Retirement and Volunteering in Germany - Historical Changes and Social Inequalities.

The first years of retirement have often been seen as a typical time window to take up (or intensify) voluntary work. Due to the changing context of retirement and historical differences in resources, the role of retirement for volunteering may have changed with historical time. We compared individuals aged 60-70 in five cross-sectional waves (1999, 2004, 2009, 2014, 2019) of the German Survey on Volunteering (Deutscher Freiwilligensurvey: FWS) to investigate how the association of retirement status and volunteering has changed. We found a negative association of retirement and volunteering, which was not significant once controlling for age, education, gender and region. While engagement levels seem to have increased with historical time, voluntary work seems to have become less time consuming. There were no historical differences in the association of retirement and volunteering. Our results highlight the role of historical time and contextual factors when investigating volunteering and post-retirement activities.

First evidence of widespread anticoagulant rodenticide exposure of the Eurasian otter (Lutra lutra) in Germany.

Exposure of wildlife to anticoagulant rodenticides (ARs) has been extensively documented for species directly or indirectly linked to pest rodents via the terrestrial food web. Recently, the scientific focus extended to a former blind spot, namely AR emissions to the aquatic environment, and provided clear evidence of AR residues in freshwater fish. As second-generation ARs are likely to be transferred along the aquatic food chain, a total of 122 Eurasian otter (Lutra lutra) individuals found dead in Germany between 2005 and 2021 were investigated to shed more light on resultant environmental risks. Target analytes comprised one pharmaceutical and eight biocidal anticoagulants, as well as one suspected bait impurity. Notably, all target compounds were detected in the analyzed livers of otters, a primarily piscivorous top predator and indicator species for the aquatic environment, strictly protected by conservation laws. In regions with pronounced rodent control measures, otters were frequently exposed to biocidal ARs. The elevated AR levels measured in multiple otters, compared to freshwater fish, hinted at biomagnification of second-generation ARs within the aquatic food web. The results indicated that risk mitigation measures implemented in Germany within the biocidal product authorization may not be sufficient to protect aquatic non-target wildlife from AR exposure, challenging the effectiveness of current regulatory measures.

Internet Use in Very Old Age: The Role of the Social Context and Individual Characteristics.

The social context plays an important role in very old age. However, little is known about its relationship with internet use, whereas individual characteristics (e.g., sociodemographic variables, and health status) are better studied. Still, representative studies for the oldest old are missing. Therefore, this study analyzes the relationship between social context variables and individual characteristics with internet use in a representative sample of oldest old from North Rhine-Westphalia, Germany (N = 1,862; Mage = 85.43, SDage = 4.15). Descriptive statistics reveal differences between oldest old onliners and offliners regarding their social context and individual characteristics. Logistic regression analyses show that the significant role of the social context (family and living situation, social contacts and activities) diminishes after adding individual characteristics to the model, which appear to be significantly related to internet use. The results indicate an association of social context variables and individual characteristics with internet use in very old age.

Improvement of the EN ISO 10273:2017 method for the cultural detection of Yersinia enterocolitica in meat.

The isolation of Yersinia enterocolitica from food is challenging, because the bacteria are readily overgrown by the concomitant microflora. In addition, thus far, no strictly selective medium for this species is available. The gold standard for cultural detection of Y. enterocolitica in food is described in the EN ISO 10273:2017. It includes a direct plating step that only enables the detection of large numbers of yersiniae. In addition, plating of the bacteria after selective enrichment for two days and a treatment with potassium hydroxide is mandatory. This approach may be critical, if the sample is highly contaminated with bacteria. Due to these limitations we improved the ISO procedure by adding a filtration and centrifugation step together with shortening the enrichment to only 6 h. This approach allowed a (i) more sensitive cultural detection than direct plating, (ii) limitation of background bacteria and (iii) saving of two days. The performance of the procedure was evaluated on minced meat samples, purchased at five supermarkets in Germany that were spiked with different numbers down to 4-6 cfu of a bioserotype B4/O:3 strain. Regardless of the background bacteria, the added strain could be isolated from every spiked sample. Moreover, biotype 1A isolates and other Yersinia species were recovered from some samples.

Temporal trends in age- and stage-specific incidence of colorectal adenocarcinomas in Germany.

BACKGROUND: A national colorectal cancer (CRC) screening programme was launched in 2002 in Germany. A comprehensive evaluation of the programme effectiveness using real-world data is still lacking. In addition, there are regional reports on increasing colorectal cancer incidence in younger populations. Therefore, we aimed to describe and compare the overall, age- and stage-specific incidence trends for colorectal, colon and rectal cancer. METHODS: We used data from seven population-based cancer registries in Germany. We report absolute and relative changes in incidence rates between the early screening phase (2003-2005) and the most recent time period available (2015-2017), as well as annual percent changes. We analysed incidences according to tumour site (colorectum, colon, and rectum) and to six age groups (young adults: 15-34, 35-39, 40-49, screening-entitled/older adults: 50-54, 55-69 and 70 + years old). RESULTS: In our sample of 271,011 colorectal adenocarcinomas, about two-thirds were located in the colon and 95% of them occurred in the age group 50+ (50-54: 5%, 55-69: 32.8%, 70+: 57.2%). For the time period 2003-2005 the age-specific incidence rates of individuals in the age group 55-69 were about 76/100,00 for colon and 54/100,000 for rectal cancer (age group 70 + colon: 179/100,000; rectum: 84/100,000). The incidence rates in young adults were less than 13% of that of individuals in the age group 55-69 (< 5% of individuals aged 70+; <33% of individuals aged 50-54). Over time, incidence decreased in individuals at the age of 55+, for all subsites considered as well as for early and late stage cancers (with few exceptions), while incidence of young adult CRC (both early and late stage) increased steepest in the youngest age groups. For late stage rectal cancer, a shift was observed in all age groups from UICC stage IV to stage III being the most frequent stage. CONCLUSIONS: Six years after the introduction of the national colonoscopy screening program, late stage CRC incidence began to decline substantially in the screening-eligible age groups (55-69, 70+). It is likely that this decline and the increase in early stage CRC observed in younger age groups can be attributed to the program. Long lasting public awareness campaigns for CRC screening might have led to opportunistic screening in younger adults. Whether these benefits outweigh the possible harm of screening in younger age groups remains unclear.

Waves in time, but not in space - an analysis of pandemic severity of COVID-19 in Germany.

While pandemic waves are often studied on the national scale, they typically are not distributed evenly within countries. This study presents a novel approach to analyzing the spatial-temporal dynamics of the COVID-19 pandemic in Germany. By using a composite indicator of pandemic severity and subdividing the pandemic into fifteen phases, we were able to identify similar trajectories of pandemic severity among all German counties through hierarchical clustering. Our results show that the hotspots and cold spots of the first four waves were relatively stationary in space. This highlights the importance of examining pandemic waves on a regional scale to gain a more comprehensive understanding of their dynamics. By combining spatial autocorrelation and spatial-temporal clustering of time series, we were able to identify important patterns of regional anomalies, which can help target more effective public health interventions on a regional scale.

Ecological and clinical evidence of the establishment of West Nile virus in a large urban area in Europe, Berlin, Germany, 2021 to 2022.

BackgroundWest Nile virus (WNV), found in Berlin in birds since 2018 and humans since 2019, is a mosquito-borne virus that can manifest in humans as West Nile fever (WNF) or neuroinvasive disease (WNND). However, human WNV infections and associated disease are likely underdiagnosed.AimWe aimed to identify and genetically characterise WNV infections in humans and mosquitoes in Berlin.MethodsWe investigated acute WNV infection cases reported to the State Office for Health and Social Affairs Berlin in 2021 and analysed cerebrospinal fluid (CSF) samples from patients with encephalitis of unknown aetiology (n = 489) for the presence of WNV. Mosquitoes were trapped at identified potential exposure sites of cases and examined for WNV infection.ResultsWest Nile virus was isolated and sequenced from a blood donor with WNF, a symptomatic patient with WNND and a WNND case retrospectively identified from testing CSF. All cases occurred in 2021 and had no history of travel 14 days prior to symptom onset (incubation period of the disease). We detected WNV in Culex pipiens mosquitoes sampled at the exposure site of one case in 2021, and in 2022. Genome analyses revealed a monophyletic Berlin-specific virus clade in which two enzootic mosquito-associated variants can be delineated based on tree topology and presence of single nucleotide variants. Both variants have highly identical counterparts in human cases indicating local acquisition of infection.ConclusionOur study provides evidence that autochthonous WNV lineage 2 infections occurred in Berlin and the virus has established an endemic maintenance cycle.

Determinants of psychosocial factors amongst the oldest old: Longitudinal evidence based on the representative "survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia".

OBJECTIVES: There are few studies investigating the determinants of psychosocial outcomes using data exclusively from the oldest old; and even fewer that use longitudinal data. Thus, our aim was to explore the determinants of psychosocial factors (in terms of life satisfaction, loneliness, and depressive symptoms) amongst the oldest old (also stratified by sex) based on representative, longitudinal data from Germany. METHODS/DESIGN: Data from "Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)" were used. This study includes community-dwelling and institutionalized individuals aged 80 years and above (n = 1760 observations in the analytical sample) located in North Rhine-Westphalia (the most populous state in Germany). The mean age was 86.6 years (SD: 4.3 years). Established instruments were used to quantify life satisfaction, loneliness, and depressive symptoms. Linear FE regressions were used in this study to mitigate the challenge of unobserved heterogeneity. Sex-stratified regressions were also conducted. RESULTS: Regressions showed that the loss of a spouse was significantly associated with worsening psychosocial factors (in terms of increases in depressive symptoms and loneliness). Furthermore, regressions revealed that increases in functional impairment were significantly associated with poorer psychosocial outcomes. CONCLUSIONS: This longitudinal study enhanced our understanding of the factors contributing to poorer psychosocial outcomes among the oldest old. Efforts to avoid or postpone functional impairment may contribute to more favorable psychosocial outcomes. Moreover, our current study underlines the importance of spousal relationships for psychosocial outcomes in the oldest age group.

Seropositivity of Borrelia burgdorferi s.l. in Germany-an analysis across four German National Cohort (NAKO) study sites.

Lyme borreliosis (LB) is caused by the transmission of Borrelia burgdorferi s.l. from ticks to humans. Climate affects tick abundance, and climate change is projected to promote shifts in abundance in Europe, potentially increasing human exposure. We analyzed serum samples collected between the years 2014-2019 from German National Cohort (NAKO) participants at four study sites (Augsburg, Berlin, Hanover, Münster) for immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using an enzyme-linked immunosorbent assay (ELISA) and line blot immunoassay as confirmatory test for positive and equivocal ELISA samples. We reported crude and weighted seropositivity proportions for local estimates. We used mixed model analysis to investigate associated factors, such as age, sex, migration background, or animal contacts. We determined the serostatus of 14,207 participants. The weighted seropositivity proportions were 3.4% (IgG) and 0.4% (IgM) in Augsburg, 4.1% (IgG) and 0.6% (IgM) in northern Berlin, 3.0% (IgG) and 0.9% (IgM) in Hanover, and 2.7% (IgG) and 0.6% (IgM) in Münster. We found higher odds for IgG seropositivity with advancing age (p < 0.001), among males compared to females (p < 0.001) and reduced odds among participants with migration background compared to those without (p = 0.001). We did not find evidence for an association between serostatus and depression, children within the household, or animal contact, respectively. We found low seropositivity proportions and indications of differences across the study locations, although between-group comparisons did not yield significant results. Comparisons to earlier research are subject to important limitations; however, our results indicate no major increases in seropositivity over time. Nevertheless, monitoring of seropositivity remains critical in light of potential climate-related Borrelia exposure.

[Pulmonary arterial hypertension in congenital heart disease - Part I]. / Pulmonale arterielle Hypertonie bei Erwachsenen mit angeborenen Herzfehlern ­ Teil I.

The number of adults with congenital heart disease (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary arterial hypertension (PAH), which may develop early in untreated CHD. Despite timely treatment of CHD, PAH often persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart defects" is addressed only relatively superficially in these guidelines. Therefore, this article addresses the perspective of congenital cardiology in greater depth.

Treatment satisfaction of adult patients with moderate-to-severe atopic dermatitis treated with baricitinib in France, Germany, and the United Kingdom: results from a cross-sectional international patient survey.

INTRODUCTION: We explored patient satisfaction with baricitinib, an oral Janus kinase inhibitor, in patients with atopic dermatitis (AD) treated in routine clinical practice. METHODS: Adults with moderate-to-severe AD treated with baricitinib in clinical practice for ≥4 weeks in France, Germany, and the UK completed a one-time online survey under market research methodologies. Treatment satisfaction was assessed using a Likert scale and abbreviated Treatment Satisfaction Questionnaire for Medication (TSQM-9). Patients reported demographic, disease, and treatment information. Data were analyzed descriptively. RESULTS: The survey was completed by 170 patients with a mean age of 39.3 years (SD = 13.5), 59% (n = 101) were female. At baricitinib initiation, 79% rated their AD as "Severe", yet 28% reported body surface area (BSA) involvement ≥10%. Most were "Satisfied" or "Very satisfied" (76%/18%) with baricitinib, with high rates reported for controlling itch (36%/56%). Itch improvements were noted by 97% of patients. Some tapered/stopped (50%/32%) topical corticosteroid use, aligned with reported improvements on the patient global assessment and BSA. Mean TSQM-9 convenience score was 78.0 (SD = 14.0). CONCLUSIONS: Satisfaction with itch control was particularly high, reflected in rates of improvement in itch since starting baricitinib. On the TSQM-9, the convenience score was the highest. Many patients tapered/stopped concomitant topicals, indicating baricitinib's effect in controlling AD symptoms.

Burden of sequelae and healthcare resource utilization in the first year of life in infants born with congenital cytomegalovirus (cCMV) infection in Germany: A retrospective statutory health insurance claims database analysis.

BACKGROUND: Congenital cytomegalovirus (cCMV) infection can have a broad range of manifestations. This study aimed to assess cCMV-associated sequelae and healthcare resource utilization (HCRU) in infants during the first year of life in Germany. METHODS: A retrospective, controlled cohort study using German claims data from the Institute for Applied Health Research Berlin (InGef) database was conducted. cCMV-associated sequelae and HCRU during the first year of life were assessed by matching (1:60) infants with at least one inpatient/outpatient cCMV diagnosis (ICD-10-GM: P35.1) ≤90 days after birth (cCMV90 cohort) and infants with at least one inpatient cCMV diagnosis plus specific sequelae ≤21 days after birth (cCMV21-S) to infants without cCMV or CMV (ICD-10-GM: B25) diagnosis (control group), respectively. Outcomes were analyzed during the first 365 days of life. RESULTS: Between 2014-2018, we identified 54 newborns for cCMV90 and 24 newborns for cCMV21-S cohort. Compared to the 3,240 and 1,440 controls, respectively, more cCMV90 infants (83.3% vs. 41.9%, p<0.01) presented with at least one sequela during the first year of life, including intrauterine growth retardation (42.6% vs. 5.3%, p<0.01), sensorineural hearing loss (SNHL) to deafness (38.9% vs. 2.2%, p<0.01), and motor development disorders (33.3% vs. 10.9%, p<0.01). Further, 13.0% of cCMV90 infants (vs. 2.3%, p<0.01) suffered from visual impairment. In cCMV21-S cohort, intrauterine growth retardation (79.2% vs. 6.0%, p<0.01), prematurity (54.2% vs. 7.3%, p<0.01), and motor development disorders (50.0% vs. 11.0%, p<0.01) were the most frequent sequelae. Infants in the cCMV90 and cCMV21-S cohort had, on average, 7.3 times and 9.5 times more hospitalizations and 2.0 times and 2.1 times more outpatient physician visits than their respective controls (p<0.01). Hospitalized infants with cCMV stayed, on average, significantly longer in hospital compared to their controls (cCMV90 cohort: 30.3 days vs. 9.0 days, p<0.01; cCMV21-S cohort: 46.5 days vs. 9.3 days, p<0.01). CONCLUSIONS: cCMV-infection shows a considerable disease and healthcare burden during the first year of life. More than 80% of the identified newborns with cCMV suffered from at least one associated sequela during the first year of life, including long-term sequelae such as SNHL (40%) and visual impairment (13%). Additional steps for prevention of cCMV infection and associated sequelae as well as a comprehensive monitoring of disease burden are needed.

[Stressful Living Conditions in Nuclear, Single Parent and Stepfamilies and Use of Prevention Services. Findings of Two Representative German Studies]. / Belastungslagen von Alleinerziehenden-, Stief- und Kernfamilien Inanspruchnahme von Unterstützungsangeboten. Befunde aus zwei repräsentativen deutschen Studien.

AIM OF THE STUDY: Comparison of (stressful) living conditions and use of universal, selective and indicated prevention services in nuclear, single parent and stepfamilies with young children. METHODS: Using two representative German surveys of mothers with children aged 0-3 years (KiD 0-3 2015, n=6,671, and AID:A 2019, n=1,501), mothers' reported burden and the use of various prevention services in different family types were examined descriptively and with Chi²-tests. RESULTS: Overall, single parent families and, to some extent, stepfamilies showed increased socioeconomic stress compared to nuclear families (e. g., young motherhood, higher poverty risk). In particular, universal prevention services (e. g., prenatal classes, parent-child courses) were used less frequently by single parent families, while selective and indicated services such as family or child guidance counselling services and offers of youth welfare agencies were used more frequently. CONCLUSION: Increased socioeconomic stress suggests a higher need for support among single parents compared to nuclear families. Universal group offers are possibly not sufficient to meet these needs, whereas selective individual counselling offers such as pregnancy and child guidance counseling are used more frequently by single parent families and stepfamilies compared to nuclear families. There seems to be a lack of (group) offers tailored to single parent families - particularly in the first developmental phase of a child's life.

[Research program "City of the Future - Healthy and Sustainable Metropolises"]. / Forschungsförderprogramm "Stadt der Zukunft ­ gesunde und nachhaltige Metropolen".

Urbanization is advancing worldwide and thus, cities are increasingly living spaces for people. Therefore, it is essential to place the health and well-being of city dwellers at the center of urban planning. The research funding program "City of the Future - Healthy and Sustainable Metropolises" from the Fritz and Hildegard Berg Foundation at the German Stiftungszentrum has been providing important inter- and transdisciplinary research impulses on this topic since 2010. Junior research groups at the interfaces of health sciences and other disciplines in the natural and social sciences were funded. One focus of the research program is to enable intensive cooperation with practitioners, in order to reflect upon and work on problems and issues from practice using the best possible scientific methods and to catalyze the transfer of knowledge. The research consortia are accompanied by annual conferences on a wide variety of urban health topics at various venues in Germany. In addition, transdisciplinary networks have been established and further initiatives (e. g., founding of an institute) have been launched. In this paper, the development of the multifaceted research funding program "City of the Future - Healthy and Sustainable Metropolises" is presented, including an outlook into its future development.

[Recommendations for Contact Tracing for Tuberculosis - Update 2023]. / Empfehlungen für die Umgebungsuntersuchungen bei Tuberkulose ­ Update 2023.

The aim of contact tracing for tuberculosis is in addition to active case finding the detection of chains of infection and the prevention of the further spread of the disease. In this context, a careful selection of contact persons is necessary, depending on the type and duration of contact, to identify persons who are recently infected and therefore to increase the benefit of a preventive therapy and to avoid unnecessary testing of persons who are not at risk of infection. Since the last update of the recommendations on contact tracing, data on the use of interferon-y release assays (IGRAs) in children has been improved markedly. These are the preferred test in contact tracing of adults. For children, both IGRAs and the tuberculin skin test can be used equivalently. Rifampicin for 4 months, rifampicin and isoniazid for 3 months, or isoniazid for 9 months are recommended as preventive therapy in cases of confirmed infection.The implementation of the contact tracing in different age groups as well as legal framework conditions and socio-medical aspects and challenges are dealt with in detail. In addition, special cases, such as environmental screening in day-care centers, schools, or other community facilities, are discussed separately.

[Mobility and Urban Health]. / Mobilität und StadtGesundheit.

Cities and communities form complex microcosms in which people with very different needs and opportunities live. The structural design and functionality of urban spaces have a significant impact on individual mobility and thus on the health and quality of life of the entire population. In recent decades, politicians and municipalities have accepted negative effects on people (especially vulnerable groups) and ecosystems as a price worth paying for ensuring mobility through car-friendly structures. The interconnection of health and sustainability aspects will be a central process component for the necessary transformation of urban structures in integrated urban and transport planning. Although there are many positive framework conditions and possible solutions in the international and national context, numerous processes need to be optimized and measures implemented on a large scale. In addition, the existing tools in urban and traffic planning must be further expanded to include health aspects more comprehensively. This requires readjustments in science, in municipal practice planning, in education and in interdisciplinary funding programs.

[City Planning, Urban Initiatives and Health]. / Stadtplanung, urbane Initiativen und Gesundheit.

Urban planning and public health are main fields of action when looking at urban development from a health perspective. In both fields of action, politics and administration as well as urban initiatives play a formative role. Action is oriented towards common overarching themes of sustainability, social justice and environmental justice. These commonalities are reflected in different memoranda. Despite the common basis of urban planning and health, there are areas of tension that are rooted, among other things, in different legal frameworks and logic of action. Against this complex background, recommendations are formulated for science, the funding landscape, practice as well as education and training in these areas.