Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

Voluntariness refers to the freedom of a decision from undue influence or pressure. It is one component of an autonomous decision for assisted suicide and, therefore, an important factor to consider when assessing requests for assisted suicide. This article examines which factors can potentially impact the voluntariness of such requests.Based on the medical ethics literature and empirical studies from related contexts, relatives, individuals providing suicide assistance, and healthcare workers are identified, among others, as key actors who may be relevant in decisions about assisted suicide. Possible forms of interpersonal influence include threats, offers, interpersonal leverage, and persuasion. In addition, structural constraints-such as socioeconomic hardship-can potentially influence voluntariness. When assessing whether requests for assisted suicide are autonomous, the potential presence of such factors should be systematically examined.Given the limited availability of empirical data to date, there is an urgent need for further research in this area. This is also essential for the development of guidelines for assessing the voluntariness of requests for assisted suicide.

Background: Since September 2019, HIV pre-exposure prophylaxis (PrEP) has been covered by statutory health insurance (SHI) in Germany. The objectives of the PrEP-Surv study module presented here were to monitor PrEP usage from 2019 to 2022 and to examine the feasibility of using SHI claims data for an annual monitoring of PrEP provision.

Methods: PrEP users were identified and analyzed using anonymized BARMER data from 2019 to 2022. The analyses included determining the number of PrEP users each year; describing the cohorts by age, gender, and treatment adherence; identifying HIV infections; and calculating the rates of sexually transmitted infections or infectious diseases (STIs).

Results: The number of PrEP users increased from 1058 in 2019 to 3194 in 2022. Demographic characteristics remained largely unchanged, while the average censored treatment adherence decreased from 98% in 2019 to 91% and 92% in the subsequent years. Two HIV infections were observed in two individuals, but the transmissions presumably occurred outside of PrEP use. No clear changes in STI rates were observed.

Discussion: The observed cohort appears to be comparable to other PrEP cohorts in Germany. The stability of the demographic characteristics possibly indicates that groups eligible for PrEP that were not reached at the beginning of PrEP reimbursement were subsequently also not reached. In addition to a description of PrEP care, a possible approach for the annual monitoring based on SHI claims data is presented.

Background: Peer support workers (PSWs) possess personal experiences of psychiatric crises and can support individuals in their mental health recovery. The aim of this study was to examine the involvement of PSWs in acute, outreach psychiatric crisis interventions by the Crisis Intervention Service (CIS) Bremen from the perspective of the involved actors.

Methods: As part of the "PeerIntervent" study conducted between April 2023 and April 2024, five semi-structured interviews with three deployed PSWs and two focus groups with nine CIS staff members were conducted. Data were analyzed using qualitative content analysis according to Kuckartz, employing a category system developed both deductively and inductively. The COREQ checklist was followed.

Results: PSWs reported improved access to patients due to their experiential knowledge. CIS staff were initially skeptical about the use of PSWs in crisis contexts, resulting in PSWs being deployed primarily outside of acute crises, where they were perceived as relieving. Key prerequisites for successful integration in crisis settings were not fully met.

Discussion: Clear support from team leadership, transparent role definitions, and training and supervision are crucial for successful collaboration in acute crisis interventions. Careful and context-sensitive implementation is necessary. Further research should clarify how greater experience, clear role definitions, and longer onboarding periods could enhance collaboration.

Background: Collaboration between science and practice in the public health service (PHS) holds the potential to translate scientific findings into practice and to incorporate practice-oriented questions back into research. Existing collaborations can provide valuable insights into structural conditions. However, no systematic mapping has been conducted in Germany to date. The aim of this study was therefore to systematically identify and analyze science-practice collaborations within the German PHS.

Methodology: In a structured screening process, various data sources from 2015 to 2024 were systematically searched: (i) Google™, (ii) conference abstract volumes, (iii) scientific databases, (iv) databases for grey literature, supplemented by (v) an online survey, (vi) snowballing, and (vii) input from the "EvidenzOGD" project consortium network. Identified collaborations were categorized according to structural characteristics and analyzed descriptively using frequency analyses stratified by subgroups.

Results: A total of 611 science-practice collaborations in the PHS were identified, most of them through conference contributions. The number of collaborations increased over the study period. Many focused on classical fields of PHS activities and were mainly implemented at the municipal level. Coordination was almost evenly distributed between academic institutions and PHS institutions, while implementation was predominantly located in western federal states.

Conclusion: This mapping of science-practice collaborations provides a comprehensive overview of a complex and multifaceted landscape of collaboration. It offers a foundation for further in-depth analyses regarding facilitating and hindering factors of collaboration, for example, as well as a better understanding of thematic and geographical clustering.

Background: The COVID-19 pandemic posed significant challenges for the public health service (ÖGD) in Germany, particularly during outbreaks in precarious living and working conditions.

Methods: As part of an after-action review (AAR) conducted in May 2023, 29 professionals from public health offices and other authorities analyzed nine such outbreak events from 2020 to 2022 based on the methodological recommendations of the World Health Organization and the European Centre for Disease Prevention and Control. The aim was to identify key challenges and successful approaches in the areas of "preparedness and response" and "public health and social measures" and to derive practical recommendations for future action.

Results: The two-day online event facilitated active discussions, which were documented and consolidated with the participants. Major challenges identified included official communication with the public, civil society, and businesses; intersectoral collaboration with diverse stakeholders; and the ÖGD's structural preparedness for complex situations. At the same time, numerous examples of good practice were documented-such as cross-sectoral cooperation, the development of internal structures, and target group-specific communication. Based on these findings, participants developed recommendations to strengthen crisis management in future outbreaks in precarious settings.

Discussion: AARs are accepted and applicable tools for structured analysis of epidemic situations and for knowledge transfer within the ÖGD and can thereby contribute to improved preparedness for future crises.

Introduction: A science-based approach in local public health services (PHS) requires robust structures both for generating practice-relevant research and for integrating this knowledge into routine public health practice. To strengthen this interface, an academia-practice research consortium developed, piloted, and evaluated the part-time trainee-rotation program "EvidenzOGD."

Methods: The formative process evaluation of the six-month pilot was guided by a theory-based logic model and employed a mixed-methods design, including document analysis, standardized online surveys, and workshops. Findings were synthesized using method and data triangulation.

Results: Trainees and mentors reported substantial gains in competencies and identified impulses for anchoring sustainable evidence transfer. At the institutional level, new forms of cooperation and structural developments were initiated. At the same time, several areas for improvement emerged, including an overly short rotation period, high documentation workload, unclear role expectations, and coordination challenges. These issues were systematically addressed, leading to adaptations of key program components, such as the rotation structure, the implementation of a unified logbook, the expansion of the training modules, and the improved integration of the trainee research project.

Discussion: The program is considered a promising approach to promoting evidence-informed practice and strengthening institutional cooperation within the PHS. Its modular structure allows for flexible implementation in different local contexts. Future research should explore its long-term effects on competency development and the institutionalization of evidence-based approaches.

Background: Studies show that the mental health of children has deteriorated since the COVID-19 pandemic and due to ongoing crises. The aim of this study is to examine the development of the prevalence of behavioral problems in recent years based on school entry data and to identify correlations and risk factors. Comparisons are made between medical and parental assessments.

Methods: The school entry data of the Hannover region for the years 2021/2022 to 2023/2024 were compared with data from 2010 to 2014. Risk factors were identified using regression analyses. Parental assessments, measured with the Strengths and Difficulties Questionnaire (SDQ), were compared with medical assessments.

Results: The prevalence of behavioral problems has increased from 9.4% to 13.5% in the medical assessment and from 7.9% to 11.2% in the parental assessment. The proportion of children receiving treatment has decreased from 6.0% to 5.2%. Positive social-emotional development is associated with higher parental education, growing up with both parents, attending kindergarten for at least three years, low media consumption, and participation in sports clubs. Medical and parental assessments of behavioral problems largely align.

Discussion: The discrepancy between the number of children with behavioral problems and those in treatment could indicate insufficient care. There is a need for counseling regarding certain risk factors. The school entry examination presents an opportunity for counseling, but additional low-threshold services are needed, especially for vulnerable families.

There is an ageing medical workforce in the public health service. At the same time, challenges in recruiting young professionals persist despite the Public Health Pact. Against this backdrop, teaching in the field of public health during medical school is considered a crucial factor in arousing students' interest and attracting them to a career in the public health service. According to the Medical Licensing Regulations, there are four teaching formats related to the public health service: (i) Querschnittsbereich 3 (health economics, the health system, and public health), (ii) Klinisches Wahlfach (clinical elective), (iii) Famulatur (clinical internship), and (iv) Praktisches Jahr (practical year) in the public health service.This evaluation examines the offerings of these courses offered at medical faculties in Germany. The teaching load is low, particularly in Querschnittsbereich 3, which is a compulsory module for public health, and only a small proportion of this is allocated to teaching in public health. Only five universities offer a Klinisches Wahlfach related to public health, and only 13 faculties offer the Praktisches Jahr in the public health service.To attract young physicians to a career in the public health service, the existing gaps in teaching must be closed. Collaborations between the universities and with the local public health authorities appear to be a useful approach, particularly to address the challenges related to qualified teaching staff.