Eating disorders and health literacy in Germany: results from two representative samples of adolescents and adults.

Introduction: Eating disorders are associated with substantial burden for the affected individuals including negative health outcomes and increased mortality. So far, prevention programs for eating disorders have yielded mixed results concerning their efficacy. Therefore, more targeted prevention programs need to be developed. Health literacy has been identified as a potential influencing factor of eating disorders. This study aimed at exploring the relationship between likely cases of eating disorders and health literacy, alongside additional sociodemographic factors. Materials and methods: Two large samples of adults (N = 3,011) and adolescents (N = 1,021) representative of the German-speaking population in Germany were recruited. Likely cases of eating disorders were identified using the SCOFF questionnaire. Health literacy was assessed with the HLS-EU-Q16 questionnaire. Sociodemographic information, including age, gender, social status and level of education, and subjective body image were obtained. χ2-tests of independence were calculated to determine the association between the investigated constructs. Results: Suspected eating disorders were more likely in female than male adolescents but were not related to gender in adults. Rates of suspected eating disorders increased with increasing age in adolescents and decreased with increasing age in adults. While levels of education were unrelated to suspected eating disorders, low social status was associated with higher rates of suspected eating disorders in adults but not adolescents. Inadequate or problematic health literacy and negative body image were associated with higher rates of suspected eating disorders compared to adequate health literacy and more positive body image. Discussion: Likely cases of eating disorders are related to health literacy and body image as well as sociodemographic factors. These constructs should therefore be addressed in future research to improve prevention programs.

Climate change distress and impairment in Germany.

Introduction: Climate change has been widely recognized as one of the most challenging problems facing humanity and it imposes serious mental health threats. It is important, however, to differentiate between the affective experience of distress over climate change and the functional impairments associated with climate change. Such a distinction is crucial because not all negative affective states are pathological, and they might even motivate pro-environmental behavior. Functional impairments, like not being able to work or maintaining social relationships, however, might require immediate treatment. This study assesses climate change distress and climate change impairment within the population of Germany using a population-representative sample. The results identify vulnerable subgroups and thereby can help to facilitate the development of target group specific intervention programs. Furthermore, this study explores whether climate change distress and climate change impairment are associated with general health, physical health, mental health, and diverse health behaviors. Methods: Study participants were drawn from a panel which is representative of the German-speaking population in Germany with Internet access. Participants answered a series of questionnaires regarding their climate change distress, climate change impairment, general health, physical health, mental health, and diverse health behaviors. To evaluate differences between subgroups, Bayesian independent samples t-tests were calculated. To evaluate associations between constructs, Bayesian correlations were calculated. Results: Especially women, younger people, people from West Germany, and people with a high level of formal education seem to experience higher levels of climate change distress. Regarding climate change impairment, the results suggest that especially women, older people, people from West Germany, people with a low level of formal education, people with a low or middle social status, and people with an inadequate/problematic health literacy seem to experience higher levels of climate change impairment. Furthermore, climate change distress and climate change impairment were weakly and differently associated with general health, physical health, mental health, and diverse health behaviors. Discussion: Climate change distress and impairment are not evenly distributed within German society. The results of this study provide a starting point for the development of target group specific intervention programs.

Exploring the role of identity in pro-environmental behavior: cultural and educational influences on younger generations.

It is of paramount importance to gain an understanding of pro-environmental behavior if we are to successfully tackle the climate crisis. The existing body of research provides evidence that identity influences pro-environmental behavior. However, such research is often over-generalised and researchers are challenged to conduct robust analyses with regard to specific local, cultural and educational factors. The present study aims to investigate whether personal or social identity has a distinct effect on three different dimensions of pro-environmental behavior, using the principles of self-categorisation theory. Additionally, the study seeks to determine whether one of these two factors, the individual or the social factor, is predominant over the other. The study group consisted of cooperative students in Germany, typically a group with high professional ambitions. The data was collected in a cross-sectional survey with a total of 568 cooperative students from academic disciplines in engineering and economics. The reliability of the scales is satisfactory (ω = 0.76-0.88), and the hypotheses are tested by estimating structural equation models. Our research demonstrates that while social identity exerts a stronger influence on activist behavior than personal identity, personal identity has a more pronounced effect on consumer behavior than social identity. Nevertheless, no general statement can be made regarding the relative strength of the effects of personal and social identity on pro-environmental behavior dimensions.

Survival outcomes of patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation in Germany: real-world evidence from an administrative database between 2010 and 2019.

Background: Limited real-world evidence is available for patients with diffuse large B-cell lymphoma (DLBCL) who received an autologous stem cell transplantation (ASCT) in Germany. Objectives: This study aims to describe the real-world survival outcomes of patients with DLBCL who received ASCT in Germany after diagnosis. Design: This study is a retrospective database analysis covering the period between 2010 and 2019. Methods: Unadjusted overall survival (OS) was plotted using the Kaplan-Meier estimator for the overall population and stratified by relapse status. A Cox regression was run to identify factors that influence OS. Results: A total of 112 patients received an ASCT, with the average time from first-line treatment to ASCT being 11.7 months. The median OS estimated by Kaplan-Meier was 83.4 months for the entire cohort. The only variable that significantly reduced the OS was the presence of subsequent treatment after ASCT in a time-dependent model. Conclusion: OS after ASCT for DLBCL patients in Germany is higher than previously reported and may still be considered a valid option for carefully selected patients with relapsed/refractory DLBCL.

Epidemiology of Streptococcus pyogenes Disease before, during, and after COVID-19 Pandemic, Germany, 2005-2023.

We analyzed 3,081 invasive and noninvasive Streptococcus pyogenes cases (January 2005-December 2023) at a tertiary care hospital in southwest Germany. Absolute numbers of case-patients increased each year from 2005 until the COVID-19 pandemic. Odds ratios for invasive streptococcal disease were significantly influenced by year, male sex, and older age.

[Effects of high thermal stress on health-a nationwide analysis based on statutory health insurance routine data between 2012 and 2021]. / Auswirkungen thermischer Belastungen auf die Gesundheit ­ eine bundesweite Analyse auf Grundlage von GKV-Routinedaten zwischen 2012­2021.

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 (rmw = 0.86 [0.81; 0.90]). Although heat stress is lower in the second quarter, a similar correlation is found here (rmw = 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.

Prevalence of Antidepressant Prescription in Adolescents Newly Diagnosed with Depression in Germany.

BACKGROUND: Depression is the most common mental illness in the world, found in nearly three in ten adolescents globally. This study aims to evaluate the prevalence of antidepressant prescriptions and the types of antidepressant therapy administered among adolescents diagnosed with depression in Germany. METHODS: This retrospective cohort study, based on data provided by 30 child and adolescent psychiatrists, included adolescents aged 13-17 years with an initial diagnosis of depression between 2010 and 2022 (index date) documented in the IQVIATM Disease Analyzer database. Kaplan-Meier curves were used to investigate the one-year cumulative incidence of antidepressant prescriptions stratified by age, sex, and depression severity. Multivariable Cox regression analyses were used to assess the association between age, sex, depression severity, co-diagnoses, and antidepressant drug prescription. RESULTS: A total of 6338 adolescents (mean age: 16 years, 67% female, 59% with moderate depression) were available. The cumulative incidence of antidepressant prescriptions was 61% and increased with age from 13 years old to 17 years old. Fluoxetine was the most prescribed drug, followed by Sertraline, Escitalopram, Serotonin and Norepinephrine reuptake inhibitors, herbal medications, and Mirtazapine. Obsessive-compulsive disorder and eating disorders were found to be significantly associated with antidepressant prescriptions within the spectrum of co-diagnosed conditions. CONCLUSIONS: Higher age, depression severity, and a co-diagnosis of an obsessive-compulsive disorder or eating disorder were significantly positively associated with antidepressant prescriptions in adolescents. Fluoxetine was the most frequently prescribed drug for depression.

Suicide among post-Arabellion refugees in Germany.

BACKGROUND: Although immigrants are considered to be vulnerable to mental illness, there is limited knowledge regarding their suicide mortality. AIMS: To investigate standardised mortality ratios (SMR) for suicide among the largest immigrant populations in Germany before and after the refugee movement of 2015. METHOD: Data on immigrants and the general population in Germany between 2000 and 2020 were provided by the scientific section of the Federal Statistical Office. SMR with 95% confidence intervals were calculated by indirect standardisation for gender, age and calendar year for the pre-2015 and post-2015 time interval, first for all the immigrant populations studied and second for the Syrian, Afghan and Iraqi populations separately. RESULTS: Immigrants from the countries studied showed a lower suicide risk compared with the German reference population (SMR = 0.38, 95% CI = 0.35-0.41). No differences in SMR were found between pre- and post-2015 time intervals, in either the aggregate data for all populations or the data for Syrian, Afghan and Iraqi populations. Post-2015, Afghan immigrants (SMR = 0.68, 95% CI = 0.54-0.83) showed a higher SMR than Syrians (SMR = 0.30, 95% CI = 0.25-0.36) or Iraqis (SMR = 0.37, 95% CI = 0.26-0.48). CONCLUSIONS: Despite the many and varied stresses associated with flight, comparison of the pre- and post-2015 time intervals showed that the suicide risk of the populations studied did not change and was considerably lower than that of the German reference population. We attribute this to lower suicide rates in the countries of origin but also to flight-related selection processes that favour more resilient individuals.

Changes in breast cancer incidence and surgical treatment in Baden-Württemberg (Germany) during the COVID-19 pandemic.

The COVID-19 pandemic affected the diagnostics and treatment of breast cancer. Numerous studies reported an early decline in breast cancer (BC) incidence during the COVID-19 pandemic. Less evidence is available on changes in medical care. Reports from individual patients have provided anecdotal evidence for a shift from breast-conserving surgery to mastectomy to reduce the number of visits to radiation units during the pandemic. This study aimed to explore changes in BC incidence and surgical treatment in the south of Germany. Using data from the Baden-Württemberg Cancer Registry, the age-standardized incidence of BC (ICD-10 C50 and D05) (women) in 2018-2021 was investigated overall and by age and stage using standardized incidence ratios. Among pre-operative stage I/IIA BC patients, differences in the time to surgery and type of surgery were investigated using negative binomial and logistic regression models. The incidence of invasive BC decreased significantly from 170.9 per 100,000 women in 2018/2019 to 159.7 in 2020 and increased to 169.2 in 2021. This decrease resulted from a lower incidence around April 2020 and was also observed for non-invasive BC. In 2021, incidence of invasive BC was still decreased by 8% in women aged 80 + years. Surgical treatment was analyzed in 22,708 BC patients with a pre-operative stage ≤ IIA. The median time to surgery was 33 days in 2018/2019, 32 days in 2020 and 36 days in 2021. The proportion of mastectomies increased from 16.1% in 2018/2019 to 17.1% in 2020 and 17.3% in 2021 (adjusted odds ratio and 95% confidence interval (2021 vs. 2018/2019): 1.13 (1.03-1.24)). The adjusted increase was strongest for patients aged 50-59 years (1.34 (1.09-1.64)) and those with high-grade tumors (1.27 (1.07-1.51)). While the early return to pre-pandemic age-standardized BC incidence rates is promising, missed cases have not been caught up until 2021. Furthermore, the decreased incidence in elderly women in 2021 warrants further attention. In early-stage BC, a slightly greater rate of mastectomies was observed, although such a change was not recommended. This result underlines the importance of good communication of adapted treatment guidelines in such exceptional circumstances.

Trends in the use of animals and non-animal methods over the last 20 years.

Despite the importance of the animal testing issue, there has been little presentation in the scientific literature of the trends in animal use. This is crucial to resolve, particularly if we are to measure the impact of initiatives to reduce and replace animal experiments that were recently announced in Europe and the USA. For the first time, the number of animals used between 2002 and 2022 are presented for the EU, key animal-using countries in Europe (the UK, France and Germany), and North America (the USA and Canada). Animal testing is on a slow decrease in the EU, 11% in the last 20 years, but animal use in the UK, France and Germany is at similar levels as it was in 2002. Notably there has been a decrease in the production of genetically altered animals in the UK and a decrease in regulatory testing in the EU. Animal use in Canada has been steadily growing, and figures for the USA are still incomplete as laboratory-bred rodents and some other species are not counted. However, globally, the use of non-animal methods in biomedical research is increasing exponentially; this accelerated in the mid-2010s. The UK appears to be the leader in this field. The technological, regulatory, political and economic factors that might explain these trends are discussed.

Animal testing is an important scientific and ethical issue. Many countries count the numbers of animals they use each year, but it has not been reported recently how the numbers are developing. We need this information if we are to measure the success of initiatives to reduce and replace animal tests that have been recently announced in Europe and the USA. Here, I present the number of animals used in Europe and North America in the last 20 years between 2002 and 2022. There has been little change in the use of animals over this time period. I argue that there have been few regulatory or political drivers over this period that would have influenced change. However, based on the scientific literature, the uptake of non-animal methods is rapidly increasing, which is positive news.

Effects of Migration on Nutritional Habits: From Turkey to Germany.

Background: Dietary habits are influenced by environmental factors. Among these environmental factors are the place of residence, cultural characteristics, food accessibility, and economic status, which can all contribute to changes in the dietary pattern. Migration is another factor that can influence changes in the aspects mentioned above. We aimed to assess the dietary habits of individuals who have migrated from Turkey to Germany in comparison to those living in Turkey. Methods: In this descriptive and cross-sectional study, 254 individuals were enrolled with 102 individuals in Germany and 152 individuals in Turkey between April 2022 and July 2023. The data collection tools included Socio-demographic Characteristics Forms, Dietary Habits and Health Status Forms, and Food Consumption Frequency Forms. The data was collected online via Google Forms. Results: There were statistically significant differences in the consumption frequency of processed meats, meat and poultry, sweetened beverages, sugar, desserts and pastries, vegetables, fruits, eggs and grains, olive oil, sunflower oil, hazelnut oil, grains, dairy products, coffee, starch, and carbonated beverages between the two groups (P<0.05). Statistically significant differences were not found in terms of butter and tea consumption frequency. Conclusion: Overall, the study results have revealed significant differences in dietary habits between Turks living in Germany and those living in Turkey. The most noteworthy dimension of these differences is that individuals living in Turkey exhibit a stronger adherence to the Mediterranean dietary pattern, while those living in Germany tend to follow a Western dietary pattern.

Seasonal variation and demographic characteristics of acute tonsillitis and peritonsillar abscess in ENT practices in Germany (2019-2023).

OBJECTIVE: Peritonsillar abscess (PTA) is a common soft tissue infection of the head and neck. It remains unclear to what extent inflammatory diseases of the palatine tonsils or other infections contribute to the development of PTA. This study examines the demographic characteristics and seasonal variations of acute tonsillitis (aT) and PTA in ENT practices in Germany using a practice database. METHODS: Retrospective analysis based on data from the German-wide IQVIA™ Disease Analyzer database for the period 2019 to 2023. Data include diagnoses of aT (ICD-10: J03) and PTA (ICD-10: J36) as well as patient demographics (age, sex). Seasonal variations were identified by analysing the monthly diagnosis rates. The Pearson correlation between the monthly case numbers of aT and PTA was determined. RESULTS: 59,934 cases of aT and 5,024 cases of PTA were recorded. The mean age was 30.3 years (aT) and 39.4 years (PTA). The proportion of female patients was 60% (aT) and 49% (PTA). Both diagnoses showed seasonal variations with peaks in winter and spring and a decline in summer, although the decline was less pronounced for PTA. The monthly case numbers of aT and PTA showed high correlations between r = 0.75 (2019) and r = 0.94 (2020). The average correlation for the period 2019-2023 was r = 0.81. During the coronavirus pandemic, a significant decrease in the case numbers of both diseases was observed, while the typical seasonal variations disappeared. After the pandemic, the case numbers increased to higher levels than before the pandemic. CONCLUSIONS: aT and PTA both show seasonal variations with peaks in winter and spring and a decline in summer. The correlation between the variations of aT and PTA could be related to a partly common aetiology or to the specific sample of the practice database. The attenuation of seasonal variation during the coronavirus pandemic illustrates the impact of COVID-19 on the incidence of other diseases and on the use of healthcare pathways by patients.

ADHD in children and adolescents: Guideline-based online assessment in the consortium project INTEGRATE-ADHD.

Background: The consortium project INTEGRATE-ADHD compared administrative data on the presence of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents with the results of a parent survey and a comprehensive clinical assessment based on the S3 guideline of the Association of the Scientific Medical Societies in Germany (AWMF). Due to the COVID-19 pandemic, the clinical assessment was carried out online. Methods: The article describes how a guideline-based clinical assessment of ADHD can be implemented in an online setting. A specially developed diagnostic matrix is presented to illustrate the assessment procedures and the diagnostic decision-making process. The matrix is intended to help the diagnostician to gain an overview of the numerous individual findings that have been collected using different assessment perspectives and methods (e.g. diagnostic interviews, rating scales, performance tests) in order to make a well-founded and transparent diagnostic decision. Discussion: The consortium project INTEGRATE-ADHD has shown that an online assessment can be implemented in a guideline-compliant manner and allows a valid clinical decision. The diagnostic strategy is discussed with reference to international guidelines and recommendations for online diagnostics (e.g. aspects of feasibility, acceptability and safety of the assessment procedures). The challenges and opportunities of using online assessments in clinical practice are also described.

Comparative Analysis of Drug Shortages in the US and Germany (2016 - 2023).

This article analyzes trends in drug shortages in the US and Germany, the largest pharmaceutical market in Europe, between 2016 and 2023. It assesses the commonalities and differences between the countries in terms of active substances in shortage, time duration in shortage, and cyclic trends.

Development of bacterial resistance in Germany from 2008 to 2022 - major culprit pathogens, antibacterial drugs, and prescribing practices.

Rising bacterial resistance is a global threat, causing rising financial burdens on healthcare systems and endangering effective treatment of bacterial infections. To ensure the efficacy of antibacterial drugs, it is essential to identify the most dangerous pathogens and vulnerable antibacterial drugs. Previous research by our group suggested irrational outpatient prescribing practices in Germany, supporting a growing bacterial resistance. This study analyses developments and characteristics for the ten most prescribed antibacterial drugs in Germany from 2008 to 2022. Conclusions are based on the development of bacterial resistance levels and an analysis of correlations between pathogens. We identified cefuroxime axetil, sulfamethoxazole-trimethoprim and nitrofurantoin as the most problematic drugs. Particularly problematic pathogens include E. faecalis, E. faecium, K. pneumoniae, and P. mirabilis. Besides increasing bacterial resistance, they are characterised by a high proportion of significant positive correlations, indicating a high potential for mutually reinforcing resistance development. Alarmingly, most of the antibacterial drugs analysed showed a growing resistance to at least one of the analysed pathogens. In most cases, the best treatment option is threatened by increasing bacterial resistance. We also identified several differences between current bacterial resistance data and therapeutic guidelines. In aggregate, our findings support irrational prescribing behaviour and underscore the urgent need for improved prescribing practices to counter rising bacterial resistance in Germany. Moreover, therapeutic guidelines for bacterial infections, the "holy grail" of pharmacotherapy, must be updated more frequently.

Integrating Intercultural Competence into a Neuroscience Curriculum through a Short-Term Study Abroad Program.

We sought to enrich our neuroscience curriculum by developing a study abroad program that would address curricular goals and requirements at several levels. "Neuroscience and Technology in Germany" was designed to include a diversity of participants, integrate intercultural competence in participants, fulfill university core curriculum requirements, build on the Science, Technology, Engineering, and Math (STEM) foundation of our major, and fulfill major electives. We also hoped that it would serve as a synthetic experience allowing students to integrate foundational coursework with novel ideas and real-world research applications. We developed an itinerary that balanced multiple activities to meet those goals. We included scientific visits, STEM-focused museums, and significant cultural and historical sites. Scientific visits covered a range of topics in the field of neuroscience including cellular and pharmacological neuroscience, development, cognition, mental illness, artificial intelligence, and the mind-body problem. Pre-visit academic activities included review lectures on general topics (e.g., visual system), scaffolded literature reading, and discussion of previous literature from our hosts. Post-visit academic activities integrated previous foundational curriculum with new research. Cultural historical activities encouraged comparison between a student's home culture, predominant North American culture, and German culture. The first iteration was successful academically and logistically. In post-program surveys, 87.5% of students felt the program had met the learning objectives (n=16). Students agreed that scientific visits and preparatory lectures were relevant to the learning objectives, together with several cultural and historical visits. Students responded positively to an outing to the mountains and found a concentration camp memorial visit moving. They nearly universally reported that the program led to their personal growth. Students did not find several guided tours of STEM-related sites were relevant to our learning objectives, and opinions were mixed as to the balance of structured vs. unstructured time, balance of scientific vs. historical/cultural activities, and how to schedule free time. Students asked for more scientific background preparation, so we modified the upcoming iteration to include a "Neuroscience Boot Camp" prior to departure. We also selected guided tours more carefully and modified scheduling according to student feedback.

Trichinella findings in Germany from 2013 to 2023 indicate an increased prevalence in wild boar (Sus scrofa) population.

In Germany, Trichinella spp. are mainly detected in the sylvatic cycle. Here, the affected animal species are wild boar, fox, badger, raccoon dog, wolf, raccoon and golden jackal. The predominantly detected species are T. spiralis, followed by T. pseudospiralis and T. britovi. Due to legal requirements in Germany, all hunted wild boars and other susceptible animals must be examined for Trichinella spp. if their meat is intended for human consumption. In recent years, an increase in the number of Trichinella-positive wild boar shot in Germany has been registered and the prevalence of positive wild boar scaled up from 0.002 % to 0.005 % between 2013 and 2023. Regarding regional distribution, most Trichinella findings in wild boar have been registered in the North-Eastern part of Germany. Here, the federal states Western-Pomerania, Brandenburg and Saxony that are bordering to Poland are particularly affected. The increase in positive wild boar may be associated with the spread of raccoon dogs and wolves in these regions. Thus, measures are required to prevent the spread of Trichinella among wild animals and to follow the systematic meat inspection in susceptible wild animals intended for food especially wild boar.

Sufrimiento psicosocial en trabajadoras migrantes latinoamericanas en tareas de cuidados en España y Alemania, durante la pandemia de COVID-19.

In the context of international migration, many migrant women face an overload of care work for other people, corroborating a lack of adequate care and protection for them, which places them in vulnerable situations and at risk of suffering psychosocial harm. emotional and physical to your health. This is aggravated in the scenario of the COVID-19 pandemic, considering the structural social inequalities that have deepened to unsustainable limits for the subaltern sectors of societies, where Latin American migrant women who work in the field of domestic care of Spain and Germany. In this way, this work seeks to analyze the problem of psychosocial suffering related to care work in migrant Latin American women in Germany and Spain during the COVID-19 pandemic. For this, the integrative review was used as a qualitative synthesis procedure of previous related studies. The importance of this study lies in the fact that there are few studies on the psychosocial health of Latin American migrant women who perform domestic and care work. Some results show that, in this labor niche in Germany and Spain, the identity of women, migrants and Latin Americans, can contribute to unleash psychological and emotional suffering, due to the precarious working conditions to which many submit out of necessity and because of the field. of care to be the first "option", derived mainly from the limited perspectives of labor and social insertion in the country of destination, than from a freely and consciously chosen task.

"Not Only a Matter of Personal Interest"-Vaccination Narratives and the Model of Moral Motives in China and Germany.

Understanding vaccination decision-making processes is vital for guiding vaccine promotion within pandemic contexts and for routine immunization efforts. Vaccine-related attitudes influencing individual decision-making can be affected by broader cultural and normative contexts. We conducted 73 qualitative interviews with adults in China (n = 40) and Germany (n = 33) between December 2020 and April 2021 to understand COVID-19 vaccination intentions and preferences, and we analyzed transcripts using a five-step framework approach. During early analysis, we identified moral considerations in line with the tenets of the Model of Moral Motives (MMM) as a recurrent theme in the data. The MMM guided further analysis steps, particularly with its distinction between motives that are proscriptive (focus on avoiding harm by inhibiting "bad" behavior) and prescriptive (focus on actively seeking positive outcomes). Proscriptive vaccination arguments that compelled vaccination in our data included avoiding negative attention, being a law-abiding citizen, preventing harm to others, and protecting one's country. Prescriptive motives focused on self-efficacious behavior such as protecting the health of oneself and others via widespread but voluntary vaccination, prioritizing elderly and predisposed individuals for vaccination, and favoring a fair and equitable distribution of vaccines at the global level. In the interviews in China, both lines of arguments emerged, with a general tendency toward more proscriptive reasoning; interviews conducted in Germany tended to reflect more prescriptive motives. We encourage research and vaccine promotion practice to reflect moral considerations when aiming to understand public health preventive behavior and when developing tailored health promotion campaigns.

Large-field irradiation techniques in Germany: A DGMP Working Group survey on the current clinical implementation of total body irradiation, total skin irradiation and craniospinal irradiation.

In 2023, a Germany-wide survey on the current clinical practice of three different large field irradiation techniques (LFIT), namely total body irradiation (TBI), total skin irradiation (TSI) and craniospinal irradiation (CSI), was conducted covering different aspects of the irradiation process, e.g., the irradiation unit and technique, dosimetrical aspects and treatment planning as well as quality assurance. The responses provided a deep insight into the applied approaches showing a high heterogeneity between participating centers for all three large field irradiation techniques. The highest heterogeneity was found for TBI. Here, differences between centers were found in almost every aspect of the irradiation process, e.g., the irradiation technique, the prescription dose, the spared organs at risk and the applied treatment planning method. For TBI, the only agreement was found in the fractionation scheme (2 Gy/fraction, 2 fractions/day) and the dose reduction to the lung. TSI was the rarest of the three LFITs. For TSI, the only agreement was found in the use of 6 MeV when irradiating with electrons. The reported approaches of CSI were closest to standard radiotherapy, using no CSI-specific irradiation techniques or treatment planning methods. For CSI, the only agreement was found in the prescribed dose to the brain (50 - 60 Gy). When asking for future requirements, participating centers considered the lack of standardization as the most important future challenge and suggested to perform (retrospective) patient studies. The results of such studies can then serve as a basis for new and improved guidelines.