Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

Digital health applications (DiGA) can play an important role in the treatment of unipolar depression. In Germany, the demand is high, but less than 1% of patients use DiGA, indicating existing barriers to their use. This article provides an overview of access and usage barriers along the patient pathway and discusses possible solutions to improve the dissemination and use of digital therapies.Based on the National Care Guideline (NVL) Unipolar Depression (2022), a patient pathway with the phases of "decision," "access," and "usage" was developed. Using this structure, existing care barriers were identified based on current literature, and solutions were derived. The narrative review shows that various factors hinder the effective use of DiGA. In the decision phase, lack of knowledge about DiGA and lack of trust in their effectiveness are central challenges. In the access phase, data protection concerns and bureaucratic hurdles are significant barriers. During the usage phase, difficulties in application and low adherence lead to limited effectiveness.Several solutions are proposed to overcome these barriers. Comprehensive education about the effectiveness of digital therapies could strengthen trust in DiGA. Improvements in user-friendliness and greater involvement of healthcare providers could increase acceptance and adherence. Additionally, targeted training for professionals and patients could promote the use of DiGA. These insights are also relevant for other areas of digital therapies.

Background: The extent to which statutory health insurance (SHI) data can be used to map associations between thermal stress and heat-related diseases is still unclear. The aim of this study is to analyse the association between climate variability and heat-associated diseases using insurance data.

Methods: The study is based on claims data (outpatient and stationary) from health insurance companies in Germany for the years 2012-2021, covering approximately 11 million people with statutory health insurance. Four heat-related ICD-10 diagnoses were considered: T67 (heat and sun damage), E86 (volume depletion), N17 (acute renal failure) and N19 (renal insufficiency). Thermal conditions were quantified using meteorological variables. The evaluation was carried out on a federal state-specific basis for the second and third quarters (Q2, Q3) using descriptive methods and correlation analyses with repeated measurements.

Results: The years 2016, 2018 and 2020 were characterised by high temperatures. Compared with Q2, Q3 was associated with higher thermal stress and more heat-related diagnoses on average during the entire observational period. Nationally, diagnoses of heat and sun damage (outpatient) correlated with the number of hot days (r_mw = 0.86 [0.81; 0.90]). Although heat stress is lower in the second quarter, a similar correlation is found here (r_mw = 0.76 [0.68; 0.82]). This striking association was also maintained when analysing the federal states specifically.

Discussion: The article shows that associations between thermal stress and morbidity can also be found in routine SHI data. Against the background of an increase in high thermal stress due to climate change, this article highlights the need for adaptation measures.

This position paper from the Digital Public Health Section of the German Public Health Association defines digital public health (DiPH) and describes its goals and potential. It also addresses the current situation and challenges as well as the need for action in Germany. The focus here is on the presentation of the nationwide promotion of (digital) health literacy; the application of DiPH in prevention, health promotion, and healthcare; the use of innovative preventive strategies for the prevention of non-communicable diseases; and the teaching of DiPH in academic public health programs. Finally, relevant measures and demands to strengthen DiPH in Germany are summarized.

National mortality registers provide important data for monitoring population health. Analyses of cardiovascular mortality in particular-and especially mortality from coronary heart disease-are frequently the basis for conclusions about the quality of healthcare and prevention. To be able to interpret disease-specific mortality differences between countries and changes in mortality over time, it is necessary to know the basics of monocausal cause-of-death statistics and the associated limitations in comparative statements.Conclusions from disease-specific mortality data can be problematic due to the highly subjective selection of diseases that are entered on a death certificate after a post-mortem examination. In death certification, unawareness of the different "roles" of specific diseases-known at the time of death-within the causal chain leading to death can result in incomplete death certificates as a data basis for mortality statistics. Comparisons of disease-specific mortality rates are difficult due to different proportions of non-informative-including unknown-causes of death and due to country-specific preferences for which diseases are recorded on a death certificate-especially in the prevalence of multimorbidity. A population's morbidity is therefore only reflected to a limited extent by mortality rates. Conceptual ambiguities with regard to the concepts of lethality and mortality when describing mortality rates can also lead to erroneous conclusions.Training of medical staff on how to complete a death certificate and the introduction of an electronic death certificate can improve the quality of mortality data. Irrespective of this, knowing potential pitfalls when analyzing mortality data will improve the quality of health reporting.

Background: In March 2023, there was no comprehensive overview of job demands, resources, and mental health consequences for nurses in Germany during the COVID-19 pandemic. Because of country-specific differences with regard to the course/management of the pandemic and the organization of the healthcare system, data from Germany were analyzed specifically.

Methods: A systematic search in databases (PubMed/Medline, PsycINFO) yielded 50 relevant studies that were included in the scoping review.

Results: The studies were based on cross-sectional designs, mostly from the hospital setting and the first year of the pandemic. Frequently investigated job demands were work intensification, lack of protective equipment, rapidly changing regulations, contact with COVID-19 patients, and pandemic-related worries/anxieties. Pandemic phase and setting-specific demand cascades became clear. Frequently examined mental health problems (including stress experience, anxiety, depression, burnout, and intention to change career/job) were higher in groups with higher levels of reported job demands. Nurses generally reported less favorable values than medical professionals. Social support, reward/appreciation, humor, resilience, and sense of coherence proved to be resources.

Conclusion: In preparation for further pandemics and crises, pre-pandemic job demands should be reduced through targeted measures and relevant resources should be strengthened. Pandemic-specific job demands should be systematically reflected and cross-organizational solutions developed. Longitudinal studies using validated instruments and intervention studies should be the focus of future research funding.

Introduction: Families in Germany who live in poverty receive citizens' benefits (Bürgergeld) within the context of welfare legislation. Basic rates for children and adolescents are included in these benefits and staggered into three groups according to age. The need for nutrition is the largest category of the basic rate. The Optimized Mixed Diet (OMD) is a practical concept of a healthy diet for children and adolescents aged 1-18 years. Traditional and home-cooked meals are preferred. The aim of this project was to calculate the food costs of the OMD based on the underlying 7‑day meal plan.

Methods: The lowest shelf prices of 87 different foods from the OMD were recorded during market inspections in different food retailers (1 supermarket, 1 discounter; November 2022, Bochum, Germany). The nutrition basic rate was compared to the total food costs per month in accordance with the age groups of the welfare legislation as well as of the German Nutrition Society (DGE) reference values. Furthermore, the contributions of the food groups were determined based on total costs and total energy intake of the OMD.

Results: The food costs of the OMD are covered 101-109% by the standard nutritional rate of the citizens' benefits for every age group of the welfare legislation. The costs for the more narrowly defined DGE age groups are covered as well with a few exceptions. The main cost drivers of the OMD were vegetables/raw foods, and the main energy sources were bread/cereal products.

Discussion: The current citizens' benefits can cover the nutritional requirement of children and adolescents, provided that meals are self-cooked and low-priced foods are used. The question remains to what extent the social needs for participation can be fulfilled as well.

Background: Child maltreatment is a significant problem in Germany. Hospital data on child maltreatment serve as a crucial foundation for planning effective prevention measures. These data enable an assessment of the extent to which at-risk children and adolescents are identified, supported, and protected. A systematic evaluation and classification of all hospital data relevant to child maltreatment in Germany is still lacking. Therefore, the aim of this article is to gain an overview of the data in this field and thus bridge the gap.

Methods: Descriptive analyses of (partially) inpatient data on child abuse and neglect (secondary diagnosis in ICD-10: T74.0, T74.1, T74.2, T74.3, T74.8, T74.9) + (procedure OPS: 1‑945.0, 1‑945.1) from the 2019-2023 data collection period. The variables age, gender, and main diagnoses relevant to maltreatment are considered in each case. The data were analyzed via the publicly accessible data browser of the Institute for the Hospital Remuneration System (InEK).

Results: The number of diagnosed cases of child maltreatment of (partially) inpatients is detached from prevalence rates in the population; in consequence, there is a significant underreporting of all forms of maltreatment, with boys and girls being recognized differently for different forms of maltreatment. In addition, the frequent lack of a link between child maltreatment-related diagnoses and procedures performed becomes apparent.

Conclusion: In addition to raising awareness, training, and further education of healthcare professionals, there is also a need for investment in political change.

Background: In February 2020, the Federal Constitutional Court declared § 217 of the German Criminal Code void. Ever since, assisted suicide services have been legal in Germany. This study aims to describe the knowledge, attitudes and experiences of members of the German Association for Palliative Medicine (DGP) regarding assisted suicide.

Methods: Online survey with members of the DGP from July to September 2023 using Qualtrics®. The study group developed the questionnaire based on current literature; it was adapted following an initial application among young physicians and an interprofessional panel of experts with consensus voting. Data was analysed using descriptive and explorative statistics.

Results: 991 DGP-members (18%) participated, of which physicians made up 57.0% (n = 545/957) and nurses 23.4% (n = 224/957). Of the participants, 197/851 (23.1%) incorrectly stated that assisted suicide is prohibited by professional code, 430/914 (47.1%) rejected a restriction of palliative care teams to suicide prevention measures, and 766/930 (82.4%) rejected personal involvement in assisted suicide regardless of a patient's health status. For patients in palliative situations, 473/926 (51.1%) could imagine participating in assisted suicide, and 71% wanted new legislation regulating assisted suicide.

Conclusion: There are gaps in the knowledge of the participating members of the DGP regarding the legal and professional status of assisted suicide. Further educational work is needed in this regard. The participants can more easily imagine assisted suicide for people in palliative disease trajectories. As in surveys of members of other medical societies, the attitudes of more experienced staff are reflected. Compared to younger healthcare professionals, they have a more restrictive attitude towards the concept of assisted suicide.