[Health information behaviour and health literacy on COVID-19 vaccination of the general population in Germany-findings from the CoSiD study]. / Gesundheitsinformationsverhalten und Gesundheitskompetenzen zur COVID-19-Schutzimpfung von Menschen in Deutschland ­ Befunde der CoSiD-Studie.

BACKGROUND: Although COVID-19 vaccination reduces severe disease progression as well as hospitalisations and deaths, every fourth to fifth person in Germany is not vaccinated against COVID-19. Effective information and communication measures are needed to reach these people. For this, it is important to know the information behaviour as well as the health competences in the area of COVID-19 vaccination, especially of previously unvaccinated people. METHODS: The third representative population survey (November/December 2021; n = 4366) of the CoSiD study (Corona vaccination in Germany) was conducted as a combined telephone and online survey. Bivariate correlations between reported information behaviour, subjective health literacy and vaccination status and intention are investigated. In addition, multivariate correlations of socio-demographic characteristics and subjective health literacy are analysed. RESULTS: Undecided people and people that are more likely to vaccinate were overall less likely to report a good subjective level of information (46.1%; 41.1%) and competences in evaluating information about COVID-19 vaccination (36.5%; 38.8%) as well as decision making (39.0%; 35.9%). Unvaccinated people without vaccination intentions are more likely to report observing information rated as untrustworthy or wrong (60.3%). People with a lower level of education, younger people and people with a migration background report lower levels of heath literacy. DISCUSSION: Communication measures to promote health literacy should specifically address people with uncertain vaccination intentions as well as younger people, people with lower levels of education and people with a migration background.

Psychometric properties and contextual appropriateness of the German version of the Early Development Instrument.

BACKGROUND: Assessing the early development of children at a population level in educational settings, may be useful for public health and policy decision making. In this study, we evaluated the psychometric properties and the contextual appropriateness of a German language version of the Early Development Instrument (EDI), a survey-based instrument originally developed in Canada, which assesses developmental vulnerability for children in preschool settings. METHODS: Sixty preschool teachers from six preschool organizations (22% of organizations contacted) in three cities in southwest Germany participated. They administered a German version of the EDI (GEDI) to 225 children (51% of eligible children). We assessed internal consistency, test-retest and interrater reliability. Preschool teachers assisted in determining face-validity by reviewing item coverage and comprehensibility. Exploratory factor analysis (EFA) was used to evaluate convergent validity. Concurrent validity was measured using correlations and agreements (Bland-Altman plots) between GEDI and other validated instrument scores. Additionally, we compared associations between GEDI domain scores and sociodemographic characteristics with similar associations in EDI studies worldwide. RESULTS: GEDI domains showed good to excellent internal consistency (0.73 < α > 0.99) and moderate to good test-retest and interrater reliability (0.50 to 0.81 and 0.48 to 0.71, respectively [p-value < 0.05]). Face validity was considered acceptable. EFA showed a factor structure similar to the original EDI. Correlations (range: 0.32 to 0.67) and agreements between GEDI scores and other German language instruments suggested good external reliability. Scoring within the lowest 10th percentile was strongly associated with age. CONCLUSIONS: Our psychometric assessment suggests good reliability and consistency of the GEDI. Differences in the age distribution of children, pedagogical objectives and educational system features of German preschools require future work to determine score thresholds indicative of vulnerability. Aside from dropping selected items from the original EDI that were inconsistent with features of the German educational system, the distribution of values in the language and cognitive development domain also suggested that context-specific cut-offs must be established for the German version. Such efforts are needed to account for relevant contextual differences between the educational systems.

Associations of Changes in Organizational Justice with Job Attitudes and Health-Findings from a Prospective Study Using a Matching-Based Difference-in-Difference Approach.

BACKGROUND: Ample evidence indicates that unfairness at the workplace (organizational injustice) is associated with both job attitudes and health of employees. Several factors that influence these associations have been identified: e.g., personality traits, such as the Big Five traits, justice sensitivity, type of occupation (e.g., white-collar), and unobserved time-invariant factors. Previous studies only addressed parts of these issues, and the ideal research design to mitigate biases-an experiment with random assignment to a treatment and control group-is not feasible. This study therefore mimics a randomized experiment using two statistical techniques. METHODS: First, matching was implemented to balance the treatment and control group in confounding factors (demographics and personality) in two prospective waves (2012-2014) of observational data (4522 white-collar, 2984 blue-collar) taken from the Linked Personnel Panel, which is an employee survey representative for German private sector companies with more than 50 employees. Second, a difference-in-difference approach excludes unobserved time-invariant factors by estimating associations of changes in organizational justice (distributive, procedural, interactional) with job attitudes (job satisfaction, turnover intention) and health (general and mental) in these groups, separate for white- and blue-collar employees. RESULTS: A decrease in perceived justice was associated with lower job attitudes (less job satisfaction and higher turnover intentions), while an increase was associated with higher values. This pattern was found for white- and blue-collar workers and also for health indicators, with the latter, however, being less pronounced. CONCLUSIONS: Increased fairness at the workplace is related to better job attitudes and health for white- and blue-collar employees, independent of personality traits and unobserved time-invariant factors.

Identification of starting points to promote health and wellbeing at the community level - a qualitative study.

BACKGROUND: As health is influenced by the social, economic and environmental conditions in which individuals live, local communities are an ideal setting to promote health and wellbeing. However, up to now various health promotion interventions at the community level have had limited success, perhaps related to an incomplete understanding of local contexts and priorities. We therefore aimed to develop a broader and deeper understanding of topics or issues that were most salient to residents of a South-West German community by exploring their perceptions of needs, challenges, barriers and existing resources related to health and well-being. METHODS: As an initial step of a multi-year community-based participatory research project, we conducted semi-structured interviews with key informants (n = 30) from various community settings (e.g., child care, elderly care, businesses, non-profit organizations, village councils, and local government). The terms "health" and "wellbeing" were included in the stem of each question in the semi-structured interview guide to enable a focus on related perceived needs, challenges, barriers and existing resources. Interviews were audiotaped, transcribed verbatim and analyzed using qualitative content analysis techniques. RESULTS: Themes emerging from our interviews appeared to center primarily in three distinct areas: natural resources and built environment, access to services, and social cohesion including subthemes on the importance of social engagement and volunteerism, sense of community, and shared identity. CONCLUSIONS: That health and wellbeing were not identified explicitly as a priority by key informants suggests that these should not be presented as the primary focus of a community-wide initiative. Instead themes with a higher priority should be addressed in ways that can lead to better health and wellbeing as a secondary goal.

Measuring social participation in children with chronic health conditions: validation and reference values of the child and adolescent scale of participation (CASP) in the German context.

BACKGROUND: While ICF-CY-based models of care are promising avenues for improving participation of children with chronic health conditions, feasible and valid instruments to assess participation as an outcome in routine are still needed. We aimed to validate a German parent-report version of the Child and Adolescent Scale of Participation (CASP) in children with chronic health conditions of different severity. METHODS: Cross-sectional data were collected in 327 children (mean age 7.8 years, 55% boys) from two paediatric centres (n = 112) and one population-based sample (n = 215). Cronbach's alpha, factor analyses, face validity assessments, correlation analyses, receiver operating characteristics (ROC) curves, and parent-reported health-related quality of life (HRQoL: KINDL) were used to examine internal consistency, test-retest reliability, and capacity to differentiate between disease severity groups. Disease severity was operationalized according to ICD-diagnosis groups and/or parent-reports on health problems, medical and educational support, and medication. A newly developed item "overall perceived participation" was added to the CASP and evaluated. RESULTS: We found good to excellent content validity, excellent internal consistency, and good-to-excellent test-retest reliability of the instrument. While children with mild disease had a significantly greater extent of participation (higher CASP scores) than children with severe disease, they did not differ from healthy children. Children with mild compared to severe disease much more differed in participation as measured by the CASP compared to the KINDL (area under the ROC curve: 0.92 vs. 0.75). In addition, the item "overall perceived participation" was highly correlated (r = 0.86) with the CASP total score, indicating the potential value of this specific single item. Finally, we provided preliminary reference values for the CASP obtained in a population-based sample of children without chronic health conditions. CONCLUSIONS: The German version of the CASP and the new item are efficient, valid and reliable measures of social participation in childhood. The CASP-measured participation focuses more on attendance than on involvement into social circumstances of everyday life. To detect children with a high burden of disease on everyday life, the CASP may be more accurate than HRQoL instruments such as the KINDL. As outcome measurement, the CASP may facilitate the implementation of patient-centred paediatric health care.

Associations between dietary factors and obesity-related biomarkers in healthy children and adolescents - a systematic review.

BACKGROUND: The obesity prevalence in children and adolescents has increased worldwide during the past 30 years. Although diet has been identified as one risk factor for developing obesity in this age group, the role of specific dietary factors is still unclear. One way to gain insight into the role of these factors might be to detect biomarkers that reflect metabolic health and to identify the associations between dietary factors and these biomarkers. This would enable nutrition-related metabolic changes to be detected early in life, which might be a promising strategy to prevent childhood obesity. However, existing literature offers only inconclusive evidence for diet and some of these obesity-related biomarkers (e.g., blood lipids). We thus conducted a systematic literature review to further examine eligible studies that investigate associations between dietary factors and 12 obesity-related biomarkers in healthy children and adolescents aged 3-18 years. METHODS: We searched the scientific databases PubMed/Medline and Web of Science Core Collection for potentially eligible articles. Our final literature search resulted in 2727 hits. After the selection process, we included 81 articles that reported on 1111 single observations on dietary factors and any of the obesity-related biomarkers. RESULTS: Around 81% of the total observations showed nonsignificant results. For many biomarkers we did not find enough observations to draw clear conclusions on possible associations between a dietary factor and the respective biomarker. In cases where we identified enough observations, the results were contradictory. Since these nonsignificant and inconclusive findings may impede the development of effective strategies against childhood obesity, this article takes a closer look at possible reasons for such findings. In addition, it provides action points for future research efforts. CONCLUSIONS: In conclusion, current evidence on associations between dietary factors and obesity-related biomarkers is inconclusive. We thus provided an overview on which specific limitations may impede current research. Such knowledge is necessary to enable future research efforts to better elucidate the role of diet in the early stages of obesity development.

Associations Between Work Characteristics, Engaged Well-Being at Work, and Job Attitudes - Findings from a Longitudinal German Study.

Objective: The Job Demand & Resources model suggests work characteristics are related to mental well-being and work engagement. Previous work describes the development of a combined construct 'engaged well-being at work' (EWB). To what extent changes in measures of this construct are responsive to changes in job demands and resources or associated with changes in job-related attitudes has not been established. Methods: Longitudinal employee-level data from three waves (German Linked Personnel Panel) were used. Logistic and linear fixed effects regression analyses explored longitudinal associations between changes in EWB for participants over a three-year period with changes in job demands and resources and job-related attitudes (job commitment, satisfaction, and turnover intentions). Results: While job resources were associated with increased odds for a change into a healthier and/or more engaged category of EWB, job demands reduced them. Job resources were more strongly related to higher EWB (ORrange = 1.22 - 1.61) than job demands (ORrange = 0.79 - 0.96). Especially psychological job demands showed negative associations with improved EWB (OR = 0.79). A change from the least desirable category 'disengaged strain' to any other category of EWB was associated with greater odds by up to 20.6 % for increased commitment and job satisfaction and lower odds for turnover intentions. Discussion: Improving work characteristics, especially job resources, could increase employees' EWB, emphasizing the importance of job characteristics for a healthy workplace. Because EWB seems to be associated with job attitudes, an improvement of this indicator would be relevant for employees and employers.

The association between supportive social ties and autonomic nervous system function-differences between family ties and friendship ties in a cohort of older adults.

Supportive family and friendship ties can serve different functions and thus might show different associations with an individual's health. Particularly, older adults might show varying health benefits of different types of supportive ties depending on their marital and retirement status. Our aim is to analyze relationships between different types of supportive social ties and autonomic nervous system (ANS) function, a physiological indicator of health that can help to establish the biological plausibility of the association-measured by heart rate variability (HRV). We present cross-sectional linear regression analyses of a German cohort of community-dwelling older adults (2008-2010; n = 1,548; mean age = 68.7 years). Our findings indicate that supportive friendship ties show significant positive associations (i.e., higher HRV) in individuals that are either not married or above retirement age. Supportive family ties show significant positive associations in individuals below retirement age. Significant results vanish or are reduced after accounting for behavioral/physical and psychological/cognitive indicators. We conclude that programs supporting the development or maintenance of friendship ties might be especially beneficial in unmarried older adults and adults above retirement age. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-021-00638-2.

Creating a measure to operationalize engaged well-being at work.

BACKGROUND: Mental well-being and work engagement are both desirable, positive states of mind that help employees to better function in the workplace. While occupational researchers have argued in favor of considering both states concurrently, it is less clear how this might be translated to provide an instrument characterizing the workforce accordingly. The present study describes empirical efforts to operationalize a construct called engaged well-being. METHODS: We used employee-level data (n = 13,538) from three waves of the German linked personnel panel (LPP; 2012-2017). Exploratory factor analysis and a combination of hierarchical and non-hierarchical cluster analyses linked with within-sum-of-squares statistics were used to identify distinct profiles describing mental well-being and work engagement concurrently. These profiles were then used as the basis to identify cut-offs to create replicable categories of engaged well-being. Using the longitudinal data from a subgroup providing data across more than one wave, we observed whether the newly constructed indicator changed over time. RESULTS: The exploratory factor analysis suggested that both states were two distinct factors. Cluster analysis linked with within-sum-of-squares statistics suggested a four-cluster solution: engaged well-being (46.9%), disengaged well-being (27.5%), engaged strain (8.8%), and disengaged strain (16.8%). One cut-off for each state was identified to replicate the cluster solution. Across observation periods, we could observe changes in engaged well-being. CONCLUSIONS: Our measure of engaged well-being can be used to simultaneously characterize a workforce's mental well-being and work engagement. Changes in this measure over time suggest its potential utility in organizational interventions. Future studies are needed to further explore both the antecedents, correlates, and potential effects of engaged well-being.

Competence-based teaching and learning in the outpatient clinic: development of a clinical elective in ambulatory medicine.

Aim: Although physicians have the most contact with patients in the outpatient setting, topics relating to ambulatory medicine have been less present in medical education. To teach professional skills, practical learning opportunities must be created in which students can practice medical skills under authentic working conditions in the outpatient setting. The clinical elective in ambulatory medicine has been developed, evaluated and revised at the Mannheim Medical School as a practical, competency-based learning experience in outpatient clinics (liver clinic, psychiatric outpatient clinic, uro-oncological consultations, etc.). Methods: The elective was designed using the plan-do-check-act (PDCA) cycle in the form of a longitudinal practical course during the fourth year of study. By selecting one of four concentrations in ambulatory care, students have the opportunity to focus on and pursue an individual interest. Students are given assignments during three separate sessions at an outpatient clinic and complete a log book which contains the learning objectives, assignments and grading criteria. Once the elective had been completed, the students (n=165) and mentors (n=7) had the option to participate in a survey to evaluate knowledge gain and satisfaction with the elective. Results: The students rated their personal growth in knowledge about common diseases and patient-centered communication positively, while rating their knowledge gain in ambulatory patient management somewhat lower. The first offering of the elective was evaluated as satisfactory by students and mentors. In 85.8% of the cases, students reported that they would recommend the selected outpatient clinic for this course. Suggestions for improvement, such as those concerning the log book and scheduling system, were considered during the first revision. Conclusion: This elective provides an opportunity to become familiar with ambulatory medicine in a practical and competency-based manner during medical studies. Skills in ambulatory medicine are already taught and applied in the fourth year of study in a practical setting and also deepened further through interconnections with other courses and chosen concentrations. Moreover, this elective format may be used by other medical schools depending on which aspects of ambulatory medicine are focused on.