Assessing readiness for childhood obesity prevention in German municipalities: application of the community readiness model.

The World Health Organization has identified childhood obesity as one of the most serious public health problems of the 21st century. Understanding a municipality's readiness to address it is crucial to achieve successful interventions. However, the preparedness of German municipalities to address childhood obesity has not yet been investigated. This study is the first in Germany to apply the community readiness model (CRM) in this context. The purpose was to determine readiness of five municipalities for childhood obesity prevention and to identify factors that influence their readiness. Therefore, 27 semi-structured key informant interviews were conducted. First, the interviews were analysed following the CRM protocol to categorize the municipalities into a readiness level between one and nine. In a second step, a content analysis was carried out for an in-depth interpretation of the readiness scores. The municipalities achieved an average readiness of 3.84, corresponding to the 'Vague Awareness' stage. A lack of prioritization and leadership support, insufficient low-threshold efforts, a lack of knowledge and problem awareness as well as a lack of structures and resources were identified as factors that can determine municipal readiness to prevent childhood obesity. This study not only extends the application of the CRM to childhood obesity in German municipalities but also offers practical implications for professionals in assessing readiness.

Application of the Community Readiness Model for childhood obesity prevention: a scoping review.

The Community Readiness Model (CRM) provides an approach to determine community readiness (CR), which is the degree of a community's preparedness to address a health issue. This scoping review aims to characterize internationally existing applications of the CRM for childhood obesity prevention. Therefore, a systematic literature research was conducted in PubMed, Cochrane Library, LIVIVO and Google Scholar. Of 285 identified records, 17 studies met the eligibility criteria and were included in the scoping review. The CRM has already been applied to childhood obesity prevention in the USA (n = 10), Australia (n = 4), UK (n = 1), Iran (n = 1) and South Africa (n = 1). Mainly geographically defined communities (n = 12) like counties and cities were analysed but also schools (n = 4) and churches (n = 1). The scoping review revealed various methodological changes to the standard protocol of which some are particularly relevant for the application to childhood obesity prevention. The identified studies reported readiness scores in the low to mid-range of the nine-point readiness scale. To increase CR, strategies were proposed that addressed raising awareness and knowledge of childhood obesity, but also supporting connectivity in and between settings. This scoping review provides researchers and health promoters with an overview of international CR measurements and setting-specific strategies to increase CR. It highlights the potential of targeted interventions to increase readiness and shows tentative support for the assumption of a possible link between CR level and changes in obesity prevalence.

Patient connectivity with healthcare professionals and health insurer using digital health technologies during the COVID-19 pandemic: a German cross-sectional study.

BACKGROUND: Digital health technologies enable patients to make a personal contribution to the improvement of their health by enabling them to manage their health. In order to exploit the potential of digital health technologies, Internet-based networking between patients and health care providers is required. However, this networking and access to digital health technologies are less prevalent in sociodemographically deprived cohorts. The paper explores how the use of digital health technologies, which connect patients with health care providers and health insurers has changed during the COVID-19 pandemic. METHODS: The data from a German-based cross-sectional online study conducted between April 29 and May 8, 2020, were used for this purpose. A total of 1.570 participants were included in the study. Accordingly, the influence of sociodemographic determinants, subjective perceptions, and personal competencies will affect the use of online booking of medical appointments and medications, video consultations with providers, and the data transmission to health insurers via an app. RESULTS: The highest level of education (OR 1.806) and the presence of a chronic illness (OR 1.706) particularly increased the likelihood of using online booking. With regard to data transmission via an app to a health insurance company, the strongest increase in the probability of use was shown by belonging to the highest subjective social status (OR 1.757) and generation Y (OR 2.303). Furthermore, the results show that the higher the subjectively perceived restriction of the subjects' life situation was due to the COVID-19 pandemic, the higher the relative probability of using online booking (OR 1.103) as well as data transmission via an app to a health insurance company (OR 1.113). In addition, higher digital literacy contributes to the use of online booking (OR 1.033) and data transmission via an app to the health insurer (OR 1.034). CONCLUSIONS: Socially determined differences can be identified for the likelihood of using digital technologies in health care, which persist even under restrictive conditions during the COVID-19 pandemic. Thus, the results indicate a digital divide with regard to the technologies investigated in this study.

The Weight Bias Internalization Scale for Youth: Validation of a Specific Tool for Assessing Internalized Weight Bias Among Treatment-Seeking German Adolescents With Overweight.

Objective: The study aimed to assess the psychometric properties of a partly adapted, German version of the Weight Bias Internalization Scale (WBIS-Y) in a sample of treatment-seeking adolescents with overweight. Methods: A survey (N = 191), including measures of weight bias internalization (WBI), self-esteem, self-efficacy, health-related quality of life, and body-related locus of control, was followed by semistructured interviews (N = 10). Cronbach's α, correlation, and factor analyses were performed. Interview data were subjected to inductive content analysis. Results: The WBIS-Y displayed good reliability and construct validity. WBI correlated negatively with self-esteem, self-efficacy, and health-related quality of life, and positively with body mass index and external body-related locus of control. Interviewees found the scale to be comprehensive, linguistically accessible, and acceptable despite its sensitive nature. Conclusions: The WBIS-Y is recommended for use both in research with adolescents and as a guide for mitigating the negative consequences of weight stigmatization in the treatment of pediatric obesity.

[Compression or expansion of morbidity in outpatient healthcare? : Generation 65plus in 2007 and 2014]. / Kompression oder Expansion der Morbidität in der ambulanten Versorgung? : Die Generation 65plus in 2007 und 2014.

BACKGROUND: The ageing population raises the question whether there is a compression or expansion of morbidity. OBJECTIVE: This study examined the development of morbidity and the associated outpatient volume of services in outpatient healthcare. MATERIAL AND METHODS: With a nationwide sample of statutory health insurance patients, the development of the documented morbidity and outpatient volume of services of the generation 65plus was empirically examined by a retrospective, cohort-specific study based on outpatient claims data covering the years 2007 and 2014. RESULTS: In 2014 the proportion of multimorbid patients was increased compared to chronically ill patients, other users and non-users. A subgroup analysis showed declining incidences for nearly all age and gender groups. In total, the average outpatient volume of services per patient increased, which is primarily attributable to increasing care of multimorbid and deceased patients. CONCLUSION: High life expectancy leads to a susceptibility for chronic diseases and multimorbidity, which indicates an expansion of morbidity in outpatient care. The resulting increased need for outpatient care should be covered with specific healthcare concepts for chronically ill and multimorbid patients. Declining incidences are a positive indication to reinforce health-promoting measures for the generation 65plus. To develop specific healthcare offers for a heterogeneous generation 65plus, a differentiated analysis for example by socioeconomic status and disease patterns is needed.

[Criteria catalogue to systematize conceptual approaches in universal prevention of childhood overweight : Methodological approach and first results]. / Kriterienkatalog zur Systematisierung konzeptioneller Ansätze in der universellen Prävention von Kinderübergewicht : Methodische Vorgehensweise und erste Ergebnisse.

BACKGROUND: Overweight and obesity are serious health risks for children and adolescents. Hence, various prevention projects have been initiated and implemented. Until now, a systematic overview of interventions in different settings has been lacking. AIM(S)/RESEARCH QUESTION: The aim of the "Prevention of child overweight" project (SkAP-project) is to prepare a systematic overview of the conceptual approaches used in universal prevention of overweight among children and adolescents. First of all, a comprehensive criteria catalogue will be developed based on systematic searches. In the next step the criteria catalogue will be applied to identify and characterize conceptual approaches. DATA AND METHODS: Criteria to describe conceptual approaches as well as determinants of childhood overweight were determined by systematic searches. The searches included relevant data bases and were further expanded by internet and hand search. Three settings (kindergarten, school and communities) and families are addressed by the systematic searches. Additional non-setting specific searches were conducted. RESULTS: A comprehensive criteria catalogue was developed, which allows a detailed analysis of conceptual approaches. This catalogue covers further quality criteria as well as determinants of childhood overweight. DISCUSSION: Currently, the criteria catalogue is being employed. Although the detailed analysis of conceptual approaches can be regarded as advantage of the criteria catalogue, there are also some limitations, such as the lack of necessary information provided in publications. Overall, the application will reveal an overview regarding universal prevention in childhood overweight, which is still lacking, and will support development in this field.

Lessons Learned from an Interprofessional European Summer School in Health Informatics.

The aim of this European interprofessional Health Informatics (HI) Summer School was (i) to make advanced healthcare students familiar with what HI can offer in terms of knowledge development for patient care and (ii) to give them an idea about the underlying technical and legal mechanisms. According to the students' evaluation, interprofessional education was very well received, problem-based learning focussing on cases was rated positively and the learning goals were met. However, it was criticised that the online material provided was rather detailed and comprehensive and could have been a bit overcharging for beginners. These drawbacks were obviously compensated by the positive experience of working in international and interprofessional groups and a generally welcoming environment.

Disparities in COVID-19 related health literacy, knowledge, and the assessment of the measures taken in Germany: a cross-sectional study.

Aim: Health literacy is necessary to access, understand, assess, and apply information on COVID-19. Studies have shown that health literacy is unequally distributed across social groups. This study aimed to analyze the differences in COVID-19-related health literacy (hereinafter referred to as "COV-19-HL"), knowledge about COVID-19, and the assessment of the measures taken regarding the sociodemographic characteristics as well as the influence of COV-19-HL on knowledge and assessments. Subject and methods: The study used the data obtained from the cross-sectional online survey "Digital divide in relation to health literacy during the COVID-19 pandemic." The data covers 1570 participants aged ≥18 years in Germany between April 29, 2020 and May 8, 2020. To analyze the differences by way of sociodemographic variables, t-tests and analyses of variance were carried out. Multivariate logistic regression models were used to determine the effect of COV-19-HL on knowledge and the assessment of measures. Results: The overall COV-19-HL was high with an average value of 37.4 (with 50 representing the highest COV-19-HL). COV-19-HL and knowledge about COVID-19 were slightly lower in men, migrants, people with low subjective social status, and with low education. Government requirements and recommendations were rated as more effective by women, older people, and individuals with a chronic illness. The chance of better knowledge about COVID-19 and rating measures as effective increased with higher COV-19-HL. Conclusion: The findings of this study show that COV-19-HL and knowledge about the virus are unequally distributed in Germany. Health communication should strengthen pandemic-related health literacy that is tailored to specific target groups.

The Representation of Trust in Artificial Intelligence Healthcare Research.

Artificial intelligence (AI) tends to emerge as a relevant component of medical care, previously reserved for medical experts. A key factor for the utilization of AI is the user's trust in the AI itself, respectively the AIt's decision process, but AI-models are lacking information about this process, the so-called Black Box, potentially affecting usert's trust in AI. This analysis' objective is the description of trust-related research regarding AI-models and the relevance of trust in comparison to other AI-related research topics in healthcare. For this purpose, a bibliometric analysis relying on 12985 article abstracts was conducted to derive a co-occurrence network which can be used to show former and current scientific endeavors in the field of healthcare based AI research and to provide insight into underrepresented research fields. Our results indicate that perceptual factors such as "trust" are still underrepresented in the scientific literature compared to other research fields.

Trust in Digitalization and AI: Findings from a Qualitative Study on Healthcare Professionals in Germany.

The acceptance and use of digital technologies depend on the trustworthiness attributed to them. Experts were interviewed about how they assign trust to digital technologies or AI (N=12). The data were analyzed applying the focused qualitative content analysis. All of the experts have experience with digital technologies, but only seven with AI. The majority of experts generally trust digital technologies, but only five experts expressed a general trust in AI. Similar reasons contributing to trust building were given for digital technologies and AI. The results show the complexity of the trust building process and the construct of trust itself. The development of explainable AI and professional training are prerequisites to support a critical and safe use of these technologies.

Continuing Education of Nurses in Patient Handovers: Development and Evaluation of a Digitally Enabled Problem-Based Learning Course.

Communication deficits belong to the most frequent errors in patient handovers calling upon specialized training approaches to be implemented. This study aims to harness problem-based learning (PBL) methods in handover education and evaluated the learning process. A digitally enabled PBL course was developed and implemented at Klinikum Osnabrück from which eight nurses participated in the course. They agreed on the stimulating effect of the setting regarding self-directed learning and on the potential to translate the new knowledge and skills into the daily clinical practice. In conclusion, the findings are promising that a digitally enabled PBL course is a suitable learning format for handover education.

An Image Based Object Recognition System for Wound Detection and Classification of Diabetic Foot and Venous Leg Ulcers.

Venous leg ulcers and diabetic foot ulcers are the most common chronic wounds. Their prevalence has been increasing significantly over the last years, consuming scarce care resources. This study aimed to explore the performance of detection and classification algorithms for these types of wounds in images. To this end, algorithms of the YoloV5 family of pre-trained models were applied to 885 images containing at least one of the two wound types. The YoloV5m6 model provided the highest precision (0.942) and a high recall value (0.837). Its mAP_0.5:0.95 was 0.642. While the latter value is comparable to the ones reported in the literature, precision and recall were considerably higher. In conclusion, our results on good wound detection and classification may reveal a path towards (semi-) automated entry of wound information in patient records. To strengthen the trust of clinicians, we are currently incorporating a dashboard where clinicians can check the validity of the predictions against their expertise.

The eHealth4all@eu Pipeline of Course Development: TIGER Recommendations in Action.

This study describes the eHealth4all@eu course development pipeline that builds upon the TIGER educational recommendations and allows a systematic development grounded on scientific and field requirements of competencies, a case/problem-based pedagogical approach and finally results in the syllabus and the course content. The pipeline is exemplified by the course Learning Healthcare in Action: Clinical Data Analytics.

Eating behaviour and its association with social living conditions and weight status among adolescent girls: results of the cross-sectional Berlin School Children's Cohort study.

OBJECTIVE: To capture a more holistic picture of eating behaviour by investigating the impact of the social living conditions and weight status of parents and daughters on food consumption frequency, the context of meals and daily portion sizes. DESIGN: Cross-sectional Berlin School Children's Cohort study. SETTING: A total of sixty-nine schools in Berlin (3 400 000 inhabitants, eastern Germany) participated in the present study. SUBJECTS: A total of 1519 girls aged 11-14 years were selected. Bi- and multivariate analyses were performed to examine the impact of age, migration background, socio-economic status (SES), parental education, family situation and the weight status of parents and daughters on three different eating behaviour scores according to nutritional recommendations. RESULTS: For the three dependent eating behaviour variables, different patterns of influencing factors emerged. Multivariate regression (model 1) revealed that low and middle SES, two-parent migration background and older age were significant risk factors. Meal context was also significantly influenced by living with a single parent. Similar results were obtained for the daily portion size scores and maternal overweight status was the most influential. Model 2 succeeded in showing that, within the composite variable of family SES, mothers' level of education was the dominant component. CONCLUSIONS: SES as a whole, and especially the component of mothers' level of education and two-parent migration background, was the strongest risk factor for an unfavourable eating pattern among adolescent girls. The results clearly indicated preventive potential. Using three different measures of eating behaviour simultaneously provided an in-depth understanding of general patterns and potential risk factors.

Chances and Barriers of Online Problem-Based Learning (ePBL) for Advanced Training in the Healthcare Sector.

An online advanced training for professionals within the healthcare sector was developed including a problem statement to be solved following the steps of problem-based learning (PBL).The findings show that it is feasible to transfer PBL electronically (ePBL) where participants favoured the flexibility and time independency of ePBL. However, the evaluation revealed issues with the learning platform, insufficient technical conditions in the hospitals and a lack of personal exchange. Thus, ePBL offers advantages especially for advanced training in the healthcare sector but requires adaptations and the necessary technical prerequisites.

Perception of a Tracing App During the Covid-19 Pandemic in Germany.

Access to digital technologies depends on the availability of technical infrastructure, but this access is unequally distributed among social groups and newly summarized under the term digital divide. The aim is to analyze the perception of a tracing app to contain Covid-19 in Germany. The results showed that participants with the highest level of formal education rate the app as beneficial and were the most likely to use the app.

Digital Skills and Skills to Deal with COVID-19 Information: Sociodemographic Differences in a Cross-Sectional Study.

In the current COVID-19 pandemic, the importance of digital media as a source of information for health-related behavior is impressively demonstrated. Until now there has been a lack of national research on the influence of socioeconomic differences in digital literacy and in the use of COVID-19 information. This study aims to analyze the influence of educational status and subjective social status on digital literacy and on the ability in using COVID-19 information. Data from a cross-sectional online survey were used. The results indicate social differences in digital literacy and in the ability to critically evaluate COVID-19 information.

The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data.

BACKGROUND: Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations' innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. OBJECTIVE: The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. METHODS: We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. RESULTS: The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model's statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. CONCLUSIONS: The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.

The relevance of cultural diversity on safety culture: a CIRS data analysis to identify problem areas and competency requirements of professionals in healthcare institutions.

Aim: The society and consequently also the health system have become increasingly culturally diverse which applies to both - patients and professionals. Studies indicate an influence of the ethnicity on the care context. With regard to this, considerably more knowledge is available regarding diversity among patients than among professionals, for example considering the effect of cultural diversity in teams. The impact of cultural diversity on patient safety has barely been investigated which means that potential effects as well as required measures and competencies cannot currently be specified. As part of the project "Gestaltungskompetenz als Innovator für hochzuverlässige Organisationen im Gesundheitssystem" (abbreviation: GIO, "Gestaltungskompetenz as an Innovator for High Reliability Organisations in the Healthcare System") these questions are investigated in the context of a case study. Therefore, a CIRS data analysis was carried out to identify specific problem areas to derive competencies for the safe handling of cultural diversity between employees. On this basis and adjusted to the target group, an interactive learning management system will be developed for the advanced training of professionals. Method: For the topic of cultural diversity, an analysis of the patient safety cases reported in CIRSmedical (Critical Incident Reporting System) was carried out followed by a qualitative summarising content analysis. The systematic search in CIRS was based on previously defined search terms as well as inclusion and exclusion criteria. Results: 45 cases were included in the analysis. The results can be classed into two categories: "(Unsuccessful) communication" and "Unsuccessful adaptation to patient needs". Cultural diversity was not usually named as a primary or explicit cause but usually a combination of several factors was given as the reason for the occurrence of an undesirable event. Conclusion: The analysis of CIRS data identified concrete challenges resulting from the intercultural composition of teams and in the care context. The approaches for improvement should include both, organisational and personnel measures. In case of the latter, it is essential that competency requirements are identified resulting in suited offers for the competence development in the course of initial and professional development training for medical and nursing staff in ethnically diverse teams.