Background In Germany Research Articles

Vitamin and Mineral Status in a Vegan Diet.

In Germany, public interest in a vegan diet is steadily growing. There are, however, no current data on the macro- and micronutrient status of vegans. In a cross-sectional study entitled "The Risks and Benefits of a Vegan Diet" (RBVD), we investigated the dietary intake, basic laboratory parameters, vitamin status, and trace-element status of 36 vegans and 36 persons on an omnivorous diet. Each group consisted of 18 men and 18 women aged 30-60. Nearly all the vegans and one-third of the persons on a mixed diet had consumed supplements in the previous 4 weeks. Vegans and nonvegans had similar energy intake but differed in the intake of both macronutrients (e.g., dietary fiber) and micronutrients (e.g., vitamins B12, B2, D, E, and K, as well as folate, iodine, and iron). There were no intergroup differences in the biomarkers of vitamin B12, vitamin D, or iron status. The ferritin values and blood counts indicated iron deficiency in four vegans and three non-vegans. Measurements in 24-hour urine samples revealed lower calcium excretion and markedly lower iodine excretion in vegans compared to non-vegans; in one-third of the vegans, iodine excretion was lower than the WHO threshold value (<20 μg/L) for severe iodine deficiency. Vitamin B12 status was similarly good in vegans and non-vegans, even though the vegans consumed very little dietary B12. This may be due to the high rate of supplementation. The findings imply a need to also assure adequate iodine intake in the population, especially among persons on a vegan diet.

Associations Between Acculturation, Depressive Symptoms, and Life Satisfaction Among Migrants of Turkish Origin in Germany: Gender- and Generation-Related Aspects

ObjectiveThe aim of the present study was to investigate the degree of depressive symptoms and life satisfaction (LS) as well as the association between acculturation and depressive symptoms among a large sample of persons with Turkish migration background in Germany, taking into account gender- and migration-related differences.MethodsThis study was part of a pretest for a large national epidemiological cohort study in Germany. Acculturation was measured using the Frankfurt Acculturation Scale (FRACC). Based on the median split of the two subscales, four acculturative styles according to Berry (integration, assimilation, separation and marginalization) were determined. Depressive symptoms were assessed with the depression module (PHQ-9) from the Patient Health Questionnaire. LS was assessed with a single item on a scale from 1 = bad to 5 = excellent. Differences in levels of depressive symptoms and LS in relation to gender and generation of migration were tested with analysis of covariance, controlling for age. Gender-stratified multiple linear regression analyses were also conducted for depressive symptoms as criterion variable.Results328 Turkish migrants participated (61.3% women). The cut-off-value of ≥10 for the PHQ-9 was achieved by 33.2% of the women and 26.4% of the men (p=0.209, φ=0.071). In female migrants, the age-adjusted mean score for depressive symptoms was 7.81 (SD=6.42), in males 6.70 (SD=6.41) (p=0.137, η2=0.007). After controlling for unemployment status, women showed a trend for being more frequently depressed than men (p=0.055, φ=0.117) and also demonstrated a trend for higher levels of depressive symptoms (p=0.072, η2=0.012). No significant gender-specific difference was found concerning age-adjusted mean score for LS (p=0.547, η2=0.001), also when controlled for unemployment status (p=0.322, η2=0.004). In both sexes, the second generation demonstrated a significantly higher age-adjusted mean score for LS of small/medium effect size than the first generation. In women, separation as acculturation style (linear regression coefficient (B=4.42, 95% CI=1.68, 7.17, p=0.002; reference: integration), having no partnership (B=2.56, 95% CI=0.26, 4.86, p=0.03) and lower education (B=-2.28, 95% CI=-4.54, -0.02, p=0.048) were associated with higher severity of depressive symptoms; in men, separation as acculturation style (B=4.01, 95% CI=0.70, 7.31, p=0.018; reference: integration) and employment status (B=-3.32, 95% CI=-5.71, -0.92, p=0.007) were related to depression levels.ConclusionsSeparation as acculturation style is associated with higher levels of depressive symptoms (for both genders). Gender-sensitive health promotion programs should target separated migrants to improve their integration into the German society.

Budget impact analysis of the use of oral and intravenous therapy regimens for the treatment of relapsed or refractory multiple myeloma in Germany

BackgroundIn Germany, several triplet therapies for treating relapsed or refractory multiple myeloma (rrMM) patients have recently been approved. While most of them are administered intravenously, ixazomib-based combination is the only orally bioavailable regimen.ObjectiveTo conduct a 1-year and 3-year budget impact analysis (BIA) of different novel triplets to treat patients with rrMM in second or subsequent therapy lines accounting for costs covered by German statutory health insurance (SHI).MethodsA 3-state partitioned survival model (PSM) was developed to evaluate the budget impact of the following regimens: carfilzomib plus lenalidomide plus dexamethasone (KRd), elotuzumab plus lenalidomide plus dexamethasone (ERd), daratumumab plus lenalidomide plus dexamethasone (DRd), and ixazomib plus lenalidomide plus dexamethasone (IRd). The analysis included direct medical costs such as drug acquisition, comedication and preparation for parenteral solutions, drug administration and other 1-time costs, adverse event management costs and direct non-medical costs, such as transportation costs.ResultsBased on current drug market shares in German healthcare market, the estimated costs after 1 year of treatment was €551 million (KRd), €163 million (ERd), €584 million (DRd), and €95 million (IRd). The total budget impact of €1393 million is mainly driven by drug acquisition and subsequent therapy costs.ConclusionAmong the regimens of interest, the oral-based therapy regimens offered cost advantages over intravenous-based therapy regimens. The higher overall costs of intravenous therapy regimens were attributed primarily to higher drug acquisition costs.

Bullying Experience among Adolescents with a Turkish Migration Background in Germany: Ethnic Class Composition, Integration, and Religiosity as Protective Factors?

Bullying is a worldwide problem that has serious effects on the mental health of both victims and perpetrators. Although bullying seems related to increasing globalization and migration, it has seldom been researched in this context. This exploratory study examined bullying experiences and related depressive symptoms among a sample of adolescents with a Turkish migration background in a German school context (N = 103, 56.7% female, MAge = 16.17, SDAge = 1.36). The study focuses on three migration-related variables as potentially salutogenic factors: Ethnic class composition, acculturation, and religiosity. While the ethnic class composition did not show any effect, an integration acculturation strategy and religiosity proved to be protective factors against bullying experience. The negative prediction of integration on depressive symptoms was not consistent throughout the multivariate analyses. The results are discussed against the background of new impulses for bullying intervention programs for this vulnerable group of adolescents from a Turkish migration background.

Efficacy of a short-term residential smoking cessation therapy versus standard outpatient group therapy (\u2018START-Study\u2019): study protocol of a randomized controlled trial

BackgroundIn Germany, evidence-based outpatient smoking cessation therapies are widely available. Long-term abstinence rates, however, are limited. Studies suggest that short-term residential therapy enables a higher level of environmental control, more intense contact and greater support among patients and from therapists, which could result in higher abstinence rates. The aim of the current START-study is to investigate the long-term efficacy of a short-term residential therapy exclusively for smoking cessation, conducted by a mobile team of expert therapists.MethodsA randomized controlled trial (RCT) is conducted to examine the efficacy of residential behavior therapeutic smoking cessation therapy compared to standard outpatient behavior therapeutic smoking cessation group therapy. Adult smokers consuming 10 or more cigarettes per day, who are willing to stop smoking, are randomized in a ratio of 1:1 between therapy groups. The primary endpoint is sustained abstinence for 6-month and 12-month periods. Secondary endpoints include smoking status after therapy, 7-day point abstinence after the 6-month and 12-month follow-ups, level of physical dependence, cost-effectiveness, use of nicotine replacement products, health-related quality of life, self-efficacy expectation for tobacco abstinence, motivational and volitional determinants of behavior change, self-reported depressive symptom severity, adverse events and possible side effects. Assessments will take place at baseline, post-therapy, and at 6-month and 12-month intervals after smoking cessation.DiscussionThere is a high demand for long-term effective smoking cessation therapies. This study represents the first prospective RCT to examine the long-term efficacy of a residential smoking cessation therapy program compared to standard outpatient group therapy as an active control condition. The residential therapeutic concept may serve as a new model to substantially enhance future cessation therapies and improve the understanding of therapeutic impact factors on tobacco abstinence. Utilizing a mobile team, the model could be applied efficiently to medical centers that do not have permanent and trained personnel for smoking cessation at their disposal.Trial registrationGerman Register for Clinical Trials (Deutsches Register für Klinische Studien), DRKS00013466. Retrospectively registered on 1 April 2019. https://www.drks.de/drks_web/navigate.do?navigationId=start.

Barriers and drivers to adult vaccination among family physicians – Insights for tailoring the immunization program in Germany

BackgroundIn Germany, vaccination gaps exist mainly among adolescents and adults. Family physicians (FPs) administer adult vaccines. FPs strongly influence the vaccination behavior and attitudes of their patients, so their own vaccination-related attitudes and behaviors are critical to achieve high vaccination coverage. The aim of this study was to identify determinants of FPs’ own vaccination uptake and their recommendation behavior. Method700 FPs participated in a random sampled telephone survey. Respondents were interviewed in both their roles as vaccine recipients and vaccine providers. Thus, participants indicated their own vaccination status and recommendation behavior as primary outcomes. Primary determinants were the 5C psychological antecedents of vaccination. In addition, participants indicated demographic data and other barriers towards vaccination. Association between outcome and determinants were examined using logistic regression models. ResultsAround 60% of physicians reported to be vaccinated against influenza, pertussis and hepatitis B, and the majority claimed to recommend vaccines to patients. Own vaccination status was significantly associated with the recommendation of vaccines. Of the psychological determinants confidence in the safety of vaccines was associated with own vaccination and recommendation behavior. Collective responsibility, constraints and complacency were associated with own vaccination status. Being from western Germany and being a homeopathic FP were independently associated with lower own vaccination behavior. Vaccine shortages (52.5%) and cost coverage problems (25.6%) were reported frequently as system-related barriers. There was a perception that the National Immunization Technical Advisory Group was influenced by other interests (14.8%) and that people are vaccinated against too many diseases (8%). Around 40% had implemented an office-based reminder system. DiscussionFPs’ vaccination behaviors are associated with various psychological determinants and additional barriers. In particular, confidence can leverage FPs’ vaccination behaviors. Promoting office-based reminder systems, reducing system-related barriers, and building trust in official recommendations are additional measures to improve adult vaccination in Germany.

Intercultural Competence Development of German Nursing Personnel via Advanced Training Projects

This paper describes the advanced training projects to develop the intercultural competence of German nursing personnel. There are many German projects, which promote the development of intercultural competence and other professional competences of doctors and nursing personnel. Within this paper, the authors analyzed the following projects: “Migrants in Geriatric Nursing” (MigA project), “German Professional Language in the Geriatric Nursing” (FaDA Projekt), “Intercultural Open Nursing Service AWO in Ulm”, “Interprofessional and intercultural activities in the area of medicine, nursing and social services” (IPIKA project), IPIKA Plus project, “MIG-COMM-EU ‒ Multilingual Intercultural Business Communication for Europe” (MIG-COMM-EU project), “Intercultural Medical Communication in Europe” (IMED-KOMM-EU project). The authors have paid much attention to the significance of the concept of intercultural competence in nursing care. Besides, the article highlights the issue of the increase in the number of people with a migrant background in Germany. This study also provides another perspective on the advanced training projects for intercultural competence development of German nursing personnel. https://doi.org/10.26803/ijlter.19.4. 6

School track and ethnic classroom composition relate to the mainstream identity of adolescents with immigrant background in Germany, but not their ethnic identity.

Although developing a cultural identity is a core task for adolescents from immigrant families and the school is a highly important context in adolescence, to date, few studies have examined whether adolescents with particular cultural identities cluster in certain school contexts. Using data from a representative German sample including 7702 secondary school students of immigrant background from 1643 classrooms, we examined how the attended school track and four aspects of ethnic classroom composition relate to adolescents' cultural identity (i.e., their ethnic identity and mainstream identity). Two-level structural equation models indicated that students' ethnic identity was not systematically associated with the attended school track and the ethnic composition of the classroom. However, attending the academic school track, a classroom with a low proportion of classmates with immigrant background and frequently using German with classmates related positively to mainstream identity. Ethnic diversity and proportion of co-ethnics in class did not relate to mainstream identification. Our findings suggest that the ethnic identity of adolescents with an immigrant background in Germany is largely independent from the different socialisation contexts related to school tracks and the ethnic classroom composition. Yet, students' with a strong mainstream identity cluster in certain school contexts.

Study on advance care planning in care dependent community-dwelling older persons in Germany (STADPLAN): protocol of a cluster-randomised controlled trial

BackgroundIn Germany, advance care planning (ACP) was first introduced by law in 2015. However, ACP is still uncommon in Germany and only few people have advance directive forms. This study aims to evaluate an ACP program in care dependent community-dwelling persons, compared to optimised usual care.MethodsA cluster-randomised controlled trial of 12 months duration will be conducted in 3 German study sites comparing the pretested ACP-counselling offered by trained nurses with a control group receiving optimised usual care. Using external concealed randomisation, 16 home care services each will be included in the intervention and the control group (30 participants per cluster; n = 960). Eligibility criteria for patients are: ≥60 years, somehow care dependent, adequate German language skills, assumed life-expectancy of ≥4 weeks, and cognitive ability for participation.ACP will be delivered by trained nurse facilitators of the respective home care services and communication will include proxy decision-makers. The primary endpoint will be patient activation, assessed by the Patient Activation Measure (PAM-13). Secondary endpoints include ACP-engagement, proportion of prepared advance directives, number and duration of hospitalisations, quality of life as well as depression and anxiety. Further, comprehensive economic and process evaluations will be conducted.DiscussionSTADPLAN is the first study in Germany that assesses an adapted ACP intervention with trained nurses in home care services and the first international study focusing on cost effectiveness of ACP in community-dwelling older persons. The results will help to improve the understanding and communicating of patients’ preferences regarding medical treatment and care and thereby contribute to patients’ autonomy.Trial registrationGerman Clinical Trials Register: DRKS00016886 (Date of registration: 04.06.2019).

Time trends of non-alcoholic beverage consumption among adults in Germany, 1990\u20132011

BackgroundIn Germany, information on trends in non-alcoholic beverage intake over the last decades is sparse. The aim of this analysis is to examine trends in non-alcoholic beverage consumption among adults living in Germany between 1990 and 2011 with special focus on gender, age and education level.MethodsWe used self-reported food frequency questionnaire information from 25 to 69 year old participants of three German National Health Interview and Examination Surveys conducted in 1990–1992 (n = 7466), 1997–1999 (n = 5825) and 2008–2011 (n = 5375) and focused on consumption frequency of fruit juice, soft drinks, water, tea and coffee. Positive answers in the categories “almost daily”, “daily” and “daily and more” were categorized as frequent beverage intake. Proportion estimates and 95%-CI were weighted to better reflect the German population using SAS 9.4 survey procedures for complex sample designs.ResultsBetween 1990–1992 and 2008–2011, the proportion of men and women who reported to frequently drink juice, soft drinks, water or tea has increased from 21.9% (95%-CI: 20.8–23.0%) to 27.2% (25.6–29.0%), 10.0% (9.0–11.1%) to 18.7% (17.3–20.3%), 59.1% (56.8–61.4%) to 87.6% (86.2–88.9%), and 32.2% (30.3–34.2%) to 39.2% (36.9–41.5%), respectively. Frequent consumption of coffee decreased from 80.6% (79.1–82.0%) in 1990–1992 to 74.9% (73.3–76.5%) in 1997–1999 and increased to 81.2% (79.8–82.6%) in 2008–2011. Frequent consumption of juice increased over time among men with middle and high education (17.7% (15.7–19.8%) to 26.4% (23.4–29.6%) and 22.9% (20.2–25.8%) to 32.7% (29.4–36.2%), respectively), whereas a similar increase was only seen among women with low education (19.8% (17.1–22.9%) to 28.4% (22.9–34.7%). Frequent soft drink consumption increased among men in all age and education groups but among women only in the 25 to 34 year age group and in the low education group. Frequent water consumption increased about 20% or more among men and women, in all age and education groups.ConclusionsThe results show changes in non-alcoholic beverage consumption over the past two decades in Germany. Exploring non-alcoholic beverage intake over time is important for the evaluation of consumption patterns with regard to guidelines and to design appropriate prevention measures.

Dialect (non-)acquisition and use by young people of migrant background in Germany

ABSTRACTThis article reports on a study investigating the use of regional language features by young people of (mostly Turkish or Balkan) background who were born, or raised from an early age on, in Stuttgart/Germany. The results of the Stuttgart study show that most young speakers from migrant families do not accommodate the local or regional dialect, but rather speak their own (multiethnolectal) variety of German. Existing evidence on dialect (non-)acquisition and (non-)use by speakers with similar social, linguistic and cultural backgrounds in other parts of Germany suggests that this finding reflects a general tendency. Some possible explanations for the non-acquisition and non-use of dialectal features are discussed.

Do Medical Students in Their Fifth Year of Undergraduate Training Differ in Their Suitability to Become a "Good Doctor" Depending on Their Admission Criteria? A Pilot Study.

BackgroundIn Germany, the pre-university grade point average (pu-GPA) has to be the main criterion for medical school applicant selection. This is also mandatory in the university-specific selection procedures (Auswahlverfahren der Hochschulen [AdH]). The admission framework has now been reworked following a judgement by the German Federal Constitutional Court. From 2020, more students will be admitted based solely on the pu-GPA and at least two selection criteria independent of the pu-GPA have to be considered in the AdH. However, the question whether an AdH (the core of the AdH at Lübeck Medical School [LMS], Germany, is a 30-mins panel interview led by two faculty members and one student) leads to better doctors as compared to pu-GPA-based selection, remains unanswered.ObjectiveTo compare students selected based either on their pu-GPA alone (“pu-GPA-students”) or based on the result of the AdH at LMS (“AdH-students”) regarding their suitability to become a good doctor.DesignWe conducted a cross-sectional observational pilot study at LMS. Students were judged regarding their overall suitability to become a good doctor by their supervising general practitioners after a two-week internship in their last year of theoretical medical education. The scores were matched to the selection procedure and compared between the pu-GPA-students and AdH-students.ResultsIn all, 79% of the AdH-students were rated as “absolutely suitable” for the medical profession, as compared to 42% of the pu-GPA-students (p = 0.01, odds ratio 5.17, 95% confidence interval = 1.41, 18.99). We did not find any association between gender or age and the suitability rating.ConclusionDespite the small sample size, our results indicate that it could be favourable to select medical students not only based on their pu-GPA but also using additional selection criteria.

Juggling Between Parental and School Expectations: The Development of Domain-Specific Acculturation Orientations in Early Adolescence.

We examined how perceived acculturation expectations from parents and school, and ethnic discrimination predicted early adolescents’ heritage and mainstream acculturation orientations at home (private domain) and in school (public domain) one year later. We surveyed 263 early adolescents of immigrant background in Germany (Mage = 10.44 years, 60% female). Multigroup path analyses revealed that perceived acculturation expectations and ethnic discrimination were more strongly related to adolescents’ private than public acculturation orientations. Parental heritage expectations were the strongest predictor of adolescents’ acculturation orientations. Boys were more susceptible than girls to ethnic discrimination and acculturation expectations in school, which affected their private and public acculturation orientations. Results highlight the importance of integrating domain‐specific and gendered experiences when analyzing adolescents’ acculturative development.

Subjective employment perspective among older workers with and without migrant background in Germany—Results of the lidA cohort study

ObjectivesThe aim of this study was to investigate the subjective employment perspective in higher working age for different employee groups with migrant background (EMB) and without (non‐EMB), meaning willing, being able, and planning to work until the individual state pension age (iSPA).MethodsA representative sample of socially insured employees born in 1959 or 1965 was surveyed in 2011, 2014, and 2018 with computer‐assisted personal interviews. The current cross‐sectional analysis is based on data from the third study wave (n = 3286) of the lidA cohort study. EMB were differentiated via generation (first generation, G1, vs second generation, G2) or nationality (German vs foreign). Applying bivariate statistics with the tests of independence and block‐wise logistic regressions, group differences were investigated. Sex, age, educational level, net household income, health, and work factors were considered as covariates.ResultsWhen comparing subgroups of EMB, significant differences appeared in bivariate analyses for willing and planning to work. G1 were to a higher degree planning to work longer than G2 and those with foreign nationality were more willing and planning than those with German nationality. Multivariate analyses revealed significant differences of G1 and non‐EMB for planning, being significant in the fully adjusted model, but not for willing.ConclusionThe findings underline the need for differentiation of migrant groups in social research and policy. When it comes to extended working lives, the first‐generation migrant group, as well as foreigners may constitute risk groups and require increased attention from a work, health, and economic point of view.

Reinforcing at the Top or Compensating at the Bottom? Family Background and Academic Performance in Germany, Norway, and the United States

Abstract Research on educational mobility usually studies socioeconomic differences at the mean of children’s academic performance but fails to consider the variation in the shape of socioeconomic differences across the outcome distribution. Theories of social mobility as well as theories about the resource allocation within families predict such variation. We use quantile regression models to estimate variation in socioeconomic differences across the distribution of academic performance using different indicators of family background (parental education, occupation, earnings, and wealth). We apply this approach to data on Germany, Norway, and the United States, three countries that represent different welfare and education regimes that may affect the intergenerational transmission of educational advantage. We find stronger socioeconomic differences at the bottom than at the middle and the smallest differences at the top of the performance distribution. These findings are virtually identical across all four indicators of family background. We also find no cross-national differences in the shape of socioeconomic differences in academic performance.

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS)

BackgroundIn Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system.MethodsThe German Health Interview and Examination Survey for Adults (DEGS) is part of Germany’s national health monitoring, and includes a large representative sample of the German population aged 18–79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services.ResultsThe sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases.ConclusionsWe observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

Prosocial motivation and behavior in children with and without Turkish immigrant background in Germany and in Turkish children in Turkey

Journal for educational research online 12 (2020) 1, S. 5-25 Padagogische Teildisziplin: Padagogische Psychologie; Padagogik der fruhen Kindheit;

Mental health among immigrants in Germany \u2013 the impact of self-attribution and attribution by others as an immigrant

BackgroundIn Germany, the term ‘migration background’ has been established to differentiate between immigrants and natives. In the present study post-traumatic stress disorder (PTSD), anxiety, and depression were analysed in immigrant populations in Germany by considering self-attribution as well as attribution by others on one’s own ‘migration background’.MethodsIn a population-based survey (N = 2317), socio-demographic characteristics, migration background (official statistics definition vs. self-attribution as well as the anticipated attribution by others), PTSD (PCL-5), and symptoms of anxiety and depression (PHQ-4) were assessed. Logistic regression models were applied to predict mental health outcomes by considering socio-demographic and immigration-related factors.ResultsA total of 10.7% of respondents (N = 248) had a ‘migration background’. Immigrants of the 2nd generation compared to 1st generation immigrants are less likely to see themselves as immigrants. Attribution as an immigrant (self and/or by others) was found as significant predictor for PTSD and depression, but not anxiety.ConclusionsIt seems useful to focus on immigration-related factors considering subjective perspectives and not only comparing immigrants and natives using a federal statistics definition. Our findings suggest that research on the association between immigration-related factors such as attribution as an immigrant and mental health outcomes might be a promising approach to better identify subgroups at higher risk of mental distress.

Nurse-led care versus physician-led care in the management of rheumatoid arthritis and psoriatic arthritis (StaerkeR): study protocol for a multi-center randomized controlled trial

BackgroundIn Germany, the care of patients with inflammatory arthritis could be improved. Although specialized rheumatology nurses could take over substantial aspects of patient care, this hardly occurs in Germany. Thus, the aim of the study is to examine structured nursing consultation in rheumatology practices.Methods/designIn total, 800 patients with a stable course of rheumatoid arthritis or psoriatic arthritis in 20 centers in North Rhine–Westphalia and Lower Saxony will be randomized to either nurse-led care or standard care. Participating nurses will study for a special qualification in rheumatology and trial-specific issues. It is hypothesized that nurse-led care is non-inferior to standard care provided by rheumatologists with regard to a reduction of disease activity (DAS28) while it is hypothesized to be superior regarding changes in health-related quality of life (EQ-5D-5L) after 1 year. Secondary outcomes include functional capacity, patient satisfaction with treatment, and resource consumption.DiscussionSince there is insufficient care of rheumatology patients in Germany, the study may be able to suggest improvements. Nurse-led care has the potential to provide more efficient and effective patient care. This includes a more stringent implementation of the treat-to-target concept, which may lead to a higher percentage of patients reaching their treatment targets, thereby improving patient-related outcomes, such as quality of life, functional capacity, and participation. Additionally, nurse-led care may be highly cost-effective. Finally, this project may form the basis for a sustainable implementation of nurse-led care in standard rheumatology care in Germany.Trial registrationGerman Clinical Trials Register, DRKS00015526. Registered on 11 January 2019.

A Longitudinal Investigation of the Ethnic and National Identities of Children With Migration Background in Germany

Abstract. How immigrants define their ethnicity and nationality is relevant for integration: They can identify with their ethnic group, the receiving society, and a combination of both. A longitudinal study with elementary-school children with migration background ( N = 200; age 9–10) in Germany investigated the predictors and stability of ethnic and national identities. Ethnic identity was more highly endorsed than national identity. National and dual identities were compatible (i.e., positively related), whereas ethnic identity was compartmentalized (i.e., unrelated to national and dual identities). Contact with Germans predicted national identity over time, but not vice versa. Thus, the study contributes to a better understanding of multiple social identities of young ethnic minority children in light of social psychological theories of social identity development.