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Germany coped with the coronavirus pandemic not least because of its well-equipped medical care system with a high density of doctors and hospitals. In the first wave in particular, the public health service also assumed responsibility for population medicine. The coronavirus crisis revealed the need for better equipment, expertise and sectoral coordination between health authorities. The pandemic exhibited the close connection between various health-related challenges, disease areas and health inequalities. Better coordination and cooperation between individual medical care, in particular general practitioners, and public health services responsible for population medicine is necessary for the future management of acute and chronic health problems. International experience shows how effective integration of these sectors can contribute to improving health care and reducing health inequalities. Against the background of the international health sciences debate, this article first presents the concepts of primary health care (PHC) and public health (PH). It then discusses the opportunities and challenges of a closer integration of primary health care and public health services, develops approaches for the corresponding further development of the German healthcare system and analyses the resulting options for improving population health.

The telemedical networking of children's clinics of varying sizes and specializations can support healthcare close to home, especially in rural regions with structural limitations. A Regional Tele-Paediatric Network was implemented in Mecklenburg-Western Pomerania and North Brandenburg (innovation fund project RTP-Net). This study examines the question of how participating parents accepted and evaluated this form of care.Parents of paediatric patients at a participating clinic were invited to take part in the study during the observation period 02.2021 to 03.2023 study. A mixed-methods approach was used that comprised a standardized questionnaire. The interviews were transcribed, categorized according to Kuckartz and subjected to descriptive evaluation. Between 12.2023 to 02.2024, telephone interviews were conducted with parents who had agreed to be recontacted.A total of 507 cases (403 patients) were included in the RTP-Net. Data from 138 questionnaires were analyzed. 74.5% of parents found that the use of telemedicine was helpful for the treatment of their child; 88.1% could imagine that telemedicine could supplement paediatric healthcare in the future. Parents interviewed over the telephone (n=11) rated telemedicine services positively. The main advantages mentioned were saving in time and distance, availability of specialist expertise and avoidance of long waiting times. There were concerns about the lack of physical contact between telemedicine doctor and patient.Parents show a high level of acceptance of telemedicine and trust in the provision of telemedical services. Telemedicine can help parents to avoid the burden of long journeys and waiting times and improve access to specialist medical expertise. In order to improve the acceptance and satisfaction of parents, it is important to inform them about the results if the telemedical advice was based on a doctor-to-doctor consultation.

With the end of the COVID-19 pandemic and the decreasing significance of official reporting figures, the Lower Saxony State Health Office developed and tested a new indicator: the "7-day sick leave incidence". Unlike previous surveillance indicators, it is intended for syndromic surveillance of COVID-19. This article explains the methodological development as well as its benefits, possible applications, and limitations.The indicator is based on the weekly number of sick leaves due to COVID-19 per 100,000 health insurance members entitled to sickness benefits (KGbM) of the AOK Lower Saxony (AOKN). The development of the indicator involved differentiating between initial and follow-up sick leaves, investigating fluctuations in the number of KGbM, analysing the doctors' assignments of ICD Codes U07.1! and U07.2!, and ensuring the timely availability of sick leave data.Initial and follow-up sick leaves were distinguished using a temporal algorithm. In 2022 and 2023, on average, 83.0% (s=5.4%) and 88.9% (s=2.3%) of all initial COVID-19-related sick notes were submitted on time by the end of the respective calendar week. Four out of 5 initial sick notes contained the doctors' ICD code U07.1! (lab-confirmed COVID-19). The number of KGbM proved to be stable (M=1.218.202, s=11.003). When comparing the new "7-day sick leave incidence" with the officially used "7-day incidence rates" during pandemic, trends were highly similar in 2022 (r=0.89), but diverged significantly in 2023 (r=0.26) due to declining diagnostic activities for the "7-day incidence rates".The new 7-day-sick-leave incidence is a good representation of the post-pandemic COVID-19 infection dynamics. The indicator uses routine data and is easy to establish. Limitations relate to possible changes in diagnostic procedures, doctors' coding behaviors and changing demands for sick leave.

The health economic impacts of centralization in the German healthcare system, particularly in the field of ENT, are insufficiently researched. Therefore, this study investigates the potential benefits of a head and neck tumor center using the example of surgical care for laryngeal carcinoma in Schleswig-Holstein.A systematic literature review was conducted using the PRISMA search schema to examine the correlation between a hospital's treatment volume and mortality rates for laryngeal carcinomas. Subsequently, an 8-year Markov model simulation was employed to demonstrate the effects of establishing centers. This was supplemented by a cost analysis based on data from the PROGNOS study.The simulation shows the hypothetical impact on patient care for the existing head and neck tumor center in Schleswig-Holstein over an 8-year period. Maintaining the center in Schleswig-Holstein over eight years would save 113 lives and gain 1,333 life years (equivalent to 933.1 QALYs), corresponding to costs of 12,866 euros per QALY.The results suggest that centralizing care has medical and economic effectiveness in the ENT sector. They provide important insights for current political discussions and decision-making processes in healthcare. Future research should expand the focus to include other ENT cancers to gain a more comprehensive understanding of the impacts of centralization.

Between March 16th and December 31st 2022, compulsory vaccination against COVID-19 in medical and care facilities was legislated through § 20a of the Infection Protection Act. Until March 15th 2022, employees in medical and care facilities had to provide proof of completed vaccination against COVID-19, proof of recovery, or a medical certificate indicating that vaccination was not feasible. In case the deadline was not met, the facility management was obliged to report immediately to the local health authority, who proceeded with a discretionary decision. There was controversy about the law among politicians, health care workers, employees in public administration as well as in the media landscape and civil society. Federal states and local authorities implemented the law to varying degrees. This study describes the implementation of compulsory vaccination in medical and care facilities in detail for the district Hamburg Eimsbüttel and presents administrative, medical and ethical challenges of the law in its implementation.

Community readiness (CR) describes the degree to which a municipality is prepared to actively address a health problem. It is a central condition for successful and sustainable prevention efforts. The CR for childhood obesity prevention is low in German municipalities, which makes it difficult to implement effective measures.The aim of this study was to develop strategies to increase CR for the prevention of childhood obesity in municipalities. In Bavarian municipalities, workshops (n=5) were conducted with municipal stakeholders after an initial CR assessment. Their specific results were analysed and based on this, strategies were developed in a participatory manner.The municipal strategies focused on three areas: (1) optimising resources for prevention efforts, (2) supporting knowledge about childhood obesity and prevention and (3) strengthening prioritisation of childhood obesity.The strategies offer practical approaches to promote CR and provide a basis for further development and implementation of effective prevention efforts. An evaluation of effectiveness can be made through follow-up measurements after implementation of the strategies.

Lung cancer represents the second most frequent tumor entity worldwide with an increasing number of patients treated in specialized centers. The aim of the WiZen study was to find out whether treatment at hospitals certified by the German Cancer Society (GCS) was associated with long-term survival benefits.Data for this cohort study was derived from the largest German statutory health insurance (SHI) AOK, four regional population-based clinical cancer registries (CCR), and standardized hospital quality reports. The analyses were based on 173,999 incident lung cancer patients in the SHI dataset and 35,702 patients in the CCR dataset who received primary treatment for lung cancer (ICD-10-GM C33, C34, D38.1) between 2009 and 2017.Distributions of age, sex, comorbidities, and most tumor characteristics were similar among patients treated in certified and non-certified hospitals. The Kaplan-Meier estimator for 5-year overall survival was 28.0% for patients from certified and 16.9% from non-certified hospitals (SHI data; CCR data: 21.4% vs. 13.6%). Cox-regression adjusting for relevant confounders yielded hazard ratios of 0.97 (SHI data; 95%CI 0.94, 1.00) and 0.85 (CCR data; 95%CI 0.82, 0.88) for all-cause mortality. The adjusted hazard ratio for recurrence-free survival (CCR data, UICC stage I-III, R0 only) was 0.82 (95%CI 0.75, 0.90).The presented analyses show that treatment in certified lung cancer centers is associated with relevant survival benefits and should therefore be supported.

The aim of this study was to describe and analyse knowledge of women in childbed with and without a migration background about ante- and postnatal support services.Questionnaires were provided in 26 languages. In a cross-sectional survey, 641 women answered questions about their knowledge of 11 different regional support services, and information sources for these and other support service providers. Median split was used to derive mothers with good and poor knowledge.German was not the mother tongue of 30% of the participants (n=194) and were therefore defined as "mothers with migration background". Of these, 83% (n=161) were aware of services offered by midwives and<40% knew of other support services. Women with migration background were significantly less likely to know the support services (OR 0.16, 95% CI 0.11 to 0.23), even after controlling for other sociodemographic variables. Furthermore, they obtained significantly less frequently information about relevant services from gynaecologists, midwives, relatives/acquaintances or by themselves.Especially for mothers with migration background, knowledge about ante- and postnatal support services must be made more accessible. In this, midwives could play a decisive role.