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Germany is ethnically diverse and the social climate is more or less welcoming for different immigrant groups. The social climate can be described by stereotypes of members of the receiving society about immigrant groups, which in turn shape receiving-society members’ behavioral tendencies of support or discrimination. We investigated warmth and competence stereotypes about 17 immigrant groups in Germany. Results showed four clusters of immigrant groups in the two-dimensional space of warmth and competence. Groups who immigrated comparatively recently and from regions of conflict (e.g., the Balkans, Northern Africa) were stereotyped most negatively (moderate warmth, low competence). Across groups, path analysis investigated the socio-structural relations proposed by the stereotype content model and the BIAS map for immigrant groups in the German context. In a pre-registered model all hypothesized paths were significant but model fit was not good. Therefore, an exploratory model included additional paths as well as intercorrelations between exogenous variables and error terms. The modified model showed good fit and partly replicated the relations proposed by the BIAS map. Threat predicted warmth, whereas status predicted competence. Warmth predicted active behavioral tendencies and competence predicted passive behavioral tendencies. Additional paths from status to warmth, threat to competence, as well as from warmth to passive behavioral tendencies and competence to active behavioral tendencies were also significant. Thus, findings support receiving-society members’ active role in the process of integrating immigrant groups into German society. Based on the results, social-psychological approaches to foster immigrant integration are discussed. [ABSTRACT FROM AUTHOR]

Background: The inverse association between mortality and individual socioeconomic status is well-documented. Due to the lack of appropriate data, little is known about the nature of this association among individuals with long-term care (LTC) needs. Objectives: We aim to fill in this knowledge gap by estimating life expectancy (LE), life expectancy without (CFLE) and with (CLE) long-term care by education for older German men; and by assessing the trends in the education-LE/CFLE/CLE gradient over time. Data and methods: We apply survival analysis and Gompertz regression to German Socioeconomic Panel data (1997–2012) to estimate the mortality levels and to construct the life tables for three educational categories. Using the administrative data from the health insurance, we adjust mortality rates upward to account for the institutionalized population. We estimate age-specific LTC prevalence from the German Microcensus data (2004, 2012) and compute life expectancy with and without LTC by employing Sullivan’s method. Slope and Relative Indices of Inequality are computed to evaluate the magnitude of educational inequalities in CFLE. Results: There is a clear and growing educational gradient in LE and CFLE among older men in Germany. In 2004, LE at age 65 among men with low education was 14.2 years, or 3.3 years lower than among highly educated individuals. The CFLE of these two educational categories ranged from 13.6 to almost 17 years. The gradient increased over time and in 2012 the difference constituted 4.6 years. The gaps between educational groups were not pronounced for CLE. The declining health ratio of years without LTC to remaining LE suggests the expansion of LTC needs, irrespective of the educational level. Conclusions: Growing inequalities by educational status among older German men with care needs demand the attention of policy-makers. Prompt actions are needed to increase the survival chances of the most vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: The combined impact of multiple healthy behaviors on health exceeds that of single behaviors. This study aimed to estimate trends in the prevalence of a healthy lifestyle among adults in Germany. Methods: A data set of 18,058 adults aged 25–69 years from three population-based national health examination surveys 1990–92, 1997–99 and 2008–11 with complete information for five healthy behavior factors was used. A ‘daily intake of both fruits and vegetables, ‘sufficient physical exercise’, ‘no current smoking’ and ‘no current risk drinking’ were assessed with self-reports and ‘normal body weight’ was calculated based on measured body weight and height. A dichotomous ‘healthy lifestyle’ indicator was defined as meeting at least four out of five healthy behaviors. Age-standardized prevalence was calculated stratified by sex, age groups (25–34, 35–44, 45–54 and 55–69 years) and education level (low, medium and high). Trends were expressed in relative change (RC) between 1990–92 and 2008–11. Results: In Germany, the overall prevalence of healthy lifestyle increased from 9.3% in 1990–92 to 13.5% in 1997–99 and to 14.7% in 2008–11 (RC: +58.1%). The prevalence increased among men and women and in all age groups, with the exception of men aged 45–54 years. The RC of increasing healthy lifestyle prevalence between 1990–92 and 2008–11 was stronger albeit on a higher level among women compared to men. Therefore, the gender difference in healthy lifestyle has increased, but age-related differences have overall decreased in this period. Among high educated men the prevalence of a healthy lifestyle increased between 1990–92 and 2008–11 from 10.6% to 16.3% (p = 0.01) and among high educated women from 16.4% to 30.3% and also among medium educated women (10.9 to 16.6, p<0.01), but no significant increase in healthy lifestyle prevalence was observed among men with low and medium education and among women with low education level. Conclusions: The prevalence of a lifestyle with at least four out of five healthy behaviors markedly increased from 1990–92 to 2008–11. Nevertheless, additional health promotion interventions are needed to improve the number of combined healthy behavior factors and the awareness in the population that each additional healthy behavior factor leads to a further improvement in health, especially in men in the age-range 45 to 54 years, and among persons with low education level. [ABSTRACT FROM AUTHOR]

Underreporting of alcohol consumption is one of the major challenges in survey research including self-reports. The aim of this study was to test whether underreporting can be reduced by prompting respondents to first reflect on their drinking in the past week and then answer quantity-frequency based screening questions on their typical alcohol use. Data come from 2,379 adults (54% female; mean age = 31.8 years, SD = 11.4 years) consecutively recruited at a local registration office in northeastern Germany. Participants responded to an electronic, self-administered questionnaire on different health behaviors. They were randomized to receiving the Alcohol Use Disorders Identification Test—Consumption (AUDIT-C) either before or after the assessment of past week timeline follow-back questions. Logistic regression models were calculated predicting positive screening results for at-risk drinking. Potential interaction effects with gender, age and educational background were explored. Results show that the assessment of past week alcohol consumption prior to the assessment of the AUDIT-C reduced the odds of obtaining positive screening results (OR = 0.83; 95% CI = 0.70–0.99). There were no interaction effects with gender, age and educational background. As a secondary finding, participants reported consistently lower alcohol consumption in the alcohol measure that was administered later in the questionnaire. Preceding questions about alcohol consumption in the past week reduced the probability of positive screening results for at-risk drinking. Our findings suggest that prompting people to recall past week alcohol use prior to screening may not be a solution to reduce underreporting. [ABSTRACT FROM AUTHOR]

Can participation in job-related training contribute to the formation and maintenance of adults’ literacy skills? Although evidence suggests that participation in training is related to higher literacy skills, it remains unclear whether this association reflects a causal effect of training participation on literacy (training effects), results from the self-selection of more high-skilled individuals into training (selection effects), or is due to other sources of endogeneity (e.g., omitted variable bias). To unravel these possibilities, we used data from the Programme for the International Assessment of Adult Competencies (PIAAC) and its German follow-up, PIAAC-Longitudinal (PIAAC-L). As these unique data offer repeated measures of literacy skills, spaced three years apart, in a large and representative sample, they allowed us to disentangle training effects from selection effects and to account for potential endogeneity. Analyses revealed that, even after taking account of formal education and a host of job characteristics, individuals with higher literacy skills were more likely to participate in training. By contrast, no evidence for effects of training on literacy skills emerged in any of our models, which comprised lagged-dependent, fixed effects, and instrumental-variable models. These findings suggest that, rather than job-related training contributing to literacy development, individuals with higher literacy skills are more likely to participate in training. [ABSTRACT FROM AUTHOR]

Background: There is wide international variation regarding food allergy knowledge among restaurant staff. Further, attitudes towards food allergy remain under-researched. Insights into the independent determinants of knowledge and attitudes are limited due to lacking mutual statistical adjustment for determinants/confounders in the vast majority of prior studies. In this study we aimed to contribute novel data on the food allergy knowledge and attitudes among restaurant staff in Germany whilst also examining potential determinants of both outcomes using multivariable approaches. Methods: We collected data face-to-face from 295 staff members in restaurants in Düsseldorf, Germany. Knowledge was assessed by asking participants to name three common food allergens and to answer five true/false-statements. Seven items assessed attitudes. A total of 16 potential determinants were examined using logistic regression models with backward selection. Results: Only 30% (n = 89) of the respondents correctly named three food allergens and 41% (n = 120) attained a perfect score on the true/false statements. The vast majority expressed positive attitudes toward the need for cooperation and shared responsibilities for food-allergic customers. However, the expressed attitudes towards serving customers with food allergies and validity of customer-reported food allergies were unfavorable. Determinants of food allergy knowledge (e.g. the type of restaurant, professional roles, or levels of school education) and of unfavorable attitudes (e.g. gender) were identified. Conclusions: Food allergy knowledge was suboptimal among restaurant staff and attitudes towards customers were rather poor. While we identified some determinants, additional studies are needed to systematically examine potential determinants for targetting educational interventions in the future. [ABSTRACT FROM AUTHOR]

Background: Large proportions of the populations in many European countries, including Germany, are migrants. Migrant children and adolescents tend to be less physically active than their non-migrant peers. However, current research is limited as it does not sufficiently consider different domains of physical activity. Using a representative dataset, the present study examines the patterns of sports participation and other domains of physical activity among migrant and non-migrant children and adolescents residing in Germany. Methods: Nationwide data from the Motorik-Modul (MoMo) Study is used. Five different domains of physical activity participation (sports clubs, outside of sports clubs, extra-curricular physical activity, physical activity, outdoor play and active commuting to school) were compared between children and adolescents with no, one-sided and two-sided migration background using logistic regression adjusted for demographic factors. Interaction terms were included in order to examine whether difference between the three groups differ by age and gender. Results: Information on n = 3,323 children and adolescents was available. As compared to non-migrants, children and adolescents with a two-sided migration background had a 40% (adjusted odds ratio [aOR] = 0.60, 95%-CI: 0.44–0.81), those with a one-sided migration background a 26% (aOR = 0.74, 95%-CI: 0.55-<1.00) lower chance of participating in sport club activities. In contrast, children and adolescents with a two-sided migration background were at 65% higher chance of participating in extra-curricular physical activity than non-migrants (OR = 1.65, 95%-CI: 1.15–2.36). Conclusion: The study shows that differences in levels of physical activity between migrant and non-migrant children and adolescents are less pronounced than previous research has suggested. In particular, it reveals that migrants are only disadvantaged regarding participation in sports clubs whereas they fare better with respect to extra-curricular physical activity. Interventions should therefore address barriers migrant children and adolescents encounter in the access to sport clubs while maintaining their high level of extra-curricular physical activity. [ABSTRACT FROM AUTHOR]

In research into higher education, the evaluation of completion and dropout rates has generated a steady stream of interest for decades. While most studies only calculate quotes using student and graduate numbers for both phenomena, we propose to additionally consider the budget available to universities. We transfer the idea of the excellence shift indicator [] from the research to the teaching area, in particular to the completion rate of educational entities. The graduation shift shows the institutions’ ability to produce graduates as measured against their basic academic teaching efficiency. It is an important advantage of the graduation shift that it avoids the well-known heterogeneity problem in efficiency measurements. Our study is based on German universities of applied science. Given their politically determined focus on education, this dataset is well-suited for introducing and evaluating the graduation shift. Using a comprehensive dataset covering the years 2008 to 2013, we show that the graduation shift produces results, which correlate closely with the results of the well-known graduation rate and standard Data Envelopment Analysis (DEA). Compared to the graduation rate, the graduation shift is preferable because it allows to take the budget of institutions into account. Compared to the DEA, the computation of the graduation shift is easy, the results are robust, and non-economists can understand them results. Thus, we recommend the graduation shift as an alternative method of efficiency measurement in the teaching area. [ABSTRACT FROM AUTHOR]

Background: The city of Wrocław in Poland represents one of Central Europeans oldest capitals of science with numerous Nobel laureates. Due to a long history of political suppressions with Nazi Germany and Communism from 1933 until 1989, its scientific community was suppressed for more than half a century. Methods: The present study assessed scientific activities in the field of social and neighbouring sciences using density equalizing mapping. On the basis of the NewQIS (New Quality and Quantity Indices in Science) platform and the Social Sciences Citation Index (SSCI) of the Web of Science database, a total of 1787 articles originating from Wrocław were identified between 1966 and 2017. Results: In total, 549 research collaborations of Wrocław with 96 different countries were present (30.7%). Among the 107 research areas the highest activity was found for the field of Business and Economics with n = 272 articles (average citation rate (AVR) of 12.54), followed by Psychology (n = 252 articles, AVR = 9.06), Psychiatry (n = 205 articles, AVR = 4.74) and Public, Environmental and Occupational Health (n = 145 articles, AVR = 7.96). The highest AVR was found for Operations Research (25.36 with n = 87 articles). Density equalizing mapping procedures revealed a global pattern of social sciences research collaborations with scientists from Germany, the UK and the US as the primary cooperating partner of Wrocław. The different countries had major differences in the area of research collaborations. Conclusions: This is the first study that depicts the global network of Wrocław scientific activities in the field of social sciences. The exorbitant increase in research activity from 2006 onwards can lead to the assumption that Wrocław social sciences encounter a fruitful future. [ABSTRACT FROM AUTHOR]

Europe recently experienced a large influx of refugees, spurring much public debate about the admission and integration of refugees and migrants into society. Previous research based on cross-sectional data found that European citizens generally favour asylum seekers with high employability, severe vulnerabilities, and Christians over Muslims. These preferences and attitudes were found to be homogeneous across countries and socio-demographic groups. Here, we do not study the general acceptance of asylum seekers, but the acceptance of refugee and migrant homes in citizens’ vicinity and how it changes over time. Based on a repeated stated choice experiment on preferences for refugee and migrant homes, we show that the initially promoted “welcome culture” towards refugees in Germany was not reflected in the views of a majority of a sample of German citizens who rather disapproved refugee homes in their vicinity. Their preferences have not changed between November 2015, the peak of “welcome culture,” and November 2016, after political debates, media reporting and public discourse had shifted towards limiting admission of immigrants. A minority of one fifth of the sample population, who were initially rather approving of refugee and migrant homes being established in their vicinity, were more likely to change their preferences towards a rather disapproving position in 2016. Experience of contact with refugees and migrants, higher education, and general pro-immigration attitudes explain acceptance of refugee and migrant homes as well as preference stability over time. Country of origin and religion of refugees and migrants are considered less important than decent housing conditions and whether refugee and migrants arrive as families or single persons. In this respect our results highlight the importance of humanitarian aspects of sheltering and integration of refugees and other migrants into society. [ABSTRACT FROM AUTHOR]

The concepts of 340 university freshmen concerning urban water cycles include various misconceptions (or intuitive conceptions) which severely contrast with correct scientific ones. Almost no student knew the correct urban water cycle in total, including cycle steps in the appropriate sequence: consumer (given), sewage-plant, nature and waterworks. Concepts mainly omit nature and waterworks, only the sewage plant is included in almost all concepts. This reflects an exaggeration of the importance of the cycle-step sewage plant relative to the other steps, when the topic is taught in school. Students acquired knowledge from two main sources: School and media. Most students are aware of the origin of drinking water, although several concepts reflect a pipe-to-pipe system, where wastewater is cleared in sewage plants and brought back to consumers, skipping the roles of nature and waterworks. Everyday matters with an important impact on our life-standards, like the urban water cycle, need specific attention during school time. Currently, only primary school syllabi include the issue of urban water cycles in Germany. More effort is needed to explain wastewater and drinking water issues in order to correct misconceptions. [ABSTRACT FROM AUTHOR]

Background: Diagnosis of fetal anomaly is a significant life event and social stigma can negatively impact on the well-being of women opting for an abortion. This study investigated the psychometric properties of a measure of stigma among women who had had an abortion after diagnosis of fetal anomaly in a German setting. Methods: The Individual Level Abortion Stigma (ILAS) scale was translated into German. Psychometric properties of the ILAS scale were examined among 130 women with a history of an abortion after diagnosis of fetal anomaly. Individual and situational factors associated with stigma in the context of an abortion after diagnosis of fetal anomaly were explored. Results: Factor analysis suggested a four-dimensional structure of the German version of the Individual Level Abortion Stigma scale (Cronbach’s α, .83–.91), corresponding to the subscales of the original scale. Test-retest reliability was acceptable for the worries about judgment subscale, the self-judgment subscale, and the community condemnation subscale, but less convincing for the isolation subscale. Associations between the subscales and measures of depression, self-esteem and secrecy were found in directions consistent with theory. Women who did not perceive their fetus to have a low survival chance and women whose fetus was at higher gestational age reported higher levels of stigma, whereas higher perceived partner support was associated with lower levels of stigma. Limitation: Generalizability of study results was limited, as participants were recruited from one clinic in Germany and the study had a response rate of 46.5%. Conclusions: The ILAS subscales are largely reliable and valid measures to assess stigma among women who have had an abortion after diagnosis of fetal anomaly. Suggestions for improving the assessment of stigma experienced in this population are outlined. The scales can be useful in research aiming at investigating psychological outcomes of abortion after diagnosis of fetal anomaly and improving care structures. [ABSTRACT FROM AUTHOR]

Hospitals in Germany employ increasing numbers of foreign-born and foreign-trained (FB&FT) physicians. Studies have investigated how FB&FT physicians experience their professional integration into the German healthcare system, however, the perspectives of stakeholders working with and shaping the work experiences of FB&FT physicians in German hospitals have so far been neglected. This study explores relevant stakeholders’ opinions and attitudes towards FB&FT physicians—which likely influence how these physicians settle in—and how these opinions were formed. We conducted a qualitative interview study with 25 stakeholders working in hospitals or in health policy development. The interviews were analyzed within a constructivist research paradigm using methods derived from Grounded Theory (situational analysis as well as open, axial and selective coding). We found that stakeholders tended to focus on problems in FB&FT physicians’ work performance. Participants criticized FB&FT physicians’ work for deviating from presumably shared professional standards (skill or knowledge and behavioral standards). The professional standards invoked to justify problem-focused statements comprised the definition of an ideal behavior, attitude or ability and a tolerance range that was adapted in a dynamic process. Behavior falling outside the tolerance range was criticized as unacceptable, requiring action to prevent similar deviations in the future. Furthermore, we derived three strategies (minimization, homogenization and quality management) proposed by participants to manage deviations from assumed professional standards by FB&FT physicians. We critically reflect on the social processes of evaluation and problematization and question the legitimacy of professional standards invoked. We also discuss discriminatory tendencies visible in evaluative statements of some participants as well as in some of the strategies proposed. We suggest it will be key to develop and implement better support strategies for FB&FT physicians while also addressing problematic attitudes within the receiving system to further professional integration. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate Facebook Addiction Disorder (FAD) in a German student sample over a period of one year. While mean FAD level did not increase during the investigation period, a significant increase was shown in the number of participants reaching the critical cutoff score. FAD was significantly positively related to the personality trait narcissism and to negative mental health variables (depression, anxiety, and stress symptoms). Furthermore, FAD fully mediated the significant positive relationship between narcissism and stress symptoms, which demonstrates that narcissistic people can be specifically at risk to develop FAD. Present results give a first overview of FAD in Germany. Practical applications for future studies and limitations of present results are discussed. [ABSTRACT FROM AUTHOR]

A popular initiative in support of regulating future immigration to Switzerland was accepted by the electorate in 2014. Assuming that the initiative acted as an exclusionary threat for current immigrants of Switzerland, we conducted an online survey among a sample of highly-skilled German-speaking immigrants (“expats”). Participants reported having experienced negative affect following the vote. Moreover, having a more left-wing orientation, living in a political constituency that had voted pro-regulation and having proportionally few Swiss friends positively predicted negative affect following the vote. Negative affect was associated with a reported negative change in one’s attitudes towards Switzerland, increased considerations to leave the country, and impaired satisfaction with life. In sum, the results suggest that a powerful exclusionary threat such as a national vote may be experienced as distressful by highly-skilled immigrants currently living in the country. [ABSTRACT FROM AUTHOR]

Research on social processes in the production of scientific output suggests that the collective research agenda of a discipline is influenced by its structural features, such as “invisible colleges” or “groups of collaborators” as well as academic “stars” that are embedded in, or connect, these research groups. Based on an encompassing dataset that takes into account multiple publication types including journals and chapters in edited volumes, we analyze the complete co-authorship network of all 1,339 researchers in German political science. Through the use of consensus graph clustering techniques and descriptive centrality measures, we identify the ten largest research clusters, their research topics, and the most central researchers who act as bridges and connect these clusters. We also aggregate the findings at the level of research organizations and consider the inter-university co-authorship network. The findings indicate that German political science is structured by multiple overlapping research clusters with a dominance of the subfields of international relations, comparative politics and political sociology. A small set of well-connected universities takes leading roles in these informal research groups. [ABSTRACT FROM AUTHOR]

Background: In patients with life-limiting conditions and a history of migration, a higher risk of not dying at home and limited access to palliative care services has been reported. Aim: To explore the views and end-of-life preferences of patients with a migration history in Germany and to identify migration specific themes. Design: Two-armed study using Kaufmann’s ‘understanding interview’ (‘focused interview’) method and grounded theory approach. Thematic content analysis was applied using MaxQDA 12 software. Setting/Participants: Migrant and non-migrant adult patients with far advanced, life-limiting disease receiving palliative care in different specialist level settings (specialist home palliative care, palliative care inpatient unit, inpatient hospice). Results: The 37 interviewees (19 native Germans and 18 patients from Europe and the U.S., Israel, Turkey, and Indonesia) expressed eleven themes covering health care- and patient-related issues, of which four emerged to be specific for migrants: worse survival in home country; the perception of an altered identity and ‘not belonging’; language skills as prerequisite to survive; and longing for ‘home’ while being attached to Germany. From these categories, three overarching themes were derived: (1) a limited understanding of the concept of ‘palliative care’; (2) the suppression of end of life discussions for its association with suffering and loss of autonomy; and (3) the significance of complex individual migration histories. Conclusions: Based on these findings, the concept of a ‘double home’ experience is proposed. Barriers to access to palliative care should be minimized for all patients while cultural stereotyping has to be avoided. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the cost-effectiveness of the state-wide implementation of the health promotion program “Join the Healthy Boat” in primary schools in Germany. Methods: Cluster-randomized intervention trial with wait-list control group. Anthropometric data of 1733 participating children (7.1 ± 0.6 years) were taken by trained staff before and after a one year intervention period in the academic year 2010/11. Parents provided information about the health status, and the health behaviour of their children and themselves, parental anthropometrics, and socio-economic background variables. Incidence of abdominal obesity, defined as waist-to-height ratio (WHtR) ≥ 0.5, was determined. Generalized linear models were applied to account for the clustering of data within schools, and to adjust for baseline-values. Losses to follow-up and missing data were analysed. From a societal perspective, the overall costs, costs per pupil, and incremental cost-effectiveness ratio (ICER) to identify the costs per case of averted abdominal obesity were calculated. Results: The final regression model for the incidence of abdominal obesity shows lower odds for the intervention group after an adjustment for grade, gender, baseline WHtR, and breakfast habits (odds ratio = 0.48, 95% CI [0.25; 0.94]). The intervention costs per child/year were €25.04. The costs per incidental case of averted abdominal obesity varied between €1515 and €1993, depending on the different dimensions of the target group. Conclusion: This study demonstrates the positive effects of state-wide, school-based health promotion on incidental abdominal obesity, at affordable costs and with proven cost-effectiveness. These results should support allocative decisions of policymakers. An early start to the prevention of abdominal obesity is of particular importance because of its close relationship to non-communicable diseases. Trial registration: German Clinical Trials Register (DRKS), Freiburg University, Germany, DRKS-ID: . [ABSTRACT FROM AUTHOR]

Scientific outreach delivers science to the people. But it can also deliver people to the science. In this work, we report our experience from a large-scale public engagement project promoting genomic literacy among Danish high school students with the additional benefit of collecting data for studying the genetic makeup of the Danish population. Not only did we confirm that students have a great interest in their genetic past, but we were also gratified to see that, with the right motivation, adolescents can provide high-quality data for genetic studies. [ABSTRACT FROM AUTHOR]

The (German) market for law professors fulfils the conditions for a hog cycle: In the short run, supply cannot be extended or limited; future law professors must be hired soon after they first present themselves, or leave the market; demand is inelastic. Using a comprehensive German dataset, we show that the number of market entries today is negatively correlated with the number of market entries eight years ago. This suggests short-sighted behavior of young scholars at the time when they decide to prepare for the market. Using our statistical model, we make out-of-sample predictions for the German academic market in law until 2020. [ABSTRACT FROM AUTHOR]

Background: Socially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES). Methods: The analyses were based on data from 6,754 participants in the Robert Koch Institute’s German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data. Results: After adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08–1.46; women: IRR = 1.20; 95% CI = 1.07–1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51–0.91; women: OR = 0.56; 95% CI = 0.41–0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians. Conclusion: The findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care. [ABSTRACT FROM AUTHOR]

Background: Animal trade plays an important role for the spread of infectious diseases in livestock populations. The central question of this work is how infectious diseases can potentially spread via trade in such a livestock population. We address this question by analyzing the underlying network of animal movements. In particular, we consider pig trade in Germany, where trade actors (agricultural premises) form a complex network. Methodology: The considered pig trade dataset spans several years and is analyzed with respect to its potential to spread infectious diseases. Focusing on measurements of network-topological properties, we avoid the usage of external parameters, since these properties are independent of specific pathogens. They are on the contrary of great importance for understanding any general spreading process on this particular network. We analyze the system using different network models, which include varying amounts of information: (i) static network, (ii) network as a time series of uncorrelated snapshots, (iii) temporal network, where causality is explicitly taken into account. Findings: We find that a static network view captures many relevant aspects of the trade system, and premises can be classified into two clearly defined risk classes. Moreover, our results allow for an efficient allocation strategy for intervention measures using centrality measures. Data on trade volume do barely alter the results and is therefore of secondary importance. Although a static network description yields useful results, the temporal resolution of data plays an outstanding role for an in-depth understanding of spreading processes. This applies in particular for an accurate calculation of the maximum outbreak size. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is a well-known and underused protective factor for numerous health outcomes, and interventions are hampered by lack of objective data. We combined accelerometers with diaries to estimate the contributions to total activity from different domains throughout the day and week in adolescents. Methods: Accelerometric and diary data from 1403 adolescents (45% male, mean age 15.6 ± 0.5 years) were combined to evaluate daily levels and domains of sedentary, light, and moderate-to-vigorous activity (MVPA) during a typical week. Freedson’s cutoff points were applied to determine levels of activity. Total activity was broken down into school physical education (PE), school outside PE, transportation to school, sport, and other time. Results: About 2/3 of adolescents’ time was spent sedentary, 1/3 in light activity, and about 5% in MVPA. Boys and girls averaged 46 (SD 22) and 38 (23) minutes MVPA per day. Adolescents were most active during leisure sport, spending about 30% of it in MVPA, followed by PE (about 20%) transport to school (14%) and either school class time or other time (3%). PE provided 5% of total MVPA, while leisure sport provided 16% and transportation to school 8%. School was the most sedentary part of the day with over 75% of time outside PE spent sedentary. Conclusions: These German adolescents were typical of Europeans in showing low levels of physical activity, with significant contributions from leisure sport, transportation and school PE. Leisure sport was the most active part of the day, and participation did not vary significantly by sex, study center (region of Germany) or BMI. Transportation to school was frequent and thus accounted for a significant fraction of total MVPA. This indicates that even in a population with good access to dedicated sporting activities, frequent active transportation can add significantly to total MVPA. [ABSTRACT FROM AUTHOR]

Objective: Various childhood adversities have been found to be associated with chronic pain in adulthood. However, associations were moderate in most studies, i.e. odds ratios (OR) were between one and two. Method: An internet survey was performed in 508 Polish and 500 German subjects. A total of 19 childhood adversities were selected and their associations with headaches explored. Age, gender and country were included as potential confounders, as well as their two-way interaction with the risk factors. Results: Two strong risk factors were identified. (1) A combined score for physical and emotional neglect showed an odds ratio (OR) of 2.78 (p < .002) to the frequency of headache in adulthood as a main effect. (2) Father having had chronic pain showed an OR of 4.36 (p < .001) with headache in adulthood for women, but not for men (OR = 0.86, p < .556). The majority of the examined childhood adversities were not associated with adult headache, neither when tested individually nor as a sum score. Conclusion: This study confirms results from previous ones that childhood adversities may play a role in the development of adult headache, but it is a rather minor one. Contrary to other studies, neglect turned out to be one of the strongest predictors. [ABSTRACT FROM AUTHOR]

Population aging is an inevitable global demographic process. Most of the literature on the consequences of demographic change focuses on the economic and societal challenges that we will face as people live longer and have fewer children. In this paper, we (a) briefly describe key trends and projections of the magnitude and speed of population aging; (b) discuss the economic, social, and environmental consequences of population aging; and (c) investigate some of the opportunities that aging societies create. We use Germany as a case study. However, the general insights that we obtain can be generalized to other developed countries. We argue that there may be positive unintended side effects of population aging that can be leveraged to address pressing environmental problems and issues of gender inequality and intergenerational ties. [ABSTRACT FROM AUTHOR]

Objective: Considering the high number of stressors encountered in the context of elite sports, a high sense of coherence (SOC) is crucial to allow athletes to maintain their health from both short- and long-term perspectives. The aim of this cross-sectional study was to investigate SOC in a population of elite athletes, focusing on identification of subsets of athletes with particularly high and low SOC scores, and any related predictors. The elite athletes' SOC scores were also evaluated for differences with those of the general population of Germany; whether a correlation between SOC and subjective health existed was additionally examined. Method: In total, 698 male and female elite athletes, drawn from Germany's highest-level national track and field squads, and first and second division handball teams, completed a survey that included the SOC-L9 Scale and measures of subjective health, sociodemographic information, and the number of injury lay-offs experienced during the athletes' careers to date. Results: Classification tree analysis reveals six contrast groups with varying SOC scores. Several interacting factors determine the group to which an athlete belongs. Together with overuse injuries, additional factors are age, gender, and completed/not completed apprenticeship/degree. Female athletes aged between 19 and 25, who had already been subject to lay-offs due to overuse injuries, comprise the group with the lowest SOC scores. Overall, the SOC of elite athletes is slightly lower than in the general population. In accordance with other studies, a stronger SOC is also correlated significantly with better global subjective health. Conclusion: The identification of contrast groups with varying SOC scores contributes to the development of more targeted salutogenetic health promotion programs. Such programs would ideally include learning modules pertaining to coping with overuse injuries, as well as social support systems aiming to effectively combine education and elite sport. [ABSTRACT FROM AUTHOR]

Objectives: To assess the relationship between proximity to specific sports facilities and participation in the corresponding sports activities for adolescents in Germany. Methods: A sample of 1,768 adolescents aged 11–17 years old and living in 161 German communities was examined. Distances to the nearest sports facilities were calculated as an indicator of proximity to sports facilities using Geographic Information Systems (GIS). Participation in specific leisure-time sports activities in sports clubs was assessed using a self-report questionnaire and individual-level socio-demographic variables were derived from a parent questionnaire. Community-level socio-demographics as covariates were selected from the INKAR database, in particular from indicators and maps on land development. Logistic regression analyses were conducted to examine associations between proximity to the nearest sports facilities and participation in the corresponding sports activities. Results: The logisitic regression analyses showed that girls residing longer distances from the nearest gym were less likely to engage in indoor sports activities; a significant interaction between distances to gyms and level of urbanization was identified. Decomposition of the interaction term showed that for adolescent girls living in rural areas participation in indoor sports activities was positively associated with gym proximity. Proximity to tennis courts and indoor pools was not associated with participation in tennis or water sports, respectively. Conclusions: Improved proximity to gyms is likely to be more important for female adolescents living in rural areas. [ABSTRACT FROM AUTHOR]

Objective: Internalizing the pervasive weight bias commonly directed towards individuals with overweight and obesity, co-occurs with increased psychopathology and impaired quality of life. This study sought to establish population norms and psychometric properties of the most widely used self-report questionnaire, the Weight Bias Internalization Scale (WBIS), in a representative community sample. Design and Methods: In a survey of the German population, N = 1158 individuals with overweight and obesity were assessed with the WBIS and self-report measures for convergent validation. Results: Item analysis revealed favorable item-total correlation of all but one WBIS item. With this item removed, item homogeneity and internal consistency were excellent. The one-factor structure of the WBIS was confirmed using confirmatory factor analysis. Convergent validity was shown through significant associations with measures of depressive and somatoform symptoms. The WBIS contributed to the explanation of variance in depressive and somatoform symptoms over and above body mass index. Higher WBIS scores were found in women than in men, in individuals with obesity than in individuals with overweight, and in those with lower education or income than those with higher education or income. Sex-specific norms were provided. Conclusions: The results showed good psychometric properties of the WBIS after removal of one item. Future research is warranted on further indicators of reliability and validity, for example, retest reliability, sensitivity to change, and prognostic validity. [ABSTRACT FROM AUTHOR]

Emotional facial expressions provide important nonverbal cues in human interactions. The perception of emotions is not only influenced by a person’s ethnic background but also depends on whether a person is engaged with the emotion-encoder. Although these factors are known to affect emotion perception, their impact has only been studied in isolation before. The aim of the present study was to investigate their combined influence. Thus, in order to study the influence of engagement on emotion perception between persons from different ethnicities, we compared participants from China and Germany. Asian-looking and European-looking virtual agents expressed anger and happiness while gazing at the participant or at another person. Participants had to assess the perceived valence of the emotional expressions. Results indicate that indeed two factors that are known to have a considerable influence on emotion perception interacted in their combined influence: We found that the perceived intensity of an emotion expressed by ethnic in-group members was in most cases independent of gaze direction, whereas gaze direction had an influence on the emotion perception of ethnic out-group members. Additionally, participants from the ethnic out-group tended to perceive emotions as more pronounced than participants from the ethnic in-group when they were directly gazed at. These findings suggest that gaze direction has a differential influence on ethnic in-group and ethnic out-group dynamics during emotion perception. [ABSTRACT FROM AUTHOR]

Background: Health Technology Assessments (HTAs) are used to inform decision-making and their usefulness depends on the quality and relevance of research and specific studies for health-policy decisions. Little is known about the country of origin of studies used for HTAs. Objective: To investigate which countries have made the largest contributions to inform health policy decisions through studies included in HTAs in Germany. Methods: The country of origin was extracted from all studies included in HTAs of the German Institute for Quality and Efficiency in Health Care, (IQWiG), published from 2/2006 to 9/2010. Studies were ranked according to the total number of studies per country, adjusted for population size, gross domestic product (GDP), and total health expenditure. Results: 1087 studies were included in 54 HTA reports. Studies were assigned to 45 countries. Most of the studies (27%) originated from the United States (USA), 18% were multinational, followed by 7% from the United Kingdom (UK) and 5% from Germany. Nordic countries led the ranking when adjusting for population size/million (ranks 1-3,6,9/45 countries), GDP/billion US$ (1,2,5,9,14/45), or health expenditure/billion US$ (1,3,5,12,13/45). The relative contribution of the UK was stable in the analyses when adjusted for population size (7/45), GDP (7/45), and health expenditure (9/45), whereas the USA (13, 18, and 30/45) and Germany (17, 19, and 21/45) dropped in the ranking. Conclusions: More than half of the studies relevant for evidence-informed decision-making in Germany originated from the USA, followed by multinational research and the UK. Only 5% of the studies originated from Germany. According to our findings, there appears to be some discrepancy between the use of globally generated evidence and the contribution to the knowledge pool by individual countries. [ABSTRACT FROM AUTHOR]