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Abstract Nutrition plays a crucial role in human and planetary health, as prevailing nutritional patterns significantly contribute to the global non-communicable disease pandemic. Moreover, the global food system is inextricably linked to planetary health deterioration. The relevance of nutrition for individual and planetary health is insufficiently addressed in German medical schools. Here, we present a two-week course for medical students in the 8th semester at Charité - Universitätsmedizin Berlin on nutrition and fasting in the context of human and planetary health. The course was developed iteratively along the Kern cycle for medical curricula and underwent evaluation through a mixed-methods design spanning across two consecutive semesters. Assessment involved quantitative questionnaires and qualitative interviews. The main exploratory outcome was the overall module rating. Further outcomes encompassed in-depth evaluations of specific aspects, including content, teaching methods, instructor performance, and subjective experiential aspects. The conceptualisation resulted in a highly participative two-week course of 37.5 h. The main learning objectives aimed at the acquisition of technical competences and personal competencies in four areas: (1) the role of nutrition in health and disease; (2) the exploration of global food systems; (3) communication on subjects of nutrition; (4) culinary medicine. Various interactive didactic methodologies were used. 77.8% (n = 27) of the participants rated the course as very good or good. The conviction that nutrition influences health and disease increased over the course (Wilcoxon signed rank test, z = -2.82, p = 0.005, r = 0.57). In the qualitative interviews (n = 8) the course content, its didactical diversity and the positive group experience were appreciated. Our results indicate that it could be worthwhile to further incorporate nutrition curricula in medical education.

Background: Preventing postoperative infection and promoting patient safety are essential responsibilities of the operating room nurse. In some hospitals, splash basins are used to rinse instruments during surgery, although previous studies emphasise the risk of bacterial contamination. A recent systematic review calls for further investigation into surgical teams’ use of splash basins. Objectives: Our objective was to investigate bacterial contamination in splash basins and to identify the variables that may have an influence on this contamination. Methods: This prospective observational pilot study involved collecting, cultivating, and analysing water samples obtained from splash basins during operations performed in the thoracic and neurosurgical departments. The ventilation systems, length of surgery, number of instruments in the splash basin, number of persons present in the operating room, frequency of door openings during surgery, and type of bacteria were observed. Results: Bacterial growth was found in 44% of the final water samples: 41% from the thoracic surgical department, which had laminar airflow ventilation systems/unidirectional airflow ventilation, and 47% from the neurosurgical department, which had conventional ventilation systems/turbulent mixing ventilation. However, the binary logistic regression analysis revealed no significant correlation between bacterial growth and the ventilation systems, length of surgery, number of instruments in the splash basin, number of people in the operating room, or frequency of door openings. The most common types of bacteria found were coagulase-negative staphylococci and Micrococcus luteus. Conclusions: Splash basins become contaminated with bacteria during surgery. Therefore, using splash basins with sterile water is not recommended. Further research is needed to determine the best evidence-based practice for rinsing instruments perioperatively.

PurposeApproximately 10–20% of couples in Germany are unable to conceive. About 50% of this subfertility can be attributed to the male partner. Preclinical studies suggest that fasting could potentially influence central mechanisms of spermatogenesis. This study aimed at investigating feasibility and effects of a Fasting Mimicking Diet (FMD) in the context of male subfertility.Materials and methodsIn this two-arm, randomized, controlled, exploratory mixed methods study men with impaired sperm quality were randomized into a fasting and a waiting-list control group. The fasting group followed an FMD (500 kcal/d for 5 days) thrice within 4 months, while the control group was instructed to maintain their lifestyle and diet. We assessed sperm quality according to WHO criteria (total and progressive sperm motility, concentration, total sperm count, ejaculation volume and sperm morphology) from baseline to 6 months later. Semi-structured interviews were conducted in a subgroup and evaluated by structured content analysis.ResultsRecruitment proved difficult, with 18 out of only 22 recruited participants completing all visits. There were no marked group differences between fasters (n = 10, 36.9 ± 5.17 years) and controls (n = 8, 36.1 ± 2.8 years) regarding sperm parameters. Effect sizes suggest slight positive trends regarding between group changes in the ANCOVA for total sperm motility (eta2 = 0.030) progressive sperm motility (eta2 = 0.059), total sperm count (eta2 = 0.001), concentration (eta2 = 0.050), normal sperm morphology (eta2 = 0.019) and the percentage of round cells (eta2 = 0.462) in the fasting group and a general decrease of sperm quality in the control group. This decrease of sperm quality concerned all parameters but the ejaculation volume, which increased in the CG but decreased in the FG (eta2 = 0.254). The decline of sperm quality in the CG is not explicable by the study setting. We also saw positive trends concerning the intragroup changes (e.g., within group change for progressive sperm motility: d = 0.36), Qualitative analysis (10 interviews) showed FMD feasibility, and its compatibility with full-time work. Motivation toward a healthier lifestyle after the FMD and a feeling of self-empowerment concerning one’s fertility were reported.ConclusionThis limited exploratory study showed FMD feasibility but found no notable differences between groups regarding all parameters. Yet, we saw positive trends regarding the between and within group changes in favour of the fasting group. Possible beneficial effects of the FMD on sperm quality should be investigated in larger studies. Interview results suggest that fasting could be a useful supportive intervention in male subfertility regarding self-efficacy and positive lifestyle changes.

IntroductionNutrition plays a crucial role in current German public health strategies. While sociodemographic differences in nutrition have been extensively studied, recent data specific to Germany remains limited.MethodsAn online-representative cross-sectional survey was conducted in 2022 among German-speaking adults aged 18–75 using a Computer Assisted Web Interview (CAWI) format. The survey addressed personal eating habits, the importance of nutrition, motivations behind food choices, and openness to dietary changes. Data analysis included both descriptive and inferential statistics, incorporating CHAID decision tree analysis and nonparametric methods for inductive statistical evaluation.ResultsAmong the 4,065 participants, 62.3% regarded healthy nutrition as important, with women, individuals with higher education, and those aged under 26 or over 70 demonstrating greater emphasis on nutrition. CHAID analysis identified education as the most significant predictor of attitudes toward healthy nutrition, followed by sex and income. Participants with a positive attitude toward healthy nutrition reported higher HRQoL scores (EQ-Index = 0.862) compared to neutral or negative attitudes (EQ-Index = 0.835)0.10.5% of participants reported not to eat meat, 28.6% were self-reported flexitarians and 54.1% of participants considered themselves omnivorous. Gender-specific dietary preferences were observed, with plant-based diets being much more popular among females. Participants identified taste preference as the primary factor influencing food choices (77.2%) when asked about the main reasons for their eating habits. Approximately 18% of participants predominantly or exclusively bought organic foods. Interestingly, one third of participants indicated a willingness to adopt a more plant-based diet if recommended by physicians or scientists.ConclusionThis online representative survey revealed significant associations between nutrition and sociodemographic aspects. Understanding this complex interplay might be useful for public health nutrition strategies that promote healthier national eating patterns.

Background: Evidence on the health benefits of spending time in nature has highlighted the importance of provision of blue and green spaces where people live. The potential for health benefits offered by nature exposure, however, extends beyond health promotion to health treatment. Social prescribing links people with health or social care needs to community-based, non-clinical health and social care interventions to improve health and wellbeing. Nature-based social prescribing (NBSP) is a variant that uses the health-promoting benefits of activities carried out in natural environments, such as gardening and walking. Much current NBSP practice has been developed in the UK, and there is increasing global interest in its implementation. This requires interventions to be adapted for different contexts, considering the needs of populations and the structure of healthcare systems. Methods: This paper presents results from an expert group participatory workshop involving 29 practitioners, researchers, and policymakers from the UK and Germany’s health and environmental sectors. Using the UK and Germany, two countries with different healthcare systems and in different developmental stages of NBSP practice, as case studies, we analysed opportunities, challenges, and facilitators for the development and implementation of NBSP. Results: We identified five overarching themes for developing, implementing, and evaluating NBSP: Capacity Building; Accessibility and Acceptability; Networks and Collaborations; Standardised Implementation and Evaluation; and Sustainability. We also discuss key strengths, weaknesses, opportunities, and threats for each overarching theme to understand how they could be developed to support NBSP implementation. Conclusions: NBSP could offer significant public health benefits using available blue and green spaces. We offer guidance on how NBSP implementation, from wider policy support to the design and evaluation of individual programmes, could be adapted to different contexts. This research could help inform the development and evaluation of NBSP programmes to support planetary health from local and global scales.

Ultra-high performance liquid chromatography-high-resolution mass spectrometry (UPHLC-HRMS) is used to discover and monitor single or sets of biomarkers informing about metabolic processes of interest. The technique can detect 1000s of molecules (i.e., metabolites) in a single instrument run and provide a measurement of the global metabolome, which could be a fingerprint of activity. Despite the power of this approach, technical challenges have hindered the effective use of metabolomics to interrogate microbial communities implicated in the removal of priority contaminants. Herein, our efforts to circumvent these challenges and apply this emerging systems biology technique to microbiomes relevant for contaminant biodegradation will be discussed. Chlorinated ethenes impact many contaminated sites, and detoxification can be achieved by organohalide-respiring bacteria, a process currently assessed by quantitative gene-centric tools (e.g., quantitative PCR). This laboratory study monitored the metabolome of the SDC-9™ bioaugmentation consortium during cis-1,2-dichloroethene (cDCE) conversion to vinyl chloride (VC) and nontoxic ethene. Untargeted metabolomics using an UHPLC-Orbitrap mass spectrometer and performed on SDC-9™ cultures at different stages of the reductive dechlorination process detected ~10,000 spectral features per sample arising from water-soluble molecules with both known and unknown structures. Multivariate statistical techniques including partial least squares-discriminate analysis (PLSDA) identified patterns of measurable spectral features (peak patterns) that correlated with dechlorination (in)activity, and ANOVA analyses identified 18 potential biomarkers for this process. Statistical clustering of samples with these 18 features identified dechlorination activity more reliably than clustering of samples based only on chlorinated ethene concentration and Dhc 16S rRNA gene abundance data, highlighting the potential value of metabolomic workflows as an innovative site assessment and bioremediation monitoring tool.

IntroductionAyurveda, South Asia’s largest and most relevant system of Traditional Medicine, holds a legal status akin to conventional Western medicine in India and elsewhere. There is an almost complete lack of data on the use of Ayurveda in Germany. The aim of this study was to investigate Ayurveda’s utilization patterns, entry points, and factors influencing its use and the perception of Ayurveda among the German population.MethodsBasis of this manuscript was an online-representative survey which involved 4,065 participants aged 18–75 about the use and acceptance of Traditional, Complementary and Integrative Medicine (TCIM) in Germany. The survey was conducted online using Computer Assisted Web Interview (CAWI) in 2022. The dataset was analyzed descriptively and inferentially.ResultsAltogether 9.3% (n = 377) of all survey participants (n = 4,065) had already used Ayurveda somehow, either more often (1.7%) or at least once in a lifetime (7.6%). Responders associated Ayurveda primarily with Indian Medicine (27.7%) and wellness (18%). Commonly used Ayurvedic services included non-medical treatments at wellness resorts/spas (48.3%), in outpatient practices (27.1%), and hotels (23.6%). 30.2% of the participants believe in Ayurveda’s therapeutic potential. 76.7% of Ayurveda users find healthy nutrition important or very important. Nine predictors were found to classify Ayurveda users vs. non-users with spirituality and belief in Ayurveda’s therapeutic efficacy as the most relevant ones. Ayurveda seems to be primarily used by well-educated and female individuals, often from higher-income groups and with a rather modern social milieu-orientation.ConclusionStudy results suggest that about every tenth German citizen has used Ayurveda in the past and about one third believes in its therapeutic potential. Because Ayurvedic therapies are often not evidence-based, there is an urgent need to perform high quality randomized controlled trials to investigate potential effects and safety of Ayurveda and how evidence-based Ayurveda treatments can be integrated into the German healthcare system.

Abstract Background Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care. Objective To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance—Primary Care Antibiotic Audit and Feedback Network. Methods We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement. Results The final set of guidelines include 13 best practice statements in four categories: general considerations (n = 3), selecting feedback recipients (n = 1), data and indicator selection (n = 4), and feedback delivery (n = 5). Conclusion We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.

BackgroundOlder representative surveys show that Traditional, Complementary and Integrative Medicine (TCIM) is used by about 60% of the German population. However, no data exists for the current nationwide situation. The main aim of this cross-sectional study is to investigate the current use and acceptance of TCIM in Germany.MethodsThis study is based on a representative sample of the German population aged 18–75 years. Participants were asked about the use and acceptance of TCIM. The survey was conducted online using Computer Assisted Web Interview (CAWI) in 2022 by three renowned German market research institutes on behalf of and in close coordination with the working group. The data set was analyzed descriptively and inferentially.ResultsIn total, 4,065 participants (52% female, 48% male, 0.4% diverse) responded completely (response rate: 21.5%). Among participants, 70% stated that they had used TCIM at some point in their lives, with 32% doing so in the last 12 months and 18% currently. The most common reason given (17%) was musculoskeletal pain. For their own health, 39% stated that TCIM is important. Traditional European Medicine was rated as very/mainly effective by 27% of participants and as partly effective by 44% (conventional medicine: 69% very/mainly effective, 19% partly effective). As a complementary treatment strategy to conventional medicine, 35% considered TCIM to be optimal (“Complementary Medicine”), 33% in combination with conventional medicine (“Integrative Medicine”) and 5% without conventional medicine (“Alternative Medicine”). The majority of the participants were in favor of more research on TCIM and stated that the costs of TCIM services should be covered by health insurance companies (71% and 69%, respectively).ConclusionThese results from a representative online-population suggest that the use of TCIM in Germany remains at a high level. The nationwide relevance of TCIM should be given greater consideration in German health care policy making. TCIM should be systematically investigated using appropriate study designs and methods including high quality randomized clinical trials to investigate their effectiveness, efficacy, therapeutic safety and costs in the future.

Background: This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities. Method: Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests. Results: The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < 0.001) and lower BMI (OR = 0.859, p = 0.001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity. Conclusions: Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.

IntroductionSince cannabinoids were partially legalized as prescription medicines in Germany in 2017, they are mostly used when conventional therapies do not suffice. Ambiguities remain regarding use, benefits and risks. This web-based survey explored the perspectives of patients whose experiences are not well enough known to date.MethodsIn an anonymous, exploratory, cross-sectional, one-time web-based observational study, participants receiving cannabinoid therapy on prescription documented aspects of their medical history, diagnoses, attitudes toward cannabinoids, physical symptoms, and emotional states. Participants completed the questionnaires twice here: first regarding the time of the survey and then, retrospectively, for the time before their cannabinoid therapy. Participants were recruited in a stratified manner in three German federal states.ResultsN = 216 participants (48.1% female, aged 51.8 ± 14.0) completed the survey, most of which (72%, n = 155) reported pain as their main reason for cannabinoid therapy. When comparing the current state with the retrospectively assessed state, participants reported greater satisfaction with their overall medical therapy (TSQM II: +47.9 ± 36.5, p

BackgroundMany individuals with intellectual disability (ID) have a sedentary lifestyle. Few interventions aimed at increasing their level of physical activity (PA) have shown lasting effects.AimTo assess the feasibility and acceptability of a pilot intervention study using innovative mobile health (mHealth) support systems to encourage PA in individuals with ID.MethodsNine individuals with ID and a low level of PA, aged 16–36 years, were included in the present convergent triangulation mixed method design. Two mHealth support systems (apps) were developed and tested. PA was measured with a Fitbit smartwatch, accelerometer, the International Physical Activity Questionnaire—Short Form (IPAQ-S), and Goal attainment scaling. Data were collected through online pre-, mid- (4 weeks), and post-intervention (12 weeks) questionnaires and activity trackers. Semi-structured qualitative interviews with participants and/or a family or staff member were held after the 12-week follow-up. Data were analyzed using conventional nonparametric statistics and thematic analyses.ResultsThe response rate and retention to the trial were 16% and 100%, respectively. Data quality was high, except for missing data from Fitbit activity trackers of approximately 30% from the 4- and 12-week follow-up stages. The feasibility challenges with activity trackers include rashes, size, non-acceptance, and loss of motivation. Participants and family members/staff reported interest in the study theme and were pleased with the data collection method. All but one participant achieved their PA goals. Most participants reported being satisfied with the apps as they were enjoyable or provided a reminder for performing physical and other activities. Social support for PA among family members also increased. However, app support from staff and family members was needed, and apps were not used regularly. Two of nine participants (22%) had increased their PA measured as steps per day with Fitbit at the 12-week follow-up.ConclusionsThe acceptability and feasibility of using tailored mobile applications in natural settings to increase PA among adults with ID are promising. This study aligns with previous studies in showing the challenges to increasing PA, which requires the inclusion of family members, staff, and stakeholders. The intervention requires modifications before a randomized controlled trial can be conducted.

Introduction Chronic inflammatory diseases like rheumatoid arthritis (RA) and neurodegenerative disorders like Parkinson’s disease (PD) have recently been associated with a decreased diversity in the gut microbiome, emerging as key driver of various diseases. The specific interactions between gut-borne microorganisms and host pathophysiology remain largely unclear. The microbiome can be modulated by interventions comprising nutrition.The aim of our clinical study is to (1) examine effects of prolonged fasting (PF) and time-restricted eating (TRE) on the outcome parameters and the immunophenotypes of RA and PD with (2) special consideration of microbial taxa and molecules associated with changes expected in (1), and (3) identify factors impacting the disease course and treatment by in-depth screening of microorganisms and molecules in personalised HuMiX gut-on-chip models, to identify novel targets for anti-inflammatory therapy.Methods and analysis This trial is an open-label, multicentre, controlled clinical trial consisting of a cross-sectional and a longitudinal study. A total of 180 patients is recruited. For the cross-sectional study, 60 patients with PD, 60 patients with RA and 60 healthy controls are recruited at two different, specialised clinical sites. For the longitudinal part, 30 patients with PD and 30 patients with RA undergo 5–7 days of PF followed by TRE (16:8) for a period of 12 months. One baseline visit takes place before the PF intervention and 10 follow-up visits will follow over a period of 12 months (April 2021 to November 2023).Ethics and dissemination Ethical approval was obtained to plan and conduct the trial from the institutional review board of the Charité-Universitätsmedizin Berlin (EA1/204/19), the ethics committee of the state medical association (Landesärztekammer) of Hessen (2021–2230-zvBO) and the Ethics Review Panel (ERP) of the University of Luxembourg (ERP 21–001 A ExpoBiome). The results of this study will be disseminated through peer-reviewed publications, scientific presentations and social media.Trial registration number NCT04847011.