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Inger M Janssen,1 Fueloep Scheibler,2 Ansgar Gerhardus3,4 1Department of Epidemiology and International Public Health, University of Bielefeld, Bielefeld, 2Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, 3Department for Health Services Research, Institute for Public Health and Nursing Research, University of Bremen, 4Health Sciences Bremen, University of Bremen, Bremen, Germany Background: The selection of important outcomes is a crucial decision for clinical research and health technology assessment (HTA), and there is ongoing debate about which stakeholders should be involved. Hemodialysis is a complex treatment for chronic kidney disease (CKD) and affects many outcomes. Apart from obvious outcomes, such as mortality, morbidity and health-related quality of life (HRQoL), others such as, concerning daily living or health care provision, may also be important. The aim of our study was to analyze to what extent the preferences for patient-relevant outcomes differed between various stakeholders. We compared preferences of stakeholders normally or occasionally involved in outcome prioritization (patients from a self-help group, clinicians and HTA authors) with those of a large reference group of patients. Participants and methods: The reference group consisted of 4,518 CKD patients investigated previously. We additionally recruited CKD patients via a regional self-help group, nephrologists via an online search and HTA authors via an expert database or personal contacts. All groups assessed the relative importance of the 23 outcomes by means of a discrete visual analog scale. We used descriptive statistics to rank outcomes and compare the results between groups. Results: We received completed questionnaires from 49 self-help group patients, 19 nephrologists and 18 HTA authors. Only the following 3 outcomes were ranked within the top 7 outcomes by all 4 groups: safety, HRQoL and emotional state. The ratings by the self-help group were generally more concordant with the reference group ratings than those by nephrologists, while HTA authors showed the least concordance. Conclusion: Preferences of CKD patients from a self-help group, nephrologists and HTA authors differ to a varying extent from those of a large reference group of patients with CKD. The preferences of all stakeholders should form the basis of a transparent approach so as to generate a valid list of important outcomes. Keywords: patient preferences, hemodialysis patients, patient-centered outcomes, preference elicitation, rating scale

Abstract Background Patient and Public Involvement (PPI) is increasingly recognized as an essential aspect of clinical research, particularly for ensuring relevancy and impact of research to those most affected. This study addresses the gap in involving older patients, particularly nursing home residents, in the research process by exploring motivations, expectations, and experiences of nursing home residents in Bremen, Germany, involved in PPI for developing a clinical trial on polypharmacy. Methods Two Patient Advisory Boards (PABs) were established in nursing homes as part of the INVOLVE-Clin project. A Patient Advocate (PA) facilitated communication between nursing home residents and researchers. A qualitative case study approach was employed, involving semi-structured interviews and group discussions with nursing home residents and researchers. Data was analyzed using structured qualitative content analysis. Results The study found varied motivations and expectations between nursing home residents and researchers. Nursing home residents valued the social interaction and the opportunity to voice their health concerns, while researchers aimed to incorporate patients’ perspectives into study design. The PA was considered crucial in facilitating communication between nursing home residents and researchers. Challenges included the complexity of the study topic and the need for methodological adjustments to suit nursing home residents´ cognitive abilities. Generally, PAB participation was experienced to provide mental stimulation and increased confidence among nursing home residents in discussing their medication management. The PAB’s influence led to the decision not to conduct a polypharmacy study. Discussion The findings underscore the importance of flexible approaches to PPI, particularly when involving older nursing home residents. Methodological adjustments, such as tailoring content and structure of PABs, and the inclusion of additional boards for diverse perspectives, are vital for effective involvement. The study also highlights the need for ongoing innovation in PPI methods to ensure meaningful engagement of older patients in clinical research. Conclusion This study contributes essential insights into the practical implementation of PPI with nursing home residents, highlighting the need for patient-centric approaches that recognize their unique challenges and contributions. These findings are critical for shaping scientifically robust but also socially relevant and impactful research, especially in an aging society.

Abstract Background There has been a growing push to involve patients in clinical research, shifting from conducting research on, about, or for them to conducting it with them. Two arguments advocate for this approach, known as Patient and Public Involvement (PPI): to improve research quality, appropriateness, relevance, and credibility by including patients’ diverse perspectives, and to use PPI to empower patients and democratize research for more equity in research and healthcare. However, while empowerment is a core objective, it is often not clear what is meant by empowerment in the context of PPI in clinical research. This vacancy can lead to insecurities for both patients and researchers and a disconnect between the rhetoric of empowerment in PPI and the reality of its practice in clinical trials. Thus, clarifying the understanding of empowerment within PPI in clinical research is essential to ensure that involvement does not become tokenistic and depletes patients’ capacity to advocate for their rights and needs. Methods We explored the historical roots of empowerment, primarily emerging from mid-20th century social movements like feminism and civil rights and reflected the conceptual roots of empowerment from diverse fields to better understand the (potential) role of empowerment in PPI in clinical research including its possibilities and limitations. Results Common themes of empowerment in PPI and other fields are participation, challenging power structures, valuing diverse perspectives, and promoting collaboration. On the other hand, themes such as contextual differences in the empowerment objectives, the relationship between empowerment and scientific demands, research expertise, and power asymmetries mark a clear distinction from empowerment in other fields. Conclusion PPI offers potential for patient empowerment in clinical trials, even when its primary goal may be research quality. Elements like participation, sharing opinions, and active engagement can contribute to patient empowerment. Nonetheless, some expectations tied to empowerment might not be met within the constraints of clinical research. To empower patients, stakeholders must be explicit about what empowerment means in their research, engage in transparent communication about its realistic scope, and continuously reflect on how empowerment can be fostered and sustained within the research process.

Inger Miriam Janssen,1 Ansgar Gerhardus,2,3 Gero D von Gersdorff,4 Conrad August Baldamus,4 Mathias Schaller,4 Claudia Barth,5 Fueloep Scheibler6 1Department of Epidemiology and International Public Health, Bielefeld University, Bielefeld, Germany; 2Department for Health Services Research, University of Bremen, Bremen, Germany; 3Health Sciences Bremen, University of Bremen, Bremen, Germany; 4Department of Internal Medicine II, University Hospital of Cologne, Cologne, Germany; 5KfH Kuratorium fuer Dialyse und Nierentransplantation e.V., Neu-Isenburg, Germany; 6Department of Non-Drug Interventions, Institute for Quality and Efficiency in Health Care, Cologne, Germany Background: Chronic kidney disease is an increasing health problem worldwide and in its final stage (stage V) can only be treated by renal replacement therapy, mostly hemodialysis. Hemodialysis has a major influence on the everyday life of patients and many patients report dissatisfaction with treatment. Little is known about which aspects of treatment are considered important by hemodialysis patients. The objective of this study was to rate the relative importance of different outcomes for hemodialysis patients and to analyze whether the relative importance differed among subgroups of patients.Patients and methods: Within the framework of a yearly questionnaire which is distributed among patients receiving hemodialysis by the largest hemodialysis provider in Germany, we assessed the relative importance of 23 outcomes as rated on a discrete visual analog scale. Descriptive statistics were used to rank the outcomes. Subgroup analyses were performed using Mann–Whitney U or Kruskal–Wallis tests.Results: Questionnaires of 4,518 hemodialysis patients were included in the analysis. The three most important outcomes were safety of treatment, health-related quality of life, and satisfaction with care. Further important outcomes were hospital stays, accompanying symptoms, hemodialysis duration, and the improvement or preservation of a good emotional state. Age, profession, and education had the strongest influence on relevant differences of preferences for outcomes; no relevant influence of sex or comorbidity was observed.Conclusion: Outcomes concerning the delivery or provision of care and aspects influencing quality of life are rated by patients to be at least as important as clinical outcomes. Many of the outcomes judged to be important by the patients are not regularly considered in research, evaluation studies, or quality programs. Keywords: patient-centered outcomes, preference elicitation, chronic disease, patient-centered research, rating scale

BackgroundSocial health in the context of dementia has recently gained interest. The development of a social health conceptual framework at the individual and social environmental levels, has revealed a critical need for a further exploration of social health markers that can be used in the development of dementia intervention and to construct social health measures.ObjectiveTo identify social health markers in the context of dementia.MethodThis international qualitative study included six countries: Australia, Germany, Indonesia, Italy, Poland, and the Netherlands. Using purposive sampling, three to five cases per country were recruited to the study, with each case consisting of a person living with dementia, a primary informal caregiver, an active network member, and a health care professional involved in the care of the person with dementia. In-depth interviews, using an agreed topic guide, and content analysis were conducted to identify known and new social health markers. The codes were then categorized against our conceptual framework of social health.ResultsSixty-seven participants were interviewed. We identified various social health markers, ranging from those that are commonly used in epidemiological studies such as loneliness to novel markers of social health at the individual and the social environmental level. Examples of novel individual-level markers were efforts to comply with social norms and making own choices in, for example, keeping contact or refusing support. At a social environmental level, examples of novel markers were proximity (physical distance) and the function of the social network of helping the person maintaining dignity.ConclusionsThe current study identified both well-known and novel social health markers in the context of dementia, mapped to the social health framework we developed. Future research should focus on translating these markers into validated measures and on developing social health focused interventions for persons with dementia.

BackgroundDigital public health (DiPH) interventions may help us tackle substantial public health challenges and reach historically underserved populations, in addition to presenting valuable opportunities to improve and complement existing services. However, DiPH interventions are often triggered through technological advancements and opportunities rather than public health needs. To develop and evaluate interventions designed to serve public health needs, a comprehensive framework is needed that systematically covers all aspects with relevance for public health. This includes considering the complexity of the technology, the context in which the technology is supposed to operate, its implementation, and its effects on public health, including ethical, legal, and social aspects. ObjectiveWe aimed to develop such a DiPH framework with a comprehensive list of core principles to be considered throughout the development and evaluation process of any DiPH intervention. MethodsThe resulting digital public health framework (DigiPHrame) was based on a scoping review of existing digital health and public health frameworks. After extracting all assessment criteria from these frameworks, we clustered the criteria. During a series of multidisciplinary meetings with experts from the Leibniz ScienceCampus Digital Public Health, we restructured each domain to represent the complexity of DiPH. In this paper, we used a COVID-19 contact–tracing app as a use case to illustrate how DigiPHrame may be applied to assess DiPH interventions. ResultsThe current version of DigiPHrame consists of 182 questions nested under 12 domains. Domain 1 describes the current status of health needs and existing interventions; domains 2 and 3, the DiPH technology under assessment and aspects related to human-computer interaction, respectively; domains 4 and 5, structural and process aspects, respectively; and domains 6-12, contextual conditions and the outcomes of the DiPH intervention from broad perspectives. In the CWA use case, a number of questions relevant during its development but also important for assessors once the CWA was available were highlighted. ConclusionsDigiPHrame is a comprehensive framework for the development and assessment of digital technologies designed for public health purposes. It is a living framework and will, therefore, be updated regularly and as new public health needs and technological advancements emerge.

Abstract Introduction There is an increasing emphasis on exploring ways to improve students' transition from the classroom into the clinical environment. Diagnostic radiography (DR) students undergo rigorous theoretical and practical training before they are exposed to the clinical environment. It has been found that when DR students commence clinical learning in the workplace for the very first time, they experience difficulties in this transition. At the site of investigation, a newly integrated and dedicated clinical preparedness (CP) programme was offered; however, little is known about the DR students' perceptions of this programme. Methods A qualitative approach coupled with a self‐developed, cross‐sectional research tool was employed. First‐year DR students were purposefully sampled against the inclusion and exclusion criteria. The principle of voluntary participation was upheld throughout the data collection process. The data were analysed using Braun and Clarke's six steps of thematic analysis. Results Forty‐two responses were collected. Following a thematic analysis, two overarching themes were developed, namely: (1) reflections on the CP programme and (2) suggestions for future CP programmes. Conclusion This study demonstrated the need for effective CP programmes as an approach to ease the transition of first‐year DR students from the classroom into the clinical environment. Several suggestions, for example, an extended CP programme and a clinical information pack were made for the offering of similar programmes in the future.

To address societal challenges, research and innovation approaches, involving a wide range of actors, are increasingly promoted by policy communities. This paper explores the practice of Quadruple Helix collaborations for responsible innovation and how these implement the theoretical ambition of including actors from different societal sectors in innovation, including actors from the fields of arts, media and civil society, which is conceptualized as the Fourth Helix in this concept. Referring to cross-sector collaboration literature and based on an empirical investigation, we explore which actors, representing the Fourth Helix, actually engage in innovation collaborations, how this engagement plays out in practice, and the institutional and systemic dynamics involved in output and value creation. We rely on data from three Social Labs in Austria, Germany, and the Netherlands, which constitute qualitative, change-oriented research processes, where we researched and engaged with actors from cases constituting- or aiming for a Quadruple Helix collaboration. This was accompanied by a desktop study including qualitative interviews of 51 further cases. We find that the actual engagement of actors from civil society is fragile and that forces beyond Quadruple Helix cases impact these quite firmly in some cases.

ObjectivesThis study aimed to develop and apply a structured approach for prioritising topics for systematic reviews in public health, framed according to the readily applicable PICO format, which encourages the involvement of stakeholders’ preferences in a transparent matter.MethodsWe developed a multi-stage process, consisting of a scoping and two Delphi stages with web-based surveys and invited public health stakeholders in Switzerland to participate: First, respondents specified topics for different public health domains, which were reformulated in a PICO format by content analysis. Second, respondents rated the topics using five stakeholder-refined assessment criteria. Overall rankings were calculated to assess differences between stakeholder groups and rating criteria.ResultsIn total, 215 respondents suggested 728 topics altogether. The response rate in the two Delphi stages was 91.6% and 77.6%, respectively. Most top-rated review topics focused on the effectiveness of interventions providing education to different target groups, followed by interventions to increase access to specific healthcare services.ConclusionOur approach encourages involvement of stakeholders in identifying priorities for systematic reviews and highlights disparities between stakeholders and between individual criteria.

Abstract Objective This scoping review aims to provide an overview of how theories were used in the development or evaluation of social prescribing (SP) intervention studies. Background SP describes a patient pathway where general practitioners (GPs) connect patients with community activities through referrals to link workers. This review seeks to understand the explanations provided for the outcomes and implementation process of SP. Inclusion criteria Studies using a defined theory to develop or evaluate a specific SP intervention in primary care and the community sector. Methods This scoping review was conducted in accordance with JBI methodology. The following databases were searched on 8th of July 2022: PubMed, ASSIA, Cochrane, Cinahl, PsycINFO, Social Care Online, Sociological Abstracts, Scopus, and Web of Science. The search only considered English language texts. Additional literature was identified by searching relevant web pages and by contacting experts. The selection of sources and the data extraction was done by two reviewers independently. Results The search resulted in 4240 reports, of which 18 were included in the scoping review. Of these, 16 were conducted in the UK, one in Canada and one in Australia. The majority of reports employed a qualitative approach (11/18). Three were study protocols. 11 distinct theories were applied to explain outcomes (4 theories), differences in outcomes (3 theories), and the implementation of the intervention (4 theories). In terms of practical application, the identified theories were predominantly used to explain and understand qualitative findings. Only one theory was used to define variables for hypothesis testing. All theories were used for the evaluation and none for the development of SP. Conclusion The theories influenced which outcomes the evaluation assessed, which causal pathway was expected to generate these outcomes, and which methodological approaches were used. All three groups of theories that were identified focus on relevant aspects of SP: fostering positive patient/community outcomes, addressing inequalities by considering the context of someone’s individual circumstances, and successfully implementing SP by collaboratively working across professions and institutional boundaries. Additional insight is required regarding the optimal use of theories in practical applications.

Every nation has its own language with distinctive features and historical background that differentiate between one another. Indonesian language and Afrikaans language is regarded to possess several historical resemblances. Indonesia was once colonized by the Dutch for 350 years, and therefore, some of the words or language structure in Indonesian language are influenced by Dutch language. In the meantime, South African people in the northern part of the country are very familiar with Dutch language. The study found out several similar words between Indonesian and Afrikaans language. The unique variations discovered in this study comprised: 1) similar spelling and pronunciation, 2) different spelling but similar pronunciation, 3) similar spelling but different pronunciation, and 4) almost similar spelling and pronunciation, but with similar meaning. Therefore, both languages are comparable in terms of identifying similarities and differences between both languages' sound and spelling. The study intended to provide a reference for the Indonesian Language for Foreign Learners ("Bahasa Indonesia bagi Penutur Asing," or henceforth, BIPA) teachers that conduct language teaching to the BIPA learners from South Africa. Vice versa, the BIPA learners will be able to comprehend Indonesian words following the dissemination of language kinship between Indonesian and Afrikaans language. Following that, the BIPA learning process will be more effective.

Introduction Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings.Methods and analysis This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes.Ethics and dissemination This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners.Trial registration number DRKS00029377.

Abstract Anthropogenic pressures on nature have been causing population declines for centuries. Intensified persecution of apex predators, like the golden eagle, resulted in population bottlenecks during the 19th and 20th centuries. To study population genetics and demographic history of the golden eagle throughout its distribution, we collected museum samples from previously underrepresented regions, such as Russia and Central Asia. We used 12 microsatellite loci and a fragment of the mitochondrial DNA control region to re‐evaluate phylogeography of Eurasian golden eagles and study the impacts of the population bottleneck. Our results revealed a north–south genetic gradient, expressed by the difference between Mediterranean and Holarctic lineages, as well as genetically distinct Northern Europe and Central Asia and Caucasus regions. Furthermore, Northern Europe exhibited the lowest, whereas Central Asia and Caucasus had the highest genetic diversity. Although golden eagles maintained relatively high genetic diversity, we detected genetic signatures of the recent bottleneck, including reduced genetic diversity and a decline in the effective female population size around the year 1975. Our study improves the knowledge of the genetic composition of Eurasian golden eagles and highlights the importance of understanding their historical population dynamics in the face of ongoing and future conservation efforts.

Abstract Background Research priority setting (RPS) studies are necessary to close the significant gap between the scientific evidence produced and the evidence stakeholders need. Their findings can make resource allocation in research more efficient. However, no general framework for conducting an RPS study among public health stakeholders exists. RPS studies in public health are rare and no such study has been previously conducted and published in Germany. Therefore, we aimed to investigate which research topics in public health are prioritised by relevant stakeholders in Germany. Methods Our RPS study consisted of a scoping stage and a Delphi stage each split into two rounds. Firstly, we invited members of the German Public Health Association to gather expert insights during two initial workshops. Next, we defined the relevant stakeholder groups and recruited respondents. Thereafter, we collected research topics and assessment criteria with the respondents in the first Delphi round and aggregated the responses through content analysis. Finally, we asked the respondents to rate the research topics with the assessment criteria in the second Delphi round. Results In total, 94 out of the 140 invited public health organisations nominated 230 respondents for the Delphi study of whom almost 90% participated in both Delphi rounds. We compiled a comprehensive list of 76 research topics that were rated and ranked by several assessment criteria. We split the research topics into two types, substantive research topics and methodological-theoretical research topics respectively, to ensure the comparability among the research topics. In both types of research topics—substantive research topics and methodological-theoretical research topics—the respective top five ranked research topics hardly differed between public health researchers and public health practitioners. However, clear differences exist in the priority ranking of many (non-top priority) research topics between the stakeholder groups. Conclusions This research demonstrates that it is possible, with limited resources, to prioritise research topics for public health at the national level involving a wide range of pertinent stakeholders. The results can be used by research funding institutions to initiate calls for research projects with an increased relevance for health and/or scientific progress.

Orientation: The introduction of various incentive schemes in the South African workplace creates incentive-induced employee productivity spillovers but could differ between industries and geographic areas. Research purpose: The aim of the study was to determine the industry and geographic nature of incentive-induced employee productivity spillovers to inform managerial decision-making on intrinsic and extrinsic motivators. Motivation for the study: The introduction of incentive schemes is an important motivator of employee productivity in the workplace. For this study, it was deemed important to indicate whether incentive-induced employee productivity spillovers differ between industries and geographic areas by taking into consideration firm-size, firm-profitability, different incentive schemes, trade union presence, employee age and skill levels. Research approach/design and method: Fixed-effect panel data estimations were computed to predict incentive-induced employee productivity spillover effects based on secondary firm-based data sets. Main findings: Incentive scheme-induced employee productivity spillover effects were generally similar for all the different industry and geographic areas. The spillovers increased with greater firm-sizes, higher profitability levels, introduction of greater levels of monetary-based incentive schemes (especially for unionised employee segments), and allocation of incentive schemes to the middle- age employee grouping (35 years–55 years) as well as higher skilled employees. Practical/managerial implications: The effective introduction of incentive schemes in the workplace is an important mechanism for creating positive employee productivity spillover effects and it is generally common for all firms irrespective of the industry or geographic area. Contribution/value-add: Improved understanding of incentive-induced employee productivity spillovers in the South African workplace will enable the effective alignment of incentive schemes with firm profitability.

Soil crusting (surface sealing) is widespread and serious in ecotouristic game parks and reserves in southern Africa, and especially South Africa. In this study, mineral soil crusts were found to be the problem in the Dinokeng Game Reserve (DGR), South Africa. Large areas of bare soil crusted areas were found in this reserve. The cause of this crusting was found to be historical agricultural practices such as cultivation with maize on non-arable soils and overgrazing by cattle. Negative impacts of soil crusting include reduction of water infiltration, leading to increased runoff and erosion and induced drought; inhibiting soil aeration; inhibiting germination and seedling emergence; and inhibiting root functioning and development. In this study in the DGR, a bare crusted area, where cultivation was abandoned 50 years before and there has been no recovery to rangeland since then, was selected for a field trial to determine the effectiveness of the application of various soil ameliorants on soil crust alleviation and improvement of water infiltration rate. The following ameliorants were evaluated: polyacrylamide (PAM) at levels of 5 and 20 kg/ha, gypsum at 2.5 t/ha, and molasses meal at 5 t/ha, as well as combinations of PAM and molasses meal, PAM and gypsum and gypsum and molasses meal. Brush packing, without any ameliorant applied, was also included as treatment, as well as a control with no treatments. PAM treatments increased final infiltration rate (FIR) by between 100–206%. The high efficacy of the lowest PAM treatment is at a cost of only USD 15 per hectare economically important. On the studied soil gypsum application reduced FIR by 81%, while molasses meal had minimal effect. These ameliorants can therefore not be recommended on such soil.