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Abstract Background The accumulation of trace elements in mosses is used as an indirect measure of atmospheric deposition and an important complement to the techniques used to monitor the Geneva Air Pollution Convention. The aim of this paper is to quantify and map temporal and spatial trends of metal enrichment in mosses collected in Germany in 1990, 1995, 2000, 2005, 2015 and 2020. Collection and chemical analysis of the moss samples were carried out according to international guidelines. Results The analysis shows that since 1990, the median concentrations of As, Cd, Cu, Ni, Pb and Sb in the mosses have been decreasing significantly, with the with the highest decline of Pb (− 86%). This trend reversed in 2000 and 2005 and between 2015 and 2020 by increases in the concentrations of some trace elements. In the 2000 Moss Survey, higher concentrations were measured for Cd, Cu, Ni and Sb than in 2015, ranging from + 26% (Cu) to + 165% (Ni). For As and Pb, no significant changes can be observed in 2020 compared to 2015. The increase in metal concentrations in the mosses over the last five years does not correspond to the corresponding trends in reported metal emissions in Germany (2015–2020). In contrast, the long-term trends of the As, Cd, Cu, Ni and Pb concentrations measured in the mosses showed good overall correspondence with the emission trends in Germany (1990–2020). The long-term trends of the moss data are mostly weaker than those of the emission data. The spatial patterns of the temporal trends were mapped and discussed for As, Cd, Cu, Ni, Pb and Sb. Conclusions The study shows that for valid monitoring of atmospheric deposition, it is not enough to consider only emission data or the modelled deposition derived from these data. In this respect, the study provides one of many necessary contributions to the discussion on the extent to which analytes of current monitoring programmes are still relevant and up-to-date and whether there are new substances that are also relevant or even more relevant than existing analytes and to what extent this should be taken into account in designing future environmental monitoring.

Mosses are suitable for recording the bioaccumulation of atmospheric deposition over large areas at many sites. In Europe, such monitoring has been carried out every five years since 1990. Mosses have been collected and chemically analysed for metals (since 1990), nitrogen (since 2005), persistent organic pollutants (since 2010) and microplastics (2020). The aims of this study were the following: (1) to analyse the temporal trends of metal and nitrogen accumulation in mosses between 1990 or 2005, respectively, and 2020 in Germany; (2) to compare the accumulation trends with emission data; and (3) to determine the effect of tree canopy drip on metal and nitrogen accumulation in mosses. For the temporal trend analysis, the minimum sample number required for a reliable estimation of arithmetic mean values and statistical parameters based on it was calculated. It was only achieved for nitrogen, but not for metals. Therefore, the temporal trends of the bioaccumulation of metals and nitrogen were calculated on the basis of median values. For the analysis of tree canopy effects on element accumulation in mosses, 14 vegetation structure measures were used, which together with 80 other descriptors characterise each moss collection site and its environment. The comparison of the data obtained during the first monitoring campaign with those of the 2020 survey showed a significant decrease in metal bioaccumulation. However, in contrast to the emission data, an increase in the accumulation of some metals was observed between 2000 and 2005 and of all metals from 2015 to 2020. Trends in Germany-wide nitrogen medians over the last three campaigns (2005, 2015 and 2020) show that nitrogen medians decreased by −2% between 2005 and 2015 and increased by +8% between 2015 and 2020. These differences are not significant and do not match the emission trends. Inferential statistics confirmed significantly higher metals and nitrogen accumulation in mosses collected under tree canopies compared to adjacent open areas. Measured concentrations of metals and nitrogen were significantly higher under tree canopies than outside of them, by 18–150%.

Abstract Background Quality of life (QoL) of people with dementia (PwD) is an important indicator of quality of care. Studying the impact of acute hospital settings on PwD’s QoL requires assessment instruments that consider environmental factors. Until now, dementia-specific QoL instruments have not yet demonstrated their feasibility in acute hospitals because their use takes up too much time or their validity depends on observation periods that usually exceed the average length of hospital stays. Therefore, validated instruments to study QoL-outcomes of patients with dementia in hospitals are needed. Methods Data stem from a study that analyzed the impact of a special care concept on the QoL of patients with dementia in acute hospitals. Total sample size consisted of N = 526 patients. Study nurses were trained in using an assessment questionnaire and conducted the data collection from June 2016 to July 2017. QoL was assessed with the QUALIDEM. This instrument consists of nine subscales that can be applied to people with mild to severe dementia (N = 344), while six of the nine subscales are applicable for people with very severe dementia (N = 182). Scalability and internal consistency were tested with Mokken scale analysis. Results For people with mild to severe dementia, seven out of nine subscales were scalable (0.31 ≤ H ≤ 0.75). Five of these seven subscales were also internally consistent (ρ ≥ 0.69), while two had insufficient reliability scores (ρ = 0.53 and 0.52). The remaining two (positive self-image, feeling at home) subscales had rather low scalability (H = 0.17/0.16) and reliability scores (ρ = 0.35/0.36). For people with very severe dementia, all six subscales were scalable (0.34 ≤ H ≤ 0.71). Five out of six showed acceptable internal consistency (ρ = 0.65–0.91). Only the item social relations had insufficient reliability (ρ = 0.55). Conclusions In comparison with a previous evaluation of the QUALIDEM in a long-term care setting, the application in a hospital setting leads to very similar, acceptable results for people with mild to severe dementia. For people with very severe dementia, the QUALIDEM seems to fit even better in a hospital context. Results suggest either a revision of unsatisfactory items or a general reduction to six items for the QUALIDEM, for all PwD. In general, the QUALIDEM can be recommended as instrument to assess the QoL for PwD in the context of hospital research. Additionally, an investigation of the inter-rater reliability is necessary because the qualification of the nurses and the length of stay of the patients in the hospital differ from the previous investigations of the inter-rater reliability of QUALIDEM in the nursing home.

Abstract Background Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self‐help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self‐help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration. Methods A cross‐sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self‐Help and the federal associations of cancer self‐help. Results According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities. Conclusions The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs. Patient or Public Contribution The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self‐help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants.

This data article establishes the first data model for the Multi-Level Capacitated Lot-Sizing Problem with Linked Lot Sizes and Backorders (MLCLSP-L-B) for tablets manufacturing processes. The dataset consists out of nine tables and collects all required meta-information for capacitated lot-sizing problems with linked lot sizes and backorders. Furthermore, it is compatible to store information for single- and multi-level lot-sizing problem instance information. An exact field description and field type is provided for each table. Anonymized real-world data represents four single-level packaging and five multi-level tablets manufacturing processes that are shared with lot-sizing research community by the standardized data template.

Background Nowadays, much hope and expectations are associated with digitization in the health sector. The digital change also affects health-related self-help. A nationwide survey of self-help organizations (SHOs) aimed to show chances and limitations in the use of interactive IT tools like webforums, online meetings or social media as well as digital infrastructures for their organizational management. In this survey, we also determined whether SHO staff themselves have support and qualification needs with regard to this topic. Design The online survey was conducted between 14 November and 8 December 2019, i.e., immediately before the outbreak of the Covid-19 pandemic. The questionnaire consisted of 50 questions consisting of 180 single items which could be answered in 30–40 min. After two reminder letters, 119 questionnaires of the SHOs were gathered and analysed. Results SHOs already have a lot of experience with digital media/tools (e.g., own homepage, social media, cloud computing). Some tools are attested a “high” or “very high” benefit by more than 80% of users. Perceived benefits, however, are also facing a number of problems, ranging from lack of resources to data protection issues. Despite, or even because of the limits of digitization, there is great desire and need for support and further training in SHOs (and self-help groups). Conclusions At many points in the survey it was shown that digital media can be a useful extension of “traditional” collective self-help. Taking into account the risks and limitations associated with digital tools, SHOs can be central stakeholders in digitization in health-related self-help. Patient or Public Contribution The study was financially supported by the Federal Ministry of Health, Germany. A detailed representation of the results is publicly available at: https://www.uke.de/dish .

Abstract Background Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. Methods The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. Results More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. Conclusions Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.

Purpose: The aim of this observational study was firstly, to assess the Health-related Quality of Life (HrQoL) among migrants and German natives in Hamburg, Germany, using the SF-12 mental and physical summary scores and secondly, to evaluate the contribution of selected sociodemographic and socioeconomic variables to explain the variance in mental and physical HrQoL separately for migrants and natives. Methods: Face-to-face interviews were conducted with n=809 participants between May 2018 and July 2019 in six randomly selected statistical districts of Hamburg grouped into four levels of socioeconomic status (SES). The SF-12 questionnaire was used to measure the HrQoL. Socioeconomic (school education, income) and sociodemographic (age, gender, marital status, children) data was recorded, too. Results: Migrants and natives scored higher in mental (migrants: M=45.77, SD=7.66; natives: M=47.60, SD=6.14) than in physical HrQoL (migrants: M=42.55, SD=5.55; natives: M=42.03, SD=4.71). Natives had a significantly higher (p

Research Data Management (RDM) is regarded as an elementary component of empirical disciplines. Taking Landscape Ecology in Germany as an example the article demonstrates how to integrate RDM into the research design as a complement of the classic quality control and assurance in empirical research that has, so far, generally been limited to data production. Sharing and reuse of empirical data by scientists as well as thorough peer reviews of knowledge produced by empirical research requires that the problem of the research in question, the operationalized definitions of the objects of investigation and their representative selection are documented and archived as well as the methods of data production including indicators for data quality and all data collected and produced. On this basis, the extent to which this complemented design of research processes has already been realized is demonstrated by research projects of the Chair of Landscape Ecology at the University of Vechta, Germany. This study is part of a joined research project on Research Data Management funded by the German Federal Ministry of Education and Research.

Abstract Background This paper aims to investigate the correlations between the concentrations of nine heavy metals in moss and atmospheric deposition within ecological land classes covering Europe. Additionally, it is examined to what extent the statistical relations are affected by the land use around the moss sampling sites. Based on moss data collected in 2010/2011 throughout Europe and data on total atmospheric deposition modelled by two chemical transport models (EMEP MSC-E, LOTOS-EUROS), correlation coefficients between concentrations of heavy metals in moss and in modelled atmospheric deposition were specified for spatial subsamples defined by ecological land classes of Europe (ELCE) as a spatial reference system. Linear discriminant analysis (LDA) and logistic regression (LR) were then used to separate moss sampling sites regarding their contribution to the strength of correlation considering the areal percentage of urban, agricultural and forestry land use around the sampling location. After verification LDA models by LR, LDA models were used to transform spatial information on the land use to maps of potential correlation levels, applicable for future network planning in the European Moss Survey. Results Correlations between concentrations of heavy metals in moss and in modelled atmospheric deposition were found to be specific for elements and ELCE units. Land use around the sampling sites mainly influences the correlation level. Small radiuses around the sampling sites examined (5 km) are more relevant for Cd, Cu, Ni, and Zn, while the areal percentage of urban and agricultural land use within large radiuses (75–100 km) is more relevant for As, Cr, Hg, Pb, and V. Most valid LDA models pattern with error rates of

Abstract Background Since 1990, every 5 years, moss sampling is conducted within the European moss monitoring programme to assess the atmospheric deposition of airborne pollutants. Besides many other countries, Germany takes regularly part at these evaluations. Within the European moss monitoring 2015, more than 400 moss samples across Germany were taken according to a harmonized methodology for the assessment heavy metal and nitrogen input. In a pilot programme, eight of these sites were chosen for additional investigations on a broad range of organic contaminants to evaluate their accumulation in moss and thereby their presence in atmospheric deposition in Germany. Target compound classes comprised polycyclic aromatic hydrocarbons (PAH), polychlorinated dibenzodioxins and –furans (PCDD/F), dioxin-like and non-dioxin-like polychlorinated biphenyls (dl-PCB, ndl-PCB), polyfluorinated alkyl substances, classical flame retardants as well as emerging chlorinated and brominated flame retardants. In total, 120 target compounds were analysed. For some analytes, comparisons of accumulation in moss and tree leave samples were possible. Results Except for certain flame retardants, PFAS, and ndl-PCB, substances of all other compound classes could be quantified in moss samples of all sites. Concentrations were highest for PAH (40–268 ng g−1) followed by emerging flame retardants (0.5–7.7 ng g−1), polybrominated diphenyl ethers (PBDE; 0.3–3.7 ng g−1), hexabromocyclododecane (HBCD; 0.3–1.2 ng g−1), dl-PCB (0.04–0.4 ng g−1) and PCDD/F (0.008–0.06 ng g−1). Conclusions Results show the widespread atmospheric distribution and deposition of organic contaminants across Germany as well as the suitability of moss as bioaccumulation monitor for most of these compound classes. Compared to nearby tree leaf samples, accumulation potential of moss appeared to be higher for pollutants of high octanol–air partition coefficient (KOA) and octanol–water partition coefficient (KOW).

BackgroundIn most western countries a shortage of general practitioners (GP) exists. Newly qualified GPs often prefer to work in teams rather than in single-handed practices. Therefore, new practices offering these kinds of working conditions will be attractive in the future. From a health care point of view, the location planning of new practices will be a crucial aspect. In this work we studied solutions for locating GP practices in a defined administrative district under different objectives.MethodsUsing operations research (OR), a research discipline that originated from logistics, different possible locations of GP practices were identified for the considered district. Models were developed under two main basic requirements: that one practice can be reached by as many inhabitants as possible and to cut down the driving time for every district's inhabitant to the next practice location to less than 15 minutes. Input data included the demand (population), driving times and the current GP locations.ResultsThree different models were analysed ranging from one single practice solution to five different practices. The whole administrative district can reach the central community "A" in at most 23 minutes by car. Considering a maximum driving time of 15 minutes, locations in four different cities in the district would be sufficient.ConclusionOperations research methods can be used to determine locations for (new) GP practices. Depending on the concrete problem different models and approaches lead to varying solutions. These results must be discussed with GPs, mayors and patients to find robust locations regarding future developments.

Deposition of N and heavy metals can impact ecological and human health. This state-of-the-art review addresses spatial and temporal trends of atmospheric deposition as monitored by element accumulation in moss and compares heavy metals Critical Loads for protecting human health and ecosystem’s integrity with modelled deposition. The element accumulation due to deposition was measured at up to 1026 sites collected across Germany 1990–2015. The deposition data were derived from chemical transport modelling and evaluated with regard to Critical Loads published in relevant legal regulations. The moss data indicate declining nitrogen and HM deposition. Ecosystem and human health Critical Loads for As, Ni, Zn, and Cr were not exceeded in Germany 2009–2011. Respective Critical Loads were exceeded by Hg and Pb inputs, especially in the low rainfall regions with forest coverage. The Critical Load for Cu was exceeded by atmospheric deposition in 2010 in two regions. Human health Critical Loads for Cd were not exceeded by atmospheric deposition in 2010. However, the maximum deposition in 2010 exceeded the lowest human health Critical Load. This impact assessment was based only on deposition but not on inputs from other sources such as fertilizers. Therefore, the assessment should be expanded with regard to other HM sources and specified for different ecosystem types.