Racism against healthcare users in inpatient care: a scoping review.

BACKGROUND: Racism in the healthcare system has become a burgeoning focus in health policy-making and research. Existing research has shown both interpersonal and structural forms of racism limiting access to quality healthcare for racialised healthcare users. Nevertheless, little is known about the specifics of racism in the inpatient sector, specifically hospitals and rehabilitation facilities. The aim of this scoping review is therefore to map the evidence on racial discrimination experienced by people receiving treatment in inpatient settings (hospitals and rehabilitation facilities) or their caregivers in high-income countries, focusing specifically on whether intersectional axes of discrimination have been taken into account when describing these experiences. METHODS: Based on the conceptual framework developed by Arksey and O'Malley, this scoping review surveyed existing research on racism and racial discrimination in inpatient care in high-income countries published between 2013 and 2023. The software Rayyan was used to support the screening process while MAXQDA was used for thematic coding. RESULTS: Forty-seven articles were included in this review. Specifics of the inpatient sector included different hospitalisation, admission and referral rates within and across hospitals; the threat of racial discrimination from other healthcare users; and the spatial segregation of healthcare users according to ethnic, religious or racialised criteria. While most articles described some interactions between race and other social categories in the sample composition, the framework of intersectionality was rarely considered explicitly during analysis. DISCUSSION: While the USA continue to predominate in discussions, other high-income countries including Canada, Australia and the UK also examine racism in their own healthcare systems. Absent from the literature are studies from a wider range of European countries as well as of racialised and disadvantaged groups other than refugees or recent immigrants. Research in this area would also benefit from an engagement with approaches to intersectionality in public health to produce a more nuanced understanding of the interactions of racism with other axes of discrimination. As inpatient care exhibits a range of specific structures, future research and policy-making ought to consider these specifics to develop targeted interventions, including training for non-clinical staff and robust, transparent and accessible complaint procedures.

On the correlation between gratitude and resilience in medical students.

Objective: Medical students' health and resilience have increasingly been the subject of current research in recent years. A variety of interventions are recommended to strengthen resilience or its known or suspected influencing factors, although the literature shows that the evidence on the effectiveness of the interventions is inconsistent. The present study investigated whether gratitude is a direct protective factor for resilience in medical students or whether resilience factors (optimism, self-efficacy, social support) and stress mediate the effects of gratitude on resilience. Methods: 90 medical students at Witten/Herdecke University took part in the study that determined their gratitude, resilience, optimism, self-efficacy, social support and stress levels using validated questionnaires (GQ-6, RS-25, LOT-R, SWE, F-SozU, PSS). Correlations were analyzed using Pearson correlation coefficients. In addition, a multivariate regression analysis and a path analysis were calculated to determine the direct and indirect effects of gratitude on resilience. Results: Multivariate regression analysis showed that only optimism, social support and stress were significantly associated with resilience (B=0.48, 95% CI: 0.31, 0.66; B=0.23, 95% CI: 0.01, 0.44 and B=-0.02, 95% CI: -0.03, -0.001, respectively). The direct effect of gratitude on resilience was minimal and not significant in the path analysis. However, there was an indirect effect of gratitude on resilience (B=0.321; p<0.05). Mediation via the optimism variable was mainly responsible for this effect (indirect effect B=0.197; p<0.05). Conclusion: This study shows that gratitude has only a minimal direct influence on resilience. However, results indicate that optimism as a mediating factor strengthens the resilience of medical students. Against this background, it may be useful to integrate interventions that promote an optimistic attitude into medical studies in order to strengthen the mental health of future doctors in the long term.

[Immigrant nurses' experiences of discrimination by patients and nursing home residents: a narrative review]. / Erfahrungen eingewanderter Pflegefachpersonen mit Diskriminierung durch Pflegebedürftige.

Immigrant nurses' experiences of discrimination by patients and nursing home residents: a narrative review Abstract: Background and aim: Immigrant nurses are filling the shortage of skilled workers in many countries. Studies suggest that they may face discrimination in their destination countries. This paper aims to provide an overview of the experiences of immigrant nurses with regard to discrimination in their interactions with patients. Methods: A systematic literature review was performed by searching the databases PubMed and CINAHL. Additional articles were identified through a search in Google Scholar and by reviewing reference lists. Studies published between 1/2013 and 3/2023 were included. Results: The literature search yielded 103 studies, 18 of which were included in the narrative review. The review showed that immigrant nurses may experience discrimination in the form of rejection, questioning of their qualifications, unequal treatment, derogatory remarks, threats, as well as violence from patients. Discrimination is based on their ethnicity, country of origin, external characteristics, language, and accent. Conclusions: Overall, available data is insufficient. The results of this review can serve as a basis for further studies and help managers and policy makers to better understand discrimination against immigrant care workers, to develop strategies to support them and to implement appropriate prevention measures.

[Impact of the 2020 lockdown on prehospital psychiatric emergencies in a large city]. / Auswirkungen des Lockdowns 2020 auf präklinische psychiatrische Notarzteinsätze in einer Großstadt.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. OBJECTIVE: The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city. MATERIAL AND METHODS: A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference. RESULTS: During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown. CONCLUSION: The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.

[Management Of Covid-19 Pandemic In Shelters For Asylum Seekers: Results From A Mixed Methods Study.] / Pandemie-Management in Unterkünften für Geflüchtete ­ Ergebnisse einer mixed methods-Studie während der COVID-19-Pandemie.

BACKGROUND: Refugees in Germany are often housed in shelters, where their influence on the organization of everyday life is severely limited. During the COVID-19 pandemic, these shelters therefore had a special responsibility to take measures to protect the health of their residents. The aim of this research project was to examine how this task was managed and how the pandemic affected daily life in refugee shelters, with the aim to formulate recommendations for practice. METHODS: Using a mixed-methods study, the first step was a scoping review of the literature on the management of infectious disease outbreaks in refugee shelters. Building on the findings of the review, management of the pandemic was then explored in an online survey and in interviews with experts and residents of shelters. In a third step, the results of the preceding steps were summarized and discussed with a panel of experts. Recommendations for practice were developed with the expert panel in two discussion rounds two months apart. RESULTS: The refugee shelters included in the study were inadequately prepared for the pandemic and often did not develop contingency plans until the pandemic was underway. In many cases, the contingency plans included the establishment of crisis teams, but the interests and perspectives of facility residents were generally not represented by these teams. This subsequently led to problems: Pandemic measures were often not communicated in a timely or sufficiently understandable manner, gaps in care resulting from measures were not identified or addressed, and psychosocial stresses associated with the pandemic and quarantine measures were not adequately mitigated. CONCLUSION: • Refugee shelters should establish mechanisms to integrate residents' interests and perspectives into decision-making processes in a structured manner, regardless of the pandemic.• Depending on the type of shelter, this should be realized through resident involvement in decision-making bodies or other appropriate representation of interests. • Measures introduced during the pandemic that may have a negative impact on the psychosocial situation of residents should be terminated as soon as the epidemic justification for the measures no longer applies.

[Supporting rehabilitation facilities in implementing diversity-sensitive care: Development of the DiversityKAT manual]. / Unterstützung von Rehabilitationseinrichtungen bei der Umsetzung einer diversitätssensiblen Versorgung: Entwicklung der DiversityKAT-Handreichung.

BACKGROUND: Expectations regarding health care including rehabilitation differ depending on age, gender, and also the migration history of the patient population. To meet the diverse expectations, health care needs to be diversity-sensitive, which can have a positive effect on the utilization and outcomes of care. Diversity-sensitive care, however, should take into consideration not only the expectations of diverse patient groups but also the opportunities and challenges offered by diversity of staff. Managers of health care facilities and health care staff in Germany are well aware of the need for diversity-sensitive care, but corresponding measures, so far, have been applied rarely and only unsystematically. The aim of the study was to develop a manual consisting of a catalogue of instruments and a guideline that can support rehabilitation facilities in implementing diversity-sensitive care. METHODS: A mixed methods approach was used for the study. Based on a scoping review, suitable instruments (n=34) were identified that can be used for the implementation of diversity-sensitive health care. Consensus on a draft of the manual was then reached in seven focus group discussions with health care staff (n=44) and a discussion circle consisting of n=5 representatives of the rehabilitation providers. RESULTS: The DiversityKAT manual, which was developed in a participatory manner, presents diversity-sensitive tools, including instructions, questionnaires, checklists and concepts that can be used to take into account the diversity of needs and expectations in everyday health care. In line with the feedback from health care staff, the manual includes information that can be used as a step-by-step guide to select and implement appropriate tools. At the request of the staff and the rehabilitation providers, exemplary case descriptions were added to present the use of selected instruments in specific situations. A matrix was developed for purposes of quick orientation and pre-selection of suitable instruments. DISCUSSION: Through practice-oriented advice and low-threshold guidance, the DiversityKAT-manual can increase user orientation in rehabilitation but needs to be further examined in future evaluation studies.

The significance of nonurgent psychiatric emergencies in an ED: a retrospective study.

BACKGROUND: In emergency departments, patients with mental health conditions are a major concern and make up the third or fourth of the most common diagnosis seen during all consultations. Over the past two decades, there has been a noticeable rise in the number of cases, particularly due to an increase in nonurgent visits for somatic medical issues. The significance of nonurgent visits for psychiatric patients is yet to be determined. This study aims to uncover the significance and identify the characteristics of this group. METHODS: A retrospective analysis of psychiatric emergency visits at an interdisciplinary emergency department of a German general hospital in 2015 was conducted. For this purpose, patient records were reviewed and evaluated. An analysis was conducted based on the German definition of psychiatric emergencies according to the German guidelines for emergency psychiatry. RESULTS: A total of 21,124 emergency patients visited the evaluated Emergency Department. Of this number, 1,735 psychiatric patient records were evaluated, representing 8.21% of the total population. Nearly 30% of these patients did not meet any emergency criteria according to German guidelines. Significant differences were observed between previously treated patients and those presenting for the first time. CONCLUSIONS: The high proportion of nonurgent psychiatric patients in the total volume of psychiatric emergency contacts indicates a possible control and information deficit within the emergency system. Just as prior research has emphasized the importance of investigating nonurgent somatic medical visits, it is equally imperative to delve into studies centered around psychiatric nonurgent presentations.

Participatory development of a manual for the implementation of diversity-sensitive palliative and hospice care in Germany: a mixed-methods study protocol.

BACKGROUND: The diversity of the population is associated with different needs and expectations towards palliative and hospice care. Current approaches available in Germany generally fall short in addressing the role of diversity and intersectionality in this health care setting and healthcare facilities struggle with organizational difficulties and missing information on how to implement corresponding diversity-sensitive measures. The present study aims to develop a hands-on manual that enables providers of hospice and palliative care to implement measures and strategies for diversity-sensitive care, while taking into account the perspective of healthcare users and explicitly including vulnerable and minority patient groups. METHODS: A participatory approach is used to co-create the aforementioned manual using an explanatory sequential mixed-methods design. First, based on a systematic analysis of existing measures, an initial draft of the manual will be developed. Subsequently, an online survey will be conducted among all hospice and palliative care providers in Germany (n = 2,823). Based on the results of the survey, 12 to 15 qualitative problem-centered interviews will be conducted with employees of selected providers who took part in the survey. Results of the survey and the qualitative interviews will be integrated and analyzed. In parallel to the development and research process, a comprehensive dissemination strategy will be developed. DISCUSSION: The manual will assist providers of palliative and hospice care in determining goals, needs, and available resources in order to utilize patient-centered and diversity-sensitive measures to meet a wide range of expectations. It can also be informative for providers in other countries. The participatory co-development approach ensures the practical relevance of the manual, while the mixed-methods design allows for targeted input on the manual's usability, acceptance, and viability as a supportive tool.

Investigating discrimination in the workplace. Translation and validation of the Everyday Discrimination Scale for nursing staff in Germany.

BACKGROUND: The Everyday Discrimination Scale (EDS) is a frequently used questionnaire in the field of health and social psychology that aims to explore perceptions of discrimination, especially instances of injustice related to various diversity characteristics. No adaptation to health care staff exists. The present study translates and adapts the EDS to nursing staff in Germany and examines its reliability and factorial validity as well as its measurement equivalence between men and women and different age groups. METHODS: The study was based on an online survey conducted among health care staff of two hospitals and two inpatient care facilities in Germany. The EDS was translated using a forward-backward translation approach. Direct maximum likelihood confirmatory factor analysis (CFA) was conducted to examine the factorial validity of the adapted EDS. Differential item functioning (DIF) related to age and sex was investigated by means of multiple indicators, multiple causes (MIMIC) models. RESULTS: Data on 302 individuals was available, of whom 237 (78.5%) were women. The most commonly employed one-factor, 8-item baseline model of the adapted EDS showed a poor fit (RMSEA = 0.149; CFI = 0.812; TLI = 0.737; SRMR = 0.072). The model fit improved considerably after including three error covariances between items 1 and 2, items 4 and 5, and items 7 and 8 (RMSEA = 0.066; CFI = 0.969; TLI = 0.949; SRMR = 0.036). Item 4 showed DIF related to sex and age, item 6 showed DIF related to age. DIF was moderate in size and did not bias the comparison between men and women or between younger and older employees. CONCLUSIONS: The EDS can be considered a valid instrument for the assessment of discrimination experiences among nursing staff. Given that the questionnaire, similar to other EDS adaptations, may be prone to DIF and also considering that some error covariances need to be parameterized, latent variable modelling should be used for the analysis of the questionnaire.

[Web scraping applications in health services research: For web experts only, or a tool for every health services researcher?!] / Anwendungskontexte von Web Scraping in der Versorgungsforschung - Nur für Web-Expert:innen? Oder eine Methode für alle Versorgungsforscher:innen!?

Reviewing various care-related data, such as patient satisfaction, can provide valuable information for a health care organization to improve its services. Regular and automatic data collection of internet data can save time and money. This data collection can be performed using web scraping. Web scraping is well-suited for collecting and linking (secondary) data from the internet. In this paper, a low-threshold option for web scraping is illustrated: Web scraping using the commercial software OutWit. This method is also suitable for researchers with no experience in web scraping. Following web scraping, classical statistical methods can be used for quantitative data or qualitative content analysis for qualitative data. Before collecting data using web scraping methods, the legal framework for the individual research project should be clarified. Additionally, ethical considerations should be addressed because the automated extraction of data is not always compatible with the respective data holder's applicable terms of use.

[Implementation Strategies of Diversity-Sensitive Health Care and Administration - A Nationwide Postal Survey of Inpatient Rehabilitation Facilities]. / Umsetzungsstrategien einer diversitätssensiblen Gesundheitsversorgung und Unternehmensführung ­ Eine bundesweite postalische Befragung von Rehabilitationseinrichtungen.

BACKGROUND: Diversity characteristics such as disability, gender, age or migration background are associated with different expectations towards health care. If these are not sufficiently considered in rehabilitative care, this may have a negative impact on the satisfaction with and outcomes of health care. Sensitivity towards the diversity of patients can promote patient-centered health care by helping to address different needs and expectations. The aim of the present study was to examine what measures inpatient rehabilitation facilities in Germany use to provide diversity-sensitive health care and which barriers prevent their proper implementation. METHODS: Between May and August 2019, administrative managers of rehabilitation facilities were invited to participate in a nationwide postal questionnaire survey (n=1,233). The questionnaire included questions on addressing the diversity of employees and rehabilitation patients. Responses were received from a total of 223 inpatient rehabilitation facilities (response rate: 18.9%). Results were analyzed descriptively. RESULTS: The survey shows that diversity-sensitive health care is a relevant topic for many rehabilitation facilities. It is regarded particularly important for the satisfaction of rehabilitation patients, treatment outcomes and employee satisfaction. Obstacles to the implementation of diversity-sensitive care comprise a lack of incentives on the part of health care organization, a lack of financial resources and organizational difficulties. DISCUSSION: The majority of the administrative managers surveyed acknowledge the relevance of diversity-sensitive care. Instruments enabling it, however, are used only sparingly and unsystematically. To promote diversity-sensitive care, health care facilities need support in competence building and in selecting and implementing appropriate measures. A handbook with instructions on how diversity-sensitive care can be implemented can contribute to that goal.

Perceived controllability of a SARS-CoV-2 infection: an investigation of intersectional differences.

BACKGROUND: The perceived ability to influence an infection with SARS-CoV-2 has an impact on compliance with protective measures. Factors influencing perceived controllability are not yet fully known. The aim of this study was to identify intersectional differences in perceived controllability. Insights into these intersectional differences could help to develop user-centered strategies to improve the acceptance of protective measures. METHODS: Data from the seventh wave of the German Ageing Survey (DEAS) was used to investigate differences in the population regarding the perceived controllability. The role of socio-demographic and socio-economic predictors was investigated using multivariable linear regression modeling. Intersectional differences were examined using interaction terms. RESULTS: Information on 4,823 respondents aged 46 to 100 years were available, of which 50.9% were female. Migration status (yes vs. no: ß = -0.27; 95%-CI = -0.48,-0.06), education level (high vs. low: ß = 0.31; 95%-CI: 0.08, 0.55) and employment status (retired vs. employed: ß = 0.33; 95%-CI: 0.19, 0.48) were found to be significantly influencing perceived controllability. Interaction effects were found with respect to sex and migration status, with migrant women rating their perceived controllability lower than non-migrant women (ß = -0.51; 95%-CI = -0.80, -0.21), while no differences were evident between migrant and non-migrant men (ß = -0.02; 95%-CI = -0.32, 0.28). Further intersectional differences were not observed. CONCLUSIONS: The results show that intersectional differences in perceived controllability occur especially between migrant and non-migrant women. Possible causes may lie in language barriers, which in connection with lower health literacy may affect perceived controllability. Dedicated efforts to improve controllability among older adults, those with lower educational attainment and migrant women are warranted.

Factors predicting admission of psychiatric emergency contacts after presenting to the emergency department: results of a regression analysis.

BACKGROUND: Psychiatric emergency patients have great relevance in the interdisciplinary emergency department. Emergency physicians in this setting often have to make decisions under time pressure based on incomplete information regarding the patient's further treatment. The aim of this study was to identify possible predictors associated with an increased likelihood of inpatient psychiatric admission. METHODS: A retrospective cross-sectional study of all psychiatric emergency contacts in an interdisciplinary emergency department (ED) of a general hospital in a large German city was conducted for 2015. A binary regression analysis was performed to identify possible predictors. RESULTS: In 2015, a total of 21421 patient contacts were reported in the emergency department, of which 1733 were psychiatric emergencies. Psychiatric emergency was the fourth most common cause presenting to the ED. The most common diagnosis given was mental and behavioral disorders due to the use of psychotropic substances (F1). Factors associated with an increased probability of inpatient psychiatric admission were previously known patients, patients under a legal care order (guardianship), and previous outpatient medical contact. No association for gender or age was found. Data demonstrated a negative relationship between a neurotic, stress-related and somatoform disorder diagnosis and admission. CONCLUSIONS: The present study shows some significant characteristics associated with an increased likelihood of emergency admission. Independent of the health care system, the predictors found seem to be relevant with regard to the probability of admission, when compared internationally. To improve the treatment of patients in emergency units, these factors should be taken into account.

COVID-19 Vaccine Acceptance and Its Determinants among Migrants in Germany-Results of a Cross-Sectional Study.

Vaccinations are a core element of infection control. Migrants have been reported to have low vaccination rates for many infectious diseases, including COVID-19. Still, determinants of migrants' uptake of COVID-19 vaccinations are not sufficiently clear. The present study addresses this gap and examines the respective influence of three potential determinants: barriers to access, attitude towards vaccinations in general, and towards COVID-19 vaccines. The study uses a cross-sectional online survey among migrants in Germany. The questionnaire assessed the aforementioned determinants using standardized tools. Information on 204 individuals was available. The vaccination rate in the sample was 80%. Vaccinated as compared to unvaccinated respondents reported more often the absence of financial barriers (71% (95%CI: 64-73%) vs. 45% (95%CI: 28-63%)), short waiting times (51% (95%CI: 43-59%) vs. 22% (95%CI: 5-38%)), and the presence of a vaccination center close-by (91.5% (95%CI: 87-96%) vs. 69.7% (95%CI: 54-85%)). Concerning COVID-19 vaccine acceptance, the majority of respondents (68%) agreed that the vaccine is important. Unvaccinated respondents more often feared side effects, were convinced that the vaccine is not safe, and assumed that COVID-19 is not dangerous. Correspondingly, acceptance of vaccinations in general was higher among vaccinated respondents. In line with findings from previous studies, our survey found that all three determinants seem to influence migrants' vaccination status while their overall vaccination rate was comparable to the general population. Hence, migration background per se does not sufficiently explain vaccine acceptance and further research is needed to identify subgroups of migrants that should be specifically addressed to increase their vaccination rate.

Diversity-sensitive measures in German hospitals - attitudes, implementation, and barriers according to administration managers.

BACKGROUND: Populations have varying needs and expectations concerning health care that result from diversity characteristics such as a migrant background, gender identity, disability, and age. These needs and expectations must be considered to ensure adequate utilization and quality of health services. Approaches to address diversity do exist, however, little is known about the extent to which they are implemented by health care facilities. The present study aims to examine, which measures and structures hospitals in Germany employ to address diversity, as well as which barriers they encounter in doing so. METHODS: A mixed-mode survey among administration managers of all registered German hospitals (excluding rehabilitation hospitals; n = 1125) was conducted between May and October 2019 using pen-and-paper and online questionnaires. Results were analyzed descriptively. RESULTS: Data from n = 112 hospitals were available. While 57.1% of hospitals addressed diversity in their mission statement and 59.9% included diversity considerations in quality management, dedicated working groups and diversity commissioners were less prevalent (15.2% each). The majority of hospitals offered multi-lingual admission and exit interviews (59.8%), treatments or therapies (57.1%), but only few had multi-lingual meal plans (12.5%) and seminars or presentations (11.6%). While 41.1% of the hospitals offered treatment and/or nursing exclusively by staff of the same sex, only 17.0% offered group therapies for both sexes separately. According to the managers, the main barriers were a lack of financial resources (54.5%), a lack of incentives from the funding providers (49.1%), and organizational difficulties (45.5%). Other reported barriers were a lack of conviction of the necessity among decision makers (28.6%) and a lack of motivation among staff members (19.6%). CONCLUSIONS: Administration managers from only a small proportion of hospitals participated in our survey on diversity sensitivity. Even hospitals of those who did are currently not adequately addressing the diversity of staff members and patients. Most hospitals address diversity on an ideational level, practical measures are not widely implemented. Existing measures suggest that most hospitals have no overarching concept to address diversity in a broader sense. The main reported barriers relate to economic aspects, a lack of support in organizing and implementing corresponding measures and a lack of awareness or motivation.

COVID-19 pandemic in shelters for asylum seekers: a scoping review of preventive measures.

OBJECTIVE: To investigate which measures are recommended by guidelines on prevention and management of infectious disease outbreaks in refugee shelters, how outbreaks have been dealt with in these facilities in the past and how measures taken compare with the recommendations identified in the literature. DESIGN, DATA SOURCES AND ELIGIBILITY CRITERIA: The review comprised German and English language literature on refugees residing in shelters located in high-income countries, published between 1990 and 2021. We searched PubMed, CINAHL and Web of Science. DATA EXTRACTION AND SYNTHESIS: We extracted information concerning the characteristics of the setting and the study population, measures for outbreak prevention and reported difficulties with implementing these measures. The findings were evaluated using descriptive statistics and were narratively summarised. RESULTS: Of a total of 1162 publications, 36 were included in the review, of which 19 were original research articles and 17 were guidelines/commentaries. In the guidelines, 37 different measures of infection control were mentioned. Among those, social distancing and isolation or quarantine were mentioned most frequently. In the outbreak reports, 27 different measures were reported, of which testing was reported most often. Different reasons why recommendations are difficult to implement in shelters were described, which are related to space, equipment, staff and financial constraints. Discrepancies between recommendations and actual practice mostly relate to the lack of preparation for outbreaks and the lack of appropriate measures to ensure intersectoral cooperation. CONCLUSIONS: Recommendations on infection control and outbreak management and the measures actually taken in refugee shelters differ considerably. Among others, this results from a lack of intersectoral cooperation between state ministries, municipal health offices and the administration of the facilities as well as from guidelines not sufficiently tailored to the characteristics of refugee shelters.

What are the reasons for refusing a COVID-19 vaccine? A qualitative analysis of social media in Germany.

BACKGROUND: Vaccination against COVID-19 has been available in Germany since December 2020. However, about 30% of the population report not wanting to be vaccinated. In order to increase the willingness of the population to get vaccinated, data on the acceptance of vaccination and its influencing factors are necessary. Little is known about why individuals refuse the COVID-19 vaccination. The aim of this study was to investigate the reasons leading to rejecting vaccination, based on posts from three social media sites. METHODS: The German-language versions of Instagram, Twitter and YouTube were searched regarding negative attitudes towards COVID-19 vaccination. Data was extracted until a saturation effect could be observed. The data included posts created from January 20, 2020 to May 2, 2021. This time frame roughly covers the period from the first reports of the spread of SARS-CoV-2 up to the general availability of vaccines against COVID-19 in Germany. We used an interpretive thematic approach to analyze the data and to inductively generate codes, subcategories and categories. RESULTS: Based on 333 posts written by 323 contributing users, we identified six main categories of reasons for refusing a COVID-19 vaccination: Low perceived benefit of vaccination, low perceived risk of contracting COVID-19, health concerns, lack of information, systemic mistrust and spiritual or religious reasons. The analysis reveals a lack of information among users and the spread of misinformation with regard to COVID-19 and vaccination. Users feel inadequately informed about vaccination or do not understand the information available. These information gaps may be related to information not being sufficiently sensitive to the needs of the target group. In addition to limited information for the general population, misinformation on the internet can also be an important reason for refusing vaccination. CONCLUSIONS: The study emphasizes the relevance of providing trustworthy and quality-assured information on COVID-19 and COVID-19 vaccination to all population groups. In addition, vaccinations should be easily accessible in order to promote the population's willingness to be vaccinated.

Additional burdens of family caregivers during the COVID-19 pandemic: A qualitative analysis of social media in Germany.

Caregiving is associated with various burdens for family caregivers. The COVID-19 pandemic and the protective measures implemented to restrict public life, such as social distancing and the closure of services and educational institutions, add further challenges. Little is known about how they are perceived by family caregivers. Based on an analysis of German social media posts, the aim of this study was to explore the additional strains family caregivers experience during the pandemic. The websites of three social media services were searched using the respective search engines provided by the websites. Data from a 10-month period (March to December 2020) were identified and examined. A total of 237 publicly available posts were included in the analysis. Seven main categories were identified using a thematic approach: care and support, deterioration of the condition of the person being cared for, psychological challenges, financial challenges, infection control, access to protective equipment, and acknowledgement of family caregivers. Family caregivers are affected by additional burdens during the pandemic, which makes the development of support and relief services tailored to this population group necessary.

Perspectives of physicians and pharmacists on rational use of antibiotics in Turkey and among Turkish migrants in Germany, Sweden and the Netherlands: a qualitative study.

BACKGROUND: Antimicrobial resistance may result from inappropriate use of antibiotics in health care. Turkey is one of the countries with the highest antibiotic consumption in the world. Considering the role of transnational ties between Turkish migrants and their social contacts in Turkey, the attitudes and behaviors relating to rational antibiotic use in Turkey can also affect the use of antibiotics by Turkish migrants residing abroad. This study explores physicians' and pharmacists' experiences and perspectives on rational antibiotic use among Turkish adults in Turkey and among Turkish migrants in Germany, Sweden, and the Netherlands, three European countries with large populations of Turkish migrants. METHODS: Following a qualitative study design using convenience and snowball sampling, in-depth interviews with 21 family physicians and 24 pharmacists were conducted in the aforementioned countries. We transcribed all interviews verbatim and performed content analysis separately in the countries, followed by translation, pooling and joint interpretation of the findings. RESULTS: Physicians and pharmacists encountered irrational use of antibiotics among their patients in Turkey. Physicians interviewed in the three European countries explained that Turkish migrants differ from non-migrants with respect to their attitudes towards antibiotics, for example by more often expecting to be prescribed antibiotics. All physicians and pharmacists in the selected countries reported to inform their patients on how to use antibiotics upon prescription; however, Turkish migrants' poor language proficiency was considered as a substantial communication barrier by the physicians and pharmacists interviewed in the European countries. CONCLUSIONS: The study illustrated some aspects of irrational antibiotic use among the population in Turkey and Turkish migrants in selected European countries. It emphasized the need for closer community participation, adequate information campaigns, as well as in-service training of health care providers in Turkey. The strategies and interventions on rational antibiotic use should also be supported and encouraged by health care providers, who need to reach out to people with various cultural backgrounds.

Pictorial Assessment of Health-Related Quality of Life. Development and Pre-Test of the PictoQOL Questionnaire.

The aim of the present study was to develop a pictorial questionnaire for the assessment of health-related quality of life (PictoQOL) and to examine its content validity and usability across three exemplary population groups of different origin residing in Germany (non-migrants, Turkish migrants and Arabic-speaking migrants). A mixed-methods design combining qualitative and quantitative methods was used, comprising 6 focus group discussions with a total of 17 participants, 37 cognitive interviews and a quantitative pretest with 15 individuals. The PictoQOL consists of a pictorial representation of a total of 15 different situations. Using a visual Likert scale, respondents indicate how much each situation applies to them. Some representations proved to be culturally sensitive and were adapted. Respondents found the use of an additional graphic layer in the form of symbols in addition to pictures helpful for interpretation. The PictoQOL is considered to allow a more accessible assessment and better comparability of HRQOL across different population groups regardless of their literacy level. It is therefore considered to be superior to existing instruments for routine use in health research and practice. Future studies need to examine its convergent and factorial validity.