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Background: There are significant regional differences in antibiotic prescribing behaviour. The reasons for this are still largely unknown. Beneath demographic and morbidity-related factors, doctor-specific or "cultural" factors may also play a role. A differentiated analysis including diagnostic data is needed to put these data into context., Methods: A data analysis with secondary data available via the Westphalia-Lippe Association of Statutory Health Insurance Physicians (KVWL) was conducted on infection diagnoses and antibiotic prescriptions of outpatient paediatricians in the KV district of Bielefeld from 2015 to 2018. In addition, algorithmized 1:1 connections between diagnoses and prescriptions were performed., Results: For 262,969 "medication patients" (AMP), 28,248 antibiotic prescriptions and 90,044 infection diagnoses were evaluated, from which 11,131 1:1 connections could be generated. Concerning the prescribing behaviour of individual paediatric GP offices, after adjusting for the denominator AMP and despite a comparable age and gender structure, there were some significant differences. This affected both the frequency of prescriptions and the qualitative composition of the substance groups prescribed., Discussion: The differences in antibiotic prescribing behaviour, even at GP office level, cannot be adequately explained by the demographic composition or different morbidities of the respective clientele. Individual attitudes and local prescribing cultures are likely to play a relevant role. To address these offers an important approach for antibiotic stewardship (ABS). In addition to the area of outpatient paediatrics presented here, the methodology described can also be used as a model for more detailed analysis in other outpatient speciality groups., (© 2024. The Author(s).)

Objectives: Few studies have assessed whether refugees' health is associated with accommodation characteristics. We aimed to devise a typology of refugee accommodation based on variables on the accommodation and its physical context before assessing its association with health in multivariate analyses. Methods: We performed a cluster analysis based on a hierarchal, agglomerative clustering algorithm using Euclidean Distance and Ward's method. We analysed accommodation clusters based on number of inhabitants, degree of housing deterioration, urbanity of location (urban/rural distinction), and remoteness (walking distance to shops, medical or administrative services). In total, we analysed health and accommodation data of 412 refugees and asylum seekers from 58 different accommodation facilities in the federal state of Baden-Württemberg in the south-west of Germany. Results: Accommodations with a moderate occupation, lowest levels of deterioration, and a central urban location showed the best health outcomes in terms of subjective general health status, depression, and generalized anxiety disorder (GAD). Associations were strongest for GAD and weakest for depression. Conclusion: Our findings inform policymakers on layout and location of refugee collective accommodation centres., Competing Interests: The authors declare that they do not have any conflicts of interest., (Copyright © 2023 Mohsenpour, Dudek, Bozorgmehr, Biddle, Razum and Sauzet.)

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.

The Public Health Service (PHS) in Germany has had difficulties in recruiting enough qualified staff for years, but there is limited research on what factors drive decisions to (not) join the PHS workforce. We explored reasons for this perceived (lack of) attractiveness. We conducted two cross-sectional surveys among medical students (MS), public health students and students from other PHS-relevant fields (PH&ONM) in Germany before (2019/2020) and during the COVID-19 pandemic (2021). Both waves surveyed self-reported reasons for why students did (not) consider working in the PHS as attractive and how this could be improved, using open-question items. Qualitative and quantitative content analyses were conducted according to Mayring. In total, 948 MS and 445 PH&ONM provided valid written responses. Reasons for considering the PHS as attractive were, among others, the perception of a good work-life balance, high impact, population health focus, and generally interesting occupations. Suggestions to increase attractiveness included reducing bureaucracy, modernization/digitalization, and more acknowledgement of non-medical professionals. Among MS, reasons against were too little clinical/patient-related activities, low salary, and occupations regarded as boring. Our findings indicate areas for improvement for image, working conditions in, and institutional structures of the PHS in Germany to increase its attractiveness as an employer among young professionals.

Background: Public health actors contribute significantly to health protection, promotion, and prevention at the population level. An overview of the public health landscape can facilitate collaboration among the stakeholders and increase transparency of career paths for young professionals., Objectives: This study aims to develop an overview and category system of supra-regional public health actors in Germany., Methods: Based on a list of institutional actors that participated in the national conference Future Forum Public Health ("Zukunftsforum Public Health") and a targeted online search by the authors, supra-regional institutions and organizations with a public health focus were identified. All actors were screened independently by ≥ 2 authors. Community-level actors as well as those without a direct public health focus were excluded. Additional actors were identified via a snowballing process. In order to cluster the actors thematically, a category system was formed inductively., Results: Out of a total of 645 screened actors, 307 (47.6%) were included and subsequently assigned to 12 main and 30 subcategories. Professional associations (n = 60) made up the largest category, followed by civil society (n = 49) and state actors (n = 40). In addition to a tabular and graphical overview, an interactive visualization of the actors was created ( www.noeg.org )., Conclusions: This study provides a comprehensive overview of supra-regional institutional public health actors in Germany and highlights the breadth of the German public health landscape. The results of this work offer new opportunities for collaboration and can support young professionals in their career paths. Building on this work, further research on public health actors is recommended., (© 2021. The Author(s).)

The Covid-19 pandemic poses a major challenge for the management of collective accommodation centres for refugees. The often-overcrowded facilities hinder satisfactory implementation of social distancing and hygiene practices. Adequate information policies as well as a rapid, efficient management of suspected and confirmed Covid-19 cases are essential. However, scientific evidence on this is largely lacking. Besides partially implemented approaches, such as isolation areas or cluster quarantine, plans to evacuate overcrowded facilities should also be considered. The German Public Health Service (ÖGD) plays a vital role in the current Covid-19 pandemic. In order to fulfil their routine tasks of infection control and support health services management for refugee accommodation centres, the ÖGD urgently needs to be strengthened in terms of personnel and material. Additionally, means for a rapid exchange of best practice examples of Covid-19 interventions across federal states as well as collaborative structures and capacity within the ÖGD for accompanying operational research are needed. Refugees, their housing situation and their access to health care need to be included in pandemic plans. Only an integrative health care system can achieve regional and international targets for the control of Covid-19 and other infectious diseases., Competing Interests: KB leitet das PriCare-Projekt und die Entwicklung der nicht-kommerziellen RefCare-Software; OR ist Mitglied des wissenschaftlichen Beirats des PriCare-Projekts sowie des Steuerungskreises des Zukunftsforums Public Health. AM ist Mitglied des Nachwuchsnetzwerk Öffentliche Gesundheit (NÖG). VP gibt keine Interessenkonflikte an., (© Georg Thieme Verlag KG Stuttgart · New York.)

The current reform process of Germany's public health system has opened a window of opportunity for strengthening this field in research, policy and practice in Germany. The present article discusses challenges and necessary measures from the perspective of young professionals. The authors argue that public health education and training in Germany needs to be strengthened and reformed. Moreover, Germany's public health community must create and strengthen structures and processes needed to make its voice heard more strongly in politics and society, including an effective professional organization. Discussions on these challenges have begun in a number of fora and should be translated into concrete actions soon., Competing Interests: Die AutorInnen geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)