Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

Background: In Germany, about a fifth of families with young children live under psychosocially stressful conditions that can threaten the healthy development of the child. In order to improve the referral of these families from pediatric practices to early childhood intervention services ("Frühe Hilfen"), the PATH intervention was developed and implemented in Baden-Württemberg. The first step in the referral process is to identify psychosocially stressed families. This study investigated whether the PATH intervention increases the proportion of identified families with psychosocial stress by pediatricians.

Method: In a quasi-experimental study, a total of 293 psychosocially stressed families who were cared for by 29 pediatricians from established pediatric practices were examined. The intervention group (IG) consisted of families with pediatricians from Baden-Württemberg who took part in the PATH intervention. The control group (CG) consisted of families with pediatricians from Bavaria who did not take part in the PATH intervention. Additional qualitative telephone interviews were conducted with 10 pediatricians from the IG and 20 families from the IG with psychosocial stress.

Results: A significantly higher proportion of psychosocially stressed families was identified in the IG than in the CG. The difference was about 20 percentage points and was similar regardless of the family's level of stress.

Discussion: The results show that the PATH intervention improves the identification of psychosocially stressed families by pediatricians. This improved identification of psychosocially stressed families is an important prerequisite for referring families to tailored early childhood intervention services such as those provided by the "Frühe Hilfen".

The future development of early preventive services and intervention depends on structural anchoring, the resources of the professionals working in the field, and utilization and acceptance by the target population. In order to understand the dynamics of the development, this discussion contribution first presents the contemporary historical origins of early intervention in Germany since the beginning of the 20th century. Further sections bring together the bodies of knowledge from various relevant sciences, in particular neuroscientific findings on the early childhood development of the brain, attachment theory, results of family and prevention research, trauma studies, and health economic models on the benefits of social interventions. From this, requirements for the further growth of the early intervention system are derived. These can be conceptually classified as a "Health in all Policies" strategy (with a particular focus on combating child poverty) combined with interprofessional learning and collaboration, inclusive access for all children, and diversity-friendliness as characteristics of good process quality. To further develop and expand early interventions, proof of benefits must be carefully planned and implemented through long-term, interdisciplinary research programs in the aforementioned fields of knowledge through independent research funding. The complex methods for evaluating complex interventions at the individual level, subgroups, and the entire population, including health economic effects and participatory and qualitative empirical research, are partly available and should be further developed.

Background: Fatigue is one of the most frequent symptoms in post-COVID syndrome (PCS) patients and describes a long-term feeling of tiredness and exhaustion. Frequently, it follows an infection or is a component of depressive symptoms. But fatigue itself is also a risk to mental health like other chronic conditions. The objective of this paper was to analyse the relationship between fatigue and depression/anxiety and the differences between PCS patients and fully recovered COVID-19 cases.

Methods: In a longitudinal study with three measurement points, insured members of the Statutory Accident Insurance and Prevention in the Health and Welfare Service with a SARS-CoV‑2 infection in 2020 were asked about fatigue, depression/anxiety and persisting COVID-19 symptoms. To analyse the longitudinal effects of the two variables, a cross-lagged panel model was applied.

Results: In the present sample (n = 860), a proportion of 68.7% to 75.1% of people was suffering from PCS. The results showed a model fit of R² = 61.49% and all effects were significant, but the cross-lagged effects were not significantly different from each other. If stratified according to whether PCS symptoms were present, the cross-lagged effects weakened in both groups, while the effects of fatigue on depression and anxiety only remained in the group of those affected by PCS.

Discussion: The results show a relationship in both directions between fatigue and depression/anxiety. PCS patients can benefit from psychotherapeutic treatment to tackle fatigue and prevent depression and anxiety.

The sociomedical report is an essential basis for making decisions about benefits from social insurance providers. As an instrument of medical information, the sociomedical assessment can be based on very different questions, such as the question of ability to work, earning capacity, participation in professional or social life, or the need for medical treatment. It is important to obtain a comprehensive picture of the individual situation in order to create the basis for decisions about benefit entitlements and support measures. The various issues in the respective sociolegal context may require not only the sociomedical report but also other expertise. The international classification of functioning, disability, and health (ICF) and the World Health Organization (WHO) bio-psycho-social model on which it is based enable health problems and their effects to be considered in the context of life and work. The components of functional ability and disability are assessed in their interaction from a sociomedical perspective. What is important is not the diagnosis but rather the person and the individual impact of the health disorders on their activities and participation.In the case of fatigue and burnout, a medical symptom complex with (psychophysical) exhaustion and the resulting attention and concentration disorders are in the focus of the sociomedical assessment. It can be difficult to objectify symptoms and complaints in these diseases, which can lead to particular challenges during assessment, especially when validating complaints.

Cancer-related fatigue (CRF) during and after tumor therapy influences all aspects of life and lowers performance and quality of life. Regular CRF screening and diagnostic evaluation are important factors in the care of patients. This article presents strategies for recognizing and treating CRF. Multiprofessional and personalized therapies can improve CRF. Outpatient and inpatient rehabilitative strategies should be implemented after completion of tumor therapy.

Background: The rapid global spread of the SARS-CoV‑2 virus during the COVID-19 pandemic led to widespread non-pharmaceutical interventions, such as school closures, to curb infections. This study investigates the influence of school closures on the number of new infections to reduce the existing knowledge gap in this area.

Methods: The effect of school closures starting on 16 December 2020, was quantified using COVID-19 infection data from the district and city of Landshut in Bavaria between November 2020 and January 2021. An interrupted time series (ITS) analysis was performed to analyze daily new infections among 6-18 year olds and the entire population in the region before and after the school closures using a negative binomial regression model.

Results: The analysis showed that the trend of daily new COVID-19 infections among 6-18 year olds significantly decreased after the school closures (incidence rate ratio (IRR) 0.93; 95% confidence interval (CI): 0.89-0.96; p < 0.001). This was also true for the entire study population (IRR 0.95; 95% CI: 0.93-0.97; p < 0.001).

Discussion: In the context of various concurrent measures to contain the COVID-19 pandemic, the study provides evidence for a significant association between school closures and reduced COVID-19 infections. By optimizing the existing incomplete evidence base on the role of school closures in pandemic control, this finding can support involved stakeholders and contribute to strengthening future approaches to pandemic prevention.

Background: Fatigue is an unspecific symptom complex characterized by tiredness, lack of energy, and lack of concentration and is of considerable public health relevance, due to its links with incapacity for work, risk of accidents, and increased need for healthcare.

Methods: The analyses are based on data from 9766 adults of the telephone survey "Gesundheit in Deutschland aktuell (GEDA)" 2023. Fatigue was recorded using the Fatigue Assessment Scale (FAS), a validated instrument with 10 questions for self-assessment of fatigue. The scale was dichotomized into yes (at least mild to moderate fatigue) versus no (no fatigue). Population-weighted prevalences of fatigue and associated sociodemographic and health-related factors were calculated in descriptive analyses and multivariable Poisson regression.

Results: The overall prevalence of fatigue in adults in Germany is 29.7% (95% CI 28.1-31.2), is highest in 18- to 29-year-olds (39.6% (95% CI 35.0-44.4)), and decreases in the age groups up to 65-79 years (20.6% (95% CI 18.2-23.3)). It is higher again in the very old age group (33.2% (95% CI 28.9-37.7)). Women have a higher risk of fatigue than men (aRR 1.19 (95% CI 1.08-1.32)). Fatigue is significantly associated with age, lower education, chronic illness, depression, and long COVID, regardless of covariates.

Discussion: GEDA 2023 is one of the few population-based studies to have collected data on fatigue. The results allow estimates to be made for Germany on the frequency of fatigue and the significance of physical, psychological, and social influencing factors. They can be used as a reference or as a basis for trends over time as part of continuous health monitoring in Germany.

Subjective complaints are of great importance in medicine. They have an impact on the diagnosis of illnesses, the assessment of illness severity, and treatment selection. There are no objective criteria for such symptoms, and clinicians have to rely on the report of patients only. Examples are complaints about pain, cardiac insufficiency, mood, or fatigue. There are many possibilities for distorted reports. Clinicians must therefore clarify what is meant and validate patient reports. A discrimination must be made between signs of illness and "healthy suffering," to avoid medicalization of daily nuisances and to avoid misdiagnoses and inadequate treatments. Diagnostic algorithms for healthy suffering are described, as this diagnosis is of importance in medicine. This is outlined using the example of fatigue.