[Pre-existing Mental Disorders and Depressiveness in the Second Wave of the SARS-CoV-2-Pandemic - The Role of Pandemic-Associated Stressors]. / Psychische Vorerkrankungen und Depressivität in der 2. Welle der SARS-CoV-2-Pandemie in Deutschland ­ Die Rolle pandemieassoziierter Stressoren.

The second wave of the SARS-CoV-2 pandemic was characterized by drastic restrictions. From previous pandemics as well as from the first wave, it is known that especially individuals with a history of mental disorders may be highly vulnerable to develop poor mental health. Therefore, this paper examines the association of prior mental disorders (PMD) and depressiveness in the 2nd pandemic wave, considering general stress, perceived isolation, perception of political measures to curb the pandemic, fears regarding consequences of the pandemic and changes in the employment and income situation. A cross-sectional analysis was conducted with data of 812 participants of the health related beliefs and health care experiences in Germany study (HeReCa). The association between PMD and depressiveness was studied by means of weighted (for education and age) logistic regression, adjusted for the named variables as well as sociodemographic characteristics. Individuals with PMD displayed substantially more often higher depressiveness than individuals without PMD (OR: 25.1; 95% CI: 11.0-57.3). This association decreased partially by accounting for higher general stress and stress from isolation. Lack of partnership, low income, and male sex were associated with higher depressiveness, but only marginally changed the association of PMD and depressiveness. Overall, during the pandemic, persons with PMD were more likely to develop higher depressiveness than persons without. It is strongly advised to provide care for mental illness in pandemic times, which can be completed by E-Mental-Health or professional support for coping with stress.

[The importance of health-conscious nutrition education in schools : Results of an analysis of selected German framework curricula]. / Der Stellenwert gesundheitsbewusster Ernährungsbildung in der Schule : Ergebnisse einer Analyse ausgewählter deutscher Rahmenlehrpläne.

BACKGROUND: Obesity, including among children and adolescents, is a major problem both nationally and internationally and is strongly linked to nutrition. Eating habits are formed at an early age and can influence the development of disease. Schools as places of learning and living can promote balanced and sustainable eating habits. The aim of this study was therefore to analyze selected curricula on nutrition education in order to identify deficits and suggestions for improvement in school nutrition education. METHODS: The most recent version of the scientific and home economics framework curricula of secondary schools as of 2019 were examined by means of qualitative curriculum analysis. The focus was on nutrition topics as well as their possibilities for in-depth study, practical implementation, and timeframe. RESULTS AND DISCUSSION: According to this analysis, nutrition and human biology are taught mainly up to grade 8 in all curricula, while more complex topics tend to be taught from grade 9 onward. Concrete learning content relevant to everyday life on practical nutrition, food quality, and the role of nutrition in disease prevention can significantly improve students' nutritional literacy but currently receive too little attention in the curricula. Home economics subjects address consumer issues, among other topics, but are offered in only three out of six states. Electives and honors courses can supplement nutrition education, but are not part of the curriculum at all schools. The amount of time and the practical implementation of nutrition education are strongly dependent on internal school factors. In some cases, there are considerable deficits in nutrition education. CONCLUSION: It is considered useful to intensify nutrition education in higher grades, to introduce home economics subjects in all types of schools, and to standardize the curriculum content among the individual states.

Maternal knowledge of the child's heart defect over a 1-year time span, its development and associated factors.

BACKGROUND: Mothers are the link between patients, physicians, and other caregivers. Therefore, they should be well informed about the child's heart defect and accompanying issues. This study aimed to assess the mothers' understanding of their child's heart defect at hospitalisation and one year later and to analyse the individual development and associated factors. MATERIAL AND METHODS: Mothers of children with CHD (aged ≤2 years) were interviewed at time of hospitalisation and after one year. Development was calculated using the Wilcoxon signed-rank test. Knowledge was assessed using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease that consists of eight subscales. Associated factors were self-assessed knowledge at hospitalisation, educational level, cardiac diagnosis, self-assessed severity of CHD, and source of information at follow-up. RESULTS: Mothers showed mixed understanding at hospitalisation, but their knowledge improved over a 1-year time span. This was especially true for the subscales "management of CHD" and "surveillance of deterioration", which resulted in an overall good knowledge at follow-up, whereas knowledge on infective endocarditis was still poor. Mothers with lowest and highest education had the most notable improvements. The same holds for caregivers with children with more severe CHD and who rated their knowledge as less than good. CONCLUSION: Overall, mothers showed significant improvement especially for topics that are important to provide adequate care, but still revealed knowledge gaps one year after hospitalisation. Consequently, clinicians should evaluate the individual knowledge level at all times and inform mothers accordingly.

Social mobility, accumulation of disadvantages and health. An analysis with retrospective data from the GSOEP (2002-14).

BACKGROUND: Socioeconomic position (SEP) in different life stages is related to health-related quality of life (HRQoL). Yet, research on the relevance of life course processes is scarce. This study aims to analyse the association between accumulation of disadvantages, social mobility and HRQoL. METHODS: Analyses were conducted using population-averaged panel-data models and are based on data from the German Socio-Economic Panel 2002-14, including retrospective biographical information, comprising 25 473 observations from 8666 persons. Intergenerational and intragenerational mobility included the occupational positions in childhood (parental position), first job and middle age. Accumulation of disadvantages was measured using an accumulation index. HRQoL was assessed using the Mental and Physical Component Summary Scores of the SF12v2. RESULTS: Accumulation of disadvantages was the main predictor for the Physical Component Summary in mid-age. Men and women in a stable low SEP or with a steep downward mobility showed the least favourable physical HRQoL. This holds for intergenerational and intragenerational mobility. Mental HRQoL did not seem to be associated with accumulation or social mobility. CONCLUSION: The results show that physical HRQoL is related to social mobility and accumulation of (dis-)advantages. Further research is needed thoroughly analysing this association.

[Intragenerational Mobility and Subjective Health: Findings of the Socio-Economic Panel (GSOEP) 1992-2012]. / Intragenerationale Mobilität und subjektive Gesundheit ­ Ergebnisse des Sozio-oekonomischen Panels (SOEP) von 1992­2012.

AIM OF THE STUDY: International research suggests that mobility plays an important role in determining health in later life. The aim of this study was to analyze the relationship between intragenerational mobility and subjective health on the basis of data from Germany, taking different periods from 1992 to 2012 into account. DATA AND METHODS: Data is derived from the Socio-economic Panel (GSOEP), taking three time periods into account (1992-1995, 2000-2003 and 2008-2012). Intragenerational mobility was measured by comparing first occupational position and current job. Logistic regressions were used in order to analyze the relationship between health and mobility. RESULTS: Men and women who were downwardly mobile in unemployment or stable low reported the worst health. Up- and downwardly mobile people were located between the stable-up and stable-low groups. The relationship was not affected by origin (East/West Germany). Yet, upward mobility was more common in West Germany and downward mobility was more frequent in East Germany. In general, men and women showed similar patterns. The relationship between intragenerational mobility and health remained stable over time. CONCLUSION: Occupational development showed a strong relationship with health in later life. Especially downward mobility into unemployment or staying in lower positions had strong influence on health. Socio-political measures should be taken to prevent a further divergence of health opportunities.

[Intergenerational mobility and health inequalities in East and West Germany : A trend analysis from 1992 to 2012]. / Intergenerationale Mobilität und gesundheitliche Ungleichheiten in Ost- und Westdeutschland : Eine Trendanalyse von 1992 bis 2012.

BACKGROUND: Social mobility processes, i. e. the movement of a person from one social position to another, are central mechanisms for explaining health inequalities. Social differences in health status or behaviour may also change with changes in social status. This article examines the importance of intergenerational mobility, i. e. the rise and fall of social status in relation to parental social position, for subjective health in East and West Germany and whether this relationship has changed over 20 years. MATERIAL AND METHODS: The data basis is the socio-economic panel from 1992-2012. Employees aged between 25 and 59 were taken into account. Different mobility paths were determined by comparing their current occupational positions with those of their parents. For these, prevalence and logistic regression of subjective health were calculated. RESULTS: Those in low occupational positions rated their health more often as being worse in all periods. Upwardly mobile individuals had a lower risk of poorer health (OR 0.72) compared to those who remained in their original position. Persons affected by downward mobility had a similarly worse self-rated health (OR 1.55 or OR 1.86). Significant differences in gender or region of origin (East-West Germany) could not be determined. Education and income contribute to explaining the relationship. CONCLUSION: The results suggest that social advancement has a positive effect on health, whereas social decline is negative - regardless of gender, region of origin or time. It is therefore important to reinforce political efforts aimed at increasing the mobility opportunities of all social groups in a positive sense and thus reducing social inequalities.

Maternal understanding of infective endocarditis after hospitalization: assessing the knowledge of mothers of children with congenital heart disease and the practical implications.

This study aimed to examine the knowledge of mothers of children with congenital heart disease as well as the association of cardiological factors and maternal characteristics with maternal understanding. Mothers of 135 children (≤2 years old) were interviewed to assess maternal knowledge of infective endocarditis (IE) using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease. Two subscales, endocarditis and risk factors, were used. Cardiological data as well as maternal characteristics were collected. Two-thirds of the mothers achieved only low scores, answering 0-20 % of the questions correctly (endocarditis = 64.4 %; risk factors = 71.1 %). Mothers with higher education recalled the correct definition of IE (P = 0.001) and the importance of dental hygiene (P = 0.004) more often. Mothers with only one child were more likely to know the most typical symptom (P = 0.007). The severity of the heart disease and the requirement of endocarditis prophylaxis did not influence maternal understanding. Yet, mothers assessing the heart disease as severe showed better knowledge (typical symptom P = 0.021; importance of dental hygiene P = 0.007). If mothers learned the diagnosis before their child's birth, they remembered relevant information more often. Mothers receiving information by the medical staff and from the Internet showed better knowledge (definition P = 0.014; importance of dental hygiene P = 0.001). Due to low levels of knowledge, more efforts must be put into the education of mothers. Educational programs should take maternal characteristics into account, providing written material and thereby keeping the instruction of lower-educated persons in mind. Furthermore, education should be focused on mothers of children requiring IE prophylaxis.

Analysis of problems and potentials for increasing pandemic resilience in public health administrations in Saxony-Anhalt, Germany-a mixed-methods approach.

INTRODUCTION: The COVID-19 pandemic has shown the importance of resilient, modern, and well-equipped public health administrations from national to communal levels. In Germany, the surveillance, contact tracing, and local adaptions went through local health offices, revealing both their important role and also their lack of equipment and general preparation for health crises. Research on the mode of operation of the public health service (PHS), especially in a time of crisis, is rare. The present study aims to qualitatively and quantitatively assess problem areas, conflict potentials, and challenges that have become apparent for the PHS of Saxony-Anhalt during the pandemic. It focuses on the individual insight of employees of the PHS of Saxony-Anhalt and its 14 health offices to derive concrete needs and fields of action for increasing pandemic preparedness. Furthermore, the prospective personnel and resource-based requirements as well as the necessary structural and organisational changes of the public health departments are to be considered. METHODS AND ANALYSIS: The study will follow a sequential mixed-methods approach. Introductory expert interviews (n=12) with leading staff of Saxony-Anhalt's PHS will be conducted, followed by focus group interviews (n=4) with personnel from all departments involved in the pandemic response. Thereafter, a quantitative survey will be carried out to validate and complement the results of the qualitative phase. ETHICS AND DISSEMINATION: Ethical approval was obtained by the Martin-Luther-Universität Halle-Wittenberg ethics commission (Ref number 2023-102). The authors will submit the results of the study to relevant peer-reviewed journals and give national and international oral presentations to researchers, members of the PHS, and policymakers.

Health and Well-Being of Adolescents in Different Family Structures in Germany and the Importance of Family Climate.

The family is of exceptional and lifelong importance to the health of adolescents. Family structure has been linked to children's and adolescents' health and well-being; a nuclear family has been shown to be indicative of better health outcomes as compared with a single-parent family or a step-family. Family climate is rarely included in studies on children's and adolescents' health and well-being, albeit findings have indicated it is importance. Using data from n = 6838 students aged 12-13 years from the German National Educational Panel Study, this study shows that stronger familial cohesion and better a parent-child relationship are associated with better self-rated health, higher life satisfaction, more prosocial behavior, and less problematic conduct, and that these associations are stronger than those for family structure. Surveys on young people's health are encouraged to include family climate above and beyond family structure alone.

Income and housing satisfaction and their association with self-rated health in different life stages. A fixed effects analysis using a German panel study.

OBJECTIVE: We aim to investigate the effect of income and housing satisfaction on self-rated health in different life stages. DESIGN: A population-based panel study (German Socio-Economic Panel). PARTICIPANTS: The final sample consisted of 384 280 observations from 50 004 persons covering the period between 1994 and 2016. OUTCOME MEASURES: Average marginal effects were calculated based on fixed effects regressions to obtain the effect of changes in income and housing satisfaction on changes in self-rated health for each year of age. Self-rated health was assessed on a 5-point scale, with higher values indicating better health. RESULTS: Changes in income and housing satisfaction showed a small association with changes in self-rated health. The association was stronger for income, where it also varied considerably in different life stages. The average marginal effects for income satisfaction varied between 0.02 and 0.05 in men and 0.02 and 0.04 in women and peaked between the ages of 55-60. For housing satisfaction, average marginal effects ranged from 0.02 to 0.04 (men) and from 0.02 to 0.03 (women). CONCLUSION: Higher satisfaction with housing and income was associated with better self-rated health. Therefore, studies on the social determinants of health should not only focus on objective material conditions but also on how individuals perceive and evaluate their situation.

Educational inequalities in subjective health in Germany from 1994 to 2014: a trend analysis using the German Socio-Economic Panel study (GSOEP).

INTRODUCTION: As trend studies have shown, health inequalities by income and occupation have widened or remained stable. However, research on time trends in educational inequalities in health in Germany is scarce. The aim of this study is to analyse how educational inequalities in health evolved over a period of 21 years in the middle-aged population in Germany, and whether the trends differ by gender. METHODS: Data were obtained from the German Socio-Economic Panel covering the period from 1994 to 2014. In total, n=16 339 participants (106 221 person years) aged 30-49 years were included in the study sample. Educational level was measured based on the 'Comparative Analysis of Social Mobility in Industrial Nations' (CASMIN) classification. Health outcomes were self-rated health (SRH) as well as (mental and physical) health-related quality of life (HRQOL, SF-12v2). Absolute Index of Inequality (Slope Index of Inequality (SII)) and Relative Index of Inequality (RII) were calculated using linear and logarithmic regression analyses with robust SEs. RESULTS: Significant educational inequalities in SRH and physical HRQOL were found for almost every survey year from 1994 to 2014. Relative inequalities in SRH ranged from 1.50 to 2.10 in men and 1.25 to 1.87 in women (RII). Regarding physical HRQOL, the lowest educational group yielded 4.5 to 6.6 points (men) and 3.3 to 6.1 points (women) lower scores (SII). Although educational level increased over time, absolute and relative health inequalities remained largely stable over the last 21 years. For mental HRQOL, only few educational inequalities were found. DISCUSSION: This study found persistent educational inequalities in SRH and physical HRQOL among adults in Germany from 1994 to 2014. Our findings highlight the need to intensify efforts in social and health policies to tackle these persistent inequalities.