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Mehr als die Hälfte der deutschen Bevölkerung hat Schwierigkeiten im Umgang mit Gesundheitsinformationen. Es ist eine wichtige Aufgabe der Versorgungsforschung zu untersuchen, wie sich die Professionen und Organisationen des Gesundheitssystems dieser Herausforderung stellen können. Das DNVF Memorandums Gesundheitskompetenz (Teil 1) nimmt Begriffsbestimmungen der individuellen und organisationalen Gesundheitskompetenz vor, präsentiert den nationalen und internationalen Forschungsstand und stellt ethische Aspekte der versorgungsbezogenen Gesundheitskompetenzforschung dar. Weiterhin wird die Relevanz der Gesundheitskompetenzforschung in verschiedenen Lebensphasen, bei unterschiedlichen Personengruppen sowie in verschiedenen Kontexten der Gesundheits- und Krankenversorgung erarbeitet. Vor diesem Hintergrund werden zentrale Forschungsgegenstände und zukünftige Forschungsdesiderata abgeleitet., More than half of the German population has difficulties in dealing with health information. It is an important task of health services research to examine how healthcare professionals and health care organizations can meet this challenge. The DNVF Memorandum Health Literacy (Part 1) defines the terms of individual and organizational health literacy, presents the national and international state of research and ethical aspects of health literacy research in health care settings. The relevance of health literacy research is worked out in different phases of life, for different target groups and in different healthcare contexts. Central research topics and future research desiderata are derived. © Georg Thieme Verlag KG Stuttgart · New York.

Drawing on ethnographic fieldwork in two different teaching hospitals that deployed the da Vinci surgical robot, this paper traces how the introduction of robotics reconfigures the sensory environment of surgery and how surgeons and their teams recalibrate their work in response. We explore the entangled and mutually supportive nature of sensing within and between individual actors and the broader world of people and things (with emphasis on vision and touch) and illustrate how such inter-sensory dependencies are challenged and sometimes extended under the conditions of robotic surgery. We illustrate how sensory (re)articulations and compensations allow the surgeon and surgical teams to adapt to a more-than-human sensorium and conclude by advocating new forms of sensory-aware design capable of enhancing and supporting embodied sensory conditions both individually and across teams.

Aaron Antonovsky advanced the concept of salutogenesis almost four decades ago (Antonovsky, Health, Stress and Coping. Jossey-Bass, San Francisco, CA, 1979; Unravelling the Mystery of Health. Jossey-Bass, San Francisco, CA, 1987). Salutogenesis posits that life experiences shape the sense of coherence (SOC) that helps to mobilize resources to cope with stressors and manage tension successfully (determining one’s movement on the health Ease/Dis-ease continuum). Antonovsky considered the three-dimensional SOC (i.e. comprehensibility, manageability, meaningfulness) as the key answer to his question about the origin of health. The field of health promotion has adopted the concept of salutogenesis as reflected in the international Handbook of Salutogenesis (Mittelmark et al., The Handbook of Salutogenesis. Springer, New York, 2016). However, health promotion mostly builds on the more vague, general salutogenic orientation that implies the need to foster resources and capacities to promote health and wellbeing. To strengthen the knowledge base of salutogenesis, the Global Working Group on Salutogenesis (GWG-Sal) of the International Union of Health Promotion and Education produced the Handbook of Salutogenesis. During the creation of the handbook and the regular meetings of the GWG-Sal, the working group identified four key conceptual issues to be advanced: (i) the overall salutogenic model of health; (ii) the SOC concept; (iii) the design of salutogenic interventions and change processes in complex systems; (iv) the application of salutogenesis beyond health sector. For each of these areas, we first highlight Antonovsky’s original contribution and then present suggestions for future development. These ideas will help guide GWG-Sal’s work to strengthen salutogenesis as a theory base for health promotion.

In the wake of COVID-19, university students have experienced fundamental changes of their learning and their lives as a whole. The present research identifies psychological characteristics associated with students’ well-being in this situation. We investigated relations of basic psychological need satisfaction (experienced competence, autonomy, and relatedness) with positive emotion and intrinsic learning motivation, considering self-regulated learning as a moderator. Self-reports were collected from 6,071 students in Austria (Study 1) and 1,653 students in Finland (Study 2). Structural equation modeling revealed competence as the strongest predictor for positive emotion. Intrinsic learning motivation was predicted by competence and autonomy in both countries and by relatedness in Finland. Moderation effects of self-regulated learning were inconsistent, but main effects on intrinsic learning motivation were identified. Surprisingly, relatedness exerted only a minor effect on positive emotion. The results inform strategies to promote students’ well-being through distance learning, mitigating the negative effects of the situation.

Due to the COVID-19 pandemic, higher educational institutions worldwide switched to emergency distance learning in early 2020. The less structured environment of distance learning forced students to regulate their learning and motivation more independently. According to self-determination theory (SDT), satisfaction of the three basic psychological needs for autonomy, competence and social relatedness affects intrinsic motivation, which in turn relates to more active or passive learning behavior. As the social context plays a major role for basic need satisfaction, distance learning may impair basic need satisfaction and thus intrinsic motivation and learning behavior. The aim of this study was to investigate the relationship between basic need satisfaction and procrastination and persistence in the context of emergency distance learning during the COVID-19 pandemic in a cross-sectional study. We also investigated the mediating role of intrinsic motivation in this relationship. Furthermore, to test the universal importance of SDT for intrinsic motivation and learning behavior under these circumstances in different countries, we collected data in Europe, Asia and North America. A total of N = 15,462 participants from Albania, Austria, China, Croatia, Estonia, Finland, Germany, Iceland, Japan, Kosovo, Lithuania, Poland, Malta, North Macedonia, Romania, Sweden, and the US answered questions regarding perceived competence, autonomy, social relatedness, intrinsic motivation, procrastination, persistence, and sociodemographic background. Our results support SDT’s claim of universality regarding the relation between basic psychological need fulfilment, intrinsic motivation, procrastination, and persistence. However, whereas perceived competence had the highest direct effect on procrastination and persistence, social relatedness was mainly influential via intrinsic motivation.

The Conference on Power System Engineering has a long-term tradition. It is an annual meeting of professors and experts from departments and universities where power system engineering is taught. The 20th year of this event was held in Pilsen (Czech Republic) between 7th and 9th September 2021 and was hosted by Department of Power System Engineering of Faculty of Mechanical Engineering, University of West Bohemia in Pilsen.

This paper develops an optimization model to find the optimal values for the parameters of the double-exponential function. This function can be used to reproduce the volt-time curves of the standard and nonstandard applied impulse voltages in a software environment. Reproducing a similar applied laboratory impulse voltage in a software environment plays a crucial role in obtaining precise results and validates the model to be applied for further studies. In the literature, most of the papers use the existing standard and nonstandard models in which either an RC circuit has been used or a trial and error method has been used to approximately reproduce the applied impulse. However, more often than not, inappropriate adjustments cause a large error in the outcome results. Therefore, the proposed optimization-based approach can act as a facilitating tool for reproducing the nonstandard volt-time curves as close as possible to the laboratory applied impulse. The proposed model is verified by reproducing the volt-time curve of a 125 kV impulse voltage. Comparing the simulated impulse with the experimental impulse voltage shows the usefulness and effectiveness of the proposed approach in adjusting the sensitive parameters of the double-exponential function in EMTP-RV (Electromagnetic Transients Program) software.

Background Health literacy concerns the ability of citizens to meet the complex demands of health in modern society. Data on the distribution of health literacy in general populations and how health literacy impacts health behavior and general health remains scarce. The present study aims to investigate the prevalence of health literacy levels and associations of health literacy with socioeconomic position, health risk behavior, and health status at a population level. Methods A nationwide cross-sectional survey linked to administrative registry data was applied to a randomly selected sample of 15,728 Danish individuals aged ≥25 years. By the short form HLS-EU-Q16 health literacy was measured for the domains of healthcare, disease prevention, and health promotion. Adjusted multinomial logistic regression analyses were used to estimate associations of health literacy with demographic and socioeconomic characteristics, health risk behavior (physical activity, smoking, alcohol consumption, body weight), and health status (sickness benefits, self-assessed health). Results Overall, 9007 (57.3%) individuals responded to the survey. Nearly 4 in 10 respondents faced difficulties in accessing, understanding, appraising, and applying health information. Notably, 8.18% presented with inadequate health literacy and 30.94% with problematic health literacy. Adjusted for potential confounders, regression analyses showed that males, younger individuals, immigrants, individuals with basic education or income below the national average, and individuals receiving social benefits had substantially higher odds of inadequate health literacy. Among health behavior factors (smoking, high alcohol consumption, and inactivity), only physical behavior [sedentary: OR: 2.31 (95% CI: 1.81; 2.95)] was associated with inadequate health literacy in the adjusted models. The long-term health risk indicator body-weight showed that individuals with obesity [OR: 1.78 (95% CI: 1.39; 2.28)] had significantly higher odds of lower health literacy scores. Poor self-assessed health [OR: 4.03 (95% CI: 3.26; 5.00)] and payments of sickness absence compensation benefits [OR: 1.74 (95% CI: 1.35; 2.23)] were associated with lower health literacy scores. Conclusions Despite a relatively highly educated population, the prevalence of inadequate health literacy is high. Inadequate health literacy is strongly associated with a low socioeconomic position, poor health status, inactivity, and overweight, but to a lesser extent with health behavior factors such as smoking and high alcohol consumption.

Background Due to the digital transformation in late modern society, digital (or e-) health literacy (DHL) is becoming increasingly relevant for people to take health related decisions. Yet despite its importance for evidence-based policy, very few tools have been developed to measure DHL, and even fewer studies have measured DHL in general populations. The Action Network on Measuring Population and Organizational Health Literacy (M-POHL) is one of the first to include a measure of DHL and its relevant correlates in the Health Literacy Survey 2019 (HLS19). Methods Based on an existing instrument (Van der Vaart & Drossaert, 2017), adapted to the format of the HLS-EU questionnaire for measuring comprehensive health literacy, 10 items with four Likert categories were developed to measure self-reported DHL, as well as 6 questions measuring the use of digital resources to obtain health related information and communicate with their health care system, as an optional package of the HLS19 study. Ten of the 15 countries participating in HLS19 included this optional package into their national survey. Data were collected from probability samples of at least 1.000 respondents per country, taken from the general population 18+ by personal interviews, telephone interviews or internet. Results For comparisons between countries, distributions of the answers to single items as well as psychometric validation and descriptive data for an index of DHL will be presented. Associations of DHL with general comprehensive health literacy, with the use of digital resources, and with other selected correlates based on correlational and regression analysis will also be presented comparatively for countries. Conclusions This study is the first to present standardized comparative data for the distributions of DHL and its correlates in the general population of WHO-Europe region Member States. The relevance of these results for national and European health policy will be discussed. Panelists: Doris Schaeffer Interdisciplinary Centre for Health Literacy Research, Bielefeld University, Bielefeld, Germany Contact: doris.schaeffer@uni-bielefeld.de Maria Lopatina Department of Public Health, National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia Contact: ms.lopatina@gmail.com Miguel Arriaga Division of Literacy, Health and Well-being, Directorate-General on Health, Lisbon, Portugal Contact: miguelarriaga@dgs.min-saude.pt

Background: Diabetes self-management education (DSME) is generally considered to be a key determinant of the treatment outcomes and related costs of diabetes mellitus. While DSME programmes generally have positive outcomes, their effects may depend on certain factors, such as the type of programmes provided and patients’ level of health literacy (HL). Low HL has been associated with poorer self-management behaviours and poor medication adherence in diabetic patients, but its impact on the effects of DSME has not yet been systematically investigated. This study aimed to investigate the influence of HL on the self-reported effects of DSME programmes while taking the type of programme into consideration.Method: A total of 366 diabetic patients from nine countries completed a questionnaire measuring HL, selfmanagement behaviours, problem perception, coping, perceived general health and well-being, before and after participating in a DSME programme.Results: DSME programmes were found to have positive effects on self-reported self-management behaviours and almost all psychological and health outcomes, regardless of HL level. Patients with high HLscored better on several diabetes outcomes than those with low HL, but all patients described benefiting from DSME. Individual and group-based programmes resulted in more positive effects on several diabetesoutcomes than self-help groups, but no interaction with HL was found.Conclusion: Our findings confirm those of previous studies showing that DSME programmes have positive effects and that low HL is associated with lower diabetes outcomes but do not support the assumption that the effects of DSME programmes are influenced by the patient’s HL. However, due to the limitations of thisstudy, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes’ effectiveness.

Internationally and interdisciplinarily collaborating academics in research projects communicate with several LSPs, embedded in an individual language used by all project members.Commonly, English is appropriate as lingua franca for such purposes. During the course of these projects, a kind of “common language” accrues, including a project-specific terminology. This article will describe this developing terminology based on one project involving partners from Europe, Africa and India where intercultural communication in interdisciplinary research teams is a daily practice. In this research project, the terminology was not created and implemented consciously – so how can this evolving project-specific terminology be defined and classified? For answering this question, the data sources of this paper include minutes from meetings attended by representatives of all project partners, notes from participant observation as well as the outcomes from surveys conducted with the project participants. Additionally, as to the characteristics and function of this terminology, the acquisition will also be discussed in this article.

Users of mobile apps sometimes express discomfort or concerns with what they see as unnecessary or intrusive permission requests by certain apps. However encouraging mobile app developers to request fewer permissions is challenging because there are many reasons why permissions are requested; furthermore, prior work [25] has shown it is hard to disambiguate the purpose of a particular permission with high certainty.In this work we describe a novel, algorithmic mechanism intended to discourage mobile-app developers from asking for unnecessary permissions. Developers are incentivized by an automated alert, or "nudge", shown in the Google Play Console when their apps ask for permissions that are requested by very few functionally-similar apps---in other words, by their competition. Empirically, this incentive is effective, with significant developer response since its deployment. Permissions have been redacted by 59% of apps that were warned, and this attenuation has occurred broadly across both app categories and app popularity levels. Importantly, billions of users' app installs from the Google Play have benefited from these redactions.

Current ovarian cancer maintenance therapy is limited by toxicity and no proven impact on overall survival. To study a maintenance strategy targeted at missense mutant p53, we hypothesized that the release of mutant p53 from mortalin inhibition by the SHetA2 drug combined with reactivation of mutant p53 with the PRIMA-1(MET) drug inhibits growth and tumor establishment synergistically in a mutant-p53 dependent manner. The Cancer Genome Atlas (TCGA) data and serous ovarian tumors were evaluated for TP53 and HSPA9/mortalin status. SHetA2 and PRIMA-1(MET) were tested in ovarian cancer cell lines and fallopian tube secretory epithelial cells using isobolograms, fluorescent cytometry, Western blots and ELISAs. Drugs were administered to mice after peritoneal injection of MESOV mutant p53 ovarian cancer cells and prior to tumor establishment, which was evaluated by logistic regression. Fifty-eight percent of TP53 mutations were missense and there were no mortalin mutations in TCGA high-grade serous ovarian cancers. Mortalin levels were sequentially increased in serous benign, borderline and carcinoma tumors. SHetA2 caused p53 nuclear and mitochondrial accumulation in cancer, but not in healthy, cells. Endogenous or exogenous mutant p53 increased SHetA2 resistance. PRIMA-1(MET) decreased this resistance and interacted synergistically with SHetA2 in mutant and wild type p53-expressing cell lines in association with elevated reactive oxygen species/ATP ratios. Tumor-free rates in animals were 0% (controls), 25% (PRIMA1(MET)), 42% (SHetA2) and 67% (combination). SHetA2 (p = 0.004) and PRIMA1(MET) (p = 0.048) functioned additively in preventing tumor development with no observed toxicity. These results justify the development of SHetA2 and PRIMA-1(MET) alone and in combination for ovarian cancer maintenance therapy.

This article offers an alternative method of calibrating partial discharge meters for research and teaching purposes. Most current modern calibrators are implemented as precise voltage pulse sources with a coupling capacitor. However, our calibrator is based on the physical principles of dielectric materials distributed in a plane or space. Calibrator design is unique and there is an attempt to get closer to the behavior of the measured real objects. The calibration impulses are created by energy from a high voltage power supply at the specific or nominal value of the applied voltage. At the same time, it is possible to simulate the value and quantity of the discharges and their position in the object relative to the input electrodes. The calibrator creates conditions as a real measured object with adjustable parameters. This paper describes a design of this type of calibrator, its implementation, numerical simulation of discharge values and laboratory measurements with functional verification using the Tettex 9520 calibrator and galvanic measured system DDX 7000/8003 and DDX 9121b. All measurements are carried out using the CVVOZEPowerLab Research Infrastructure equipment.

The High Voltage Test Laboratory in CVVOZEPowerLab is equipped with a Haefely Hipotronics HV Test Transformer HHT7300-300T5-760. This test system is used for withstand voltage, breakdown voltage tests and diagnostics of dielectrics - measurement of partial discharges and electronic bridge measurement up to 300 kV. Unfortunately, the system produces output voltage with high value of harmonic distortion, mainly in the condition of low output load. Higher harmonics in the output test voltage make it impossible to carry out accurate withstand tests and affects the measurement accuracy of the dissipation factor and the operation of the PD system. These problems were solved for last 5 years and currently are found several partial solutions. In this paper are described several basic concepts used to improve the operating parameters of the 300 kV AC source.

e20559 Background: Immune cells have a broad impact on tumor initiation, growth, and progression, and many of these effects are mediated by proinflammatory cytokines. The prognostic impact of dynamic changes of inflammatory cytokines in non-operable stage III NSCLC patients treated with (chemo)-radiotherapy ± immune checkpoint inhibition is unknown. In a prospective analysis, pro-inflammatory cytokines including interleukin 2, 6, and 8 from peripheral blood samples were evaluated 5-10 days before treatment start (T1), on the last day of thoracic radiotherapy (T2), and 3 weeks after radiation (T3) for their impact on overall survival (OS) and progression-free survival (PFS). Methods: Twenty patients, 85% male, at a median age of 65.5 (range 33-77) years were prospectively enrolled in this study. Eighteen (90%) patients received platinum-based concurrent chemoradiotherapy (CRT); seven (35%) patients additional concurrent and/or sequential immune checkpoint inhibition (four patients nivolumab and three durvalumab); patients treated with nivolumab received induction chemotherapy. Thoracic irradiation (TRT) was applied in all patients with a median cumulative dose in equivalent 2Gy fractions (EQD2) of 64Gy (range: 52-65Gy). Results: Median follow-up achieved 25 (range 14-30) months, median OS was not reached and median PFS was 11.8 (95%CI 5.2-18.4) months. To analyze pre-treatment data, median values were used as cut-off for dichotomization. Higher IL6 levels (≥9.75pg/ml) before irradiation (T1) were associated with impaired OS (median 11 months vs. not reached; p < 0.001) and PFS (median 7.0 months vs. not reached; p = 0.041). Higher IL8 levels (≥4.62pg/ml) were also associated with shorter OS (median 16 months vs. not reached; p = 0.009) and PFS (median 7 months vs. not reached p = 0.040). Patients with a decline of ≥10% of IL8 level between T1 and T2 had a significantly shorter PFS (11.8 months vs. not reached; p = 0.028). Conclusions: High proinflammatory cytokine levels were significantly associated with deterioration of outcome regarding OS and PFS in patients enrolled in multimodal treatment for stage III NSCLC. A decline of ≥10% of IL8 level during TRT was associated with impaired PFS.

e20503 Background: Acute lymphocytopenia is associated with poor survival in solid cancers treated with multimodal therapy. A prospective analysis of peripheral blood mononuclear cells (PBMCs) during multimodal treatment in inoperable stage III NSCLC patients was performed to assess a correlation of T-lymphocytes changes with 6-months progression-free survival rates (PFS6M). Methods: Twenty patients at median age of 65.5 years (range 33-77), 85% male, 55% with adenocarcinoma and 40% with squamous cell carcinoma, were prospectively enrolled in this study. Eighteen (90%) patients received platinum-based concurrent chemo-radiotherapy (cCRT); seven (35%) patients additional concurrent and/or sequential immune check-point inhibition (four patients nivolumab and three durvalumab); patients treated with nivolumab received induction chemotherapy. Thoracic irradiation (TRT) was applied in all patients with median cumulative dose in equivalent 2Gy fractions (EQD2) of 64Gy (range: 52-65Gy). Peripheral blood was collected 5-10 days before treatment begin (A1), on the last day of TRT (RTend), and during follow-up. Samples were analyzed using polychromatic flow cytometry. Results are reported for three time-points: A1, RTend, and 6 months after TRT (C3) or the last sample available before that time-point. Results: From A1 to RTend, 16 (80%) patients experienced severe T-cell (CD3+, CD3+CD4+, CD3+CD8+) depletion, including 3 (15%) patients who received two doses of concurrent nivolumab. T-lymphocyte nadir was independent of the absolute numbers of PBMCs before treatment begin. In two patients, T-cell count remained stable, and increased in two other patients. No correlation of dynamic changes from A1 to RTend with PFS6M was observed. From RTend to C3, T-lymphocytes recovered in 11 (55%) patients; in 6 (30%) T-cell count further decreased or remained at very low levels. For total CD3 T-cells, CD3+CD4+ and CD3+CD8+ subsets, progressive disease in the first six months after TRT was associated with a decrease of median values (P = 0.03 for total CD3+ and CD3+CD4+, P = 0.08 for CD3+CD8+ T-cells). In contrast, an increase of all medians was associated with PFS6M (P = 0.007 for total CD3+, P = 0.002 for CD3+CD4+, P = 0.06 for CD3+CD8+ T-cells). Conclusions: There is a significant difference between patients with regards to T-lymphocytes recovery after the end of TRT, which is predictive for PFS6M, with poor median recovery observed in patients with early progress.

BACKGROUND: Health literacy has been increasingly recognized as one of the most important social determinants for health. However, an appropriate and comprehensive assessment tool is not available in many Asian countries. This study validates a comprehensive health literacy survey tool European health literacy questionnaire (HLS-EU-Q47) for the general public in several Asian countries. METHODS: A cross-sectional survey based on multistage random sampling in the target countries. A total of 10,024 participants aged ≥15 years were recruited during 2013-2014 in Indonesia, Kazakhstan, Malaysia, Myanmar, Taiwan, and Vietnam. The questionnaire was translated into local languages to measure general health literacy and its three domains. To evaluate the validity of the tool in these countries, data were analyzed by confirmatory factor analysis, internal consistency analysis, and regression analysis. RESULTS: The questionnaire was shown to have good construct validity, satisfactory goodness-of-fit of the data to the hypothetical model in three health literacy domains, high internal consistency (Cronbach's alpha >0.90), satisfactory item-scale convergent validity (item-scale correlation ≥0.40), and no floor/ceiling effects in these countries. General health literacy index score was significantly associated with level of education (P from

e21011 Background: Lymphocytopenia is associated with deterioration of patient survival in solid cancers treated with concurrent chemo/radiotherapy (cCRT). A prospective analysis of peripheral blood mononuclear cells during cCRT in inoperable stage III NSCLC patients was performed to determine dynamic changes of individual lymphocyte subsets. Methods: Twenty-one patients were prospectively enrolled in this study. Eighteen patients received platinum-based cCRT, seven of them received, additionally, concurrent and/or sequential immune checkpoint-inhibition (ICI). Thoracic irradiation (TRT) was delivered with median total dose of 62Gy (31 daily fractions of 2Gy) in all patients. Peripheral blood was collected 5-10 days before treatment (A1), three weeks after start of cCRT (A3), on the last day of TRT (RTend) and during follow-up. Samples were analyzed using polychromatic flow cytometry. Results are reported for time-points A1, A3 and RTend. Results: Sixteen patients met final analysis criteria, 50% of them received concurrent and/or sequential ICI. All patients developed severe lymphocytopenia; in 81% of them lymphocyte nadir was documented at A3. Lymphocyte subsets, B cells, T cells (CD4, CD8), regulatory T cells, and NK cells, decreased with medians between 99.9% and 59%. Lymphocyte nadir was independent of the absolute numbers of immune cells that a patient had before start of cCRT or whether additional ICI was applied. From A3 to RTend, all lymphocyte subsets started to recover in patients treated with cCRT alone, while they remained low in patients who received additional ICI. The ratios of CD4/CD8 and CD8/Treg cells did not change during treatment (A1 to RTend) and was not different between the patients treated with or without ICI. However, the fraction of PD-1 cells among CD8 T-cells decreased in patients treated with ICI and remained low until RTend (range 0.55%-13.8%). In contrast, in 50% of patients treated with cCRT alone, PD-1 T-cell among CD8 T-cells increased and remained high (range 6.8%-46.3%) until RTend. Conclusions: Delayed recovery of lymphocyte subsets in peripheral blood was observed in patients treated with cCRT combined with concurrent or sequential ICI. A decrease of PD-1 T-cells among CD8 T-cells was described exclusively in patients treated with additional ICI.

Background: Health literacy (HL) is defined as the ability to process health-related information to make decisions to maintain health and improve quality of life. A growing number of studies demonstrate that people with lower HL are less likely to use preventive services but more likely to use curative, emergency, or hospital care. Objective: This study investigated the relationship between HL and the use of different types of health services in a sample of the general German population, as we expected that the effect of HL on the frequency of use differs by type of health service. Methods: A nationally representative sample of 2,000 people in Germany was interviewed in person in 2014. Analyses of the data included frequencies of contacts with doctors, other health professionals, hospitals, and emergency services. Analysis also included a HL measure (European Health Literacy Survey Questionnaire), as well as sociodemographic and health status indicators. To test whether and how HL is related to the frequency of use of the different types of curative health services, regression analyses were performed. Key Results: Respondents with lower HL scores reported more frequent use of all four included types of curative health services. Although multiple regression analysis showed a direct significant effect of HL only on doctor (β = −.066) and other health professionals visits (β = −.103), no significant direct effect of HL on hospital and emergency services use was found when sociodemographic and health-related factors were controlled for. Conclusions: Health professionals should be aware that their patients are likely to have difficulties in understanding and processing health-related information. Interventions to strengthen HL should aim at improving health care literacy and, moreover, not only address individuals but also consider demands related to the health care system and health professionals' communication skills. Plain Language Summary: This study investigates the relationship between health literacy and health service use in Germany. The results show that health services are used more often by individuals with low health literacy. Thus, health professionals need to take low health literacy into account in their communication with patients. [ HLRP: Health Literacy Research and Practice. 2018;2(2):e115–e122.]

This case report presents three cases of Meigs' syndrome: a benign ovarian tumor with ascites and a hydrothorax. After removal of the ovarian tumor, the symptoms resolved and the patients became asymptomatic. In daily practice, Meigs' syndrome is at first sight often mistaken for ovarian cancer. With this case report we would like to emphasize that the clinical presentation of an ovarian tumor might be ovarian cancer, but can masquerade as something uncommon like Meigs' syndrome. In a time span of two years we encountered three cases.

The International Union for Health Promotion and Education (IUHPE) Position Statement on Health Literacy provides an overview of existing evidence and continuing debate on health literacy. Developed by the IUHPE Global Working Group on Health Literacy, including experts from around the globe, the Statement provides a basis for discussion and advocacy, by and with IUHPE, both within the health promotion community, and among stakeholders and partners in health promotion. The Statement offers a detailed introduction to the concept of health literacy, calling for global action to improve health literacy in populations. It positions health literacy as an important and modifiable social determinant of health, that plays a significant role in broadly-based strategies for health promotion. The Statement emphasises the necessity of a systems approach to health literacy, underpinned by global, national, regional and local policies. It summarises key evidence to guide practice and policy development, recognising the importance of continued investment in intervention research, in professional and consumer capacity building, and in the transfer of research findings into frontline health promotion practice. In summary, health literacy is understood as an important cross-cutting issue in health promotion throughout the lifespan, which has practical application in guiding clinical practice, public health interventions and public policy for the advancement of global health.

Single coronary artery is a rare congenital coronary artery anomaly. It can be associated with myocardial ischemia, increased risk of sudden cardiac death or other congenital cardiac anomalies. The authors present a case of isolated single coronary artery with origin of the right coronary artery (RCA) from the left circumflex artery (LCx) with benign course, found on coronary angiography and computed tomography coronary angiography. A 79-years old female patient presenting with shortness of breath and atypical chest pain was examined. No significant stenosis was detected, and the patient was dismissed from the hospital with adjustment of her medication only. The contribution of conventional coronary angiography, and cardiac computed tomography for meticulous anatomic depiction of coronary arteries is discussed.

This in-depth survey of salutogenesis shows the breadth and strengths of this innovative perspective on health promotion, health care, and wellness. Background and historical chapters trace the development of the salutogenic model of health, and flesh out the central concepts, most notably generalized resistance resources and the sense of coherence, that differentiate it from pathogenesis. From there, experts describe a range of real-world applications within and outside health contexts, from positive psychology to geriatrics, from small towns to corrections facilities, and from school and workplace to professional training. Perspectives from scholars publishing in languages other than English show the global relevance of the field.Among the topics in the Handbook: Emerging ideas relevant to the salutogenic model of health Specific resistance resources in the salutogenic model of health The sense of coherence and its measurement The application of salutogenesis in communities and neighborhoods The application of salutogenesis to health development in youth with chronic conditions The application of salutogenesis in mental health care settings The Handbook of Salutogenesis summarizes an increasingly salient field for graduate and professional students of public health, nursing, psychology, and medicine, and for their instructors. It will also appeal to health-related academicians and professionals who wish to have a thorough grounding in the topic.

Christa Pelikan: 0000–0002–5526–8878 Mario Ragazzi: 0000–0002–6913–4264 This chapter offers a comparative discussion of the meaning, practices and implications of ‘active participation’ in the specific settings of our project. Drawing up a critical appraisal of the literature on new governance models and radical practices from the 1960s onwards, the authors analyse participatory processes in the four action research sites along the key dimensions of stakeholder selection, their decision-making powers and ownership of resources. This research highlights an emergent potential role of restorative justice as a balancing factor, increasing active participation in highly institutionalised contexts like Vienna, while making it more inclusive in socio-ethnically polarised situations where bottom-up initiatives may tend to reinforce in-group dynamics.

Objective Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, “The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services”. Methods A generic literature review was conducted followed by a Delphi procedure to prepare the New Haven Recommendations. From systems theory perspective, three conceptual levels are used to map action areas to enhance patient and family engaged care. Results The recommendations propose a multilevel approach to enable patient, family, (and citizen representatives’) involvement (a) within direct service provision; (b) among hospitals and health services; (c) in planning healthcare delivery systems and policy. Conclusion The New Haven Recommendations provide a strategic tool and practical recommendations, which can be used for reflection on current practices or generating new ways of thinking about patient and family engaged care. They support the development of patient and family engaged care as core aspect of high quality healthcare, and can contribute to achieving the Ottawa Charter’s claim of reorienting health services. Practice implications The potential benefit of the multilevel approach is to reorient the basic culture of healthcare towards patient- and health-centered care.

The role of health-related behaviors in the association between age and health literacy has not been well-elucidated. The present cross-sectional study evaluated the interactions between age and health-related behaviors in 942 women in Taiwan between February and October 2013. Women aged 18-78 years were randomly sampled and recruited from the national administrative system. Self-reported health literacy was measured by the European Health Literacy Survey Questionnaire (HLS-EU-Q47) in Mandarin, asking about sociodemographics and essential health-related behaviors (watching health-related television, community involvement). The interviews were conducted confidentially by well-trained interviewers after having participants' consent. In multiple linear regression models adjusted for education attainment, self-perceived social status, ability to pay for medication, and health-related behaviors, health literacy was significantly negatively related to age (unstandardized regression coefficient, B = -0.04; 95% confidence interval [CI] = (-0.07; 0.00); p = .03). The lower health literacy among older women was significantly modified by watching health-related television programs (from "rarely/not-at-all", B = -0.08 (-0.12, -0.04), p.001 to "often"; B = 0.10 (0.07, 0.12); p.001) and community involvement (from "rarely/not-at-all", B = -0.06 (-0.10, -0.03); p = .001 to "often", B = 0.06 (0.03, 0.08); p.001). Specific health behaviors were protective of older women's health literacy and likely their health.

Email flooding, deleting emails without reading them – both common parts of our daily workflows. Emails need to motivate their recipients to read them and of course, the number of emails we receive every day play a crucial role. The present paper shall not only describe how the email communication between the members of a research project could be enhanced, but also show how helpful emails are for implementing strategic communication optimisation. By involving the project members as probands in a study based on AMASA (Research project “Accessing Medicines in Africa and South Asia”) emails for developing a restructuring of the internal communication, the process of communication optimisation was accepted by the project members and the strategic superiour aims could be met.