Climate protection, health and other motives for active transport - results of a cross-sectional survey in Germany.

BACKGROUND: Active transport- for example walking and bicycling to travel from place to place- may improve physical fitness and health and mitigate climate change if it replaces motorised transport. The aim of this study is to analyse the active transport behaviour of adults living in Germany, to investigate differences among population groups and to determine whether climate protection is a frequent motive for this behaviour. METHODS: This study uses self-reported data of 4,971 adults who participated in a national health survey (German Health Update 2021), which was conducted as a telephone survey from July to December 2021. Associations between active transport behaviour and corresponding motives with sociodemographic and health-related variables were analysed using logistic regression models. RESULTS: Of the adult population, 83% use active transport at least once a week. The frequency and duration of walking per week are significantly higher than those for bicycling (walking 214 min/week; bicycling 57 min/week). Those with a lower education level are less likely to practise active transport than those with a higher education level. Furthermore, women are less likely to use a bicycle for transport than men. Among those practising active transport, the most frequently mentioned motive is "is good for health" (84%) followed by "to be physically active" (74%) and "is good for the climate/environment" (68%). Women and frequent bicyclists (at least 4 days/week) mention climate protection as a motive more often than men and those bicycling occasionally. CONCLUSIONS: The improvement of active transport, especially among people with lower education and women (for bicycling), may benefit from better insights into motives and barriers. Climate protection is an important motivator for practising active transport within the adult population living in Germany and should therefore have greater emphasis in behavioural change programmes.

[Capabilities for Physical Activity in Older People: Development and Testing of a Measurement Tool]. / Messung von Handlungsmöglichkeiten (capabilities) für körperliche Aktivität: Entwicklung und Erprobung eines Messinstruments für ältere Menschen.

INTRODUCTION: Based on Sen's capability approach, this study addresses the operationalization of capabilities for leading an active lifestyle. By assessing capabilities, processes of change can be mapped and the development of interventions to promote physical activity in different population groups, e. g., older adults, can be supported. However, no standardized German-language instrument for measuring physical activity-related capabilities is available to date. METHODS: Building on an exploratory interview study (Sauter et al., 2019) that identified relevant physical activity-related capabilities in older adults, a standardized questionnaire with 41 items was designed. Two different question formulations were designed to query perceived capabilities for physical activity. The "think-aloud" method was conducted to validate the instrument. This involved recording all verbal comments made by participants while completing the questionnaire and conducting supplementary interviews for comprehensibility and applicability. The sample included 16 older adults (w=9, MW=66.3 years). RESULTS: Overall, respondents rated the instrument's usability and comprehensibility as good. For the questioning of perceived capabilities, the formulation "I have the possibility to..." was favored instead of "I perceive my personal opportunities as…". Difficulties in understanding and ambiguities were found in a few items. Thus, further changes were made to specify these questions with regard to unclear terms such as "walking paths". CONCLUSION: The questionnaire seems to be suitable to asses perceived capabilities for leading an active lifestyle in older adults. The final questionnaire is available in English and in German. Further research is needed to test the applicability of the instrument in other population groups and verify objectivity, reliability and validity.

How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis.

BACKGROUND: Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups. METHODS: We searched seven databases and included studies for children and adolescents (≤ 19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index and School Closure Index as indicators of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using the 'Risk of Bias in Non-randomized Studies - of Exposure' [ROBINS-E]) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Unpublished data was requested from study authors. Data were pooled in random effects models. An a priori protocol was published, reporting is carried out in accordance with the 'Preferred Reporting Items for Systematic Review and Meta-Analyses' (PRISMA) statement. RESULTS: Of 14,897 non-duplicate records, 26 publications (n = 15,038 pre-pandemic, n = 13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 min per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8-12) and adolescents were particularly affected by the decline. School closures were associated with a reduction in physical activity. The certainty of evidence for all outcomes was low. CONCLUSIONS: A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend. TRIAL REGISTRATION: PROSPERO: CRD42023395871.

Social factors of health-related quality of life in older adults: a multivariable analysis.

PURPOSE: The objective of the analysis was to examine the relationships between sociodemographic, socioeconomic, psychosocial, and behavioural factors and both physical and mental health-related quality of life (HRQOL) in older adults. METHODS: The analysis was based on recent cross-sectional data of 1687 community residents from a whole population postal survey of German adults aged 65 years and older (33% response rate, 52% female, mean age 76 years). HRQOL was assessed using the 36-Item Short Form Survey (SF-36v2). For a differentiated analysis, hierarchical multiple linear regressions were performed. RESULTS: An internal health locus of control, physical activity, social support, and income were positively associated with physical HRQOL (Adj. R2 = 0.34; p < 0.001) and mental HRQOL (Adj. R2 = 0.18; p < 0.001), whereas an external health locus of control and age were negatively associated with both. Alcohol use and educational level were positively associated only with physical HRQOL, whilst female gender was negatively associated only with mental HRQOL. CONCLUSION: Sociodemographic, socioeconomic, psychosocial, and behavioural factors were associated with physical and mental HRQOL. These results highlight the importance of social factors in HRQOL and provide approaches for policy and practice to develop and implement tailored health interventions for older adults. Our findings may be transferable to municipalities in metropolitan areas of high-income European countries. CLINICAL TRIAL REGISTRATION: Not applicable.

[Eating Habits with Climate Impact: At Which Meals and How Often Do 6- to 11-year-olds Eat Meat and Meat Products?] / Klimarelevante Ernährungsgewohnheiten: Zu welchen Mahlzeiten und wie häufig essen 6- bis 11-Jährige Fleisch und Wurstwaren?

BACKGROUND: Climate change presents one of the greatest public health challenges. Regarding diet, the production of animal-based foods contributes significantly to greenhouse gas emissions. In Germany, even children often eat more meat and meat products than is recommended for a healthy diet. To plan, implement, and tailor interventions to the needs of different target groups, it is crucial to better understand people's eating habits. METHODS: Using data from 4-day eating records of 1,190 participants of the EsKiMo II study (Nutrition study as KiGGS module, 2nd survey), which was carried out nationwide in Germany from 2015 to 2017, a detailed analysis of the consumption of meat and meat products of children aged 6-11 years, including consumption quantities and frequencies with regard to different meals, was conducted. RESULTS: On average, children ate 71 g of meat and meat products per day, 2/3 of the amount during lunch and dinner. More red meat (pork, beef, and lamb) were chosen than poultry. Almost half of the children ate these food items twice a day, another 40% once a day. Only five percent consumed meat or meat products less than once a day. CONCLUSIONS: Meat and meat products are therefore part of the daily diet of almost all children at this age with a general high intake among both boys and girls. Consumption could be reduced by replacing meat and meat products with vegetarian dishes or plant-based sandwich fillings, particularly for lunch and dinner. While school lunch can considerably contribute to a healthy and climate-friendly diet, families should also reduce meat servings at dinner.

Transmission of SARS-CoV-2 among children and staff in German daycare centres.

In daycare centres, the close contact of children with other children and employees favours the transmission of infections. The majority of children <6 years attend daycare programmes in Germany, but the role of daycare centres in the SARS-CoV-2 pandemic is unclear. We investigated the transmission risk in daycare centres and the spread of SARS-CoV-2 to associated households. 30 daycare groups with at least one recent laboratory-confirmed SARS-CoV-2 case were enrolled in the study (10/2020-06/2021). Close contact persons within daycare and households were examined over a 12-day period (repeated SARS-CoV-2 PCR tests, genetic sequencing of viruses, symptom diary). Households were interviewed to gain comprehensive information on each outbreak. We determined primary cases for all daycare groups. The number of secondary cases varied considerably between daycare groups. The pooled secondary attack rate (SAR) across all 30 daycare centres was 9.6%. The SAR tended to be higher when the Alpha variant was detected (15.9% vs. 5.1% with evidence of wild type). The household SAR was 53.3%. Exposed daycare children were less likely to get infected with SARS-CoV-2 than employees (7.7% vs. 15.5%). Containment measures in daycare programmes are critical to reduce SARS-CoV-2 transmission, especially to avoid spread to associated households.

Changes in healthcare seeking and lifestyle in old aged individuals during COVID-19 lockdown in Germany: the population-based AugUR study.

BACKGROUND: Containment measures in the COVID-19 pandemic protected individuals at high risk, particularly individuals at old age, but little is known about how these measures affected health-related behavior of old aged individuals. We aimed to investigate the impact of the spring 2020 lockdown in Germany on healthcare-seeking and health-related lifestyle in the old aged and to identify susceptible subgroups. METHODS: We conducted a follow-up survey among the pre-pandemically well-characterized participants of our AugUR cohort study, residents in/around Regensburg aged 70+ years and relatively mobile. A self-completion questionnaire on current behavior, perceived changes, and SARS-Cov-2 infection was mailed in May 2020, shortly before contact restrictions ended. Pre-pandemic lifestyle and medical conditions were derived from previous study center visits. RESULTS: Among 1850 survey participants (73-98 years; net-response 89%), 74% were at increased risk for severe COVID-19 according to medical conditions; four participants reported SARS-CoV-2 infection (0.2%). Participants reported changes in behavior: 29% refrained from medical appointments, 14% increased TV consumption, 26% reported less physical activity, but no systematic increase of smoking or alcohol consumption. When comparing during- and pre-lockdown reports of lifestyle within participant, we found the same pattern as for the reported perceived changes. Women and the more educated were more susceptible to changes. Worse QOL was perceived by 38%. CONCLUSIONS: Our data suggest that the spring 2020 lockdown did not affect the lifestyle of a majority of the mobile old aged individuals, but the substantial proportions with decreased physical activity and healthcare-seeking are markers of collateral damage.

Influences on the physical activity of Syrian migrants in Germany: results of a qualitative study.

Due to the ongoing Syrian conflict, Syrian migrants represent the third-largest group of immigrants in Germany. They are, therefore, potential addressees for health-promotion programs, such as physical activity (PA). Thus, this study aimed to explore the relevance of PA, how PA may change with increasing length of stay and what are the facilitators and barriers of PA in the host country. Using a longitudinal, qualitative study design, 30 semi-standardized qualitative interviews with Syrian migrants were conducted in 2018 and 17 migrants could be followed-up after 12 months in 2019 and were asked for changes in their PA-behavior. Interviews were conducted in German, English or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used. We identified three PA phases that Syrian immigrants underwent during their first years in Germany. Phase 1 includes bureaucratic matters. Health-promoting behaviors, such as PA, are not relevant. Phase 2 comprises the establishment of basic structures. PA can gain importance and (new) behaviors can be established. In Phase 3, immigrants feel under pressure to successfully complete an (academic) education in Germany. Feelings toward PA can become ambivalent. Overall, health-promoting behaviors, such as PA, are often of secondary priority and factors influencing PA are heterogeneous not only on an individual but also societal and institutional level. PA-programs should be advertised bilingually, offered low-threshold and at low cost in order to reach the target group. In addition, there is a high demand for mental health services.

Due to the ongoing Syrian conflict, Syrian immigrants represent the third-largest group of immigrants in Germany and are, therefore an important target group for health-promotion programs, such as physical activity (PA). To better understand, how important PA is for Syrian migrants, how their PA-behavior in Germany differs compared to Syria and what factors have an impact on PA, we conducted 30 interviews with Syrian migrants. After 12 months, we re-contacted the same 30 people, to ask for a second interview, of whom 17 agreed. All 47 interviews were conducted in German, English or Arabic, transcribed and translated into English if necessary. The interview narratives reveal that health-promoting behaviors, such as PA, are often secondary priorities. This is not only true for the beginning of migrants' stays in their host country, but also as the duration of their stays increases. Processing major life changes and traumatic experiences, meeting acculturation requirements and managing everyday life in a foreign country require migrants' full attention. Public health efforts must be more responsive to Syrian migrants' specific needs. Future research should continue to focus on Syrian migrants' living, working and social conditions and their impacts on health-related behaviors.

Exploring how Syrian women manage their health after migration to Germany: results of a qualitative study.

BACKGROUND: In the recent years, the number of Syrians living in Germany increased drastically due to the massive displacement caused by the Syrian conflict. Syrian migrant women in Germany are challenged by both the migration process and the changing of social roles. Seeking out healthcare may be hampered by linguistic and cultural barriers, but the new context may offer opportunities for health and well-being (free access to health care, civil/human rights). Little is known about how Syrian women manage their health after their resettlement in Germany. METHODS: In depth interviews in Arabic were conducted with 9 Syrian women who were recruited through purposive sampling (18-55 years, migrated in 2011-2017, different education levels), focusing on capabilities to control one's health and to navigate the German healthcare system, and social/environmental barriers and facilitators to effectively manage their health. Interview transcripts were analysed using qualitative content analysis. RESULTS: The women reported their health to be impaired by post-migration stressors, such as perceived discrimination, loss of social status and worrying about the future. Many interviewees felt disempowered and incompetent to successfully and actively navigate the German healthcare system, lacking information and not understanding their rights and options under the health insurance plan. The language barrier added to feeling vulnerable. Many women experienced doctors declining to treat them for capacity reasons; when treated, they often did not feel taken seriously or were dissatisfied with the emotional/cultural aspects of care. If possible, Arabic doctors were sought out. Some women, however, described improved resources for health, and appreciated better women's rights as a source of power. CONCLUSIONS: The lack of information about the structure and offers of the German healthcare system, language and culture specific barriers as well as socio-cultural challenges are undermining the ability of Syrian women to manage their health effectively after their resettlement in Germany. Providing tailored information on the German healthcare system, creating a health-literacy supportive environment, and improving cultural sensitivity in healthcare provision could help Syrian women better utilize medical care offered in Germany.

Factors influencing the nutritional behavior of Syrian migrants in Germany - results of a qualitative study.

BACKGROUND: Syrian migrants represent the third-largest group of foreigners in Germany and are therefore potential users of health promotion initiatives, including nutrition programs. It is little known how (healthy) nutrition is understood and implemented by this group and which factors influence their experiences related to food and eating in the host country. Thus, this study aimed to explore the importance of (healthy) nutrition, facilitators, and barriers of a preferred diet; nutritional changes in relation to the country of origin; and how nutrition may change with increasing length of stay. METHODS: Thirty semi-structured qualitative interviews with Syrian migrants (male = 16, female = 14, 18-35 years, length of stay 10-68 months) were conducted in 2018. Seventeen migrants could be followed-up after 12 months and were interviewed in 2019 again and were asked for changes in their nutritional behavior. Interviews were conducted in German, English, or Arabic, transcribed and translated into English if necessary. For analysis, an abbreviated version of the Grounded Theory was used. RESULTS: We identified six overarching themes that described influencing factors on a favored diet in Germany over the course of stay: (1) managing everyday life; (2) intercultural contact with local residents; (3) social context of cooking and eating; (4) ambiguity toward Arabic food; (5) mistrust toward certain types of food; and (6) influence of postmigration stressors. In general, the importance of nutrition is high among Syrian migrants. However, daily stressors, the lack of practical knowledge of how to cook favored dishes, and food insecurity in the new food environment make it difficult to obtain a preferred diet. With increasing stay, many developed a higher awareness of healthy eating, mainly due to a new independence or influences from the social environment in Germany. CONCLUSION: Results highlight the need for health promotion interventions to be more responsive to the specific needs of Syrian migrants, including nutrition. Syrian migrants differ in their capabilities, needs, and aims, and they should be addressed differently by health professionals, social services or migrant specific services. Future research should continue to focus on the living conditions of Syrian migrants and its influence on nutrition.

How German health insurance providers use social online networks to promote healthy lifestyles: a content analysis of Facebook® accounts.

BACKGROUND: Social networking sites such as Facebook® can contribute to health promotion and behaviour change activities, but are currently underused for this purpose. In Germany, health insurance companies are relevant public health agencies that are responsible for health promotion, primary prevention, and health education. We intended to analyse the Facebook® accounts of health insurance providers to explore the range of prevention topics addressed, identify the communication formats used, and analyse user activity stimulated by prevention-related posts. METHODS: We performed a quantitative content analysis of text and picture data on Facebook® accounts (9 months in retrospect) in a cross-sectional study design. 64/159 German health insurance providers hosted a Facebook® page, 25/64 posted ≥ 10 posts/months. Among those 25, we selected 17 health insurance companies (12 public, 5 private) for analysis. All posts were categorized according to domains in the classification system that was developed for this study, and the number of likes and comments was counted. The data were analysed using descriptive statistics. RESULTS: We collected 3,763 Facebook® posts, 32% of which had a focus on prevention. The frequency of prevention-related posts varied among health insurance providers (1-25 per month). The behaviours addressed most frequently were healthy nutrition, physical activity, and stress/anxiety relief, often in combination with each other. All these topics yielded a moderate user engagement (30-120 likes, 2-10 comments per post). User engagement was highest when a competition or quiz were posted (11% of posts). The predominant communication pattern was health education, often supplemented by photos or links, or information about offline events (e.g. a public run). Some providers regularly engaged in two-side communication with users, inviting tips, stories or recipes, or responding to individual comments. Still, the interactive potential offered by Facebook® was only partly exploited. CONCLUSIONS: Those few health insurace companies that regularly post content about prevention or healthy lifestyles on their Facebook® accounts comply with suggestions given for social media communication. Still, many health insurance providers fail to actively interact with wider audiences. Whether health communication on Facebook® can actually increase health literacy and lead to behaviour changes still needs to be evaluated.

Capacity building in participatory stakeholder groups: results from a German research consortium on active lifestyles.

To implement sustainable health-promoting structures in a setting, various agents must work together. In the Capital4Health research network, participatory stakeholder groups consisting of key persons, stakeholders, representatives of the target group, and facilitating experts are assembled in five settings (child care center, school, company, rural community, nursing home). In a Cooperative Planning process, the various groups meet regularly to plan and implement strategies to promote physical activity across different settings. This study evaluates whether participatory stakeholder groups have been established and also examines the capacity-building processes that took place in these stakeholder groups. For process evaluation, 78 group meetings were documented in 16 different stakeholder groups using a semi-structured protocol based on established capacity-building domains. For outcome evaluation, six semi-structured interviews (1-2 per setting) with facilitating experts were conducted. Data were analyzed by content analysis. Across all settings, capacity-building processes were successful to a certain degree (e.g. problem assessment, resource mobilization). However, in most groups it was difficult to broadly assess problems, to establish sustainable networks, or to find persons with leadership characteristics. Also, irregular participation, lack of motivation to take over responsibility, and minimal institutional readiness for structural and personal changes often hindered the progress of the projects. Stakeholder groups can actively involve setting members in the development of physical activity promotion programs. It seems challenging, however, to sustainably establish such groups that continue working independently without assistance from a facilitating expert.

It is well known that public health programs are most effective when health experts, setting members and the target group work together in developing and implementing suitable interventions that fit the needs of the target group. Stakeholder groups are well suited to facilitate the regular exchange between the different agents and the health experts. Although stakeholders are experts in their various living environments, it is often necessary to expand various capacities in order to successfully plan, implement and maintain interventions in the long term. We are interested in what is required to successfully establish such stakeholder groups, and how the capacity-building processes will work in them, in order to understand which capacities are easiest to improve and in which domains it is more difficult. Therefore, we monitored 15 different stakeholder groups over a time span of 3 years; these were assembled in five settings (child care center, school, company, rural community, nursing home) and addressed interventions for encouraging a physically active lifestyle. In total, 78 group meetings were documented using a semi-structured protocol based on established capacity-building domains. Afterwards, we held interviews with the health experts involved to identify barriers and enablers of the group processes.

[The Person Who Plays Handball Needs the Ball, the Contact and the Community - Changes in Sport Club Activities Due to the COVID-19 Pandemic and its Significance for Sports Clubs]. / "Der Mensch, der Handball spielt, braucht den Ball, den Kontakt und die Gemeinschaft" ­ Veränderungen im Sportangebot durch die COVID-19 Pandemie und deren Bedeutung für Sportvereine.

AIM: Sports clubs play an important role in the promotion of physical activity and health in Germany. Against the background of restrictions due to the COVID-19 pandemic, the present study explores the changes in sport activities and their significance for sports clubs. METHODS: We conducted 15 expert interviews with representatives of Bavarian sports clubs. The data were transcribed and evaluated inductively by means of thematic analysis. RESULTS: The clubs developed extensive activities to provide members with opportunities for sport and exercise even under the conditions of the COVID-19 pandemic. In general, the club members were understanding and positive towards the changes in the clubs. The participation in the newly created digital offers by the members seemed to differ from those in real courses. Nevertheless, the interviewees were skeptical about the long-term potential of digital sports offerings. Participants could miss the personal contact, the collective experience and team spirit when meeting only virtually. CONCLUSIONS: The efforts of the sports clubs to provide regular opportunities for sport and exercise during the COVID-19-pandemic underlines their importance for prevention and health promotion. From a public health perspective, changes in the offered activities may outlast the pandemic. However, further research is necessary.

[Risk communication in the containment of the COVID-19 pandemic: challenges and promising approaches]. / Risikokommunikation bei der Eindämmung der COVID-19-Pandemie: Herausforderungen und Erfolg versprechende Ansätze.

Risk communication plays a central role in public health emergencies: it must enable informed decisions, promote protective or life-sustaining behaviour, and maintain trust in public institutions. In addition, uncertainties in knowledge must be named transparently; irrational fears and rumours must be refuted. Success factors for risk communication are the participation of citizens as well as the continuous recording of risk perception and risk competence in population groups. The current COVID-19 (corona virus disease 2019) pandemic poses specific challenges for risk communication.The state of knowledge on many important aspects concerning COVID-19 was and is often uncertain or preliminary, e.g. on transmission, symptoms, long-term effects and immunity. Communication is characterised by scientific language and an array of figures and statistics, which can render the content difficult to understand. Alongside the official announcements and statements by experts, COVID-19 is widely communicated on social media, spreading misinformation and speculation; this "infodemic" can complicate risk communication.Various national and international scientific projects will help tailor risk communication on COVID-19 to target groups and thereby render it more effective. These projects include explorative studies on how people deal with COVID-19-related information; the COVID-19 Snapshot Monitoring (COSMO) project, a regularly conducted online survey on risk perception and protective behaviour; and an interdisciplinary qualitative study that compares the design, implementation and effectiveness of risk communication strategies in four countries.

[Cooperative planning of measures to promote physical activity : New paths for expanding capabilities-results from the Capital4Health research consortium]. / Kooperative Planung von Maßnahmen zur Bewegungsförderung : Neue Wege zur Erweiterung von Handlungsmöglichkeiten ­ Ergebnisse aus dem Forschungsverbund Capital4Health.

BACKGROUND: Despite various national and international political initiatives for promoting physical activity at the population level, the development of effective interventions for physical activity promotion remains a challenge. In this context, there is a growing interest in participatory approaches that actively involve central setting actors in the development of specific measures. AIM OF THE ARTICLE: This article reports on the experience made by the Capital4Health research consortium while using a participatory approach called "cooperative planning" to increase capabilities for physical activity across different age groups. RESULTS: Capital4Health employed the cooperative planning approach in the childcare, school, vocational training (car mechatronics and nursing), and community setting (with a focus on men 50+). While the central elements of the approach were implemented in all settings, planning processes varied significantly with respect to the spectrum of involved actors, the number of participants and sessions, the specific measures developed, the evaluation methods, and the effects achieved at an individual and systems level. CONCLUSION: From the perspective of the Capital4Health principal investigators, the preliminary empirical results from the different settings allow for the overall conclusion that the cooperative planning approach can work and generate health promotion impact in very different settings. However, it must (and can) be adapted to the respective setting, especially in relation to involving population groups. Actors' readiness for change is crucial, as physical activity does not always have top priority in settings. In this context, key individuals can make a decisive contribution to a project's success.

[SARS-CoV-2 incidence, transmission, and containment measures in daycare centers during the COVID-19 pandemic-findings from the Corona Daycare Study]. / Infektionsgeschehen und Eindämmungsmaßnahmen in Kitas während der COVID-19-Pandemie ­ Erkenntnisse aus der Corona-KiTa-Studie.

BACKGROUND: Daycare centers are of substantial sociopolitical and pedagogical relevance; at the same time, the close contact of children in daycare groups among each other and with employees favors the transmission of infections. In the COVID-19 pandemic, questions arose about how infection events occur in daycare centers, what role daycare children play in the pandemic, and what protective and hygienic measures are implemented in daycare centers. From 06/2020 to 12/2021, we conducted the "Corona Day Care Study," in which we address pedagogical and infection epidemiological topics in a joint approach. METHODS: In the study, data are collected from different sources. Official reporting data as well as weekly data from daycare centers in the so-called KiTa Register are continuously evaluated. In addition, SARS-CoV­2 outbreaks in daycare centers are investigated on site by repeated sample collection and interviews. RESULTS: SARS-CoV­2 infection incidence in daycare centers or in daycare-aged children was very dynamic from 03/2020 to 05/2021. In the second and third pandemic waves, the number of SARS-CoV­2 outbreaks in daycare centers rose sharply, accompanied by a substantial increase in daycare and group closures. Most recently, the proportion of affected children in outbreaks increased steadily. However, preliminary examinations of SARS-CoV­2 outbreaks (n = 28) revealed that, on average, only a fraction of daycare contact persons (6.8%) were infected by child index cases. Transmission frequencies differed markedly between the individual daycare centers. DISCUSSION: The combination of regularly collected reporting and survey data as well as outbreak investigations allows a multilayered monitoring and understanding of infection events in daycare centers; its findings could be incorporated into recommendations for public health measures.

'Wait and wait, that is the only thing they can say': a qualitative study exploring experiences of immigrated Syrian doctors applying for medical license in Germany.

BACKGROUND: Due to the civil war in Syria, many Syrian citizens have had to flee their country during recent years, among them many physicians. Germany is among the preferred immigration countries. Immigrant Syrian physicians could help overcome the prevailing shortage of medical specialists in Germany. This study explores the experiences and perceptions of Syrian physicians of the licensure process and job application. The study aims at understanding barriers in integrating Syrian doctors into the German health care system. METHODS: We conducted 20 semi standardized interviews with Syrian doctors (n = 17 m; n = 3 f) living in different federal states in Germany. The interviews dealt with the procedure of the accreditation process, its speed and challenges, the interactions with authorities, and the job application process; they were transcribed verbatim. A detailed content analysis was performed. RESULTS: All interviewees described the licensure process as a complex, lengthy, ever-changing and non-transparent procedure, which is perceived as a partly unfair, sometimes arbitrary bureaucracy. They often feel at mercy of Government employees and report experiences with reviewers who ask for absurd and impossible accomplishments, refuse to give information, and act at random. As a consequence, the interviewees describe themselves as depressed, irritated and/or in despair. According to the interviews, informational and practical support from official institutions was scarce. Instead, the Syrian doctors relied on peers or, in some cases, German friends to understand the requirements and seek information about the licensure process. To find a job placement, it was very helpful, if not essential, to have a German acquaintance establishing contact with possible employers. All three interviewed female doctors reported that their wearing a Hijab led to episodes of discrimination in their job search. CONCLUSIONS: The study points towards the necessity to establish an official information source which provides immigrant doctors with accurate and detailed information about the licensure process, e.g. required documents, estimated waiting times, regulation for courses and exams, criteria regarding credentials, sources of help, etc. Additionally, it seems advisable to consider providing help with regard to the job search and sensitize hospital management for cultural and religious diversity to avoid discrimination.

[Political Implementation of Population-Level Prevention: Challenges and Success Factors]. / Politische Umsetzung von Verhältnisprävention auf Bevölkerungsebene: Herausforderungen und Erfolgsfaktoren.

Public policy plays a key role in creating health-promoting environments. Implementation of effective policies is often hampered by lobbyism, compartimentalized policy fields, and cultural rifts between academia and politics. Improved communication and cooperation between researchers and policymakers, engagement of the public, and alliances with civil society can help to overcome these barriers.

German senior citizens' capabilities for physical activity: a qualitative study.

Sen's capability approach (CA) has found its way into health promotion over the last few years. The approach takes both individual factors as well as social and environmental conditions into account and therefore appears to have great potential to explore opportunities for ('capabilities') and barriers to active lifestyles. Thus, our objective in this study was to investigate which capabilities senior citizens perceive to have available to them in order to be physically active. In Southern Germany, we conducted 26 semi-standardized interviews with senior citizens aged 66-97, as well as 9 interviews with key persons who have close contact to senior citizens in their work life. We identified 11 capabilities which the interviewees considered as important in leading an active lifestyle. They could be grouped into four domains: (1) individual resources, (2) social interactions and norms, (3) living conditions and (4) organizational environment. Results highlight the need for health-promoting interventions that widen the range of capabilities on social and environmental levels in a way that individuals can freely choose to be as physically active as they like. The results make clear that interventions should not only target and involve older adults themselves, but also their families, nursing home staff or community representatives, because these groups are important in shaping older adults' capabilities for an active lifestyle.