Representation of social determinants of health in German medical education: protocol of a content analysis study

Introduction: Action on the social determinants of health has been key for improving health and prolonging life in the past, and remains so today. Against this background, WHO's Commission on Social Determinants of Health has called for increased efforts to create health workforces trained in recognising, understanding and acting on the social determinants of health. However, little is known about the extent to which current medical education systems prepare graduates for this challenge. We, therefore, aim to analyse the extent to which the medical curriculum in Germany incorporates content on the social determinants of health. Methods and analysis: We will conduct a qualitative and quantitative content analysis of four key document groups which influence medical education in Germany: the national medical catalogue of learning objectives; examination content outlines provided by the German Institute for Medical and Pharmaceutical Examination Questions; the online textbook most widely used for final examination preparation and the full set of questions from two national medical licensing examinations. We will analyse these documents based on a coding system, which we derived deductively from the report of WHO's Commission on Social Determinants of Health as well as other key publications of WHO. We will report quantitative indicators, such as the percentage of text related to social determinants of health for each document type. Moreover, we will conduct a semiqualitative analysis of relevant content. Ethics and dissemination: This study is based on the analysis of existing documents which do not contain personal or otherwise sensitive information. Results from the study will be published in a scientific peer-reviewed journal

Virushepatitis C im Jahr 2021

Für das Jahr 2021 wurden insgesamt 4.747 Fälle von Hepatitis C übermittelt, was einer bundesweiten Inzidenz von 5,7 übermittelten Infektionen/100.000 Einwohner entspricht und die Inzidenz des Vorjahres (5,5) nur minimal übersteigt. Der beobachtete Rückgang der Anzahl übermittelter HCV-Infektionen seit 2020 ist möglicherweise bedingt durch Unterdiagnose und -erfassung während der COVID-19-Pandemie. Ein Teil des Rückgangs kann aber auch einem tatsächlichen Rückgang der Inzidenz durch effektive Hepatitis-C-Behandlungen und dadurch seltenerem Auftreten von Transmissionsereignissen entsprechen. Gleichzeitig sinkt jedoch die Zahl der Behandelten kontinuierlich ab, wodurch das Erreichen der Hepatitis-C-Eliminationsziele bis 2030 gefährdet ist. Der Jahresbericht zur Virushepatitis C gibt einen Überblick u. a. über die epidemiologische Situation weltweit, in Europa und in Deutschland sowie den Stand der Hepatitis-C-Eliminierung.Peer Reviewe

The words we choose matter: recognising the importance of language in decolonising global health.

Recognition of the relevance of colonial history to the contemporary practice of global health is not new, but the recent increase in visibility and prominence given to it by global health institutions and flagship journals is welcome when accompanied by meaningful reflection and action

The JNK Inhibitor XG-102 Protects against TNBS-Induced Colitis

The c-Jun N-terminal kinase (JNK)-inhibiting peptide D-JNKI-1, syn. XG-102 was tested for its therapeutic potential in acute inflammatory bowel disease (IBD) in mice. Rectal instillation of the chemical irritant trinitrobenzene sulfonic acid (TNBS) provoked a dramatic acute inflammation in the colon of 7–9 weeks old mice. Coincident subcutaneous application of 100 µg/kg XG-102 significantly reduced the loss of body weight, rectal bleeding and diarrhoea. After 72 h, the end of the study, the colon was removed and immuno-histochemically analysed. XG-102 significantly reduced (i) pathological changes such as ulceration or crypt deformation, (ii) immune cell pathology such as infiltration and presence of CD3- and CD68-positive cells, (iii) the production of tumor necrosis factor (TNF)-α in colon tissue cultures from TNBS-treated mice, (iv) expression of Bim, Bax, FasL, p53, and activation of caspase 3, (v) complexation of JNK2 and Bim, and (vi) expression and activation of the JNK substrate and transcription factor c-Jun. A single application of subcutaneous XG-102 was at least as effective or even better depending on the outcome parameter as the daily oral application of sulfasalazine used for treatment of IBD

Humanitäre Hilfe und Entwicklungszusammenarbeit im Wandel - eine Analyse von Diskursen und Aktivitäten deutscher Hilfsorganisationen im Gesundheitsbereich seit 1970

This thesis sets out discourses and activities of German aid organizations in the health sector since the 1970s against the background of changes in humanitarian aid and development cooperation (DC). The analysed aid organizations were Cap Anamur, the German Red Cross (GRC) and medico international. The self-perception, principles and motivation to provide international health care, which shaped concepts and contents of projects, both differed significantly across and changed within the assessed aid organizations over time. Medico international has undergone a significant change as organization, which was founded as humanitarian aid organization with disaster response as its key pillar and nowadays considers itself as a global development and human rights organization. Cap Anamur and the GRC showed changes on different levels, like the extension of scope of their activity, whereas their core focus remained on humanitarian aid. The relationship between humanitarian health care and politics became an increasing challenge for aid organizations, which need to position themselves within this tension field. In political conflicts, especially the GRC needed to defend neutrality as its core organizational principle. The issue of a distinction between humanitarian aid and DC in the health sector was of great importance for the analysed aid organizations. Whereas a rather clear boundary between humanitarian aid and DC existed from the 1970s to the 1990s, more integrated approaches developed with the concept of linking relief, rehabilitation and development (LRRD), which was established in the middle of the 1990s. The analysis showed internal shifts within the organizations’ priorities and also that long-term development cooperation was a binding element besides humanitarian aid. The comparison of core elements of operational work, such as important project contents, requirements for posted personnel and conflicts during a specific project, demonstrated characteristics of the analysed actors and set these in a larger developmental and historical context. Moreover, the research results illustrated how extensive changes in the global health governance system require adequate approaches for aid and cooperation at a global scale - thereby building a bridge from the historical context to current as well as future challenges in humanitarian aid and development cooperation

Humanitäre Hilfe und Entwicklungszusammenarbeit im Wandel : eine Analyse von Diskursen und Aktivitäten deutscher Hilfsorganisationen im Gesundheitsbereich seit 1970

This thesis sets out discourses and activities of German aid organizations in the health sector since the 1970s against the background of changes in humanitarian aid and development cooperation (DC). The analysed aid organizations were Cap Anamur, the German Red Cross (GRC) and medico international. The self-perception, principles and motivation to provide international health care, which shaped concepts and contents of projects, both differed significantly across and changed within the assessed aid organizations over time. Medico international has undergone a significant change as organization, which was founded as humanitarian aid organization with disaster response as its key pillar and nowadays considers itself as a global development and human rights organization. Cap Anamur and the GRC showed changes on different levels, like the extension of scope of their activity, whereas their core focus remained on humanitarian aid. The relationship between humanitarian health care and politics became an increasing challenge for aid organizations, which need to position themselves within this tension field. In political conflicts, especially the GRC needed to defend neutrality as its core organizational principle. The issue of a distinction between humanitarian aid and DC in the health sector was of great importance for the analysed aid organizations. Whereas a rather clear boundary between humanitarian aid and DC existed from the 1970s to the 1990s, more integrated approaches developed with the concept of linking relief, rehabilitation and development (LRRD), which was established in the middle of the 1990s. The analysis showed internal shifts within the organizations’ priorities and also that long-term development cooperation was a binding element besides humanitarian aid. The comparison of core elements of operational work, such as important project contents, requirements for posted personnel and conflicts during a specific project, demonstrated characteristics of the analysed actors and set these in a larger developmental and historical context. Moreover, the research results illustrated how extensive changes in the global health governance system require adequate approaches for aid and cooperation at a global scale - thereby building a bridge from the historical context to current as well as future challenges in humanitarian aid and development cooperation

Multi-, Inter-, and Transdisciplinarity within the Public Health Workforce:A Scoping Review to Assess Definitions and Applications of Concepts

In light of the current public health challenges, calls for more inter- and transdisciplinarity in the public health workforce are increasing, particularly to respond to complex and intersecting health challenges, such as those presented by the climate crisis, emerging infectious diseases, or military conflict. Although widely used, it is unclear how the concepts of multi-, inter-, and transdisciplinarity are applied with respect to the public health workforce. We conducted a scoping review and qualitative content analysis to provide an overview of how the concepts of multi-, inter-, and transdisciplinarity are defined and applied in the academic literature about the public health workforce. Of the 1957 records identified, 324 articles were included in the review. Of those, 193, 176, and 53 mentioned the concepts of multi-, inter-, and transdisciplinarity, respectively. Overall, 44 articles provided a definition. Whilst definitions of multidisciplinarity were scarce, definitions of inter- and transdisciplinarity were more common and richer, highlighting the aim of the collaboration and the blurring and dissolution of disciplinary boundaries. A better understanding of the application of multi-, inter-, and transdisciplinarity is an important step to implementing these concepts in practice, including in institutional structures, academic curricula, and approaches in tackling public health challenges

Barriers to Healthy Eating among Medical Students at University Hospital and Medical School Canteens in Germany: Results from a Cross-sectional Study

Background Cafeterias (canteens) can influence dietary intake, the formation of dietary habits, and the incidence of overweight and obesity. In Germany, previous research has revealed a high prevalence of unhealthy eating patterns at school and high school cafeterias (Arens-Azevedo 2014, Müller 2013). Improving diets at cafeterias is therefore a goal of the National Nutrition and Health Action Plan (BMG 2014, DGE 2014a). Cafeterias at university hospitals and medical schools should be expected to lead by example, providing best practice examples for worksite and university cafeterias more generally. Objectives Assessing the food environment and identifying barriers to healthy eating at university hospital and medical school cafeterias in Germany. Methods A cross-sectional survey was conducted among medical students eating in university hospital and medical school cafeterias in Germany. 5170 students completed an online questionnaire with 39 closed and open questions on the perceived food environment and adherence to dietary recommendations by WHO and the German Nutrition Association concerning six food items (salad, vegetables, fruit, whole grain or potatoes, meat and fish). Participants reporting non-adherence to a specific dietary recommendation were asked to provide reasons for non-adherence. Study participants were recruited by emails sent out by faculties and local student unions. Results on the level of individual cafeterias were calculated for all cafeterias with a minimum sample size of 50 study participants. Results Results show a large variation of customers’ dietary patterns amongst the 23 cafeterias in the study. The median rate of adherence to standard dietary advice was 46%, ranging from 36 to 57% (see table 1; in the tables’ color-coding, red and orange highlight issues in need of attention). The largest variation was found in the regular consumption of salad, which ranged from 20 to 84%. In general, most students regularly consume vegetables and salad at their cafeteria, whereas fruit and sea food are consumed only rarely. Generally, reported reasons for non-adherence differ considerably for different recommended food items and for individual cafeterias (see table 2 and 3). Overall, lack of variety, availability and quality are the most frequently cited reasons. Only for salad the price is the most important barrier to increased consumption. Stable dietary preferences are among the three most frequently cited reasons for seafood and vegetarian dishes only, whereas craving for salty, savory and fatty food and lack of variety are the two most important reported reasons for higher than recommended intake of meat. In average, study participants reported eating in hurry in more than half of all occasions on which they eat in their cafeteria (see table 4, bottom left). The most frequently stated reasons for hurried eating were the length of the lunch break, a demanding and stressful day-to-day workload at university or in the hospital, and the dining hall being noisy or uncomfortable. Conclusions The prevalence of unhealthy eating patterns among medical students eating at cafeterias is high, and the most frequently stated reasons for non-adherence to dietary recommendations can be amended through changes in the cafeteria food environments. Based on the results of our survey, a promising strategy for supporting healthy diets at university and hospital cafeterias would be offering a larger variety of healthy foods, and to improve their quality and availability. Subsidies could help to increase the consumption of salad and fruits, while a more varied, palatable and tempting choice of vegetarian dishes could contribute to lowering meat consumption to recommended levels. A number of cafeterias are considerably more successful in providing their customers with a healthful, varied diet than the average. This shows that best-practice examples exist, which can act as role models for the rest. However, the large variation in the reported reasons for non-adherence to dietary advice also highlights the importance of the local context. In sum, there is considerable room for improvement and a clear need for action in the product range, food environment and choice architecture provided by university hospitals and medical school cafeterias in Germany

Barriers to Healthy Eating among Medical Students at University Hospital and Medical School Canteens in Germany: Results from a Cross-sectional Study

Background Cafeterias (canteens) can influence dietary intake, the formation of dietary habits, and the incidence of overweight and obesity. In Germany, previous research has revealed a high prevalence of unhealthy eating patterns at school and high school cafeterias (Arens-Azevedo 2014, Müller 2013). Improving diets at cafeterias is therefore a goal of the National Nutrition and Health Action Plan (BMG 2014, DGE 2014a). Cafeterias at university hospitals and medical schools should be expected to lead by example, providing best practice examples for worksite and university cafeterias more generally. Objectives Assessing the food environment and identifying barriers to healthy eating at university hospital and medical school cafeterias in Germany. Methods A cross-sectional survey was conducted among medical students eating in university hospital and medical school cafeterias in Germany. 5170 students completed an online questionnaire with 39 closed and open questions on the perceived food environment and adherence to dietary recommendations by WHO and the German Nutrition Association concerning six food items (salad, vegetables, fruit, whole grain or potatoes, meat and fish). Participants reporting non-adherence to a specific dietary recommendation were asked to provide reasons for non-adherence. Study participants were recruited by emails sent out by faculties and local student unions. Results on the level of individual cafeterias were calculated for all cafeterias with a minimum sample size of 50 study participants. Results Results show a large variation of customers’ dietary patterns amongst the 23 cafeterias in the study. The median rate of adherence to standard dietary advice was 46%, ranging from 36 to 57% (see table 1; in the tables’ color-coding, red and orange highlight issues in need of attention). The largest variation was found in the regular consumption of salad, which ranged from 20 to 84%. In general, most students regularly consume vegetables and salad at their cafeteria, whereas fruit and sea food are consumed only rarely. Generally, reported reasons for non-adherence differ considerably for different recommended food items and for individual cafeterias (see table 2 and 3). Overall, lack of variety, availability and quality are the most frequently cited reasons. Only for salad the price is the most important barrier to increased consumption. Stable dietary preferences are among the three most frequently cited reasons for seafood and vegetarian dishes only, whereas craving for salty, savory and fatty food and lack of variety are the two most important reported reasons for higher than recommended intake of meat. In average, study participants reported eating in hurry in more than half of all occasions on which they eat in their cafeteria (see table 4, bottom left). The most frequently stated reasons for hurried eating were the length of the lunch break, a demanding and stressful day-to-day workload at university or in the hospital, and the dining hall being noisy or uncomfortable. Conclusions The prevalence of unhealthy eating patterns among medical students eating at cafeterias is high, and the most frequently stated reasons for non-adherence to dietary recommendations can be amended through changes in the cafeteria food environments. Based on the results of our survey, a promising strategy for supporting healthy diets at university and hospital cafeterias would be offering a larger variety of healthy foods, and to improve their quality and availability. Subsidies could help to increase the consumption of salad and fruits, while a more varied, palatable and tempting choice of vegetarian dishes could contribute to lowering meat consumption to recommended levels. A number of cafeterias are considerably more successful in providing their customers with a healthful, varied diet than the average. This shows that best-practice examples exist, which can act as role models for the rest. However, the large variation in the reported reasons for non-adherence to dietary advice also highlights the importance of the local context. In sum, there is considerable room for improvement and a clear need for action in the product range, food environment and choice architecture provided by university hospitals and medical school cafeterias in Germany