Implementing evidence ecosystems in the public health service: Development of a framework for designing tailored training programs.

The COVID-19 pandemic has highlighted the importance of local evidence ecosystems in which academia and practice in the Public Health Service (PHS) are interconnected. However, appropriate organizational structures and well-trained staff are lacking and evidence use in local public health decision-making has to be integrated into training programs in Germany. To address this issue, we developed a framework incorporating a toolbox to conceptualize training programs designed to qualify public health professionals for working at the interface between academia and practice. We conducted a scoping review of training programs, key-informant interviews with public health experts, and a multi-professional stakeholder workshop and triangulated their output. The resulting toolbox consists of four core elements, encompassing 15 parameters: (1) content-related aspects, (2) context-related aspects, (3) aspects relevant for determining the training format, and (4) aspects relevant for consolidation and further development. Guiding questions with examples supports the application of the toolbox. Additionally, we introduced a how-to-use guidance to streamline the creation of new training programs, fostering knowledge transfer at the academia-practice interface, equipping public health researchers and practitioners with relevant skills for needs-based PHS research. By promoting collaborative training development across institutions, our approach encourages cross-institutional cooperation, enhances evidence utilization, and enables efficient resource allocation. This collaborative effort in developing training programs within local evidence ecosystems not only strengthens the scientific and practical impact but also lays a foundation for implementing complex public health measures effectively at the local level.

[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.

Ensuring Networks Work Well: Development of a Self-evaluation Tool for Network Quality in Community Health Promotion.

BACKGROUND: Networks are an essential component of community-based health research. Community-based networks require a high degree of collaboration, and the quality of this collaboration is a key factor for intervention success. As such, it is important to measure collaboration quality through network evaluation. Established tools, such as social network analysis, primarily measure connections between network members as opposed to network quality. Additionally, only few tools developed for this purpose are used in practice. METHODS: This paper describes the process of developing a network assessment tool to measure the quality of network collaboration in practice. To this end, we collaborated with practice partners from a community-based health promotion network and the community health service. We adopted a mixed-methods approach consisting of a literature review and a needs assessment involving practical experts in Germany. On this basis, we developed a new network evaluation tool, the Self-Evaluation Tool for Network Quality Assessment by Practitioners in Community Health Promotion (SNAP-HP), in cyclic-iterative collaboration with our practice partners. CONCLUSIONS: The next steps include piloting, evaluating, and adapting the SNAP-HP for final open access.

Racism in public health services: A research agenda.

Despite racism and its impact on health inequities being increasingly studied in health care settings, racism in public health services has so far been neglected in public health research. Studying racism in public health services provides many opportunities to explore the relationship between racism and health protection. We identify several research themes to be explored on (1) non-stigmatizing and community-driven risk communication, (2) surveillance by public health authorities of racialized minority groups, (3) racism experiences in everyday interactions with public health authorities, (4) legal consequences of encounters with public health authorities and (5) public health infrastructure, structural racism and the intersectionality of marginalization. Tackling these research themes will help to start building an evidence base on how racism interferes with equitable health protection and how to dismantle it.

What Factors Influence the Interest in Working in the Public Health Service in Germany? Part I of the OeGD-Studisurvey.

As in many European countries, the Public Health Service (PHS) in Germany has had considerable difficulties in attracting well-qualified personnel for decades. Despite ongoing political and societal debate, limited empirical research on possible causes and explanations is available. To identify areas of action, we explored reasons for the (lack of) interest in working in the PHS by conducting two cross-sectional surveys among 3019 medical students (MS), public health students, and students from other PHS-relevant fields (PH&ONM) in Germany right before (wave 1, 2019/2020) and during the COVID-19 pandemic (wave 2, 2021). While interest in working in the PHS among MS was low, it was considerably higher among PH&ONM. The prevalent underestimation of the importance of public health and low levels of knowledge about the PHS were identified as potential barriers. Although core activities of the PHS were often considered attractive, they were repeatedly not attributed to the PHS. A negative perception of the PHS (e.g., it being too bureaucratic) was prevalent among students with and without PHS interest, indicating that both a negative image and potentially structural deficits need to be overcome to increase attractiveness. Based on the findings, we propose approaches on how to sustainably attract and retain qualified personnel.

Closing the gap between practice and science in school- and community-based participatory physical literacy promotion: study protocol of the StuPs project.

BACKGROUND: The role of physical activity in the promotion of children's well-being and health is widely known. However, research indicates that the time spent physically exercising and participating in organized sport activities is decreasing among children. Although there is currently no gold standard for promoting sustainable physical activity in children, community-based approaches, particularly those that are multicomponent, appear to be the most successful. The project StuPs: a school- and community-based participatory approach for promoting physical activity in children and their families aims to develop a community-based approach to promoting physical activity by increasing physical literacy among elementary school children and their household members. METHODS: The project is built upon the intervention mapping approach and consists of two periods with an overall duration of 3 years. Period I will last 9 months and include an assessment of needs, wants, strengths, and weaknesses regarding physical activity and health promotion at the community- and school-based level according to the keywords "capacity building" and "physical literacy." Based on the knowledge gained in this stage, measures for capacity building to promote healthy lifestyles and physical literacy in children will be developed using the community-based participatory research and capacity building approach. In Period II, the measures will be applicated, implemented and evaluated using a pre-/post-design to assess efficacy. DISCUSSION: Although the efficacy of using community-based and capacity building approaches to reach children is promising, there remains a gap regarding best practices for changing existing structures and habits over the long term and in the sense of promoting physical literacy.

[Good practice in health reporting-from the beginning to version 2.0]. / Gute Praxis Gesundheitsberichterstattung ­ von der Idee bis zur Version 2.0.

In the context of public health, health reporting functions as a mediator between science and policy. The development of guidelines for good practice in health reporting took place in response to needs that were frequently expressed by experts in this public health area. The pilot version of the guidelines was drawn up in 2011 and discussed at a number of relevant conferences. After the publication of version 1.0 in 2017, another peer review process followed, which led to the extensively revised guidelines for good practice in health reporting as version 2.0. As health reporting is currently in a process of innovation and increasing in importance, it is foreseeable that the guidelines will have to be revised again in the not too distant future.

[Contact-Tracing Apps in Contact Tracing of COVID-19]. / Contact-Tracing-Apps als unterstützende Maßnahme bei der Kontaktpersonennachverfolgung von COVID-19.

Contact tracing is currently one of the most effective measures to contain the COVID-19 pandemic. In order to identify persons that would otherwise not be known or remembered and to keep the time delay when reporting an infection and when contacting people as short as possible, digital contact tracing using smartphones seems to be a reasonable measure additional to manual contact tracing. Although first modelling studies predicted a positive effect in terms of prompt contact tracing, no empirically reliable data are as yet available, neither on the population-wide benefit nor on the potential risks of contact tracing apps. Risk-benefit assessment of such an app includes investigating whether such an app fulfils its purpose, as also research on the effectiveness, risks and side effects, and implementation processes (e. g. planning and inclusion of different participants). The aim of this article was to give an overview of possible public health benefits as well as technical, social, legal and ethical aspects of a contact-tracing app in the context of the COVID-19 pandemic. Furthermore, conditions for the widest possible use of the app are presented.

Good Practice in Health Reporting - Guidelines and Recommendations 2.0: The boards of the German Society for Social Medicine and Prevention and the German Society for Epidemiology have approved this second edition of Good Practice in Health Reporting.December 2018.

Health reporting provides a description of the health of the population, analyses problems and demonstrates areas in which action needs to be taken in health care provision, health promotion and disease prevention. Accordingly, it offers a rational basis for participatory processes and health policy decision-making. This edition of Good Practice in Health Reporting resulted from a revision of the first edition, which was first published in March 2017. It incorporates contributions from experts, and various institutions and associations from the German federal-state and national levels. This revised edition rose out of the need for continual development in health reporting. In some cases, a number of changes were made so that certain aspects could be defined more clearly; in other cases, changes were made to methodology, for example, in order to accommodate participatory and qualitative approaches. This publication is aimed at providing people working in health reporting with professional direction and guidance. We welcome your feedback.

[Methodological Challenges of Prevention Reporting - More to it Than Just Evidence Reporting!] / Methodische Herausforderungen der Präventionsberichterstattung.

BACKGROUND: The German Prevention Act came into force in 2015 with the aim of strengthening prevention of disease and health promotion, focussing on settings-based approaches. An established field of public health action is thus strengthened and expanded by a set of rules that has largely come into force as a social security law. The implementation of legislation is to be accompanied by the establishment of a prevention reporting system. AIMS: Types of reporting are contextualized and delimited from one another by means of the planning stages of the public health action cycle with their different goals, content and data sources. RESULTS: Prevention reports must reflect not only the state of health and intervention features but also intended and unintended structural changes in the public health action field. Due to its obvious relevance to the envisioned settings, the local level seems to be of particular importance. Special attention also deserves legally unintended shifts of tasks from public to social security financing. A reporting system misconceived primarily as evidence reporting would be likely to fail the intended strengthening of settings-based approaches and instead would favour downstream measures that are easier to evaluate.

Good Practice in Health Reporting - guidelines and recommendations.

Health reporting provides descriptions of the health of a population, analyses problems and demonstrates areas in which action needs to be taken in health care, health promotion and disease prevention. As such, it provides a rational basis for participatory processes and a foundation for health policy decision-making. Good Practice in Health Reporting was developed by a working group that includes representatives from all levels of health reporting with the aim of strengthening the field at the local, federal-state and national level. The document sets out guidelines and recommendations that are intended to provide professional guidance for the creation of health reports. It makes 11 recommendations that address the ethical principles behind health reporting, the necessary framework, the selection of topics (the report's focus), the foundation of the work undertaken (data quality), data preparation, analysis, interpretation and protection, as well as communications and quality assurance. The pilot version of the document was presented at the conferences of the German Society for Epidemiology (DGEpi), the German Society for Social Medicine and Prevention (DGSMP) and the Federal Association of Physicians of German Public Health Departments (BVÖGD) where it was discussed and subsequently revised. After further review, the guidelines were adopted by all of these institutions. Finally, Good Practice in Health Reporting is to be strengthened and developed further as part of a comprehensive review.

The measurement of effort-reward imbalance at work: European comparisons.

Using comparative data from five countries, this study investigates the psychometric properties of the effort-reward imbalance (ERI) at work model. In this model, chronic work-related stress is identified as non-reciprocity or imbalance between high efforts spent and low rewards received. Health-adverse effects of this imbalance were documented in several prospective and cross-sectional investigations. The internal consistency, discriminant validity and factorial structure of 'effort', 'reward', and 'overcommitment' scales are evaluated, using confirmatory factor analysis. Moreover, content (or external) validity is explored with respect to a measure of self-reported health. Data for the analysis is derived from epidemiologic studies conducted in five European countries: the Somstress Study (Belgium; n = 3796), the GAZEL-Cohort Study (France; n = 10,174), the WOLF-Norrland Study (Sweden; n = 960), the Whitehall II Study (UK; n = 3697) and the Public Transport Employees Study (Germany; n = 316). Internal consistency of the scales was satisfactory in all samples, and the factorial structure of the scales was consistently confirmed (all goodness of fit measures were > 0.92). Moreover, in 12 of 14 analyses, significantly elevated odds ratios of poor health were observed in employees scoring high on the ERI scales. In conclusion, a psychometrically well-justified measure of work-related stress (ERI) grounded in sociological theory is available for comparative socioepidemiologic investigations. In the light of the importance of work for adult health such investigations are crucial in advanced societies within and beyond Europe.

Effort-reward imbalance model and self-reported health: cross-sectional and prospective findings from the GAZEL cohort.

Psychosocial factors at work have been found to be significant contributors to health, especially cardiovascular health. This study is aimed at exploring the relationship between psychosocial factors at work as defined by the effort-reward imbalance (ERI) model and self-reported health, using alternative formulations of this model, and comparing cross-sectional and prospective analyses for a large occupational cohort of men and women. The French version of the ERI model was used to measure the three scales of effort, reward, and overcommitment. Self-reported health was used as health outcome. Covariates included chronic diseases, frequent depressive symptoms, and personal, occupational, and behavioural factors. The cross-sectional and prospective analyses concerned, respectively, 10175 and 6286 workers. Men and women were analysed separately. Cross-sectional analysis revealed that ERI was significantly associated with self-reported health whatever the formulation used (ratio over one, quartiles, continuous ratio, or log-transformed ratio) for both genders. When effort and reward were studied as two separate variables, reward was a significant risk factor for both genders, whereas effort was for men only. Overcommitment was also found to be a risk factor for self-reported health for both sex. Prospective analysis showed that ERI was a significant predictor of poor self-reported health for men and women for two formulations (continuous ratio and log-transformed ratio). For both genders, effort did not predict self-reported health, but reward did. Overcommitment was predictive of poor self-reported health for men only. Our results highlighted the predictive effects of the ERI model on self-reported health in a 1-year follow-up study. They urged to explore various formulations of the ERI model. They also underlined the need for longitudinal study design and separate analyses for men and women in the field of psychosocial factors at work.

[Effort-reward imbalance at work and depressive symptoms--a cross-sectional investigation of middle-aged employees]. / Berufliche Gratifikationskrisen und depressive Symptome--Eine Querschnittsstudie bei Erwerbstätigen im mittleren Erwachsenenalter.

This study explored associations of psychosocial stress at work with depressive symptoms in a group of middle-aged employees. Psychosocial stress at work was conceptualized in terms of the model of effort-reward imbalance. This model is measured by a psychometric scale containing 23 Likert-scaled items. Depressive symptoms were assessed by the German version of the CES-D scale. The sample consisted of 316 (44.6 +/- 7.5 years) men and women employed in an urban transport enterprise. Multivariate logistic regression analysis adjusting for relevant confounders indicated an odds ratio of 5.9 (95 % CI 2.4 - 14.3) for depressive symptoms among employees defined by imbalance of high effort and low reward at work. An association of similar strength was found among employees characterized by a high level of work-related over-commitment. Findings reported for the first time in Germany are in line with two international investigations.

Perceived work stress, overcommitment, and self-reported musculoskeletal pain: a cross-sectional investigation.

The objective of this study was to analyze associations of three indicators of perceived work stress (physical job demand, low control at work, and an imbalance between effort and reward), and of overcommitment, a personal pattern of coping with work demands, with musculoskeletal pain. A standardized questionnaire measuring these conditions in addition to self-reported musculoskeletal pain at different locations was administered to a group of 316 male and female employees of a public transport enterprise. After we adjusted for confounding effects of age, sex, socioeconomic status, shift work, and negative affectivity, we observed elevated prevalence odds ratios in employees who scored high on overcommitment, who were exposed to physical job demand, and, to a lesser extent, who reported psychosocial work stress. Results have implications for a more comprehensive approach to primary and secondary prevention of musculoskeletal pain.