[Loneliness in Bavaria before and during the COVID-19 pandemic]. / Einsamkeit in Bayern vor und während der COVID-19-Pandemie.

BACKGROUND: Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes. METHODS: Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources. RESULTS: According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups. DISCUSSION AND CONCLUSIONS: During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted.

[Avoidable mortality-a new indicator version for prevention reporting]. / Vermeidbare Sterblichkeit ­ Neufassung eines Indikators für die Präventionsberichterstattung.

BACKGROUND: "Avoidable mortality" is used as an indicator in health reporting. The indicator aggregates selected causes of death. In Germany two versions exist, both of which are no longer up to date. A new version is proposed. METHODS: The new version is based on preparatory work on the European level. The feasibility and plausibility of a common OECD Eurostat list are examined using official statistics data from Bavaria from 2016 to 2018. The analysis includes an examination of the variability over time and within the Bavarian administrative districts, as well as possible systematic errors through regional differences in coding behaviour or changes over time. RESULTS: The OECD Eurostat list can be implemented at the regional level with only minor modifications. The age-standardized avoidable mortality in Bavaria in 2018 is almost 23 deaths per 10,000 inhabitants, with preventable deaths by far outweighing treatable deaths. For men, the death rate due to avoidable causes is 30 per 10,000 male inhabitants, which is almost twice as high as that for women (16 per 10,000 female inhabitants). The regional findings on avoidable mortality are consistent with findings on regional health from other studies. DISCUSSION AND CONCLUSION: The results do not indicate a threat to reliability due to random fluctuation or systematic methodological errors. The new version is recommended for application in health reporting.

Amniotic fluid-derived multipotent stromal cells drive diabetic wound healing through modulation of macrophages.

BACKGROUND: Cutaneous wounds in patients with diabetes exhibit impaired healing due to physiological impediments and conventional care options are severely limited. Multipotent stromal cells (MSCs) have been touted as a powerful new therapy for diabetic tissue repair owing to their trophic activity and low immunogenicity. However, variations in sources and access are limiting factors for broader adaptation and study of MSC-based therapies. Amniotic fluid presents a relatively unexplored source of MSCs and one with wide availability. Here, we investigate the potential of amniotic fluid-derived multipotent stromal cells (AFMSCs) to restore molecular integrity to diabetic wounds, amend pathology and promote wound healing. METHOD: We obtained third trimester amniotic fluid from term cesarean delivery and isolated and expanded MSCs in vitro. We then generated 10 mm wounds in Leprdb/db diabetic mouse skin, and splinted them open to allow for humanized wound modeling. Immediately after wounding, we applied AFMSCs topically to the sites of injuries on diabetic mice, while media application only, defined as vehicle, served as controls. Post-treatment, we compared healing time and molecular and cellular events of AFMSC-treated, vehicle-treated, untreated diabetic, and non-diabetic wounds. A priori statistical analyses measures determined significance of the data. RESULT: Average time to wound closure was approximately 19 days in AFMSC-treated diabetic wounds. This was significantly lower than the vehicle-treated diabetic wounds, which required on average 27.5 days to heal (p < 0.01), and most similar to time of closure in wild type untreated wounds (an average of around 18 days). In addition, AFMSC treatment induced changes in the profiles of macrophage polarizing cytokines, resulting in a change in macrophage composition in the diabetic wound bed. We found no evidence of AFMSC engraftment or biotherapy induced immune response. CONCLUSION: Treatment of diabetic wounds using amniotic fluid-derived MSCs encourages cutaneous tissue repair through affecting inflammatory cell behavior in the wound site. Since vehicle-treated diabetic wounds did not demonstrate accelerated healing, we determined that AFMSCs were therapeutic through their paracrine activities. Future studies should be aimed towards validating our observations through further examination of the paracrine potential of AFMSCs. In addition, investigations concerning safety and efficacy of this therapy in clinical trials should be pursued.

[Oral health in health reporting]. / Mundgesundheit in der Gesundheitsberichterstattung.

Oral health plays a subordinate role in the range of topics in health reporting. Possible reasons are the limited availability of oral health data as well as that health reporting has historically focused on major risk factors and common diseases. Given the fact that oral health is an important public health issue, particularly in the perspective of prevention and healthcare, it would be desirable to give more consideration to the issue in health reporting. Based on Internet research, this article attempts to take stock of the extent to which oral health is already being addressed in health reporting in Germany, what professional standards exist, and what data sources are available. On this basis, further development of health reporting is suggested.

[Prevention reporting-a new impetus for health reporting?] / Präventionsberichterstattung ­ neue Impulse für die Gesundheitsberichterstattung?

In 2015 the "Act to Strengthen Health Promotion and Prevention" (German Prevention Act) was passed. This act stipulates reporting on its implementation and impact by means of a regular prevention report by the National Prevention Conference. It also furthers prevention reporting at the regional level in the federal states. There are varying approaches and concepts of prevention reporting.The first prevention report by the National Prevention Conference was published in 2019. In the federal states, prevention reporting develops in different ways and at different rates, mirroring the heterogeneous conditions and concepts at the local level. This includes a varied interpretation of the relation of health reporting to prevention reporting: some see prevention reporting as part of health reporting, others tend not to and focus on aspects like the reporting of prevention structures and interventions.Challenges for the future of prevention reporting include the development of indicators and identification of data sources, particularly regarding resources for health, structural aspects, and living conditions. Further tasks are the development of feasible approaches to survey and report prevention interventions as well as the attempt to report outcomes and effects within causal models instead of merely reporting inputs and outputs.In conclusion, the dynamic induced by the German Prevention Act serves as a stimulus to health reporting-with a view to its contents, methods and policy relevance. Research to accompany and support the development of prevention reporting would be highly desirable.

Steatorrhea and Hyperoxaluria in Severely Obese Patients Before and After Roux-en-Y Gastric Bypass.

BACKGROUND AND AIMS: Hyperoxaluria after Roux-en-Y gastric bypass (RYGB) is generally attributed to fat malabsorption. If hyperoxaluria is indeed caused by fat malabsorption, magnitudes of hyperoxaluria and steatorrhea should correlate. Severely obese patients, prior to bypass, ingest excess dietary fat that can produce hyperphagic steatorrhea. The primary objective of the study was to determine whether urine oxalate excretion correlates with elements of fat balance in severely obese patients before and after RYGB. METHODS: Fat balance and urine oxalate excretion were measured simultaneously in 26 severely obese patients before and 1 year after RYGB, while patients consumed their usual diet. At these time points, stool and urine samples were collected. Steatorrhea and hyperoxaluria were defined as fecal fat >7 g/day and urine oxalate >40 mg/day. Differences were evaluated using paired 2-tailed t tests. RESULTS: Prior to RYGB, 12 of 26 patients had mild to moderate steatorrhea. Average urine oxalate excretion was 61 mg/day; there was no correlation between fecal fat and urine oxalate excretion. After RYGB, 24 of 26 patients had steatorrhea and urine oxalate excretion averaged 69 mg/day, with a positive correlation between fecal fat and urine oxalate excretions (r = 0.71, P < .001). For each 10 g/day increase in fecal fat output, fecal water excretion increased only 46 mL/day. CONCLUSIONS: Steatorrhea and hyperoxaluria were common in obese patients before bypass, but hyperoxaluria was not caused by excess unabsorbed fatty acids. Hyperphagia, obesity, or metabolic syndrome could have produced this previously unrecognized hyperoxaluric state by stimulating absorption or endogenous synthesis of oxalate. Hyperoxaluria after RYGB correlated with steatorrhea and was presumably caused by excess fatty acids in the intestinal lumen. Because post-bypass steatorrhea caused little increase in fecal water excretion, most patients with steatorrhea did not consider themselves to have diarrhea. Before and after RYGB, high oxalate intake contributed to the severity of hyperoxaluria.

[Establishing Prevention Reporting in Bavaria - Concept, Implementation and First Results]. / Aufbau einer Präventionsberichterstattung in Bayern ­ Konzept und erste Umsetzungsschritte.

BACKGROUND: Bavaria is currently embarking on the endeavour of building up systematic prevention reporting. Prevention reporting is meant to support the implementation of the Bavarian Prevention Plan and the German Prevention Law and to further the ongoing development in the field of health promotion and health-related prevention in Bavaria. GOALS: Prevention reporting in Bavaria aims to draw on general health reporting and complement it with specific prevention-related data taking into special consideration the Bavarian Prevention Plan. Particularly, data on prevention-amenable health determinants, prevention interventions, prevention spending and on indicators related to the targets of the Bavarian Prevention Plan are meant to be included. Periodic reporting will allow ongoing monitoring and the observation of trends. The reporting system will encompass shorter publications for the general public as well as more extensive reports for an expert audience. Where possible, data will be reported not only Bavaria wide but also on a smaller regional level to support local action. IMPLEMENTATION AND FIRST RESULTS: An extensive stocktaking of prevention and health promotion activities in Bavaria in 2014/2015 as well as a survey of the partner organisations in the Bavarian Prevention Alliance in 2016 presented an overview of the prevention scene in Bavaria. A core indicator set to support the implementation of the Bavarian Prevention Plan was developed in 2016 and a first short data brochure for the public was published. A comprehensive compilation of prevention-related data and a Bavarian prevention report are planned for 2017 and 2018. CONCLUSIONS: Like health reporting, prevention reporting, as conceptualised in Bavaria, presents overview data and thus allows a monitoring of prevention. For specific planning or evaluation purposes, it needs to be supplemented by more in-depth analyses. Current challenges include the development of valid, prevention-specific indicators, the generation of an empiric database and the attempt of a coordinated approach amongst the federal states within Germany.

[Communication and Networking - Results of the Working Group 8 of the Forum Future Public Health, Berlin 2016]. / Kommunikation und Vernetzung.

Steady changes in society present challenges to constructive cooperation between stakeholders in the diverse PH landscape of Germany through individualism, globalisation, medical progress, digitalisation, etc. Working group 8 therefore suggests that the PH community should build new internal structures, in order to be able to respond jointly to external challenges, facilitate networking amongst the actors and speak with one voice, when needed. The suggestion is to establish an office that has the task to organise further meetings, harmonize written joint statements and moderate the dialogue amongst peers.

[Big Data and Public Health - Results of the Working Group 1 of the Forum Future Public Health, Berlin 2016]. / Big Data und Public Health.

Big Data is a diffuse term, which can be described as an approach to linking gigantic and often unstructured data sets. Big Data is used in many corporate areas. For Public Health (PH), however, Big Data is not a well-developed topic. In this article, Big Data is explained according to the intention of use, information efficiency, prediction and clustering. Using the example of application in science, patient care, equal opportunities and smart cities, typical challenges and open questions of Big Data for PH are outlined. In addition to the inevitable use of Big Data, networking is necessary, especially with knowledge-carriers and decision-makers from politics and health care practice.

[Regional life expectancy rankings : Methodological artefacts in population updates]. / Rangfolgen der Lebenserwartung auf Kreisebene : Methodische Artefakte durch Bevölkerungsfortschreibungen.

For the calculation of life expectancy on a regional level, data from the mortality statistics and population numbers are needed. The latter are derived from population censuses, which have to be undertaken every 10 years according to the EU regulation No. 763/2008. In Germany, the last census took place in 2011 (Census 2011). The current population numbers are calculated on the basis of the most recent population census (population update). Births, deaths, immigration and migration, in addition to other data, are taken into account in this calculation. However, with passing time since the last census, inaccuracies in population updates may increase, which can affect the value of life expectancy calculations.Based on the comparison of life expectancy rankings, the impact and extent of changing over from the 1987 to the more recent 2011 census for regional comparisons were examined in two parts of Germany, Bavaria and North Rhine-Westphalia. As expected, the results show that larger changes in the calculated life expectancy result from larger changes in population statistics. However, noteworthy changes in life expectancy rankings do not necessarily follow larger changes in the population numbers. Regional life expectancy rankings are potentially always influenced by inaccuracies in the underlying population statistics. This should be taken into account when interpreting such small-scale differences.