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We explore the relationship between newcomer refugee families' linguistic competencies in the language of the host country and their collaboration in and with the school. Following a case study design and through the qualitative analysis of interviews with refugee family members and school staff from a German primary school, we analyse these actors' perspectives on factors hindering and/or supporting the involvement of the families and the responsiveness of the school. In the literature, family language policies and host country linguistic and educational policies are framed as some of those factors, but our results point towards a more fine-grained consideration of the role played by language(s) in the cooperation between newcomer refugee families and the school. Our study reveals the importance of considering linguistic skills in the majority language alongside literacy practices and parents' (schooling) paths in the home country, and claims that differentiated opportunities for collaboration should be offered depending on refugee families' trajectories in the home and host countries.

Many metropolitan cities have undergone rapid demographic changes in recent years, and such changes hasten and widen linguistic diversities. Similar changes are happening in Sydney, Australia and Hamburg, Germany. These changes are most acutely felt and observed in the classrooms where multiple languages are spoken, despite a prevalent monolingual mindset in education in both these contexts. What do pre-service teachers think of language learning and multilingualism in the face of demographic and sociolinguistic changes? This is a particularly urgent question for pre-service teachers, whose perspectives on multilingualism will considerably influence on how their students view language learning and maintenance. Based on a survey of 436 pre-service teachers in Sydney and Hamburg, this comparative study explores the relationship between their linguistic profiles (monolingual, multilingual and how they become multilinguals) and the way they perceive societal multilingualism and the need to promote multilingual education to all. The findings suggest that formal language education, more than heritage backgrounds and knowledge, provided the necessary experience to foster a more open attitude towards societal multilingualism and language learning.

Despite the global trend of growing diversity in student enrolment, most teacher education programmes remain inward-looking, oriented to national core standards and resist academic calls for internationalisation. While we agree that internationalisation at home is possible under certain circumstances, we put forward the argument that dialogic contact between student teachers in different national contexts has the potential to foster teacher education students' intercultural competence and offer opportunities for professional development that go beyond those offered by traditional programmes. This paper reports on the creation of a virtual transnational 'third place' for teacher education students based in Hamburg and Sydney, built around the mutual analysis of their respective visual linguistic biographies. We will show that such a transnational space and reflexive activity enhances student teachers' awareness of what it means to be and become a multilingual subject in other parts of the world, thus promoting self-awareness and the ability to decentre. Additionally, we claim that these activities have the potential to enhance teacher education students' attitudes towards the implementation of multilingual pedagogies.

In this contribution, I reflect on how multilingual pedagogies can be added to STEM and S.T.E.M. practices, in what could be called a "double-crossing": on the one hand, crossing linguistic boundaries and, on the other, crossing specific subject knowledge. Based on a content analysis of teachers' interviews referring to their pedagogical experiences with a multilingual platform providing subject content in several languages, I reflect on the extent to which and how multilingual STEM and S.T.E.M. pedagogies are implemented and accounted for. More specifically, I analyse the arguments put forward by teachers for using or not using multilingual practices in STEM and S.T.E.M. and I delve into the apparent contradictions underlying the fact that, despite using a multilingual platform, its multilingual affordances are sometimes overlooked, underestimated or even used in monolingualised practices in multilingual settings.

This article investigates how linguistic landscapes (LLs) can foster critical thinking about linguistic power relations and tensions in multilingual areas by acting as stimuli to reflect on the ethnolinguistic vitality of languages in a given region. We examine the pedagogical use of LLs as resources for the implementation of plurilingual pedagogies in mainstream secondary school classrooms in two distinct sites: Germany and the Netherlands. Data was collected through classroom observations, interviews with teachers, and students' assignments and questionnaires. Analysis included an examination of how students validate their linguistic and semiotic practices and those of the Other through different approaches to LL in the classroom. Results show that in the Netherlands, students and teachers co-constructed the research on LL by critically reflecting on visibility issues in their LL research; in Germany, students and teachers engaged in collaborative sequences of meaning-making based on preselected examples of the LL of their surroundings. In both sites, teachers' attitudes were central in fostering classroom interaction to enhance students' reflexivity and criticality. This study is significant as it confirms the added value of using LLs as resources for developing critical language awareness through challenging "banal monolingualism" in highly linguistic diverse classrooms and as a path towards empowerment.

After a theoretical overview of the concept of heritage language (HL) from a plurilingual perspective, we will describe the project "Images on the (teaching of) Portuguese Language abroad". For this project, several drawings were collected, produced by lusodescendant children living in Germany and attending supplementary Portuguese lessons. We will analyze four tendencies of students' representations towards Portuguese and German, as well as towards the skills they have developed in those languages. These representations illustrate four profiles of Portuguese Heritage Language (PHL) learners present in the classroom (in terms of motivations, skills, linguistic repertoires, etc.). As conclusions, we will point at: (a) the validity of a study on representations by means of a drawing collection method, in order to understand the heterogeneity of PHL learners and the need to diversify the teaching-learning strategies; and (b) the advantages of understanding the relationships subjects establish with their languages and with the multilingual and plurilingual "milieu" they live in, in order the enhance the efficiency of HL education.

The aim of this experiment was to determine if dyad practice helped individuals become aware, use, and retain information in a dynamically changing perceptual-motor task compared with practice alone. We used a computerized perceptual-motor task, where individuals were required to intercept balls that dropped from the top of the screen. A colored line at the top of the screen provided information about the direction of the dropping ball. Participants (N = 24) were randomly assigned to one of two groups: A dyad training group where two participants alternated between physical and observational practice after each block of 20 trials, and they also engaged in dialog about the task, and an individual training group where one participant practiced the task. Both groups improved their accuracy during acquisition. On the retention test, participants in the dyad group caught significantly more balls (73%) than individuals of the alone group (58%). Participants in the dyad group also showed a higher percentage of correctly identified stimuli in the recognition task. Dyad training induced performance advantages in a perceptual-motor task because individuals became aware and used information acquired during observation and/or from the dialog.

Linguistic biographies have been increasingly used in language and teacher education, even if mainly in a written form. In this study we analyse 33 visual linguistic biographies, using drawings to examine the (re)constructions of the multilingual self. The visual linguistic biographies were produced by prospective Spanish language teachers at the University of Hamburg (Winter Semester 2017). We looked at the visual composition of the linguistic biographies and the elements which student teachers combine to trace the representation and the evolution of the multilingual self. We conclude that temporal and geographic metaphors are the most commonly represented, displaying beliefs about language learning and becoming multilingual in a succession of different languages, generally in a schooling pathway. Additionally, student teachers perceive living and studying abroad as important experiences leading to linguistic proficiency. The study suggests that students developed a multilingual imagery made up of languages acquired chronologically, these being associated with specific nation-states and kept separate from each other in individuals' repertoires. We propose that these beliefs should become a starting point for discussing complexity in trajectories of multilingual becoming and heterogeneity of multilingual repertoires.

In the context of German linguistic policies, Heritage Language (HL) education ranges from formal and informal to non-formal offers. Families with migratory backgrounds seeking acquisition and maintenance of the HL frequently resort to educational or maintenance opportunities that are not institutionalized. In the region of Bavaria (Germany), the geographical context of this study, the teaching of Portuguese as an HL (PHL) mainly occurs in non-formal and informal educational spaces. The present empirical study follows an ethnographic perspective and examines how learners' parents in such non-formal environments perceive their children's bilingualism. As a secondary focus, the linguistic educational tool 'Mala de Herança' (MH) ("Heritage Suitcase" -- "free translation") shall be examined in order to assess its possible input in shaping the bilingual individual, following Van Lier's [2004. "The Ecology and Semiotics of Language Learning. A Sociocultural Perspective." Dordrecht: Springer.] ecological approach to language teaching. The data described in the study, obtained from parents' interviews, were collected through semi-structured interviews and interpreted through content analysis. Results point towards a very heterogeneous perception of the 'bilingual child' by the parents, compatible with the reviewed literature.

This article takes the plurilingual repertoires of foreign language teachers -- and thus the teachers' linguistic diversity -- as a starting point for exploratory research into the potential of visual methods in teacher education for changing mind-sets. Describing and reflecting on the ubiquitous manifestation of a monolingual habitus in foreign language (teacher) education, we consider ways to offer linguistically responsive foreign language teacher education aiming at challenging that ethos. Reporting on a project based on the production of drawings, we present and compare the linguistic biographies of future French and Spanish teachers, using multimodal analysis. The analysis seeks to uncover whether target language (French and Spanish) and migrant background influence the visual representation of the plurilingual repertoire and of the process of becoming plurilingual. As no significant differences are observed, demonstrating the pervasiveness of the monolingual mind-set in foreign language learning and teacher education, I propose some ways forward in response to the identified language learning ideologies.

In this analysis, we overlay two lenses, politics and economics, onto the work of educators involved in welcoming and integrating newcomers into two School Boards in Ontario, Canada and in schools across the State of North Rhine, Westphalia, Germany. Although the settings are on two distant continents, for many newcomers, Canada and Germany are where they see preferable futures for themselves and their children. We will highlight both the similarities and differences in these two settings. While Canada and Germany provide a global and national context, we ask readers to pay close attention to local, subnational jurisdictions, arguing that local jurisdictions can be more flexible and adaptable to human needs. As such, we attribute high levels of educator autonomy in Germany and professional discretion and influences in Canada as successful practices. Both nations and specifically these local jurisdictions have staked their reputations as healthy democracies and economies in their educational policies and practices with respect to newcomers. While most of the world's nations have closed their borders, and use sovereignty and economics to support their decisions, Ontario and North Rhine, Westphalia have chosen a different pathway. Will they, through the work and knowledge of educators, demonstrate that education matters locally and globally?

Purpose: This study analyzed the physiological response during Yo-Yo Intermittent Recovery Level 1 (YYIR1) test and re-test by in-field ergospirometry and time-series analyses of respiratory parameters. Methods: Ten moderately trained males (23.4 ± 2.01 years, VO[subscript 2peak]= 56.81 ± 10.75 mL·kg[superscript -1]·min[superscript -1]) completed three running trials including two separate YYIR1 tests and an independent maximal performance running test with time-series analyses of gas exchange parameters. Physiological response was assessed during all tests by determination of blood lactate levels (including calculation of individual lactate threshold), heart rate, oxygen consumption and respiratory exchange ratio (RER). Results: Modeling of YYIR1 test mean VO[subscript 2] uptake kinetics over all participants revealed that VO[subscript 2] increased rapidly after the individual lactate threshold (11.49 ± 0.66 km·h[superscript -1] at 3.83 ± 0.42 mmol·L[superscript -1]) was reached with ~95% VO[subscript 2peak] at ~50% of the test duration (test, VO[subscript 2][superscript 50%]= 95.17 ± 8.74% of VO[subscript 2peak]; re-test, VO[subscript 2][superscript 50%]= 96.78 ± 7.04% of VO[subscript 2peak]). However, and despite identical YYIR1 test performance (1568 ± 364.6 m vs. 1568 ± 449.7 m, CV = 4.59%), mean VO[subscript 2peak] during YYIR1 test was 8.81 ± 5.6% higher than YYIR1 re-test (p = 0.027). Importantly, correlation of VO[subscript 2peak] with YYIR1 test performance was weak (R[superscript 2] = 0.28, p = 0.115). Conclusions: We conclude that the YYIR1 test should not be used to estimate VO[subscript 2peak]. Further studies on direct determination of gas exchange parameters during different YYI test variants are warranted.

A firm's expectation about the future business cycle is an important determinant of the decision to train apprentices, especially as German firms typically offer apprenticeships to either fill future skilled worker positions, or as a substitute for other types of labor. The current coronavirus crisis will have a strong and negative impact on the German economy, according to the current business cycle expectations of German firms. To the extent that the training decisions of firms depend on these perceptions, we expect a downward shift in firm demand for apprentices and consequently also a decrease in the equilibrium number of apprenticeship contracts. To assess the impact of changes in business cycle expectations, we analyze German data on the apprenticeship market at the state-level and at the occupation-level within states from 2007 to 2019. We apply first-differences regressions to account for unobserved heterogeneity across states and occupations, allowing us to identify the association between changes in two popular measures of business cycle expectations (the ifo Business Climate Index and the ifo Employment Barometer) and subsequent changes in the demand for apprentices, the number of new apprenticeship contracts, unfilled vacancies and unsuccessful applicants. We find that the German apprenticeship market prior to the current crisis can be characterized by excess demand for apprentices (although there are matching problems in some states, with both a high share of unfilled vacancies and a high share of unsuccessful applicants). Taking into account the most recent data on business cycle expectations up to June 2020, we estimate that the coronavirus-related decrease in firms' expectations about the business cycle can be associated with a predicted 8% decrease in firm demand for apprentices and a 6% decrease in the number of new apprenticeship positions in Germany compared to 2019 (-30,000 apprenticeship contracts; 95% confidence interval: ± 8000).

This paper addresses the issue of students' perceptions of non-native teacher authenticity, combining the literature accounts of authenticity in the fields of foreign language learning, and teacher authenticity (both teachers' skills and teachers' linguistic resources). The data Analysis from an exploratory and comparative angle, involving two European Higher Education Institutions, reveals that: (i) assessing plurilingual teachers whose mother tongue is not the language of instruction is contextually, institutionally and disciplinarily bound; (ii) students are aware of the constraints and opportunities related to the teaching situation and are willing to sacrifice some 'correctness' in order to gain in multilingual and intercultural 'depth'.

Objective The objective of this study was to synthesize the evidence from systematic reviews on the efficacy of physical therapy and exercise therapy, including interventional elements explicitly aiming at physical activity promotion (PAP) in patients with noncommunicable diseases (NCDs). Methods PubMed, Scopus, PsycINFO, and Cochrane Database of Systematic Reviews were searched from inception to February 28, 2023. Two independent reviewers screened the literature to identify systematic reviews that evaluated the effects of physical therapy and exercise therapy, including PAP interventions. Patient-reported and device-based measures of physical activity (PA) outcomes were included. Qualitative and quantitative data from systematic reviews were extracted by 2 independent reviewers. Assessment of the methodological quality of the included systematic reviews was performed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We assessed primary study overlap by calculating the corrected covered area and conducted the evidence synthesis in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Results Fourteen systematic reviews were included in the present overview, including patients with a variety of NCDs. Most included systematic reviews had critically low (n  = 5) to low (n  = 7) methodological quality. Most meta-analyses (67%; 8/12) provided evidence supporting the short- and long-term efficacy of PAP interventions, but not all pooled estimates were clinically relevant. Only three of the systematic reviews with meta-analysis included an assessment of the certainty of the evidence. The evidence from systematic reviews without meta-analysis was inconclusive. Conclusions The results of the present overview suggest that PAP interventions in physical therapy or exercise therapy may be effective in improving PA for patients with NCDs in the short and long term. The results should be interpreted with caution due to the limited certainty of evidence and critically low-to-low methodological quality of the included systematic reviews. Both high-quality primary studies and systematic reviews are required to confirm these results. Impact There is limited evidence that PAP interventions in physical therapy and exercise therapy may be effective in improving PA for patients with NCDs. [ABSTRACT FROM AUTHOR]

Background: Although the nursing sector gains growing importance in an aging society, students representing the future workforce often show insufficient health. Acknowledging the health-enhancing effects of adequate physical activity, the educational system in Bavaria, Germany, has recently integrated the promotion of physical activity-related health competence (PAHCO) into the nursing curriculum. However, it cannot be assumed that PAHCO has sufficiently permeated the educational practices and routines of the nursing schools. Therefore, the goal of the present study is to examine and compare the effectiveness as well as implementation of different intervention approaches to address PAHCO in the Bavarian nursing school system. Methods: We randomly assign 16 nursing schools (cluster-based) to four study arms (bottom-up, top-down led by teachers, top down led by external physical activity experts, control group). Schools in intervention group 1 (IG-1) develop multicomponent inventions to target PAHCO via cooperative planning (preparation, planning, and implementation phase). Intervention groups 2 and 3 (IG-2, IG-3) receive both an expert-based intervention (developed through intervention mapping) via trained mediators to address PAHCO. External physical activity experts deliver the structured PAHCO intervention in IG-2, while teachers from the nursing schools themselves conduct the PAHCO intervention in IG-3. In line with a hybrid effectiveness implementation trial, we apply questionnaire-based pre-post measurements across all conditions (sample size calculation: nfinal = 636) to examine the effectiveness of the intervention approaches and, simultaneously, draw on questionnaires, interview, and protocol data to examine their implementation. We analyze quantitative effectiveness data via linear models (times-group interaction), and implementation data using descriptive distributions and content analyses. Conclusion: The study enables evidence-based decisions about the suitability of three intervention approaches to promote competencies for healthy, physically active lifestyles among nursing students. The findings inform dissemination activities to effectively reach all 185 schools of the Bavarian nursing system. Trial registration: Clinical trials NCT05817396. Registered on April 18, 2023. [ABSTRACT FROM AUTHOR]

Religiosity influences economic behavior in various domains, but what determines religiosity? Using data from the representative Socio‐Economic Panel Study for Germany (SOEP), this paper shows that religious activity increases after a family member's death. The life event's effect is larger after a partner's death when compared to a parent's death. Our results indicate that the influence of a family member's death on religious activity is temporary and are consistent with the religious coping hypothesis. [ABSTRACT FROM AUTHOR]

Background: Learning arrangements in health care profession education are increasingly taking place in digital environments. Virtual reality (VR) in nursing education, as a digital element, is the subject of controversial debate. On one hand, it supports the authenticity of case studies by adding realistic perspectives and information. On the other hand, the costs of developing and maintaining software and hardware hinder its long-term implementation. Based in the German context, our aim is to promote the adoption of innovative digital methods in nursing education and to offer invaluable experiences from the field. Methods: In this paper, we describe our findings and insights from two different research projects focused on the incorporation of digital tools, particularly VR, into nursing education. Results: Starting with a brief recapitulation of the projects, we elucidate pedagogical strategies for embedding VR-driven scenarios in nursing education. Based on our experiences during the projects, we identify various positive aspects, such as changing perspective and simulating acute situations. Key findings: Although potential drawbacks remain, we advocate the long-term implementation and specific use of VR at the interface between theory and practice. Nevertheless, it is crucial to establish regular evaluation, observing the value of digitalisation, especially VR, for nursing education. [ABSTRACT FROM AUTHOR]

Many metropolitan cities have undergone rapid demographic changes in recent years, and such changes hasten and widen linguistic diversities. Similar changes are happening in Sydney, Australia and Hamburg, Germany. These changes are most acutely felt and observed in the classrooms where multiple languages are spoken, despite a prevalent monolingual mindset in education in both these contexts. What do pre-service teachers think of language learning and multilingualism in the face of demographic and sociolinguistic changes? This is a particularly urgent question for pre-service teachers, whose perspectives on multilingualism will considerably influence on how their students view language learning and maintenance. Based on a survey of 436 pre-service teachers in Sydney and Hamburg, this comparative study explores the relationship between their linguistic profiles (monolingual, multilingual and how they become multilinguals) and the way they perceive societal multilingualism and the need to promote multilingual education to all. The findings suggest that formal language education, more than heritage backgrounds and knowledge, provided the necessary experience to foster a more open attitude towards societal multilingualism and language learning. In recent years, population in many metropolitan cities has changed rapidly and such changes have resulted in more languages being spoken and used. Major cities like Sydney in Australia and Hamburg in Germany are also experiencing rapid population changes. We are now seeing more students speak and use many languages in the classroom, but English and German, respectively, are still the dominant languages used in the classrooms in the two countries. When student populations are changing, what do pre-service teachers think about language learning and multilingualism? This is an important question because teachers influence how their students think. We gave 436 Australian and German pre-service teachers a survey to find out about the languages they speak, their beliefs about languages and multilingual education. Even though many pre-service teachers come from families that speak different languages, they do not necessarily support additional language learning. From the survey, we found that when pre-service teachers learn languages at school, they are more likely to have open attitudes about multilingualism and language learning. [ABSTRACT FROM AUTHOR]

One of the few recurring characteristics in school shooters' stories is their expression of existential concerns. Many discuss their hatred of the world and existential loneliness in their manifestos, suicide letters, or social media updates. These expressions--called leaking--are made during the planning period preceding their deed. They are not only important in terms of prevention, but also help us understand the intrinsic meanings in this seemingly irrational and psychopathological behavior. This study offers a content analysis of the existential issues in personal expressions of school shooters prior to their deeds in order to shed more light on their motives.

We explore the relationship between newcomer refugee families' linguistic competencies in the language of the host country and their collaboration in and with the school. Following a case study design and through the qualitative analysis of interviews with refugee family members and school staff from a German primary school, we analyse these actors' perspectives on factors hindering and/or supporting the involvement of the families and the responsiveness of the school. In the literature, family language policies and host country linguistic and educational policies are framed as some of those factors, but our results point towards a more fine-grained consideration of the role played by language(s) in the cooperation between newcomer refugee families and the school. Our study reveals the importance of considering linguistic skills in the majority language alongside literacy practices and parents' (schooling) paths in the home country, and claims that differentiated opportunities for collaboration should be offered depending on refugee families' trajectories in the home and host countries. [ABSTRACT FROM AUTHOR]

Focusing on the topic of the development of the plurilingual and intercultural competence through the integration of electronic communicative practices both in foreign language classrooms and non-formal contexts, this work aims at defining and characterizing, in view of a co-actional perspective, a "pedagogical blog", by considering it from three different axes: a personal and social dimension, a collaborative and co-actional dimension and the management of linguistic and cultural repertoires dimension. In order to do so, this contribution presents and describes a case study which will highlight how blogs can be used in order to develop plurilingual and intercultural competences: we will present the classroom dynamics developed by the blog "Falar pelos cotovelos", a year-long project created within the scope of the teaching and learning of Portuguese as a foreign language, in a non-formal setting (non-scholar public). Throughout the discussion of this purposeful sampling, our analysis will allow us to consider pedagogical blogs as means of socialization, as instruments at the service of exolingual interaction and as time-spaces for languages and cultures.

In this article, we analyse visual narratives of multilingual children, in order to acknowledge their self-perception as multilingual selves. Through the analysis of drawings produced by children enrolled in Portuguese as heritage language (PHL) classes in Germany, we analyse how bi-/multilingual children perceive their multilingual repertoires and depict the relationship between the various multilingual and semiotic resources. The analysis describes five tendencies of representation of the multilingual self, covering diverse representations from juxtaposition to coordination of linguistic resources, and using several visual resources, such as flags and speech bubbles. The integrated analysis of children's linguistic and visual resources clarifies how they perceive their multilingualism and uncovers their multilingual awareness. We will (1) reflect on some pedagogical and political challenges that PHL classes in Germany face, regarding the enhancement of a deeper multilingual awareness; and (2) evaluate the data collection methodology, i.e. drawings as narratives about multilingualism or "multimodal translanguaging", namely its validity and usefulness in order to understand children's perceptions about multilingualism and about their multilingual selves.

This article explores the association of German attitudes toward social welfare and immigration, and how regional and political factors affect that relationship. The data was retrieved from Round 8 of the European Social Survey, which includes 2,852 German participants. Quantitative methodology was used to study the hypotheses. Analyses demonstrate that attitudes on immigration and social welfare are associated. However, the regional factor of Eastern and Western Germany and political self-placement shape the population concerning the relationship between social welfare and immigration. The immigration issue diverges the views of both the leftists and Western Germans to social welfare more than the rightists and Eastern Germans. In this respect, the immigration issue shapes the view of the German welfare state. [ABSTRACT FROM AUTHOR]

This study investigates the extent to which the factors included in the dynamic model of educational effectiveness are associated with student achievement gains in six different European countries. At classroom level, the dynamic model refers to eight factors relating to teacher behavior in the classroom: orientation, structuring, questioning, teaching-modeling, application, management of time, teacher role in making classroom a learning environment, and classroom assessment. This paper presents results concerned with the impact of the teacher factors on student achievement. In each participating country (i.e., Belgium/Flanders, Cyprus, Germany, Greece, Ireland, and Slovenia), a sample of at least 50 primary schools (n?=?334) was drawn. Written tests in mathematics and science were administered to all grade 4 students (n?=?10,742) at the beginning and at the end of the school year 2010-2011. Students were also asked to complete a questionnaire concerning the eight teacher factors of the dynamic model. Structural equation modeling techniques were used to test the construct validity of the student questionnaire. Both across and within country analyses revealed that student ratings are reliable and valid for measuring the functioning of the teacher factors included in the dynamic model. Multilevel analyses revealed that teacher factors are associated with student achievement gains in mathematics and science. Implications for the development of educational effectiveness research and for improving quality of teaching are drawn.

This paper argues for the value of using student ratings to measure quality of teaching. An international study to test the validity of the dynamic model of educational effectiveness was conducted. At classroom level, the model consists of eight factors relating to teacher behaviour: orientation, structuring, questioning, teaching modelling, application, management of time, teacher role in making classroom a learning environment and assessment. In each participating country (i.e. Belgium/Flanders, Cyprus, Germany, Greece, Ireland and Slovenia), a sample of at least 50 primary schools was used and all grade 4 students (n?=?9967) were asked to complete a questionnaire concerning the eight factors of the dynamic model. Structural equation modelling techniques were used to test the construct validity of the questionnaire. Both across- and within-country analyses revealed that student ratings are reliable and valid for measuring the functioning of the teacher factors of the dynamic model. Implications for teacher education are drawn.

Community-based health promotion has the potential to address existing health inequities, although such approaches are scarcely scaled up. For a successful scale up, various stakeholders at different levels and sectors need to be involved. The article's aims are to assess what kind of external support communities need for implementation and to identify facilitators and barriers for scaling up community-based health promotion. Two national digital workshops were conducted in Germany with stakeholders at the community level (n = 161) and with stakeholders at the federal and state levels (n = 84). Protocols were compiled and coded using qualitative content analysis. During the first workshop, we revealed 11 themes for external support needs ('Strategic approach', 'Define & compare indicators', 'Internal human resource', 'Tools & Aids', 'External conduction of the assessment', 'Involvement of people in difficult life situations', 'Overview of actors', 'Moderation', 'Obtain funding', 'Quality assurance/evaluation' and 'External support'). Eleven facilitators and barriers were identified for scaling up ('Assessment and evaluation', 'Intersectoral collaboration and partnerships', 'Communication', 'Characteristics of the program', 'Political and legal conditions', 'Political support', 'Local coordinator', 'Resources', 'Participation', 'Strategic planning/methods' and 'Intermediary organization'). The identified results provide practice-based evidence on support needed for scaling up, facilitators that promote scaling up and barriers that might hinder scaling up community-based health promotion in Germany. In a next step, this practice-based evidence needs to be systematically integrated with scientific-based evidence on key components for scaling up such approaches for the development of an effective scaling-up concept. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance poses a global threat to public health. Of great concern are Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales with resistance to carbapenems or third-generation cephalosporins. The aim of the present study was to investigate the in vitro activity of the novel siderophore cephaloporin cefiderocol (CID) and four comparator β-lactam-β-lactamase-inhibitor combinations and to give insights into the genetic background of CID-resistant isolates. In total, 301 clinical Enterobacterales and non-fermenting bacterial isolates were selected for this study, including randomly chosen isolates (set I, n = 195) and challenge isolates (set II, n = 106; enriched with ESBL and carbapenemase producers, as well as colistin-resistant isolates). Isolates displayed CID MIC50/90 values of 0.12/0.5 mg/L (set I) and 0.5/1 mg/L (set II). Overall, the CID activity was superior to the comparators against A. baumannii, Stenotrophomonas maltophilia and set II isolates of P. aeruginosa. There were eight CID-resistant isolates detected (MIC > 2 mg/L): A. baumannii (n = 1), E. cloacae complex (n = 5) and P. aeruginosa (n = 2). Sequencing analyses of these isolates detected the acquired β-lactamase (bla) genes blaNDM-1, blaSHV-12 and naturally occurring blaOXA-396, blaACT-type and blaCMH-3. In conclusion, CID revealed potent activity against clinically relevant organisms of multidrug-resistant Enterobacterales and non-fermenters. [ABSTRACT FROM AUTHOR]

We analyze the impact of exercising sports during childhood and adolescence on educational attainment. The theoretical framework is based on models of allocation of time and educational productivity. Using the rich information from the German Socio-Economic Panel (GSOEP), we apply generalized ordered probit models to estimate the effect of participation in sport activities on secondary school degrees and professional degrees. Even after controlling for important variables and selection into sport, we find strong evidence that the effect of sport on educational attainment is statistically significant and positive. (Contains 4 tables.)

Following the results of the Programme for International Student Assessment for Germany, the Federal Ministry of Education and Research founded the capital investment program "Future Education and Care" as a federal measure to support the expansion of all-day schooling in Germany. During this process it became obvious that learning and teaching in all-day schools had to take place within new time structures. In this context, the Land of Bremen initiated a new teaching time model, which is, so far, unique in Germany. The results of empirical longitudinal accompanying research on the presence teaching time model indicate that pupils from low socio-economic backgrounds profited most from the new model. Further, teachers' workload decreased and there was an increase in their cooperative behaviour. (Contains 2 tables and 2 figures.)

Environmental catastrophes, including the increased severity and frequency of climate extremes, can act as "windows of opportunities" that challenge citizens' mental models and motivate them to engage in reflective processes, challenging their pre-conceived ideas. Less well understood is whether experiencing changing weather conditions, common in mid-latitudes, can have a similar effect and increase the citizens' concerns about climate change and their willingness to accept more stringent climate policies. In this paper, we investigate the effects of changing seasonal temperature on the perceived seriousness of climate change and willingness to mitigate climate change. We use data from four yearly waves of a spatially explicit representative population survey in Germany and weather records from the postal code areas in which they live. To our knowledge, this study is the first analysis to link individual perceptions towards climate change and different mitigation options with seasonal temperature changes at specific locations in Europe. The analyzed perceptions were strongly influenced by socio-demographic characteristics and broader societal changes, as well as individual experiences of seasonal temperatures. The results show that experienced seasonal temperature change influences personal climate change concerns as well as the willingness to mitigate climate change, although with a weaker effect. The results indicate that it is the absolute temperature variation experienced that is important, rather than whether it is getting colder or warmer than usual. Considering the influences identified in this study can offer a window of opportunity for more stringent and targeted climate change policy. • Seasonal temperature changes influence climate change perception. • Effects can offer a window of opportunity for more stringent climate change policy. • Governmental mitigation policy solutions less supported than self-determined options. • Perceptions influenced by broader societal changes as well as individual experiences. • Need for targeted climate change communication. [ABSTRACT FROM AUTHOR]

Background Escherichia coli is the leading pathogen of community-acquired urinary tract infections. Gepotidacin is a novel, bactericidal, first-in-class triazaacenaphthylene oral antibiotic that inhibits bacterial DNA replication by a distinct mechanism of action that confers activity against most strains of target pathogens, such as E. coli , Staphylococcus saprophyticus and Neisseria gonorrhoeae , including those resistant to other antibiotics. Objectives This study assessed the in vitro activity of gepotidacin in comparison with ciprofloxacin and other oral standard-of-care antibiotics using a large collection of urine isolates of E. coli obtained from outpatients in Germany. Methods Four hundred and sixty E. coli collected from 23 laboratories during a surveillance study in 2019/2020 were tested. Forty-six isolates (10.0%) produced an ESBL of the CTX-M family, half of which belonged to MDR clonal subgroups of E. coli ST131. Antibiotic susceptibilities were tested at a reference laboratory by broth microdilution according to the standard ISO 20776-1. Results Fifty-three (11.5%) isolates were ciprofloxacin resistant, 25 (47.2%) of which also produced an ESBL. Overall, MIC50/90 values for gepotidacin were 2/4 mg/L (MIC range 0.125–16 mg/L), with no differences in activity between ciprofloxacin-susceptible and ciprofloxacin-resistant isolates, ESBL-producing and non-ESBL isolates, O25b-ST131 isolates, and isolates susceptible or resistant to fosfomycin, mecillinam or nitrofurantoin. Conclusions Gepotidacin showed promising in vitro activity against urine isolates of E. coli , including ciprofloxacin-resistant isolates, ESBL-producing isolates and isolates resistant to oral standard-of-care antibiotics. [ABSTRACT FROM AUTHOR]

This research note estimates the causal effects of a cut in the potential duration of regular unemployment benefits for older workers in Germany on the labor market outcomes of individuals with health impairments. The analyzed reform is a natural experiment that allows a difference‐in‐differences strategy with treatment intensity. The results provide evidence for a significant decrease in the number of days in regular unemployment benefits and an increase in the number of days in employment. However, the results also suggest a significant increase in the number of days in unemployment (social) assistance, which are granted upon exhaustion of regular unemployment benefits. [ABSTRACT FROM AUTHOR]

Anterior cruciate ligament (ACL) injuries are a common severe type of football injury. Injury prevention measures should be adapted to the respective type of sports and be based on sports-specific strategies. A football-specific ACL registry including prospective ACL injury data of both sexes and at different skill levels is lacking in the literature. In Germany, a prospective 'ACL registry for German Football' was implemented in the 2014–15 football season. Professional football leagues (1st to 3rd national league), semi-professional football leagues (4th until 6th leagues) and amateur football leagues (7th league and below) were monitored regarding the incidence of ACL injuries, risk factors, general treatment and rehabilitation. After the registration of an injury, injured players were sent a standardised questionnaire. Overall, 1,206 ACL ruptures were registered in the investigated population of more than 56,000 players, resulting in a prevalence of 2.1%. The highest prevalence was found in men's amateur football (2.7%) as well as in men's and women's professional football (2.1% each). This football-specific ACL registry provides for the first-time longitudinal data about ACL injury patterns and treatment at all football levels. This report describes the considerations for data collection and presents first epidemiological results of 6 years of ACL injury registration. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, there were increased concerns about glycemic control in patients with diabetes. Therefore, we aimed to assess changes in diabetes management during the COVID-19 lockdown for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM) in Germany. We included data from 24,623 patients (age>18 years) with T1DM (N=6,975) or T2DM (N=17,648) with documented data in 2019 and 2020 from the multicenter Diabetes-Prospective Follow-up registry (DPV). We conducted a groupwise comparison of identical patients in 2019 and 2020 for different time periods of pandemia. Pairwise differences of continuous parameters of treatment modalities and metabolic outcome between 2019 and 2020 were adjusted for seasonality, age, and diabetes duration. We presented these outcomes as adjusted medians with 95% confidence intervals. Rates were compared using negative-binomial models, dichotomous outcomes were compared using logistic models. Models were additionally adjusted for age and diabetes duration. These outcomes were presented as least-square means with 95% confidence intervals, p-values of<.05 were considered significant. In participants with T1DM, CGI (combined glucose indicator) increased only by 0.11–0.12% in all time periods of 2020 compared to 2019 (all p<0.001) while BMI decreased slightly by −(0.09–0.10) kg/m² (p<0.0001). In participants with T2DM, HbA1c increased by 0.12%, while BMI decreased slightly by −(0.05–0.06) kg/m² (p<0.0001). During the COVID-19 lockdown period, patients with T1DM and T2DM experienced only clinically insignificant changes in glucose control or body weight. Despite lockdown restrictions, patients were able to maintain metabolic control. [ABSTRACT FROM AUTHOR]

This paper explores diverse effects of an unemployment benefit (UB) reform in Germany on labor market outcomes of individuals with health impairment. The reform induced substantial reductions in potential duration of regular UB for older workers, which is exploited in a difference‐in‐differences setting. The results provide evidence for a decrease in days in UB, an increase in days in employment, and an increase in days in unemployment assistance. The effects on UB and employment are smaller and the effects on unemployment assistance are larger for unemployed and non‐employed individuals than for individuals who were employed before medical rehabilitations. [ABSTRACT FROM AUTHOR]

Background: While effective physical activity referral schemes (PARSs) and related structures for promoting physical activity (PA) already exist in several countries, in Germany, PARSs have not yet been implemented systematically and nationwide. Through a co-production approach with relevant actors in the German healthcare system, a PARS was developed, and an implementation plan was created (e.g. financing). This study protocol aims to evaluate the developed PARS for people with non-communicable diseases (NCDs) in Germany regarding its potential effectiveness and implementation success.Methods: To evaluate the effectiveness and implementation success of the PARS, we will apply a pragmatic cluster-randomised controlled trial (cRCT) in Hybrid II design by comparing two intervention groups (PARS vs PA advice [PAA]). The trial will take place in the Nürnberg metropolitan region, with 24 physician practices recruiting 567 people with NCDs. Both groups will receive brief PA advice from a physician to initially increase the participants' motivation to change their activity level. Subsequently, the PARS group will be given individualised support from an exercise professional to increase their PA levels and be transferred to local exercise opportunities. In contrast, participants in the PAA group will receive only the brief PA advice as well as information and an overview of regional PA offerings to become more active at their own initiative. After 12 and 24 weeks, changes in moderate to vigorous PA and in physical activity-related health competence (movement competence, control competence, self-regulation competence) will be measured as primary outcomes. Secondary outcomes will include changes in quality of life. To measure implementation success, we refer to the RE-AIM framework and draw on patient documentation, interviews, focus groups and surveys of the participating actors (physicians, exercise professionals).Discussion: Through a between-group comparison, we will investigate whether additional individual support by an exercise professional compared to brief PA advice alone leads to higher PA levels in people with NCDs. The acceptance and feasibility of both interventions in routine care in the German healthcare system will also be evaluated.Trial Registration: ClinicalTrials.gov, NCT04947787 . Registered 01 June 2021. [ABSTRACT FROM AUTHOR]

Extended-spectrum beta-lactamase (ESBL)-producing Escherichia (E.) coli have been widely described as the cause of treatment failures in humans around the world. The origin of human infections with these microorganisms is discussed controversially and in most cases hard to identify. Since they pose a relevant risk to human health, it becomes crucial to understand their sources and the transmission pathways. In this study, we analyzed data from different studies in Germany and grouped ESBL-producing E. coli from different sources and human cases into subtypes based on their phenotypic and genotypic characteristics (ESBL-genotype, E. coli phylogenetic group and phenotypic antimicrobial resistance pattern). Then, a source attribution model was developed in order to attribute the human cases to the considered sources. The sources were from different animal species (cattle, pig, chicken, dog and horse) and also from patients with nosocomial infections. The human isolates were gathered from community cases which showed to be colonized with ESBL-producing E. coli. We used the attribution model first with only the animal sources (Approach A) and then additionally with the nosocomial infections (Approach B). We observed that all sources contributed to the human cases, nevertheless, isolates from nosocomial infections were more related to those from human cases than any of the other sources. We identified subtypes that were only detected in the considered animal species and others that were observed only in the human population. Some subtypes from the human cases could not be allocated to any of the sources from this study and were attributed to an unknown source. Our study emphasizes the importance of human-to-human transmission of ESBL-producing E. coli and the different role that pets, livestock and healthcare facilities may play in the transmission of these resistant bacteria. The developed source attribution model can be further used to monitor future trends. A One Health approach is necessary to develop source attribution models further to integrate also wildlife, environmental as well as food sources in addition to human and animal data. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Escherichia coli is by far the leading cause of community-acquired UTIs. Pivmecillinam, the oral prodrug of the penicillin derivative mecillinam (amdinocillin), was re-introduced in Germany in March 2016 for first-line treatment of acute uncomplicated cystitis. This study aimed to evaluate the prevalence of resistance to mecillinam in comparison to nine other antibiotics used for oral treatment in E. coli urine isolates after the re-introduction of pivmecillinam. A total of 460 isolates were collected at 23 laboratories of clinical microbiology between October 2019 and March 2020. Forty-six isolates (10.0%) produced an extended-spectrum β-lactamase (ESBL) of the CTX-M family. Resistance to amoxicillin (43.3%) was most widespread, followed by resistance to trimethoprim-sulfamethoxazole (27.0%), amoxicillin-clavulanic acid (18.0%), cefuroxime (11.3%), and ciprofloxacin (11.1%). Twenty-four E. coli isolates (5.2%) were resistant to mecillinam. The concentrations of mecillinam needed to inhibit 50/90% of the ESBL-producing isolates and the remaining isolates were 1/4 mg/L and 0.5/4 mg/L, respectively. The findings support the recommendation to regard pivmecillinam as a first-line option for the treatment of uncomplicated lower UTIs. [ABSTRACT FROM AUTHOR]

Goats and other small ruminants are frequently used as contact animals in petting zoo settings of zoological gardens. However, they are capable to carry a broad spectrum of zoonotic pathogens without clinical signs. In this study, we analysed the presence of different zoonotic pathogens in 300 clinically healthy goats from 14 zoological gardens in Germany. Rectal and nasal swabs were investigated with a series of cultural and molecular techniques. In addition, vaginal swabs of the 230 female goats were investigated for the presence of Coxiella burnetii by real‐time PCR. Antibodies against C. burnetii were tested in milk and serum by ELISA. Campylobacter spp. were found in 22.7%, Shiga‐toxigenic Escherichia coli in 20.0% and Arcobacter spp. were found in 1.7% of the tested 300 goats after culture from rectal swabs and subsequent PCR. One sample contained an Escherichia fergusonii isolate with a blaCTX‐M‐1‐encoded extended‐spectrum beta‐lactamase phenotype. Neither Yersinia spp. nor Salmonella spp. were found. Nasal swabs of 20.7% of the goats yielded Staphylococcus aureus including one mecC‐positive methicillin‐resistant isolate. Neither Yersinia spp. nor Salmonella spp. were found, and none of the 230 vaginal swabs was positive for C. burnetii. Attempts to detect dermatophytes failed. In conclusion, a possible risk of transmission of zoonotic bacteria from goats in petting zoos to visitors should be considered. Appropriate information and facilities for hand washing and disinfection should be provided in all zoological gardens using goats as contact animals due to the regular presence of zoonotic bacteria in the collection. [ABSTRACT FROM AUTHOR]

Some linguists propose that the varieties of a given language should not be studied without analyzing the historical changes that have occurred, that is, the diatopic variation of a given language can be better understood if we focus our attention on the diachronic variation of its semantic, phonetic, morphosyntactic, and pragmatic-discursive characteristics. In fact, it seems important to us, teacher educators of future Spanish as a Foreign Language (SFL) teachers, to know the evolution of American Spanish in different stages, taking into account the influence of pre-Hispanic languages and the process of Hispanization itself. Taking into account a Didactics of Plurilingualism, teachers may bet on a holistic teaching model of pan-Hispanic uses that is capable of responding to different geographical and social uses from a common point of departure so that students feel plurilingual within this historical language. Within the scope of the VarLang project, we have developed a study with a mixed approach (qualitative and quantitative), with a documentary and exploratory analysis of scientific articles, books, and other resources in relation to the origins and current uses of these characteristics and linguistic phenomena. We have also noticed its appearance in SFL course books, developing an analysis of course books from different geographical contexts (Germany and Portugal) and their contributions regarding the issue of interlinguistic varieties. The results show that the course books present more work topics related to cultural varieties than to linguistic varieties, and their approach is almost always informative. [ABSTRACT FROM AUTHOR]

In the context of German linguistic policies, Heritage Language (HL) education ranges from formal and informal to non-formal offers. Families with migratory backgrounds seeking acquisition and maintenance of the HL frequently resort to educational or maintenance opportunities that are not institutionalized. In the region of Bavaria (Germany), the geographical context of this study, the teaching of Portuguese as an HL (PHL) mainly occurs in non-formal and informal educational spaces. The present empirical study follows an ethnographic perspective and examines how learners' parents in such non-formal environments perceive their children's bilingualism. As a secondary focus, the linguistic educational tool 'Mala de Herança' (MH) (Heritage Suitcase – free translation) shall be examined in order to assess its possible input in shaping the bilingual individual, following Van Lier's [2004. The Ecology and Semiotics of Language Learning. A Sociocultural Perspective. Dordrecht: Springer.] ecological approach to language teaching. The data described in the study, obtained from parents' interviews, were collected through semi-structured interviews and interpreted through content analysis. Results point towards a very heterogeneous perception of the 'bilingual child' by the parents, compatible with the reviewed literature. [ABSTRACT FROM AUTHOR]

Football referees need other physiological requirements on field than football players and are affected by different types of injury. The absence of referees may result in canceled matches, so special focus should be placed on injury prevention through specific training programs for referees. This study retrospectively analyzed injury occurrence and prevention strategies for German football referees at the different levels of play over one season. Data were collected by means of seasonal injury reports based on the consensus statement of injury definition and data collection. Of the 923 participating referees, 91 (9.9%) played at the professional level, 151 (16.3%) at the semi‐professional, and 681 (73.8%) at the amateur level. 86.2% (n = 796) were men and 13.8% (n = 127) women. Referees at the amateur level showed the highest injury incidence (3.14/1000 h football) compared to referees at the semi‐professional (1.92/1000 h; p < 0.001) and professional level (1.01/1000 h; p < 0.001). Most referees at the amateur (n = 372; 56.4%) and semi‐professional level (n = 46; 31.3%) conducted warm‐up programs of <10 min, whereas the mean warm‐up duration of professional referees was >11 min (n = 75; 82.4%). Although running and stretching exercises were common among referees during warm‐up, preventive exercises focusing on coordination and trunk muscles were less frequent, especially among amateur referees (jumping: 15.9%; strengthening: 9.7%; balance exercises: 7.9%). Injury incidence was highest at lower amateur levels, which thus has specific need for injury prevention. Appropriate training exercises to prevent injuries of referees were weak at all levels of play, especially the lack of strength, plyometric, and balance exercises in training and warm‐up programs. [ABSTRACT FROM AUTHOR]

Introduction: Football is the most popular sport worldwide and results in a high frequency of injuries. So far, mainly injuries in professional football have been investigated, and the literature lacks data regarding detailed injury epidemiology and current prevention data in amateur football tournaments. Materials and methods: A prospective cohort study investigated an international amateur football tournament, the UEFA Regions' Cup, which took place in 2019 in Germany. Injury epidemiology, current prevention strategies of the teams and the implementation of the UEFA concussion protocol were investigated in detail by means of standardized injury definitions and data samples for football (Fuller et al., Scand J Med Sci Sports 16:83–92, https://doi.org/10.1111/j.1600-0838.2006.00528.x, 2006). Results: 138 player of 8 teams participated in this study, while 39 players were excluded. Overall injury incidence was 12.5 per 1000 h total football exposure, 43.5 per 1000 h for match exposure. No injuries were registered during training. Injury prevalence was 14.1% per player and 1.1 injuries per match were registered. The lower extremity was predominantly affected by injuries (71.4%) and the majority of injuries (78.6%) were non-severe injury types like contusions (50%) and sprains (18.2%). Two head injuries, one contusion and one skin lesion, were handled by the guidelines of the UEFA concussion protocol. 44.4% of the players indicated at least one previous injury before tournament, 45.3% of them during the last two football seasons before start of the tournament. Injury prevention performance was included in all participating teams during the tournament by warm up or training strategies (100%). During the warm-up program just 5 exercises of the FIFA 11 + program was detected by this investigation in participating teams to be done by more half of the teams. Running exercises were the most frequently performed exercises, while trunk muscle exercises were less represented (14.3%). Conclusion: This study presents for the first time epidemiological injury and prevention data of the UEFA Regions Cup. Injury incidence was higher compared to injury reports of regular seasons, but lower compared to other amateur football tournaments. Currently used prevention programs revealed trunk muscle exercises as often neglected. [ABSTRACT FROM AUTHOR]

Aim of the study was to evaluate (1) the overall use of bone graft substitutes, autografts and allografts, (2) of different types of bone graft substitutes (calcium sulfate, calcium phosphate, calcium phosphate ceramics or polymethyl methacrylate) and of different bone grafts (cancellous vs. cortical), and (3) the use of antibiotic‐loading of bone graft substitutes in orthopedic surgery in Germany. Gross data were provided from the Federal Statistical Office of Germany and revealed an overall increase in bone defect reconstruction procedures using bone graft substitutes, autografts and allografts from 86,294 in 2008 to 99,863 cases in 2018 (+15.7%). The relative use of bone graft substitutes for these interventions strongly increased from 11.8% in 2008 (10,163 cases) to 23.9% in 2018 (23,838 cases) with an increase of +134.4%. Furthermore, antibiotic‐loaded bone graft substitutes were implanted more frequently with an overall increase of +194% (2008: n = 2,657; 2018: n = 7,811). The work shows an increasing use of bone graft substitutes and antibiotic‐loaded bone graft substitutes over the last 10 years in Germany. [ABSTRACT FROM AUTHOR]

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We analyze gender differences in expected starting salaries along the wage expectations distribution of prospective university students in Germany, using elicited beliefs about both own salaries and salaries for average other students in the same field. Unconditional and conditional quantile regressions show 5–15% lower wage expectations for females. At all percentiles considered, the gender gap is more pronounced in the distribution of expected own salary than in the distribution of wages expected for average other students. Decomposition results show that biased beliefs about the own earnings potential relative to others and about average salaries play a major role in explaining the gender gap in wage expectations for oneself. [ABSTRACT FROM AUTHOR]

Due to the beneficial impact of regular physical activity (PA) on non-communicable diseases, the number of countries integrating exercise referral schemes (ERSs) into their healthcare systems is growing. Owing to the limitations of existing PA promotion concepts in Germany's healthcare system, efforts are currently being made towards developing a nationwide referral pathway. A research group at the Friedrich-Alexander-University Erlangen-Nürnberg is coordinating these efforts within a project funded by the Federal Ministry of Health. The aim is to develop, implement and evaluate a regional-level ERS that has the potential to be scaled up across Germany in the event of its demonstrated effectiveness. The project is based on an adapted Cooperative Planning approach requiring interaction between the academic sector and different actors of the healthcare sector. The present commentary reflects on challenges faced in the early stages of the co-production process. Besides the development of an adequate co-production methodology, it critically discusses stakeholder participation, knowledge gaps and actors' willingness to take responsibility. In addition, although patients are represented by dedicated organizations, their perspective cannot be adequately captured using a co-production approach. Despite the joint development of an ERS, there remain important questions regarding the appropriateness of the co-production approach in a healthcare setting. [ABSTRACT FROM AUTHOR]

German National Recommendations for Physical Activity (PA) and PA Promotion recommend community-based approaches to promote PA at the local level with a focus on health equity. In addition, the German Federal Prevention Act addresses health equity and strengthens setting-based health promotion in communities. However, the implementation of both in the local context remains a challenge. This article describes Phase 1 of the KOMBINE project that aims to co-produce an action-oriented framework for community-based PA promotion focusing on structural change and health equity. (i) In a series of workshops, key stakeholders and researchers discussed facilitators, barriers and needs of community-based PA promotion focusing on health equity. (ii) The research team used an inductive approach to cluster all findings and to identify key components and then (iii) compared the key components with updated literature. (iv) Key components were discussed and incorporated into a gradually co-produced framework by the participants. The first result of the co-production process was a catalog of nine key components regarding PA-related health promotion in German communities. The comparison of key components with scientific evidence showed a high overlap. Finally, a six-phase action-oriented framework including key components for community-based PA promotion was co-produced. The six-phase action-oriented framework integrates practice-based and scientific evidence on PA-related health promotion and health equity. It represents a shared vision for the implementation of National Recommendations for PA and PA Promotion in Germany. The extent to which structural changes and health equity can be achieved is currently being investigated in pilot-studies. [ABSTRACT FROM AUTHOR]