INTRODUCTION:Emergency department (ED) care should be guided according to patient needs and demand. Age and gender influence consultation and care patterns. This study aims to analyze these factors as well as upstream care pathways in order to reduce misallocation and improve quality of care. METHODS:Between March and November 2024, standardized patient surveys were conducted in 5 Berlin and 18 Bavarian emergency departments (n = 10,040). Data collected included sociodemographic characteristics, presenting complaints, subjective urgency, physician contacts, and awareness of the 116117 hotline. Influencing factors were analyzed using logistic regression; only cases indicating "male" or "female" were included. RESULTS:A total of 9835 questionnaires were analyzed (49.6% female); patients were predominantly from older age groups. Reasons for presentation differed by gender: for example, women more frequently reported pain as well as neurological or abdominal complaints, whereas men more often presented with injuries. Health-related anxiety was a key motive for seeking care in about 37.8% of cases and was more common among women. A prior attempt to contact ambulatory care was reported by 48.7% of women and 44.2% of men (p < 0.001). Direct ED visits were more frequent in cases of higher urgency and injuries. Awareness of the 116117 hotline was 67.0% among women and 60.3% among men and decreased with age; willingness to use digital self-assessment tools was higher among younger individuals. DISCUSSION:Age and gender influence both utilization patterns and the steerability of emergency care. Target group-specific, low-threshold, and digital interventions may help reduce misallocation and improve quality of care.
BACKGROUND:With the Cannabis Act (CanG), the German government aimed to improve health protection and to curb the illegal cannabis market. A partial success of the CanG would be evident in the shift from illegal to legal supply channels. The following questions were central: How did sources of cannabis supply change overall and across different groups due to the Cannabis Act? Which groups subjectively benefit the most from the Cannabis Act? METHODS:To address these research questions, a non-representative, quantitative online survey was conducted from 24 March 2025 to 10 June 2025 among cannabis users aged 14 and older. Participants were asked about their sources of supply before and after the Cannabis Act took effect as well as the subjectively perceived effects. The sample included N = 11,471 participants. RESULTS:Since the CanG came into effect, a shift from illegally to legally produced cannabis has been observed among adults overall, particularly among men and people in rural areas, as home cultivation and pharmacy purchases have increased significantly. In contrast, little change was observed among adolescents. Participants reported predominantly positive subjective effects of the law. Gender and regional differences showed that men and residents of major cities-particularly Berlin and Hamburg-more frequently perceived positive subjective effects. DISCUSSION:The results suggest that certain subgroups face barriers in accessing the legal market, including adolescents, women, and the urban population. For these groups, targeted measures aimed at reducing such barriers could contribute to further curbing illegal sources of supply.
INTRODUCTION:Recruiting healthcare facilities for intervention studies is a well-documented challenge, yet evidence on effective strategies remains limited. To strengthen this evidence base, we report and discuss the recruitment approach applied in the Intervention Study to Increase HPV Vaccination Coverage in Germany (InveSt HPV). METHODS:Pediatric practices in Bremen and selected districts in Bavaria were contacted by mail and through the German Professional Association of Pediatricians (BVKJ). Each participant received incentives of up to € 200. RESULTS:In Bremen, 14 of 39 practices (35.9%) and in Bavaria 25 of 100 practices (25.0%) agreed to participate, resulting in an overall recruitment rate of 28.1%. Within participating practices, engagement exceeded 90% among both physicians and non-physician staff. The most frequently reported recruitment channels at registration were personal and written communication via the BVKJ. Reported motivations for participation included contributing to improved vaccination coverage, interest in the training sessions, and financial incentives. Telephone follow-up calls generated very few additional registrations despite considerable effort. For inquiries, practices preferred direct contact options over fixed consultation hours. DISCUSSION:The experiences from InveSt HPV indicate that leveraging existing professional networks in combination with incentives commensurate with the required time investment facilitates the recruitment of pediatric practices. In addition, a recruitment period scheduled outside the infection season and school holidays, as well as the early planning of supplementary measures in case recruitment proves unsuccessful, appear to be essential.
INTRODUCTION:Dental check-ups contribute significantly to reducing the burden of oral disease. This article examines for the first time in Germany the utilisation of dental check-ups by adults aged 20 years and older based on routine data. METHODS:The analyses were based on the outpatient dental claims data in accordance with BEMA (Uniform Assessment Scale for Dental Services) of the National Association of Statutory Health Insurance Dentists. A dental check-up was assumed to have been performed if at least one billing of BEMA 01, 151, 152, 153, 154 or 155 was documented in a calendar year. The utilisation was estimated as a proportion of all persons with statutory health insurance according to the KM6 statistics for the years 2015 to 2024, stratified by sex, age and region in a cross-sectional study design. RESULTS:The rate of utilisation of dental check-ups remained relatively constant at around 64% until 2019, with a decline in the first year of the COVID-19 pandemic in 2020 (62.1%) and a gradual increase in the subsequent years to the initial level in 2024. Compared to the overall rate, men, young and early middle-aged adults, the very old and people in western Germany had a lower utilisation rate. Over time, the east-west differences in the utilisation rate in Germany have decreased. DISCUSSION:More than one in three persons did not have a dental check-up in 2024. The results therefore highlight the need for preventive measures. For Germany, there had previously been no analyses of the utilisation of dental check-ups based on routine data. This article therefore fills a research gap.
Gene doping refers to the use of gene therapeutic substances or technologies for the purpose of illicit sport performance enhancement. A wide variety of doping analytical detection methods are currently under development, ranging from PCR (Polymerase Chain Reaction) to high-resolution mass spectrometry to clustered regularly interspaced short palindromic repeat (CRISPR) and CRISPR-associated (CRISPR/Cas)-based detection methods. Due to the diverse approaches in gene therapy clinical research, it can be assumed that a wide variety of methods will also be needed to detect cases of gene doping. The increasing availability of unapproved gene doping-related products on the open consumer market underscores the urgent need to establish new detection methods for routine doping control analysis.
INTRODUCTION:Media coverage of doping almost always focuses solely on athletes. But do they even read reports on doping? How do athletes evaluate doping coverage? And what impact can doping reports have on elite athletes? METHOD:In 2025, a quantitative online survey was conducted among German national team athletes. Using descriptive and inferential statistics, 349 questionnaires were analyzed. RESULTS:Of the athletes, 85% read doping reports to learn how a doping case arises and how the media handles it. Of the respondents, 62% are pleased when doping offenders are caught and subsequently exposed through media coverage. Disappointment sets in for 60% because doping reports can damage the image of their own sport, and 38% of athletes expressed frustration with the media's tendency to almost exclusively criticize athletes but not other groups who share responsibility for doping. Approximately 15% of respondents believe doping reports can influence mental or physical performance, with some respondents suggesting increased training intensity and greater motivation in competition, while others suspect reduced training and demotivation in competition. The variables of age and gender do not play a role in the response patterns. DISCUSSION:The majority of athletes follow doping reports primarily out of a need for information and support the media's role in providing normative criticism and control. While doping reports are perceived as damaging to the image of their own sport, the media's educational efforts and the exposure of doping offenders are also seen as an important contribution to maintaining fair competition in sports.
The use of performance-enhancing substances can be traced back to before the first modern Olympic Games were held. The International Olympic Committee (IOC), founded in 1894, issued its first guidelines on doping in 1938. These guidelines condemned doping and proposed the exclusion of athletes who consumed performance-enhancing substances. Since the 1960s, institutions dedicated to combating doping in sport have been continuously established. Regulations became more precise, and in 1968, doping controls were conducted for the first time at the Winter Olympics in Grenoble.This article provides an overview of the development of the institutional anti-doping network, with a particular focus on the IOC's Doping Subcommittee, the IOC Medical Commission (MC), the World Anti-Doping Agency (WADA), the National Anti-Doping Agencies (NADAs), and the International Testing Agency (ITA). In addition, the article examines the current challenges facing the anti-doping network in connection with the privately organized "Enhanced Games," in which doping is explicitly permitted.
BACKGROUND:Up-to-date and representative data across all populations, as well as inclusive data systems, are essential for evidence-based health policy. However, there are considerable gaps in the availability and linkage of migration-related health data. Using the example of the mental health of children and adolescents (ChAd) with a history of migration, this analysis provides an overview of available data sources in Germany and evaluates their usability for public health reporting (PHR). METHODS:Within the STRONGDATA-Kids project, data sources since 2000 were mapped if they included information on the mental health of ChAd with a history of migration and a sample size of n ≥ 1000. Data quality and barriers to access and use were assessed using a scorecard comprising eight dimensions. RESULTS:A total of 37 data sources were identified. Since 2019, a diversification in the use of migration-related indicators can be observed, particularly with regard to country of birth (including that of parents). Personal resources and resilience, as well as emotional and behavioural problems, were most frequently assessed. Routine data show strengths in standardisation and reliability, while surveys ensure timely provision of data and flexibility. The main access barriers to routine data and surveys occur at the structural level, partly due to decentralised responsibilities. DISCUSSION:Routine data and surveys are complementary and both indispensable for PHR. Despite broader use of migration-related indicators, further methodological and structural developments, such as standardised indicator sets, diversity-oriented research strategies and systematic data linkage are needed to validly represent the mental health of ChAd.
INTRODUCTION:Children and adolescents are disadvantaged when it comes to drug therapy, as drugs are frequently used off-label for this age group. Despite regulatory measures such as the EU Paediatric Regulation, off-label use in paediatrics remains widespread. Since 2021, the online platform "Kinderformularium.DE" has been providing evidence-based dosing recommendations for on- and off-label drug use in Germany, establishing itself as reliable source of information in paediatric practice. This study aims to analyse the scope of age-appropriate (off-label) dosage recommendations provided and to evaluate usage patterns and user satisfaction. METHODS:Drug monographs were examined to determine the availability and licensing status of age-specific dosing recommendations, taking into account different indications and routes of administration. A user survey was conducted between November 2024 and February 2025 and analysed using a mixed-methods approach. RESULTS:Kinderformularium.DE contains 637 monographs with 5536 individual age-specific dosage recommendations. Both the number of dosage recommendations and the licensing status vary by age: there is less dosage information available for preterm and newborn infants, and this information is more frequently classified as off-label. The survey confirms the platform's high level of acceptance-it is used frequently, particularly by doctors-and highlights its importance in the care of paediatric patients. DISCUSSION:With its age-specific (off-label) dosage recommendations, Kinderformularium.DE is an important tool for ensuring medication safety in paediatric clinical practice in Germany. The platform must continue to be updated and expanded on an ongoing basis.
To protect critical infrastructure and improve situational awareness and knowledge of drinking-water incidents in Lower Saxony, the State Health Office (NLGA), commissioned by the Ministry of Social Affairs, Health and Equality, developed the Lower Saxony Drinking-Water Incident Register (NITRIS) as a password-protected web application. It is currently in a pilot phase that has been running since September 2025. NITRIS enables municipal public health offices to record drinking-water incidents directly and in a standardized manner. Once an incident is closed, all health offices in Lower Saxony can access the case, fostering knowledge exchange and networking across jurisdictions. In addition, NITRIS provides centrally curated resources-such as guidance documents, press-release templates, and operational checklists-to support consistent communication and response.
Doping is commonly perceived as being primarily associated with professional sports rather than recreational sports. This article is a discussion paper and addresses doping in recreational sports from conceptual, methodological, and empirical perspectives. Established doping definitions, particularly those of the World Anti-Doping Agency, are only partially transferable to recreational sports contexts due to their strong focus on organizational affiliation and competitive settings. For large segments of recreational sport, the concept of performance-enhancing substance use therefore provides a more appropriate description.Assessing the prevalence of such use is methodologically challenging due to the sensitive nature of the topic and the lack of control mechanisms. Indirect survey techniques reduce socially desirable responding and yield more realistic estimates. The unrelated question model (UQM) is a randomized response technique that ensures full anonymity and enables robust prevalence estimates of sensitive behaviors at the population level.Empirical findings using the UQM among recreational athletes in endurance, fitness, and bodybuilding contexts indicate that the use of performance-enhancing substances is not a marginal phenomenon. Prevalence estimates suggest a relevant and stable level over time. Strong associations are observed with non-therapeutic use of pain medication and an increasing medicalization of performance optimization. Evidence of access via healthcare structures highlights the structural embedding of this phenomenon. Overall, the use of performance-enhancing substances in recreational sport represents a socially and medically relevant field of action that requires differentiated prevention strategies and greater integration into medical education and training.
Routine data from healthcare are gaining importance for evidence generation. In Germany, new structures have been established in recent years to support their use. As part of the Medical Informatics Initiative (MII), data integration centres (DIZ) have been set up at all university hospitals, where patient data are made available in a pseudonymized, standardized and operationalized form. Since routine data, unlike primary data, are collected for healthcare purposes, aspects of the original data collection must be considered when formulating the research question, planning and analysing the study, and interpreting the results.The EVAluation research based on data from routine clinical care 4 the MII (EVA4MII) project supports researchers in analysing nationwide clinical routine data, for example through training programs and a central advisory service. This support is provided by an interdisciplinary team with methodological-statistical, data-technical, and clinical-epidemiological expertise in close coordination with data-providing institutions. The service covers the entire research process, from study planning and formal requirements to implementation, analysis, evaluation, and publication, and is available to projects within the MII and beyond.The aim of this article is to highlight the importance of methodological support in the analysis of clinical routine data and to identify key stages in the research process where such support is particularly relevant. Finally, an outlook on future advisory needs is provided, including the potential role of artificial intelligence as a supportive tool.
BACKGROUND:Hospitals should plan a staffing surge capacity to prepare for a new pandemic or disaster. As medical students are a possible surge capacity resource, this study investigated whether including students in surge capacity plans is desirable and under which conditions it is feasible. METHODS:We performed two retrospective multicentre observational trials in 2023 by enrolling medical students from 20 German faculties and leadership from critical areas of inpatient care at two university hospitals. We investigated the integration of medical students in the COVID-19 effort, assessed the willingness to include students in future preparedness plans, and explored possible requirements for such a deployment. RESULTS:Both leadership staff (n = 72) and students (n = 1249) displayed a clear willingness for cooperation in the context of preparedness plans (81.9% and 90.8% approval respectively). Most agreed on delegating diagnostic, medical assistance, nursing and logistical tasks to the surge capacity help force. Students addressed financial compensation, clearance of academic obligations and sufficient training as prerequisites for their deployment. Leadership staff also emphasized the need for adequate training. Both parties cited students' academic obligations amongst the main limiting factors. CONCLUSION:Both surveys display a high acceptance for including students into the surge capacity workforce. These results support the need for predefined roles for surge capacity helpers and emphasize the necessity of pre-emptive preparedness training and the clarification of academic obligations ahead of time.
Against the backdrop of the Pact for the Public Health Service (Pakt für den Öffentlichen Gesundheitsdienst; Pakt ÖGD), the commitment to evidence-informed practice is increasingly shaping the strategic development of Germany's Public Health Service (ÖGD). Particularly at the municipal and federal state levels, closer collaboration between research and public health practice is needed. In Saxony-Anhalt, a cooperation agreement was concluded in 2024 between the City of Magdeburg and Magdeburg University Medicine (UMMD) to institutionally strengthen their existing collaboration. In the same year, a project agreement involving additional public health stakeholders was established to create a sustainable framework for systematic exchange between academia and public health administration.This article presents ongoing collaborative initiatives in Saxony-Anhalt, including projects on the analysis of school entry examinations, in-depth evaluations of Early Childhood Intervention Services (Frühe Hilfen), e‑mental health interventions for children and adolescents, and the public health response to Mpox. These examples illustrate how regional cooperation between academia and practice can be operationalized and highlight the opportunities such collaborations offer for the continued development of the Public Health Service. In addition, knowledge translation formats such as regular coordination meetings, scientific events, and practice-oriented training play a key role in facilitating the transfer of evidence into public health practice.The experiences from Saxony-Anhalt are consistent with the recommendations of the Advisory Board of the Pakt ÖGD, which has called, among other measures, for the establishment of teaching and research public health offices, bridge professorships, and sustainable funding structures. The examples of collaboration demonstrate that the future-oriented development of the Public Health Service requires both local innovation and supra-regional structures that systematically connect science and practice.
BACKGROUND:Preparations containing plant-derived components, such as those found in herbal medicinal products, medical devices, dietary supplements, and cosmetics, are readily accessible and may lead to adverse effects or poisoning if used incorrectly. Poison information centers (PICs) respond to exposure-related inquiries. The aim of this study was to analyze exposure inquiries concerning preparations with plant-derived components at the Joint Poison Information Center in Erfurt (GGIZ) in order to identify preventive approaches. METHODS:A statistical analysis of exposure inquiries received by the GGIZ from 2013 to 2022 was conducted. Data from nine federal states were included. Only inquiries related to single preparations that had been reported at least 10 times were considered. Symptom severity was assessed using the poisoning severity score (PSS), and poisoning risk was calculated using a modified Litovitz risk factor. RESULTS:A total of 36 preparations with 2512 exposures (mean 251.2/year; trend τ = 0.8667, p = 0.0007) were identified. Of those affected, 60.2% (1511) were toddlers. Most exposures (98.5%, 2474) occurred in the home environment. In 64.5% (1620) of cases, exposures were unintentional. Oral exposure accounted for 93.4% (2345) of cases. Of the exposures with known outcomes, 75.3% (1780/2365) remained asymptomatic, 23.5% (556/2365) resulted in minor/mild symptoms, 1% (24) in moderate symptoms, and 0.2% (5) in severe symptoms. Severe intoxications were associated with Colchysat® Bürger and Klosterfrau® Melissengeist concentrate. DISCUSSION:Toddlers represent a relevant risk group in the use of preparations containing plant-derived components. Preparations containing colchicine or ethanol may lead to fatal intoxications, particularly in cases of intentional exposure. It is recommended to store oral and topical preparations separately and out of reach of unauthorized persons, and to provide comprehensive education.
The use of antibiotics for antimicrobial therapy revolutionized medical practice. However, the frequent and sometimes inappropriate use of these drugs in both human and veterinary medicine has had significant consequences. This article provides an overview of the pathways by which antibiotics enter the environment and their impacts. Through wastewater, sewage sludge, and agricultural fertilizers, antibiotics and their degradation products enter various environmental compartments such as soil and water, where they promote the emergence and spread of antimicrobial resistance (AMR) via subinhibitory concentrations of antibiotics. Worldwide, exceedances of ecotoxicological threshold values (predicted no effect concentrations; PNECs) have repeatedly been detected in municipal wastewater treatment plants, surface waters, and agricultural soils. In addition, subinhibitory environmental concentrations act as stress factors that alter the structure and function of microbial communities, thereby disrupting biogeochemical cycles. Bidirectional interactions between climate change and AMR have already been postulated, since altered microbial metabolic processes may trigger climate-relevant feedback mechanisms, while extreme weather events such as floods can further facilitate the dissemination of AMR. The resistance problem therefore requires an integrated, globally coordinated approach in the sense of One Health and Planetary Health.
The efficacy of antimicrobial therapies depends on achieving a pharmacokinetic/pharmacodynamic target. Therefore, correct dosing is crucial for the efficacy and safety of antimicrobial therapies. This article provides an overview of the pharmacological considerations of antimicrobial therapy in older adults and children. These groups, in particular, face an increased risk of improper dosage, as standardized dosing regimens are generally based on studies in middle-aged adults and may not adequately reflect individuals with different pharmacokinetics (absorption, distribution, metabolism, and excretion; PK) and pharmacodynamics (interaction with the pathogen and therapeutic effect; PD). However, incorrect dosing increases the likelihood of treatment failure, the development of antimicrobial resistance, and side effects.In older adults, absorption, distribution, metabolism, and elimination of the anti-infective agent can be affected by reduced absorption, changes in body composition, reduced liver and kidney function, and polypharmacy. In children, relevant aspects are age-related differences in organ maturation, enzyme activity, and glomerular filtration rate. These factors can impair treatment success and can lead to subtherapeutic doses, thus fostering selection of resistant microorganisms.For older adults and children, individualized dose adjustments that take into account their pharmacokinetic specifics are therefore necessary. In addition, thorough patient education and support are essential to ensure efficacy, safety, and adherence as well as to prevent the spread of resistance.
Vaccinations against bacterial pathogens play a crucial role in infection prevention, especially given the growing prevalence of antibiotic resistance. Historically, vaccines against cholera, diphtheria, and pertussis (whooping cough) marked the first significant advances in the fight against bacterial diseases. Later, vaccines against meningococcus and tetanus, among others, were added. These active immunizations expose the immune system to components of the pathogen, stimulating the production of antibodies, T helper cells, B cells, and memory cells, thereby providing long-term protection. The targeted development of new vaccines, even against difficult-to-treat bacterial pathogens, is enabled by a wide range of vaccine types, including inactivated, toxoid-based, and recombinant vaccines, as well as modern approaches such as reverse vaccinology and messenger Ribonucleic Acid (mRNA) technologies combined with enhancing adjuvants. In addition to active immunization, passive immunization, in which pathogen-specific antibodies are administered directly, also plays an important role.At the population level, clear epidemiological effects of vaccination programs are evident, as vaccinations protect not only individuals but also communities, thus contributing to public health. Despite the clear medical and economic advantages of vaccination programs, their acceptance among the population must be significantly increased through objective information policies. Currently, numerous vaccines are under development, which, through innovative technologies, are opening up new avenues for effectively preventing and controlling bacterial infections-a crucial step in an era of increasing antibiotic resistance.
INTRODUCTION:In livestock, antibiotics are often used to treat groups of animals, such as poultry. With the 16th amendment of the Medicinal Products Act, the antibiotic minimization concept was introduced in Germany in 2014. As a result, treatment frequencies were reduced in many animal populations. The aim of this study is to present the development of antibiotic use and resistance in the populations of fattening turkeys and broiler chickens as well as the effects on the resistance situation in human medicine. METHODS:The treatment frequencies in fattening turkeys and broiler chickens for 2014-2024 were compared with data from zoonosis monitoring, namely the resistance rates of Escherichia (E.) coli, Campylobacter (C.) coli, and C. jejuni against antibiotics, and contextualized in relation to the human resistance situation based on Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA) work. RESULTS:The treatment frequency decreased from 60.9 to 45.6 days (-26%) in fattening turkeys but increased from 41.5 to 45.9 days (+11%) in broiler chickens. The use of critically important antibiotics has been greatly reduced in both populations. In fattening turkeys, the resistance rates of E. coli decreased significantly, whereas in broiler chickens, some increases were observed. Resistance of C. jejuni to ciprofloxacin increased despite reduced antibiotic use. The JIACRA reports show that the development of resistance in E. coli from animals and humans is associated with the use of antibiotics in the respective population, whereas in Campylobacter there is a direct relationship between animal and human resistance rates. DISCUSSION:The results illustrate the need for targeted measures to further reduce the use of antibiotics and point to complex dynamics in resistance development.
Antibiotic resistance threatens the effectiveness of standard therapies. The dynamics of antibiotic resistance are substantially affected by inappropriate antibiotic use. Therefore, this article places humans at the center of efforts to reduce inappropriate antibiotic use, with a focus both on ambulatory and stationary care. We analyze psychological factors that contribute to inappropriate antibiotic prescribing by physicians and to inappropriate use by patients.Drawing on a narrative review, we identify the following physician-side determinants: (i) knowledge and problem awareness, (ii) diagnostic and prognostic uncertainty, (iii) processes related to judgment and decision-making, (iv) social norms and team structures, and (v) relationships with patients. On the patient side, we identify (i) knowledge and problem awareness, (ii) processes related to judgment and decision-making, and (iii) dealing with diagnostic and prognostic uncertainty.For each factor, we present evidence-based measures that can positively influence both appropriate prescribing and use. Systematically integrating these approaches into antibiotic stewardship initiatives can help improve prescribing and consumption practices.
