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Background: SARS-CoV-2 has been spreading worldwide since late 2019. Before vaccines became available, exclusively non-pharmaceutical measures were used to prevent transmission of infection. Despite the fact that vaccinations are now available, it is still important to identify relevant transmission routes in order to contain the COVID-19- or further pandemics. Therefore, this study aims to systematically analyse data from the largest public health department in Germany to determine the significance of the various known and unknown transmission situations in terms of the proportion of infections. Methods: All infections in Cologne were systematically recorded by the local health department. In addition to clinical data, the transmission situations were recorded and categorised as pertaining to social contact, work contact, travellers, health care workers, users of educational institutions, visitors of community institutions, infection in the context of medical treatment, and unknown infection. Findings: The analysis included 25,966 persons. A transmission situation could be identified in 82.7% of the cases (n = 21,477). Most persons (42.1%) were infected due to social contact, primarily within their own household. Another 22.3% were infected at their place of work; this was particularly common among staff members of medical facilities, nursing homes and educational institutions. In 17.3% of the cases, the transmission situation remained unknown; the cases with unknown transmission situation were slightly more often symptomatic (75.2%) than the cases with known transmission situation (69.4%). Interpretation: Considering that during the study period the leading strains were the wild-type and alpha-variant transmission rather occurred during scenarios involving close contacts than in anonymous situations. Presumably, however, the findings can be transferred to the new variants. Therefore, in order to prevent transmission, besides vaccination regular antigen tests and/or appropriate protective measures remain relevant until this pandemic has subsided. [ABSTRACT FROM AUTHOR]

In the Author Contributions, Lukas Broichhaus should be listed as the only author who wrote the paper under 'Writing–original draft.By Lukas Broichhaus; Julian Book; Sven Feddern; Barbara Grüne; Florian Neuhann; Johannes Nießen; Gerhard A. Wiesmüller; Annelene Kossow and Christine JoistenReported by Author; Author; Author; Author; Author; Author; Author; Author; Author [Extracted from the article]

Background: In 2015, Germany recorded the highest rates of refugees since the early 1990s. Access to medical care is a legally regulated fundamental element of aid for refugees. In practice, there are several hurdles such as language barriers and legal regulations. In response to the massively increased need, special outpatient services for refugees were started in several German cities. In Cologne, an outpatient clinic (OPD) was established in the largest emergency accommodation centre for refugees supported by the Cologne municipality and operated by the German Red Cross and physicians from the Association of Statutory Health Insurance Physicians. This study reports experiences of the first year of the OPD regarding structure, processes and utilization.Methods: Employing mixed methods, between May and December 2015 cross sectional pseudonymized data from patients' contacts were collected, coded in the International Classification of Primary Care (ICPC) and evaluated. Infrastructure, equipment, process organisation and function of the OPD were assessed during five participatory observations and triangulated with results of a self-administered questionnaire for staff and four qualitative interviews with key informants.Results: During the observation period a total of 2205 persons (67% male) stayed in the emergency accommodation and 984 patient contacts (51% male) were registered, mainly by young persons from Western Balkan countries and Syria. Medical treatment was sought primarily for acute respiratory-, loco-motor-system- and skin symptoms followed by chronic physical diseases. Headache, back and neck pain and acute respiratory infection were the most frequent diagnoses. Questionnaires and interviews among staff revealed language barriers and psycho-trauma as the most frequently reported challenges. Equipment and staffing was adequate, but patient documentation was not systematic, leading to loss of information.Conclusion: To facilitate refugees' appropriate access to health care, the OPD was seen as functional for this refugee accommodation centre. Need was recognised for standardized, data protective documentation and a health passport for clients for medical information. Psychological support for refugees needs expansion taking legal circumstances and coverage of costs into consideration. To improve patient communication employees working with refugees should be offered an introduction to culturally sensitive understanding of health and illness. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this article was to re-evaluate and possibly modify the standardized Environmental Worry Scale (EWS) by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] with regard to its content and structure. In order to do this, 161 participants were chosen as a reference group to take part in a survey. The data were analyzed and a factor analysis yielded two instead of one component of worry, namely “personal” and “general” environmental worry, leading to a new evaluation method. This revised evaluation method was then applied to patients (n=227) with or without self-reported multiple chemical sensitivity (MCS) and thus used in the context of reported health complaints. The outlined results indicate that the assessment of worry as proposed by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] should be elaborated by the newly developed evaluation method with which a ratio determined by “personal” and “general” worry can be calculated. In addition to analyzing the absolute quantity of worry, the calculated ratio allows to draw conclusions on the structure of worry. It will be discussed to what extent the results present new insights into the role of worry among patients suffering from environmental diseases. [Copyright &y& Elsevier]

Abstract: The problem of communication in treating multiple chemical sensitivity (MCS) was analysed and evaluated using the documentation of an MCS chatroom which was set up in April 2001 following the TV programme Gesundheitsmagazin Praxis (Health Magazine: Practice). Approaches were developed for solving communication problems in the chatroom. A total of 490 cases were evaluated, most of which (355) were directly or indirectly affected, 76 came from self-help groups and 10 were from 4 guest experts invited by ZDF (Zweites Deutsches Fernsehen, Second German TV channel). Of these 4 experts, 2 were environmental medicine specialists, 1 psychosomatics expert and 1 psychiatrist. Fourty-nine of the cases included a petition for chatroom participants to join a class-action law. Aside from exchanging basic information on MCS, frequent topics of discussion on the air were the assessment of physicians, clinics, self-help groups and experts. The participants also expressed their views on problems with society, politics, the economy, science and social security. Another common topic was communication in the chatroom itself, which for the most part consisted of sarcasm and insults, which were cause for conflicts in the chatroom. These communication problems led to the conclusion that a chatroom is not the best medium for discussing MCS. If a chatroom is to be used profitably to this end, it is imperative to have a well-defined organisational framework which allows the exchange of current, scientifically accurate information while keeping discussions from escalating and degenerating into arguments. [ABSTRACT FROM AUTHOR]