Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz最新文献

{"title":"[The value of places and landscapes for health].","authors":"Thomas Kistemann, Timo Falkenberg","doi":"10.1007/s00103-025-04116-3","DOIUrl":"10.1007/s00103-025-04116-3","url":null,"abstract":"<p><p>The concept of therapeutic landscapes has proven itself empirically in recent decades as an analytical framework for better understanding the significance of specific places and landscapes for health and health-related well-being. It is based on the fundamental assumption that a specific set of ecological, social and cultural characteristics of spatial settings has a measurable effect on health. As a theory, it offers the possibility of providing a conceptual order for the empirical complexity of the phenomenal world. The background in terms of the history of ideas includes salutogenesis, health promotion, the cultural turn and the spatial turn. Approaches to explaining the development of therapeutic landscapes are based on the actor-network theory (ANT) and the concept of mentalising, based on the \"theory of mind\". While the focus was initially on extraordinary places and healing effects, it is now more about everyday places and diverse health-relevant effects.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1163-1169"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Measures to ensure outpatient care in rural and structurally weak regions-a narrative review].","authors":"Jobst Augustin, Nirohshah Trialonis-Suthakharan, Enno Nowossadeck","doi":"10.1007/s00103-025-04119-0","DOIUrl":"10.1007/s00103-025-04119-0","url":null,"abstract":"<p><p>Various public health measures are being implemented to ensure healthcare provision in rural and structurally vulnerable regions. However, the actual effect of these measures has not yet been fully clarified. This narrative review aims to identify relevant measures and compile existing evaluation results on their effectiveness.As part of a literature and document analysis, Google Scholar was used to search specific websites and databases of self-governing bodies in the healthcare sector (e.g. associations of statutory health insurance physicians and ministries) as well as relevant German journals. The results reveal a variety of conceptual approaches and practical measures designed to ensure healthcare provision. These are implemented as individual measures (e.g. \"Rollende Arztpraxis\") or complex bundles of measures (e.g. \"Digitales Dorf\"). Measures to improve the context, such as promoting the establishment of practices through the provision of affordable building land, and new organisational structures, such as doctor networks, are frequently employed, but their impact is often limited. Due to their relatively simple implementation, telemedicine measures are particularly important and are predominantly rated as having a positive effect.In principle, the evaluation of measures should be intensified further, with greater attention being paid to the methods and criteria used to evaluate their effectiveness. An accompanying evaluation should also ensure that successfully evaluated measures are not discontinued at the end of the project, but transferred to standard care if they are effective. Due to regional and local conditions, region-specific solutions should also be sought to optimise care.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1147-1154"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Geography and health-the example of the COVID-19 pandemic in Bremen].","authors":"Christoph Buck, Daniela Koller, Eva Kibele, Katharina Schulze, Jobst Augustin","doi":"10.1007/s00103-025-04125-2","DOIUrl":"10.1007/s00103-025-04125-2","url":null,"abstract":"<p><strong>Background: </strong>Geography is, among other things, the study of spatial and temporal changes in structures and processes. Health geography applies the methods, models, and paradigms of geography to health-related issues. The example of the COVID-19 pandemic in Bremen is used to illustrate the geographical perspective on health and its benefits.</p><p><strong>Methods: </strong>The study is based on spatio-temporal data of new COVID-19 infections by calendar week at the district level in the city of Bremen between March 2020 and May 2022. In addition to the number of cases, selected indicators of the socio-demographic situation (e.g., household structure, social status, and migration status) were taken into account. Spatio-temporal analyses were performed descriptively and using linear regression models.</p><p><strong>Results: </strong>The first wave of the pandemic shows clear local differences and high incidence respectively period prevalence in individual city districts. For the later waves, a clustering with high case numbers in predominantly deprived city districts was identified. For example, in wave 2 there was an association between the number of cases and the number of persons per household (β = 1.099, p < 0.001) and in wave 4 with the SGBII rate (β = 0.056, p = 0.004).</p><p><strong>Discussion: </strong>The results show spatial differences in COVID-19 case numbers and a greater burden in deprived city districts. The study has shown the great benefit of a spatio-temporal perspective using the example of the COVID-19 pandemic in Bremen. This applies not only to the analysis of the dynamics of the pandemic, but also from a public health perspective to the identification of vulnerable populations and the implementation of targeted prevention measures.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1100-1110"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460524/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Utilization of the influenza vaccination among individuals over 60 years: spatial variations and regional risk factors].","authors":"Manas K Akmatov, Claudia Kohring, Jakob Holstiege, Doreen Müller","doi":"10.1007/s00103-025-04103-8","DOIUrl":"10.1007/s00103-025-04103-8","url":null,"abstract":"<p><strong>Background: </strong>The aims of the study were to determine the influenza vaccination coverage among individuals aged 60 and older, examine spatial variations, and identify spatial clusters as well as regional risk factors for low vaccination coverage.</p><p><strong>Methods: </strong>The study was based on nationwide outpatient claims data from 2022 and 2023. The study population consisted of 22,303,411 individuals with statutory health insurance aged 60 and older. The influenza vaccination coverage was calculated as the proportion of vaccinated individuals during the 2022/23 season among all persons with Statutory Health Insurance (SHI) who had contact with SHI-authorized physicians in 2022. Global spatial autocorrelation, local spatial clusters, and regional risk factors for low vaccination coverage were examined using global and local Moran's I as well as geographically weighted regression.</p><p><strong>Results: </strong>The nationwide influenza vaccination coverage was 37%, with district-level variations ranging from 10% to 61%. The global autocorrelation was 0.87 (global Moran's I, p < 0.0001). Two strongly pronounced local clusters were identified. A large spatial cluster with relatively high vaccination coverage spanned across all eastern federal states as well as districts in southeastern Lower Saxony, Schleswig-Holstein, and Hamburg. Another cluster with relatively low vaccination coverage encompassed almost all districts in southern Germany. The risk factors for low vaccination coverage included residence in western Germany and in sparsely populated rural districts. The density of general practitioners showed a positive correlation with vaccination coverage. The relationships between vaccination coverage and explanatory variables varied regionally.</p><p><strong>Discussion: </strong>The identification of spatial clusters and regional risk factors for low vaccination coverage can serve as a basis for regionally tailored intervention measures to improve vaccine uptake.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1138-1146"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460560/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[\"Promoting health means promoting democracy\": conference report on the 2025 Poverty and Health Congress].","authors":"Nicole Böhme, Dominica Czora, Julia Demirdizen, Maren Janella, Marina Martin, Jens Hoebel","doi":"10.1007/s00103-025-04128-z","DOIUrl":"10.1007/s00103-025-04128-z","url":null,"abstract":"","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1204-1209"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460518/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Impact of a national policy change on rapid diagnostic testing for HIV, hepatitis C and syphilis by lay providers in community-based organisations and local public health centres: a cross-sectional study].","authors":"Annabelle Cremer, Ralf Reintjes, Bernd Schulte, Carlo Kantwerk, Axel Jeremias Schmidt","doi":"10.1007/s00103-025-04113-6","DOIUrl":"10.1007/s00103-025-04113-6","url":null,"abstract":"<p><strong>Background: </strong>To improve the diagnosis of undetected infections with the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and syphilis infections among key populations, Section 24 of the Infection Protection Act was amended. Since 1 March 2020, non-medical staff have also been permitted to perform rapid tests. This study aims to examine the impact of the legal change in low-threshold AIDS and drug services as well as in public health offices.</p><p><strong>Methods: </strong>In a cross-sectional survey, 274 drug services, 100 member organisations of the German AIDS Service Organisation and 342 public health offices were invited to take part in an online questionnaire. Topics included facility structure, service provision and the acceptance, implementation and effects of the legal change. Data were analysed descriptively; where sample size allowed, results were differentiated by facility type.</p><p><strong>Results: </strong>Of the 716 facilities contacted, 286 participated. After the legal change, 80 (28%) introduced rapid testing by non-medical staff. Facilities with existing testing services were more likely to adopt testing by non-medical staff than those without prior experience (56.8% vs. 13.6%). The average monthly number of HIV, HCV, and syphilis rapid tests increased significantly. The number of reactive test results remained unchanged.</p><p><strong>Conclusion: </strong>The legal change shows positive effects but there is still potential for broader implementation. Existing test infrastructure appears to support uptake. Additional support measures are needed to expand testing by non-medical staff. However, this alone is not sufficient to detect undiagnosed infections. Expansion and promotion of outreach testing services remain essential.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1194-1203"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Spatial access to palliative care units in Germany: integrated analysis of availability and accessibility using the E2SFCA method].","authors":"Theresa Petzold, Friedemann Nauck, Christian Banse, Jobst Augustin, Maximiliane Jansky","doi":"10.1007/s00103-025-04124-3","DOIUrl":"10.1007/s00103-025-04124-3","url":null,"abstract":"<p><strong>Introduction: </strong>Demographic change and rising patient numbers pose challenges for local access to palliative care units. Availability and accessibility as dimensions of spatial access, which have mostly been considered separately in previous studies, are integrated using the method \"Enhanced Two-Step Floating Catchment Area\" (E2SFCA) in order to identify regional differences by providing a more realistic picture of the care situation.</p><p><strong>Methods: </strong>At the community level, an access index (Z_i) was calculated using the E2SFCA method. It was based on population data , bed capacity, and accessibility within a 30-minute drive. The index was divided into quintiles and assigned to categories with low (Q1, Q2), medium (Q3), and high access index (Q4, Q5).</p><p><strong>Results: </strong>Access to the 372 palliative care units identified in Germany varies greatly between and within urban and rural areas. In sparsely populated areas, care services lead to above-average access. At the same time, long travel times arise in more remote communities (e.g., Mecklenburg-Western Pomerania). Urban regions often achieve high access indices due to a high density of services. A high population density results in average access when services are available (e.g., North Rhine-Westphalia).</p><p><strong>Discussion and conclusion: </strong>Most people in Germany could reach palliative care units within 30 min, with large regional differences. The E2SFCA method, applied for the first time to palliative care units, offers a more precise analysis than studies based on district-specific bed capacities and number of inhabitants. In order to reflect the actual regional care situation, the care provision in areas with poor access must be examined in detail.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1128-1137"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding changes to life expectancy and inequalities in the UK, Germany, and other high-income countries.","authors":"Gerry McCartney, David Walsh","doi":"10.1007/s00103-025-04126-1","DOIUrl":"10.1007/s00103-025-04126-1","url":null,"abstract":"<p><p>The rate of improvement in life expectancy and mortality slowed considerably in a number of high-income countries from the early 2010s, predating the COVID-19 pandemic by almost a decade. Evidence for different countries, including the separate nations of the United Kingdom (e.g. Scotland and England), shows that this overall 'stalling' of improvement has been driven by markedly worsening mortality rates among poorer populations, thereby considerably widening spatial inequalities. Here we synthesise international data and evidence-with a particular focus on the United Kingdom and Germany-to highlight the common causes of these trends, most notably economic 'austerity' policies that were implemented in the aftermath of the 2007/2008 financial crash. These have demonstrably increased rates of poverty, reduced availability of required social services, and left public services more threadbare, all of which has negatively impacted mental and physical health and mortality. We conclude with a discussion of the economic policy responses required to address this multi-nation population health emergency.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1178-1184"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Point-of-care tests for sexually transmitted infections-what is the current status?]","authors":"Viviane Bremer, Heinrich Scheiblauer, Maximilian Muenchhoff, Christian Schüttler, Jörg Timm, Michael Baier, Susanne Buder, Kristin Meyer-Schlinkmann, Thomas Neiße, Roger Dumke, Thomas Meyer, Gyde Steffen, Klaus Jansen, Norbert Brockmeyer","doi":"10.1007/s00103-025-04067-9","DOIUrl":"10.1007/s00103-025-04067-9","url":null,"abstract":"<p><p>Point-of-care tests (PoCTs) enable the rapid diagnosis of sexually transmitted infections (STIs) directly at the point of care and play a central role in achieving the goals of the World Health Organization (WHO) for the global elimination of AIDS and hepatitis and the reduction of STIs by 2030.The European Union's new regulation for in vitro diagnostics raises the quality standards for PoCTs. All STI tests must now undergo more rigorous reviews. Advances in PoCT development have improved testing options for HIV, syphilis, and hepatitis C, particularly through WHO prequalified tests. However, the HIV self-tests available in Germany only detect the antibody component, which means that a negative result is only reliably conclusive 12 weeks after exposure. For syphilis, PoCTs are available for antibody screening, but these still require subsequent laboratory confirmation. For infections with chlamydia, gonococci, and mycoplasma, the quality of PoCTs is still largely inadequate. Further developments in the field of nucleic acid amplification tests (NATs) show promising approaches.PoCTs are particularly beneficial for low-threshold services aimed at marginalized groups, as they enable swift diagnosis and timely treatment within the test setting. However, challenges remain, including quality assurance and potential psychological stress due to false-positive results. There remains a need for continuous development and the integration of PoCTs into the healthcare system in order to improve access to diagnostics and to reduce the spread of infections.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1185-1193"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224398","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Environmental justice-challenges for spatial analysis and monitoring].","authors":"Gesa Czwikla, Klaus Telkmann, Stefanie Dreger, Gabriele Bolte","doi":"10.1007/s00103-025-04118-1","DOIUrl":"10.1007/s00103-025-04118-1","url":null,"abstract":"<p><p>Spatiotemporal analysis and monitoring of socially unequally distributed environmental hazards and resources as well as their effects on health provide an important basis for political decisions under environmental justice aspects. Appropriate analysis and monitoring approaches are accompanied by diverse conceptual and methodological challenges, which are described and discussed in this paper.A major challenge lies in the comprehensive modeling of environmental exposures, as measurement data are often only selectively available, requiring complex interpolation methods. Further challenges lie in quantifying inequalities in environmental exposures, as environmental and social data are usually only available in aggregate form at the level of administrative spatial units, and in the lack of data on subjective assessment of the quality of environmental exposures. Specific challenges to large-scale, Europe-wide monitoring of health-relevant environmental inequalities by the World Health Organization (WHO) arise from a lack of information on relevant environmental exposures or inequality dimensions, different types of data, and a lack of quantification of social differences in vulnerability. This currently limits the ability to make statements about the social distribution of environmental exposures in the European Region and their health effects.In order to make informed political decisions and reduce socially unequally distributed environmental burdens and resources as well as their health effects in an evidence-based manner, a substantial improvement regarding data availability is necessary as a prerequisite for a comprehensive, standardized monitoring.</p>","PeriodicalId":9562,"journal":{"name":"Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz","volume":" ","pages":"1170-1177"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12460478/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}