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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, self-management 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 HL scored 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 diabetes outcomes 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 this study, further investigation is necessary to support these findings and improve our understanding about the impact of HL on DSME programmes' effectiveness.

Concerning the determinants of health literacy (HL) mostly socio-demographic or -economic factors have been considered, much less so psychological factors such as self-efficacy. To date, it has mostly been considered to explain the relationship of HL and health outcomes. However, self-efficacy could also be an important determinant for HL. This study therefore examines the effect of self-efficacy on comprehensive HL within the general population in Germany. Data from the German HL Survey (HLS-GER), a cross-sectional, computer-assisted personal interview study among 2000 respondents aged 15+ years in 2014 were used. Self-efficacy was measured using the German version of general self-efficacy short scale (ASKU), comprehensive HL was measured using the German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). Correlation and multi-variate linear regression analyses were performed to analyze independent effects of socio-demographic factors—age, gender, social status, educational level and migration background—functional HL and self-efficacy on comprehensive HL. Self-efficacy and comprehensive HL are statistically significantly correlated (Spearman's Rho = 0.405; p  < 0.01), respondents with better self-efficacy had better HL scores. Both concepts are significantly associated with most socio-demographic factors and functional HL. Self-efficacy showed the strongest association with HL in the multivariate analyses (model 2: β =0.310, p  < 0.001). The effect size of the other predictors decreased, when adding self-efficacy into the equation, but remained statistically significant. Self-efficacy is a rather strong predictor of comprehensive HL. Future research and measures to improve HL should therefore take self-efficacy adequately into account. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has negatively impacted mobility worldwide. As a corollary, the health of top- and lower-level athletes alike is profoundly reliant on movement and exercise. Thus, the aim of this study is to understand impacts of the COVID-19 pandemic lockdown on athletes' motivation to exercise and train. In detail, we aim to better understand who (i.e., demographic, sport-specific, and psychological state and trait variables) reported a change in motivation to train due to the lockdown, why they reported lower motivation (i.e., open-ended questions on problems), what they did to help themselves, what support they received from others, and what they are looking forward to after the lockdown (i.e., open questions). Questionnaire data and answers to these open-ended questions were assessed via an online questionnaire, completed by 95 amateur and recreational athletes during the first COVID-19 lockdown in Germany (April to mid-May 2020). Results show that greater numbers of female athletes are less motivated to train in comparison to male athletes (p = 0.029). No differences in motivation were found regarding type of sport (individual vs. team sport) and number of competitions during the year. Also, more motivated to train amateur and recreational athletes showed lower athletic identity than athletes who reported no change in motivation to exercise during the lockdown (p = 0.03). Additionally, differences in state emotional, perceived stress, and personality variables (i.e., orientation to happiness, volition) were found between athletes who stated that they were less motivated to train compared to athletes who reported no changes in motivation. In particular, closure of sports facilities and social distancing measures were perceived to be highly problematic. Even though athletes received emotional support, organized themselves via routines and schedules, and trained using online tools, they predominately stated that they wished that their coaches would have supported them more. Understanding the impacts of a pandemic-related lockdown on athletes' motivation, athletes' coping strategies, and their desired support will help better support them in future crises. [ABSTRACT FROM AUTHOR]

The German Biosecurity Programme was launched in 2013 with the aim to support partner countries overcome biological threats including natural outbreaks or the intentional misuse of highly pathogenic agents. As part of this programme, this paper describes the development and implementation of a multilateral biosafety and biosecurity training initiative, called 'Global Partnership Initiated Biosecurity Academia for Controlling Health Threats' (GIBACHT). To achieve its objectives, GIBACHT implemented a blended-learning approach with self-directed, distance-based learning phases and three training-of-trainer workshops. The programme follows Kirkpatrick's model of learning to guarantee sustainable effects of improved knowledge and skills. One hundred nine fellows from 26 countries have been trained in seven cohorts. Many GIBACHT alumni have established additional biosafety/biosecurity trainings in their home countries. The knowledge exchange is strengthened by the implementation of a Moodle-based alumni network. GIBACHT has the potential to contribute to strengthening the capacities of partner countries in Africa, the Middle East, and South and Central Asia to respond and build resilience to biological threats., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mertens, Zimmermann, Dywicki, Lee, Pelikan, Bürkin, Rutebemberwa and Hoffmann.)

The Russian language is the eighth most spoken language in the world. Russian speakers reside in Russia, across the former Soviet Union republics, and comprise one of the largest populations of international migrants. However, little is known about their health literacy (HL) and there is limited research on HL instruments in the Russian language. The purpose of this study was to adapt the Health Literacy Questionnaire (HLS 19 -Q) developed within the Health Literacy Survey 2019-2021 (HLS 19 ) to the Russian language to study HL in Russian-speaking populations in Germany, Israel, Kazakhstan, Russia, and the USA. The HLS 19 -Q was translated either from English or from a national language to Russian in four countries first and then critically reviewed by three Russian-speaking experts for consensus. The HLS 19 protocol and "team approach" method were used for linguistic and cultural adaptation. The most challenging was the adaptation of HLS 19 -Q questions to each country's healthcare system while general HL questions were flexible and adaptable to specific contexts across all countries. This study provides recommendations for the linguistic and cultural adaptation of HLS 19 -Q into different languages and can serve as an example of international collaboration towards this end.

Concerning the determinants of health literacy (HL) mostly socio-demographic or -economic factors have been considered, much less so psychological factors such as self-efficacy. To date, it has mostly been considered to explain the relationship of HL and health outcomes. However, self-efficacy could also be an important determinant for HL. This study therefore examines the effect of self-efficacy on comprehensive HL within the general population in Germany. Data from the German HL Survey (HLS-GER), a cross-sectional, computer-assisted personal interview study among 2000 respondents aged 15+ years in 2014 were used. Self-efficacy was measured using the German version of general self-efficacy short scale (ASKU), comprehensive HL was measured using the German version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47). Correlation and multi-variate linear regression analyses were performed to analyze independent effects of socio-demographic factors-age, gender, social status, educational level and migration background-functional HL and self-efficacy on comprehensive HL. Self-efficacy and comprehensive HL are statistically significantly correlated (Spearman's Rho = 0.405; p < 0.01), respondents with better self-efficacy had better HL scores. Both concepts are significantly associated with most socio-demographic factors and functional HL. Self-efficacy showed the strongest association with HL in the multivariate analyses (model 2: β =0.310, p < 0.001). The effect size of the other predictors decreased, when adding self-efficacy into the equation, but remained statistically significant. Self-efficacy is a rather strong predictor of comprehensive HL. Future research and measures to improve HL should therefore take self-efficacy adequately into account., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Self-management education (SME) is a key determinant of diabetes treatment outcomes. While SME programs are often adapted for implementation, the impact of adaptations on diabetes SME effectiveness is not well documented. This study evaluated the impact of the implementation fidelity of diabetes SME programs on program effectiveness, exploring which factors influence implementation fidelity. Data from 33 type 2 diabetes SME program providers and 166 patients were collected in 8 countries (Austria, Belgium, Germany, Ireland, UK, Israel, Taiwan and USA). Program providers completed a questionnaire assessing their adherence to the program protocol and factors that influenced the implementation. Patients answered a pre-post questionnaire assessing their diabetes-related health literacy, self-care behavior, general health and well-being. Associations between implementation fidelity and outcomes were estimated through logistic regressions and repeated measures MANOVA, controlling for potential confounders. Adaptations of the program protocol regarding content, duration, frequency and/or coverage were reported by 39% of the providers and were associated with better, not worse, outcomes than strict adherence. None of the factors related to the participants, facilitating strategies, provider or context systematically influenced the implementation fidelity. Future research should focus on individual and contextual factors that may influence decisions to adapt SME programs for diabetes.

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., Competing Interests: Dr. Christoph Kowalski ist Mitarbeiter der Deutschen Krebsgesellschaft. Alle anderen Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In Germany there are many successful special applications of telemedicine. However, these projects are generally not extendable to the whole nation because of the highly complex German health care system, limited funding, heterogeneous IT standards in ambulatory and hospital care, insufficient official electronic health card use, the different data protection and privacy regulations of the federal and state governments, doubts of physicians and patients as well as unequal costs and benefits for the various persons involved in telemedicine. These problems can be overcome by better legal regulations for a seamless interaction of ambulatory and hospital care, improved IT standards and support of the interoperability of telemedical and other health care IT, adaption of the health care organization, work flow and reimbursement of telemedicine services, better information and education of all persons involved about the necessity and limits of telemedicine. There are no doubts about the benefits of telemedicine but to achieve these advantages for the whole healthcare system in Germany requires much work, time and good will.

In large installations of a Picture Archiving and Communication System (PACS), data protection becomes an issue. Above all, not every employee should have access to all data stored in the system. At the Freiburg University Hospital, we developed a concept of dynamic assignment of authorization, assuring that every physician is authorized to the data of all patients under his care. We describe the technical implementation of data protection developed for the integration of PACS and electronic patient records in Freiburg. The system was installed in January 2001 and the experience of its two years in operation is reported.

Modern network technologies provide the basic infrastructure for information and communication systems in the hospital today. The goal to build up a universal network infrastructure which meets the broadly varied requirements. Analysis of data communication in the hospital and the evaluation of established network technologies, as well as new developments, leads to the switching concept as the suitable solution. Two technologies play the major role in building enterprise networks: the Ethernet family, based on frame switching, and ATM, based on cell switching. Orientation on established standards is the key to free system choice and grants interoperability between systems from different manufacturers. However, the network design must meet the application and system architecture of the information technology in order to achieve successful mapping of the involved communication profiles. This means scaling of the bandwidth as needed, suitable segmenting of the network and resilient links. In a further step, policy-based networking takes advantages of prioritizing critical applications and therefore reduces interdependencies across the network.

Since 1996 a picture archiving and communications system (PACS) is installed at the university hospital of Freiburg. The PACS is integrated in the hospital information system (HIS) and several modalities of different vendors are attached to it. During the implementation phase three critical factors to the success of our PACS installation where identified: the support of the workflow, the interface of the radiological information system (RIS) to the modalities, and the security policy to allow hospital-wide access to the images and results in the PACS.