection of data generated by digital devices. However, acceptance of smart sensing among psychotherapy patients remains unclear. Based on the unified theory of acceptance and use of technology (UTAUT), this study investigated (1) the acceptance toward smart sensing in a sample of psychotherapy patients (2) the effectiveness of an acceptance facilitating intervention (AFI) and (3) the determinants of acceptance. Methods: Patients (N = 116) were randomly assigned to a control group (CG) or intervention group (IG). The IG received a video AFI on smart sensing, and the CG a control video. An online questionnaire was used to assess acceptance of smart sensing, performance expectancy, effort expectancy, facilitating conditions and social influence. The intervention effects of the AFI on acceptance were investigated. The determinants of acceptance were analyzed with structural equation modeling (SEM). Results: The IG showed a moderate level of acceptance (M = 3.16, SD = 0.97), while the CG showed a low level (M = 2.76, SD = 1.0). The increase in acceptance showed a moderate effect in the intervention group (p < .05, d = 0.4). For the IG, performance expectancy (M = 3.92, SD = 0.7), effort expectancy (M = 3.90, SD = 0.98) as well as facilitating conditions (M = 3.91, SD = 0.93) achieved high levels. Performance expectancy (γ = 0.63, p < .001) and effort expectancy (γ = 0.36, p < .001) were identified as the core determinants of acceptance explaining 71.1% of its variance. The fit indices supported the model's validity (CFI = .95, TLI = .93, RMSEA = .08). Discussion: The low acceptance in the CG suggests that enhancing the acceptance should be considered, potentially increasing the use and adherence to the technology. The current AFI was effective in doing so and is thus a promising approach. The IG also showed significantly higher performance expectancy and social influence and, in general, a strong expression of the UTAUT factors. The results support the applicability of the UTAUT in the context of smart sensing in a clinical sample, as the included predictors were able to explain a great amount of the variance of acceptance. [ABSTRACT FROM AUTHOR]

The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income. [ABSTRACT FROM AUTHOR]

Migration scholars have long regarded the trajectory of the third generation as a critical test of assimilation; however, scholarship to date has been limited and largely focused on socioeconomic attainment. In this article, we rely on a large dataset of adolescent respondents in England, Germany, and the Netherlands to compare the second and third generations in terms of their social networks and cultural identities. The third generation shows stronger ties to the native fourth-plus generation alongside weaker ties to coethnics. We document comparable, albeit more moderate, dynamics of assimilation over generations in regard to national and ethnic identification, along with substantial variation by country of destination and ethnic origin group. Our results point to a dominant trend of assimilation at the third generation and suggest future challenges to provide a more durable assessment of postwar migration waves two generations after settlement. [ABSTRACT FROM AUTHOR]

Purpose: Various health systems are challenged by a multifaceted crisis of increased service demand and workforce shortages. The effects are devastating and may end up in decreased access to care, poor quality of patient care and extreme demands on the workforce. The introduction of the physician assistant (PA) profession provided an avenue to address such challenges in several countries. In Germany, the integration of PAs has been proceeding slowly. Design/methodology/approach: To understand the integration of the profession in Germany, we conducted 15 expert interviews to reveal how the PA profession is perceived among healthcare experts as well as the barriers and facilitators of integration in inpatient care. Findings: Our results highlight a generally positive perception of PAs, particularly in terms of workload relief and bridging the gap between healthcare professionals. Nonetheless, barriers include resistance from healthcare workers unfamiliar with the PA role, while workforce shortages and collaborative teamwork facilitate integration. Originality/value: These findings lay the groundwork for potential integration-enhancing strategies in Germany. [ABSTRACT FROM AUTHOR]

Background: Implantology, as a recognized therapeutic approach, is gaining prominence. The decision-making process and success of implant therapy are closely linked to patient knowledge and expectations. This study aims to explore the association between age and knowledge regarding oral implants. Methods: Participants were categorized into three age groups (ag): ag 1 (35–44 years), ag 2 (65–74 years), and ag 3 (75 years and older). A total of 400 participants per age group were randomly selected using data from the residents' registration office of Berlin, Germany. Structured telephone interviews were conducted between 2016 and 2017, employing a 67-item questionnaire covering awareness, information level, cost estimation, attitudes, and experiences with oral implants. Results: Despite a low overall knowledge level across all age groups, there was no significant correlation between age and knowledge about oral implants. Awareness increased with age. Information sources varied, with friends, acquaintances, and dentists playing key roles. Participants expressed diverse opinions on implants, with durability and stability identified as crucial characteristics. Significant differences in knowledge were observed between age groups regarding awareness, information sources, and perceptions of dentists offering implants. Conclusions: The study suggests a need for targeted educational programs, emphasizing age-appropriate information sources to enhance health literacy in oral implantology, particularly among older individuals. Educating physicians on oral implant basics is also crucial. Implementing these measures could empower individuals to make informed decisions about oral implant treatment, thereby contributing to improved oral health outcomes. [ABSTRACT FROM AUTHOR]

This study assessed differences in interprofessional collaboration, perception of nonbeneficial care, and staff well-being between critical care and palliative care teams. In six German hospitals, a staff survey was conducted between December 2013 and March 2015 among nurses and physicians in intensive and palliative care units. To allow comparability between unit types, a matching was performed for demographic characteristics of staff. N = 313 critical care and 79 palliative care staff participated, of which 72 each were successfully matched. Critical care nurses perceived the poorest overall quality of collaboration compared with critical care physicians and palliative care physicians and nurses. They also reported less inclusive leadership from attendings and head nurses, and the least collaboration on care decisions with physicians. They were most likely to perceive nonbeneficial care, and they reported the lowest levels of job satisfaction and the highest intention to leave the job. In partial correlations, aspects of high-quality collaboration were associated with less perceived nonbeneficial care and higher staff well-being for both critical care and palliative care staff. Our findings indicate that critical care teams could improve collaboration and enhance well-being, particularly among nurses, by adopting principles of collaborative work culture as established in palliative care. [ABSTRACT FROM AUTHOR]

Our cross-sectional study, conducted from October 2022 to January 2023, aims to assess post-COVID job satisfaction, crucial work dimensions, and self-reported factors influencing nursing retention. Using an online survey, we surveyed 2572 nurses in different working fields in Bavaria, Germany. We employed a quantitative analysis, including a multivariable regression, to assess key influence factors on nursing retention. In addition, we evaluated open-ended questions via a template analysis to use in a joint display. In the status quo, 43.2% of nurses were not committed to staying in the profession over the next 12 months. A total of 66.7% of our surveyed nurses were found to be dissatisfied with the (i) time for direct patient care. Sources of dissatisfaction above 50% include (ii) service organization, (iii) documentation, (iv) codetermination, and (v) payment. The qualitative data underline necessary improvements in these areas. Regarding retention factors, we identified that nurses with (i) older age, (ii) living alone, (iii) not working in elder care, (iv) satisfactory working hours, (v) satisfactory career choice, (vi) career opportunities, (vii) satisfactory payment, and (viii) adequate working and rest times are more likely to remain in the profession. Conversely, dissatisfaction in (ix) supporting people makes nurses more likely to leave their profession and show emotional constraints. We uncovered a dichotomy where nurses have strong empathy for their profession but yearn for improvements due to unmet expectations. Policy implications should include measures for younger nurses and those in elderly care. Nevertheless, there is a need for further research, because our research is limited by potential bias from convenience sampling, and digitalization will soon show up as a potential solution to improve, e.g., documentation and enhanced time for direct patient time. [ABSTRACT FROM AUTHOR]