[Quantifying the Developments of Shortages in Public Health Specialists in the Public Health Service and its Effects]. / Quantifizierung der Entwicklungen des Mangels an Fachärzten/innen für Öffentliches Gesundheitswesen im Öffentlichen Gesundheitsdienst und seine Auswirkungen.

The institutions of the Public Health Service at the level of the federal government, the states and the local authorities play a central role in public health in Germany. To manage the many practical tasks of health protection, disease prevention and health promotion in accordance with legal requirements, employees with different skills work together and contribute to social coherence. There are no empirical data on nationwide staffing levels. For years, different actors have been reporting a decreasing number of public health consultants and associated quality of public health work. The aim of this study was to quantify the public health consultant decline and to present regional trends. Regularly collected and freely available data on medical consultants registered in Germany from 1998 to 2018 were descriptively analysed with regard to developments in the number of consultants in Germany, in the regions of the Medical Associations, by specialty and age. While the total number of medical consultants in Germany has continuously increased (52%), the number of those working in administrative positions, public corporate bodies, etc. has remained relatively constant at 2%. In contrast, the number of public health consultants working in administrative offices, public corporate bodies, etc. over the last 20 years has decreased by almost 30%. Similar developments can be seen in all regions, with some even larger decreases in some regions. Bavaria is the only region with a contrasting development. There is almost no new generation of public health consultants and the number of older consultants in this field is increasing. Against this background, the availability of a sufficient number of qualified professionals to manage administrative and other tasks relevant to population medicine must be questioned. These developments threaten public health in general, public concern for vulnerable population groups in particular, and ultimately the functioning of the democratic welfare state.

[Brushing Teeth and Acute Respiratory Infections in Day Care Facilities: An Ecological Study in Selected Regions of Lower Saxony, Germany (2013-2018)]. / Zähneputzen und akute respiratorische Infektionen in Kindertageseinrichtungen (ZINFEKT): Eine ökologische Studie in ausgewählten Regionen Niedersachsens (2013­2018).

AIM OF THE STUDY: Dental group prophylaxis in day-care centers with teeth brushing as one of its components is intended to reduce caries incidence and promote dental health. However, various barriers can hinder implementation of this preventive measure. One concern relates to an increased risk of transmission of acute respiratory infections (ARI) in day-care centers. The ZINFEKT study aimed at determining whether and to what extent there are differences in the occurrence of ARI between day-care centers that implement vs. those that do not implement teeth brushing. METHODS: In an ecological study, 2013-2018 data from the ARI surveillance of the Public Health Agency of Lower Saxony were merged with information from the Dental Services on teeth brushing for n=33 day-care facilities from the urban municipality of Braunschweig, the region of Hannover, and the administrative district of Osnabrück (all Lower Saxony, Germany). Following the concept of patient days from hospital infection surveillance, "ill child weeks" were specified as observational units, defined as weeks for which an ARI had been reported for a registered child. Besides cross-tabulations, relative risks for ill child weeks by teeth brushing and Breslow-Day Tests for interactions with area, size of day-care center, ARI season and time slot with ARI seasons were computed. RESULTS: Overall, the ARI-rate, defined at the proportion of ill child weeks, was 4.6% higher in day-care centers in which teeth brushing took place, vs. centers in which this measure was not implemented (17.9 vs. 13.3%, p<0.0001). In analyses stratified by the geographic and temporal co-variables, the direction of this difference did not change (with one exception: day-care centers with 50 or less registered children) . CONCLUSION: The assumption that regular teeth brushing is associated with higher ARI rates in day-care centers does seem to have an empirical basis. However, despite the study's limitations (primarily its ecological design and possibly limited representativeness of the day-care centers), the identified difference - due both to its magnitude and possibly improvable hygiene compliance - to our assessment does not speak against brushing teeth as a component of dental group prophylaxis in day-care centers.