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Background: The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. Methods: This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. Results: In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. Conclusion: Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.

Hintergrund: Licht ist die Quelle des Lebens. Dies gilt gleichermaßen für die Tier- und Pflanzenwelt sowie den Menschen. Im Hinblick auf unseren Alltag stellen soziale Interaktion, Produktivität oder das emotionale Befinden nur einen kleinen Ausschnitt der Aspekte dar, auf die das Licht einen positiven Einfluss hat. Ziel der Studie: Der Zusammenhang zwischen Sonnenexposition und dem individuellen Glücksempfinden wird im internationalen Vergleich untersucht. Material und Methoden: Für die Analyse wurden Daten der Sonnenscheindauer (Anzahl der Sonnenstunden) und der geografischen Lage der betrachteten Regionen (Breitengrade) vom Deutschen Wetterdienst manuell zu den Daten des International Social Survey Programme (2011) Health and Health Care ergänzt und eine multivariate lineare Mehrebenenanalyse durchgeführt. Ergebnisse: Sonnenstunden haben einen positiven und statistisch signifikanten Einfluss auf das Glücksempfinden. Interessant ist, dass Personen, die dem Einfluss wechselnder Jahreszeiten ausgesetzt sind, sich statistisch signifikant in gleichem Maße schlechter in ihrem Glücksempfinden einschätzen als Personen, die so nah am Äquator wohnen, dass sie keinen saisonbedingten Klimaveränderungen ausgesetzt sind. Schlussfolgerung: Sonnenstunden wirken sich statistisch signifikant positiv auf das Glücksempfinden aus. Ein Mix an weiteren Einflüssen zur Steigerung des Glücksempfindens setzt sich zusammen aus Vertrauen in das nationale Gesundheitswesen, hoher Bildung, Rauchabstinenz, sportlicher Aktivität und Arbeitsmarktbeteiligung. Diese Mechanismen wirken sich im Durchschnitt in allen berücksichtigten Länderkontexten gleichermaßen positiv auf das Glücksempfinden der Menschen aus. Background: Light is the source of life. This applies equally to the animal and plant world as well as to humans. In terms of our everyday lives, social interaction, productivity and emotional well-being represent only a small section of the aspects on which light has a positive influence. Objective: The relationship between sun exposure and individual happiness is examined in an international comparison. Materials and methods: In order to consider the connection between sun exposure and happiness, sunshine duration and degree of latitude lines were manually enriched from the German Meteorological Service (Deutscher Wetterdienst) to the International Social Survey Programs (2011): Health and Health Care and analyzed with a linear multilevel regression. Results: Hours of sunshine have a positive and statistically significant effect on happiness. Interesting to note is that individuals who are exposed to the influence of changing seasons assess their happiness to be statistically significantly worse than people who live close to the equator so that they have no seasonal climate changes. Conclusion: Hours of sunshine have a statistically significant positive effect on happiness. A mix of other happiness determinants includes trust in the national healthcare system, higher education, abstinence from smoking, physical activity and labor market participation. On average, these mechanisms have an equally positive effect on people’s perception of happiness in all countries considered.

Context: Children with life-limiting diseases suffer from gastrointestinal (GI) symptoms. Since the introduction of specialized palliative home care (SPHC) in Germany, it is possible to care for these children at home. In phase 1 of care the aim is to stabilize the patient. In phase 2, terminal support is provided.Objectives: Analysis were performed of the differences between these phases. The causes and modalities/outcome of treatment were evaluated.Methods: A retrospective study was performed from 2014 to 2020. All home visits were analyzed with regard to the abovementioned symptoms, their causes, treatment and results.Results: In total, 149 children were included (45.9% female, mean age 8.17 ± 7.67 years), and 126 patients were evaluated. GI symptoms were common in both phases. Vomiting was more common in phase 2 (59.3 vs. 27.1%; p < 0.001). After therapy, the proportion of asymptomatic children in phase 1 increased from 40.1 to 75.7%; (p < 0.001). Constipation was present in 52.3% (phase 1) and 54.1% (phase 2). After treatment, the proportion of asymptomatic patients increased from 47.3 to 75.7% in phase 1 (p < 0.001), and grade 3 constipation was reduced from 33.9 to 15% in phase 2 (p < 0.05).Conclusion: Painful GI symptoms occur in both palliative care phases but are more common in phase 2. The severity and frequency can usually be controlled at home. The study limitations were the retrospective design and small number of patients, but the study had a representative population, good data quality and a unique perspective on the reality of outpatient pediatric palliative care in Germany.