[Viral zoonoses in Germany: a One Health perspective]. / Virale Zoonosen in Deutschland aus der One Health-Perspektive.

The COVID-19 pandemic and the increasing occurrence of monkeypox (mpox) diseases outside Africa have illustrated the vulnerability of populations to zoonotic pathogens. In addition, other viral zoonotic pathogens have gained importance in recent years.This review article addresses six notifiable viral zoonotic pathogens as examples to highlight the need for the One Health approach in order to understand the epidemiology of the diseases and to derive recommendations for action by the public health service. The importance of environmental factors, reservoirs, and vectors is emphasized, the diseases in livestock and wildlife are analyzed, and the occurrence and frequency of diseases in the population are described. The pathogens selected here differ in their reservoirs and the role of vectors for transmission, the impact of infections on farm animals, and the disease patterns observed in humans. In addition to zoonotic pathogens that have been known in Germany for a long time or were introduced recently, pathogens whose zoonotic potential has only lately been shown are also considered.For the pathogens discussed here, there are still large knowledge gaps regarding the transmission routes. Future One Health-based studies must contribute to the further elucidation of their transmission routes and the development of prevention measures. The holistic approach does not necessarily include a focus on viral pathogens/diseases, but also includes the question of the interaction of viral, bacterial, and other pathogens, including antibiotic resistance and host microbiomes.

[Bavarian online database for corona screening tests-development and use of a digital solution in the pandemic]. / Bayerisches Meldeportal für Corona-Reihenuntersuchungen ­ Entwicklung und Einsatz einer digitalen Lösung in der Pandemie.

During the SARS-CoV­2 pandemic, various data had to be collected to support political decisions for pandemic preparedness and response. Nevertheless, using analogue tools like paper and pencil as well as sending files with media discontinuity that have to be merged later are not useful and can hardly provide usable data in real time. With the selected system architecture, the Bavarian Online Database for Corona Screening Tests (BayCoRei) is a central, Bavaria-wide, consistent digital solution that is agile and easy to use. BayCoRei uses established technical components and interfaces. Apart from this, the support of the individual stakeholders (e.g., health authorities, service providers, and district governments) plays a decisive role in the success of the solution. The present article describes BayCoRei and two other online databases as examples that comprise the technology and architecture that have proven to be (rapidly) deployable and points out the gap between intention and reality regarding pandemic management.

[The maturity model for the public health service-a tool for assessing and improving the digital maturity level of German public health agencies]. / Das Reifegradmodell für den Öffentlichen Gesundheitsdienst ­ Ein Instrument zur Erfassung und Verbesserung des digitalen Reifegrades von deutschen Gesundheitsämtern.

The COVID 19 crisis has highlighted the key role of the public health service (PHS), with its approximately 375 municipal health offices involved in the pandemic response. Here, in addition to a lack of human resources, the insufficient digital maturity of many public health departments posed a hurdle to effective and scalable infection reporting and contact tracing. In this article, we present the maturity model (MM) for the digitization of health offices, the development of which took place between January 2021 and February 2022 and was funded by the German Federal Ministry of Health. It has been applied since the beginning of 2022 with the aim of strengthening the digitization of the PHS. The MM aims to guide public health departments step by step to increase their digital maturity to be prepared for future challenges. The MM was developed and evaluated based on qualitative interviews with employees of public health departments and other experts in the public health sector as well as in workshops and with a quantitative survey. The MM allows the measurement of digital maturity in eight dimensions, each of which is subdivided into two to five subdimensions. Within the subdimensions a classification is made on five different maturity levels. Currently, in addition to recording the digital maturity of individual health departments, the MM also serves as a management tool for planning digitization projects. The aim is to use the MM as a basis for promoting targeted communication between the health departments to exchange best practices for the different dimensions.

[Epidemiology of mental well-being in childhood and adolescence. Results from three epidemiological studies before and during the COVID-19 pandemic]. / Epidemiologie seelischen Wohlbefindens von Kindern und Jugendlichen in Deutschland. Ergebnisse aus 3 Studien vor und während der COVID-19-Pandemie.

BACKGROUND: Continuous nationwide health monitoring is important to track the well-being of children and adolescents and to map developmental trajectories. Based on the results of three selected epidemiological studies, developments in child well-being over the past 20 years are presented. METHODS: Data are based on (1) the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (BELLA study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; (2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, N = 1600-1700), which is based on the BELLA Study; and (3) the International Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). Well-being was assessed in 7­ to 17-year-olds using indicators of health-related quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC)). RESULTS: Overall, children and adolescents show consistently high health-related quality of life and high overall life satisfaction pre-pandemic (2002-2018), which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years later, improvements are evident but have not yet reached baseline levels. Psychological problems, as well as symptoms of anxiety and depression, increased by up to 12 percentage points at the beginning of the pandemic and are still higher two years after the onset of the pandemic compared to pre-pandemic studies. CONCLUSION: The epidemiology of child well-being provides a necessary data basis to assess the support needs of children and adolescents and to use this as a basis for developing measures of health promotion, prevention, and intervention.

Digital Public Health Solutions in Response to the COVID-19 Pandemic: Comparative Analysis of Contact Tracing Solutions Deployed in Japan and Germany.

BACKGROUND: In response to the COVID-19 pandemic, numerous countries, including the likes of Japan and Germany, initiated, developed, and deployed digital contact tracing solutions in an effort to detect and interrupt COVID-19 transmission chains. These initiatives indicated the willingness of both the Japanese and German governments to support eHealth solution development for public health; however, end user acceptance, trust, and willingness to make use of the solutions delivered through these initiatives are critical to their success. Through a case-based analysis of contact tracing solutions deployed in Japan and Germany during the COVID-19 pandemic we may gain valuable perspectives on the transnational role of digital technologies in crises, while also projecting possible directions for future pandemic technologies. OBJECTIVE: In this study, we investigate (1) which types of digital contact tracing solutions were developed and deployed by the Japanese and German governments in response to the COVID-19 pandemic and (2) how many of these solutions are open-source software (OSS) solutions. Our objective is to establish not only the type of applications that may be needed in response to a pandemic from the perspective of 2 geographically diverse, world-leading economies but also how prevalent OSS pandemic technology development has been in this context. METHODS: We analyze the official government websites of Japan and Germany to identify digital solutions that are developed and deployed for contact tracing purposes (for any length of time) during the timeframe January-December 2021, specifically in response to the COVID-19 pandemic. We subsequently perform a case-oriented comparative analysis, also identifying which solutions are published as open-source. RESULTS: In Japan, a proximity tracing tool (COVID-19 Contact-Confirming Application [COCOA]) and an outbreak management tool (Health Center Real-time Information-sharing System on COVID-19 [HER-SYS]) with an integrated symptom tracking tool (My HER-SYS) were developed. In Germany, a proximity tracing tool (Corona-Warn-App) and an outbreak management tool (Surveillance Outbreak Response Management and Analysis System [SORMAS]) were developed. From these identified solutions, COCOA, Corona-Warn-App, and SORMAS were published as open-source, indicating support by both the Japanese and German governments for OSS pandemic technology development in the context of public health. CONCLUSIONS: Japan and Germany showed support for developing and deploying not only digital contact tracing solutions but also OSS digital contact tracing solutions in response to the COVID-19 pandemic. Despite the open nature of such OSS solutions' source code, software solutions (both OSS and non-OSS) are only as transparent as the live or production environment where their processed data is hosted or stored. Software development and live software hosting are thus 2 sides of the same coin. It is nonetheless arguable that OSS pandemic technology solutions for public health are a step in the right direction for enhanced transparency in the interest of the greater public good.

Mental health and well-being in the first year of the COVID-19 pandemic among different population subgroups: evidence from representative longitudinal data in Germany.

OBJECTIVES: To examine potential deteriorations in mental health and well-being in the first COVID-19 pandemic year compared with the previous decade focusing on the following vulnerable subgroups in Germany: women with minor children in the household, those living without a partner, younger and older adults, those in a precarious labour market situation, immigrants and refugees, and those with pre-existing physical or mental health risks. DESIGN: Analyses of secondary longitudinal survey data using cluster-robust pooled ordinary least squares models. PARTICIPANTS: More than 20 000 individuals (aged 16+ years) in Germany. PRIMARY AND SECONDARY OUTCOME MEASURES: Mental Component Summary Scale (MCS) of the 12-item Short-Form Health Survey measuring mental health-related quality of life, single item on life satisfaction (LS). RESULTS: We find a decline in the average MCS in the 2020 survey that is not particularly striking in the overall time course, still resulting in a mean score below those of all preceding waves since 2010. We find no change in LS from 2019 to 2020 against the background of a general upward trend. Regarding vulnerability factors, only the results on age and parenthood are partially in line with our expectations. In 2020, LS declined among the youngest adults; MCS declined among mothers (and women and men without children) but not fathers. Unlike respective comparison groups, refugees, those unemployed before the pandemic and those with pre-existing mental health risks experienced no MCS declines in 2020, whereas persons living without a partner, the eldest, and those with pre-existing health risks exhibited continued increases in LS. CONCLUSIONS: There is no evidence for substantial breakdowns in mental health or subjective well-being in the first pandemic year in the German population or its subgroups, particularly when considering developments of the previous decade. Since the majority of hypothesised vulnerable groups to pandemic stressors showed more stable MCS and LS, our results warrant further study.

State of implementation of the Corona-Virus-Disease-2019 resuscitation guidelines : An online-based survey one year after publication in Germany.

BACKGROUND: The present study evaluated the implementation of the European Resuscitation Council Corona-Virus-Disease 2019 (COVID-19) resuscitation guidelines in Germany 1 year after publication. AIM OF THE WORK: To evaluate the practical implementation of the COVID-19 resuscitation guidelines in Germany one year after their publication. MATERIAL AND METHODS: In an online survey between April and May 2021 participants were asked about awareness of COVID-19 resuscitation guidelines, corresponding training, the resuscitation algorithm used and COVID-19 infections of emergency medicine personnel associated with COVID-19 resuscitation. RESULTS: A total of 961 (8%) of the 11,000 members took part in the survey and 85% (818/961) of questionnaires were fully completed. While 577 (70%) of the respondents were aware of the COVID-19 guidelines, only 103 (13%) had received respective training. A specific COVID-19 resuscitation algorithm was used by 265 respondents (32%). Adaptations included personal protective equipment (99%), reduction of staff caring for the patient, or routine use of video laryngoscopy for endotracheal intubation (each 37%), securing the airway before rhythm analysis (32%), and pausing chest compressions during endotracheal intubation (30%). Respondents without a specific COVID-19 resuscitation algorithm were more likely to use mouth-nose protection (47% vs. 31%; p < 0.001), extraglottic airway devices (66% vs. 55%; p = 0.004) and have more than 4 team members close to the patient (45% vs. 38%; p = 0.04). Use of an Filtering-Face-Piece(FFP)-2 or FFP3 mask (89% vs. 77%; p < 0.001; 58% vs. 70%; p ≤ 0.001) or performing primary endotracheal intubation (17% vs. 31%; p < 0.001) were found less frequently and 9% reported that a team member was infected with COVID-19 during resuscitation. CONCLUSION: The COVID-19 resuscitation guidelines are still insufficiently implemented 1 year after publication. Future publication strategies must ensure that respective guideline adaptations are implemented in a timely manner.

[Smoking in Netflix feature films and youth protection]. / Rauchen in Netflix-Spielfilmen und Jugendschutz.

BACKGROUND: With the aim of protecting minors, the World Health Organization has recommended classifying films with smoking scenes as unsuitable for children and adolescents. In recent years, films have increasingly been viewed via video streaming services - a trend which has been intensified by the COVID-19 pandemic - which poses new challenges for the protection of minors. AIM: To examine the frequency of smoking scenes in Netflix feature films and the age recommendations for Netflix productions with smoking scenes. METHOD: A total of 235 films that were made available for streaming exclusively by the Netflix platform in 2021 and 2022 were content coded in order to find out (1) how high the proportion of smoke-free films was in this film sample, (2) how often smoking scenes occurred in these films and (3) the proportion of films with smoke scenes classified as appropriate for young people in Germany and the USA. All films with an age rating of under 16 were considered suitable for children and young people. RESULTS: Smoking scenes occurred in 113 of 235 analyzed films (48.1%). Of the 113 films with smoking scenes, 57 (50.4%) in Germany and 26 films (23.0%) in the USA were classified as youth films (p<0.001). A total of 3,310 smoking scenes were registered. Of these, 39.4% (n=1,303) were in films with youth ratings in Germany, and in Netflix USA this proportion was 15.8% (n=524). DISCUSSION: Smoking scenes are a common feature in Netflix movies. Neither in the US nor in Germany does Netflix adhere to the recommendations of the WHO Framework Convention on Tobacco Control to restrict access by young people to films depicting smoking. However, the protection of minors in the US is better than in Germany, since half of the Netflix films with smoking scenes in Germany were rated as suitable for minors, in the USA less than a quarter.

[COVID-19 Pandemic-Related Effects on Psychiatric and Psychosocial Care in Urban and Rural Areas - Two Studies Implementing the Questionnaire PandA-Psy]. / Corona-Pandemie-bedingte Auswirkungen auf die psychiatrische und psychosoziale Versorgung im städtischen und ländlichen Raum ­ Zwei Untersuchungen mit dem Fragebogen PandA-Psy.

OBJECTIVE: To assess COVID-19 pandemic-related changes in psychiatric and psychosocial services and their impact on the care of people with severe mental illness in two contrasting regions. METHODS: Development and use of an online questionnaire (PandA-Psy) in Leipzig (N=50) and Mecklenburg-Western Pomerania (N=126). RESULTS: In community psychiatric care, mostly comparable changes caused by the COVID-19 pandemic were observed in the two selected regions. These mainly concern the decrease in face-to-face contacts and group services, the increase in digital and telephone services, as well as the increasing constraints of staff. Differences between the regions are discussed. CONCLUSION: PandA-Psy was successfully used to map changes caused by the COVID-19 pandemic in psychiatric and psychosocial services in two areas. In addition to the predominantly negative consequences of the pandemic situation, we also found opportunities arising from the crisis.

[Occupational medical aspects of COVID-19 pandemic containment: experiences from a large chemical company]. / Arbeitsmedizinische Aspekte bei der Eindämmung der COVID-19-Pandemie: Erfahrungen aus einem Großunternehmen der chemischen Industrie.

INTRODUCTION: With the present paper we aim to describe the experience of a large chemical company in tackling the COVID-19 pandemic. Specifically, we describe the timing and content of implemented measures and outline the course of the pandemic from the company's perspective. METHODS: We describe the infection protection measures and the pandemic course at the company's main site in Ludwigshafen (Germany) from March 2020 to May 2022. Company-specific data on the date of reporting an infection, suspected place of infection, number of close contacts, and the employee group were used to calculate 7-day-incidences and visualized, among other things, by means of a plant map (active infections) and a network chart (chains of infection). In addition, a weighted average of the incidences from districts close to the plant (weighted by the number of resident employees within the district) was calculated using publicly available data by the Robert Koch Institute and compared with the course of company-specific incidences. RESULTS: At the end of follow-up on 31st May 2022, 9,379 infections with SARS-CoV-2 had been recorded in employees and 758 more in leasing staff, including 368 (4%) and 84 (11%) suspected infections at the workplace/on-site, respectively. The course of 7-day incidences among employees was mainly consistent with that in the surrounding districts. The incidence of suspected infections on-site/at the workplace remained predominantly at a comparatively low level below 100 new infections over 7 days/100,000. DISCUSSION: The continuous monitoring and analysis of new SARS-CoV-2 cases among employees provides valuable information for the effective management of protective measures in the company. It enables a targeted response to changes in the number of new cases on the plant site by tightening or relaxing protective measures.

Burden of hospital admissions and resulting patient interhospital transports during the 2020/2021 SARS-CoV-2 pandemic in Saxony, Germany.

Secondary transports of patients from one hospital to another are indicated for medical reasons or to address local constraints in capacity. In particular, interhospital transports of critically ill infectious patients present a logistical challenge and can be key in the effective management of pandemic situations. The state of Saxony in Germany has two characteristics that allow for an extensive evaluation of secondary transports in the pandemic year 2020/2021. First, all secondary transports are centrally coordinated by a single institution. Second, Saxony had the highest SARS-CoV-2 infection rates and the highest COVID-19 associated mortality in Germany. This study evaluates secondary interhospital transports from March 2019 to February 2021 in Saxony with a detailed analysis of transport behaviour during the pandemic phase March 2020 to February 2021. Our analysis includes secondary transports of SARS-CoV-2 patients and compares them to secondary transports of non-infectious patients. In addition, our data show differences in demographics, SARS-CoV-2- incidences, ICU occupancy of COVID-19 patients, and COVID-19 associated mortality in all three regional health clusters in Saxony. In total, 12,282 secondary transports were analysed between March 1st, 2020 and February 28th, 2021, of which 632 were associated with SARS-CoV-2 (5.1%) The total number of secondary transports changed slightly during the study period March 2020 to February 2021. Transport capacities for non-infectious patients were reduced due to in-hospital and out-of-hospital measures and could be used for transport of SARS-CoV-2 patients. Infectious transfers lasted longer despite shorter distance, occurred more frequently on weekends and transported patients were older. Primary transport vehicles were emergency ambulances, transport ambulances and intensive care transport vehicles. Data analysis based on hospital structures showed that secondary transports in correlation to weekly case numbers depend on the hospital type. Maximum care hospitals and specialized hospitals show a maximum of infectious transports approximately 4 weeks after the highest incidences. In contrast, standard care hospitals transfer their patients at the time of highest SARS-CoV-2 case numbers. Two incidence peaks were accompanied by two peaks of increased secondary transport. Our findings show that interhospital transfers of SARS-CoV-2 and non-SARS-CoV-2 patients differ and that different hospital care levels initiated secondary transports at different times during the pandemic.

[Parental Burden, Need for Support and Resources After Almost Two Years of COVID-19-Pandemic: Results of a Representative Study in Germany]. / Elterliche Belastungen, Unterstützungsbedarf und Ressourcen nach fast zwei Jahren COVID-19-Pandemie: Ergebnisse einer repräsentativen Studie in Deutschland.

Studies assessing the burden of families in the second year of the COVID-19-pandemic and the need for support are scarce. Burden, negative and positive changes, resources, and the need for support during the COVID-19-pandemic of a representative sample of 1,087 parents (52,0 % female; mean age 40,4) of minors in Germany were assessed in December 2021. We used a mixed-method approach.More than 50 % percent of parents were burdened about the development of the pandemic (58,5 %), restrictions in activities outside (54,8 %), the mental health of others (54,0 %), and social distance (53,7 %). Parents reported negative changes in partnership (esp. increase in conflicts and crises; 29,4 %), school development (esp. deterioration of school performance; 25,7 %), and mental health of children (38,1 %). In retrospect, over one-third of the parents saw a need for better political communication (36,0 %) and financial support (34,1 %) during the pandemic. In December, 23,8 % of parents still reported the need for support: financial (51,3 %), social (26,6 %), and psychotherapy for themselves (25,8 %). However, parents reported positive changes, especially within the family, feelings of gratitude and new attitudes. Social interaction and positive activities were identified as resources. In the second year of the pandemic, parents experienced much burden and needed support. Interventions and policies should be more targeted and needs-oriented.

[Sentiments in the COVID-19 crisis communication of German authorities and independent experts on Twitter : A sentiment analysis for the first year of the pandemic]. / Emotionalität in der COVID-19-Krisenkommunikation von Behörden und unabhängigen Expert*innen auf Twitter : Eine Sentiment-Analyse für das erste Pandemiejahr.

BACKGROUND: At the beginning of the COVID­19 pandemic in Germany, there was great uncertainty among the population and among those responsible for crisis communication. A substantial part of the communication from experts and the responsible authorities took place on social media, especially on Twitter. The positive, negative, and neutral sentiments (emotions) conveyed there during crisis communication have not yet been comparatively studied for Germany. STUDY AIM: Sentiments in Twitter messages from various (health) authorities and independent experts on COVID­19 will be evaluated for the first pandemic year (1 January 2020 to 15 January 2021) to provide a knowledge base for improving future crisis communication. MATERIAL AND METHODS: From n = 39 Twitter actors (21 authorities and 18 experts), n = 8251 tweets were included in the analysis. The sentiment analysis was done using the so-called lexicon approach, a method within the social media analytics framework to detect sentiments. Descriptive statistics were calculated to determine, among other things, the average polarity of sentiments and the frequencies of positive and negative words in the three phases of the pandemic. RESULTS AND DISCUSSION: The development of emotionality in COVID­19 tweets and the number of new infections in Germany run roughly parallel. The analysis shows that the polarity of sentiments is negative on average for both groups of actors. Experts tweet significantly more negatively about COVID­19 than authorities during the study period. Authorities communicate close to the neutrality line in the second phase, that is, neither distinctly positive nor negative.

National survey of referrals for precocious puberty in Germany.

An unusual high number of girls were referred to our paediatric endocrine clinic with suspected precocious puberty (PP) since the beginning of the COVID-19 pandemic. We analysed our data and initiated a survey among German paediatric endocrinologists.At our centre, less than 10 patients were diagnosed of PP annually between 2015 and 2019. This increased to n=23 (2020) and n=30 (2021). A German survey confirmed this observation: Out of 44 centres which completed the questionnaire, 30/44 (68%) reported an increase of PP. Above this, 32/44 (72%) stated an increase in girls diagnosed with 'early normal puberty' since the beginning of the COVID-19 pandemic.

[Strengths and Difficulties of 3- to 15-Year-Old Children and Adolescents in the Second andThird Year of the Corona Pandemic - Results of a Household-Representative Survey in Germany]. / Stärken und Probleme von 3- bis 15-jährigen Kindern und Jugendlichen im zweiten und dritten Jahr der Corona- Pandemie ­ eine haushaltsrepräsentative Befragung.

Behavioural strengths and psychosocial problems in children and adolescents between the ages of 3 and 15 are reported. The survey is based on a household-representative sample of 2,421 parents or guardians providing information on their everyday family-life in summer 2021 by online-questionnaire. 704 of the respondents participated again in the spring of 2022. In result, the behaviour of a quarter of the children and adolescents is described as psychosocially borderline/abnormal over the survey period (SDQ total). About a third of children and adolescents have emotional problems, behavioural problems or problems with their peers (respective SDQ-subscales). The proportion of primary-school children with emotional problems increases from summer 2021 to the following spring. Families in which children with disabilities live are disproportionally more affected. The results are discussed with regard to the SDQ standard values available for Germany, as well as the families' self-reported supportneeds and their planned use of professional support-services. Given the psychosocial burden of children, adolescents and their families presented here, which become apparent well after the closures of day-care centres and schools, or other contact-restricting measures to contain the pandemic, have ended, it remains of interest to observe how their well-being will further develop over time.

[Webinars for ENT specialists in Germany during the Lockdown phase of the COVID-19 pandemic 2020/2021]. / Webinare für HNO-Fachärzte in Deutschland während der Lockdown-Phase der COVID-19-Pandemie 2020/2021.

INTRODUCTION: During the COVID-19 pandemic, webinars are one of the few opportunities to continue CME training to a large majority of ENT doctors. However, experiences with the quality of this digital form of education is still limited. METHODOLOGY: In this study, six webinars for ENT specialists during the second lockdown in Germany (January to March 2021, provider Zoom) were evaluated. The quality control was performed by participants and speakers using special quality questions. School grades (1-6) were used for the evaluation. Answers were statistically evaluated. RESULTS: On average, 1108 participants attended the six webinars. 330 ENT doctors answered the surveys. The return of the questionnaires was 30.2%, that of the speakers 100%. Eight of the nine questions asked received school grades better than 2.0 on average. The speakers needed an average of 12.8 hours to prepare the webinar. The cost per webinar was about 3.50 €. CONCLUSIONS: Webinars have become an effective form of CME-training for ENT doctors in Germany. They can be organized quickly for a large number of participants, are less expensive and environmentally benefical. Webinars might have an important place in CME-training in the future.

[Medical care in GP practices during the Covid-19 pandemic: A questionnaire-based survey among general practitioners and medical practice assistants asking for their opinion about changes, needs and burdens]. / Die hausärztliche Versorgung während der COVID-19-Pandemie: eine Fragebogenerhebung unter Hausärzt*innen und Medizinischen Fachangestellten zu ihrer Perspektive auf Veränderungen, Bedarfe und Belastungen.

INTRODUCTION: The coronavirus pandemic did not only result in changes in the provision and utilization of health care services in general practice but also in an increased workload for physicians and medical practice assistants. The VeCo practice study retrospectively explores the experiences of both professional groups two years after the start of the pandemic. METHODS: In March and April 2022, general practitioners and medical practice assistants in the three German federal states of Berlin, Brandenburg and Thuringia were asked to complete a paper-based questionnaire. RESULTS: 657 general practitioners and 762 medical practice assistants completed the questionnaire. Both professional groups agreed to statements indicating a reduction in regular health care provisions. Nevertheless, 74% of the physicians and 82.9% of the medical practice assistants considered the health care provided to their patients during the pandemic as good. This was only possible through considerable additional effort and stress. While more than half of both groups reported that work was still enjoyable, three quarters of both groups stated that the challenges arising from the pandemic outstripped their capacity. Both groups would like to receive more recognition from society (medical practice assistants 93.2%, general practitioners 85.3%) and from their patients (87.7% and 69.9%, respectively). DISCUSSION: General practitioners and medical practice assistants reduced regular health care provision but were still able to maintain a good quality of care for their patients during the pandemic. It became clear that more appreciation and adequate financial compensation are necessary to ensure long-term sustainability of GP care. CONCLUSION: The subjective view of general practitioners and medical practice assistants on their health care provision shows that appreciation and adequate financial renumeration, particularly when working under most difficult conditions, are necessary to increase the attractiveness of a career in general practice, for both physicians and medical practice assistants.

Is COVID-19 to Blame? Trends of Incidence and Sex Ratio in Youth-Onset Type 2 Diabetes in Germany.

OBJECTIVE: We investigated the incidence of pediatric type 2 diabetes (T2D) in Germany during 2 years of the coronavirus disease 2019 (COVID-19) pandemic (2020-2021) compared with the control period 2011-2019. RESEARCH DESIGN AND METHODS: Data on T2D in children (aged 6 to <18 years) were obtained from the DPV (German Diabetes Prospective Follow-up) Registry. Poisson regression was used to estimate incidences for 2020 and 2021 based on data from 2011 to 2019, and these were compared with observed incidences in 2020 and 2021 by estimating incidence rate ratios (IRRs) with 95% CIs. RESULTS: Incidence of youth-onset T2D increased from 0.75 per 100,000 patient-years (PYs) in 2011 (95% CI 0.58, 0.93) to 1.25 per 100,000 PYs in 2019 (95% CI 1.02, 1.48), an annual increase of 6.8% (95% CI 4.1, 9.6). In 2020, T2D incidence increased to 1.49 per 100,000 PYs (95% CI 1.23, 1.81), which was not significantly higher than predicted (IRR 1.15; 95% CI 0.90, 1.48). In 2021, the observed incidence was significantly higher than expected (1.95; 95% CI 1.65, 2.31 vs. 1.38; 95% CI 1.13, 1.69 per 100,000 PYs; IRR 1.41; 95% CI 1.12, 1.77). Although there was no significant increase in incidence in girls in 2021, the observed incidence in boys (2.16; 95% CI 1.73, 2.70 per 100,000 PYs) significantly exceeded the predicted rate (IRR 1.55; 95% CI 1.14, 2.12), leading to a reversal of the sex ratio of pediatric T2D incidence. CONCLUSIONS: In Germany, incidence of pediatric T2D increased significantly in 2021. Adolescent boys were more affected by this increase, resulting in a reversal of the sex ratio of youth-onset T2D.