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Objective: To investigate the impact of eating behaviour traits on central obesity, prediabetes and associated major dietary food patterns.Design: Assessment of eating behaviour was based on the revised German version of the Three-Eating Factor Questionnaire using cross-sectional and longitudinal data of a feasibility study in employees. Data on lifestyle and nutrition were obtained by validated self-administered questionnaires. Baseline characteristics were analysed by the univariate χ2 test or the Mann-Whitney test. To quantify correlations linear regression analysis was used.Setting: The Delay of Impaired Glucose Tolerance by a Healthy Lifestyle Trial (DELIGHT), which investigated measures to prevent type 2 diabetes mellitus in 2004-2008.Subjects: Employees (21-64 years, 127 men, 157 women) with elevated waist circumference (men ≥ 94 cm, women ≥ 80 cm) of five medium-sized companies in northern Germany.Results: At baseline (T0), BMI but particularly waist circumference showed a strong inverse correlation with flexible control (P < 0.0001) and a positive correlation with disinhibition (P < 0.0001) and rigid control (P = 0.063). Flexible control was also significantly inversely related to fasting plasma glucose (P = 0.040), energy intake (P < 0.0001), intake of meat and meat products (P = 0.0001), and positively associated with intake of fruit and vegetables (P < 0.0001) at baseline (T0). Changes in flexible control within the first year of intervention (T1 v. T0) predicted changes in central obesity (P < 0.0001) and fasting plasma glucose (P = 0.025).Conclusions: DELIGHT shows that flexible control characterizes individuals with a higher dietary quality, a lower waist circumference and a lower glucose level. Enhancing flexible control more than rigid control, and decreasing disinhibition, seems beneficial in terms of central adiposity and glucose levels. [ABSTRACT FROM AUTHOR]

Background: Coronary heart disease (CHD) is the leading cause of death among adults in Germany. There is evidence that occupational exposure to particulate matter, noise, psychosocial stressors, shift work and high physical workload are associated with CHD. The aim of this study is to identify occupations that are associated with CHD and to elaborate on occupational exposures associated with CHD by using the job exposure matrix (JEM) BAuA-JEM ETB 2018 in a German study population., Methods: Cross-sectional data from 8,070 participants, members of the first sub-cohort of the Hamburg City Health Study (HCHS), was used. To classify occupations, we rely on standard occupational titles (ISCO-08). The level of exposure is assigned to each job using a JEM. CHD is measured by self-reported diagnosis. Absolute and relative frequencies were calculated. Using logistic regression, the association of CHD and standard occupation titles via ISCO-08 and the association of CHD and occupational exposures via JEM were calculated and adjusted for potentially confounding covariates. Multiple imputations with chained equations (MICEs) were applied for missing values. Sensitivity analyses were performed., Results: The CHD prevalence in the study population was 4.6% (95% CI 4.2-5.1). Occupations associated with CHD were Physical and Engineering Science Technicians, Other Health Associate Professionals, General Office Clerks, Secretaries (general), Material Recording and Transport Clerks, Hairdressers, Beauticians and Related Workers, Electronics and Telecommunications Installers and Repairers, Other Craft and Related Workers, Car, Van and Motorcycle Drivers, Mobile Plant Operators and Domestic, Hotel and Office Cleaners and Helpers. Among occupational exposures retrieved from the JEM, Environmental Demands showed an association with CHD in the crude model but not after adjustment. The results remained robust in sensitivity analyses., Conclusions: This study is the first to assess the association of a wide range of occupations and occupational exposures with CHD in a German study population. We found no association between occupational exposures and CHD after adjustment, but 11 occupations associated with CHD were identified. The results are limited by cross-sectional design, healthy worker effect (HWE), and small group sizes. Further studies with a larger sample and longitudinal design containing data on occupational history, occupational exposures and time of CHD diagnosis are needed., Competing Interests: Declarations. Competing interests: B.T. receives project-related funding by the German Foundation of Heart Research, Ernst und Berta Grimmke-Stiftung (co-recipient) and Werner Otto Stiftung outside the submitted work. B.T. also received travel grants by the German Center for Cardiovascular Research (DZHK) and is the representative of the partner sites Hamburg/Kiel/Lübeck in the Use and Access Committee of the DZHK Heart Bank. Ethics approval and consent to participate: The Hamburg City Health Study (HCHS) was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all subjects involved in the study. During the study conception, the local ethics committee of the Landesärztekammer Hamburg (State of Hamburg Chamber of Medical Practitioners, PV5131) was consulted and its approval for the study protocol as well as the approval by the Data Protection Commissioner of the University Medical Center of the University Hamburg-Eppendorf and the Data Protection Commissioner of the Free and Hanseatic City of Hamburg were obtained. The study has been registered at ClinicalTrial.gov on 2019-01-04 (NCT03934957). Consent for publication: Not applicable. Competing interests: BT receives project-related funding by the German Foundation of Heart Research, Ernst und Berta Grimmke-Stiftung (co-recipient) and Werner Otto Stiftung outside the submitted work. BT also received travel grants by the German Center for Cardiovascular Research (DZHK) and is the representative of the partner sites Hamburg/Kiel/Lübeck in the Use and Access Committee of the DZHK Heart Bank., (© 2025. The Author(s).)

The present study analyses the technical requirements as well as the user behaviour of seafarers for an app-based health prevention, including apps for wellness, prevention, fitness, medical care and mental well-being. In a maritime field study 976 seafarers on 65 merchant ships participated in the survey carried out with a questionnaire. The vast majority (98.4%) of the respondents had a mobile device on board. 52.5% stated to already have downloaded a health app, with a higher proportion among the officers (adjusted Odds Ratio (aOR) 1.67; 95% CI (1.13-2.50)). The most common reasons for downloading this kind of app were activity tracking (74.8%), weight loss (41.8%) and exercise (41.0%). Officers downloaded apps significantly more often for activity tracking (p< 0.001) and sleep tracking (p = 0.001). 51.1% of downloaders stopped the use of a health app. Frequent reasons for not downloading or stopping the use of a health app were loss/absence of interest and that the desired health apps could not be used offline. Frequency and duration of use were highest at home, followed by the use at sea and then in port. No correlation between the WHO Well-being Index and the use of health apps could be found. Overall, two kinds of obstacles to implementing app-based health intervention could be identified: maritime-specific obstacles and general obstacles (obstacles not exclusively assignable to the naval environment); the maritime-specific obstacles primarily consisted of being offline for long periods of time and limited recreational time. Among the most important general problems were economic and social problems as well as a significant loss/absence of interest. Nevertheless, the basic requirements for an app-based health prevention for seafarers seem to be in place. Measures taken by the shipping company could consist of providing internet access for app usage and educating seafarers on the benefits of health apps. Providing preselected options and guidance on app selection and licenses for paid apps could further encourage usage among seafarers and strengthen success of an app-based health intervention eventually leading to improved physical and mental health in their employees. Additionally, if follow-up maritime studies can objectively demonstrate benefits and positive health effects, the International Maritime Organization (IMO) could officially recommend the use of health apps as a health management measure and play an important political role by recommending and supporting the development of health apps specifically designed for maritime conditions with key features like offline availability., Competing Interests: the authors have declared that no competing interests exist., (Copyright: © 2024 Arslan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: In ovarian cancer frequently reported side effects are muscle wasting and malnutrition, leading to frailty, decreased health-related quality of life (HRQoL), and cancer-related fatigue (CRF). Both often begin during first-line chemotherapy and develop progressively into a refractory state, if left untreated., Method: Primary objective is to evaluate effectiveness of a newly developed app-based exercise and nutrition program under non-standardized conditions of clinical routine. We hypothize that patients who receive an individually tailored exercise and nutrition program for six months will have improved physical performance compared to patients who receive usual care. This is a multicenter randomized controlled open-label trial comparing an intervention group receiving a six-month exercise and nutrition intervention and a control group receiving usual care. Primary endpoint is the change in 6-Minute Walk Test (6MWT) from baseline to T2 (26 weeks after baseline) as a measure of physical functioning. Secondary endpoints include patients' utilization and adherence to the nutrition program (MEDAS), their malnutrition risk (NRS2002), as well as patients' HRQoL (see Table 1). Using the two-sample t-test with a two-sided type I error of 5% and 80% power, a medium effect size of Cohen's d = 0.50 can be demonstrated with a minimum of 128 participants (64 per group). With a conservatively estimated dropout rate of 30%, 182 patients will be recruited. Patients who are included must be over 18 years of age, be diagnosed with ovarian cancer, cancer of fallopian tubes, or peritoneal cancer, FIGO stages II-IV, receive surgery and chemotherapy (adjuvant or neoadjuvant). Exclusion criteria are an ECOG status greater than 2, inadequate proficiency in German, or physical or mental impairments hindering the implementation of the program or execution of study procedures., Discussion: In case of success, the project contributes in the long term to (i) improving medical care (diagnosis, psychoeducation, patient orientation, and empowerment), (ii) reducing the burden of disease and promoting physical autonomy for patients, and (iii) being incorporated into relevant guidelines., Trial Registration: The study was registered at ClinicalTrials.gov (NCT06250686)., Competing Interests: Declarations Ethics approval and consent to participate The study is conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of the Hamburg Medical Association (2023-101090-BO-ff). All participants gave informed consent. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Vitamin D plays a role in inflammatory skin conditions and can improve them. Hidradenitis suppurativa (HS) is an autoinflammatory chronic skin disease in which most patients exhibit a hypovitaminosis D. However, it is uncertain whether vitamin D supplementation could relieve the severity of HS. A systematic literature search of PubMed and Web of Science was conducted on 4 September 2023. Studies that investigated vitamin D and its potential implications for the severity of HS were included. In contrast, studies that focused on the prevalence of vitamin D deficiency were excluded, as well as studies on syndromic HS. Seven studies with a total of 575 patients were included in the qualitative synthesis, of which 3 utilized a cross-sectional design, 2 were pilot studies, 1 a controlled cohort study, and 1 a prospective case-control study. In all included studies, HS patients were vitamin D deficient. There was evidence indicating that serum vitamin D levels negatively correlated with the severity of the disease, and at least suggestive evidence that vitamin D supplementation could have a positive impact on the course of HS. To better understand these correlations, conducting a randomized controlled trial study on vitamin D and its effects on HS severity is imperative.

Background and Aims: Adverse pregnancy outcomes (APO) have been related to increased cardiovascular (CV) risk and mortality in later life. Underlying pathomechanisms for the development of CV disease in these women are not yet fully understood. In this study, we aimed to investigate the relationship between APO and individual CV risk profiles in later life., Methods: We used cross-sectional data from 10,000 participants enrolled in the Hamburg City Health Study (HCHS). We analysed self-reported APO, CV risk factors and health status, including biomarkers, electrocardiogram, echocardiography and vascular ultrasound. To examine associations, Wilcoxon rank sum test and Pearson's χ 2 -test were performed. Multivariable-adjusted regression models were calculated to determine associations., Results: N = 1970 women who reported pregnancies were included. Median age was 63 years, 8.7 % reported gestational hypertension (gHTN), 18 % excessive weight gain and 2.4 % gestational diabetes. Ten percent had delivered newborns with birth weight <2.5 kg, 14 % newborns with birth weight >4 kg. In multivariable-adjusted models, significant associations between APO, CV risk profiles and cardiac remodeling were identified. gHTN correlated with higher body mass index (BMI) (Beta 1.68, CI 95 % 0.86-2.50; p < 0.001), hypertension (OR 4.58, CI 95 % 2.79-7.86; p < 0.001), left ventricular remodeling (e.g. left ventricular mass index (Beta 4.46, CI 95 % 1.05-7.87; p = 0.010)) and myocardial infarction (OR 3.27, CI 95 % 0.94-10.07; p = 0.046)., Conclusions: In this population-based sample, APO were associated with CV risk profiles and cardiac remodeling in later life, suggesting early manifestations of future CV risk during pregnancy. Prospective data is needed for individual risk stratification in women with APO., Competing Interests: Declaration of competing interest All participating institutes and departments from the University Medical Center Hamburg-Eppendorf contribute with scaled budgets to the overall funding of the Hamburg City Health Study (HCHS). Moreover, HCHS has received funding from the Innovative medicine initiative (IMI) under Grant No. 116074 (European public-private-partnership), Fondation Leducq (Grant Number 16 CVD 03), euCanSHare (Grant Agreement No. 825903-euCanSHare H2020) and the Deutsche Forschungsgemeinschaft (DFG project Grant TH1106/5-1; AA93/2-1). The HCHS is further supported by Joachim Herz Foundation; Deutsche Gesetzliche Unfallversicherung (DGUV); Deutsches Krebsforschungszentrum (DKFZ); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK); Deutsche Stiftung für Herzforschung; Seefried Stiftung; Bayer; Amgen, Novartis; Schiller; Siemens; Topcon, Unilever and by donations from the “Förderverein zur Förderung der HCHS e.V.”, and TePe® (2014). Sponsor funding has in no way influenced the content, conclusions or management of this study. E.U., K.B., G.A., P.S., C.V.R. and C.A.B. have not received any project related funding. N.M. reports personal fees from Abbott Laboratories, outside the submitted work. C.M. receives study-specific funding from the German Center for Cardiovascular Research (DZHK; Promotion of women scientists’ programme; FKZ 81X3710112), the Deutsche Stiftung für Herzforschung, the Dr. Rolf M. Schwiete Stiftung, NDD, and Loewenstein Medical unrelated to the current work. C.M. has received speaker fees from AstraZeneca, Novartis, Boehringer Ingelheim/Lilly, Bayer, Pfizer, Sanofi, Aventis, Apontis, Abbott outside this work. C.M. has participated in a Boehringer Ingelheim heart failure advisory board. S.B. is supported by the Innovative medicine initiative (IMI) under Grant No. 116074, the Fondation Leducq under Grant Number 16 CVD 03, Siemens, Bayer, Astra Zeneca, Deutsche Gesetzliche Unfallversicherung (DGUV) and Novartis for project related analyses. B.C.Z. has received an unrestricted project-related funding from BASF and Unilever for implementing a food frequency questionnaire into the interviews of the Hamburg City Health Study and reports fees from Jenapharm GmbH and BESINS Heathcare for lectures outside this work. R.B.S. has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme under the grant agreement No 648131, from the European Union's Horizon 2020 research and innovation programme under the grant agreement No 847770 (AFFECT-EU) and German Center for Cardiovascular Research (DZHK e.V.) (81Z1710103 and 81Z0710114); German Ministry of Research and Education (BMBF 01ZX1408A) and ERACoSysMed3 (031L0239). Wolfgang Seefried project funding German Heart Foundation. R.B.S. has received lecture fees and advisory board fees from BMS/Pfizer and Bayer outside this work. E.U., N.M., K.B., P.S., C.V.R, G.A, C.M., C.A.B, S.B., B.C.Z. and R.B.S. report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Poor oral and dental health due to oral dysbiosis during pregnancy increases the risk for negative pregnancy outcomes. Communicating the importance of oral health is therefore essential in reducing the risk of adverse pregnancy outcomes. Professional guidance could substantially support women's positive perception of their own competence. Information on oral health should be provided by healthcare professionals such as midwives, obstetricians and dentists. The aim of this study was to assess the needs, wishes and preferences of pregnant women in Germany, regarding interprofessional collaboration and guidance on oral health during pregnancy., Methods: Sources of information, preferences regarding information supply as well as the need for interprofessional collaboration of involved healthcare professions were investigated in six online focus groups with pregnant women. In addition, three expert interviews with a midwife, an obstetrician and a dentist were conducted. The focus groups and interviews were analysed using qualitative content analysis according to Kuckartz., Results: 25 pregnant women participated in focus groups. Pregnant women in all trimesters, aged 23 to 38 years, were included. Many women did not receive any or received insufficient information on oral health during pregnancy and wished for more consistent and written information from all involved healthcare providers. The extent of oral health counselling women received, heavily relied on their personal initiative and many would have appreciated learning about the scientific connection between oral health and pregnancy outcomes. An overall uncertainty about the timing and safety of a dental visit during pregnancy was identified. Interviews with experts provided additional insights into the working conditions of the involved healthcare professionals in counselling and emphasised the need for improved training on oral health during pregnancy in their respective professional education as well as thematic billing options in relation to this topic., Conclusion: Guidance of women on oral health during pregnancy appears to be insufficient. Providing information adapted to the needs, wishes and preferences of women during pregnancy as well as the implementation of this topic in the education of involved healthcare professionals could contribute to an improved prenatal care for pregnant women and subsequently a reduced risk of negative pregnancy outcomes., (© 2024. The Author(s).)

The current situation in Germany is characterised by significant differences between the two types of higher education institutions offering bachelor's degree programmes in midwifery at both universities of applied sciences and universities. These differences are noticeable in admission procedures, resource allocation, content focus and competence assessment at the respective institutions, which in turn result in heterogeneous study experiences. This article highlights the challenges currently facing bachelor degree programmes and the academic qualification of midwives, and identifies future requirements for the development of degree programmes in theory and practice as well as theory-practice transfer, and assessment formats. Furthermore, this article covers the content-related and structural-organisational requirements to develop in-depth academic skills grounded in theory teaching, the facilitation of clinical placements at an academic level, the training of qualified practical instructors and the development of applicable competence-based assessment formats, especially for the state exam. The development of a standardised, high-quality academic education for midwives in Germany requires networking of the different academic sites/locations to exchange experiences in teaching/learning and assessment formats. Furthermore, it can facilitate the development of a standardised competence-oriented model and core curriculum as well as the definition of quality criteria and standards for study programmes of midwifery science. The Midwifery Science Committee (AHW) in the DACH Assoviation for Medical Education (GMA) offers an optimal platform for cooperation between the different universities. The existing challenges for the further professional development of midwives can only be overcome by collaboration and pooled expertise., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Plappert et al.)

The objective of academic training is to prepare midwives as independent healthcare professionals to make a substantial contribution to the healthcare of women in their reproductive years as well as to the health of their children and families. This article therefore describes the professional and educational requirements derived from the legal midwifery competencies within the new midwifery act. Furthermore, it identifies the conditions that need to be established to enable midwives in Germany to practise to their full scope in compliance with statutory responsibilities. Educational science, academic efforts, policymaking and accompanying research should work in synergy. This in turn enables midwives to achieve the maximum scope of their skills, with the objective of promoting physiological pregnancies and births. Consequently, it can strengthen early parenthood in alignment with the national health objectives of "health around childbirth". The academisation of the midwifery profession presents a profound opportunity for professional development in Germany. It is essential that midwives receive training based on the principles of educational science and care structures that are yet to be developed. This can enable them to perform within the wide range of their professional tasks to the highest standards, thereby ensuring the optimal care of their clients. Moreover, there is a chance to implement sustainable improvements in healthcare provision for women and their families during the reproductive phase and the period of parenthood in Germany., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Striebich et al.)

Objectives: The care of women and their families around childbirth requires effective interprofessional collaboration of the midwifery and medical profession. Given the academisation of midwifery, early interaction between students of midwifery and medicine is both necessary and feasible. As there is a lack of comprehensive data on interprofessional education (IPE) for midwifery and medical students at higher education institutions in Germany, Austria, and Switzerland (DACH region), the aim was to identify existing IPE activities, and their curricular determination., Methods: The exploratory study was conducted in the DACH region over three months (Dec. 2022-Feb. 2023). Higher education institutions offering midwifery science and/or medicine were invited to participate in a web-based survey. The questionnaire focused on the structure and curricular implementation of IPE courses, on cooperation, financial support and more., Results: A total of 58 out of 96 invited institutions (60%) participated in the survey, of which 34 (59%) offered IPE. Eighteen institutions (19%) offered 32 IPE courses for midwifery and medical students through cooperation within faculty ( n =8) and between faculties ( n =10). Notably, most of these IPE courses (60%) were integrated into the required curriculum of both study programmes. Most IPE courses were offered without financial support (71%)., Conclusion: The current status quo highlighted the existence of numerous IPE offers for midwifery and medical students in the DACH region that warrant further curricular integration of proven and well-established best practice examples to further enhance these initiatives., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2024 Juschka et al.)

Background: Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany., Methods: Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions., Results: Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students)., Conclusions: Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions., (© 2024. The Author(s).)

Background: Seafarers' diets are often high in fat, sugar and calories, thus contributing to an increased risk of obesity, metabolic syndrome and cardiovascular disease. The multitude of obstacles to healthy eating in the on-board environment on merchant ships makes it essential to find new approaches for health promotion. This study explored seafarers' attitudes, the status quo of support measures and chances to improve nutrition on merchant ships from the perspective of crews and cooks., Methods: In the course of the EU-funded project "e-healthy ship", European and Southeast Asian seafarers (N = 810) and ship cooks (N = 62) were examined by using two questionnaires on 68 ships of two German shipping companies., Results: Almost all seafarers (98.8%) considered a healthy diet important for their well-being and the majority of seafarers reported being open-minded about changing their eating habits (88.4%). However, European seafarers were less likely to respond that they are willing to eat less meat [OR 0.11; 95%CI (0.07-0.17); p < .001], more vegetables [OR 0.10; 95%CI (0.02-0.49); p = .005] and more fruits [OR 0.11; 95%CI (0.02-0.61); p = .011] than their Southeast Asian colleagues. On the one hand, 82.3% of the ship cooks reported having taken part in at least one cooking course organized by their employer (1: 33.9%, 2: 25.8%, 3: 14.5%, 4 or more: 8.1%), on the other hand, slightly above half stated that the last of these courses had taken place more than 2 years ago. Furthermore, the ship cooks showed a positive attitude towards the use of a tablet-based digital platform that supports the ship cooks in daily and complex tasks (> 85% agreement)., Conclusions: To improve nutrition on board merchant ships, various parameters need to be adjusted, such as ensuring a demand-oriented food supply on board or supporting seafarers' healthy food choices through target group-specific nutrition education. Ship cooks would be able to play a crucial role if they receive support. The development of a tablet-based digital platform that supports the ship cooks in their daily tasks, offers training and empowers them to implement health-promoting measures themselves seems to be an accepted and promising approach., (© 2024. The Author(s).)

Objectives: The immediate living environment might, like other lifestyle factors, be significantly related to mental well-being. The current study addresses the question whether five relevant subjective home environment variables (i.e., protection from disturbing nightlight, daylight entering the home, safety at home, quality of window views, and noise disturbance) are associated with levels of self-reported depression over and above well-known sociodemographic and common lifestyle variables., Methods: Data from the Hamburg City Health Study (HCHS) were analyzed. In N = 8757 with available PHQ-9 depression data, multiple linear regression models were computed, with demographic data, lifestyle variables, and variables describing the subjective evaluation of the home environment., Results: The model explained 15% of variance in depression levels, with ratings for the subjective evaluation of home environment accounting for 6%. Better protection from disturbing light at night, more daylight entering the home, feeling safer, and perceived quality of the window views, were all significantly associated with lower, while more annoyance by noise was associated with higher levels of self-reported depression. Results did not differ if examining a sample of the youngest (middle-aged participants: 46-50 years) versus oldest (70-78 years) participants within HCHS., Conclusion: Beyond studying the role of lifestyle factors related to self-reported depression, people's homes may be important for subclinical levels of depression in middle and older age, albeit the direction of effects or causality cannot be inferred from the present study. The development of a consensus and tools for a standardized home environment assessment is needed., (© 2024 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Objective: The main goals of our study were (I) the investigation of expectations and preferences as well as (II) the determination of needs of women in regard to midwifery care., Design: Descriptive phenomenology was used to investigate the ways in which women experienced childbirth and early parenthood. A descriptive qualitative research design was chosen, using focus groups., Setting: ix online focus groups were carried out with 19 women for this part of the Midwifery Care (MiCa) study, mainly from the north of Germany., Participants: Women shortly after birth, in puerperium and the first year after childbirth were recruited in Germany. A purposeful strategy according to maximum variation sampling was applied to reach diversity in the sample regarding age and previous children. Data were analysed using qualitative content analysis, according to Mayring, with support of the qualitative data analysis software MAXQDA 2022., Findings: Six main categories were derived for both childbirth and early parenthood: (a) involvement of family, (b) need for information, (c) physical and psychological aspects and (d) orientation in the healthcare system. In each group, one main category about provision of healthcare was developed: (e) care around childbirth and (f) midwifery care in early parenthood. Women attached great importance to the communication with midwives and favoured the involvement of their partners in the childbirth process and during parenting. Based on different experiences and inconsistency of information, women would prefer consistency in staff and communication as well as standardised information., Conclusions: From the user's perspective, midwifery care is crucial during childbirth and the child's first year of life. Current health care during and after childbirth and early parenthood lacks individualised care models, emotional support, adequate and professional communication between different health care providers, and consistency in midwifery care. Our findings should be translated into health care delivery with effective interprofessional teamwork within the continuity of midwifery care. Further quantitative research should analyse the individual healthcare situations of women in the reproductive phase of their life as well as of the applied healthcare models in order to personalise care and to improve healthcare quality., Competing Interests: Declaration of competing interest TMJ, NM, JS, CA, ME, and BCZ declare no conflict of interest. CB received grants or contracts to the institution from Amgen/Celgene, AstraZeneca, Bauerfeind, Pfizer, The EuroQol Group; spreaker honoraria from Amgen/Celgene, AstraZeneca, Hartmann, Helios Klinik Leisnig, medi; support for attending meetings and/or travel from AstraZeneca, Hartmann, Helios Klinik Leisnig., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The link between metabolic syndrome (MetS) and neurodegenerative as well as cerebrovascular conditions holds substantial implications for brain health in at-risk populations. This study elucidates the complex relationship between MetS and brain health by conducting a comprehensive examination of cardiometabolic risk factors, brain morphology, and cognitive function in 40,087 individuals. Multivariate, data-driven statistics identified a latent dimension linking more severe MetS to widespread brain morphological abnormalities, accounting for up to 71% of shared variance in the data. This dimension was replicable across sub-samples. In a mediation analysis, we could demonstrate that MetS-related brain morphological abnormalities mediated the link between MetS severity and cognitive performance in multiple domains. Employing imaging transcriptomics and connectomics, our results also suggest that MetS-related morphological abnormalities are linked to the regional cellular composition and macroscopic brain network organization. By leveraging extensive, multi-domain data combined with a dimensional stratification approach, our analysis provides profound insights into the association of MetS and brain health. These findings can inform effective therapeutic and risk mitigation strategies aimed at maintaining brain integrity., Competing Interests: MP, FH, FN, CM, MS, DR, BZ, SK, AO, KP, SE, BC No competing interests declared, TZ TZ is listed as co-inventor of an international patent on the use of a computing device to estimate the probability of myocardial infarction (PCT/EP2021/073193, International Publication Number WO2022043229A1). TZ is shareholder of the company ART-EMIS GmbH Hamburg, JG JG has received speaker fees from Lundbeck, Janssen-Cilag, Lilly, Otsuka and Boehringer outside the submitted work, JF JF reported receiving personal fees from Acandis, Cerenovus, Microvention, Medtronic, Phenox, and Penumbra; receiving grants from Stryker and Route 92; being managing director of eppdata; and owning shares in Tegus and Vastrax; all outside the submitted work, RT RT is listed as co-inventor of an international patent on the use of a computing device to estimate the probability of myocardial infarction (PCT/EP2021/073193, International Publication Number WO2022043229A1). RT is shareholder of the company ART-EMIS GmbH Hamburg, GT GT has received fees as consultant or lecturer from Acandis, Alexion, Amarin, Bayer, Boehringer Ingelheim, BristolMyersSquibb/Pfizer, Daichi Sankyo, Portola, and Stryker outside the submitted work, (© 2023, Petersen et al.)

Background: A healthy nutrition in pregnancy supports maternal health and fetal development, decreasing the risk for adverse pregnancy outcomes. Guidance by prenatal care professionals can increase women's awareness regarding the importance of nutrition in pregnancy and thereby contribute to a reduced risk for adverse pregnancy outcomes. The aim of this study was to assess the needs, wishes and preferences of pregnant women regarding the interprofessional guidance on nutrition in pregnancy., Methods: Using a qualitative approach and a purposive maximum variation sampling strategy, 25 pregnant women were recruited to participate in six semi-structured, guideline-oriented online focus groups. In addition, two semi-structured, guideline-oriented interviews, with a midwife and an obstetrician, were conducted. The focus groups and interviews were audio-recorded and transcribed. Transcripts were analysed using a systematic deductive-inductive approach to qualitative content analysis according to Kuckartz., Results: Focus group participants covered diverse perspectives in terms of their age, different models of prenatal care as well as dietary forms from omnivorous to vegan. The majority of women perceived the guidance on nutrition during pregnancy as insufficient. Involved healthcare professionals, namely midwives and obstetricians, should provide more consistent information, especially to avoid uncertainties exacerbated by the internet and social media. There is a need for individual nutrition information regarding dietary supplements and the specifics of different dietary forms during pregnancy, such as a vegan diet. The majority of participants supported the integration of a free-of-charge professional nutrition counselling in prenatal care. Interviews with experts identified time pressure and the complexity of nutrition as a topic as the main obstacles in consultation settings. Both midwife and obstetrician emphasised the need for improved professional education on nutrition in pregnancy in their respective studies., Conclusion: Professional guidance for pregnant women on nutrition and uncertainties going along with certain forms of diet during pregnancy could alleviate the burden and overwhelming amount of web-based information. Additionally, information adapted to the needs, wishes and preferences of pregnant women would improve prenatal care through a more personalised approach. The quality of nutrition guidance in pregnancy should be improved by the implementation of this topic in the education of involved healthcare professionals., (© 2024. The Author(s).)

Midwifery services play an important role in healthcare provision, birth preparation and prevention. Knowledge on women's expectations, preferences and needs regarding midwifery care is crucial not only for clinical care during preconception and pregnancy and research, but also for educational purposes. This descriptive qualitative study aimed to investigate the expectations, preferences and the needs of women concerning midwifery care in Germany. Experienced researcher team conducted interviews with women who have the desire to get pregnant and online focus groups with women in early and late pregnancy. A purposeful recruitment strategy with maximum variation sampling was applied to reach diversity in the sample regarding age, previous children and socioeconomic background. A total of 26 women participated. In the qualitative content analysis according to Mayring, seven main categories were developed for both preconceptional phase and pregnancy: (a) care by midwife, (b) care by obstetrician, (c) involvement of family, (d) need for information, (e) physical aspects, (f) psychological aspects and (g) orientation in healthcare system. One additional category referenced (h) organisation and bureaucracy in pregnant women. Women appreciated the personalised experience provided by midwives leading to trust and empowerment. Women's experiences with midwifery care varied. They reported contradictory information they received about services and care options. They valued interprofessional cooperation, continuity of care, structured information and personalised counselling. Midwives play an important role in healthcare provision, birth preparation and prevention. In order to depict the care situation quantitatively, to personalise care and to optimise healthcare models, a tool to assess the quality of healthcare and to evaluate women's needs and benefits of midwifery care will be developed based on the findings of this study. From the public health perspective, deficits in the German healthcare system concerning insufficient intra-sectoral communication, time pressure and low remuneration should be resolved in further research steps and policy action., Competing Interests: The authors Toni Maria Janke, Nataliya Makarova, Janne Schmittinger, Caroline Johanna Agricola, Merle Ebinghaus and Birgit-Christiane Zyriax declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Christine Blome declare the following financial interests/personal relationships which may be considered as potential competing interests: grants or contracts to the institution from Amgen/Celgene, AstraZeneca, Bauerfeind, Pfizer, The EuroQol Group; spreaker honoraria from Amgen/Celgene, AstraZeneca, Hartmann, Helios Klinik Leisnig, medi; support for attending meetings and/or travel from AstraZeneca, Hartmann, Helios Klinik Leisnig., (© 2024 The Authors.)