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This position paper from the Digital Public Health Section of the German Public Health Association defines digital public health (DiPH) and describes its goals and potential. It also addresses the current situation and challenges as well as the need for action in Germany. The focus here is on the presentation of the nationwide promotion of (digital) health literacy; the application of DiPH in prevention, health promotion, and healthcare; the use of innovative preventive strategies for the prevention of non-communicable diseases; and the teaching of DiPH in academic public health programs. Finally, relevant measures and demands to strengthen DiPH in Germany are summarized., Competing Interests: Einhaltung ethischer Richtlinien. Interessenkonflikt: L. Maaß, C. Dockweiler, Z. Hocke-Bolte, S. Hoffmann, F. Fischer, S. Forberger, J. Gebert, F. Holl, R. Hrynyschyn, S. Kernebeck, C. Pischke, J. Posselt und J. Spallek geben an, dass kein Interessenkonflikt besteht. Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien., (© 2024. The Author(s).)

In health research, there is a need for comprehensive survey instruments capable of assessing the multidimensionality and variability of sex/gender. The research project DIVERGesTOOL was conducted in response to this need, which has become increasingly evident in recent years. The aim was to develop an application-oriented toolbox for the assessment of sex/gender diversity in quantitative health-related research in Germany.The development process followed a participatory design, as representatives of large epidemiological studies in Germany were directly involved. During four collaborative workshops, a toolbox was developed that contains several different elements. The basic items are a generally usable set of three different questionnaire items based on the two-step approach. They are recommended as a replacement for the binary sex or gender item that are currently routinely used in health-related research. In addition, the toolbox contains further exemplary questionnaire items for specific research questions or study populations. The developed items were supplemented with detailed instructions for their application and additional information. The toolbox is an open online resource accessible to any user ( https://www.uni-bremen.de/divergestool-projekt/divergestool-toolbox ).In the long term, the DIVERGesTOOL is intended to support researchers in integrating sex/gender diversity into their own research and thus to contribute to more sex/gender sensitivity in health-related research and valid findings., (© 2024. The Author(s).)

In an ageing society, maintaining independent mobility into old age is an important objective. Mental and physical wellbeing depends not only on individual health status, but also to a large extent on the spatial conditions. Local politics and municipal administrations can influence this, especially in urban planning. This discussion article brings together perspectives from public health and urban planning on urban development and mobility against the background of health equity.The results of the AFOOT (Securing urban mobility of an ageing population) cross-sectional study on socio-spatial conditions in small- and medium-sized towns in northwestern Germany and walking and cycling by older people show the importance of residential environmental factors such as proximity to everyday destinations, walking and cycling infrastructure, and street connectivity. Preferences for the design of an age-friendly living environment and the quality of public spaces exist in terms of urban design quality, quality of stay, and safety in public spaces.In order to improve spatial conditions, the situation needs to be recorded using defined indicators and monitoring, and the perspectives of older people need to be integrated. Strategies and measures to promote active mobility in old age are aimed at the multifunctional design of public spaces, the prioritization of active mobility on everyday trips, and ensuring the accessibility of everyday destinations through urban development. Cross-sectoral cooperation between urban planning, transport planning, and public health is essential to promote the active mobility and health of older people., (© 2024. The Author(s).)

The burden of mental diseases is enormous and constantly growing worldwide. The resulting increase in demand for psychosocial help is also having a negative impact on waiting times for psychotherapy in Germany. Digital interventions for mental health, such as interventions delivered through or with the help of a website (e.g. "telehealth"), smartphone, or tablet app-based interventions and interventions that use text messages or virtual reality, can help. This article begins with an overview of the functions and range of applications of digital technologies for mental health. The evidence for individual digital forms of interventions is addressed. Overall, it is shown that digital interventions for mental health are likely to be cost-effective compared to no therapy or a non-therapeutic control group. Newer approaches such as "digital phenotyping" are explained in the article. Finally, individual papers from the "Leibniz ScienceCampus Digital Public Health" are presented, and limitations and challenges of technologies for mental health are discussed., (© 2024. The Author(s).)

Among other things, digital health applications offer users support in better understanding their physical and mental health through digital data, thereby promoting positive health behavior. In addition to state-approved digital health applications (DiGA) and digital care applications (DiPA), there is a wide array of other commercial health applications available to users. Particularly in non-approved applications, developers often deploy manipulative design strategies (dark patterns), intentionally or unintentionally, to deceive users into making specific decisions. This article provides an overview of current and widespread dark patterns and assesses the risks posed by them in digital health applications.In the future, "light" should be shed on dark patterns by creating more transparency for users, providing regulators with a more accurate understanding of dark patterns, and paying more attention to the implementation of guidelines. Thus, users may gain autonomy using healthcare applications and their data can be better protected., (© 2024. The Author(s).)

A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger‑2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL., (© 2024. The Author(s).)

Digital public health has received a significant boost in recent years, especially due to the demands associated with the COVID-19 pandemic. In this report, we provide an overview of the developments in digitalization in the field of public health in Germany since 2020 and illustrate these with examples from the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH).The following topics are central: How do digital survey methods as well as digital biomarkers and artificial intelligence methods shape modern epidemiology and prevention research? What is the status of digitalization in public health offices? Which approaches to health economics evaluation of digital public health interventions have been utilized so far? What is the status of training and further education in digital public health?The first years of the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH) were also strongly influenced by the COVID-19 pandemic. Repeated population-based digital surveys of the LSC indicated an increase in use of health apps in the population, for example, in applications to support physical activity. The COVID-19-pandemic has also shown that the digitalization of public health enhances the risk of misinformation and disinformation., (© 2024. The Author(s).)

Digital care technologies are becoming increasingly important in long-term care. They encompass all technologies that change processes and products by means of networking and/or sensor technology and include artificial intelligence, that is, processes, methods, and algorithms for learning by means of data and enabling meaningful decisions based on this. Their application ranges from the promotion of professional collaboration, control and management, knowledge acquisition and transfer, interaction and relationships to physical caregiving.Digital care technologies have the potential to simultaneously increase the quality of care and improve working conditions in care. However, there are obstacles to this at various levels: The development of these technologies is often driven by technical possibilities, resulting in products that do not provide any concrete benefits in routine nursing care. During implementation, only the operator is trained; however, there is no organizational development for the systematic integration of these technologies into routine work. In addition, there is a lack of high-quality evaluations showing evidence of the actual benefits to routine work in order to attract potential users to these technologies. Finally, there is no sustainable financing, especially for the maintenance of these technologies.Successful digitization in long-term care therefore requires that technology developers and users, as well as policymakers and scientists, jointly overcome these obstacles. This implies that caregivers are involved in the development process from the outset (co-creation) but also that spaces are created where the effect of digital care technologies can be evaluated in routine caregiving., (© 2024. The Author(s).)

The potential benefits of digital health technologies in population-based health research depend mainly on whether and to what extent these technologies can be based on the processing of personal health data. However, there needs to be more certainty in the application and interpretation of the relevant legal regulations on the processing of research data using digital health technologies. Research practice primarily uses consent as a legitimation basis for data processing, although the information model of the German and European legislator, with its ambitious requirements for voluntary and informed consent, is unrealistic and needs to be revised. Even the concepts of broad consent, dynamic consent, and meta consent, which represent alternatives to the classic consent solution, cannot remedy all the deficits of the consent model.In order to guarantee the informational self-determination of the persons concerned and, at the same time, keep an eye on the interests of research in the public health sector, data protection for research purposes must be further developed. Solutions should not only be tailored to consent behavior but must also consider the legitimization of research data processing without consent or aim to remove the personal reference of the data irretrievably. To date, the law has only fulfilled its task of striking an appropriate balance between the interests of all stakeholders to a limited extent. However, improvement is in sight, especially given current regulatory initiatives and new legal solutions. This discussion article illustrates the ambivalent role of law: on the one hand, health data protection law is often perceived as an obstacle to innovation, but on the other hand, law can pave the way for digital health technologies if further developed., (© 2024. The Author(s).)

Background: Professionals, especially in the field of digital public health (DiPH), are crucial for a successful digital transformation in social and health care. However, it is still unclear to what extent academic professionals are taught DiPH-related content in their public health (PH) studies., Methods: This study used a systematic module handbook analysis to analyze accredited full-time PH-oriented degree programs at public colleges and universities in Germany for DiPH-related module content. Through the "Hochschulkompass" platform and the member programs of the German Public Health Association (DGPH), 422 programs were identified. Included module handbooks were evaluated by content analysis using MAXQDA., Results: Only 10 bachelor and 6 master programs contain DiPH. They are heterogeneous in their focus and belong to different subfields of public health ("methods, definition, history, and social medicine" = 5; "health management" = 5; "digital health" = 3; "health services research" = 2; "health communication" = 1). Differences were found between the common understanding of DiPH in academia and the content in the module handbooks. The content identified in the analysis focuses mainly on technical areas. Social and health science content is only marginally present., Discussion: The heterogeneous study programs with a connection to DiPH allow academic PH specialists to develop specific profiles. To achieve comprehensive competencies in DiPH, there is a need for further development of modules with relevance to the respective degree program. The results could be used for the (further) development of relevant modules and a core curriculum in DiPH., (© 2024. The Author(s).)

Misinformation and disinformation in social media have become a challenge for effective public health measures. Here, we examine factors that influence believing and sharing false information, both misinformation and disinformation, at individual, social, and contextual levels and discuss intervention possibilities.At the individual level, knowledge deficits, lack of skills, and emotional motivation have been associated with believing in false information. Lower health literacy, a conspiracy mindset and certain beliefs increase susceptibility to false information. At the social level, the credibility of information sources and social norms influence the sharing of false information. At the contextual level, emotions and the repetition of messages affect belief in and sharing of false information.Interventions at the individual level involve measures to improve knowledge and skills. At the social level, addressing social processes and social norms can reduce the sharing of false information. At the contextual level, regulatory approaches involving social networks is considered an important point of intervention.Social inequalities play an important role in the exposure to and processing of misinformation. It remains unclear to which degree the susceptibility to belief in and share misinformation is an individual characteristic and/or context dependent. Complex interventions are required that should take into account multiple influencing factors., (© 2024. The Author(s).)

From free choice to forced flight, there are many reasons for migration. Accordingly, the backgrounds and living conditions of migrating people are also diverse. The different associated exposures affect the health of migrants and their children. To capture such a complex phenomenon, an approach is required that takes specific living conditions during the life course of migrants into account.An established methodological approach that can accomplish this is life course epidemiology. When applied to migrating populations, it examines exposures before, during, and after migration. In epidemiological research on the health of migrant populations, it is desirable to consider all three phases. This is countered by the fact that reliable data on the entire life course is not always available.A valid, timely collection and data protection-compliant linkage of longitudinal data from different sources can improve life course-related research on the health of migrants in Germany. In the future, corresponding data should also be included from the countries of origin of migrants., (© 2023. The Author(s).)

Based on scientific findings, the World Health Organization (WHO) has recommended stricter guideline values for air quality in 2021. Significant reductions in the annual mean values of particulate matter (particle size 2.5 µm or smaller, PM 2.5 ) and long-term exposure to nitrogen dioxide (NO 2 ) and ozone (O 3 ) were put forward. The risk of mortality already increases above the WHO guideline values, as shown in studies investigating low concentrations of air pollutants. In Germany, the 2021 WHO guideline values for PM 2.5 and NO 2 were clearly exceeded in 2022.In this position paper we give the following recommendations for the European Air Quality Directive: (1) set binding limit values according to WHO 2021, (2) apply the limit values to the whole of Europe, (3) continue and expand the established country-based monitoring networks, (4) expand air quality measurements for ultrafine particles and soot particles, and (5) link air pollution control and climate protection measures.Stricter limits for air pollutants require societal and political changes in areas such as mobility, energy use and generation, and urban and spatial planning. Implementation according to WHO 2021 would lead to a net economic benefit of 38 billion euros per year.Ambitious limit values for air pollutants also have an impact on climate change mitigation and its health impacts. The Environmental Public Health commission concludes that more ambitious limit values are crucial to enable effective health protection in Germany and calls for air pollutant limit values in line with the 2021 WHO recommendations to become binding in Europe., (© 2023. The Author(s).)

Background: We investigated the impact of HIV pre-exposure prophylaxis (PrEP) as a new service of the statutory health insurance (SHI) on the incidence of HIV and other sexually transmitted infections (STIs) in Germany. In addition, PrEP needs and access barriers were analyzed., Methods: The following data were evaluated as part of the evaluation project: HIV and syphilis notification data and extended surveillance by the Robert Koch Institute (RKI), pharmacy prescription data, SHI routine data, PrEP use in HIV-specialty care centers, Checkpoint, the BRAHMS and PrApp studies, as well as a community board., Results: The majority of PrEP users were male (98-99%), primarily aged between 25-45 years, and predominantly of German nationality or origin (67-82%). The majority were men who have sex with men (99%). With regard to HIV infections, PrEP proved to be highly effective. There were only isolated cases of HIV infections (HIV incidence rate 0.08/100 person years); in most cases the suspected reason was low adherence. The incidences of chlamydia, gonorrhea, and syphilis did not increase but remained almost the same or even decreased. A need for information on PrEP for people in trans*/non-binary communities, sex workers, migrants, and drug users emerged. Needs-based services for target groups at increased risk of HIV are necessary., Discussion: PrEP proved to be a very effective HIV prevention method. The partly feared indirect negative influences on STI rates were not confirmed in this study. Due to the temporal overlap with the containment measures during the COVID-19 pandemic, a longer observation period would be desirable for a conclusive assessment., (© 2023. The Author(s).)

When long-term care insurance was introduced in 1994, a number of conceptual decisions were made that continue to shape the system today. This discussion article examines three of these decisions. In each case, an evaluation standard is formulated against which the current situation is assessed. In the case of a negative assessment, reform options are discussed.In combination with the lack of benefit adjustments, the design of long-term care insurance as a system with capped insurance benefits and unlimited co-payments has led to co-payment levels in nursing homes that the majority of residents cannot cover from their income. Therefore, in order to fulfill its original objectives, long-term care insurance would have be turned upside down - by imposing an absolute limit on the amount and duration of the individual co-payments.The "dual insurance system" consisting of a social insurance for the majority and a private mandatory plan for a minority of the population has also proved to be a "birth defect" of the system. Since the group of privately insured persons has a much more favorable risk structure and higher average incomes, the "equal distribution of burdens" in financing required by the Federal Constitutional Court does not exist. To remedy this inequality, the dual system must be transformed into an integrated long-term care insurance system, or at least a risk structure equalization scheme between the two branches must be implemented.The introduction of long-term care insurance as a separate branch of social insurance, however, can be justified. In order to overcome interface problems, it would nevertheless be necessary to place the financing competence for geriatric rehabilitation with long-term care insurance and that for medical treatment care in nursing homes with health insurance., (© 2023. The Author(s).)

Introduction: During the COVID-19 pandemic, people in need of long-term care were among the most vulnerable population groups. Home-care services were under exceptional strain, especially at the beginning of the pandemic. The aim of this study is to examine the situation and problems of care services and the people in need of care during the first two waves of the pandemic in Germany., Methods: Two cross-sectional studies were conducted during the first two COVID-19 waves (first survey 28 April to 12 May 2020, second survey 12 January to 7 February 2021). In total, data from N = 1029 outpatient care services were included in the analysis. Descriptive measures were used for the analysis., Results: The clients of home-care services were severely burdened in the first two waves of the pandemic. This can be seen on the one hand in an increased risk of illness and increased mortality, and on the other in the loss of various care and support services. The latter also has negative effects on the psychosocial condition of those in need of care, for example. Care services were affected by high staff absenteeism and additional work due to protective measures., Discussion: The COVID-19 pandemic led to immense burdens for people in need of care and home-care services and to a reduction in care services. The deterioration of care provision met with an already tense situation. It has become clear that the provision of care for those in need of care by outpatient care services is not crisis-proof, and that additional challenges such as a pandemic can have dramatic consequences. For the future, reliable structures and readily available emergency plans should be established with concrete instructions for action., (© 2023. The Author(s).)

Background: The consequences of the COVID-19 pandemic have posed major challenges to different groups. One of these are informal caregivers. This study investigates the changes the pandemic has caused for informal caregivers and the extent to which quality of life and burden of care have changed for specific subgroups., Methods: Data for this cross-sectional study was gathered in the summer of 2020 in a convenient sample of informal caregivers (< 67 years of age, N = 1143). In addition to sociodemographic data, information on the care situation, compatibility of care and work, as well as stress and quality of life was collected in an online survey. The analysis of care situations and compatibility of care and work is done descriptively. Logistic regression models are used for a subgroup analysis of quality of life and care burden., Results: The care situation has changed for 54.7% of participants and has become more time consuming. For 70.8% of respondents, the COVID-19 pandemic has made it even more difficult to balance care-giving and work. However, most respondents were satisfied with their employers' pandemic management (65.9%). A sharp decline in the quality of life and an increase in the burden of care for informal caregivers was ascertained. Both developments are stronger for young and female caregivers and for those caring for people with a greater need of support., Discussion: The results indicate that living situations worsened for a substantial proportion of informal caregivers during the COVID-19 pandemic. Policymakers should recognize additional challenges that informal caregivers have faced since the outbreak of the COVID-19 pandemic and how they vary by subgroups. It is important to include home-based informal care as well as other care settings in future pandemic concepts., (© 2023. The Author(s).)

Artificial intelligence (AI) is becoming increasingly important in healthcare. This development triggers serious concerns that can be summarized by six major "worst-case scenarios". From AI spreading disinformation and propaganda, to a potential new arms race between major powers, to a possible rule of algorithms ("algocracy") based on biased gatekeeper intelligence, the real dangers of an uncontrolled development of AI are by no means to be underestimated, especially in the health sector. However, fear of AI could cause humanity to miss the opportunity to positively shape the development of our society together with an AI that is friendly to us.Use cases in healthcare play a primary role in this discussion, as both the risks and the opportunities of new AI-based systems become particularly clear here. For example, would older people with dementia (PWD) be allowed to entrust aspects of their autonomy to AI-based assistance systems so that they may continue to independently manage other aspects of their daily lives? In this paper, we argue that the classic balancing act between the dangers and opportunities of AI in healthcare can be at least partially overcome by taking a long-term ethical approach toward a symbiotic relationship between humans and AI. We exemplify this approach by showcasing our I‑CARE system, an AI-based recommendation system for tertiary prevention of dementia. This system has been in development since 2015 as the I‑CARE Project at the University of Bremen, where it is still being researched today., (© 2023. The Author(s).)

Background: In recent years, there has been an increasing demand for the reuse of research data in accordance with the so-called FAIR principles. This would allow researchers to conduct projects on a broader data basis and to investigate new research questions by linking different data sources., Objectives: We explored if nationwide linking of claims data from statutory health insurances (SHI) with data from population-based cancer registries can be used to obtain additional information on cancer that is missing in claims data and to assess the validity of SHI tumour diagnoses. This paper focuses on describing the specific requirements of German federal states for such data linkage., Materials and Methods: The Pharmacoepidemiological Research Database GePaRD at the Leibniz Institute for Prevention Research and Epidemiology - BIPS and six cancer registries were used as data sources. The logistically complex direct linkage was compared with a less complex indirect linkage. For this purpose, permission had to be obtained for GePaRD and for each cancer registry from the respective responsible authority., Results: Regarding the linkage of cancer registry data with GePaRD, the cancer registries showed profound differences in the modalities for data provision, ranging from a complete rejection to an uncomplicated implementation of linkage procedures., Discussion: In Germany, a consistent legal framework is needed to adequately enable the reuse and record linkage of personal health data for research purposes according to the FAIR principles. The new law on the consolidation of cancer registry data could provide a remedy regarding the linkage of cancer registry data with other data sources., (© 2021. The Author(s).)

Epidemiology as a scientific discipline is predestined to address key problems in the COVID-19 pandemic. In order to do so, classic and new methods are used, and new challenges are emerging.This paper addresses the various phases of the population-based progression of SARS-CoV‑2 infection and COVID-19. Based on a selective literature search, sample questions from studies conducted in Germany and internationally are presented, their respective epidemiological approaches discussed, and research gaps described.Scientific questions to be answered with epidemiological data and research approaches arise in every phase of infection and disease. Descriptive data are often generated via (repeated) cross-sectional studies. For analytical questions, such as the identification of risk groups, case-control studies could have provided valuable results, especially in the early phase of the pandemic, but were rarely conducted. Data from health insurance companies have an important function in the analysis of the course of disease; however, the potential of this data source with regard to questions on vaccination can probably hardly be used. Improved coordination of the various studies and a more "open data" oriented research infrastructure can further strengthen the contribution of epidemiology to the control of the current and future pandemics., (© 2021. The Author(s).)

Public health research and epidemiological and clinical studies are necessary to understand the COVID-19 pandemic and to take appropriate action. Therefore, since early 2020, numerous research projects have also been initiated in Germany. However, due to the large amount of information, it is currently difficult to get an overview of the diverse research activities and their results. Based on the "Federated research data infrastructure for personal health data" (NFDI4Health) initiative, the "COVID-19 task force" is able to create easier access to SARS-CoV-2- and COVID-19-related clinical, epidemiological, and public health research data. Therefore, the so-called FAIR data principles (findable, accessible, interoperable, reusable) are taken into account and should allow an expedited communication of results. The most essential work of the task force includes the generation of a study portal with metadata, selected instruments, other study documents, and study results as well as a search engine for preprint publications. Additional contents include a concept for the linkage between research and routine data, a service for an enhanced practice of image data, and the application of a standardized analysis routine for harmonized quality assessment. This infrastructure, currently being established, will facilitate the findability and handling of German COVID-19 research. The developments initiated in the context of the NFDI4Health COVID-19 task force are reusable for further research topics, as the challenges addressed are generic for the findability of and the handling with research data., (© 2021. The Author(s).)

After the global outbreak of the COVID-19 pandemic, an infection dynamic of immense extent developed. Since then, numerous measures have been taken to bring the infection under control. This was very successful in the spring of 2020, while the number of infections rose sharply the following autumn. To predict the occurrence of infections, epidemiological models are used. These are in principle a very valuable tool in pandemic management. However, they still partly need to be based on assumptions regarding the transmission routes and possible drivers of the infection dynamics. Despite numerous individual approaches, systematic epidemiological data are still lacking with which, for example, the effectiveness of individual measures could be quantified. Such information generated in studies is needed to enable reliable predictions regarding the further course of the pandemic. Thereby, the complexity of the models could develop hand in hand with the complexity of the available data. In this article, after delineating two basic classes of models, the contribution of epidemiological models to the assessment of various central aspects of the pandemic, such as the reproduction rate, the number of unreported cases, infection fatality rate, and the consideration of regionality, is shown. Subsequently, the use of the models to quantify the impact of measures and the effects of the "test-trace-isolate" strategy is described. In the concluding discussion, the limitations of such modelling approaches are juxtaposed with their advantages., (© 2021. The Author(s).)

The database "Insights for healthy settings" was developed by the GKV-Bündnis für Gesundheit, a joint initiative of all health insurance funds for developing and implementing setting-based health promotion and prevention measures. It aims to support health insurance funds and other practice partners in planning and implementing evidence-based health promotion and prevention measures in different settings. The database complements existing intervention databases by providing insights based on findings from systematic reviews. This article aims to present the database, describe possible applications, and discuss options for further development.The database contains findings on the effectiveness and strategies for implementation of setting-based health promotion and prevention measures. In addition to structured summaries of systematic reviews, it includes summaries of scoping reviews and rapid reviews. Different search options (e.g., free text search, subject headings, and search filters) can be used to find database entries (currently n = 13). Quality-assured database entries are created by means of a standardized form and based on the four-eyes principle. To allow for easy access, key findings are presented briefly, and technical terms are clarified. Experts from health insurance funds are continuously involved in the development process of the database.As part of the database's further development, new reviews of the GKV-Bündnis für Gesundheit as well as from other sources will be added. Additionally, quality assessments of included reviews will be depicted and supporting activities developed to further encourage translation of scientific knowledge into practice.

Between 2014 and 2022, the 5 German research networks AEQUIPA, CAPITAL4HEALTH, HLCA, PartKommPlus, and SMARTACT are investigating topics of primary prevention and health promotion with the aim of further deepening the evidence base in these areas. The work of the 5 research networks for primary prevention and health promotion is presented, analysed, and discussed from an internal perspective. A model of evidence-based public health serves as a structuring framework.The 5 research networks use a variety of access routes for the generation of evidence with regard to the participation of nonacademic, civil society actors and users. There is a wide range of study designs - from randomised controlled trials and systematic reviews to diverse qualitative designs. The use of models and theories supports the evidence base. Beyond evidence generation, all research networks focus on at least exemplary implementation of new evidence.Due to the diversity of methods, a diversified evidence-based approach can be realised, taking into account network-specific aspects. Structural circumstances limit the further systematic strengthening of the evidence base. In particular, the involvement of nonacademic, civil society actors for the work with hard-to-reach target groups often cannot be financed or is considered too time consuming under the given circumstances. The COVID-19 pandemic highlights the importance of a flexible spectrum of methods, employing both digital and analogue methods in a meaningful way.

Homeopathy is one of the frequently used alternative healing methods in Germany. This article is intended to discuss and analyze why homeopathy should not be part of medicine and should rather be understood as a concept of belief that lies outside of scientific methods. The clinical, legal, and political dimensions of the homeopathy debate are explained. Finally, the question of the legitimacy of placebo applications is discussed in light of the demand for patient-centered medicine.

Background: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA., Material and Methods: Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex., Results: In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated., Conclusion: The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.

Background: Infectious diseases continue to play an important role for disease perception, health-economic considerations and public health in Germany. In recent years, infectious diseases have been linked to the development of non-communicable diseases. Analyses of the German National Cohort (GNC) may provide deeper insights into this issue and pave the way for new targeted approaches in disease prevention., Objectives: The aim was to describe the tools used to assess infectious diseases and to present initial data on infectious disease frequencies, as well as to relate the GNC assessment tools to data collection methods in other studies in Germany., Methods: As part of the baseline examination, questions regarding infectious diseases were administered using both an interview and a self-administered touchscreen questionnaire. Data from the initial 101,787 GNC participants were analysed., Results: In the interview, 0.2% (HIV/AIDS) to 8.6% (shingles) of respondents reported ever having a medical diagnosis of shingles, postherpetic neuralgia (in cases where shingles was reported), hepatitis B/C, HIV/AIDS, tuberculosis or sepsis if treated in hospital. In the questionnaire, 12% (cystitis) to 81% (upper respiratory tract infections) of respondents reported having experienced at least one occurrence of upper or lower respiratory tract infections, gastrointestinal infections, cystitis or fever within the past 12 months., Outlook: The cross-sectional analyses of data and tools presented here - for example on determinants of susceptibility to self-reported infections - can be anticipated from the year 2021 onward. Beyond that, more extensive research into infectious disease epidemiology will follow, particularly once analyses of GNC biological materials have been performed.

Background: In the German National Cohort (NAKO Gesundheitsstudie), the largest prospective cohort study in Germany, data on self-reported cancer diagnoses are now available for the first half of participants., Objectives: Description of the methods to assess self-reported cancer diagnoses and type of cancer in the NAKO and presentation of first results., Materials and Methods: In a computer-assisted, standardized personal interview, 101,787 participants (54,526 women, 47,261 men) were asked whether they had ever been diagnosed with cancer (malignant tumors including in situ) by a physician and how many cancer diagnoses they had. The type of cancer was classified with a list. Absolute and relative frequencies of self-reported cancer diagnoses and types of cancer were calculated and compared with cancer registry data., Results: A physician-diagnosed cancer was reported by 9.4% of women and 7.0% of men. Of the participants who reported a cancer diagnosis, 88.3% reported to have had only one cancer diagnosis. In women, the most frequent malignancies were breast cancer, cervical cancer, and melanoma. In men, the most frequent malignancies were prostate cancer, melanoma, and colorectal cancer. Comparing the frequencies of cancer diagnoses reported by 45- to 74-year-old NAKO participants within the last five years to cancer registry-based 5‑year prevalences, most types of cancer were less frequent in the NAKO, with the exception of melanoma in men and women, cervical cancer and liver cancer in women, and bladder cancer and breast cancer in men., Conclusions: The NAKO is a rich data basis for future investigations of incident cancer.

Background: Data on self-reported cardiovascular and metabolic diseases are available for the first 100,000 participants of the population-based German National Cohort (GNC, NAKO Gesundheitsstudie)., Objectives: To describe assessment methods and the frequency of self-reported cardiovascular and metabolic diseases in the German National Cohort., Materials and Methods: Using a computer-based, standardized personal interview, 101,806 participants (20-75 years, 46% men) from 18 nationwide study centres were asked to use a predefined list to report medical conditions ever diagnosed by a physician, including cardiovascular or metabolic diseases. For the latter, we calculated sex-stratified relative frequencies and compared these with reference data., Results: With regard to cardiovascular diseases, 3.5% of men and 0.8% of women reported to have ever been diagnosed with a myocardial infarction, 4.8% and 1.5% with angina pectoris, 3.5% and 2.5% with heart failure, 10.1% and 10.4% with cardiac arrhythmia, 2.7% and 1.8% with claudicatio intermittens, and 34.6% and 27.0% with arterial hypertension. The frequencies of self-reported diagnosed metabolic diseases were 8.1% and 5.8% for diabetes mellitus, 28.6% and 24.5% for hyperlipidaemia, 7.9% and 2.4% for gout, and 10.1% and 34.3% for thyroid diseases. Observed disease frequencies were lower than reference data for Germany., Conclusions: In the German National Cohort, self-reported cardiovascular and metabolic diseases diagnosed by a physician are assessed from all participants, therefore representing a data source for future cardio-metabolic research in this cohort.

Background: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated., Objectives: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality., Materials and Methods: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level‑1 examination, the number of teeth and prostheses were recorded. As part of the level‑2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed., Results: Analyses included data of 57,967 interview participants, 56,913 level‑1 participants and 6295 level‑2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners., Conclusions: The results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC's overall assessment program. However, rigorous dental support of the study centres is required for quality management.

The focus of the German National Cohort, the largest population-based cohort study in Germany to date, is the investigation of the most important widespread diseases, such as cardiovascular diseases, diabetes, cancer, neurological and psychiatric disorders, and frequent respiratory and infectious diseases. This cohort will answer questions on the development of these diseases and on the impact of genetic, environmental and lifestyle-related risk factors. Another focus is on the identification of early, subclinical markers of emerging diseases. To answer these questions, a comprehensive assessment of these health outcomes as well as of all potential determinants and precursors is mandatory.This paper describes the various health outcomes that are assessed in the German National Cohort, as well as the examination modules that are applied for deep phenotyping of study participants. Repeated collection of biosamples as well as functional measurements and application of modern imaging techniques at various time points allow for assessing the dynamics of physiological changes related to the individuals' health status. The prognostic value of these changes for disease development will be explored and translated to novel approaches for prevention and personalised medicine. Incident diseases are being assessed through self-reports by study participants and through record linkage with data from health insurances and cancer registries. Additional information about clinical diagnoses is obtained from the treating physicians to ensure the highest possible validity.

Background: Persons with a migration background (PmM) as a population group usually differ from the autochthonous population in terms of morbidity, mortality, and use of the health care system, but they participate less frequently in health studies. The PmM group is very heterogeneous, which has hardly been taken into account in studies so far., Objectives: Sociodemographic characteristics of PmM in the NAKO health study (age, sex, time since migration, education) are presented. In addition, it is examined through an example whether migration background is related to the use of cancer screening for colorectal cancer (hemoccult test)., Methods: Data of the first 101,816 persons of the NAKO were analyzed descriptively and cartographically. The migration background was assigned on the basis of the definition of the Federal Statistical Office, based on nationality, country of birth, year of entry, and country of birth of the parents., Results: Overall, the PmM proportion is 16.0%. The distribution across the 18 study centers varies considerably between 6% (Neubrandenburg) and 33% (Düsseldorf). With 153 countries of origin, most countries are represented in the NAKO. All variables show clear differences between the different regions of origin. In the hemoccult test, persons of Turkish origin (OR = 0.67) and resettlers (OR = 0.60) have a lower participation rate. PmM born in Germany do not differ in this respect from the autochthonous population (OR = 0.99)., Conclusion: PmM in the NAKO are a very heterogeneous group. However, due to the sample size, individual subgroups of migrants can be studied separately with respect to region of origin.

Background: In epidemiologic studies, standardised measurement of socio-demographic and employment-related factors is becoming increasingly important, as variables such as gender, age, education or employment status are factors influencing health and disease risks., Aims: The article gives an overview of the scientific background and assessment of socio-demographic factors in the German National Cohort Study. In addition, the distribution of individual characteristics in the cohort as well as relationships with health-related measures are presented by way of example., Material and Methods: The analysis is based on the data of the first half of the baseline survey (n = 101,724). On this basis, we present the distribution of key socio-demographic characteristics and analyse relationships with exemplary selected health indicators (body mass index, self-reported health) to assess the validity of socio-demographic data measurements., Results: On average, study participants were 52.0 years old (SD = 12.4). Of the participants, 53.6% were women, 54.3% had high education, 60.1% were married and 72% were employed while 3.4% were unemployed. Well-established correlations between socio-demographic factors and health could be reproduced with the German National Cohort data. For example, low education, old age and unemployment were associated with an increased prevalence of obesity and poor self-reported health., Discussion: The German National Cohort provides a comprehensive measurement of socio-demographic characteristics. Combined with a wide range of health data and the longitudinal measurements available in the future, this opens up new opportunities for health science and social epidemiological research in Germany.

Background: The German National Cohort (NAKO) is an interdisciplinary health study aimed at elucidating causes for common chronic diseases and detecting their preclinical stages. This article provides an overview of design, methods, participation in the examinations, and their quality assurance based on the midterm baseline dataset (MBD) of the recruitment., Methods: More than 200,000 women and men aged 20-69 years derived from random samples of the German general population were recruited in 18 study centers (2014-2019). The data collection comprised physical examinations, standardized interviews and questionnaires, and the collection of biomedical samples for all participants (level 1). At least 20% of all participants received additional in-depth examinations (level 2), and 30,000 received whole-body magnet resonance imaging (MRI). Additional information will be collected through secondary data sources such as medical registries, health insurances, and pension funds. This overview is based on the MBD, which included 101,839 participants, of whom 11,371 received an MRI., Results: The mean response proportion was 18%. The participation in the examinations was high with most of the modules performed by over 95%. Among MRI participants, 96% completed all 12 MRI sequences. More than 90% of the participants agreed to the use of complementary secondary and registry data., Discussion: Individuals selected for the NAKO were willing to participate in all examinations despite the time-consuming program. The NAKO provides a central resource for population-based epidemiologic research and will contribute to developing innovative strategies for prevention, screening and prediction of chronic diseases.

Physical fitness is defined as an individual's ability to be physically active. The main components are cardiorespiratory fitness (CRF), muscle strength, and flexibility. Regardless of physical activity level, physical fitness is an important determinant of morbidity and mortality.The aim of the current study was to describe the physical fitness assessment methodology in the German National Cohort (NAKO) and to present initial descriptive results in a subsample of the cohort.In the NAKO, hand grip strength (GS) and CRF as physical fitness components were assessed at baseline using a hand dynamometer and a submaximal bicycle ergometer test, respectively. Maximum oxygen uptake (VO 2max ) was estimated as a result of the bicycle ergometer test. The results of a total of 99,068 GS measurements and 3094 CRF measurements are based on a data set at halftime of the NAKO baseline survey (age 20-73 years, 47% men).Males showed higher values of physical fitness compared to women (males: GS = 47.8 kg, VO 2max  = 36.4 ml·min -1  · kg -1 ; females: GS = 29.9 kg, VO 2max  = 32.3 ml · min -1  · kg -1 ). GS declined from the age of 50 onwards, whereas VO 2max levels decreased continuously between the age groups of 20-29 and ≥60 years. GS and VO 2max showed a linear positive association after adjustment for body weight (males β = 0.21; females β = 0.35).These results indicate that the physical fitness measured in the NAKO are comparable to other population-based studies. Future analyses in this study will focus on examining the independent relations of GS and CRF with risk of morbidity and mortality.

High levels of adiposity in the population have a major impact on various diseases, but previous epidemiologic studies have largely been restricted to simple anthropometric measures such as the body mass index (BMI), an imperfect predictor of disease risk. There is a critical need for the use of improved measures of relative weight and body composition in large-scale, population-based research.The current article presents initial descriptive results of body composition and fat distribution based on the midterm baseline dataset of the German National Cohort, which included 101,817 participants who were examined in 18 study centers in Germany between March 2014 and March 2017. The anthropometric measures encompassed body weight, height, waist and hip circumference, bioelectrical impedance analysis (BIA), sonography of abdominal adipose tissue, 3D-body scanning, and magnetic resonance imaging.BMI analyses showed that 46.2% of men and 29.7% of women were overweight and 23.5% of men and 21.2% of women were obese. On average, women in almost all age groups demonstrated more subcutaneous adipose tissue layer thickness than men. The mean values of visceral adipose tissue layer thickness, on the other hand, were higher among men than among women in all age groups and increased continuously across age groups in both sexes.The comprehensive assessment of body composition and fat distribution provides novel future opportunities for detailed epidemiologic analyses of overweight and adiposity in relation to the development of chronic diseases.

Background: Noise annoyance is associated with adverse health-related conditions and reduced wellbeing. Thereby, subjective noise annoyance depends on the objective noise exposure and is modified by personal and regional factors., Objective: How many participants of the German National Cohort Study (GNC; NAKO Gesundheitsstudie) were annoyed by transportation noise during nighttime and what factors were associated with noise annoyance?, Materials and Methods: This cross-sectional analysis included 86,080 participants from 18 study centers, examined from 2014 to 2017. We used multinomial logistic regression to investigate associations of personal and regional factors to noise annoyance (slightly/moderately or strongly/extremely annoyed vs. not annoyed) mutually adjusting for all factors in the model., Results: Two thirds of participants were not annoyed by transportation noise during nighttime and one in ten reported strong/extreme annoyance with highest percentages for the study centers Berlin-Mitte and Leipzig. The strongest associations were seen for factors related to the individual housing situation like the bedroom being positioned towards a major road (OR of being slightly/moderately annoyed: 4.26 [95% CI: 4.01;4.52]; OR of being strongly/extremely annoyed: 13.36 [95% CI: 12.47;14.32]) compared to a garden/inner courtyard. Participants aged 40-60 years and those in low- and medium-income groups reported greater noise annoyance compared to younger or older ones and those in the high-income group., Conclusion: In this study from Germany, transportation noise annoyance during nighttime varied by personal and regional factors.

Digital public health promises not only more comprehensive medical care, but also individual health promotion and support for positive lifestyle changes. Mobile digital health devices and services, also called mobile health (mHealth), play a key role in this. They include health-specific hardware and software applications such as smartphone apps and wearable technology for recording, monitoring, and evaluating specific health parameters. Although there is scientific evidence for the effectiveness of individual applications, most often applications are used for a relatively short amount of time. In order to achieve a higher acceptance and utilization rate, evidence is needed that is more practice oriented.This paper explains how participatory development approaches take into account the individual needs and preferences of users and can improve the quality and effectiveness of mHealth services. The sociodemographic characteristics of the target group as well as individual, social, linguistic, and cultural barriers should be considered. The wishes of users, for example personalization, transmission of real-time information, and transparency in terms of privacy should also be considered. In the co-design approach, users are therefore included directly in the product concept. However, the study situation is still limited and there are no methodical approaches.In order to increase the use of mHealth services in the future, participation processes should be systematized. In addition, a framework for classification and certification as well as procedures for promoting effective applications should be developed.

The discussion of digital health technologies, in particular medical and health apps, is currently dominated by a focus on their potential to reach large parts of the population for the dissemination of evidence-based health promotion and prevention content. However, potentially unintended consequences, side effects, and negative effects of digital health technologies are rarely discussed in public health.In this paper, via a narrative literature review, we propose a perspective on unintended consequences and side-effects of digital health technologies on multiple hierarchical levels of a socio-ecological model of health. Unintended consequences and side-effects of digital health technologies can be identified on an individual level, a level of social relationships, and a health services level.We propose a broader conceptualization of unintended consequences and side-effects of digital health technology together with a more thorough documentation of such effects using multiple levels in a socio-ecological approach. This would build a cumulative evidence base of unintended effects and shift the focus from development-centered discussion of risks and challenges to a comprehensive conception of side effects and undesirable effects of digital health technologies. The proposed division into three effect levels may be helpful here.

The rapid development and proliferation of digital health technologies have not only changed the medical professions, but offer great potential for public health, particularly in health promotion and disease prevention.At the same time, this emerging field is also characterized by conceptual and terminological fuzziness, a marked lack of high-quality evidence, and an absence of an honest discussion of unintended consequences and side effects. Further challenges for digital public health lie in the fact that the development of new health technologies is mainly driven by technological progress and less by evidence-based needs and research in public health.In this overview paper, we aim at conceptually denoting the field of digital public health, using principal public health functions as guiding principles. We discuss some current applications of digital health technologies in fulfilling public health functions and propose a needs-based development of digital health technologies.We will further address specific challenges to digital public health, in particular socio-economic differences in the usage of and profiting from digital health technologies, data protection and privacy issues, as well as ethical issues.

Background: Tattooing has become very popular in recent years. In this context, socio-demographic information and health orientation is important., Objectives: The objective of this study was to evaluate the development of the prevalence of tattoos over the last thirteen years and the social and economic background of people with tattoos. Three national representative surveys were compared for this purpose; men and women residing in Germany were included. Additionally, the purpose of the study was to assess socio-demographic information and the health orientation of respondents with tattoos., Materials and Methods: Three national, representative surveys were conducted on German participants (2016: n = 2510, 2009: n = 2512, 2003: n = 2043). The number of tattoos and socio-demographic information were investigated. The Health Regulatory Focus Scale (HRFS) assessing the individual's health orientation was used in 2016., Results: Currently, one out of five Germans (≥14 years) has at least one tattoo. In Germany, tattoos are most prevalent among younger adults of both sexes aged 25 to 34 years. People with all levels of education have tattoos, although there were weak correlations with a lower education level and unemployment. Only men with several tattoos showed a significantly lower health orientation than non-tattooed ones., Conclusion: The fact that nearly one fifth of the German population has tattoos suggests that this permanent body art is becoming more and more accepted in German society. As a result, a need for better health risk information on the topic for both tattooists and the people getting tattoos appears evident because of the high prevalence of tattoos in younger generations as well as the lower health orientation in men with several tattoos.