Developmental language disorders (DLD, ICD-11 6A01.2) represent the most common indication for speech and language therapy in children. In Germany, language therapy is predominantly delivered as individual, face-to-face sessions. Within the framework of the project “Effectiveness of an Online Interval Small-Group Therapy for Children with Developmental Language Disorders” (THEON), this study is being conducted to investigate whether video-assisted group language therapy is as effective as conventional face-to-face individual treatment in children with DLD. Prior to the implementation of the randomized controlled trial (RCT), a preliminary qualitative interview study was conducted with parents, speech and language therapists (SLTs), and physicians to explore their attitudes, requirements, and perceived barriers regarding this novel form of therapy delivery. This manuscript presents the findings of this preparatory qualitative study. Ten semi-structured interviews were conducted by two trained researchers with four parents of children with DLD, four SLTs, and two physicians. Participants were asked about their views on online group speech and language therapy. A semi-structured interview guide served as the basis for the virtual interviews. The guide addressed themes that were identified in advance through a literature search while also allowing room for open discussion and the emergence of additional relevant aspects. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis supported by MAXQDA. Online therapy was perceived as particularly suitable for older children and children with clearly defined speech or language disorders. The advantages perceived included improved access to care, no travel time, and the possibility of recording sessions. Concerns related to reduced concentration and compliance, technical problems, limited methodological flexibility, and changes in therapeutic relationships due to the required presence and active role of caregivers. The findings informed the development of a mixed-methods process evaluation accompanying the THEON trial, including a standardized questionnaire assessing feasibility, satisfaction, acceptance, and implementation barriers among parents and SLTs. Overall, stakeholders perceived online group therapy as a feasible complementary approach under specific conditions, particularly for older children and clearly defined disorders. At the same time, the interviews highlighted the importance of adequate technical infrastructure, active caregiver involvement, and careful patient selection for successful implementation into routine care.
Effective referral systems are essential for timely and equitable access to preventive and health promotion services. However, limited evidence exists on how referral flows are perceived to be appropriate and functional across sectors. This study aims to investigate how referral practices from general practitioners (GPs), hospitals, and municipal staff to municipal preventive and health promotion services are perceived and experienced in municipalities, with a focus on actor-specific challenges and municipal strategies to address them. This nationwide sequential mixed-methods study combined a survey of municipal health directors (response rate 98
This study aims to examine differences in disease burden between informal caregivers and non-caregivers using claims data, with a particular focus on mental disorders and on characteristics related to high morbidity. The study applied a retrospective observational design using claims data from two major German statutory health insurance funds. We identified 139,002 informal caregivers based on caregiving-related insurance records and compared them to 272,716 insured individuals without official caregiving responsibilities. The analysis assessed morbidity based on documented diagnoses coded according to the International Classification of Diseases. Disease categories included mental and behavioral disorders, musculoskeletal disorders, cardiovascular diseases, and other major diagnostic groups. We calculated odds ratios with 95
Climate change increasingly impacts human health through mechanisms such as heat waves and elevated ultraviolet (UV) radiation. Rising UV exposure is of particular concern, as it is the primary risk factor for skin cancer, the most prevalent cancer worldwide. Children are especially vulnerable. However, climate change-related health burdens in childcare settings remain insufficiently researched. An exploratory cross-sectional online survey was conducted among educational professionals in German daycare centers. The questionnaire assessed experiences with climate change-related health burdens, informational needs, and measures already implemented. Data were analyzed descriptively. Exploratory factor analysis was used to examine the structure of perceived health impacts. Multivariable linear regression analyses explored associations with the resulting dimensions. Among 3655 participants (92.6
This study aims to assess the variation in methodological choices and input data in burden of disease (BoD) studies addressing air pollution and noise, and whether these choices are adequately reported. We carried out systematic literature searches in the MEDLINE, Embase, Global Health, and Web of Science databases. We included studies that estimated BoD attributable to long-term exposure to ambient air pollution and environmental noise. In total, 92 studies were included in the scoping review. The majority (75
