Background:Residents of urban heat islands, particularly older adults, experience significant health impacts during heat waves. In the context of ongoing climate and demographic change, the development and implementation of adaptation strategies are essential. Thus we investigated applied adaptation strategies by senior citizens. Methods and materials:Four types of research areas were defined based on socio-economic factors and amount of greenery. From September to November 2011, a total of 901 individuals were surveyed on heat-related issues across four study areas in Vienna. Face-to-face interviews were carried out with residents of senior citizens' homes (≥65 years; n=200), while telephone interviews were conducted with older adults in private homes (≥65 years; n=401) and a control group (18-55 years; n=300). Additional expert interviews were conducted to identify discrepancies between recommended heat-protective behaviours and the actual practices. In a second wave two years later, older residents living in urban heat islands (≥65 years; n=200) in socio-economically advantaged and disadvantaged Viennese areas were asked regarding heat symptoms and protection measures. Results:The most common effects of heat, regardless of age, were fatigue and sleep disturbances. While physical measures in hot weather such as drinking more fluids were taken regardless of symptoms, indoor measures increased with increasing heat-related symptoms. Outdoor strategies were used more frequently when symptoms were less severe. Overall, 70% of residents in senior citizens' homes, 66% in private households and 54% of the control group stayed mainly indoors during hot weather. In heat islands, 80% of respondents rated their homes as hot to extremely hot during a heatwave, with residents of socio-economically disadvantaged districts reporting more heat-related complaints. Discussion and conclusions:Older adults who have difficulty adapting to heat are at greater risk not only for health problems but also for social isolation. Individuals most impacted by the heat tend to retreat from public spaces and stay more indoors. While this may provide some relief if it is cooler indoors, it also increases the risk of social isolation, which in turn heightens vulnerability during heat waves. Creating heat-resilient residential areas and neighbourhoods is a vital public health challenge to reduce health inequalities among older populations.
Introduction:Parents and family carers (pA) of children/adolescents with increased support or care needs due to disability or chronic illness experience significant stress and have elevated health risks. PA organise and support each other in peer support groups. There is a need for research to demonstrate the effects of peer support on self-reported health (SH) and quality of life (QoL). Methodology:In a prospective, interdisciplinary intervention study, the longitudinal effects of co-creative peer support on pA's SH and QoL were examined in caring communities throughout Germany (multi-centre approach). Results:Long-term observation statistically demonstrated improved SH, especially among single caregiving parents, and improved QoL among part-time employed pA in the intervention group. Discussion:The strengthening of peer support among pA holds significant social medicine and economic importance. Self-assessed health is a predictor of morbidity and mortality and is closely linked to the child's health and healthy development. Co-creative methods in peer support have substantial potential to empower pA in terms of health promotion and improving QoL. Given the small sample size, the results should be interpreted cautiously and should be further validated by subsequent studies involving larger populations observed over a longer period.
Abstract:The Good Practice Guidelines (GPS) for Secondary Data Analysis were first published in 2005. Following a further revision in 2025, Version 4 is now being released. The revision of the GPS was carried out by the Working Group on the Collection and Use of Secondary Data (AGENS) of the German Society for Social Medicine and Prevention (DGSMP) and the German Society for Epidemiology (DGEpi), as well as the Working Group on the Validation and Linkage of Secondary Data of the German Network for Health Services Research (DNVF). Abstract:Compared to the previous version, in addition to clarifications and updates to the content, some recommendations have also been added. These include recommendations on the study population (recommendation 3.3), analysis strategy (3.6), registration (3.8), the interaction between data analysis, clinical expertise, and the patient perspective (5.3), data dictionary (6.8), interim analyses (7.3), distributed computing (7.4), documentation of analysis steps (7.6), use of pooled data and analyses of data distributed across different locations (8.12), legal framework (9.1), and scientific communication (11.4). Abstract:The GPS establish a standard for conducting secondary data analyses in accordance with scientific principles. It specifically complements other good practice guidelines and reporting standards in the fields of epidemiology and health services research (GEP, Good Practice Data Linkage, STROSA reporting standard). The GPS is intended as a guideline for the planning, conducting, and analysis of studies based on secondary data, in accordance with current legal frameworks. Specific study conditions and the specific characteristics of certain data may necessitate deviations from the GPS recommendations, provided such deviations are justified. Abstract:The GPS is intended for all researchers who use scientific methods to study, analyze and interpret secondary data. The GPS focus on health-related data in Germany, i. e., typically healthcare-related data such as routine data from statutory health, long-term care, pension, and accident insurance (social data), outpatient and inpatient care facilities, and registry data.
Background:Infertility affects approximately one in six people of reproductive age worldwide and represents a major global health issue, regardless of world region or income level. It limits the realization of individuals' desire to have children, thereby underscoring the importance of high-quality fertility care. Method:The guideline was developed by WHO in accordance with WHO standards. It. The executive summary was translated into German by the WHO Collaborating Centre for Evidence-based Medicine at the University of Continuing Education Krems (Austria). Results:In addition to general good practice recommendations for the management of infertility, the guideline includes four recommendations on prevention, eleven on diagnosis, and 24 on the treatment of infertility. The diagnostic and treatment recommendations further distinguish between female, male, and unexplained infertility. Conclusions:This guideline is the first WHO guideline on the prevention, diagnosis, and treatment of infertility. It aims to improve the implementation of evidence-based interventions related to infertility.
Background:Digital physical activity-related health care services (dbVL) are becoming increasingly important in the German healthcare system, whilst quality requirements and criteria regarding efficacy are still undergoing a dynamic development process. The aim of this article is to provide a conceptual classification for dbVL and a systematic overview of the current state of their potential usage and quality requirements in healthcare practice. Methods:To establish a conceptual classification, existing perspectives on physical activity-related health care and international classification systems for digital health interventions were taken into account. Legal frameworks and specific quality and effectiveness requirements for dbVL were systematically synthesized from available healthcare-related documents. Results:In all healthcare settings, the legal framework generally permits the use of dbVL. However, in some cases the analysis reveals significant healthcare sector-specific heterogeneity and fragmentation regarding quality and effectiveness requirements. Discussion:The analysis highlights the need for consistent, cross-contextual systematization, quality requirements, and evaluation criteria for dbVL. Key implications include the integration of physical activity-related expertise, user-centered development, and technology-appropriate evaluation approaches. The current sectoral fragmentation calls for consensus-based, cross-contextual concepts of evidence and benefits, as well as, a more coherent regulatory restructuring in the long term.
Background:The increasing proportion of female physicians, combined with the emerging shortage of medical professionals, makes the reconciliation of family responsibilities and medical work a central issue for healthcare systems. Returning to work after maternity leave poses substantial structural and organisational challenges for female physicians. Objective:This study examines factors that facilitate or hinder the return to clinical work of female physicians with children, as well as existing opportunities to improve compatibility of family and professional life. Methods:Twenty semi-structured, guideline-based interviews were conducted with female physicians working in inpatient and outpatient settings. Data were analysed using Mayring's structuring content analysis. Results:Four key factors were found to shape the re-entry experience: (1) institutional conditions, such as the availability and suitability of childcare; (2) organisational structures, particularly flexible working hours and duty schedules; (3) team and leadership culture, including appreciation, integration, and understanding of family responsibilities; and (4) regulations governing residency training, especially regarding crediting of training periods, duration of training, and disadvantages in rotation or position allocation. A lack of structured re-entry processes and uncertainties regarding legal frameworks further increase the burden. Many physicians report role conflicts, mental strain, and doubts about long-term compatibility, which may lead to delayed re-entry, changes in specialty, or considerations of leaving clinical practice. Conclusion:The findings demonstrate that work-family compatibility in medicine is primarily a structural challenge that requires structural solutions. Family-friendly working models, reliable childcare, supportive leadership cultures, and flexible training regulations are essential levers to facilitate re-entry and sustainably counteract the shortage of physicians.
Introduction:Respecting patient autonomy is one of the guiding principles of contemporary medical ethics. Supporting autonomy can improve patients' health literacy and promote their adherence to and the outcomes of medical treatments. Quantitative studies on the extent of patients' experience of autonomy and the predictors of this experience are lacking in general practice. Methods:In a multicenter cross-sectional study, patients in three general practices in Lower Saxony were surveyed in 2024. Via a paper-pencil questionnaire, patient characteristics and perceived autonomy were assessed using the German version of the Health Care Climate Questionnaire (HCCQ). Results:The study included n=637 participants. Participants demonstrated a high level of perceived autonomy on a scale of 1-7 (M=6.1, SD=1.1). In the multi-regression analysis, age (ß=0.127; T=2.609; p=0.009), partnership (ß=0.101; T=2.421; p=0.016), and education level (ß=-0.112; T=-2.518; p=0.012) emerged as statistically significant predictors. Conclusion:This study was the first to quantitatively assess patients' experience of autonomy in a general practice setting in Germany. Overall, a higher level of autonomy was observed than in studies in inpatient settings. This might indicate an egalitarian doctor-patient relationship and a situation in which patients already feel that their individual autonomy is recognized. The analysis of predictors provides evidence that specific groups, such as those with low levels of education, should be specifically helped in the promotion of autonomy.
Background:Healthy nutrition in childhood and adolescence is essential for health and well-being and can be purposefully promoted through a healthy school food environment. The present WHO guideline includes policies and interventions that influence the school food environment and formulates evidence-informed recommendations towards the same goal. Methods:Guideline development followed standardized WHO procedures, involving the WHO Nutrition Guidance Expert Advisory Group (NUGAG) and assessing the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation System (GRADE). The evidence base comprised a scoping review, a systematic literature review (literature search conducted in 04-05/2020), and a rapid review update of the literature up to 10/2023 covering three intervention areas: direct school food provision, nutrition standards and regulations, and nudging interventions. No eligible studies were identified for interventions on marketing restrictions or pricing policies. Results:WHO recommends using food provision at schools to increase the consumption of foods and beverages that contribute to a healthy diet. WHO also recommends setting and using nutrition standards or rules to increase the availability, purchase and consumption of foods and beverages at schools that contribute to a healthy diet and to decrease the availability, purchase and consumption of foods and beverages at schools that do not contribute to a healthy diet. Nudging interventions that modify the food environment at schools to increase the selection, purchase and consumption of foods and beverages that contribute to a healthy diet should be implemented, ideally through the simultaneous implementation of multiple nudging interventions. The implementation of this guideline should take into account local factors such as the country's nutrition situation, the socio-cultural and socio-economic context, regionally available foods, food security, climate change, dietary habits, available infrastructure, resources, political and legal frameworks, and governance structures of the WHO Member State. Furthermore, a coordinated approach with other relevant guidelines and recommendations should be pursued.
Background:Workplace health promotion (WHP) is essential to counter rising work-related stress, yet participation remains low. This study aimed to identify barriers and facilitators for WHP uptake and derive actionable recommendations. Methods:Mixed-methods design combining an online survey (n=103) and three workshops (n=23). Results:Lack of time, inflexible programmes and insufficient managerial support emerged as key barriers. Employees preferred flexible, working-time-integrated offers, company fitness, bonus schemes and digital formats. Conclusion:Managers are pivotal; a combined action bundle including incentives, leadership training and tailored programmes is recommended.
Background:Climate change, demographic change and digitalisation jointly influence public health and health-care systems. Older people are particularly vulnerable to climate-related health risks and are also more frequently affected by digital exclusion. Objective:This article presents the KliMATE project as an applied example to show how digital and analogue interventions can promote climate, health and digital literacy. In addition, key design principles are discussed in the context of Digital Humanism. Methods/Approach:Conceptual analysis combined with project-based experience from developing an intervention consisting of a Progressive Web App and participatory formats. Results/Implications:Initial experience shows that low-threshold access, the combination of digital and social formats, and participatory development are crucial for acceptance. Project materials also indicate that KliMATE purposefully links physical activity, climate-adapted training planning, social commitment and low-threshold digital support. Conclusion:Digital technologies can contribute to preventing climate-related health risks if they are designed in a user-centred, transparent and inclusive manner. Digital Humanism provides a suitable ethical framework for this purpose.
Introduction:Families with chronically ill or care-dependent children often face considerable organizational, psychosocial, and health-related burdens. At the same time, complex care structures and unclear responsibilities can hinder access to support services. This study aimed to describe the burden experienced by families with care-dependent children in Lower Saxony and to identify factors associated with key dimensions of parents' living situation. Methods:In September 2024, postal questionnaires were sent to 600 families with care-dependent children (0-18 years) insured by AOK Lower Saxony. The questionnaire was based on a preceding qualitative interview study and included sociodemographic characteristics, disease-related information, and 26 burden indicators. Four dimensions of the parents' living situation were assessed: coping with everyday life, adequacy of care provision, availability of support services, and parents' self-reported health status. Data were analyzed descriptively, and associations were examined using Spearman rank correlations. Results:111 families participated in the survey (response rate: 19%). Care for the children is primarily provided by the parents themselves; only 12.6% use a care service for support. Frequently reported burdens include concerns about the child (95%), the significant time commitment required for care (91%), and a lack of time as a couple (83%). At the same time, 73% of respondents reported unclear responsibilities among social service providers, and 54% reported insufficient support services. Social factors-particularly the impact on siblings, social isolation, and a lack of support-are associated with all dimensions of living conditions examined. Conclusion:The findings indicate a high multidimensional burden among families with care-dependent children. In addition to structural gaps in care provision, psychosocial factors and parental health play a central role. Improved care coordination and low-threshold information and support services may help reduce the burden on affected families.
Aim:The aim of this study is to identify demographic data, the "first measles vaccination dose rate after vaccination offer as part of the first medical assessment" (EMID rate) and barriers to measles vaccination among asylum seekers in the reception centre "Oldentruper Hof" Bielefeld (EAE OTH) in 2024. Methodology:This study is a retrospective data analysis. Demographic data and vaccination data are taken from the administrative Excel sheets and the vaccination lists of the EAE OTH. Results:Data from 3213 asylum seekers in the EAE OTH were analysed for the year 2024. Most were young and male. The ten most frequent countries of origin in descending order were: Syria, Afghanistan, Turkey, Iraq, Iran, Serbia, (North) Macedonia, China, Algeria and both Angola und Azerbaijan (there were as many asylum seekers from Angola as from Azerbaijan). 3047 of them were of an age at which they needed to be immunised against measles. 6.3% of the 3047 were able to present a measles immunisation document from outside the EAE OTH. 84.0% of the 3047 had no external proof of measles immunisation and received their first measles vaccination dose in the EAE OTH. The EMID rate was therefore 90.3%. 9.7% had neither an external measles vaccination certificate nor did they receive their first measles vaccination dose at the EAE OTH. The following reasons were identified for this non-vaccination: Refusal by 1.5%, illness by 1.2%, pregnancy by 2.6%, 'other' by 4.3%. Conclusion:Overall, the EMID rate of the EAE OTH in 2024 was found to be high at 90.3%. Efforts must continue to further optimise this vaccination rate. Further studies in the different asylum reception centres and beyond are needed to obtain more research data on asylum seekers in Germany.
