@misc{HoffmannSanderRattayetal., author = {Hoffmann, Stephanie and Sander, Lydia and Rattay, Petra and Blume, Miriam and H{\"o}vener, Claudia and Schneider, Sven and Richter, Matthias and Pischke, Claudia R. and Sch{\"u}ttig, Wiebke and De Bock, Freia and Spallek, Jacob}, title = {Do family characteristics contribute to a socioeconomic gradient in overweight in early childhood? - Single mediation analyses of data from German preschool children}, series = {Preventive Medicine Reports}, volume = {33}, journal = {Preventive Medicine Reports}, issn = {2211-3355}, doi = {10.1016/j.pmedr.2023.102178}, abstract = {Children's overweight is strongly associated with family socioeconomic position (SEP) and family characteristics (FC). There is limited research on the extent to which FC account for a socioeconomic gradient in childhood overweight. This study examined whether FC explain SEP differences in the prevalence of overweight. The study used baseline data of preschool-aged children from the German 'PReschool INtervention Study'. The sample (n = 872, 48\% girls) was recruited at kindergartens in Baden-W{\"u}rttemberg, Germany. Data included children's measured weight status and parents' reports on socioeconomic indicators (e.g., school education, vocational education, income) and FC. Variables represent main determinants of overweight (nutrition: sweets consumption in front of TV, soft drink consumption, regular breakfast, child sets table; physical activity: outdoor sports; parental role model). In single mediation analyses indirect effects of SEP on overweight were analysed (OR[95\%CI]). Preschool girls and boys with low parental education had higher odds for overweight than children with high parental education. Among boys, low levels of parental education contributed to the odds of overweight via indirect effects by both factors 'sweets consumption in front of TV' (OR = 1.31[1.05-1.59]) and 'no sports' (OR = 1.14[1.01-1.38]). Among girls, FC measured did not explain SEP differences in overweight. Family nutrition and parental/family physical activity contribute to inequalities in overweight among preschool boys, but not girls. Research is needed to identify FC that explain inequalities in overweight for both.}, language = {en} } @misc{BoeckmannJaehnBergholzetal., author = {B{\"o}ckmann, Robert and Jaehn, Philipp and Bergholz, Andreas and Spallek, Jacob and Rapp, Michael A. and Holmberg, Christine}, title = {Entwicklung eines Sozialstrukturindex zur Ermittlung des soziostrukturellen Versorgungsbedarfs in der ambulanten medizinischen Versorgung in Brandenburg}, series = {Das Gesundheitswesen}, volume = {85}, journal = {Das Gesundheitswesen}, number = {12}, issn = {1439-4421}, doi = {10.1055/a-2042-9874}, pages = {1140 -- 1148}, abstract = {Introduction: Despite the growing numbers of physicians in outpatient care, continuing discussion about the planning of physician requirements suggests remaining problems in this field, which could be due to focussing on the ratio of physician to population rather than on morbidity-based evaluations. Against this background, this paper tries to depict the latent need in outpatient care, illustrates supply and demand and further tests the hypothesis that there is a relative inequality in distribution due to physicians preferring to locate in socially privileged areas in the German state of Brandenburg. Methods: We aggregated all data available on a small scale with potential impact on demand and examined it via principal component analysis. The generated factor was mapped together with the locations of general practitioners and specialists in general care. Using linear regressions, the number of practitioners was compared to the local index value to determine regional inequalities. Results: The PCA suggested a one factor solution; that factor was designated Social Structure Index due to its values. The mapping showed a tendency of higher index values towards the central areas of Brandenburg surrounding Berlin. Regressions of the number of practitioners against the index values revealed no significant differences between communities with high and low index values. Conclusion: The extension of factors concluding the evaluation of physician demand in outpatient care confirms the problems of physician supply in rural areas, where sparse populations meet social disadvantages and poor accessibility. An underlying inequality in distribution in terms of physicians preferring socially privileged areas could not be detected.}, language = {de} } @misc{BergholzJaehnBoeckmannetal., author = {Bergholz, Andreas and Jaehn, Philipp and B{\"o}ckmann, Robert and Reibis, Rona and Spallek, Jacob and Rapp, Michael A. and Ritter, Oliver and Demmerer, Niklas and Holmberg, Christine}, title = {Erreichbarkeit der kardiologischen Versorgungsinfrastruktur im Bundesland Brandenburg in Abh{\"a}ngigkeit vom lokalen Versorgungsbedarfs}, series = {Das Gesundheitswesen}, journal = {Das Gesundheitswesen}, issn = {1439-4421}, doi = {10.1055/a-2075-7748}, abstract = {Ziel der Studie Im bundesweiten Vergleich weist Brandenburg eine der h{\"o}chsten Morbidit{\"a}ts- und Mortalit{\"a}tsraten isch{\"a}mischer Herzerkrankungen auf. Die Erreichbarkeit der medizinischen Versorgungsinfrastruktur gilt dabei als eine Erkl{\"a}rungsm{\"o}glichkeit f{\"u}r regionale gesundheitliche Ungleichheit. Demnach verfolgt die Studie das Ziel, die Distanzen zu verschiedenen Versorgungsarten der kardiologischen Versorgung auf Gemeindeebene zu berechnen und diese im Zusammenhang mit dem lokalen Versorgungsbedarf zu betrachten. Methodik Pr{\"a}ventive Sportangebote, Haus{\"a}rzte, kardiologische Praxen, Krankenh{\"a}user mit Herzkatheterlabor und Einrichtungen ambulanter Rehabilitation wurden als wesentliche Einrichtungen f{\"u}r die kardiologische Versorgung herangezogen und kartiert. Daraufhin wurden die Distanzen {\"u}ber das Straßenverkehrsnetz vom Mittelpunkt jeder Brandenburger Gemeinde zum n{\"a}chsten Standort der jeweiligen Versorgungseinrichtung berechnet und in Quintile eingeteilt. Mediane und Interquartilsabst{\"a}nde des deutschen sozio{\"o}konomischen Deprivationsindex und des Anteils der Bev{\"o}lkerung {\"u}ber 65 Jahre wurden als Proxys f{\"u}r den Versorgungsbedarf herangezogen und mit den Distanzquintilen je Versorgungsart in Zusammenhang gesetzt. Ergebnisse F{\"u}r 60\% der Brandenburger Gemeinden sind Haus{\"a}rzte innerhalb von 2,5 km, pr{\"a}ventive Sportangebote innerhalb von 19,6 km, kardiologische Praxen innerhalb von 18,3 km, Krankenh{\"a}user mit Herzkatheterlabor innerhalb von 22,7 km und Einrichtungen ambulanter Rehabilitation innerhalb von 14,7 km erreichbar. Der Median des deutschen Deprivationsindexes steigt bei allen Versorgungsarten mit zunehmender Distanz an. Der Median des Anteils {\"u}ber 65-J{\"a}hriger zeigt keine nennenswerte Variation zwischen den Distanzquintilen. Schlussfolgerung Die Ergebnisse zeigen f{\"u}r hohe Bev{\"o}lkerungsanteile teilweise große Distanzen zu spezialisierten kardiologischen Versorgungsangeboten, w{\"a}hrend haus{\"a}rztliche Praxen f{\"u}r einen hohen Anteil erreichbar scheinen. In Brandenburg scheint eine regionale und an lokalen Bedarfen orientierte sektoren{\"u}bergreifende Versorgung notwendig.}, language = {de} } @misc{DeSantisMuellmannPanetal., author = {De Santis, Karina Karolina and M{\"u}llmann, Saskia and Pan, Chen-Chia and Hoffmann, Stephanie and Spallek, Jacob and Haug, Ulrike and Zeeb, Hajo}, title = {Digital technology use for physical activity promotion: Results of a nationwide survey in Germany}, series = {37th Annual Conference of the European Health Psychology Society}, journal = {37th Annual Conference of the European Health Psychology Society}, doi = {10.13140/RG.2.2.22062.48967}, pages = {1}, abstract = {Background. Digital technologies can contribute to healthy behaviour. We aimed to investigate a digital technology use for physical activity (PA) promotion using a nationwide survey. Methods. Our cross-sectional survey was conducted using a panel sample of 1020 adult internet users living in Germany (age: 18-92 years, 47\% female). Computer-assisted telephone interviews were conducted using a self-developed questionnaire in November 2022. Survey data were analysed using relative frequencies and bivariate logistic regression. Findings. Among all participants, 626/1020 reported internet use in health context and 278/626 (44\%) reported digital technology use for PA promotion. Most of the 278 users for PA promotion reported that such technologies are easy to use (92\%) and use them at least once a week (91\%). The reasons for using digital technologies were to measure own PA (74\%) or to find exercise ideas (57\%). Most participants reported using mobile devices (e.g., smartphones, 77\%, or activity trackers, 58\%) and rated device feedback as helpful (69\%). Among sociodemographic factors (age, gender, education, household income), health status and eHealth literacy, younger age was the only significant predictor (OR=.98, 95\% CI: .97-.99) of digital technology use for PA promotion. Discussion. Despite their availability, the prevalence of digital technology use for PA promotion is still low among adult internet users in Germany. Such technologies are likely to support PA behaviour change because users rate them as easy to use, their feedback as helpful and use them frequently. Health interventions are necessary to encourage digital technology use for PA promotion among adults in Germany.}, language = {en} } @misc{MuellmannDeSantisPanetal., author = {M{\"u}llmann, Saskia and De Santis, Karina Karolina and Pan, Chen-Chia and Hoffmann, Stephanie and Spallek, Jacob and Haug, Ulrike and Zeeb, Hajo}, title = {Attitudes towards digital technology use in health context according to a nationwide survey in Germany}, series = {37th Annual Conference of the European Health Psychology Society}, journal = {37th Annual Conference of the European Health Psychology Society}, doi = {10.13140/RG.2.2.24579.07200}, pages = {1}, abstract = {Background Digitalization has led to a proliferation of digital health technologies and online health information. We aimed to assess the attitudes towards digital technology use in health context using a nationwide survey. Methods A cross-sectional nationwide survey of a panel sample of adult internet users living in Germany was conducted in November 2022. Participants completed computer-assisted telephone interviews using a self-developed, 30-item questionnaire. Survey data were analysed using frequencies and univariate multiple regression analysis. Findings Among 1,020 participants (18-92 years, 56±16 years, 47\% female), 62\% completed up to tertiary education and 42\% reported the household income of up to 3500 Euro/month. The minority of participants reported that they trust health websites when recommended by friends and family (39\%), that their social network relies on the internet for health information (35\%), that they consider the internet as the immediate source of health information (39\%) and that they are interested in digital health technologies (40\%). Most participants (71\%) reported that they prefer to receive health information in person or on paper. The preference for such sources of health information was associated with lower eHealth literacy (β= -.12, p<.001), worse health status (β= -.08, p=.026) and female gender (β= -.08, p=.033). Discussion The trust in the internet as the source of health information and the interest in digital health technologies were low among internet users in Germany. Interventions should strengthen eHealth literacy to empower adults to find, understand and assess reliable health information on the Internet.}, language = {en} } @misc{HoffmannSchulzeLoeffleretal., author = {Hoffmann, Stephanie and Schulze, Susanne and L{\"o}ffler, Antje and Becker, Juliane and Hufert, Frank and Gremmels, Heinz-Detlef and Holmberg, Christine and Rapp, Michael A. and Entringer, Sonja and Spallek, Jacob}, title = {Depressive Symptome bei Besch{\"a}ftigten im Gesundheitswesen w{\"a}hrend der COVID-19-Pandemie: Ergebnisse einer Kohortenstudie in einem Krankenhaus der Regelversorgung in Deutschland}, series = {Gesundheitswesen}, volume = {85}, journal = {Gesundheitswesen}, number = {809}, doi = {10.1055/s-0043-1770597}, abstract = {Einleitung Bisher liegen in Deutschland wenig empirische Ergebnisse zu den Auswirkungen der COVID-19 Pandemie auf die seelische Gesundheit von Besch{\"a}ftigten im Gesundheitswesen vor. In dieser Studie wird die zeitliche Entwicklung depressiver Symptome und der Zusammenhang mit a) der Stresswahrnehmung, b) der eigenen COVID-19-Infektion und c) der arbeitsplatzbezogenen COVID-19-Exposition untersucht. Methoden Die Kohortenstudie mit 91 Besch{\"a}ftigten (90\% wbl, x̅=45 Jr) eines Krankenhauses schloss (1) medizinisches, pflegerisches und therapeutisches sowie (2) administratives Personal im Zeitraum von Juli 2020 bis Dezember 2020 ein. Gemischte Modelle analysierten zeitliche Depressionswerte ('Allg. Depressionsskala') mit wahrgenommenem Stress ('Perceived Stress Scale'). Eine eigene COVID-19-Infektion (Laborbefund) wurde als Moderator getestet. Die zeitliche Entwicklung von Symptommodalit{\"a}ten (u.a. somatisch) wurde nach beruflicher Exposition analysiert. Ergebnisse Die Depressionswerte stiegen insgesamt w{\"a}hrend des Studienzeitraums an (b=.03, .02-.05). Stressempfinden war mit depressiven Symptomen assoziiert (b=.12, .10-.14). Eine eigene Infektion war mit einem h{\"o}heren Anstieg assoziiert (b=.06, .01-.10). Somatische Depressionssymptome nahmen nur bei beruflichem Kontakt mit COVID-19 zu (b=.25, .13-.38). Schlussfolgerung Die Zunahme somatischer depressiver Symptome bei Besch{\"a}ftigten mit beruflichem Kontakt zu COVID-19 zeigt einen Bedarf an Forschung {\"u}ber und Ressourcen f{\"u}r Gesundheitsschutz und -f{\"o}rderung. Das Bewusstsein f{\"u}r Schutzmaßnahmen sollte gest{\"a}rkt werden.}, language = {de} } @misc{LoefflerHoffmannDeSantisetal., author = {L{\"o}ffler, Antje and Hoffmann, Stephanie and De Santis, Karina Karolina and M{\"u}llmann, Saskia and Pan, Chen-Chia and Haug, Ulrike and Zeeb, Hajo and Spallek, Jacob}, title = {Digitale Gesundheitskompetenz und Interesse an digitalen Gesundheitstechnologien im l{\"a}ndlichen Raum - eine Querschnitterhebung}, series = {Gesundheitswesen}, volume = {85}, journal = {Gesundheitswesen}, number = {811}, doi = {10.1055/s-0043-1770604}, abstract = {Einleitung Digitale Gesundheitstechnologien k{\"o}nnten einen bedeutenden Beitrag zur Sicherstellung einer hochwertigen und effizienten Gesundheitsversorgung insbesondere im ruralen, d{\"u}nnbesiedelten Raum leisten. Diese Studie untersucht die Zusammenh{\"a}nge zwischen Ruralit{\"a}t, digitaler Gesundheitskompetenz und Interesse an digitalen Gesundheitstechnologien. Methoden Daten einer deutschlandweiten telefonischen Befragung Erwachsener zu Einstellung und Nutzung digitaler Gesundheitstechnologien wurden mit Ruralit{\"a}t (Einwohnerdichte/km²) verlinkt (n=941). Zusammenh{\"a}nge zwischen digitaler Gesundheitskompetenz (eHEALS-Skala), Interesse an digitalen Gesundheitstechnologien (gering/hoch) und Ruralit{\"a}t wurden mit bi- und multivariaten Verfahren, adjustiert f{\"u}r Alter, Sozialstatus und Geschlecht analysiert. Ergebnisse Digitale Gesundheitskompetenz und Interesse an digitalen Gesundheitstechnologien sind im l{\"a}ndlichen Raum schw{\"a}cher ausgepr{\"a}gt als im urbanen Raum (t (877) =-3.13, p=.002, d =-.254; Chi² (1, N=936) =6.04, p=.014). Geringere Einwohnerdichte ist mit einer niedrigeren Gesundheitskompetenz (β=.07; p=.043) und mit weniger Interesse an digitalen Gesundheitstechnologien assoziiert (OR=1.21; 95\%KI 1.084-1.352). Schlussfolgerung Bewohnende des l{\"a}ndlichen Raums unterscheiden sich hinsichtlich ihrer digitalen Gesundheitskompetenz und ihres Interesses an digitalen Gesundheitstechnologien von urbanen Regionen. R{\"a}umliche Faktoren sollten als m{\"o}gliche Zugangsbarrieren bei der Implementierung digitaler Gesundheitstechnologien ber{\"u}cksichtigt werden.}, language = {de} } @misc{MichalskiTetzlaffHoffmannetal., author = {Michalski, Niels and Tetzlaff, Fabian and Hoffmann, Stephanie and Spallek, Jacob and Hoebel, Jens}, title = {Der German Index of Socioeconomic Deprivation (GISD) - Ein Tool zur Verkleinerung „blinder Flecken" der Sozialepidemiologie in Deutschland?}, series = {BEWEGTE ZEITEN: LEBENSWELTEN IM WANDEL - Programm und Abstract-Band_DGMP-DGMS2023}, journal = {BEWEGTE ZEITEN: LEBENSWELTEN IM WANDEL - Programm und Abstract-Band_DGMP-DGMS2023}, pages = {S. 37}, abstract = {Hintergrund: Die Sozialepidemiologie in Deutschland konnte in den letzten Jahrzehnten in wichtigen Fragen zur internationalen Forschung aufschließen. Dennoch bestehen hierzulande im Vergleich zu vielen anderen L{\"a}ndern weiterhin einige Datenl{\"u}cken und „blinde Flecken", z.B. hinsichtlich sozialer Unterschiede in der ursachenspezifischen Mortalit{\"a}t oder dem Zusammenspiel von individuellen und sozialr{\"a}umlichen Einfl{\"u}ssen auf Gesundheit. Diese h{\"a}ngen u.a. mit fehlenden Verkn{\"u}pfungsm{\"o}glichkeiten von Gesundheits- und Sozialdaten auf Individual- und Raumebene zusammen. Der German Index of Socioeconomic Deprivation (GISD) des Robert Koch-Instituts stellt ein Maß zur Verf{\"u}gung, mit dem ein Beitrag zur Bearbeitung dieser Fragen geleistet werden kann. Methoden: Anhand von Anwendungsbeispielen werden Analysepotentiale des GISD f{\"u}r die Sozialepidemiologie in Deutschland aufgezeigt. Daf{\"u}r wird der GISD mit Daten 1) der amtlichen Statistik (z.B. Todesursachenstatistik), 2) der Schuleingangsuntersuchung sowie 3) der Studie Corona-Monitoring bundesweit (RKISOEP- 2) auf kleinr{\"a}umiger Ebene verkn{\"u}pft. Zur Anwendung kommen epidemiologische Methoden wie die Berechnung altersstandardisierter Raten und relativer Risiken, u.a. mittels (Mehrebenen-)Regressionsmodellen. Ergebnisse: 1) F{\"u}r nahezu alle h{\"a}ufigen Todesursachen zeigt der GISD regionale sozio{\"o}konomische Gradienten in der Mortalit{\"a}t. Bei Krebserkrankungen beispielsweise weisen Frauen und M{\"a}nner, die in sozio{\"o}konomisch hoch deprivierten Kreisen leben, eine bis zu dreimal h{\"o}here Lungenkrebssterblichkeit auf als jene in wohlhabenden Kreisen. 2) Hinsichtlich des allgemeinen Entwicklungsstandes von Kindern bei der Schuleingangsuntersuchung werden bei Kindern aus h{\"o}her deprivierten Gemeinden h{\"a}ufiger Entwicklungsverz{\"o}gerungen festgestellt, selbst nach Kontrolle f{\"u}r den famili{\"a}ren sozio{\"o}konomischen Status. 3) Die niedrigste COVID-19-Impfquote zeigte sich unabh{\"a}ngig von der regionalen sozio{\"o}konomischen Deprivation bei Personen mit niedrigen Bildungsabschl{\"u}ssen. Stratifiziert nach GISD-Quintilen wird ersichtlich sich, dass diese Bildungsunterschiede in der Impfquote mit steigender sozio{\"o}konomischer Deprivation der Wohnregion zunehmen. Diskussion: Der GISD bietet f{\"u}r die sozialepidemiologische Forschung ein breites Analysepotenzial. Insbesondere bei der Analyse gesundheitlicher Ungleichheit kann er f{\"u}r verschiedene Gesundheitsoutcomes und Lebensphasen zur Erschließung bislang ungenutzter Routinedatenquellen (z.B. Todesursachenstatistik) sowie Erg{\"a}nzung von Routine- und Prim{\"a}rdaten dienen, um „blinde Flecke" der Sozialepidemiologie in Deutschland zu verringern.}, language = {de} } @misc{HoffmannSchulzeLoeffleretal., author = {Hoffmann, Stephanie and Schulze, Susanne and L{\"o}ffler, Antje and Becker, Juliane and Hufert, Frank and Gremmels, Heinz-Detlef and Holmberg, Christine and Rapp, Michael A. and Entringer, Sonja and Spallek, Jacob}, title = {Did the prevalence of depressive symptoms change during the COVID-19 pandemic? A multilevel analysis on longitudinal data from healthcare workers}, series = {International Journal of Social Psychiatry}, volume = {70}, journal = {International Journal of Social Psychiatry}, number = {1}, issn = {0020-7640}, doi = {10.1177/00207640231196737}, pages = {87 -- 98}, abstract = {Background: Healthcare workers (HCW) are at high risk to develop mental health problems during the COVID-19 pandemic because of additional work load, perceived stress, and exposure to patients with COVID-19. Currently, there are few studies on change over time in the prevalence of depressive symptoms during pandemic start among HCW. Thus, the aims of the current study were to examine whether depressive symptoms increased during the pandemic and were associated with perceived stress and own COVID-19 infection and workplace exposure to virus-infected patients. Methods: The cohort study used longitudinal data from HCW collected monthly (July 2020 till December 2020) during the first year of the pandemic before vaccination became available. The sample of n = 166 was drawn from a German hospital and included medical (e.g. nurses, therapists, and physicians) and administrative staff. Using multilevel models, we analyzed the change in depressive symptoms [assessed with General Depression Scale (GDS), a validated German version of the Center for Epidemiological Studies Depression Scale (CES-D)] and its association with perceived stress across the study period. Laboratory-confirmed own infection was tested as a potential moderator in this context. Subscales of the GDS were used to examine change over time of depressive symptom modalities (e.g. emotional, somatic, and social interactions (β, 95\% confidence interval). Results: Depression scores increased significantly during the study period (β = .03, 95\% CI [0.02, 0.05]). Perceived stress was associated with depressive symptoms (β = .12, 95\% CI [0.10, 0.14]) but did not change over time. Exposure to COVID-19 infection was associated with a higher increase of depressive symptoms (β = .12, 95\% CI [0.10, .14]). Somatic symptoms of depression increased among medical HCW with workplace exposure to COVID-19 (β = .25, 95\% CI [0.13, 0.38]), but not in administrators (β = .03, 95\% CI [-0.04, 0.11]). Conclusion: Research is needed to identify factors that promote the reduction of depressive symptoms in medical HCW with exposition to COVID-19 patients. Awareness of infection protection measures should be increased.}, language = {en} } @misc{HoffmannSpallek, author = {Hoffmann, Stephanie and Spallek, Jacob}, title = {Regionale Deprivation und Entwicklungsverz{\"o}gerung bei Kindern}, series = {Public Health Forum}, volume = {31}, journal = {Public Health Forum}, number = {3}, issn = {1876-4851}, doi = {10.1515/pubhef-2023-0071}, pages = {188 -- 191}, abstract = {Die psychische Gesundheit junger Menschen h{\"a}ngt mit ihrer psychosozialen Entwicklung (z. B. Sprache) zusammen, f{\"u}r die Unterschiede anhand sozio{\"o}konomischer Bedingungen der Familie beschrieben werden. Die Deprivation der Wohnregion ist additiver Risikofaktor f{\"u}r die kindliche Entwicklung (ORweibl. = 1,35[1,13-1,62]; ORm{\"a}nnl. = 1,20[1,05-1,39]). Beide sind von besonderem Interesse f{\"u}r Public Mental Health und F{\"o}rderung der Gesundheit von Kindern in der fr{\"u}hen Kindheit und im Lebensverlauf.}, language = {de} } @misc{SpallekZeebRazum, author = {Spallek, Jacob and Zeeb, Hajo and Razum, Oliver}, title = {Lebenslauforientierte Epidemiologie in der Migrationsforschung}, series = {Bundesgesundheitsblatt}, volume = {66}, journal = {Bundesgesundheitsblatt}, number = {10}, issn = {1437-1588}, doi = {10.1007/s00103-023-03761-w}, pages = {1092 -- 1098}, abstract = {Es gibt viele Gr{\"u}nde f{\"u}r Migration, von freier Entscheidung bis zu erzwungener Flucht. Entsprechend vielf{\"a}ltig sind auch die Vorgeschichten und Lebensumst{\"a}nde der migrierenden Menschen. Die damit einhergehenden unterschiedlichen Expositionen beeinflussen die Gesundheit der Migrant*innen und ihrer Kinder. Um ein solch komplexes Ph{\"a}nomen zu erfassen, ist ein Ansatz erforderlich, der die besonderen Umst{\"a}nde im Lebenslauf der Migrant*innen einbezieht. Ein etablierter methodischer Ansatz, der dies leisten kann, ist die Lebenslaufepidemiologie. Bei der Anwendung dieses Konzepts auf migrierende Bev{\"o}lkerungen werden Expositionen vor, w{\"a}hrend und nach der Migration untersucht. In der epidemiologischen Forschung zur Gesundheit von eingewanderten Menschen ist es w{\"u}nschenswert, alle diese 3 Phasen zu ber{\"u}cksichtigen. Eine Herausforderung hierbei ist, dass verl{\"a}ssliche Daten {\"u}ber den gesamten Lebenslauf nicht immer verf{\"u}gbar sind. Eine valide, zeitnahe Erhebung und datenschutzgerechte Verkn{\"u}pfung longitudinaler Daten aus verschiedenen Quellen k{\"o}nnen die lebenslaufbezogene Forschung zur Gesundheit von Migrant*innen in Deutschland verbessern. Perspektivisch sollten entsprechende Daten auch aus den Herkunftsl{\"a}ndern von Migrant*innen einbezogen werden.}, language = {de} } @incollection{TetzlaffPurohitSpalleketal., author = {Tetzlaff, Laura and Purohit, Anne-Maria and Spallek, Jacob and Holmberg, Christine and Schrader, Thomas}, title = {Evaluating Interoperability in German Critical Incident Reporting Systems}, series = {German Medical Data Sciences 2023 - Science. Close to People, Proceedings of the 68th Annual Meeting of the German Association of Medical Informatics, Biometry, and Epidemiology e.V. (gmds) 2023 in Heilbronn, Germany}, booktitle = {German Medical Data Sciences 2023 - Science. Close to People, Proceedings of the 68th Annual Meeting of the German Association of Medical Informatics, Biometry, and Epidemiology e.V. (gmds) 2023 in Heilbronn, Germany}, publisher = {IOS Press}, address = {Amsterdam [u.a.]}, isbn = {978-1-64368-429-1}, doi = {10.3233/SHTI230722}, pages = {249 -- 257}, abstract = {Introduction: In industrialised countries, one in ten patients suffers harm during hospitalization. Critical Incident Reporting Systems (CIRS) aim to minimize this by learning from errors and identifying potential risks. However, a lack of interoperability among the 16 CIRS in Germany hampers their effectiveness. Methods: This study investigates reports' syntactic and semantic interoperability across seven different reporting systems. Syntactic interoperability was examined using WHO's Minimal Information Models (MIM), while semantic interoperability was evaluated with SNOMED concepts. Results: The findings reveal a low structural overlap, with only two terms correctly represented in the SNOMED CT terminology. In addition, most systems showed no syntactic interoperability. Conclusion: Improving interoperability is essential for increasing the effectiveness and usability of CIRS. The study suggests a unified data model such as MIM or using Health Level 7 Fast Healthcare Interoperability Resources (HL7 FHIR) resources and expanding SNOMED CT with patient safety-relevant terms for semantic interoperability. Given the current lack of both syntactic and semantic interoperability in CIRS, developing a patient safety ontology is recommended for efficient critical incident analysis too.}, language = {en} } @incollection{SpallekRazum, author = {Spallek, Jacob and Razum, Oliver}, title = {Migration und Gesundheit}, series = {Soziologie von Gesundheit und Krankheit}, booktitle = {Soziologie von Gesundheit und Krankheit}, editor = {Richter, Matthias and Hurrelmann, Klaus}, edition = {2. Auflage}, publisher = {Springer VS}, address = {Wiesbaden}, isbn = {978-3-658-42102-1}, doi = {10.1007/978-3-658-42103-8_11}, pages = {187 -- 202}, language = {de} } @misc{TallarekJostSpallek, author = {Tallarek, Marie and Jost, Annemarie and Spallek, Jacob}, title = {How do midwives deal with women's preferences during childbirth in Germany? An action model}, series = {European Journal of Public Health}, volume = {33}, journal = {European Journal of Public Health}, number = {Supplement 2}, issn = {1788-7119}, doi = {10.1093/eurpub/ckad160.1512}, pages = {S. ii603}, abstract = {Background Midwifery care is increasingly discussed in terms of its ability to promote a self-determined childbirth. The degree of self-determination (SD) depends on the extent to which women's preferences are negotiated and implemented. From the perspective of midwives in different obstetric settings in Germany, this study answered the research question: "How do midwives deal with women's preferences during birth?". Methods 11 semi-structured face-to-face interviews were conducted with active midwives. The sample showed a high variance in terms of obstetric settings (clinics, birth centers, home births), regions, and participants' characteristics (e. g. experience, age). All interviews were recorded, transcribed, anonymized, and analyzed using the Grounded Theory Methodology (Strauss/Corbin, 1994). Results A model consisting of 7 steps was developed: 1) Interpret the situation; 2) Prioritize relevant parameters; 3) Determine a frame of possibilities; 4) Match the preference(s) to the frame of possibilities; 5) Negotiate preference(s); 6) Continuously monitor contextual/situational changes; 7) Adjust the frame of possibilities. The actions are related to contextual conditions (structural; interpersonal; personal; health situation; course of birth; understanding of birth). The model shows how midwives can promote SD even if prior preferences are discarded or modified at birth. Conclusions The model describes how midwives in Germany deal with women's preferences during birth, which factors they consider decisive in doing so, and how SD may be promoted despite of discarded or modified preferences. Further research should examine the role of relationship building, test the model with regard to its generalizability, and use it to analyze and support person-centered midwifery care. Key messages • The model describes how midwives in different obstetric settings in Germany deal with women's preferences during birth and, thereby, influence self-determination. • Midwives can promote self-determination also if prior preferences are discarded, modified, or redeveloped at birth.}, language = {en} } @misc{ScholaskeSpallekEntringer, author = {Scholaske, Laura and Spallek, Jacob and Entringer, Sonja}, title = {Perceived stress and depressive symptoms during pregnancy and postpartum in Turkish-origin women living in German}, series = {Journal of Psychosomatic Research}, journal = {Journal of Psychosomatic Research}, number = {177}, issn = {0022-3999}, doi = {10.1016/j.jpsychores.2023.111570}, abstract = {Objective: People of Turkish origin (also referred to as "with a Turkish migrant background") are one of the largest migrant groups in Germany and show disparities across different stress-related health outcomes. Specifically, women of Turkish origin in Germany have a greater risk for some mental health issues and adverse pregnancy and birth outcomes compared to women without migrant background. We tested differences between women of Turkish origin and women without migrant background in self-reported pregnancy and postpartum stress experiences and depressive symptoms. Methods: 32 women of Turkish origin (mean age 29.7 years) and 77 women without migrant background (mean age 32 years) participated in a multi-site prospective cohort study with two study visits during pregnancy and one month postpartum. Women provided sociodemographic data and completed the Perceived Stress Scale (PSS) and the Center for Epidemiology - Depression (CESD) scale at each study visit. Results: Using hierarchical linear models, we found that women of Turkish origin (both first and second gen- eration) reported more perceived stress (b = 0.57, CI: 0.29-0.84, p < 0.001) and depressive symptoms (b = 0.32, CI = 0.14-0.49, p < 0.001) compared to women without migrant background across gestation. A linear regression analysis showed that there was also a significant difference in depressive symptoms at one month postpartum (b = 0.35, CI = 0.03-0.66, p < 0.05). Conclusion: Tailored psychosocial interventions are needed to address mental health needs of pregnant Turkish origin women and to intervene on the possible transmission of stress-related health disadvantages to their offspring.}, language = {en} } @misc{ObongoTallarekSpallek, author = {Obongo, Angela and Tallarek, Marie and Spallek, Jacob}, title = {Determinants of access to and use of gestational diabetes mellitus services in Kenya: a multimethod case study protocol}, series = {BMJ Open}, volume = {13}, journal = {BMJ Open}, number = {12}, issn = {2044-6055}, doi = {10.1136/bmjopen-2023-074916}, abstract = {Gestational diabetes mellitus (GDM) is a growing public health issue in many low and middle-income countries (LMICs), making up about 90\% of the global burden of GDM. Additionally, LMICs' healthcare systems are already overwhelmed by the prevalence of communicable diseases. It is crucial to understand the patterns of GDM in sub-Saharan African countries. Early detection, lifestyle and medication interventions, regular prenatal visits and effective postpartum management can help avert the future development of type 2 diabetes. GDM services present opportunities for preventive and treatment strategies for women with GDM. However, various factors contribute to challenges and obstacles in accessing GDM services, particularly suboptimal postpartum screening and follow-up. This study aims to investigate the societal and healthcare factors that facilitate or hinder access to and use of GDM services, as well as the factors that promote or obstruct the management and treatment of GDM, in Kenya, using a postcolonial theoretical approach.}, language = {en} } @misc{HoletzekHaeuslerGoeddeetal., author = {Holetzek, Tim and H{\"a}usler, Andreas and G{\"o}dde, Kathrin and Rapp, Michael and Spallek, Jacob and Holmberg, Christine}, title = {The role of the installed base in information exchange among general practitioners in Germany : mixed methods study}, series = {Journal of Medical Internet Research}, volume = {27}, journal = {Journal of Medical Internet Research}, publisher = {JMIR Publications}, issn = {1438-8871}, doi = {10.2196/65241}, pages = {1 -- 17}, abstract = {Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5\%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2\%, SD 24.64), fax (n=109, 43.9\%, SD 25.40), or post (n=50, 20.2\%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8\%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5\%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs' communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs' practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers' perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation.}, language = {en} } @misc{IashchenkoSchuettigBammertetal., author = {Iashchenko, Iryna and Sch{\"u}ttig, Wiebke and Bammert, Philip and Schneider, Udo and Spallek, Jacob and Rattay, Petra and Schneider, Sven and Moor, Irene and Pischke, Claudia and Sundmacher, Leonie}, title = {Can invitation systems increase participation in preventive health screening among adolescents? : an evaluation of a state-wide intervention in Germany using a difference-in-differences analysis of claims data}, series = {European Journal of Public Health}, volume = {35}, journal = {European Journal of Public Health}, number = {2}, publisher = {Oxford University Press}, address = {Oxford}, issn = {1464-360X}, doi = {10.1093/eurpub/ckaf026}, pages = {312 -- 318}, abstract = {In Germany, routine screenings are used to monitor the health and development of children and adolescents, enabling timely discovery and treatment of health issues. One such screening, called J1, is recommended for adolescents aged 12-14 years, but participation is only 43\%. In the state of Bavaria, a lack of awareness is the main reason cited for not attending. 'Your Ticket to J1' was an invitation system implemented across the state to inform adolescents about the screening. Our study investigated whether this intervention increased J1 participation and if its effects varied by family socioeconomic position (SEP). We used pseudonymized data from a large statutory health insurer from 2016 to 2018 and containing 267 650 observations. To investigate the effect of the intervention, we employed a difference-in-differences analysis at the individual level. Assuming parallel trends at the state level, we compared J1 participation rates between Bavaria and other German states before and after the intervention. We additionally stratified analyses by SEP. The intervention led to an increase in J1 participation by about 1\%. In the stratified regressions, the effect size was larger for children from families with a lower SEP. J1 participation increased by about 4\% among adolescents whose primary insured parent had the lowest occupational status. A state-wide invitation system had a small but statistically significant positive impact on J1 participation and might reduce socioeconomic inequities in healthcare utilization. Informing adolescents about J1 appears to increase participation, particularly among those from families with a lower SEP.}, language = {en} } @incollection{RazumButlerSpallek, author = {Razum, Oliver and Butler, Jeffrey and Spallek, Jacob}, title = {Gesundheitliche Chancen und Risiken von Migrant*innen: Handlungsm{\"o}glichkeiten einer kommunalen Gesundheitspolitik.}, series = {Handbuch Lokale Integrationspolitik.}, booktitle = {Handbuch Lokale Integrationspolitik.}, editor = {Gesemann, Frank and Filsinger, Dieter and M{\"u}nch, Sybille}, edition = {2. Auflage}, publisher = {Springer VS}, address = {Wiesbaden}, isbn = {978-3-658-43195-2}, doi = {10.1007/978-3-658-43195-2_34-1}, pages = {1 -- 23}, abstract = {Migrant*innen haben gesundheitliche Vor- und Nachteile gegen{\"u}ber der nicht-migrierten Bev{\"o}lkerung. Der Zusammenhang zwischen Migration und Gesundheit ist mehrdimensional, weitere - insbesondere soziale - Faktoren m{\"u}ssen bei der Interpretation beachtet werden. Erkl{\"a}rungsmodelle bilden die Komplexit{\"a}t des Zusammenhangs ab. Die zentralen Modelle haben eine Perspektive auf den gesamten Lebenslauf von migrierten Menschen (vor, w{\"a}hrend und nach der Migration). Sie helfen der kommunalen Gesundheitspolitik, geeignete Daten zu erheben und wirksame Interventionen zu entwickeln.}, language = {de} } @misc{HoffmannMichalskiDraganoetal., author = {Hoffmann, Stephanie and Michalski, Niels and Dragano, Nico and Spallek, Jacob}, title = {Does individual-level socio-economic position modify the association between area-level deprivation and early childhood language development? : a multilevel analysis of cross-sectional population data from Germany}, series = {European journal of public health}, journal = {European journal of public health}, publisher = {Oxford University Press}, address = {Oxford}, doi = {10.1093/eurpub/ckaf082}, pages = {1 -- 6}, abstract = {Early childhood is a public health priority for enhancing health equity across the life course. Children are susceptible to individual-level socio-economic position (SEP) and the socio-economic deprivation of their place of residence, both of which contribute to differences in psychomotor development, including language. This study investigates whether individual-level SEP modifies the association between area-level deprivation and language development. This study used population-based, cross-sectional data from a School Entry Survey in Germany (2021; female: n = 9751, male: n = 10 623; age in years: ≤6 n = 11 423; 6-≤7 n = 8 746; >7 n = 205; native language: German n = 18 752; not German n = 943; bilingual n = 679), which was linked to the 'German Index of Socioeconomic Deprivation' (GISD). Binary multilevel models [odds ratio (OR), 95\% CI] were used to analyse the interaction of GISD (measured continuously) with individual-level SEP (categorized as high/medium/low) according to delayed language development (DLD in \% yes/no), which was assessed using validated instruments of 'social-pediatric screening of developmental status for school entry'. Individual SEP was tested as a moderator by stratifying the analyses. The interaction of GISD with SEP was associated with DLD (ORmediumSEP*GISD = 1.13; 1.04-1.24; ORlowSEP*GISD = 1.27; 1.13-1.43), with the main effect of GISD (OR = 0.85; 0.77-0.93). In SEP stratification, GISD was only partially associated with DLD (ORhighSEP = 0.81; 0.73-0.91; ORmediumSEP = 0.97; 0.89-1.07; ORlowSEP = 1.14; 0.99-1.32). This study demonstrates an association between area-level deprivation and DLD that is modified by individual-level SEP. The findings underscore the importance of stratification by individual-level SEP in analysing area-level effects on health, as the area-level effects can be contradictory according to individual-level SEP.}, language = {en} }