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Demographic and social development in Germany has increased the pressure on the statutory health insurance funds to stabilize the financing of the social health insurance system as well as the quality and range of healthcare provision. For the latter, rules concerning integrated healthcare, established in the Social Health Insurance Modernization Act of 2003, provide new flexibility for statutory health insurance funds and healthcare providers. Both are now able to establish integrated healthcare programmes with new process routines or technologies. They also imply opportunities for patients to receive high-grade medical healthcare in combination with better service components. The motivation for statutory health insurance funds to develop and introduce such new healthcare provision programmes is often based on an urgent need for action as in the case of cardiovascular diseases; the number one cause of death in Germany. To eliminate deficits in healthcare provision, statutory health insurance funds together with innovative healthcare providers use new, at least for the German social health insurance system, technologies such as telemonitoring. The evaluation of integrated healthcare projects such as ‘telemedicine for the heart’ show that the use of telemonitoring systems can positively contribute to the course of cardiovascular diseases. The introduction of nationwide healthcare programmes and new technologies is very difficult in the current framework for healthcare planning and reimbursement. More flexible contracting conditions between statutory health insurance funds and healthcare providers will promote the widespread adoption of new technologies, such as telemonitoring, and a decrease in the use of isolated applications. [ABSTRACT FROM AUTHOR]

Sampling points belonging to the Harz National Park river system, Germany, were selected between the period of 2014 and 2017 for monitoring polycyclic aromatic hydrocarbons (PAHs), polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs) in water, air, and sediment. Triolein-containing Virtual Organisms (VO) were employed to assess the levels of chemicals in water, air and triolein as surrogate for natural fat. To avoid overestimation of the concentrations 20 performance reference compounds (PRCs)-16 PRCs-PAHs and 4 PRCs-PCBs were covering the range of properties of native compounds. Results manifested the highest concentration of individual PAH as follows: 31 ng fluoranthene/L water, 3600 ng pyrene/g fat, 62 ng phenanthrene/m 3 air and 2800 ng fluoranthene/g dw sediment. All PCBs and OCPs values were below above mentioned PAH concentrations and far below EU-limit levels. Environmental partition of chemicals was investigated by calculating fugacity, suggesting a mass transport from water to air. Only quite volatile compounds such as hexachlorobutadiene showed higher fugacity in air. Ratios of sediment/water concentrations and log Kow within individual sampling periods at Holtemme River exhibited strong linear relationships. Interestingly, during summer months of the years water and fat contents well correlate to the flow rates of Holtemme River. Our results show that VO can be successfully used as a tool for ongoing exposure assessment studies and predictions of worst case levels in food and nutrition., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

The cross-cultural testing of scales represents an important step in the scale validation process. The present study evaluated whether the eight-item short version of the recently developed Food Disgust Scale (FDS-short) is a reliable and valid tool for measuring food disgust sensitivity in ten countries: Australia, China, England, France, Germany, Mexico, South Africa, Spain, Sweden, and the USA. In an online survey, the participants (N = 6128) answered items from the FDS-short and other scales related to (food) disgust sensitivity so as to test the construct and criterion validity of the FDS-short. Confirmatory factor analysis of the one-factor structure of the FDS-short revealed an adequate to good model fit in all the countries except for China. Multiple group analysis to test measurement invariance showed the FDS-short to be metrically invariant in all the tested countries (except for China) relative to Australia. With regard to the construct validity, significant positive correlations were observed in all the countries between the FDS-short and pathogen disgust sensitivity, sexual disgust sensitivity, moral disgust sensitivity, germ aversion, and food neophobia. Criterion validity of the FDS-short in all the tested countries was confirmed by the positive correlations between it and having a sensitive stomach, experiencing gastrointestinal complaints after eating animal-based foods (except for France and Germany), and the perceived infection risk of food-borne diseases in one's country. The direction of the correlations indicated that for each country, those with higher FDS-short scores also scored higher on all the tested constructs than those with lower FDS-short scores. Taken together, the present results indicate that the FDS-short is a reliable and valid tool for assessing food disgust sensitivity across countries., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The occurrence of bromocarbazoles and chlorocarbazoles was studied in 86 forest soil samples from different regions in Germany. Carbazole, 3-chlorocarbazole, 3-bromocarbazole and 3,6-dibromocarbazole were qualitatively detected in the humic layer of 59 soil samples with bromocarbazoles reported here for the first time in soil. Furthermore, the halogenated carbazoles, PCDD/Fs and PCBs were detected in the humic and mineral soil horizons (0-5 cm and 5-10 cm) of a subset of 11 soil samples subjected to quantitative analysis. Concentrations ranged from 0.6 to 267.6 ng/g (carbazole); 0.2-7.2 ng/g (3-bromocarbazole); 0.0-9.1 ng/g (3-chlorocarbazole); 0.2-19.8 ng/g (3,6-dibromocarbazole); 0.4-67.6 ng/g (3,6-dichlorocarbazole); 0.0-0.7 ng/g (PCDDs); 0.0-0.3 ng/g (PCDFs) and 0.0-33.7 ng/g (PCBs). Concentrations decreased with depth and correlated positively to total organic carbon (TOC). When it was based on TOC%, an increase in concentration with depth was observed in most soil samples. With respect to dioxin-like toxicity, 3-bromocarbazole, 3-chlorocarbazole, 3,6-dibromocarbazole and 3,6-dichlorocarbazoles caused induction of CYP1A1-dependent EROD activity in HII4E rat hepatoma cell line. Their relative effect potency after 72 h exposure ranged from 0.00005 to 0.00013 and was directly related to the degree of halogenation with 2,3,7,8-tetrachlorodibenzo-p-dioxin as reference. Furthermore, their contribution to overall soil dioxin-like toxicity was not significant in comparison to PCDD/Fs and PCBs though the sum toxic equivalency was limited to three halogenated carbazole congeners. Bromocarbazoles and chlorocarbazoles are emerging dioxin-like toxic environmental contaminants with potential for wide distribution occurring simultaneously with PCDD/Fs and PCBs., (Copyright © 2016 Elsevier Ltd. All rights reserved.)