Mobile Digital Health Intervention to Promote Nutrition and Physical Activity Behaviors Among Long-term Unemployed in Rural Areas: Protocol for a Randomized Controlled Trial.

BACKGROUND: Long-term unemployed have poor nutritional and physical activity statuses, and, therefore, special health promotion needs. Particularly in rural areas, however, they often do not have access to health promotion service. Thus, new promising strategies to improve the health of long-term unemployed are needed. Hence, a digital health intervention to promote nutritional and physical health behaviors was conceived, and the effectiveness of the intervention in combination with face-to-face sessions will be evaluated in a randomized controlled trial. OBJECTIVE: The aim of this study is to elucidate the effectiveness of a mobile digital health intervention to promote the nutritional and physical activity behaviors of long-term unemployed in the rural areas of Germany. METHODS: The 9-week intervention aims to promote nutritional or physical activity behavior by improving drinking habits, increasing the consumption of fruits, vegetables, and whole grains, increasing daily step count, strengthening muscles, and improving endurance. The intervention design is based on the transtheoretical model and is implemented in a mobile app using the MobileCoach open-source platform. The effectiveness of the intervention will be elucidated by a 9-week, 2-armed, parallel-designed trial. Therefore, long-term unemployed will be recruited by employees of the German social sector institutions and randomized either to receive information brochures; the digital intervention in the form of a mobile app; and 3 face-to-face sessions regarding technical support, healthy eating, and physical activity (n=100) or to receive a control treatment consisting of solely the hand over of information brochures (n=100). The effectiveness of the intervention will be assessed using questionnaires at baseline, after 9 weeks in face-to-face appointments, and after a 3-month follow-up period by postal contact. The use of the mobile app will be monitored, and qualitative interviews or focus groups with the participants will be conducted. Incentives of €50 (US $49.7) will be paid to the participants and are tied to the completion of the questionnaires and not to the use of the mobile app or progress in the intervention. RESULTS: The effectiveness of the intervention in promoting the nutritional and physical activity behaviors of long-term unemployed participants will be elucidated. The adherence of the participants to and the acceptance and usability of the mobile device app will be evaluated. Recruitment started in March 2022, and the final publication of the results is expected in the first half of 2023. CONCLUSIONS: Positive health-related changes made by the intervention would display the potency of digital health interventions to promote nutritional and physical activity behaviors among long-term unemployed in the rural areas of Germany, which would also contribute to an improved health status of the German population in general. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024805; https://www.drks.de/DRKS00024805. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/40321.

[Factors Influencing the Caesarean Section Rates in German Hospitals in the Years 2015-2017: An Ecological Study]. / Einflussfaktoren auf die Kaiserschnittraten in deutschen Krankenhäusern in den Jahren 2015­2017. Eine ökologische Studie.

BACKGROUND: Studies in various other countries have shown that there are urban-rural differences in caesarean section rates. Most urban areas showed higher caesarean section rates. The aim of this study was to compare the caesarean section rates between hospitals in urban and rural areas in Germany, and to identify other factors affecting the caesarean section rate. METHODS: A secondary data analysis was carried out to investigate the present research topic. The years 2015-2017 were considered, using as data sources the quality reports of the hospitals. Using the statistical program SPSS, mean value comparisons and multiple linear regressions were conducted. RESULTS: The mean value analysis showed no significant differences in caesarean section rate between urban and rural hospitals (2015: urban hospitals=31.87% vs. rural hospitals=31.6%, 2016: urban hospitals=31.09% vs. rural hospitals=31.04%, 2017: urban hospitals=31.26% vs. rural hospitals: 31.03%). The multiple linear regression showed that the variables "number of beds" (2015: b=0.005, 2016: b=0.007, 2017: b=0.006), "teaching activity" (2015: b=- 1.42, 2016: b=- 1.351, 2017: b=- 1.823), "number of gynaecologists per 100,000 inhabitants" (2015: b=0.198, 2016: b=0.241, 2017: b=0.254) and the "percentage of the population with a college/university degree" (2015: b=- 0.45, 2016: b=- 0.507, 2017: b=- 0.392) were significant predictors of the caesarean section rate in all years of the study. CONCLUSION: The study was able to identify hospital characteristics as well as population- and care-specific characteristics that have an influence on the caesarean section rate in a hospital. The average level of education in the district where the hospital was located was particularly relevant. Thus, caesarean section rates seem to be influenced less by population density than by the regional level of education.

Motivation, blood donor satisfaction and intention to return during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: This study aimed to describe motives as well as donation experiences and the intention to return for further donations of German whole blood donors who donated at the beginning of the COVID-19 pandemic. MATERIALS AND METHODS: To describe motives and donor experiences, a retrospective survey was conducted among whole blood donors that had a donation appointment at the German Red Cross Blood Donation Service in the first 4 weeks of the pandemic. A donor questionnaire including 17 retrospective questions was sent to 7500 donors. Donor motivation and donor experiences were compared for different donor groups using chi-square statistics. Finally, in an ordinal logistic regression model predictors for the intention to return were identified. RESULTS: More than half of the participating donors (56.9%) wanted to contribute to the fight against the pandemic by donating blood. Most of the donors were satisfied with their last donation experience and felt safe during the blood donor appointment. However, some donors would have liked more information on how to deal with the pandemic (20.3%). Intention to return for further donations was strongly associated with overall satisfaction (OR: 1.67, CI: 1.47-1.90) and the feeling of being safe during blood donation (OR: 1.33, CI: 1.05-1.68). CONCLUSION: Donor satisfaction with the last donation was high and the vast majority of donors felt very safe. However, those donors who felt unsafe expressed a low intention to return and blood donation services should therefore carefully monitor donor satisfaction.

Changes in the Whole Blood Donor Population in South-West Germany: 2010 versus 2016.

BACKGROUND: In the recent past, the discrepancy between blood supply and future demand may have been overestimated. As medical progress develops rapidly, it will be essential to monitor ongoing demographic changes in the donor population regularly and to re-evaluate retention and recruiting strategies. The aim of the current study was to compare first-time donor (FTD) characteristics and their return rates. We therefore compared whole blood (WB) donations in total and the annual donation frequencies in 2010 and in 2015/2016. Furthermore, we evaluated whether over the same observation period, medical reasons for deferral underwent a change (2010 vs. 2015). METHODS: The return probability of FTD within 12 months was analysed in 2010 and 2015 with respect to successful donation versus deferral and with regard to age. The total number of WB donations was investigated, and age distribution was compared between 2010, 2013 and 2016. WB donation frequencies were calculated with respect to age and gender in 2010 and 2016. In a second analysis, medical reasons for deferral were differentiated into 14 categories and a possible impact of time (2010 vs. 2015) on the respective percentage was studied. RESULTS: We observed a significant decline of the FTD return rate from 42.5% to 38.8% in donors that successfully donated WB while the rate remained unchanged in deferred FTD. At the same time the mean FTD age decreased from 29.1 ± 11.6 to 28.5 ± 11.7 years in 2016. Analysis of total WB donations revealed an increase of all donations from donors ≥60 years, a constant percentage from donors <30 years but a declining proportion of donors aged 30-59 years from 2010 to 2013 to 2016. In parallel, annual mean WB donation frequencies decreased over time. Deferrals due to travel history increased significantly from 2010 to 2015 both in FTD and repeat donors. CONCLUSION: There is ongoing demographic change in our WB donor population. Our data prove a need for a re-evaluation of retention and recruitment strategies since previous marketing campaigns seem to have neglected the age group 30-59 years. This must be addressed in further studies as this age group will be highly relevant for assuring future blood supplies since donor recruitment from adolescents will be limited due to declining birth rates. Furthermore, deferral due to travel history is increasing significantly. Thus we will require further studies on the possible impact on donor retention.

Monetary compensation and blood donor return: results of a donor survey in southwest Germany.

BACKGROUND/AIMS: The aim of this study was to compare donor return patterns of non-compensated and compensated German first-time donors to assess the effect of monetary reward on donor return. METHODS: We conducted a retrospective analysis of a donor survey of 3,077 non-compensated and 738 compensated German first-time donors. Survey data were pooled and linked with blood donor return rates within the 1st, 2nd, and 3rd year. Logistic regression models were used to estimate differences in the probability of donor return between non-compensated and compensated donors. RESULTS: In the first 2 years following the initial donation, compensated donors were more likely to return with the odds of giving at least one further donation 1.86 (1st year) and 1.32 (2nd year) times higher for compensated donors than for non-compensated donors. In the 3rd year, there were no significant differences in donor return. CONCLUSION: This report, which was based on two non-randomized donor samples, suggests that monetary compensation may increase the likelihood of donors returning in the first months after the initial donation. Monetary reward may therefore be used as a short-term strategy to recruit new donors. The long-term commitment, however, seems not to be affected by monetary reward, and complementary donor retention strategies are needed.

Donor satisfaction with a new german blood donor questionnaire and intention of the donor to return for further donations.

BACKGROUND: The aim of this study was to describe donor satisfaction regarding different aspects of the new German blood donor questionnaire (BDQ) and to assess whether donor satisfaction is associated with the intention to return for further donations. METHODS: A random number of 6,600 blood donors, donating at the German Red Cross Blood Service Baden-Wuerttemberg - Hessen, were asked to rate their satisfaction with four different aspects of the BDQ. Chi-square statistics was used to test for associations between satisfaction and the intention to return. RESULTS: Most of the donors were satisfied with format and layout (72.7%) and the clarity of the questions (72.5%). However, only 39.5% of the donors were satisfied with the scope of the BDQ and 44.3% with the questions about sexual risk behavior. The lowest satisfaction seemed to be among experienced donors and among donors from small municipalities. Among experienced and very experienced donors, a significant association between the satisfaction with the different aspects and the intention to return became apparent. CONCLUSION: When considering the implementation of the BDQ, Blood Donor Services have to weigh up the advantages of increased deferral rates among donors with high-risk behavior against the potential drop-out of dissatisfied blood donors.

Individual Characteristics Associated with Blood Donation: A Cross-National Comparison of the German and Swiss Population between 1994 and 2010.

OBJECTIVE: The aim of this study is to compare individual characteristics associated with blood donation in the German and Swiss population between 1994 and 2010. METHODS: Population-based survey data from the Eurobarometer 1994 and 2009, the Swiss Health Survey 1997, and the Swiss Blood Donation Survey 2010 were used to compare age-adjusted percentages of German and Swiss adults ever having donated blood (n = 8,746). A multivariate logistic regression was applied to the pooled data to estimate odds ratios (OR). RESULTS: Donor rates between 1994 and 2010 increased by 8.6% in Germany (p = 0.0045) and remained stable in Switzerland. The likelihood to report donating increased with age. Gender differences (OR = 2.85; p = 0.0000) and differences between education levels were more pronounced in Switzerland as compared to Germany (OR = 2.56; p = 0.0000 and OR = 2.73; p = 0.0010). Furthermore education differences were more marked in men in both countries (OR = 1.99; p = 0.0000 and OR = 1.68; p = 0.0140). CONCLUSION: The blood establishments should intensify their efforts to motivate women and lower educated people to give blood. Our data suggest that population-based surveys could be a helpful tool to describe donor rates in different countries and to guide future recruitment strategies.

Sports injuries among adolescents: incidence, causes and consequences.

AIM: The purpose of this study was to evaluate the 1-year incidence, location, type, mechanism and severity of sports injuries for adolescents in Germany. METHODS: Data were from the 'German Health Interview and Examination Survey for Children and Adolescents', a nationwide study of n = 17 641 children and adolescents. Analyses were based on a weighted total sample size of n(w) = 7451 adolescents between 11 and 17 years of age, 51% of them boys. RESULTS: A total of 577 adolescents (8%) reported having experienced a sports injury during the past year. Collisions and falls were reported as being the most important causes. The most frequent diagnoses were contusions, dislocations, strains and sprains (60%), followed by fractures (26%). Most injuries (88%) were treated on an outpatient basis with only 12% resulting in hospitalisation. Gender-specific analyses showed that 9% of the boys and 7% of the girls suffered from a sports injury during the past year. After adjusting for the level of physical activity, these gender differences disappeared (OR(girls) 0.94; 95% confidence intervals: 0.74-1.18). Excluding injuries incurred from falls while horse riding, there were no gender differences in the mechanism of injury. Among boys, 30% of all injuries were fractures, among girls 20% (P < 0.05). Apart from fractures, no further differences between the sexes in the range of diagnoses were identified. CONCLUSIONS: Although these results suggest that the risk of sports injuries does not differ significantly based on adolescents' gender, the incidence rate of adolescent sports injuries within Germany is relatively high.

Characteristics of Lapsed German Whole Blood Donors and Barriers to Return Four Years after the Initial Donation.

BACKGROUND: The aim of the study was to identify characteristics of lapsed donors 4 years after the initial donation as well as self-reported barriers to return for further blood donations. METHODS: A random number of 8,000 blood donors, donating for the German Red Cross Blood Service Baden-Württemberg - Hessen, were asked to fill in a self-administered questionnaire. The response rate was 38.5%. Donors were categorized as 'lapsed' if they had not donated within the last 24 months. The odds of being a lapsed donor were determined in a multivariate logistic regression. RESULTS: Multivariate analysis showed that lapsed donors were more likely to be female, between 26 and 33 years old, not employed, have moved, and were dissatisfied with the last donation experience. Furthermore, lapsed donors were less likely to have family members or friends who also donate blood. Medical reasons and having moved to another city were the most frequently named reasons preventing lapsed donors from continuing to donate blood. CONCLUSION: The importance of medical reasons and having moved was rated much higher than in previous studies. We conclude that barriers to return may vary considerably between countries and blood services. Therefore, donor surveys are required to guide reactivation campaigns.

Donor Deferral Rates after the Implementation of a New German Blood Donor Questionnaire.

BACKGROUND: The implementation of a new national German blood donor questionnaire was proposed to improve donor and recipient safety. METHODS: We compared deferral/exclusion rates of whole blood donors before (May 2010, n = 64,735) and after (May 2011, n = 71,687) the implementation of a new blood donor questionnaire. Considering seasonal variations, analysis was performed with respect to collection site (mobile vs. fixed), sex, donor status (first-time vs. repeat), age, and the frequencies of sexual risk behavior and other reasons for deferral. RESULTS: We observed a statistically significant increase (p < 0.001) of the overall deferral/exclusion rate from 6.2 to 8.1%, irrespective of type of collection site (fixed: from 6.0 to 8.5%; mobile: from 6.2 to 8.0%), sex (females: from 7.5 to 9.9%; males: from 5.1 to 6.6%), donor status (first-time donors: from 19.7 to 24.7%; repeat donors: from 4.6 to 6.3%) or age (18-29 years: from 9.1 to 11.7%; 60-71 years: from 5.1 to 6.6%). Confidential self-exclusion increased from 0.08 to 0.14% (p < 0.001). Besides risk behavior, various medical reasons could be identified that explain this increase. CONCLUSIONS: The new blood donor questionnaire resulted in an increased deferral/exclusion of all donor groups. Thus the impact on future blood supply must be considered carefully, and long-term studies and investigation of donor acceptance will be needed.

What happens after the implementation of electronic locking devices for adolescents at cigarette vending machines? A natural longitudinal experiment from 2005 to 2009 in Germany.

INTRODUCTION: As of January 01, 2007, electronic locking devices based on proof of age (electronic cash cards or European driving licenses) were installed on 500,000 cigarette vending machines across Germany to restrict the purchase of cigarettes to those over the age of 16 years. In 2009, the age limit was raised to 18 years. The aim of this study was to compare the number of cigarette vending machines and other commercial sources before and after the enactment of the new law and to examine the association between commercial cigarette sources and area socioeconomic status (SES). METHODS: We recorded and mapped using Geographical Information System software the total number of commercial cigarette sources in 4 selected districts in the major German city of Cologne. The city was the ideal setting for this study as we were able to use existing sociogeographical data from this area. We compiled a complete inventory of commercial cigarette sources in autumn 2005 and 2009. An interim inventory was also completed in 2007. RESULTS: Between 2005 and 2009, the total number of cigarette sources decreased from 369 to 325 within the study area. Although the most obvious reduction was detected in the number of outdoor vending machines (-44%), the number of indoor vending machines also decreased by 5%. In 2005 as well as in 2009, we found significantly fewer commercial cigarette sources in districts with above-average SES than in districts with below-average SES. CONCLUSIONS: Although the number of overall cigarette vending machines decreased, the disparity in distribution of cigarette sources between socially advantaged and disadvantaged areas increased.