Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

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.

Health literacy is a central resource for health-related decisions. Since the 1970s, however, the understanding of this term has changed in several ways. Initially, health literacy was considered only from the point of view of individual competencies, but in recent decades it has evolved into a more contextual understanding. Despite this conceptual evolution, current social and health challenges are still not adequately addressed.This article reflects on the developments in the understanding of the concept and on the relevance of health literacy in the face of the current polycrisis. Reference is made to a recent concept paper developed by the authors, which shows that health literacy is a central resource at the interface of healthcare, disease prevention, and health promotion and that it can occur at different levels and in different forms. The discussion on health literacy also highlights the need to consider the challenges of systems, organizations, and settings, as decisions about health and well-being are made in all these contexts.The importance of health literacy as a key resource is increasing, particularly in addressing current social challenges, and is gaining additional relevance as a social determinant of health. Health literacy interventions can only be effectively developed, implemented, and evaluated if a shared understanding of health literacy exists, current challenges and contexts are considered, and key stakeholders act together when implementing measures.

About ten years ago, studies on health literacy in Germany indicated that population health literacy was low. This prompted a group of distinguished experts to initiate the development of a National Action Plan for Health Literacy (NAP-HL) for Germany, modeled after those of other countries. This article explains the origins and development of the plan in Germany, provides an overview of the steps taken during its creation, and summarizes its content. Subsequently, the transfer strategy, including the three steps of diffusion, dissemination, and implementation, is discussed. The concluding assessment evaluates the plan's achieved impacts and critically reflects on the implementation strategy. Overall, numerous impulses were provided for agenda setting and the promotion of health literacy. The challenge remains to develop sustainable interventions for strengthening health literacy, accompanied by systematic research.

Introduction: Barriers to accessing abortion care can delay access to services, which can lead to delayed abortion and health risks. Barriers include geographical accessibility, confidentiality, waiting times, stigmatization, poor or inaccessible information and the cost of abortion. This article examines barriers to accessing abortion care in Germany. This includes barriers in the availability and accessibility of care services, access to information, costs associated with abortion and organisational barriers.

Methods: The analyses are based on data from an online cross-sectional survey of 594 women in Germany who had an unwanted pregnancy terminated, which was conducted as part of the ELSA Study in 2021 and 2022.

Results: The findings indicate that access to abortion care in Germany is associated with various barriers for many women. Of the respondents, 80.1% reported at least one barrier to accessing abortion, 65.5% reported more than two barriers and 40.5% reported three or more barriers. In particular, the non-disclosure of the procedure and the associated fear of stigmatisation represented hurdles for many participants.

Discussion and conclusion: The results of the study underline the need to improve access to safe abortions. Reducing access barriers therefore includes the decriminalisation of abortion, a comprehensive care structure, financial support services, improved information services and the reduction of stigmatisation and discrimination.

After a decline in the number of annual abortions from around 130,000 in the years 1996 to 2004 to around 100,000 since 2013/14, there was recently a certain increase again to 106,000 abortions in 2023. The decline from 2004 to 2013 was driven by a decrease in the number of women of childbearing age and a lower probability of having an abortion in the key age groups. When comparing the result structures over time, the constant development towards the use of Mifegyne® is noticeable. Regarding the duration of the terminated pregnancy, the proportion of early abortions has increased in recent years.There are differences in structures between the federal states. The probability of an abortion by age is relatively low in the south of the Republic but is above average in the city states and the new federal states. Further differences between the federal states can be identified with regard to the type of intervention used or the provider. The proportion of abortions carried out in another federal state also varies. The number of reporting healthcare providers can offer basic statistical information. Legal developments have been initiated, primarily for improved regionalization of data-while respecting statistical confidentiality.

The COVID-19 pandemic has had a drastic impact on healthcare systems. They had to react, adapt and innovate in order to build resilience, that is maintain healthcare access and health equity. For example, access to abortion services during the pandemic was increasingly facilitated through "Telehealth for Early Medical Abortion" (TEMA).This narrative review article compares Germany, France and Great Britain in terms of abortion numbers, methods and settings from 2018 to 2023. Changes in the availability of services and legislation during the pandemic are presented, and the differences between the countries, as well as various innovation factors, are discussed. We used national statistics and conducted a literature and online search (Rapid Review).In the three countries, there are differences in abortion rates, the share of medical abortions and the impact of the pandemic. In France and Great Britain, where medical abortion is the main method of abortion and where abortion care was more accessible before the pandemic than in Germany, a series of innovations were officially introduced to facilitate access during the pandemic. They included teleconsultations and the mailing of abortion medication. Most changes have been sustained since then, contributing to addressing historic and systemic health inequities in terms of access. In Germany, innovations during the pandemic have been crafted mainly by civil society organisations, offering for the first time teleabortion services.The COVID-19 pandemic provoked or accelerated innovation in terms of abortion care in France, Germany and Great Britain. The sustainability and scaling-up of those innovations remain fragile, especially in Germany, where the disruptive approach of civil society organisations has not yet found its way into mainstream healthcare services.

The termination of a pregnancy in the first trimester is regulated by law. Guidelines serve the purpose of presenting the current state of medical science in order to enable the best possible care. S3 guidelines represent the highest level of guideline development and contain all elements of systematic development, including systematic research, evaluation of the evidence, and structured consensus-building using formal technology. The existing S2k guideline is to be raised to an S3 level. For this purpose, the Institute for Quality and Efficiency in Health Care (IQWiG) conducted an evidence search on eight central questions. The result showed a predominantly very poor level of evidence. The article describes the development of the S3 guideline and the existing problems and limitations.

Background: Smoking is still the largest preventable health risk in Germany, which is why a higher success rate in smoking cessation would benefit both public and individual health. In order to achieve this, a better understanding of the smoking cessation methods used and the factors that facilitate and prevent smoking cessation is required. The RauS study therefore aimed to investigate which methods have been used in attempts to stop smoking, how successful these methods have been, and which factors have been perceived as helping or hindering smoking cessation.

Methods: From March to December 2022 a quantitative online survey was conducted among current or former smokers over 14 years of age (N = 6192).

Results: Of the sample, 93% have tried to quit smoking at least once. In general, for the respondents who did or did not use e‑cigarettes/tobacco heaters, "personal willpower" was the most frequently used and perceived as the most helpful method. Among people who have used e‑cigarettes/tobacco heaters to quit smoking, e‑cigarettes with nicotine were used most frequently and were rated as the most helpful. Potential or concrete health consequences were most likely to be perceived as motivating. Rituals associated with smoking were the main barrier to quit smoking, while withdrawal symptoms played a much smaller role.

Discussion: Overall, the results show that the focus on "nicotine addiction" in smoking cessation should be reconsidered, and social and ritual dimensions should be addressed more strongly. For at least some of those affected, e‑cigarettes may be a helpful method of reducing harm and/or quitting smoking.