VersKiK qualitative study design: actual follow-up needs of paediatric cancer survivors, their informal caregivers and follow-up stakeholder perceptions in Germany.

INTRODUCTION: This article presents the study design of the qualitative part of the VersKiK study (Long-term care, care needs and wellbeing of individuals after cancer in childhood or adolescence: study protocol of a large scale multi-methods non-interventional study) aiming to explore actual follow-up needs of childhood and adolescence cancer survivors and their informal caregivers, gaps in current follow-up care provision and trajectories of cancer survivors' transition from paediatric to adult healthcare. METHODS AND ANALYSIS: We will conduct up to 30 interviews with survivors of childhood and adolescence cancer and their informal caregivers with up to 20 participant observations of follow-up appointments. The results of these will be discussed in up to four focus groups with healthcare professionals and representatives of self-help groups. The study design aims to evaluate follow-up care after childhood cancer considering perspectives from survivors, their informal caregivers as well as healthcare providers. The combination of different data sources will allow us to get an in-depth understanding of the current state of follow-up care after paediatric cancer in Germany and to suggest recommendations for care improvement. ETHICS AND DISSEMINATION: The VersKiK study was approved by the Ethics Committee Otto von Guericke University on 2 July 2021 (103/21), by the Ethics Committee of Johannes Gutenberg University Mainz on 16 June 2021 (2021-16035), by the Ethics Committee University of Lübeck on 10 November 2021 (21-451), by the Ethics Committee University of Hospital Bonn on 28 February 2022 (05/22). For each part of the qualitative study, a separate written informed consent is prepared and approved accordingly by the ethics committees named above. TRIAL REGISTRATION NUMBER: Registered at German Clinical Trial Register, ID: DRKS00026092.

[Determinants of the utilization of cancer screening among older adults in Saxony-Anhalt-What is the influence of health literacy?] / Determinanten der Inanspruchnahme der Krebsfrüherkennung von älteren Erwachsenen in Sachsen-Anhalt ­ Welchen Einfluss hat die Gesundheitskompetenz auf die Inanspruchnahme?

BACKGROUND: In order to preserve health and thus social participation, it is important for older people to make health-related decisions, such as those regarding the use of a secondary prevention service like cancer screening. National and international studies show that various predictors determine cancer screening participation. The aim of this study is to determine the cancer screening utilization of older people in a structurally weak region. METHODS: In 2021, a cross-sectional study in each of two urban and rural communities in Saxony-Anhalt surveyed individuals aged 55 years and older about determinants, reasons, and barriers to preventive service use (n = 954). Binary logistic regression analysis is used to analyze determinants of cancer screening use. RESULTS: Three quarters of the study population (76.6%) self-reported participating in a cancer screening service at least once. The multivariable analyses demonstrate factors that influence the utilization of cancer screening. Age, partial knowledge on cancer screening, cancer screening as a benefit offered by a statutory health insurances' bonus program, experience with cancer in the immediate environment, thoughts about one's own health, and the feeling of security that participation gives are factors that significantly influence the use of cancer screening. Descriptively, the physician's recommendation is the strongest factor for participation. CONCLUSION: The analyses show that cancer screenings are generally well received by older people in Saxony-Anhalt, but participation in them is not related to health literacy. In keeping with the National Cancer Plan, older people should generally be supported in making an informed decision, for example, through target-group-specific physician education.

[Research Data Center on Health - Vision for Further Development from the Research Perspective]. / Forschungsdatenzentrum Gesundheit ­ Vision für eine Weiterentwicklung aus Sicht der Forschung.

The German research data center for health will provide claims data of statutory health insurances. The data center was set up at the medical regulatory body BfArM pursuant to the German data transparency regulation (DaTraV). The data provided by the center will cover about 90% of the German population, supporting research on healthcare issues, including questions of care supply, demand and the (mis-)match of both. These data support the development of recommendations for evidence-based healthcare. The legal framework for the center (including §§ 303a-f of Book V of the Social Security Code and two subsequent ordinances) leaves a considerable degree of freedom when it comes to organisational and procedural aspects of the center's operation. The present paper addresses these degrees of freedom. From the point of view of researchers, ten statements show the potential of the data center and provide ideas for its further and sustainable development.

Digital Health Information Provided by Public Health Stakeholders on Colorectal Cancer Screening: A Systematic Evaluation.

In the federal state of Germany, Saxony-Anhalt, colorectal cancer is the second most frequent cause of death among cancer patients. In order to identify cancer precursors early, colorectal cancer screenings are essential. In this context, health information contributes to informing individuals and imparting them with necessary knowledge to make a decision about (non-)utilization of preventive services. Numerous public health stakeholders (e.g., statutory health insurances) provide health information. This study aimed to evaluate the quality of web-based health information offered by public health stakeholders in Saxony-Anhalt, Germany. A systematic evaluation was used. A search was performed using pre-defined eligibility criteria and search terms. Two independent reviewers assessed the search results based on seven main categories (60 items) developed by the study team in line with the "Guideline Evidence-based Health Information". In total, 37 materials from 16 different stakeholders were included and yielded a "mediocre quality" (median = 69%). The materials had only partially fulfilled the requirements of national recommendations for evidence-based health information. Access to digital health information regarding colon cancer screening was unsatisfactory, especially for individuals with auditory or visual impairments, due to use of inappropriate communication technologies. Further efforts are required to improve digital health information about colorectal cancer screening.

Regional Utilization of Preventive Services in the 55-Plus Age Group: Protocol for a Mixed Methods Study.

BACKGROUND: In Germany, the proportion of people with chronic diseases and multimorbidity is increasing. To counteract the emergence and worsening of age-related conditions, there is a need for preventive care structures and measures. The preventive services that are financed by statutory health insurance (SHI; eg, vaccinations, cancer screening) are only used by part of the German population. There are no current findings about the utilization of these services by older adults in the eastern German federal state of Saxony-Anhalt, which is particularly strongly affected by demographic change. OBJECTIVE: The aim of this study is to investigate the actual utilization and determinants of, reasons for, and barriers to utilization of preventive services financed by the SHI in Saxony-Anhalt in the 55-plus age group. METHODS: In this study, a convergent mixed methods design is used. The actual use of preventive services will be shown by means of (1) a claims data analysis looking at data on statutory outpatient medical care from both the Central Research Institute of Ambulatory Health Care in Germany (Zi) and the Association of Statutory Health Insurance Dentists in Saxony-Anhalt (KZV LSA). The determinants, attitudes, and behaviors associated with use will be analyzed through (2) a cross-sectional survey as well as (3) qualitative data from semistructured interviews with residents of Saxony-Anhalt and from focus group discussions with physicians. (4) A stock take and systematic evaluation of digitally available informational material on colorectal cancer screening, by way of example, provides an insight into the information available as well as its quality. The conceptual framework of the study is the behavioral model of health services use by Andersen et al (last modified in 2014). RESULTS: (1) The Zi and KZV LSA are currently preparing the requested claims data. (2) The survey was carried out from April 2021 to June 2021 in 2 urban and 2 rural municipalities (encompassing a small town and surrounding area) in Saxony-Anhalt. In total, 3665 people were contacted, with a response rate of 25.84% (n=954). (3) For the semistructured interviews, 18 participants from the 4 different study regions were recruited in the same period. A total of 4 general practitioners and 3 medical specialists participated in 2 focus group discussions. (4) For the systematic evaluation of existing informational material on colorectal cancer screening, 37 different informational materials were identified on the websites of 16 health care actors. CONCLUSIONS: This study will provide current and reliable data on the use of preventive services in the 55-plus age group in Saxony-Anhalt. It will yield insights into the determinants, reasons, and barriers associated with their utilization. The results will reveal the potential for preventive measures and enable concrete recommendations for action for the target population of the study. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024059; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024059. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33512.

[Health and Social Status in Hamburg's Urban Quarters - An Approach to Mapping Social Status with Health-Related Routine Data]. / Gesundheit und soziale Lage in Hamburger Quartieren ­ Ein Ansatz zur Abbildung von Soziallagen mit gesundheitsbezogenen Routinedaten.

AIM OF THE STUDY: The aim of this study was to test an innovative approach to the small-scale and social situation-sensitive localisation and analysis of health-related routine data. For this purpose, SHI billing data and deployment data of the ambulance service were supplemented with a small-scale neighbourhood-related indicator of the social situation of the place of residence and/or deployment as a proxy for the personal social situation. METHODS: Anonymised accounting data from three statutory health insurances and deployment data from the rescue service of the Hamburg fire brigade, each from the year 2017, were used. The social situation of the place of residence of the insured or transported persons (in the case of the rescue service data, also the deployment location) was mapped with the help of the so-called status index classes (high - medium - low - very low) of the Hamburg social monitoring. The allocation via the addresses of the persons concerned was carried out by the respective data owners with the help of an allocation procedure developed in the project. RESULTS: Exemplary results of descriptive analysis of accident occurrence and acute inpatient care of children and adolescents showed that known social situation dependencies from primary studies can also be depicted in the secondary data used. This would speak for the suitability of the social indicator, e. g. in the context of extended social and health reporting. CONCLUSION: The neighbourhood-based indicator we used seems promising and should be validated in further analyses. Based on this, approaches can be developed for its use in the context of health services research and health reporting as well as in the sense of a comprehensive health-in-all-policies strategy for designing health-promoting and needs-oriented political decisions and programmes.

[Now is the Time to Establish an Efficient Health Research Data Centre]. / Jetzt die Weichen stellen für ein leistungsfähiges Forschungsdatenzentrum Gesundheit.

Based on sections 303a to 303f social code book V, the course is currently being set for an innovative and high-performance national information and data platform. This requires short-term provision of current and relevant data on the health care system, especially process data on statutory health insurance and other social insurance carriers, using established methodological standards as well as taking into account data protection regulations. From the point of view of future users, expectations regarding an "ideal" research health data centre are formulated in ten recommendations. The present article is an offer from health services researchers intended to support decision-makers in the field of politics and self-administration in the German health system in their task of establishing and further development of a research health data centre.

Breast cancer and exposure to aircraft, road, and railway-noise: a case-control study based on health insurance records.

Objectives Aircraft, road, and rail traffic noise can cause sleep disturbances. Since night work and shorter sleep durations have been linked to increased risks of breast cancer, we examined if 24-hour, or day- or night-time traffic noise exposure may also increase the risk of breast cancer. Methods To investigate the noise-related risks of breast cancer, the pseudonymized insurance records of three large statutory health companies (2005-2010) for women aged ≥40 years living in the region surrounding the Frankfurt international airport were analyzed with address-specific acoustic data representing aircraft, road, and rail-traffic noise. Noise exposure among women with incident breast cancer (N=6643) were compared with that of control subjects (N=471 596) using logistic regression and adjusting for age, hormone replacement therapy, education and occupation (only available for 27.9%), and a regional proportion of persons receiving long-term unemployment benefits as an ecological indicator of socioeconomic level. Analyses were also stratified according to estrogen receptor (ER) status. Results An increased odds ratio (OR) was observed for ER negative (ER-) tumors at 24-hour aircraft noise levels 55-59 dB [OR 55-59 dB 1.41, 95% confidence interval (CI) 1.04-1.90] but not for ER positive (ER+) breast cancers (OR 55-59 dB 0.95, 95% CI 0.75-1.20). Clear associations between road and rail traffic noise were not observed. Conclusions The results indicate increased aircraft noise may be an etiologic factor for ER- breast cancers. However, information regarding potential confounding factors was largely unattainable. Further research is required to understand how environmental noise may be involved in the pathogenesis of ER- breast cancers.

[Mammogram results in ambulatory care--a mammography quality circle in Braunschweig, Germany, between 1998 and 2001]. / Ergebnisse ambulanter Mammographien--Qualitätszirkel Mammographie Braunschweig 1998 bis 2001.

Radiologists from seven independent practices in Germany (average number of cases 3,500 in 2001) combined to form a mammography quality control group. Documentation and follow up were standardised for all cases that resulted in a referral for open biopsy. A quantitative analysis of the data would be expected to clarify the quality achieved in ambulatory care and to show further possibilities for quality assurance measures. The first overall analysis of 2,500 referrals for biopsy from 1998 to 2001 shows differences between practices as regards the frequency of referral for biopsy and the proportion of referrals for suspected malignancy, which are based on practice-specific conditions (referral behaviour, age structure of patients) and individual case management. Practices are very close in relation to positive predictive value (ppv) and detection rate. The biopsy rate in 2001 slightly exceeded 3%, the overall detection rate was 1.7%, and ppv 81%. For asymptomatic women detection rate and ppv were 0.5% and 70%, respectively. Quality parameters for all mammography referrals in total exceed those of screening programmes. When restricted to asymptomatic women, results have been achieved that are comparable to those of established screening programmes. Naturally the patients involved here are those in whom mammography was indicated. Nonetheless, these results demonstrate a high quality of detection on the part of those performing mammography in routine ambulatory care, and can be used as a reference for other types of care. With consistent quality assurance in relation to technical considerations and personnel, a performance quality can be achieved in independent practices which to date has not been surpassed by specialist mammography centres.