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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]

In the first half of 2020, the coronavirus pandemic led to a drastic slump in the automotive industry, which was replaced by a surprisingly rapid growth in demand in the fall of 2020, and consequently led to the current shortages in microelectronic products. The prospect of an equally rapid economic recovery in the automotive industry is still threatened by supply bottlenecks for raw materials and key components, foremost for semiconductors. The so-called 'semiconductor crises' show exemplarily the overlapping of short-term supply chain disruptions with long-term structural features of the semiconductor industry. The combination of both is preventing that the supply situation in the automotive industry will improve quickly. First in this paper, the reasons for and respective effects of the crisis on the automotive industry are investigated by a quantitative market analysis. Second, specific strategic measures and options of automotive Original Equipment Manufacturers (OEM) and suppliers in Germany to cope with the situation and increase resilience in future supply chains are described by the means of qualitative expert interviews. By that, the paper helps in understanding the actual situation in the automotive industry, on the one hand, and contributes to the field of strategic supply chain and risk management with a focus on practical implications on the other hand. The results aim to support political stakeholders as well as small and medium sized enterprises to prepare themselves for future developments in the automotive market and changes in manufacturer–supplier relationships due to the transformation to new powertrain technologies and digitization. [ABSTRACT FROM AUTHOR]

Focusing on rural destinations and calling on the evolutionary resilience concept as a theoretical lens, this paper investigates whether COVID-19 provokes "revenge tourism" after periods of lockdown or whether the pandemic can be used as a chance for a degrowth-oriented restart that forms the foundation for a more sustainable tourism sector. Analysing tourism data and documents regarding political and economic actors' actions in two rural destinations in Ireland (Burren and Cliffs of Moher Geopark) and Germany (Southeast Rügen Biosphere Reserve), the study reveals that so far, neither "revenge travel" nor a degrowth-oriented restart of tourism can be identified. Rather, current development indicates that the two rural destinations show resilience in the sense of bouncing back to the pre-COVID-19 era and a continuation of further growth-oriented rural tourism as far as possible under the conditions of political COVID-19 measures. As this development will not allow the sector to genuinely come to grips with the negative ecological and sociocultural effects of rural tourism, the paper pleads for initiation of a debate about influencing business realities on a supranational level, and in this context, about the value of rural tourism destinations and possible forms of financial compensation for degrowth in rural tourism. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has led to various challenges in German health care, including pregnancy care. This paper aims to provide an overview of the pandemic-related challenges faced by pregnant women, new mothers, and their families in maternal and newborn care. A literature review was performed by including international literature as well as recommendations of institutions and official stakeholders. These challenges refer to restrictions at all stages of pregnancy, including wearing masks during labour, limitations of a companion of choice during birth, and restrictions of unvaccinated women from attending, e.g., antenatal classes. Compared with the general population, COVID-19 vaccination of pregnant women was recommended later, as pregnant women were initially excluded from clinical trials. Women who gave birth during the COVID-19 pandemic also reported mental health issues. The findings stress the importance of the inclusion of pregnant women in clinical trials. This might also help to overcome vaccine hesitancy among pregnant women and women seeking family planning. Taking the COVID-19 pandemic as an example, one must weigh the changes and restrictions associated with the potential disadvantages for mothers, newborns, and their families in pregnancy care against the measures to control the pandemic.

The COVID-19 pandemic has had a significant impact on the wellbeing of children and families globally. With extended lockdown periods, early childhood education and school closures, and remote learning, families experienced increased stress and anxiety, financial hardship, and disrupted routines. This paper aims to explore associations between children's social-emotional wellbeing and environmental factors (including the burden of COVID-19 on the family, early learning experiences in the home and early childhood education, and parent wellbeing and mental health) during COVID-19 in Australia and Germany, two countries that experienced significant lockdown periods. Using a longitudinal online survey design, parents of young children (aged 1–6 years) in Australia (N = 66) and Germany (N = 53) completed surveys on their own wellbeing; their child's wellbeing; the home learning environment, and their satisfaction with early childhood education and care at two time points in 2020 and 2021. The burden of COVID-19 mitigation measures on families' everyday lives correlated with child wellbeing outcomes in both the Australian and German cohorts. Findings also provide evidence of potential protective factors of children's social-emotional wellbeing during stressful events, such as the lockdowns experienced by families in Germany and Australia during the pandemic. [ABSTRACT FROM AUTHOR]

The protocol presents a research project that explores the relationship between science and politics in the COVID-19 pandemic from the perspective of public health (PH) scientists in Germany with situational analysis (SA). In context of this global crisis, we ask how PH scientists negotiate their roles as scientists and political citizens; how PH scientists perceive the relationship between their own and other scientific disciplines; and which normative assumptions PH scientists make in the production and dissemination of research findings. To conduct SA, we combine qualitative interviews with PH experts and published documents from scientific societies in PH and related disciplines (e.g., position and opinion papers) to analyze the complexity of integrating evidence-based knowledge into politics. Data are analyzed using different SA mapping tools, focusing on social worlds/arena maps and positional maps. The approach will reveal both explicit positions in the PH community and implicit or hidden voices and will reflect normative assumptions as well as internal structures of PH in Germany. The findings will be discussed with the philosophy sub-project and in a stakeholder workshop with politicians and the public. Further insights will be gained for politics and PH responses to future global crises.

Background: The measures taken to contain the COVID-19 pandemic have led to significant changes in people's daily lives. This paper examines changes in substance use during the first lockdown (March-July 2020) and investigates mental health burdens in substance users with increased consumption of alcohol, nicotine or tetrahydrocannabinol (THC) in Germany compared to users with unchanged or reduced consumption., Method: In a cross-sectional online survey, 2369 people were asked about their mental health and their substance use during the first lockdown in Germany., Results: Of the participants, 28.5% increased their alcohol use, 28.8% their use of tobacco products, and 20.6% their use of THC-containing products during the pandemic. The groups with increased alcohol, nicotine, and THC use during the first lockdown reported more depressive symptoms and anxiety. Individuals who reported increased consumption of alcohol or nicotine were also more likely to experience loneliness and have suicidal thoughts and were more often stressed due to social distancing., Conclusion: Alcohol, nicotine and THC increased in a subgroup of consumers who reported to have more mental health problems compared to individuals who did not increase their consumption. This increased substance use could, therefore, be understood as a dysfunctional strategy to cope with negative emotions during the lockdown.

This research paper examines the adoption of digital services for the vaccination during the COVID-19 pandemic in Germany. Based on a survey in Germany's federal state with the highest vaccination rate, which used digital vaccination services, its platform configuration and adoption barriers are analyzed to understand existing and future levers for optimizing vaccination success. Though technological adoption and resistance models have been originally developed for consumer-goods markets, this study gives empirical evidence especially for the applicability of an adjusted model explaining platform adoption for vaccination services and for digital health services in general. In this model, the configuration areas of personalization, communication, and data management have a remarkable effect to lower adoption barriers, but only functional and psychological factors affect the adoption intention. Above all, the usability barrier stands out with the strongest effect, while the often-cited value barrier is not significant at all. Personalization is found to be the most important factor for managing the usability barrier and thus for addressing the needs, preferences, situation, and, ultimately, the adoption of the citizens as users. Implications are given for policy makers and managers in such a pandemic crisis to focus on the click flow and server-to-human interaction rather than emphasizing value messages or touching traditional factors. [ABSTRACT FROM AUTHOR]

Populism has been at the center of recent debates in political science and international relations scholarship. Recognized as a contested concept and framed as a new global phenomenon, populism emerged in the context of liberal democracies, where political actors inflate social antagonisms by putting the people against the elite. Facing a global health crisis where a sense of threat, uncertainty, and emergency has pushed normal politics into the realm of politics of crisis, populists have actively engaged in creating a spectacularization of failure—of science, institutions, experts, governments—vis-à-vis the new Coronavirus, and in creating doubts about and devaluing scientists, experts and governments. Issues such as mask mandates, lockdown measures, compulsory vaccination, medicine effectiveness, and vaccine certificates became politicized. That is, they have been taken from normal politics and made contingent and controversial in order to deepen already existing political divisions and polarization. Exploring the case of Germany and Brazil, we will show how populists tried to use the pandemic to forge divisions between the people and the elite (represented by scientists, health experts, and the press). This conceptual-empirical paper wishes to make a contribution to the debate on how populists brought scientific public health issues into their black-and-white, antagonistic vision of society and hence instrumentalized COVID-19 for their own political gain. [ABSTRACT FROM AUTHOR]

In the European Union, SARS-CoV-2 vaccines became available in December 2020. The vaccination campaign in Germany was initially implemented through mass vaccination centers and later joined by general practitioners (GPs) in spring 2021. This study compared population characteristics, perceived access barriers, and satisfaction with the vaccination procedure between vaccination centers and GP practices. A paper-based survey was distributed (07/2021–10/2021) among newly vaccinated individuals in ten GP practices (n = 364) and two vaccine centers (n = 474). Participants in vaccine centers were younger compared to participants in GP practices. GP preference was higher in older participants and those with pre-existing illnesses. Wait time at vaccination site was longer in GP practices, whereas travel distance to site was longer for participants in vaccine centers. However, satisfaction with patient education and recommendation of site were more likely with increasing comprehensibility of the vaccination procedure and physicians' information as well as perceived sufficiency of patient education duration, factors that can be easily modified by all vaccination sites. Our results demonstrate that both types of vaccination sites complement each other in terms of accessibility and target population and that satisfaction with the vaccination procedure can be promoted at all sites by an easy-to-understand process. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is permanently changing modern social and economic coexistence. Most governments have declared infection control to be their top priority while citizens face great restrictions on their civil rights. A pandemic is an exemplary scenario in which political actors must decide about future, and thus uncertain, events. This paper tries to present a tool well established in the field of entrepreneurial and management decision making which could also be a first benchmark for political decisions. Our approach builds on the standard epidemiological SEIR model in combination with simulation techniques used in risk management. By our case study we want to demonstrate the opportunities that risk management techniques, especially risk analyses using Monte Carlo simulation, can provide to policy makers in general, and in a public health crisis in particular. Hence, our case study can be used as a framework for political decision making under incomplete information and uncertainty. Overall, we want to point out that a health policy that aims to provide comprehensive protection against infection should also be based on economic criteria. This is without prejudice to the integration of ethical considerations in the final political decision.

This paper aims to analyze the ethical challenges in experimental drug use during the early stage of the COVID-19 pandemic, using Germany as a case study. In Germany uniform ethical guidelines were available early on nationwide, which was considered as desirable by other states to reduce uncertainties and convey a message of unity. The purpose of this ethical analysis is to assist the preparation of future guidelines on the use of medicines during public health emergencies. The use of hydroxychloroquine, remdesivir and COVID-19 convalescent plasma in clinical settings was analyzed from the perspective of the ethical principles of beneficence, non-maleficence, justice and autonomy. We observed that drug safety and drug distribution during the pandemic affects all four ethical principles. We therefore recommend to establish ethical guidelines (i) to discuss experimental treatment options with patients from all population groups who are in urgent need, (ii) to facilitate the recording of patient reactions to drugs in off-label use, (iii) to expand inclusion criteria for clinical studies to avoid missing potentially negative effects on excluded groups, and (iv) to maintain sufficient access to repurposed drugs for patients with prior conditions.

Worldwide, politicians, scientists, and entrepreneurs are operating under high uncertainty and incomplete information regarding the adequacy of measures to deal with the COVID-19 pandemic. It seems indisputable that only widespread and global immunity can bring normalization to social life. In this respect, the development of a vaccine was a milestone in pandemic control. However, within the EU, especially in Germany, the vaccination plan is increasingly faltering, and criticism is growing louder. This paper considers the EU's political decision in general and the decisions of the German government to procure vaccine doses against the background of modern economics as a decision under uncertainty and critically analyzes the process.

This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found that about 60% of the individuals rather disagreed about having had problems accessing medical care. Furthermore, 73% of the individuals rather disagreed to having experienced health deteriorations due to restrictions on the availability of medical care. Moreover, 85% of the individuals were rather optimistic about future access to healthcare services. Overall, slightly better past and future access to healthcare services has been reported in wave 16. Several determinants were identified in regression analysis. In conclusion, data suggest that perceived past and future access to healthcare services during the COVID-19 pandemic is reasonably good.

The current COVID-19 pandemic is having a major impact on our daily lives. Social distancing is one of the measures that has been implemented with the aim of slowing the spread of the disease, but it is difficult for blind people to comply with this. In this paper, we present a system that helps blind people to maintain physical distance to other persons using a combination of RGB and depth cameras. We use a real-time semantic segmentation algorithm on the RGB camera to detect where persons are and use the depth camera to assess the distance to them; then, we provide audio feedback through bone-conducting headphones if a person is closer than 1.5 m. Our system warns the user only if persons are nearby but does not react to non-person objects such as walls, trees or doors; thus, it is not intrusive, and it is possible to use it in combination with other assistive devices. We have tested our prototype system on one blind and four blindfolded persons, and found that the system is precise, easy to use, and amounts to low cognitive load.

Precautionary measures and governmental regulations during the COVID-19 pandemic's first wave have drastically altered daily activities and hence water consumption patterns. Many people had to change their working routines, the organization of childcare and hygiene practices. While first evidence appears on the impacts of COVID-19 on, e.g., carbon emissions, energy demand and water treatment, even indicating an unexpected increase in water consumption during that period, no study has investigated the pandemic's sole and in-depth implications for water supply so far. This paper investigates hourly and daily water consumption volumes of a utility in northern Germany for the first wave of the pandemic. We performed a linear mixed model to compare the 2020 daily water consumption volumes with previous years. We eliminated the effects of climate using Bayesian statistic in order to carve out and estimate the original COVID-19 effect. We also compared hourly water consumption of similar time periods and calculated the percentage difference between 2020 and the two previous years. Our results reveal about 14.3% (3 968 m3) higher residential water consumption per day with higher morning and evening demand peaks during the day. We hypothesis that the reasons for the increasing water demand may be found in changed behavioral routines with an important question for water utilities, if and which of these new dynamics may persist after COVID-19 and hence pose a challenge for long-term infrastructure planning. [ABSTRACT FROM AUTHOR]

Background/Objectives: The main outcomes of the COVID-19 pandemic can be used to assess the capability and sustainability of public healthcare and Long-Term Care (LTC) systems. This study aims to identify the population's demographic and socio-economic characteristics, as well as other national resources associated with the incidence and mortality of COVID-19, by comparing three European countries during the first pandemic period (Italy, Spain, and Germany). The results will identify possible strengths and weaknesses that could be considered as hints of the need for health and social intervention. Methods: Variables describing the countries' core demographics, socio-economic characteristics, and national resources were collected from 2001–2021 from well-established international databases. COVID-19 incidence and death figures from 1 March 2020 to 31 March 2021 were extracted from national health databases. Analysis focused on bivariate and weighted multivariable linear regressions between incidence, mortality, and socio-economic covariates. Results: Findings show that both care models and socio-demographic characteristics influenced the capability of the first year's response to the COVID-19 emergency. Formal public care appears to represent the most effective strategy against incidence and mortality regarding COVID-19, especially for older people, because it mitigates the adverse effects of socio-economic characteristics. Conclusions: Current strategies oriented towards privatizing care should, therefore, be considered critically, since they may result in weaker protection of vulnerable groups, such as frail older people, due to the unequal position of individuals with different socio-economic conditions in purchasing services from the care market. [ABSTRACT FROM AUTHOR]

Background/Objectives: The previous literature has identified increased work-related stress among healthcare workers (HCWs) during the COVID-19 pandemic. This study analyzes work-related perceived stress experienced by therapists during the COVID-19 pandemic in Germany to identify potential for supporting this crucial group of HCWs in future health crises. Methods: Survey data on stress, measured through the Perceived Stress Scale 4, among HCWs (therapists n = 612, nurses n = 501, and doctors n = 461) were analyzed using descriptive statistics, and data from four semi-structured interviews and seven focus group discussions with therapists were analyzed using thematic content analysis. Data were collected from March to September 2022. Results: Therapists reported similar stress levels to other HCWs, with the reporting of perceived stress differing between work contexts. Eight stressors were identified through the thematic analysis: (1) concerns about maintaining the quality of care, (2) uncertainty about the future, (3) workload, (4) interactions with colleagues and patients, (5) PPE, (6) the risk of infection, (7) insufficient information flow, and (8) the lack of public and political recognition. Conclusions: This study emphasizes the distinct challenges that therapists experienced during the COVID-19 pandemic. By identifying the factors that contributed to the stress experienced, the study can inform targeted support strategies which can enhance therapists' work, ultimately contributing to sustaining essential healthcare services during public health crises. [ABSTRACT FROM AUTHOR]

The paper is meant as a timely intervention into current debates on the impact of the global pandemic on the rise of global far-right populism and contributes to scholarly thinking about the normalisation of the global far-right. While approaching the tension between national political elites and (far-right) populist narratives of representing "the people", the paper focuses on the populist effects of the "new normal" in spatial national governance. Though some aspects of public normality of our 21st century urban, cosmopolitan and consumer lifestyle have been disrupted with the pandemic curfew, the underlying gendered, racialised and classed structural inequalities and violence have been kept in place: they are not contested by the so-called "hygienic demonstrations". A digital pandemic populism during lockdown might have pushed further the mobilisation of the far right, also on the streets. [ABSTRACT FROM AUTHOR]

Background: Suboptimal influenza and pneumococcal vaccination rates have been reported before the COVID-19 pandemics in certain populations at risk for severe infection. The aim of this longitudinal cohort study was to investigate changes in influenza and pneumococcal vaccination rates and patient perceptions in patients with psoriasis (PsO) before and during the pandemic. Methods: Data on vaccination, patient and disease characteristics, comorbidity, and patient perceptions were collected with questionnaires before and during the pandemic approximately one year later. Results: Over the whole cohort who participated in the follow-up visit (n = 287; 59.2% male; mean age: 56.3 years), both influenza and pneumococcal lifetime vaccination prevalences increased significantly from 50.5% to 66.2% and from 16.0% to 41.5%, respectively. A total of 88.5% of PsO patients were interested in a COVID-19 vaccination or had already received it. The reasons for and against vaccinations changed significantly before and during the pandemic. Conclusions: Despite a promising increase in the vaccination prevalence in our PsO cohort, it remains important that awareness for vaccinations is encouraged and closely monitored in future research, particularly in populations at risk. [ABSTRACT FROM AUTHOR]

Efficiency in stock markets is essential for economic stability and growth. This study investigates the efficiency and herding behavior of the stock markets from the top economies of the world (known as G20 countries). We classify stock market indices using MSCI classification for the developed and emerging markets to provide a comparative examination using the latest data and by employing the robust multifractal detrended fluctuation (MFDFA) method. In addition to the full sample, the analysis uses sub-sample periods to reveal the hidden features and efficiencies of the G20 markets during the Russia–Ukraine War and COVID-19 for the first time. The findings show the availability of varied multifractality among all G20 stock markets during the overall and crisis periods, exhibit long-range correlations, and may support the fractal market hypothesis. In addition, Italy remains the least efficient, while Germany remains the most efficient stock market. The sub-sample results further reveal unevenness in the local fluctuations and resultant higher inefficiency considering the sheer magnitude and impact of crises on the G20 stock markets. However, the efficiency of developed stock markets performed better as compared to emerging markets. The study of G20 stock markets is useful and provides several implications for a wider audience. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 outbreak necessitated physical distancing, as part of secondary prevention, at a personal and professional level. Working from home (WFH) became increasingly important. In this study, the impact of the COVID-19 pandemic restrictions on physical and mental health is investigated, compared with pre-pandemic data, and with employees who WFH and are on-site. Methods: Data from the German Saxon longitudinal study population were used. Attitudes towards WFH as well as mental and physical health assessments during the COVID-19 pandemic were examined. Comparisons were made with corresponding pre-pandemic scores and between employees WFH and on-site in 2022. Results: In total, 319 participants with equal gender distribution were included. Of those, 86 worked from home stating better organizability of their work, more time for partnership, less stress, and greater work satisfaction. Compared to pre-pandemic data, the D-score, PHQ-4, G-Score, and PHQ-SSS-8 showed a significant increase. No difference in physical or mental health between employees WFH and on-site was observed. Conclusion: In general, COVID-19 restrictions had a negative impact on mental and physical health. Although WFH is well accepted, it did not show significant health benefits. [ABSTRACT FROM AUTHOR]

The Omicron variants BA.1, BA.2, and BA.5 caused several waves of SARS-CoV-2 in Germany in 2022. In this comparative study, public health data on SARS-CoV-2 infections from Mecklenburg-Western Pomerania, Germany, between January and October 2022 were examined retrospectively using Pearson's chi-squared tests and Fisher's exact tests for testing for statistical significance. Compared to BA.5 infections, BA.1 and BA.2 infections affected younger individuals aged up to 19 years significantly more often, whereas BA.5 infections occurred significantly more frequently in patients between 40 and 59 years of age when compared to BA.1 and BA.2. Infections with all three variants predominantly caused flu-like symptoms; nevertheless, there were significant differences between the reported symptoms of BA.1, BA.2, and BA.5 infections. Especially, the symptoms of 'fever', 'severe feeling of sickness', 'loss of taste', and 'loss of smell' were significantly more often present in patients with BA.5 infections compared to BA.1 and BA.2 cases. Additionally, BA.2 and BA.5 cases reported significantly more often the symptoms of 'runny nose' and 'cough' than BA.1-infected cases. Our findings indicate remarkable differences in the clinical presentations among the sub-lineages, especially in BA.5 infections. Furthermore, the study demonstrates a powerful tool to link epidemiological data with genetic data in order to investigate their potential impact on public health. [ABSTRACT FROM AUTHOR]

Background and Objectives: The aim of this study was to evaluate the levels of selected cytokines and their possible influence on the development of cardiovascular and pulmonary complications in patients hospitalized at the Silesian Centre for Heart Disease in Zabrze after having undergone COVID-19. Materials and methods: The study included 76 randomly selected patients from the SILCOVID-19 database. The median time from symptom onset to the study visit was 102 (86–118) days. The median age of the study group was 53 (44–60) years. Assays of a panel of 30 cytokines were carried out in the serum of patients on a Luminex100 platform using the Milliplex MAP kit from Merck KGaA Germany. Results: There were no statistically significant differences in most of the cytokines analyzed between patients with confirmed or excluded lung lesions or cardiac abnormalities. Additionally, no statistically significant differences in cytokine concentrations according to gender, age, comorbidity of diabetes, renal disease, hypertension, increased risk of thrombotic disease, or psychological disorders were demonstrated. There were high concentrations of cytokines such as platelet-derived growth actor-AA (PDGF-AA), monocyte chemoattractant protein-1 (MCP-1), monokine-induced gamma interferon (MIG), and vascular endothelial growth factor-A (VEGF-A). Conclusions: No direct impact of the dependencies between a panel of cytokines and the incidence of cardiovascular and pulmonary complications in patients hospitalized at the Silesian Centre for Heart Disease in Zabrze after having undergone COVID-19 was demonstrated. The demonstration of high levels of certain cytokines (PDGF-AA, VEGF, MIG, and IP10) that are of significance in the development of many lung diseases, as well as cytokines (MCP-1) that influence the aetiopathogenesis of cardiovascular diseases seems to be highly concerning in COVID-19 survivors. This group of patients should receive further monitoring of these cytokine levels and diagnostic imaging in order to detect more severe abnormalities as early as possible and administer appropriate therapy. [ABSTRACT FROM AUTHOR]

Background: The mental burdens of general practitioners (GPs) and practice assistants (PrAs) during the COVID-19 pandemic are well investigated. Work-related conditions like overtime are known to contribute to perceived chronic stress and burnout symptoms. However, there is limited evidence regarding the specific mechanisms, which link pandemic-related overtime, chronic stress and burnout symptoms. This study used data from the IMPROVEjob trial to improve psychological well-being in general practice personnel. Methods: This prospective study with 226 German GPs and PrAs used the baseline (pre-pandemic: October 2019 to March 2020) and follow-up data (pandemic: October 2020 to April 2021) of the IMPROVEjob trial. Overtime was self-reported as hours above the regular work time. Perceived chronic stress was assessed using the Trier Inventory for the Assessment of Chronic Stress Screening Scale (TICS-SSCS), while burnout symptoms were evaluated using a short version of the Maslach Burnout Inventory (MBI). A mediation analysis investigated the differences of the three main variables between pre-pandemic and pandemic periods. Results: Burnout symptoms increased significantly from baseline to follow-up (p = 0.003). Overtime correlated positively with burnout symptoms (Total Effect: 0.13; 95% CI: 0.03, 0.23). Decomposition of the total effect revealed a significant indirect effect over perceived chronic stress (0.11; 95% CI: 0.06, 0.18) and no significant direct effect (0.02; 95% CI: −0.08, 0.12), indicating a full mediation. Conclusion: In this large longitudinal study, pandemic-related overtime led to significantly higher levels of burnout symptoms, linked by a pathway through perceived chronic stress. Future prevention strategies need to aim at reducing the likelihood of overtime to ensure the mental well-being of practice personnel. [ABSTRACT FROM AUTHOR]

To reduce the number of COVID-19 cases, vaccines were rapidly made available worldwide. For a strategically targeted response to the COVID-19 pandemic, population vaccination coverage was to be maximized. The target groups also included healthy children. In this context, it is important to understand the determinants and beliefs that lead parents to favor or oppose COVID-19 immunization in children. This study aimed to investigate parents' COVID-19 vaccination willingness in Germany for children aged 5–11 years in 2021/2022. For this purpose, the determinants and beliefs behind parents' vaccination decisions were examined. Descriptive analysis and bivariate correlations were performed on COVID-19 vaccination willingness and parents' mental health status, general vaccination attitudes, and SARS-CoV-2 politics perceptions. In total, 2401 participants fully participated in this cross-sectional study. The COVID-19 vaccination uptake (71.4%) outweighed the vaccination refusal (19.4%). Correlations revealed higher vaccine acceptance in parents presenting full vaccination certificates (90.9%), COVID-19 immunizations (99.9%), or increased COVID-19 fear (93.6%). Vaccination-refusal was associated with higher perceived pressure by COVID-19 vaccination campaigns (87.7%), higher experienced restrictions due to COVID-19 protective measures in parents' social environment (83.6%), and engagement against COVID-19 protective measures (51.6%). Besides general anxiety, no significant correlations were observed between parents' mental health variables and vaccination willingness. Although several factors are ultimately associated with vaccination willingness, future vaccination campaigns should prioritize reducing pressure, increasing trust, and considering parents' differentiation between familiar and unfamiliar pathogens during their vaccination decision-making process. [ABSTRACT FROM AUTHOR]

Vaccines against COVID-19 and influenza are highly recommended for the chronically ill. They often suffer from co-morbid mental health issues. This cross-sectional observational study analyzes the associations between depression (PHQ-9) and anxiety (OASIS) with vaccination readiness (5C) against COVID-19 and influenza in chronically ill adults in primary care in Germany. Sociodemographic data, social activity (LSNS), patient activation measure (PAM), and the doctor/patient relationship (PRA) are examined as well. Descriptive statistics and linear mixed-effects regression models are calculated. We compare data from n = 795 study participants. The symptoms of depression are negatively associated with confidence in COVID-19 vaccines (p = 0.010) and positively associated with constraints to get vaccinated against COVID-19 (p = 0.041). There are no significant associations between symptoms of depression and vaccination readiness against influenza. Self-reported symptoms of a generalized anxiety disorder seem not to be associated with vaccination readiness. To address confidence in COVID-19 vaccines among the chronically ill, targeted educational interventions should be elaborated to consider mental health issues like depression. As general practitioners play a key role in the development of a good doctor/patient relationship, they should be trained in patient-centered communication. Furthermore, a standardized implementation of digital vaccination management systems might improve immunization rates in primary care. [ABSTRACT FROM AUTHOR]

Given the crucial role of vaccination in halting the COVID-19 pandemic, it is imperative to understand the factors that motivate adolescents to get vaccinated. We surveyed adolescents and their accompanying guardians scheduled to receive a COVID-19 vaccination (Comirnaty) in an urban region in Germany in mid-2021 regarding their motivation for getting vaccinated and collected data on their sociodemographic characteristics, medical history, vaccination status, and any history of COVID-19 infection in the family. We also queried information strategies related to the SARS-CoV-2 pandemic. Motivations for getting vaccinated were similar among adolescents and their parents. The primary reasons for vaccination were protection against SARS-CoV-2-related illness and gaining access to leisure facilities. This was not influenced by gender, health status, migration background, or the presence of chronic or acute diseases. The percentage of parents who had received SARS-CoV-2 immunization and the proportion of parents with a high level of education were higher among study participants than in the general population. Adolescents were especially willing to be vaccinated if they came from a better educational environment and had a high vaccination rate in the family. Emphasizing the importance of vaccination among all segments of the population and removing barriers to vaccines may lead to an ameliorated acceptance of COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Objective: Understanding factors that impaired mental health during the COVID-19 pandemic is extremely relevant in order to mitigate long-term consequences of the pandemic and to promote resilience in future crises. Method: Data were collected in southern Germany in a population-based survey study (CoKoS) with three times of measurement in May 2020, November 2020 and July 2021. Predictors of depressive and anxiety symptoms were measured with a short version of the Patient Health Questionnaire (PHQ-4) in the general population (N = 758) and individuals who were infected with SARS-CoV-2 in the beginning of the pandemic (N = 412). We investigated differences between both samples and how stress components (worry, tension, demands and joy) measured with the Perceived Stress Questionnaire (PSQ) varied with depressive and anxiety symptoms over time. Three linear mixed models (GLMMs) were fitted to predict the PHQ-4 stepwise, including sociodemographic variables and stress (PSQ). Results: Depressive and anxiety symptoms increased from May 2020 to November 2020 and remained stable until July 2021. There were no differences between people with SARS-CoV-2 infection and the general population. Those with a pre-existing disease and lower education reported higher levels of depressive and anxiety symptoms. Stress explained a substantial fraction of variance in depressive and anxiety symptoms. The stress component worry emerged as the strongest predictor of depressive and anxiety symptoms, whereas joy seemed to buffer these symptoms. Conclusions: The results suggest that mitigating people's worry and increasing joy may promote resilience in future crises. Future studies should assess mental health interventions targeted at vulnerable groups, such as those with lower socioeconomic status and poorer health. [ABSTRACT FROM AUTHOR]

During the COVID-19 vaccination campaign, Germany, like other high-income countries, introduced mass vaccination centers for administering vaccinations. This qualitative study aimed to examine the role that these novel, temporary government healthcare structures played in a mass immunization roll-out and how they can be optimally deployed. In addition, learnings for general emergency preparedness were explored. A total of 27 high-level policymakers responsible for planning and implementing the COVID vaccination campaign at the national and state level in Germany were interviewed in May and June 2022. The semi-structured interviews were analyzed using thematic analysis. Interviewees indicated that mass vaccination structures played an essential role with respect to controllability, throughput, accessibility and openness in line with the key success criteria vaccination coverage, speed and accessibility. In contrast to the regular vaccination structures (private medical practices and occupational health services), public administration has direct authority over mass vaccination centers, allowing for reliable vaccine access prioritization and documentation. The deployment of vaccination centers should be guided by vaccine availability and demand, and vaccine requirements related to logistics, as well as local capacities, i.e., public-health-service strength and the physician density, to ensure effective, timely and equitable access. Improvements to the capacity use, scalability and flexibility of governmental vaccination structures are warranted for future pandemics. [ABSTRACT FROM AUTHOR]

In 2020, Germany and Spain experienced lockdowns of their school systems. This resulted in a new challenge for learners and teachers: lessons moved from the classroom to the children's homes. Therefore, teachers had to set rules, implement procedures and make didactical–methodical decisions regarding how to handle this new situation. In this paper, we focus on the roles of mathematics teachers in Germany and Spain. The article first describes how mathematics lessons were conducted using distance learning. Second, problems encountered throughout this process were examined. Third, teachers drew conclusions from their mathematics teaching experiences during distance learning. To address these research interests, a questionnaire was answered by N = 248 teachers (N1 = 171 German teachers; N2 = 77 Spanish teachers). Resulting from a mixed methods approach, differences between the countries can be observed, e.g., German teachers conducted more lessons asynchronously. In contrast, Spanish teachers used synchronous teaching more frequently, but still regard the lack of personal contact as a main challenge. Finally, for both countries, the digitization of mathematics lessons seems to have been normalized by the pandemic. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) represents a relevant risk factor regarding morbidity and mortality worldwide. However, only limited data exist regarding the impact of DM on the clinical outcome of patients with COVID-19 infection. Methods: All hospitalized patients with confirmed COVID-19-infection (ICD-code U07.1) during the year 2020 in Germany were included in the present study. Patients were stratified regarding the co-prevalence of DM (ICD-codes E10-E14), and the impact of DM on in-hospital case fatality and in-hospital adverse events was analyzed. Results: Overall, 176,137 hospitalizations with confirmed COVID-19 infection were documented; of these, 45,232 (25.7%) patients had an additional diagnosis of DM. Diabetic patients with COVID-19 were more often of male sex and 7 years older (median 76.0 (IQR: 66.0–83.0) vs. 69.0 (52.0–81.0) years, p < 0.001). COVID-19 patients with DM demonstrated an aggravated comorbidity profile, as reflected by a higher Charlson comorbidity index (6.0 (IQR: 4.0–8.0) vs. 3.0 (1.0–5.0), p < 0.001). Risk for pneumonia (OR 1.38 (95% CI: 1.35–1.41), p < 0.001), acute respiratory distress syndrome (OR 1.53 (95% CI: 1.47–1.60), p < 0.001), and need for intensive care (21.3% vs. 13.3%, p < 0.001) were increased in DM patients. DM was an independent risk factor for acute kidney failure (OR 1.49 (95% CI: 1.44–1.53), p < 0.001), dialysis (OR 1.56 (95% CI: 1.47–1.66), p < 0.001), mechanical ventilation (OR: 1.49 (95% CI: 1.43–1.56), p < 0.001), extracorporeal membrane oxygenation (OR 1.44 (95% CI: 1.27–1.62), p < 0.001), major adverse cardiac and cerebrovascular events (OR: 1.24 (95% CI: 1.20–1.27), p < 0.001), and in-hospital mortality (OR: 1.26 (95% CI: 1.22–1.30), p < 0.001). Conclusions: In patients with COVID-19-infection, DM is a relevant risk factor for adverse events, including mortality. The vulnerable patient group of diabetics with COVID-19 requires intense medical care and monitoring during hospitalization. [ABSTRACT FROM AUTHOR]

Results from an explorative study revealing spatio-temporal patterns of the SARS-CoV-2/ COVID-19 epidemic in Germany are presented. We dispense with contestable model assumptions and show the intrinsic spatio-temporal patterns of the epidemic dynamics. The analysis is based on COVID-19 incidence data, which are age-stratified and spatially resolved at the county level, provided by the Federal Government's Public Health Institute of Germany (RKI) for public use. Although the 400 county-related incidence time series shows enormous heterogeneity, both with respect to temporal features as well as spatial distributions, the counties' incidence curves organise into well-distinguished clusters that coincide with East and West Germany. The analysis is based on dimensionality reduction, multidimensional scaling, network analysis, and diversity measures. Dynamical changes are captured by means of difference-in-difference methods, which are related to fold changes of the effective reproduction numbers. The age-related dynamical patterns suggest a considerably stronger impact of children, adolescents and seniors on the epidemic activity than previously expected. Besides these concrete interpretations, the work mainly aims at providing an atlas for spatio-temporal patterns of the epidemic, which serves as a basis to be further explored with the expertise of different disciplines, particularly sociology and policy makers. The study should also be understood as a methodological contribution to getting a handle on the unusual complexity of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Multisystemic Inflammatory Syndrome in children (MIS-C) is a rare autoimmune disorder occurring after a latency period following acute SARS-CoV-2 infection. The therapeutic regime of MIS-C is adapted to the therapy of the Kawasaki disease, as clinical symptoms are similar. Since the Kawasaki disease can potentially result in severe symptoms, which may even affect long-term health, it is essential to gain further knowledge about MIS-C. Thus, we aimed to investigate the incidence, symptoms, therapeutical procedure and outcome of MIS-C patients in the metropolitan area of Nuremberg-Erlangen during the SARS-CoV2 pandemic. Material and Methods: Retrospective analysis of clinical charts of MIS-C patients was carried out at three children's hospitals covering the medical care of the metropolitan area of Nuremberg-Erlangen in Germany. Demographic characteristics and symptoms at first visit, their clinical course, therapeutic regime and outcome were recorded within the time period January 2021–December 2022. Results: Analysis of 10 patients (5 male, 5 female) with MIS-C resulting in an incidence of 2.14/100.000 children. The median time between COVID-19 infection and admission to hospital was 5 weeks. The median age was 7 years. Symptoms comprised fever (100%), rash (70%), bilateral non-purulent conjunctivitis (70%) and urticaria (20%). At the time of presentation, diagnosis-defining inflammation parameters were increased and the range for C-reactive protein was 4.13 mg/dL to 28 mg/dL, with a median of 24.7 mg/dL. Procalcitonin was initially determined in six patients (1.92 ng/mL to 21.5 ng/mL) with a median value of 5.5 pg/mL. Two patients displayed leukocytosis and two displayed leukopenia. None of the patients presented coronary pathologies. Nine of the ten patients received intravenous immunoglobulin (IVIG) therapy. In addition, patients received intravenous steroids (80%) and acetylsalicylic acid (80%). Conclusion: SARS-CoV virus may rarely exert multiorgan manifestations due to hyperinflammatory immunological processes. Within two years of the COVID-19 pandemic, we identified ten patients with COVID-induced MIS-C in the metropolitan area Nuremberg-Erlangen. In the description of the patient collective, we can confirm that MIS-C is distinguished from the Kawasaki disease by the lack of coronary manifestations. Interestingly, although having monitored all pediatric facilities in the investigated area, we find lower incidences of MIS-C compared to findings in the literature. In conclusion, an overestimation of incidences in the upcoming MIS-C during the pandemic needs to be considered. [ABSTRACT FROM AUTHOR]

Background and Importance: The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. Objective: To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. Design, setting and participants: This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. Outcomes measure and analysis: We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. Main results: Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. Conclusions: Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic. [ABSTRACT FROM AUTHOR]

Colorectal cancer remains one of the most commonly diagnosed cancers. Advanced rectal cancer patients receive neoadjuvant radiochemotherapy as well as surgery and suffer from reduced health-related quality of life due to various side effects. We were interested in the role of the COVID-19 pandemic and how it affected those patients' quality of life. A total of 489 advanced rectal cancer patients from the University Hospital Erlangen in Germany were surveyed between May 2010 and March 2022 and asked to fill out the EORTC QLQ-C30 and QLQ-CR38 questionnaires over eight different time points: at the beginning, during and after radiochemotherapy, right before surgery, and in yearly intervals after surgery for up to four years. Answers were converted to scores to compare the COVID-19 period to the time before March 2020, focusing on the follow-ups, the developments over time—including by sex and age—and the influence of the TNM cT-stage. Overall, a trend of impaired functional and symptom scores was found across all surveys with few significances (body image −10.6 percentage points (pp) after one year; defecation problems +13.5 pp, insomnia +10.2 pp and weight loss +9.8 pp after three years; defecation problems +11.3 pp after four years). cT4-stage patients lost significantly more weight than their cT1-3-stage counterparts (+10.7 to 13.7 pp). Further studies should be conducted to find possible causes and develop countermeasures for future major infectious diseases. [ABSTRACT FROM AUTHOR]

The rapid availability of effective vaccines against SARS-CoV-2 was key during the COVID-19 pandemic. However, vaccine hesitancy and relatively low vaccine coverage rates among the general population and particularly vulnerable populations such as healthcare staff reduced the potential benefits of these vaccines. During the early phase of the pandemic, fear of vaccine-related adverse events was common among individuals who refused vaccination. Between March and May 2021, we comparatively assessed the self-reported reactogenicity of different SARS-CoV-2 prime-boost regimens using mRNA-based (BNT162b2 and mRNA-1273) and vector-based vaccines (ChAdOx1 nCoV-19) in (a) healthcare workers (HCW), and (b) police staff from southwest Germany. The majority of participants (71.8%; 1564/2176) received a homologous vaccination. Among HCW, 75.0% were female, whereas 70.0% of police staff were male. The most frequently reported reactions following the first vaccine administration were pain at the injection site (77.94%; 1696/2176), tiredness (51.75%; 1126/2176), and headache (40.44%; 880/2176), which were more commonly reported by HCW as compared to police staff. In homologous, mRNA-based and heterologous vaccination schedules, more reactions were reported after the second vaccine dose. We conclude that the frequency and intensity of self-perceived vaccine reactogenicity may differ between specific population groups and might be mitigated by tailored communication strategies. [ABSTRACT FROM AUTHOR]

Our study uses 24 waves of the survey Establishments in the COVID-19 crisis (BeCOVID), a high-frequency dataset collected at monthly intervals by the Institute for Employment Research during the COVID-19 pandemic, to investigate the behaviour of establishments with respect to the dynamics of their employment, in particular their use of short-time work. Due to the high-frequency intervals, the present data are considerably better suited than annual panel surveys to investigate adjustment processes. This is especially true for the role of short-time work, which is seen as a particularly fast adjustment option and thus reduces adjustment costs rapidly. Our estimations reveal a much faster overall workforce adjustment process compared with previous studies, which rely on annual panel surveys. In addition, our empirical results show that the employment adjustment in establishments using short-time work during the COVID-19 crisis occurred almost immediately within one month. [ABSTRACT FROM AUTHOR]

Simple Summary: As a direct consequence of the COVID-19 pandemic, cancer screening programs, management of chronic disease and cancer treatments were either cancelled or delayed. 164 patients with hepatocellular cancer (HCC) were evaluated to understand the impact of the first lockdown on treatment delays, and 1-year survival. We observed that 70% of patients were not treated within 31 days, with the median time to treatment being 49 days. This was particularly true of those with early-stage disease undergoing surgical or interventional radiology treatment. However, we noted that delay to treatment had no impact on mortality at 1-year. Given the diversity of the patients included in the study, we investigated possible factors influencing treatment delay, such as age, ethnicity, and geographical location. None of these factors were found to be associated with treatment delays. Future studies with longer follow-up are needed to assess whether delay to treatment had a negative impact on patients' survival. Our study allows a better understanding of treatment delays and short-term impact on survival during severe health services disruptions. Findings from this study highlight the need for better prioritisation of HCC treatment services particularly for the management of early-stage disease during any future pandemic lockdown. Introduction: The COVID-19 pandemic has caused severe disruption of healthcare services worldwide and interrupted patients' access to essential services. During the first lockdown, many healthcare services were shut to all but emergencies. In this study, we aimed to determine the immediate and long-term indirect impact of COVID-19 health services utilisation on hepatocellular cancer (HCC) outcomes. Methods: A prospective cohort study was conducted from 1 March 2020 until 30 June 2020, correlating to the first wave of the COVID-19 pandemic. Patients were enrolled from tertiary hospitals in the UK and Germany with dedicated HCC management services. All patients with current or past HCC who were discussed at a multidisciplinary meeting (MDM) were identified. Any delay to treatment (DTT) and the effect on survival at one year were reported. Results: The median time to receipt of therapy following MDM discussion was 49 days. Patients with Barcelona Clinic Liver Cancer (BCLC) stages-A/B disease were more likely to experience DTT. Significant delays across all treatments for HCC were observed, but delay was most marked for those undergoing curative therapies. Even though severe delays were observed in curative HCC treatments, this did not translate into reduced survival in patients. Conclusion: Interruption of routine healthcare services because of the COVID-19 pandemic caused severe delays in HCC treatment. However, DTT did not translate to reduced survival. Longer follow is important given the delay in therapy in those receiving curative therapy. [ABSTRACT FROM AUTHOR]

In this paper, we present the estimation of surface NO 2 concentrations over Germany using a machine learning approach. TROPOMI satellite observations of tropospheric NO 2 vertical column densities (VCDs) and several meteorological parameters are used to train the neural network model for the prediction of surface NO 2 concentrations. The neural network model is validated against ground-based in situ air quality monitoring network measurements and regional chemical transport model (CTM) simulations. Neural network estimation of surface NO 2 concentrations show good agreement with in situ monitor data with Pearson correlation coefficient (R) of 0.80. The results also show that the machine learning approach is performing better than regional CTM simulations in predicting surface NO 2 concentrations. We also performed a sensitivity analysis for each input parameter of the neural network model. The validated neural network model is then used to estimate surface NO 2 concentrations over Germany from 2018 to 2020. Estimated surface NO 2 concentrations are used to investigate the spatio-temporal characteristics, such as seasonal and weekly variations of NO 2 in Germany. The estimated surface NO 2 concentrations provide comprehensive information of NO 2 spatial distribution which is very useful for exposure estimation. We estimated the annual average NO 2 exposure for 2018, 2019 and 2020 is 15.53, 15.24 and 13.27 µ g/m 3 , respectively. While the annual average NO 2 concentration of 2018, 2019 and 2020 is only 12.79, 12.60 and 11.15 µ g/m 3 . In addition, we used the surface NO 2 data set to investigate the impacts of the coronavirus disease 2019 (COVID-19) pandemic on ambient NO 2 levels in Germany. In general, 10–30% lower surface NO 2 concentrations are observed in 2020 compared to 2018 and 2019, indicating the significant impacts of a series of restriction measures to reduce the spread of the virus. [ABSTRACT FROM AUTHOR]

Despite protection from severe COVID-19 courses through vaccinations, some people with multiple sclerosis (PwMS) are vaccination-hesitant due to fear of post-vaccination side effects/increased disease activity. The aim was to reveal the frequency and predictors of post-SARS-CoV-2-vaccination relapses in PwMS. This prospective, observational study was conducted as a longitudinal Germany-wide online survey (baseline survey and two follow-ups). Inclusion criteria were age ≥18 years, MS diagnosis, and ≥1 SARS-CoV-2 vaccination. Patient-reported data included socio-demographics, MS-related data, and post-vaccination phenomena. Annualized relapse rates (ARRs) of the study cohort and reference cohorts from the German MS Registry were compared pre- and post-vaccination. Post-vaccination relapses were reported by 9.3% PwMS (247/2661). The study cohort's post-vaccination ARR was 0.189 (95% CI: 0.167–0.213). The ARR of a matched unvaccinated reference group from 2020 was 0.147 (0.129–0.167). Another reference cohort of vaccinated PwMS showed no indication of increased post-vaccination relapse activity (0.116; 0.088–0.151) compared to pre-vaccination (0.109; 0.084–0.138). Predictors of post-vaccination relapses (study cohort) were missing immunotherapy (OR = 2.09; 1.55–2.79; p < 0.001) and shorter time from the last pre-vaccination relapse to the first vaccination (OR = 0.87; 0.83–0.91; p < 0.001). Data on disease activity of the study cohort in the temporal context are expected for the third follow-up. [ABSTRACT FROM AUTHOR]

Background: Acute respiratory distress syndrome (ARDS) is a severe lung condition that can be caused by a variety of underlying illnesses. Due to SARS-CoV-2, the number of cases with ARDS has increased worldwide, making it essential to compare this form of acute respiratory failure with classical causes of ARDS. While there have been several studies investigating the differences between COVID-19 and non-COVID-19 ARDS in early stages of the pandemic, little is known about the differences in later phases, especially in Germany. Aim: The aim of this study is to characterize and compare the comorbidities, treatments, adverse events, and outcomes of COVID-19-associated ARDS and non-COVID-19 ARDS using a representative sample of German health claims data from the years 2019 and 2021. Methods: We compare percentages and median values of the quantities of interest from the COVID-19 and non-COVID-19 ARDS group, with p-values calculated after conducting Pearson's chi-squared test or the Wilcoxon rank sum test. We also run logistic regressions to access the effect of comorbidities on mortality for COVID-19 ARDS and non-COVID-19 ARDS. Results: Despite many similarities, we find that that there are some remarkable differences between COVID-19 and non-COVID-19 ARDS cases in Germany. Most importantly, COVID-19 ARDS cases display fewer comorbidities and adverse events, and are more often treated with non-invasive ventilation and nasal high-flow therapy. Conclusions: This study highlights the importance of comprehending the contrasting epidemiological features and clinical outcomes of COVID-19 and non-COVID-19 ARDS. This understanding can aid in clinical decision making and guide future research initiatives aimed at enhancing the management of patients afflicted with this severe condition. [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]

Numerous research results have already pointed towards the negative influence of increased mental stress on educational processes and motivational criteria. It has also been shown that the global public health crisis induced by COVID-19 was related to anxiety symptoms and elevated levels of distress. To holistically elucidate the dynamics of the pandemic-related mental stress of first-year medical students, the associated parameters of three different cohorts were measured at the beginning of the pandemic-related restrictions on university life in Germany (20/21), at the peak of the COVID-19-related restrictions (21/22) and during the easing of the restrictions in the winter term 22/23. In a repeated cross-sectional study design, the constructs of worries, tension, demands and joy were collected from first-year medical students (n = 578) using the Perceived Stress Questionnaire. The results demonstrate significantly increased values of the constructs worries (p < 0.001), tension (p < 0.001) and demands (p < 0.001) at the peak of the pandemic related restrictions compared to the previous and following year as well as significantly decreasing values of general joy of life during the observed period of 3 years (all p-values < 0.001). A confirmatory factor analysis was performed to verify the questionnaire's factor structure regarding the addressed target group during the pandemic (CFI: 0.908, RMSEA: 0.071, SRMR: 0.052). These data, collected over a period of three years, provide information regarding dynamically manifesting mental stress during the COVID-19 pandemic, and refer to new areas of responsibility for the faculties to adequately counteract future crisis situations. [ABSTRACT FROM AUTHOR]

Abundant studies have examined mental health in the early periods of the COVID-19 pandemic. However, empirical work examining the mental health impact of the pandemic's subsequent phases remains limited. In the present study, we investigated how mental vulnerability and resilience evolved over the various phases of the pandemic in 2020 and 2021 in Germany. Data were collected (n = 3522) across seven measurement occasions using validated and self-generated measures of vulnerability and resilience. We found evidence for an immediate increase in vulnerability during the first lockdown in Germany, a trend towards recovery when lockdown measures were eased, and an increase in vulnerability with each passing month of the second lockdown. Four different latent trajectories of resilience–vulnerability emerged, with the majority of participants displaying a rather resilient trajectory, but nearly 30% of the sample fell into the more vulnerable groups. Females, younger individuals, those with a history of psychiatric disorders, lower income groups, and those with high trait vulnerability and low trait social belonging were more likely to exhibit trajectories associated with poorer mental well-being. Our findings indicate that resilience–vulnerability responses in Germany during the COVID-19 pandemic may have been more complex than previously thought, identifying risk groups that could benefit from greater support. [ABSTRACT FROM AUTHOR]

Background: during the COVID-19 pandemic, psychological burden increased. Contact restrictions were predominantly stressful for families. Parenthood was reported to be especially challenging for parents of preterm children. Material and Methods: a cross-sectional online-based survey on the psychological burden of parents of preterm and full-term born infants and toddlers during the second lockdown of the COVID-19 pandemic in Germany was offered by social media, webpages, etc. Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-2 (PHQ-2), COVID-19 Anxiety (C-19-A), COVID-19-related child protection behavior (PB) were used. Results: 2742 parents—predominantly females—took part in the study, 2025 parents of full-term and 717 parents of preterm born children. Female caregivers of full-term children reported significantly more depression symptoms than those of preterm children during the second lockdown of the COVID-19 pandemic. The PB correlated with increased COVID-19 anxiety as well as with increased generalized anxiety and depression symptoms. Female caregivers of preterm children showed significantly more protection behavior than those of full-term born children. [ABSTRACT FROM AUTHOR]

On a global scale, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) poses a serious threat to the health of the human population. Not only humans can be infected, but also their companion animals. The antibody status of 115 cats and 170 dogs, originating from 177 German households known to have been SARS-CoV-2 positive, was determined by enzyme-linked immunosorbent assay (ELISA), and the results were combined with information gathered from a questionnaire that was completed by the owner(s) of the animals. The true seroprevalences of SARS-CoV-2 among cats and dogs were 42.5% (95% CI 33.5–51.9) and 56.8% (95% CI 49.1–64.4), respectively. In a multivariable logistic regression accounting for data clustered in households, for cats, the number of infected humans in the household and an above-average contact intensity turned out to be significant risk factors; contact with humans outside the household was a protective factor. For dogs, on the contrary, contact outside the household was a risk factor, and reduced contact, once the human infection was known, was a significant protective factor. No significant association was found between reported clinical signs in animals and their antibody status, and no spatial clustering of positive test results was identified. [ABSTRACT FROM AUTHOR]

During the outbreak of a disease caused by a pathogen with unknown characteristics, the uncertainty of its progression parameters can be reduced by devising methods that, based on rational assumptions, exploit available information to provide actionable insights. In this study, performed a few (~6) weeks into the outbreak of COVID-19 (caused by SARS-CoV-2), one of the most important disease parameters, the average time-to-recovery, was calculated using data publicly available on the internet (daily reported cases of confirmed infections, deaths, and recoveries), and fed into an algorithm that matches confirmed cases with deaths and recoveries. Unmatched cases were adjusted based on the matched cases calculation. The mean time-to-recovery, calculated from all globally reported cases, was found to be 18.01 days (SD 3.31 days) for the matched cases and 18.29 days (SD 2.73 days) taking into consideration the adjusted unmatched cases as well. The proposed method used limited data and provided experimental results in the same region as clinical studies published several months later. This indicates that the proposed method, combined with expert knowledge and informed calculated assumptions, could provide a meaningful calculated average time-to-recovery figure, which can be used as an evidence-based estimation to support containment and mitigation policy decisions, even at the very early stages of an outbreak. [ABSTRACT FROM AUTHOR]

The World Health Organization declared the emergence of the novel coronavirus (SARS-CoV-2) in January 2020. To trace infection chains, Germany launched its smartphone contact tracing app, the "Corona-Warn-App" (CWA), in June 2020. In order to be successful as a tool for fighting the pandemic, a high adoption rate is required in the population. We analyse the respective factors influencing app adoption based on the health belief model (HBM) with a cross-sectional online study including 1752 participants from Germany. The study was conducted with a certified panel provider from the end of December 2020 to January 2021. This model is primarily known from evaluations of medical treatments, such as breast cancer screenings, but it was rarely applied in prior work for a health-related information system such as the CWA. Our results indicate that intrinsic and extrinsic motivation to use the CWA are the strongest drivers of app use. In contrast, technical barriers, privacy concerns and lower income are the main inhibitors. Our findings contribute to the literature on the adoption of contact tracing apps by questioning actual users and non-users of the CWA, and we provide valuable insights for policymakers regarding influences of adoption and potential user groups of disease prevention technologies in times of pandemics. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic led to psychological distress among children and adolescents. Due to multiple psychosocial burdens, the youth in residential care were especially exposed to an increased risk of mental health problems during the pandemic. In a multi-center, single-arm feasibility trial, N = 45 children and adolescents aged 7–14 years were allocated to a 6-week blended care intervention, conducted in six outpatient residential child welfare facilities. The intervention covered a once weekly face-to-face group session for guided creative (art therapy, drama therapy) and movement-oriented (children's yoga, nature therapy) activities. This was accompanied by a resilience-oriented mental-health app. Feasibility and acceptance analyses covered app usage data and qualitative data. Effectiveness was determined by pre-post comparisons in quantitative data on psychological symptoms and resources. Further, subgroups for poorer treatment outcome were explored. The intervention and app were considered to be feasible and were accepted by residential staff and the children. No significant pre-post changes were found across quantitative outcomes. However, being female, being in current psychosocial crisis, a migration background, or a mentally ill parent were correlated with change in score of outcomes from baseline. These preliminary findings pave the way for future research on blended care interventions among at-risk children and adolescents. [ABSTRACT FROM AUTHOR]