Development and validation of a self-regulation scale within the German version of the Early Development Instrument.

BACKGROUND: Early childhood self-regulation (SR) is key for many health- and education-related outcomes across the life span. Kindergarten age is a crucial period for SR development, and within this developmental window, potential SR difficulties can still be compensated for (e.g., through interventions). However, efficient measurement of SR through brief, comprehensive, and easy-to-use instruments that identify SR difficulties are scarce. To address this need, we used items of an internationally applied kindergarten teacher questionnaire-the Early Development Instrument (EDI) - to develop and validate a specific SR measurement scale. METHODS: The psychometric evaluation and validation of the selected SR-items was performed in data collected with the German version of the EDI (GEDI), in two independent data sets - (a) the development dataset, with 191 children, and b) the validation dataset, with 184 children. Both included three- to six-year-old children and contained retest and interrater reliability data. First, three independent raters-based on theory-selected items eligible to form a SR scale from the two SR-relevant GEDI domains "social competence" and "emotional maturity". Second, exploratory and confirmatory factor analysis using structural equation modeling examined the item structure across both data sets. This resulted in a defined SR scale, of which internal consistency, test-retest and interrater reliability, cross-validation, and concurrent validity using correlation and descriptive agreements (Bland-Altman (BA) plots) with an existing validated SR-measuring instrument (the Kindergarten Behavioral Scales) were assessed. RESULTS: Confirmatory factor analysis across both data sets yielded the best fit indices with 13 of the GEDI 20 items initially deemed eligible for SR measurement, and a three-factor structure: a) behavioral response inhibition, b) cognitive inhibition, c) selective or focused attention (RMSEA: 0.019, CFI: 0.998). Psychometric evaluation of the resulting 13-item-GEDI-SR scale revealed good internal consistency (0.92), test-retest and interrater reliability (0.85 and 0.71, respectively), validity testing yielded stability across populations and good concurrent validity with the Kindergarten Behavioral Scales (Pearson correlation coefficient: mean 0.72, range 0.61 to 0.84). CONCLUSIONS: The GEDI contains 13 items suitable to assess SR, either as part of regular EDI developmental monitoring or as a valid stand-alone scale. This short 13-item (G)EDI-SR scale may allow early detection of children with SR difficulties in the kindergarten setting in future and could be the basis for public health intervention planning. To attain this goal, future research should establish appropriate reference values using a representative standardization sample.

[Attitudes Toward Influenza Vaccination in Fall/Winter 2021: Results of the COSMO Study]. / Einstellung zur Grippeimpfung im Herbst/Winter 2021: Ergebnisse der COSMO-Studie.

AIM OF THE STUDY: There is a lack of knowledge about attitudes to influenza vaccination in Germany in 2021/2022. Based on the COSMO survey ("COVID-19 Snapshot Monitoring"), the aim of this study was to shed some light on this topic. METHODS: Wave 49 (August 10 and 11, 2021) of the COSMO survey (n=967; Germany-wide non-probabilistic quota sample; 18 to 74 years). RESULTS: This year, about one-third of respondents (and health care workers) plan to get a flu shot, and among the at-risk group of people aged 60 and older (up to 74 years in our sample), more than half. Correlates (such as gender: women with a lower likelihood of a planned flu shot) were identified. CONCLUSION: Physicians should inform women in particular about the advantages of influenza vaccination, especially during the pandemic, and communicate data on the proven protective effect of influenza vaccination as convincingly as possible (e. g., using existing brochures).

Associations of individual factors and early childhood education and care (ECEC) centres characteristics with preschoolers' BMI in Germany.

BACKGROUND: The number of obese children is rising worldwide. Many studies have investigated single determinants of children's body mass index (BMI), yet studies measuring determinants at different potential levels of influence are sparse. The aim of this study is to investigate the independent role of parental socioeconomic position (SEP), additional family factors at the micro level, as well as early childhood education and care (ECEC) centre characteristics at the meso level regarding BMI. METHODS: Analyses used the baseline data of the PReschool INtervention Study (PRINS) including up to 1,151 children from 53 ECEC centres. Multi-level models first estimated the associations of parental SEP indicators (parental school education, vocational training, and household income) with the children's standard deviation scores for BMI (SDS BMI, standardised for age and gender). Second, structural (number of siblings), psychosocial (strained family relationships), and nutrition behavioural (soft-drink consumption, frequency of fast-food restaurant visits) family factors at the micro level were included. Third, characteristics of the ECEC centre at the meso level in terms of average group size, the ratio of overweight children in the group, ECEC centre type (all-day care), and the location of the ECEC centre (rural vs urban) were included. All analyses were stratified by gender and adjusted for age, migration background, and parental employment status. RESULTS: Estimates for boys and girls appeared to differ. In the full model, for boys the parental SEP indicators were not related to SDS BMI. Factors related to SDS BMI in boys were: two or more siblings; B = -.55; p = 0.045 [ref.: no sibling]), the characteristics of the ECEC centre in terms of average group size (20 - 25 children; B = -.54; p = 0.022 [ref.: < 20 children]), and the ratio of overweight children (more overweight children B = -1.39; p < 0.001 [ref.: few overweight children]). For girls the number of siblings (two and more siblings; B = .67; p = 0.027 [ref.: no sibling]) and average group size (> 25 children; B = -.52; p = 0.037 [ref.: < 20 children]) were related to SDS BMI. CONCLUSIONS: The BMI of preschool children appears to be associated with determinants at the micro and meso level, however with some gender differences. The identified factors at the micro and meso level appear largely modifiable and can inform about possible interventions to reduce obesity in preschool children.

Willingness to bear economic costs of measures against SARS-CoV-2 in Germany.

BACKGROUND: The aim of this study was to assess the willingness of the general population in Germany to bear the economic costs of measures against the spread of SARS-CoV-2. METHODS: Repeated cross-sectional data were taken from three waves of a nationally representative survey of individuals aged 18 to 74 years (wave 8: 21-22 April 2020, N = 976; wave 16: 7-8 July 2020, N = 977; wave 38: 9-10 March 2021). The willingness to accept a reduction of annual household income in order to bear the economic costs of the measures against SARS-CoV-2 served as outcome measure. Two-part models were used including explanatory variables on sociodemographic and (subjectively assessed) potential health hazard caused by COVID-19. RESULTS: 65.5% (61.6%; 56.9%) of respondents in wave 8 (wave 16; wave 38) were willing to accept a reduction of income, with the likelihood for accepting a reduction of income being positively associated with higher affect (i.e. emotional reaction) and presumed severity regarding COVID-19 in all three waves. The mean maximum percentage of income participants were willing to give up was 3.3% (95% CI: 2.9 to 3.7%) in wave 8, 2.9% (95% CI: 2.5 to 3.3%) in wave 16 and 4.3% (95% CI: 3.6 to 5.0%) in wave 38, with presumed severity of COVID-19 being positively associated with this percentage in all three waves. CONCLUSIONS: The majority of respondents indicated willingness to sacrifice income in order to bear the costs of measures against the spread of SARS-CoV-2, with the potential health hazard caused by COVID-19 being consistently associated with this willingness. However, the proportion of individuals who were willing to give up income slightly decreased throughout the pandemic.

The four weeks before lockdown during the COVID-19 pandemic in Germany: a weekly serial cross-sectional survey on risk perceptions, knowledge, public trust and behaviour, 3 to 25 March 2020.

BackgroundDuring the COVID-19 pandemic, public perceptions and behaviours have had to adapt rapidly to new risk scenarios and radical behavioural restrictions.AimTo identify major drivers of acceptance of protective behaviours during the 4-week transition from virtually no COVID-19 cases to the nationwide lockdown in Germany (3-25 March 2020).MethodsA serial cross-sectional online survey was administered weekly to ca 1,000 unique individuals for four data collection rounds in March 2020 using non-probability quota samples, representative of the German adult population between 18 and 74 years in terms of age × sex and federal state (n = 3,910). Acceptance of restrictions was regressed on sociodemographic variables, time and psychological variables, e.g. trust, risk perceptions, self-efficacy. Extraction of homogenous clusters was based on knowledge and behaviour.ResultsAcceptance of restrictive policies increased with participants' age and employment in the healthcare sector; cognitive and particularly affective risk perceptions were further significant predictors. Acceptance increased over time, as trust in institutions became more relevant and trust in media became less relevant. The cluster analysis further indicated that having a higher education increased the gap between knowledge and behaviour. Trust in institutions was related to conversion of knowledge into action.ConclusionIdentifying relevant principles that increase acceptance will remain crucial to the development of strategies that help adjust behaviour to control the pandemic, possibly for years to come. Based on our findings, we provide operational recommendations for health authorities regarding data collection, health communication and outreach.

[Establishing evidence-based prevention and health promotion: criteria for evidence-based interventions and necessary organizational requirements and capacities]. / Mehr Evidenzbasierung in Prävention und Gesundheitsförderung: Kriterien für evidenzbasierte Maßnahmen und notwendige organisationale Rahmenbedingungen und Kapazitäten.

The German Prevention Act underlines the need for an evidence-based approach to prevention and health promotion. It is unclear which steps and processes are necessary for the evolving system of prevention and health promotion in Germany to meet this requirement. This overview article aims to define and operationalize evidence-based interventions in prevention and health promotion and describes the necessary organizational support and capacity building to foster evidence-based action in practice.Based on the international scientific literature and the Federal Centre for Health Education's Memorandum on Evidence-based Prevention and Health Promotion, the term evidence-based intervention is defined and operationalized, and implementation requirements in terms of organizational processes and capacity building are described and discussed.To foster implementation of evidence-based action in practice, decision makers in policy and practice should draw on a shared understanding of the concept of evidence-based interventions and of the need for evaluations that assure generating evidence while implementing interventions. Moreover, organizational support is necessary, such as emphasizing the value of evidence-based action within organizations, ensuring access to existing evidence databases with a transparent and relevant presentation of evidence, advancing competencies of the workforce in searching for and interpreting evidence syntheses, as well as promoting a systematic cooperation between practitioners and researchers.Implementing the above-described elements for more evidence-based action is an important step towards strengthening the evolving system of prevention and health promotion as a fifth pillar of the German health system.

[Development of intervention databases to promote evidence-based prevention and health promotion-methodological considerations]. / Aufbau von Interventionsdatenbanken für mehr Evidenzbasierung in Prävention und Gesundheitsförderung ­ methodische Überlegungen.

Municipal actors do not experience sufficient scientific support in the development and selection of preventive and health promoting interventions. Intervention databases can remedy this by presenting scientifically validated and well-documented interventions. This allows local decisions to be informed by scientific evidence on the effectiveness of interventions. The databases can also be used to promote quality development of interventions.This paper explains methodological and conceptual considerations on how preventive and health-promoting interventions can be identified for databases and how they can be classified in terms of their effectiveness and prepared in a way that is appropriate for the target group. It is based on findings from the public health literature and the project "Ageing in Balance" ("Älter werden in Balance") of the Bundeszentrale für gesundheitliche Aufklärung (BZgA).Systematic reviews are of limited use in the search for suitable interventions for the database, partly because the types of interventions listed in them are limited and information relevant to implementation is often incompletely presented. However, it seems promising to include interventions from practice in the database if they are additionally classified with regard to their effectiveness or if consequences for further development and evaluation are formulated. In addition, as much information as possible should be provided on the practical implementation of interventions. A first suggestion shows what a description of the measures could look like. In addition, manuals for the implementation of measures should be available.

Implementation of evidence-based health promotion and disease prevention interventions: theoretical and practical implications of the concept of transferability for decision-making and the transfer process.

Evidence-based health promotion and disease prevention require incorporating evidence of the effectiveness of interventions into policy and practice. With the entry into force of the German Act to Strengthen Health Promotion and Prevention (PrävG), interventions that take place in people's everyday living environments have gained in importance. Decision-makers need to assess whether an evidence-based intervention is transferable to their specific target context. The Federal Centre for Health Education (BZgA) recommends that transferability of an intervention should be clarified before any decision to implement it. Furthermore, transferability needs to be finally determined after an evaluation in the target context. In this article, we elaborate on theoretical and practical implications of the concept of transferability for health promotion and disease prevention based on the Population-Intervention-Environment-Transfer Models of Transferability (PIET-T). We discuss how decision-makers can anticipate transferability prior to the intervention transfer with the help of transferability criteria and how they can take transferability into account in the further process. This includes the steps of the analysis of a health problem and identification of effective interventions, the steps of the initial transferability assessment and identification of the need for adaptation, and the steps of the implementation and evaluation. Considering transferability is a complex task that comes with challenges. But it offers opportunities to select a suitable intervention for a target context and, in the transfer process, to understand the conditions under which the intervention works in this context. This knowledge helps to establish an evidence base, which is practically relevant.

[Promotion of physical activity among the elderly as an example of knowledge translation: How do scientific findings enter community practice?] / Wissenstranslation am Beispiel Bewegungsförderung von älteren Menschen: Wie gelangen wissenschaftliche Erkenntnisse in die kommunale Praxis?

BACKGROUND: Scientific findings can be an important source of knowledge for public health stakeholders involved in promoting physical activity, but several barriers hinder their use. Knowledge translation can simplify this process, but it requires the understanding of the stakeholder's needs. OBJECTIVES: This qualitative study aims to describe how public health stakeholders access information and scientific findings, identify possible barriers, and highlight the needs of stakeholders in terms of presentation and processing. MATERIALS AND METHODS: Semi-structured interviews were conducted with twelve local- and state-level stakeholders from North Rhine-Westphalia, Saxony-Anhalt, and Thuringia working in the area of physical activity promotion. The interviewees were selected through purposive sampling. The interviews were evaluated using qualitative content analysis. RESULTS: The benefits of scientific findings are emphasized by the interviewees, but a lack of resources in combination with a flood of information, high complexity, and technical jargon complicate their application. There is a need for tailored preparation in the form of summaries, filter functions, elaboration of practice-relevant elements, and ways of provision. CONCLUSIONS: To achieve successful knowledge translation, collaboration and interactive exchange between researchers, policymakers, and practice as well as a demand-oriented processing of scientific findings are central. Networking and bundling of knowledge on a platform are important tasks for the future.

[Evidence-based public health: perspectives and specific implementation factors]. / Evidenzbasierte Public Health: Perspektiven und spezifische Umsetzungsfaktoren.

An evidence-based approach is considered a central requirement in the public health system. Five general principles apply in evidence-based medicine as well as in evidence-based public health (EBPH). These comprise a systematic approach, transparency in relation to uncertainty, integration and participation, management of conflicts of interest, and a structured, reflective process. This article aims to promote a common understanding of what taking an evidence-based approach entails in the field of public health.We explored the international understanding of EBPH through systematic literature searches of definitions, concepts, and models regarding an evidence-based approach in public health. In this manner, 20 English sources and one German source were identified and examined using content analysis. Beyond the above-described general principles, characteristics of these perspectives are concerned with a population orientation, the underlying concept of evidence, disciplines, and stakeholder groups to be involved in the process, as well as relevant criteria and necessary competencies for implementing an evidence-based approach.Based on this, and taking into account methodological developments to address complexity, four specific implementation factors of EBPH can be derived. These include theory, interdisciplinarity, context-sensitivity, and complexity as well as general societal aspects.The practical implementation of EBPH requires human and financial resources as well as competencies - among others, for conducting systematic reviews of the effectiveness of measures, examining other relevant questions in a scientific manner, and establishing transparent processes to formulate recommendations.

[Burden in parents of school-aged children during different phases of the COVID-19 pandemic in Germany: an analysis within the COVID-19 snapshot monitoring (COSMO) study]. / Belastung von Eltern mit Kindern im Schulalter während verschiedener Phasen der COVID-19-Pandemie in Deutschland: Eine Analyse der COVID-19-Snapshot-Monitoring-(COSMO­)Daten.

BACKGROUND: Parents face a variety of personal challenges during the COVID-19 pandemic, while simultaneously being confronted with additional, school-related pandemic containment measures. OBJECTIVES: To investigate burden in parents of school-aged children across different phases of the COVID-19 pandemic in Germany and to identify particularly affected subgroups. METHODS: The COSMO project is a repetitive cross-sectional survey monitoring the psychosocial situation of the population in Germany during the pandemic with a sample size of approximately n = 1000 respondents per survey wave. A quantitative analysis of COSMO data was conducted using closed survey questions on the item "burden" as the main outcome, and, if applicable, on parenthood-associated burden from March 2020 until January 2021. RESULTS: During the first COVID-19 wave, parents of school-aged children were significantly more burdened compared to the general study population. However, burden decreased significantly from March/April to June 2020. During the second COVID-19 wave in January 2021, burden was homogeneously high across all groups. Single parenthood, a low household income, having a chronic health condition, a COVID-19 infection and a migration background were associated with higher burden, although none of these factors was consistently significant across the survey waves. Mothers reported to be more affected by parenthood-related burden than fathers. CONCLUSIONS: School measures for infection control have to be weighed carefully against the psychological impact on parental burden with subsequent negative impact on the family system. An English full-text version of this article is available at SpringerLink as Supplementary Information.

[What role do children in school and kindergarten settings play in transmitting SARS-CoV-2? An evidence-based perspective]. / Welche Rolle spielen Kinder in Schulen und Kindertagesstätten bei der Übertragung von SARS-CoV-2? ­ Eine evidenzbasierte Perspektive.

Are children and adolescents relevant disease vectors when it comes to the transmission of SARS-CoV-2? Moreover, do they play a role as relevant disease vectors in a school or kindergarten setting? These questions could not be sufficiently answered at the beginning of the pandemic. Consequently, schools and childcare facilities were closed to stop the spread of SARS-CoV­2. Over the past few months, researchers have gained a more detailed understanding of the overall pandemic situation. The SARS-CoV­2 infection rate in children below 10 years of age in 2020 has been substantially lower than in adults. In addition, it showed that children had a milder course of disease.Although a majority of the analyses performed in schools and childcare facilities revealed that the virus is transmitted in these facilities, these transmissions did not, however, have a considerable influence on the overall rate of new infections. Despite these findings, German politicians continue to advocate for the closure of childcare facilities, including schools, to fight the pandemic, whereas many specialist societies such as the German Society for Pediatric Infectious Diseases (DGPI) have emphasized that such closures should be the measure of last resort in combating the pandemic. The same message is also conveyed by a German evidence-based S3 guideline established by an interdisciplinary expert group that had already put forward clear recommendations for high incidences in the general population at the beginning of February 2021, indicating that school closures were only required in exceptional cases.In this article, we would like to outline the situation based on the currently available data, try to predict the future, and discuss the circumstances necessary to realize normal classroom teaching without accepting the risk of an uncontrolled spread of SARS-CoV­2.

[Demand-driven communication strategy of the Federal Centre for Health Education (BZgA) during the COVID-19 pandemic]. / Bedarfsbezogene Kommunikationsstrategie der Bundeszentrale für gesundheitliche Aufklärung (BZgA) während der COVID-19-Pandemie.

With the declaration of a pandemic situation of national significance by the German Bundestag, the Federal Centre for Health Education (BZgA) is fulfilling its task of providing information for understanding the pandemic situation and implementing the necessary protective measures in a clear manner throughout Germany within the framework of the adapted National Pandemic Plan COVID-19. The BZgA targets its information according to the needs of specific groups and actively involves multipliers.In order to incorporate the perspectives of the population as well as those of prevention and health promotion professionals into the services developed by the BZgA, given the particularly initial low level of knowledge in the population, various methods and data sources were used: the COVID-19 Snapshot Monitoring (COSMO) population survey, the monitoring of citizens' enquiries via telephone and e­mail to the BZgA, surveys of counselling professionals from nationwide telephone and online counselling centres, surveys of health professionals in early help (NZFH) and interdisciplinary practice expert hearings. Beyond providing pure information, practical and everyday offers should be developed and provided according to WHO guidelines and evidence-based criteria of effective communication in order to support the competences for a gradual adaptation to a "new normality".The paper describes the data-based and evidence-informed development process of communication content and offers, their dissemination via existing websites and channels for other topics as well as their integration into the new online platform www.zusammengegencorona.de . This demonstrates how demand-driven and target group-specific communication offers can be implemented beyond the classic and proven campaign appearance.

[Impact of wearing face masks in public to prevent infectious diseases on the psychosocial development in children and adolescents: a systematic review]. / Beeinflussung der psychosozialen Entwicklung von Kindern und Jugendlichen durch das Tragen von Gesichtsmasken im öffentlichen Raum zur Prävention von Infektionskrankheiten: Ein systematischer Review.

BACKGROUND: Wearing face masks in public is recommended under certain circumstances in order to prevent infectious diseases transmitted through droplets. AIM: The objective was to compile all German and English research results from peer-reviewed journal articles using a sensitive literature search on the effects of mask-wearing for preventing infectious diseases on the psychosocial development of children and adolescents. METHODS: A systematic review was conducted considering different study designs (search period up until 12 July 2021). The risk of bias in the studies was determined using a risk of bias procedure. A descriptive-narrative synthesis of the results was performed. RESULTS: Thirteen studies were included, and the overall risk of bias was estimated to be high in all primary studies. There are some indications from the included surveys that children, adolescents, and their teachers in (pre)schools perceived facial expression processing as impaired due to mask wearing, which were confirmed by several experimental studies. Two studies reported psychological symptoms like anxiety and stress as well as concentration and learning problems due to wearing a mask during the COVID-19 pandemic. One survey study during the 2002/2003 SARS pandemic examined oral examination performance in English as a foreign language and showed no difference between the "mask" and "no mask" conditions. DISCUSSION: Only little evidence can be derived on the effects of wearing mouth-nose protection on different developmental areas of children and adolescents based on the small number of studies. There is a lack of research data regarding the following outcomes: psychological development, language development, emotional development, social behavior, school success, and participation. Further qualitative studies and epidemiological studies are required.

[Change in psychological burden during the COVID-19 pandemic in Germany: fears, individual behavior, and the relevance of information and trust in governmental institutions]. / Veränderung der psychischen Belastung in der COVID-19-Pandemie in Deutschland: Ängste, individuelles Verhalten und die Relevanz von Information sowie Vertrauen in Behörden.

BACKGROUND: The potential impact of the COVID-19 pandemic on mental health was evident early on. The extent of the effects, especially cumulative over the long period of the pandemic, has not yet been fully investigated for Germany. OBJECTIVES: The aim of the study was to determine psychological burden as well as COVID-19-related experience and behavior patterns and to show how they changed during the different phases of the pandemic in Germany. MATERIALS AND METHODS: The Germany-wide online-based cross-sectional study (03/10-07/27/2020) included 22,961 people (convenience sample). Generalized anxiety (GAD-7), depression (PHQ-2), and psychological distress (DT) were collected, as well as COVID-19-related experiences and behavior patterns: COVID-19-related fear, trust in governmental actions, subjective level of information, adherent safety behavior, and personal risk assessment for infection/severe course of illness. The pandemic was retrospectively divided into five phases (initial, crisis, lockdown, reorientation, and new normality). RESULTS: Compared to pre-COVID-19 reference values, GAD­7, PHQ­2, and DT levels were significantly elevated and persistent throughout the different phases of the pandemic. COVID-19-related fear, information level, trust, safety behavior, and the risk assessment for infection/severe course of illness showed, after initial strong increase, a strong decrease to partly below the initial value. Exceptions were constant risk assessments of having a severe course of illness or dying of it. CONCLUSIONS: The increased levels of psychological burden, which have persisted throughout all phases of the pandemic, illustrate the need for sustainable support services. Declining values over the duration of the pandemic in terms of trust in governmental actions and the feeling of being well informed underline the need for more targeted education.

[Public trust in institutions in the first half of the Corona pandemic: findings from the COVID-19 Snapshot Monitoring (COSMO) project]. / Vertrauen der Bevölkerung in staatliche Institutionen im ersten Halbjahr der Coronapandemie: Erkenntnisse aus dem Projekt COVID-19 Snapshot Monitoring (COSMO).

BACKGROUND: In the coronavirus pandemic, two institutions play a central role in the evidence-based classification of events for politics and the population. The Robert Koch Institute (RKI) coordinates the fight against the pandemic, prepares well-founded recommendations for medical professionals, the media and the population, and advises politicians. The Federal Centre for Health Education (BZgA) informs the population and institutions. GOALS: The COVID-19 Snapshot Monitoring (COSMO) project monitors whether and how trust in institutions changes over the pandemic. Which population groups show trust and how this is related to attitudes, risk perception and behaviour are analysed. METHODS: Cross-sectional studies with approximately N = 1000 respondents per survey were conducted since March 2020 to investigate risk perception, behaviour, acceptance of measures and trust in institutions. RESULTS: Trust in the RKI and BZgA was generally high but declined over the course of the pandemic. Higher trust for both institutions was associated with higher age of respondents, higher education, higher risk perception and higher acceptance of measures. Behaviours such as physical distancing and handwashing were shown more frequently. Men and the chronically ill showed lower trust. DISCUSSION: The results show that trust should be further promoted. This could be achieved, among other things, by taking into account the population's perspective (e.g. through COSMO) in the development and justification of strategies and measures. Communication strategies and recommendations for action should aim to support and relieve people with high-risk perceptions.

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.

[Digital public health-leverage for community capacity building in health promotion : Current situation, developmental issues and TEAviisari as a model implementation]. / Digital Public Health ­ Hebel für Capacity Building in der kommunalen Gesundheitsförderung : Ausgangslage, Entwicklungsfragen, TEAviisari als modellhafte Implementierung.

In 1986, the Ottawa charter marked a paradigm shift for public health, putting the focus on strengthening community action and on creating supportive environments for health. A key to this is "capacity building" (CB), which we understand as the development and sustainable implementation of structural capacities, e.g. coordinated data collection, collaboration processes across sectors and reliable provision of basic resources in all areas of local health promotion.Many efforts and three and a half decades later we still envisage infrastructure deficits, scattered public health landscapes and restraints to intersectoral cooperation much too often. While agreement on the theoretical insights on what is needed appears to be broad, translating these insights into practice remains a challenge. In this situation, digital public health (DPH) can contribute to overcoming barriers and making knowledge for action more visible and more accessible. With DPH, data can be integrated, structured and disseminated in novel ways.We discuss why CB at the local level could benefit from technological advances and what DPH might do for the provision of information services on public health capacity. Our focus is on the web-based, interactive representation of public health data for use in information, governance or benchmarking processes. As an example from public health practice, the Finnish tool TEAviisari (National Institute for Health and Welfare, Finland) is presented.The 2020 EU Council Presidency of Germany - with the topics of digitalisation and the common European health data space - offers opportunities to decisively advance the development of CB in health promotion in this country.

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.

Subjectively and Objectively Assessed Behavioral, Social, and Physical Environmental Correlates of Sedentary Behavior in Preschoolers.

OBJECTIVE: To investigate associations between preschoolers' objective leisure-time sedentary behavior and a comprehensive set of subjective and objective potential correlates of sedentary behavior across the behavioral, social, and physical environmental domains on both the family and community level. STUDY DESIGN: In 3- to 6-year-old preschoolers (n = 738) from 52 preschools in Southern Germany, leisure time spent in sedentary behavior was assessed by accelerometry in 2008-2009. Family- and community-level potential correlates of sedentary behavior from different domains (behavioral, social, and physical environmental) were subjectively (ie, by parent-proxy report) and objectively (ie, by routine administrative data) assessed. RESULTS: None of the objective social and physical environmental correlates showed associations with sedentary behavior. Leisure-time sedentary behavior decreased with greater levels of moderate-to-vigorous physical activity (both weekends and weekday afternoons), participation in organized sports, parental leisure-time physical activity, as well as greater parental traffic safety perceptions (weekends only). CONCLUSIONS: Targeting multiple health behaviors at the same time (ie, physical activity and sedentary behavior) and focusing on the entire family (ie, preschoolers, parents, and potentially older siblings) might be useful opportunities to reduce sedentary behaviors in preschoolers.