Sustained adherence to disease-modifying therapies (DMTs) is essential for achieving therapeutic benefit in multiple sclerosis (MS). Despite the availability of effective agents, adherence has been reported as variable and often suboptimal in German cohorts, and the relative influence of clinical, demographic, and pharmacological factors remains insufficiently characterised. This study therefore examined predictors of objective adherence to DMTs in people with MS and the association between subjective and objective adherence. We analysed 795 people with MS (PwMS) receiving oral, subcutaneous, or intramuscular DMTs between October 2020 and September 2021. Objective adherence was measured using the Medication Possession Ratio (MPR), and subjective adherence using a visual analogue scale. Permutation-based multivariable analyses (PERMANOVA) were used to examine associations between predefined predictors and MPR. Objective adherence averaged 88.4

Abstract:Colorectal cancer is one of the most common oncological diseases in Germany. Although the implementation and continuous development of colorectal cancer screening has been a success story and has contributed to a reduction in morbidity and mortality, participation remains below expectations. The current analysis examined the utilization of colorectal cancer screening since the introduction of the invitation procedure and the influence of socioeconomic factors.Insured persons who reached the age of eligibility for colonoscopy for the first time and had been invited by their health insurance were included in the study and followed up for one year. The utilization of colorectal cancer screening (stool test or colonoscopy) was recorded using specific billing numbers in the remuneration scheme.Over a one-year period, the participation rate was 11.4% (stool test 6.8%; colonoscopy 5.0%). The participation was significantly higher among women (13.8%) than among men (8.5%). Furthermore, differences in the participation rate were found according to socio-economic characteristics. For example, participation among employed persons (12.0%) was significantly higher than among citizens receiving social assistance (7.4%). A social gradient was also visible in terms of school and vocational training.The heterogeneous use of screening services shows different information needs. Actions for improvement could include awareness campaigns and group-specific, easy-to-understand, multilingual information, as well as an easier access.

Background The Sustainable Development Goals combine health, social justice, sustainability, and environmental protection. Schools offer a suitable setting for linking these goals and incorporating them into the development of children and youth. The FREI DAY is a whole-school approach in German-speaking countries and at German schools abroad, designed to improve lifestyles and living conditions in both health and environmental sustainability, and to build schools’ capacity to transform into healthy and sustainable organisations. The FREI DAY is theory-based and aligned with the United Nations Sustainable Development Goals. This study examines the effectiveness of FREI DAY and the conditions necessary for its success, providing recommendations for its implementation and further development. Methods The study is designed as a natural experiment with a sequential design. Over a period of three years, at least 60 secondary schools, including vocational schools, and 30 primary schools will be surveyed during three survey periods. The schools themselves decide whether and when to implement the eight-phase FREI DAY intervention. This means that schools can switch from the control condition to the intervention condition and vice versa during the study period. In each survey year, at least 20 students per school will be surveyed, i.e., around 1,200 students per wave. In addition, five school key informants per school will be surveyed annually, making 300 per wave (open cohort design). At intervention schools, at least three members of the school board per wave will also be surveyed. Changes in the results will be evaluated using hierarchical linear models. Discussion This is the first study to evaluate the effectiveness of FREI DAY. We expect FREI DAY to improve students' well-being, life skills, environmental awareness and environmental responsibility. In addition, it is expected to strengthen the transformative capacity of schools, create a new culture of learning and sustainability, and strengthen collective resilience. Trial registration: This study was registered in the German Clinical Trials Register: DRKS00036310 on August 07, 2025.

Abstract Background Identifying symptom clusters in post-COVID-19 condition (PCC) is a necessary step toward for developing more targeted therapeutic interventions for this heterogeneous condition. Therefore, the aim of this study was to identify symptom clusters based on 14 specific PCC symptoms, accounting for both symptom presence and impairment. The identified clusters were then compared with respect to sociodemographic, clinical, and psychological factors. Methods A clinical sample of individuals with a PCC diagnosis lasting at least one year was included (final n = 1673). A two-step cluster analysis was performed to identify symptom clusters. Subsequent comparisons between clusters were performed using Mann-Whitney U tests for continuous variables and chi-square tests for categorical variables. Results A total of four clusters were identified: two symptom burden clusters ( Systemic (high burden) and Few Symptoms (low burden)) and two symptom-specific clusters ( Neurocognitive and Pain ). Participants in the Systemic (high burden) cluster exhibited the highest levels of psychological distress, reported the most severe fatigue, and were most frequently unemployed. Conclusion In PCC, different symptom clusters can be identified that differ in terms of sociodemographic, clinical, and psychological factors. Future research using biomarker, imaging, and longitudinal designs is needed to determine whether these symptom-based clusters correspond to distinct biological subgroups.

Zusammenfassung Darmkrebs gehört zu den häufigsten onkologischen Erkrankungen in Deutschland. Obwohl die Einführung und kontinuierliche Weiterentwicklung der Darmkrebsfrüherkennung eine Erfolgsgeschichte ist und zu einer Reduktion der Morbidität und Mortalität beigetragen hat, bleiben die Teilnahmeraten hinter den Erwartungen zurück. In der aktuellen Analyse wurde die Inanspruchnahme der Darmkrebsfrüherkennung nach Einführung des Einladungsverfahrens sowie der Einfluss sozioökonomischer Faktoren untersucht.Versicherte, die erstmalig das Alter für eine Anspruchsberechtigung auf eine Früherkennungskoloskopie erreichten, wurden nach Einladung von ihrer Krankenkasse ein Jahr nachbeobachtet. Die Inanspruchnahme der Darmkrebsfrüherkennung (Stuhltest oder Früherkennungskoloskopie) wurde über den EBM-Katalog abgebildet.Im 1-Jahres-Zeitraum lag die Teilnahme bei 11,4% (Stuhltest 6,8%; Koloskopie 5,0%). Frauen nahmen mit 13,8% deutlich häufiger teil als Männer mit 8,5%. Weiterhin wurden Teilnahmeunterschiede nach sozioökonomischen Charakteristika gefunden. So lag die Teilnahme von Beschäftigten (12,0%) deutlich über der von Bürgergeldempfängern (7,4%). Auch bei der Schul- und Berufsbildung wurde ein sozialer Gradient sichtbar.Die heterogene Inanspruchnahme kann gesundheitliche Ungleichheiten verstärken. Maßnahmen zur Verbesserung könnten vermehrte Aufklärung und gruppenspezifische, leicht verständliche, mehrsprachige Informationen sowie ein einfacherer Zugang sein.

Objective: This study aimed to evaluate the effectiveness of a 12-month relapse prophylaxis following a 4-week interdisciplinary multimodal pain therapy approach for patients with back pain. The study examined whether the intervention reduced days of incapacity to work (primary outcome) and improved functional capacity and health-related quality of life (secondary outcomes) compared with interdisciplinary multimodal pain therapy alone. Design: A randomized controlled trial was conducted. The recruitment period was 24 months. Subjects/Patients: The study comprised 297 employed patients from a rural region in north-west Germany, diagnosed with back pain in different regions of the spine. Methods: The analyses were based on quantitative data: claims data and questionnaire data. Results: The results showed a mean of 70.07 days of incapacity to work after the interdisciplinary multimodal pain therapy for the control group and a lower mean of 56.41 days for the intervention group. The group difference was not significant (p = 0.259). Analysis of change scores revealed statistically significant larger improvements of functional capacity and health-related quality of life in the intervention group. Conclusion: Findings of this study show improvements in the secondary outcomes. The results indicate that further studies are needed to determine how to sustainably reduce days off work due to back pain.

IntroductionPatients presenting in centers for rare diseases (CRDs) show complex symptoms, requiring multiprofessional expertise. Many patients suffer from unnoticed mental disorders. Currently, mental health experts (MHEs) are rarely involved in the diagnostic process. The aim of this study was to test the feasibility of developing a new short screening instrument for mental disorders and to test its predictive value.MethodsData were derived from 1,300 adult patients participating in ZSE-DUO (dual guidance structure in centers for rare diseases), a multicenter study in 11 CRDs (funded by G-BA, Grant 01NVF17031), evaluating the benefit of involving an MHE in the diagnostic process. Patients completed standardized questionnaires on anxiety [the 7-item Generalized Anxiety Disorder (GAD-7)], depression [the 9-item Patient Health Questionnaire (PHQ-9)], dissociation [4-item Dissociation-Tension Scale (DSS-4)], psychopathology [Symptom-Checklist K-9 (SCL-K-9)], and quality of life [12-item Short Form Health Survey (SF-12) and EQ-5D-5L] prior to and during their first CRD visit as part of the routine assessment necessary for a first contact at a CRD. Exploratory factor analysis (EFA) was performed for item reduction. The reliability of the factor structure was assessed using Cronbach’s α. Model fit was tested using confirmatory factor analysis (CFA). The predictive value of the new screening instrument was tested by calculating a receiver operating characteristic (ROC) curve using the diagnoses from the MHE.ResultsThe extracted 18-item model had a four-factor structure with acceptable to high reliability. The extracted mental health dimensions were 1) anxiety and depression, 2) mobility and activities of daily living, 3) energy or fatigue, and 4) dissociation. Excluding the dimension “dissociation” (well assessed using the DSS-4 separately), a summary score was calculated ranging from 0 to 45, with the lowest score representing the best mental health. In the CFA, the model fit indices for the extracted factor structure did meet the established thresholds. The predictive value of the new screening instrument on any mental disorder was moderate [area under the curve (AUC)=0.68; 95% CI=0.64–0.73].ConclusionThe design of a new short screening instrument for mental disorders in patients presenting at CRDs was feasible. Furthermore, the new short screening instrument may help MHEs to identify patients in need of a more thorough screening and adapted care, particularly in identifying patients with potential depressive disorders. However, due to the heterogeneity of the mental disorders in this patient group, in addition, individual assessment of patients by MHEs is necessary.

ObjectiveThis study aimed to examine the psychometric properties (reliability and validity) of a German version of the DSQ-PEM, using a representative sample from the German general population (final n = 2,263) and a clinical sample with diagnosed post-COVID-19 condition (PCC) (final n = 1,448).MethodsThe internal consistency of the German version of the DSQ-PEM was calculated separately for both samples using Cronbach’s alpha. Convergent validity was assessed in both samples through correlations between the DSQ-PEM and the Patient Health Questionnaire (PHQ - 4), and for the PCC sample, additionally through a correlation between the DSQ-PEM and the Chalder Fatigue Scale. To evaluate known-group validity, differences in DSQ-PEM scores between the general population sample and the PCC sample were analyzed, adjusting for relevant sociodemographic variables. Additionally, gender- and age-related differences in the DSQ-PEM were calculated separately for both samples.ResultsThe DSQ-PEM items demonstrated excellent internal consistency in both the general population and PCC samples. Higher DSQ-PEM scores correlated with increased symptoms of anxiety and depression in both samples and were also associated with higher scores on the Chalder Fatigue Scale in the PCC sample, indicating good convergent validity. The known-group validity analyses revealed that the German version of the DSQ-PEM effectively differentiates between individuals from the general population and those with PCC, even after adjusting for relevant sociodemographic variables. Advanced age and female gender were associated with higher DSQ-PEM scores in the general population sample. No such correlation was found in the PCC sample.ConclusionIn summary, this study confirms the strong psychometric properties of the German version of the DSQ-PEM and supports the instrument as a reliable and valid tool for measuring PEM in Germany and other German-speaking countries.

BACKGROUND:Surgical site infections (SSIs) are among the most common hospital-acquired infections. They have a particularly significant impact on orthopaedic and trauma surgery due to their severe clinical and economic consequences. AIM:This systematic review aimed to quantify the additional direct costs of SSIs in orthopaedic and trauma surgery, considering only studies that statistically adjusted for other cost-influencing variables. METHODS:PubMed and Web of Science databases were searched for literature published between January 2010 and February 2025. Only original studies were selected. Costs were standardized to 2023 US dollars using inflation and purchasing power adjustments. Study quality was assessed using a 17-item checklist based on established frameworks. RESULTS:Thirty-six studies met the inclusion criteria. SSIs were found to lead to a median relative cost increase of 120% (interquartile range [IQR]: 76%-185%) and a median absolute increase of $24,230. Costs varied according to procedure type, infection depth, follow-up duration and region. Hip and knee replacements incurred the highest long-term costs. Deep SSIs were significantly more expensive than superficial ones. Studies with a high-quality score tended to report higher relative cost increases (129% vs 112%). CONCLUSION:SSIs substantially increase treatment costs in orthopaedic and trauma surgery, particularly for deep infections and joint replacements over longer follow-up periods. The results emphasize the economic benefits of SSI prevention and the importance of robust methodological standards in cost evaluations.

People presenting to centres for rare diseases (CRD) for diagnostic work-up often suffer from mental disorders. The prevalence and distribution of these mental disorders and their relevance for care remain largely unclear and well-controlled multicentre studies are missing. The ZSE-DUO study was a multicentre, prospective, controlled cohort study involving 11 German CRD. In total, 662 adult patients with an unclear diagnosis were evaluated by an additional mental health specialist along with their usual CRD care. Mental disorders were assessed through a standardized clinical examination, including the Mini-DIPS interview. Prevalence of diagnosed mental disorders (ICD-10 coding) was assessed and compared to population prevalence. A total of 54.5 % (361 patients) of adults with unexplained symptoms presenting to a CRD had current mental disorders. Mental disorders were deemed the sole explanation for the entire symptomatology in 53.5 % of cases. In 36.2 % of cases, a combination of a mental disorder with a somatic disease was considered to explain the unexplained symptoms. In 8.3 % of cases, it was assessed that the mental disorder was not involved in explaining the unexplained symptoms. Assessing whether a mental disorder contributes to the patient's symptom complex is crucial for determining suitable treatment strategies in terms of a bio-psycho-social approach.

Purpose: Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. Participants and Methods: N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/ trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation- Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. Results: The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's alpha >= 0.85) and valid (each Root-Mean-Square-Error of Approximation <= 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability ((3 = 0.301) and planning ((3 = 0.201) showed associations with compliance for nurses only. Conclusion: The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

Background: The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation. Methods: We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months. Results: 82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existing- appointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]). Conclusion: The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies.

BACKGROUND:The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation. METHODS:We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months. RESULTS:82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existingappointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]). CONCLUSION:The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies.

BackgroundA large number of individuals suffer from post-COVID-19 condition (PCC), characterised by persistent symptoms following a SARS-CoV-2 infection with an impact on daily personal and professional activities. This study aims at examining which (health) care services are used by PCC patients in the German federal state of Lower Saxony, and how these patients manage their condition. The perspectives of patients, informal caregivers and general practitioners (GPs) will be considered.MethodsThe study will employ a mixed methods design. Patients' perspective will be evaluated through an online survey of: (1) 21,000 adult individuals with a PCC diagnosis (ICD10 U09.9!) in their statutory health insurance claims data in 2022 ("AOK survey") and (2) a self-selected sample of adult individuals with a proven SARS-CoV-2 infection in 2023 and persistent symptoms ("public survey"). Additional data sources will be claims data (n = 27,275) and 25-30 semi-structured interviews. Informal caregivers' perspective will be collected through an online survey and semi-structured interviews. GPs' perspective will be evaluated through four focus groups involving six to eight participants each and an online survey of all registered and practicing GPs in Lower Saxony (approximately 5,000). All survey data will be descriptively analysed. In addition, correlation analyses and multivariable regression analyses will be conducted, for example on factors influencing affected individuals' use of medical services. Interview and focus group data will be subjected to qualitative content analysis. A health economic analysis will be used to determine the costs of PCC to health care payers, patients and society. The project will conclude with an expert workshop to discuss the results and derive recommendations.DiscussionThe results of the study will provide a multidimensional description of the (health) care situation and needs of patients with PCC, and derive recommendations for improving health care.Trial registrationThe VePoKaP study is registered at the German Clinical Trials Register (DRKS00032846).

Background Previous investigations of multiple sclerosis (MS)-related healthcare have focused on utilisation of specific individual health services (e.g. hospital care, office-based neurologists) by people with MS (PwMS). Meanwhile, little is known about possible patterns of utilisation across health services and their potential differences across patient characteristics. Objective To comprehensively analyse and identify patterns of MS-related health service utilisation and detect patient characteristics explaining such patterns. Methods In 2021, we invited all PwMS insured by the largest insurance company in Lower Saxony, Germany, to take part in an online survey. We merged respondents’ survey and health insurance claims data. We analysed MS-related health service utilisation and defined individual characteristics for subgroup analyses based on Andersen's Behavioural Model. We executed non-parametric missing value imputation and conducted hierarchical clustering to find patterns in health service utilisation. Results Of 6928 PwMS, 1935 responded to our survey and 1803 were included in the cluster analysis. We identified four distinct health service utilisation clusters: (1) regular users (n = 1130), (2) assistive care users (n = 443), (3) low users (n = 195) and (4) special services users (n = 35). Clusters differ by patient characteristics (e.g. age, impairment). Conclusion Our findings highlight the complexity of MS-related health service utilisation and provide relevant stakeholders with information allowing them to tailor healthcare planning according to utilisation patterns.

Objectives This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates.Design Retrospective study.Setting Publicly available secondary annual data.Participants The study includes 36 OECD countries as panel members for data analysis.Outcome measures Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries.Results The following variables had a significant influence on deceased organ donation rates: ‘opt-in’ system (β=−4.734, p<0.001, ref: ‘opt-out’ system), only donation after brain death (DBD) donors allowed (β=−4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (β=0.002, p<0.001), total healthcare employment pmp (β=−0.00012, p=0.012), World Giving Index (β=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (β=0.312, p=0.009) and percentage of population aged ≥65 years (β=0.801, p<0.001) as well as high education population in percentage (β=0.118, p=0.017).Conclusions Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an ‘opt-out’ system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.

Abstract Background Acute stroke treatment is time-critical. To provide qualified stroke care in areas without 24/7 availability of a stroke neurologist, the concept of teleneurology was established, which is based on remote video communication through telemedicine organized by telestroke networks. Data on the effectiveness and efficiency of stroke treatment via teleneurology is very scarce and is therefore partly questioned in the healthcare sector. The aim was to evaluate stroke care in hospitals with and without teleneurology in Northern Germany. Methods We conducted a retrospective case–control data analysis using health insurance claims data for the years 2018 to 2021. Based on pre-defined criteria, two models were defined and clinical as well as health economic parameters were compared. In model 1, we compared patients from hospitals with and without support by a telestroke network, while in model 2, we compared patients from hospitals with and without support by a telestroke network, including only districts without a certified stroke unit. Assessed parameters were age, length of stay, patients’ comorbidities, inpatient costs, reasons for discharge, qualified stroke care treatment according to operation and procedure codes (OPS) and intravenous thrombolysis (IVT) rates. Results Hospitals supported by a telestroke network improved their rate of stroke care according to OPS and increased more than three-fold their IVT rate (p = 0.042). In comparison, patients from hospitals with support by a telestroke network had a higher number and rate of qualified stroke care according to OPS (model 1: 73.6% vs 2.2%, p < 0.001 and model 2: 57.0% vs 3.8%, p < 0.001), higher rate of IVT (model 1: 9.5% vs. 0.0%, p = 0.027 and model 2: 10.3% vs 0.0%, p = 0.056) and a lower rate of secondary transfers to another hospital (model 1: 5.9% vs. 28.9%, p < 0.001 and model 2: 5.6% vs 30.1%, p < 0.001). Inpatient costs were lower in cases treated in hospitals with support by a telestroke network (model 1: 4,476€ vs. 5,549€, p = 0.03 and model 2: 4,374€ vs. 5,309€, p = 0.02). In multivariate analysis costs were independently associated with length of stay and patient transfer to another hospital but not with support by a telestroke network. Conclusion Hospitals with support by a telestroke network are associated with improved qualified stroke care resulting in higher rates of IVT and stroke care according to OPS codes as well as lower rates of onward transfers. Costs per patient were independently associated with transfer rates and length of hospital stay.

Early detection examinations and prevention are particularly important in childhood and adolescence, as certain diseases are already developing and health-related attitudes and behaviour patterns are formed and implemented. Despite the importance of screening and prevention, not all families use the available services and programmes. The aim of this study is to identify factors associated with participation in an early detection and prevention programme for children and adolescents, as well as factors associated with actual uptake of an examination. The analyses are based on questionnaire data of an online survey of participants and non-participants. Descriptive analyses and logistic regression models are conducted on a defined sample ( n = 1,289). The results show that both groups differ with regard to several factors: age, chronic diseases, federal state, living space, number of siblings, country of birth, migration background, language spoken at home, mother’s occupational status, household income, treatment duration, and trust in treating physician. Regression I shows that participation in the programme is significantly associated with higher age, language spoken at home, mother’s occupational status and greater trust in the treating physician. The latter demonstrates the highest predictive power. Regression II indicates that the actual uptake of an examination among participants is significantly affected by age, federal state and father’s occupational status. Overall, the results of this study show that social background partly plays a role in participation, but that factors such as trust in the treating physician also have a significant impact. For the future, further research on the factors influencing participation in screening and prevention services or programmes for children and adolescents is important in order to develop strategies to overcome existing barriers and thus reach groups that have not been reached yet. In this context, trust in the treating physician and his or her influence on decision-making should in particular be considered.

Einleitung Die nicht-alkoholische Steato-Hepatitis (NASH) stellt die entzündliche, progrediente Form der nicht-alkoholischen Fettlebererkrankung dar. Die Mehrheit der Fälle bleibt unentdeckt, bis schwerwiegende Folgeerkrankungen wie Leberzirrhose oder hepatozelluläre Karzinome auftreten. Zudem ist NASH mit einem erhöhten Risiko für metabolische Erkrankungen assoziiert. Da Übergewicht aufgrund von Bewegungsmangel oder falscher Ernährung häufig die Ursache ist, bilden Lebensstilinterventionen (LI) die Basis der Therapie. Diese werden jedoch von Betroffenen eher selten genutzt. Das Projekt soll zur Optimierung von LI auf Grundlage der Präferenzen des Patientenkollektivs beitragen.