[Practical Year in Public Health: 10 Years of Experience at the Public Health Department in Frankfurt]. / Das Praktische Jahr im Fach Öffentliches Gesundheitswesen: Ergebnisse aus 10 Jahre Erfahrung am Gesundheitsamt Frankfurt am Main.

BACKGROUND: Since the winter semester 2013/14, the Public Health Department in Frankfurt has been the first to offer an internship in public health to medical students in their practical year in Germany. In this study, we analyzed how students evaluated their practical experience and the logbook within clinical training at the Public Health Department. METHODS: A rotation procedure was set up and a logbook with subject-specific learning objectives was developed. After the internship, students participated in an evaluation using a standardized questionnaire. The results of the last 10 years were evaluated quantitatively. RESULTS: The evaluation results of 15 medical students of the last 10 years showed a very high level of internship satisfaction. There was a high acceptance of the logbook regarding structure, learning objectives and skills. CONCLUSION: The internship at the Frankfurt Public Health Department provides the opportunity to be involved in daily activities of public health practice, gives an overview of learning objectives, and underlines good public health training.

[Path to health insurance coverage - The Clearing Center 1.0 at the Public Health Authority in Frankfurt am Main]. / Wege in den Krankenversicherungsschutz ­ Das Pilotprojekt Clearingstelle 1.0 am Gesundheitsamt Frankfurt am Main.

Nationwide, an estimated 500,000 to 1 million people are not insured and therefore lack access to regular health structures, which can have fatal consequences for the health of those affected. Especially in large cities, there are low-threshold medical outpatient clinics that offer basic health care parallel to the regular system. Sustainable solutions for ensuring adequate healthcare are lacking. Clearing centers (German: Clearingstelle), serving as contact points for people without health insurance coverage, and the concept of an Anonymous Treatment Voucher (German: Anonymer Behandlungsschein; ABS), bridge the gap between parallel and regular health systems. With the pilot implementation of "Clearing Center 1.0" at the Public Health Authority in Frankfurt am Main from 2020 to 2022, the basic medical care of Humanitarian Consultation Hour was complemented by professional social counseling with the aim of referring as many individuals as possible to the statutory regular system. The expansion of the counseling services and the permanent establishment of the clearing center in Frankfurt am Main are declared goals for the Public Health Authority.

[Quantifying the Developments of Shortages in Public Health Specialists in the Public Health Service and its Effects]. / Quantifizierung der Entwicklungen des Mangels an Fachärzten/innen für Öffentliches Gesundheitswesen im Öffentlichen Gesundheitsdienst und seine Auswirkungen.

The institutions of the Public Health Service at the level of the federal government, the states and the local authorities play a central role in public health in Germany. To manage the many practical tasks of health protection, disease prevention and health promotion in accordance with legal requirements, employees with different skills work together and contribute to social coherence. There are no empirical data on nationwide staffing levels. For years, different actors have been reporting a decreasing number of public health consultants and associated quality of public health work. The aim of this study was to quantify the public health consultant decline and to present regional trends. Regularly collected and freely available data on medical consultants registered in Germany from 1998 to 2018 were descriptively analysed with regard to developments in the number of consultants in Germany, in the regions of the Medical Associations, by specialty and age. While the total number of medical consultants in Germany has continuously increased (52%), the number of those working in administrative positions, public corporate bodies, etc. has remained relatively constant at 2%. In contrast, the number of public health consultants working in administrative offices, public corporate bodies, etc. over the last 20 years has decreased by almost 30%. Similar developments can be seen in all regions, with some even larger decreases in some regions. Bavaria is the only region with a contrasting development. There is almost no new generation of public health consultants and the number of older consultants in this field is increasing. Against this background, the availability of a sufficient number of qualified professionals to manage administrative and other tasks relevant to population medicine must be questioned. These developments threaten public health in general, public concern for vulnerable population groups in particular, and ultimately the functioning of the democratic welfare state.

[Children in the COVID-19 pandemic and the public health service (ÖGD) : Data and reflections from Frankfurt am Main, Germany]. / Kinder in der COVID-19 Pandemie und der Öffentliche Gesundheitsdienst (ÖGD) : Daten und Überlegungen aus Frankfurt am Main.

BACKGROUND: The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities. MATERIALS AND METHODS: Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV­2 positive persons from schools and daycare centers were screened for SARS-CoV­2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented. RESULTS: Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV­2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur. CONCLUSION: SARS-CoV­2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.

Sexual Health and the Internet: Cross-Sectional Study of Online Preferences Among Adolescents.

BACKGROUND: The Internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. OBJECTIVE: The objective of this study is to assess students' preferences when looking for sexual health information online. METHODS: We conducted a cross-sectional survey among ninth grade students in a convenience sample of 13 secondary schools in Berlin, Germany. During a regular school period, participants were requested to rate the importance they attribute to nine aspects of sexual health websites in a paper-based questionnaire. Bivariate and multivariable analyses were used to assess awareness and preferences by gender, age, migrant background, and school type. RESULTS: Of 1190 eligible students, 1177 (98.91%) students with a mean age of 14.6 (SD 0.7) years participated, 52.52% (605/1152) were male, and 52.94% (612/1156) had at least one parent born abroad. Participant numbers were spread equally across three types of secondary schools in Berlin. Website aspects most frequently cited as important were easily comprehensible wording (88.33%, 961/1088), clear information layout (80.57%, 871/1081), and reliability of the website's publisher (79.28%, 857/1081), whereas the visual style of a website was deemed important by the lowest number of students (35.13%, 378/1076). There was a marked gender difference in the importance students attached to website publisher reliability. Although 437/515 (84.9%) of female participants regarded this as important, only 420/566 (74.2%) of male participants did likewise (P<.001). In multivariable analyses, demographic differences were also particularly visible in the importance of publisher reliability: male participants were significantly less likely to find this aspect important (OR 0.50, 95% CI 0.37-0.69). The odds ratio for students with migrant background was 0.64 (95% CI 0.50-0.81, reference=no migrant background) and OR 2.04 (95% CI 1.03-4.03) for students in the most academic school type (reference=least academic). CONCLUSIONS: Students prefer easily understandable online resources. Setting up sexual health websites according to the explicit preferences of the target audience might encourage usage, especially by those subpopulations less likely to critically assess information validity: male adolescents, children of immigrants, and the academically disadvantaged.

Awareness and knowledge regarding emergency contraception in Berlin adolescents.

BACKGROUND: Lack of information has been described as a major factor in non-use of oral emergency contraception (EC) following unprotected intercourse. Despite the ongoing vociferous debate on liberalisation of access, little evidence is available on EC knowledge in Germany, particularly among adolescents. METHODS: We conducted a cross-sectional survey among ninth graders in convenience sample of 13 Berlin schools. We assessed perceived and actual knowledge on the effectiveness, timeframe and availability of EC and on pregnancy risk in six scenarios. RESULTS: A total of 1177 students between 13 and 16 years of age participated. Mean age was 14.6 years (standard deviation 0.67); 51.4% of participants were male. Whilst 8.7% had never heard of EC, 38.6% knew of its effectiveness, but only 12.7% knew the timeframe for EC. Of the sources of EC, only gynaecologists were widely known. Most students correctly evaluated pregnancy risk in given scenarios. Girls were more knowledgeable on most topics except for pregnancy risk. Attending a school of lower academic standard and being of immigrant background was associated with lower knowledge on the majority of items. CONCLUSIONS: Generally, students were aware of the existence of EC, but many lacked the knowledge of when to take it and how to access it. Especially in the light of the recent liberalisation of EC access in Germany, increased educational efforts are warranted to ensure that the population has the knowledge necessary to make a truly informed choice regarding its use.

Assessment of universal health coverage for adults aged 50 years or older with chronic illness in six middle-income countries.

OBJECTIVE: To assess universal health coverage for adults aged 50 years or older with chronic illness in China, Ghana, India, Mexico, the Russian Federation and South Africa. METHODS: We obtained data on 16,631 participants aged 50 years or older who had at least one diagnosed chronic condition from the World Health Organization Study on Global Ageing and Adult Health. Access to basic chronic care and financial hardship were assessed and the influence of health insurance and rural or urban residence was determined by logistic regression analysis. FINDINGS: The weighted proportion of participants with access to basic chronic care ranged from 20.6% in Mexico to 47.6% in South Africa. Access rates were unequally distributed and disadvantaged poor people, except in South Africa where primary health care is free to all. Rural residence did not affect access. The proportion with catastrophic out-of-pocket expenditure for the last outpatient visit ranged from 14.5% in China to 54.8% in Ghana. Financial hardship was more common among the poor in most countries but affected all income groups. Health insurance generally increased access to care but gave insufficient protection against financial hardship. CONCLUSION: No country provided access to basic chronic care for more than half of the participants with chronic illness. The poor were less likely to receive care and more likely to face financial hardship in most countries. However, inequity of access was not fully determined by the level of economic development or insurance coverage. Future health reforms should aim to improve service quality and increase democratic oversight of health care.

An explorative cross-sectional study examining self-reported health and nutritional status of disadvantaged people using food banks in Germany.

BACKGROUND: Even in high-income countries some population groups depend on food banks to support their food intake. We aimed to explore and compare health and nutritional status of food bank clients (Tafel e.V.) in different cities in Germany. METHODS: In a cross-sectional study, self-reported health and nutritional status of food bank clients living in three cities (Berlin - capital, Ludwigsburg- affluent city, Fulda - small town) which differ in size, available income and poverty rate, were assessed and compared to survey variables of the low socioeconomic status population of national surveys (DEGS and GEDA). RESULTS: Across cities, food bank clients (N = 276, response rate of 21.5 %) did not differ in main socio-demographic characteristics (age, nationality, education, professional qualification, household income). Smoking, having at least one chronic illness, estimating their own health status as moderate to poor and low consumption of fruits and vegetables were common characteristics. Comparing selected variables with the low socioeconomic status population of DEGS and GEDA, differences were found for a higher prevalence of diabetes among food bank clients and a worse self-reported health status. Considerably lower fruit consumption and lower hypertension prevalence among female and lower overweight rates among male food bank clients were found. CONCLUSIONS: Although people using food banks vary in socio-demographic background, no differences for main demographics across the cities were found. In addition, the study suggests that for some health- and nutrition-related variables, national surveys in Germany might underestimate socioeconomic differences.

Germany's national public health gets reorganized: A new institute shall take center stage.

In the aftermath of the COVID-19 pandemic, the German federal government recently orchestrated a fundamental change to its public health infrastructure. This reconstruction centers around the founding of a National Institute for Prevention and Education in Medicine (Bundesinstitut für Prävention und Aufklärung in der Medizin, BIPAM) at the cost of two federal institutions, the Robert Koch-Institute (RKI) and the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BzGA). Thus, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) plans to dissolve the BzGA and integrate its personnel into the future BIPAM. Further, all RKI research and surveillance activities related to non-communicable diseases, including AI methods development will be transferred into the BIPAM. The RKI responsibilities will solely focus on infectious diseases. According to announced plans of the BMG the primary objective for establishing the BIPAM is to address non-communicable diseases and enhance overall population health. However, the medical specialist training for public health remains non-academic at a state institution. Simultaneously the BMG already replaced two thirds of experts of the permanent commission on vaccination (Ständige Impfkommission, STIKO) and determined new procedures for appointing future expert commissioners. With these changes, Germany embarks on an extraordinary reshuffling of its national public health organizations and responsibilities, by fundamentally separating all issues around non-communicable diseases from those of infectious diseases. Germany's unraveled research tasks of public health authorities however remains unmet. Thus, 2024 marks a pivotal caesura for public health in the modern history of Germany.

Is Olfactory Testing a Useful Diagnostic Tool to Identify SARS-CoV-2 Infections Early? A Cross-Sectional and Longitudinal Analysis.

BACKGROUND: Genesis and the prognostic value of olfactory dysfunction (OD) in COVID-19 remain partially described. The objective of our study was to characterize OD during SARS-CoV-2 infection and to examine whether testing of OD may be a useful tool in clinical practice in order to early identify patients with SARS-CoV-2 infection. METHODS: Olfactory function assessment was objectively carried out using the u-Smell-it® test. In a cross-sectional study part, we evaluated this test in a control cohort of SARS-CoV-2 negative tested patients, who attended the University Hospital Frankfurt between May 2021 and March 2022. In a second longitudinal study part, sensitivity and specificity of OD was evaluated as a diagnostic marker of a SARS-CoV-2 infection in Frankfurt am Main, Germany in SARS-CoV-2 infected patients and their close contacts. RESULTS: Among 494 SARS-CoV-2 negative tested patients, OD was detected in 45.7% and was found to be significantly associated with the male gender (p < 0.001), higher age (p < 0.001), cardiovascular and pulmonary comorbidities (p < 0.001; p = 0.03). Among 90 COVID-19 positive patients, OD was found in 65.6% and was significantly associated with male gender and positive smoking status (p = 0.04 each). Prevalence and severity of OD were significantly increased in infections with the Delta variant (B.1.617.2) compared to those with the Omicron variant (BA.1.1.529). Diagnostic sensitivity and specificity of OD for diagnosis of SARS-CoV-2 infection were 69% and 64%, respectively. CONCLUSION: OD is common in COVID-19 negative and positive tested patients with significantly different prevalence rates observed between different variants. Diagnostic accuracy of OD is not high enough to implement olfactory testing as a tool in diagnostic routine to early identify patients with a SARS-CoV-2 infection.

Perceived challenges to public health in Central and Eastern Europe: a qualitative analysis.

BACKGROUND: There is a major gradient in burden of disease between Central and Eastern Europe compared to Western Europe. Many of the underlying causes and risk factors are amenable to public health interventions. The purpose of the study was to explore perceptions of public health experts from Central and Eastern European countries on public health challenges in their countries. METHODS: We invited 179 public health experts from Central and Eastern European countries to a 2-day workshop in Berlin, Germany. A total of 25 public health experts from 14 countries participated in May 2008. The workshop was structured into 8 sessions of 1.5 hours each, with the topic areas covering coronary heart disease, stroke, prevention, obesity, alcohol, tobacco, tuberculosis, and HIV/AIDS. The workshop was recorded and the proceedings transcribed verbatim. The transcripts were entered into atlas.ti for content analysis and coded according to the session headings. After analysis of the content of each session discussion, a re-coding of the discussions took place based on the themes that emerged from the analysis. RESULTS: Themes discussed recurred across disease entities and sessions. Major themes were the relationship between clinical medicine and public health, the need for public health funding, and the problems of proving the effectiveness of disease prevention. Areas for action identified included the need to engage with the public, to create a better scientific basis for public health interventions, to identify "best practices" of disease prevention, and to implement registries/surveillance instruments. The need for improved data collection was seen throughout all areas discussed, as was the need to harmonize data across countries. CONCLUSIONS: To reduce the burden of disease across Europe, closer collaboration of countries across Europe seems important in order to learn from each other. A more credible scientific basis for effective public health interventions is urgently needed. The monitoring of health trends is crucial to evaluate the impact of public health programmes.

Healthy action against poverty: a descriptive analysis of food redistribution charity clients in Berlin, Germany.

BACKGROUND: The socio-economic gap and its associated health inequalities are increasing in Germany. Actions against poverty include the redistribution of foods through charities. One project supported by the main German food redistribution charity is offering fresh produce including mostly fruits, vegetables and bread to people receiving welfare in Berlin, Germany. METHODS: Through retrospective analysis of monthly visits (from January 2006 to June 2010) data from 45 surplus food redistribution points was examined. Clients' health status and health behaviour were examined using self-report questionnaires. RESULTS: On average, 10,485 people visited the 45 food redistribution points weekly. A monthly increase of ∼900 additional clients per week over all distribution points could be observed since 2006. The percentage of retirees (28.2%), single parents (20.6%) and families with children (29.5%) was high. The results of the self-report questionnaires (n=101) revealed a sample population with a high percentage of smokers (59.4%) and moderate to heavy alcohol consumers (58.8%). Buying additional fruits and vegetables to those received through distribution points and eating breakfast regularly was associated with significantly better self- rated health status. CONCLUSION: Especially, vulnerable groups appear to supplement their diet with fresh produce from food redistribution points. The health status of the sample population is somewhat different from the German population with more unhealthy behavioural patterns. Future research is necessary to further investigate this impoverished population with increased health risks.

SARS-CoV-2 infection dynamics in the tourism season 2020 in North Frisia, Germany.

Background: International tourist activities including air travel, holiday on cruise ships, and Après-ski parties played a prominent role in the early spread of the SARS-CoV-2 pandemic. However, the effects of national tourism on infection dynamics are unclear. Methods: Data were analyzed from the health authorities in North Frisia, the northernmost district in Germany with prominent tourist hotspots such as Sylt, Amrum, and Föhr. Data were available for the time period April 2020-November 2020. Results: During the tourist season (May-October 2020), PCR-confirmed SARS-CoV-2 case numbers were low with 0 to 10 cases per day. Case numbers rose in September and peaked end of October (2nd wave). Among the confirmed cases, 13 persons were returning travelers and none were national tourists. Overall, only a small proportion of cases were related to individuals with presumed tourist contact. Conclusion: In summer 2020, the arrival of a large number of tourists apparently did not increase local case numbers, and tourism-related outbreaks were not reported. Thus, tourism presumably did not contribute substantially to SARS-CoV-2 infection dynamics in North Frisia. However, incidences were low countrywide and protective measures were in place.

Correction: Global health research and education at medical faculties in Germany.

[This corrects the article DOI: 10.1371/journal.pone.0231302.].

The 'global health' education framework: a conceptual guide for monitoring, evaluation and practice.

BACKGROUND: In the past decades, the increasing importance of and rapid changes in the global health arena have provoked discussions on the implications for the education of health professionals. In the case of Germany, it remains yet unclear whether international or global aspects are sufficiently addressed within medical education. Evaluation challenges exist in Germany and elsewhere due to a lack of conceptual guides to develop, evaluate or assess education in this field. OBJECTIVE: To propose a framework conceptualising 'global health' education (GHE) in practice, to guide the evaluation and monitoring of educational interventions and reforms through a set of key indicators that characterise GHE. METHODS: Literature review; deduction. RESULTS AND CONCLUSION: Currently, 'new' health challenges and educational needs as a result of the globalisation process are discussed and linked to the evolving term 'global health'. The lack of a common definition of this term complicates attempts to analyse global health in the field of education. The proposed GHE framework addresses these problems and presents a set of key characteristics of education in this field. The framework builds on the models of 'social determinants of health' and 'globalisation and health' and is oriented towards 'health for all' and 'health equity'. It provides an action-oriented construct for a bottom-up engagement with global health by the health workforce. Ten indicators are deduced for use in monitoring and evaluation.

Self-Collected Samples to Detect SARS-CoV-2: Direct Comparison of Saliva, Tongue Swab, Nasal Swab, Chewed Cotton Pads and Gargle Lavage.

Testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by RT-PCR is a vital public health tool in the pandemic. Self-collected samples are increasingly used as an alternative to nasopharyngeal swabs. Several studies suggested that they are sufficiently sensitive to be a useful alternative. However, there are limited data directly comparing several different types of self-collected materials to determine which material is preferable. A total of 102 predominantly symptomatic adults with a confirmed SARS-CoV-2 infection self-collected native saliva, a tongue swab, a mid-turbinate nasal swab, saliva obtained by chewing a cotton pad and gargle lavage, within 48 h of initial diagnosis. Sample collection was unsupervised. Both native saliva and gargling with tap water had high diagnostic sensitivity of 92.8% and 89.1%, respectively. Nasal swabs had a sensitivity of 85.1%, which was not significantly inferior to saliva (p = 0.092), but 16.6% of participants reported they had difficult in self-collection of this sample. A tongue swab and saliva obtained by chewing a cotton pad had a significantly lower sensitivity of 74.2% and 70.2%, respectively. Diagnostic sensitivity was not related to the presence of clinical symptoms or to age. When comparing self-collected specimens from different material, saliva, gargle lavage or mid-turbinate nasal swabs may be considered for most symptomatic patients. However, complementary experiments are required to verify that differences in performance observed among the five sampling modes were not attributed to collection impairment.

Global Health Education: a cross-sectional study among German medical students to identify needs, deficits and potential benefits (Part 1 of 2: Mobility patterns & educational needs and demands).

BACKGROUND: In recent years, education and training in global health has been the subject of recurring debate in many countries. However, in Germany, there has been no analysis of the educational needs or demands of medical students, or the educational deficits or potential benefits involved in global health education. Our purpose is to analyse international health elective patterns of medical students enrolled at German universities and assess whether or how they prepare for their electives abroad. We examine the exposure of medical students enrolled at German universities to training courses in tropical medicine or global health and assess students' perceived needs and demands for education in global health. METHODS: Cross-sectional study among medical students in Germany including all 36 medical schools during the second half of the year 2007. All registered medical students were eligible to participate in the study. Recruitment occurred via electronic mailing-lists of students' unions. We developed a web-based, semi-structured questionnaire to capture students' international mobility patterns, preparation before electives, destination countries, exposure to and demand for global health learning opportunities. RESULTS: 1126 online-replies were received and analysed from all registered medical students in Germany (N = 78.067). 33.0% of all respondents (370/1126) declared at least one international health elective and of these, 36.0% (133/370) completed their electives in developing countries. 36.0% (131/363) did not prepare specifically at all, 59.0% (214/363) prepared either by self-study or declared a participation in specific preparation programmes. 87.8% of 5th and 6th year students had never participated in a global health course and 72.6% (209/288) had not completed a course in tropical medicine. 94.0% (861/916) endorsed the idea of introducing global health into medical education. CONCLUSION: Students in our sample are highly mobile during their studies. International health electives are common, also in developing countries. Formal preparation beyond self-study is virtually non-existent amongst our sample and the participation rate in courses of tropical medicine or global health is appallingly low. We have identified unmet perceived needs and the demand for more learning opportunities in global health in our sample, urging for reforms to adjust curricula to a globalising world.