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Background: Premature infants (gestation age<37 weeks) and low-birth-weight infants (< 2.5 kg) require complex care to ensure their survival, growth and neurological development. Increased risk for developmental disorders, infections, and challenges with nutrition and body temperature regulation require comprehensive measures in care.

Aim: The aim of this guideline was to improve the care of premature and low-birth-weight infants through updated recommendations.

Methods: The recommendations of the World Health Organization (WHO) have been implemented in this guideline in accordance with the WHO handbook for guideline development. This publication has been translated into German by staff members of the WHO Collaborating Centre at the Danube University Krems (Austria).

Results/conclusions: This guideline includes 11 strong and 14 conditional recommendations, of which 16 describe preventive and promotive care, 6 recommendations about care for complications and 3 for family involvement and support, as well as one statement of good practice.

Aim of the study The study examined the distribution of places of death in the Westphalian city of Muenster over an observation period of 20 years.Methods All death certificates issued in the city of Muenster from 2001, 2011, 2017, 2021 were evaluated by places of death (home (HO), hospital (HT), hospice (HP), nursing home (NH), other place (OP)). For hospital patients, deaths on intensive care units (ICU) and palliative care units (PAL) were also considered separately. Any medical information on cause of death was used to identify decedents with malignant tumor or dementia disease.Results A total of 14,240 death certificates were evaluated. A malignant tumor disease was documented in 34.0%, dementia in 11.1%. For the general population, the distribution of places of death was as follows (2001/2021; %): HO (24.0/14.6); HT (63.2/60.2) [ICU (13.3/24.6), PAL (0.0/10.9)], HP (3.8/4.9), NH (7.8/19.5), OP (1.1/0.7). Most tumor patients died in hospital (2021: 60.6%), fewer patients at home (2021: 15.4%). From 2001 to 2021, the proportion of cancer patients who died in a PAL increased significantly (+24.4%); hospices showed a moderate increase (+5.0%). A majority of dementia patients died in nursing homes (2021: 66.6%) and fewer patients at home (2021: 12.2%).Conclusion For the general population and for tumor patients, the hospital is the most common place of death and the nursing home for patients with dementia. Overall, deaths at home decreased continuously over time. For tumor patients, palliative care units and hospices are becoming increasingly important as places of death, and for dementia patients, nursing homes in particular.

Background: Memory clinics can contribute significantly to a qualified diagnosis of dementia. Since the accessibility of medical facilities is an important predictor for their utilisation, the aim of this study was to determine the accessibility of memory clinics for persons with dementia in Bavaria.

Methods: We used a Geographic Information System (GIS) to determine travel times to the nearest memory clinic for all Bavarian municipalities based on OpenStreetMap road network data.

Results: The majority of the modelled persons with dementia in Bavaria (40%; n = 93,950) live in communities with an average travel time of 20 to 40 minutes to the nearest memory clinic. Almost 7,000 (3%) require more than one hour. Especially persons from rural communities have to travel significantly longer distances than people from urban areas.

Conclusion: In view of demographic developments, there is an urgent need for memory clinics to be accessible throughout the country for all persons with dementia, regardless of where they live. The systematic development of memory clinics in areas with long travel times or the establishment of mobile diagnostic services could help to improve dementia care.

Introduction: In 2018, medical transplant data from three institutions were merged to create a German transplant registry. Since June 2021, access to data of the registry has been available. It was planned to analyze the registry data in order to compare special allocation rules with regular allocation for heart, liver, lung, and kidney transplantation. Our approach led to a quality analysis of the registry.

Methods: Upon request, legacy data (2006-2016) of the registry was provided, divided into 61 elements. From these elements, the user had to compile the required dataset. Data checks were performed for completeness, correct allocation of information, and consistency among different sources. Software used for these tasks included R, SQL, and Excel.

Results: The initial elements ("waiting list" elements) of the four types of transplantations contained data from a total of 80,259 originally listed patients. However, these patients were only partially present in other elements resulting in complete datasets reflecting waiting time in only 23%, 30%, 50%, and 96%, and for post-transplantation outcomes in 14%, 11%, 38%, and 13% (heart, liver, lung, and kidney transplantation, respectively). The linking of urgency information with clinical data was successful in only a small proportion, with only 6% for heart transplantation. Incorrect and thus implausible allocations in the case of special allocation rules indicated incorrect entries in the registry. Data from different data providers were inconsistent.

Discussion: The incompleteness and incorrect data allocation raise doubts about the reliability of scientific studies based on the transplant registry. The complex structure also hinders the compilation of a reliable dataset, which is uncommon internationally. New data (acquisition since 2017) has only been available since December 2023.

Conclusion: The transplant registry urgently needs restructuring. Competent clinical data management, involving transplant medical expertise, and continuous quality controls are essential in this process.

In forensic psychiatric clinics, patients who have committed a criminal offense on the basis of intellectual disability are also treated in according to Sect. 63 of the German Criminal Code. This group of patients has above-average lengths of stay and specific difficulties in treatment and in transition to aftercare systems are reported from practice. The present study is based on a content-analytical evaluation of ten structured interviews with practitioners of different professions who are familiar with the treatment of this patient group in forensic psychiatry. The aim was to identify treatment experiences and challenges of inpatient forensic care for this group as well as needs for change and suggestions for improvement. Respondents confirmed the specific treatment needs and person- and diagnosis-related challenges known from other studies, which were considered to be causally related to prolonged hospital stay and problems at discharge. Numerous structural and systemic barriers were also identified that impede the shortest possible forensic inpatient care and seamless transition to the non-forensic aftercare system. At the structural level, these included the need for human resources (both quantitative and qualitative) and adapted treatment concepts. Professional aftercare was considered very important for this group of patients. In this regard, the non-availability of suitable institutions, long waiting lists and reservations on the part of these institutions towards former forensic patients were identified as problems. The fact that patients with intellectual disability were less able to make their needs known than other patients and thus often received less attention from the treatment providers can be described as a systemic obstacle. This also applies to the rather high demands that the forensic system, with its goal of "improvement" through treatment, also places on people with intellectual disability. The findings of this study can contribute to improvement of the forensic inpatient care of people with intellectual disability at systemic and structural levels.

Introduction: According to the Maternity Protection Act, an occupational risk of infection (e. g. in childcare) - combined with individual immunity gaps - can result in an irresponsible risk for pregnant women in the workplace. If this risk cannot be eliminated by any other means, the employer must impose a prohibition of employment (PE) for the pregnant woman concerned. We classified PE as preventable if the underlying immunity gaps could have been closed by immunisation prior to pregnancy.

Methods: From 01.09.2016 to 25.03.2020, 1922 pregnant employees of Bavarian state schools obtained medical counselling on their occupational risk of infection as part of a research project. If the individual combination of occupational-risk profile and immunity status resulted in an irresponsible risk for the pregnancy, a PE was recommended by the attending physician. We determined the proportion of PE that would have theoretically been preventable by full immunisation prior to pregnancy and approximated the resulting - theoretically preventable - loss of working hours and personnel costs.

Results: In 425 cases (22%), a PE was deemed necessary by the attending physician, whereby 193 (45%) were retrospectively classified as theoretically preventable. Of these cases, 53 PE (27%) were temporary (valid until the 20th week of pregnancy) and 140 were long-term (valid for the complete duration of the pregnancy). Based on these results, we approximated a loss of 2,746 working weeks for our collective, which entails theoretically preventable personnel costs totalling 5,763,305 € for the observation period of our study (3.6 years). We then extrapolated estimates for all employees of Bavarian state schools and found a loss of 4,260 working weeks and theoretically preventable personnel costs amounting to almost 8,941,000 € per year during our observation period.

Conclusion: Theoretically preventable PE caused by immunity gaps can entail a considerable loss of working hours and high personnel costs. Therefore, we should step up measures aimed at improving vaccination rates in women and increasing their willingness to be vaccinated. In view of the changes in legal and regulatory conditions in Germany since 2020, new investigations should be made as soon as there is sufficient data after the general employment prohibitions due to the SARS-CoV-2-pandemic have been lifted.

In the school years 2019/20 and 2020/21, children were physically, psychologically, and socially stressed by school closures caused by the SARS-CoV-2 pandemic. To ensure attendance with optimal infection protection, PCR pool testing was conducted during the 2021/22 school year at Bavarian elementary schools and schools for pupils with special needs for timely detection of SARS-CoV-2 infection. This study analyzes the results of PCR pool testing over time stratified by region, school type, and age of children. The data were obtained from classes in elementary and special needs schools, involving pupils aged 6 to 11 years, who participated in the Bavaria-wide PCR pool testing from 09/20/21 to 04/08/22. Samples were collected twice weekly, consisting of PCR pool samples and individual PCR samples, which were only evaluated in case of a positive pool test. A class was considered positive if at least one individual sample from that class was positive within a calendar week (CW). A school (class) was considered to be infection-prone if three or more classes in that school (students in that class) were positive within a CW. The data included 2,430 elementary schools (339 special needs schools) with 23,021 (2,711) classes and 456,478 (29,200) children. A total of 1,157,617 pools (of which 3.37% were positive) and 724,438 individual samples (6.76% positive) were analyzed. Larger schools exhibited higher PR compared to smaller schools. From January 2022, the Omicron variant led to a massive increase in PR across Bavaria. The incidence rates per 100,000 person-weeks within the individual school samples were significantly lower than the concurrently reported age-specific and general infection incidences in the overall Bavarian population. PCR pool testing revealed relatively few positive pools, with an average of four children per one hundred pools testing positive. Schools and classes were rarely considered infection-prone, even during periods of high incidences outside of schools. The combination of PCR pool testing and hygiene measures allowed for a largely safe in-person education for pupils in primary and special needs schools in the school year 2021/22.

Headache is a frequent presenting symptom in the emergency department. While most cases are of benign aetiology, it is crucially important to identify potentially dangerous underlying disorders. We hypothesized an increase in headache-related emergency presentations after venous thrombosis of cerebral sinuses had been identified as a rare side effect of vaccination with adenovirus vector-based Coronavirus-disease 2019 (COVID-19) vaccines and that information had been publicly communicated by the Paul Ehrlich Institute. Data from patients with the diagnosis of primary headache disorders or unspecified headache presenting to the Interdisciplinary Emergency Department of the University Medicine Mannheim were retrospectively analysed. Based on vaccination dashboard data published by the Federal Ministry of Health, calendar weeks 14-30 and 47-48, on the one hand, and 1-13 and 31-46, on the othe, were categorized into a variable "vaccination epoch" (14-30, 47-48: high vaccination activity if≥3 million weekly vaccinations in Germany; 1-13, 31-46: low vaccination activity if<3 million weekly vaccinations). The number of patients with headache was the dependent variable. A Poisson regression was performed to analyze whether the frequency of events, i. e., patient presentations, was a function of year (2019, 2021), epoch (high, low) and an interaction of year and epoch - the latter reflecting an impact of vaccination activity during the pandemic and expressed as incidence rate ratio. Compared to 2019, there was a more than 70% increase in presentations due to headache during periods of high vaccination activity in 2021 (p<0.001; 95% confidence interval 1.272-2.316), in 25% of presentations in 2021, patients considered their headache as vaccination-associated. Public communication and resulting nocebo effects may, among other factors, have contributed to our observation of increased numbers of emergency headache presentations, illustrating the impact of public distribution of medical information on practical aspects of emergency care during crises.

Introduction: The supply of medical aids is essential for patients with home mechanical ventilation. However, it is largely unclear to what extent this supply is needs-based and safe.

Methods: As part of a health services research project, 20 expert interviews were conducted with a heterogeneous group of stakeholders related to ventilation-specific medical aids supply. The interviews were analysed using qualitative content analysis.

Results: The interviewees pointed to challenges and problems regarding structural, procedural and personal aspects at all levels of medical aids supply. In particular, deficits in task performance, coordination and cooperation between the stakeholders and authorities involved became apparent. Such might result in avoidable safety risks and hinder needs-oriented supply of medical aids.

Conclusion: Further development in ventilation-associated medical aids supply is needed, with focus on evidence-based practices, a comprehensive, cross-sectoral and cross-professional design as well as systematic evaluation.