Lower Saxony Research Articles

A scoping review on sociodemographic inequalities in breast cancer screening attendance in Germany

Abstract Background Organized breast cancer screening (BCS) programs are effective measures among women aged 50-69 for preventing the fifth cause of death in Germany. However, still participation rates have not yet reached EU standards. It is unclear which and how sociodemographic factors are related to BCS attendance. This scoping review aims to identify sociodemographic inequalities in BCS attendance among 50-69-year-old women following implementing the Organized Screening Program in Germany. Methods Following PRISMA guidelines, we searched the Web of Science, Scopus, MEDLINE, PsycINFO, and CINAHL. We included primary studies with a quantitative study design and reviews examining BCS attendance among women aged 50-69 with data from 2005 onwards in Germany. Harvest plots depicting effect size direction for the different identified sociodemographic inequalities were developed. Results We screened 476 titles and abstracts and 33 full texts. In total, 27 records were analysed, 14 were national reports, and 13 peer-reviewed articles. Eight sociodemographic variables were identified and summarised in the harvest plots: age, education, income, migration status, type of district, employment status, partnership cohabitation and health insurance. Older women, women with lower incomes and migration backgrounds who live in rural areas and lack private insurance, respond more favourably to BCS invitations. However, from a lifetime perspective, these associations only hold for migration background, are reversed for income and urban residency, and are complemented by partner cohabitation. Finally, women living in the federal states of Lower Saxony, Saxony, Mecklenburg-Western Pomerania, Saxony-Anhalt, and Thuringia showed higher attendance rates in the last two years. Conclusions High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. Key messages • High-quality research is needed to identify women at higher risk of not attending BCS in Germany, particularly as the overall attendance rate still falls below European standards. • Women without migration background, high income, living in rural areas, and not cohabitating with their partners are at higher risk of never attending BCS in Germany.

Quality of life in people with multiple sclerosis vs general population: differences increase by age

Abstract Background To enhance health care for chronically ill people, it is crucial to understand the impact of their disease on health-related quality of life (HRQoL). More than 240,000 people in Germany live with multiple sclerosis (PwMS), the most common immune-mediated neurodegenerative disease of the central nervous system. Little is known about HRQoL in PwMS in comparison to the general population and by subgroups. Methods In 2021, 6,928 statutorily-insured PwMS aged ≥18 years and living in the federal state of Lower Saxony, Germany, were invited to take part in an online survey. The German EQ-5D-5L value set was used to analyse HRQoL by index values. Descriptive subgroup analyses were conducted (age, sex) and compared to a general German reference population (Grochtdreis et al. 2019, DOI: 10.1007/s10198-019-01054-1). Mann-Whitney-U- or Kruskal-Wallis-tests were performed as appropriate. Results Of 1,935 respondents (response rate 27.9%), 1,916 PwMS were included in the current preliminary complete case analysis. HRQoL is reduced in PwMS compared to the general population: Mean (M) 0.67 vs. M 0.88, respectively. While no significant differences by sex were found in PwMS (male: M 0.66 vs. female: M 0.68, p = 0.1), HRQoL decreased with increasing age (p < 0.001). The reduction in HRQoL is more pronounced in PwMS than in the general population (difference between means 0.53 in 18-24 years old to ≥ 75 years old PwMS vs. 0.14 in the reference population, respectively). Conclusions PwMS report an overall lower level of HRQoL compared to the general population. Increasing age correlates with a substantial decrease of HRQoL in PwMS. Targeted research is needed to improve HRQoL of this vulnerable population. Key messages • The decline in HRQoL with increasing age is more pronounced in PwMS than in the general population in Germany. • Further research should focus particularly on the extent to which MS-related factors are solely attributable for the considerable decline of HRQoL in PwMS.

Perspectives of Families with Seriously ill Children and Adolescents in Lower Saxony: Focus on Care and Support - An Analysis of the Current Situation and Possible Support Services

The care of children and adolescents in need of care at home is exacerbated by the shortage of skilled workers in the care sector, which leads to bottlenecks in care and presents caring families with major challenges. The implementation of new care approaches in existing structures in the healthcare system is proving to be a key development task in order to provide targeted support for affected families in the future. Qualitative explorative interview study to record the perspective of families with (seriously) ill children and adolescents on the current care situation and possible helpful support services. The sampling was criteria-driven and the analysis and evaluation was content-analytical. Respondents were given a short questionnaire to record socio-demographic characteristics. In particular, the transmission of the diagnosis, the everyday challenges and the impact on quality of life were named as stress factors by n=10 participating parents. Improved access to information, voluntary structures and central contact points as well as digital services were named as key development needs. The interviews from real life and needs-oriented perspective show that there is a need to expand low-threshold care coordination services, strengthen voluntary structures and use telemedical services. Meeting these needs should enable access to specialized treatment and helpful services, especially in rural areas.

Student perspectives on the flipped classroom concept in secondary math lessons

The flipped classroom concept is the reversal of the traditional teaching activities so that new content is first worked through by the learners independently and then the joint lesson time is used to practise and consolidate this content. This concept can result in didactic advantages. However, it is assumed that the concept also places increased demands on learners. As part of an intervention study with 452 participants in 15 lower secondary schools in Lower Saxony (Germany), pupils were given a questionnaire including the following items “I like this in the flipped classroom” and “I don’t like this in the flipped classroom”. This article analyses the answers to those questions using a qualitative content analysis. The resulting categories are analysed in more detail in a thematic analysis to identify specific aspects of the flipped classroom that the learners like or dislike. The preparation through videos, self-directed learning and adaptability of the learning speed were named particularly frequently in the positively connoted categories. The negative aspects included comprehension problems, the desire for more explanations from the teachers, time pressure, and time management problems. These results contrast with previous research results on the flipped classroom concept in higher education didactics.

A new palaeodictyopteran Haseneura jarmilae gen. et sp. nov. from the Pennsylvanian of Piesberg reveals the structure of alinota

ABSTRACT A newly discovered palaeodictyopteran from the Pennsylvanian of Piesberg quarry (Lower Saxony, Germany) displays variability of wing venation on both wing pairs, well-preserved structure of thoracic nota and partially preserved wing base elements. Haseneura jarmilae gen. et sp. nov. is attributed to the family Archaemegaptilidae (Eugereonoidea) based on the wing venation characters, but several characters are also shared with representatives of Lycocercidae such as Apopappus Handlirsch, 1906. The preserved thoracic nota and wing bases demonstrate that wings were held in an outstretched position at rest, allowing to identify structural details. After the evaluation of venation characters across the superfamily Eugereonoidea and the re-examination of the holotype of Lithomantis meyeri Brauckmann et al., 2009 described from the same locality of Piesberg quarry, we propose transferring this species to Haseneura gen. nov. within the family Archaemegaptilidae as Haseneura meyeri comb. nov. zoobank: urn:lsid:zoobank.org:pub:D6839EFE-5AD0-4D89-9AD0-19BA0EF9580F

Investigations on the Health Status and Infection Risk of Harbour Seals (Phoca vitulina) from Waters of the Lower Saxon Wadden Sea, Germany.

Harbour seals (Phoca vitulina) are the most common pinniped species in the Wadden Sea of Schleswig-Holstein, Hamburg and Lower Saxony, Germany. Their numbers have recovered after significant depletion due to viral outbreaks and effects of anthropogenic activities like pollution and habitat disturbance. Within the Wadden Sea National Park of Lower Saxony the harbour seal is protected. As a top predator in the Wadden Sea ecosystem, the harbour seal is a sentinel species for the state of the environment. Between 2015 and 2017, a total of 80 stranded dead harbour seals were collected along the coastline of Lower Saxony and submitted for pathological investigations. Of these, 70 seals were born in the same year (0-7 months, age group 1) and eight in the previous year (8-19 months, age group 2), due to high mortality rates in these age groups. However, two perennial animals were also available for examination during this period, one of which was in good nutritional condition. Many of the seals that had been mercy-killed and found dead were in poor nutritional status. Histopathological, microbiological, parasitological and virological examinations were conducted on 69 individuals (86% (69/80)) in a suitable state of preservation. Respiratory tract parasitosis, cachexia, and bronchopneumonia were the most common causes of death or disease. Overall, there was no evidence of a relapse of a viral disease outbreak. Macrowaste, such as plastic waste or fishery-related debris, were not found in any gastrointestinal tract of the animals examined. There was also no evidence of grey seal predation. Weakness and cachexia were prominent causes of disease and death in harbour seals found within a few weeks after birth, but bronchopneumonia and septicaemia also developed in slightly older animals. Frequently found microbial pathogens in seals from Lower Saxony were similar to those found in other studies on seals from the Wadden Sea region in Schleswig-Holstein, for example streptococci and Escherichia coli/v. haemolytica, Brucella spp. and Erysipelothrix rhusiopathiae, potentially human pathogenic germs. The results of the examinations of dead harbour seals from Lower Saxony show that pathological investigations on a representative number of animals deliver urgently needed information on the health status of the population. The results represent an important contribution to the state of the top predators of the Wadden Sea as part of the obligations within the Trilateral Wadden Sea Agreement, Oslo and Paris Convention for the Protection of the Marine Environment of the North-East Atlantic (OSPAR) and the Marine Framework Directive. The investigations should be continued as a matter of urgency and the stranding network should be expanded.

Assessing groundwater level modelling using a 1-D convolutional neural network (CNN): linking model performances to geospatial and time series features

Abstract. Groundwater level (GWL) forecasting with machine learning has been widely studied due to its generally accurate results and low input data requirements. Furthermore, machine learning models for this purpose can be set up and trained quickly compared to the effort required for process-based numerical models. Despite demonstrating high performance at specific locations, applying the same model architecture to multiple sites across a regional area can lead to varying accuracies. The reasons behind this discrepancy in model performance have been scarcely examined in previous studies. Here, we explore the relationship between model performance and the geospatial and time series features of the sites. Using precipitation (P) and temperature (T) as predictors, we model monthly groundwater levels at approximately 500 observation wells in Lower Saxony, Germany, applying a 1-D convolutional neural network (CNN) with a fixed architecture and hyperparameters tuned for each time series individually. The GWL observations range from 21 to 71 years, resulting in variable test and training dataset time ranges. The performances are evaluated against selected geospatial characteristics (e.g. land cover, distance to waterworks, and leaf area index) and time series features (e.g. autocorrelation, flat spots, and number of peaks) using Pearson correlation coefficients. Results indicate that model performance is negatively influenced at sites near waterworks and densely vegetated areas. Longer subsequences of GWL measurements above or below the mean negatively impact the model accuracy. Besides, GWL time series containing more irregular patterns and with a higher number of peaks might lead to higher model performances, possibly due to a closer link with precipitation dynamics. As deep learning models are known to be black-box models missing the understanding of physical processes, our work provides new insights into how geospatial and time series features link to the input–output relationship of a GWL forecasting model.

Impact of Contextual Factors on the Perceived Participation of People With Multiple Sclerosis and Gait Impairment Using Mobility Assistive Devices: A Qualitative Analysis.

People with multiple sclerosis and gait impairment are particularly susceptible to facing restrictions in their participation. This study aims to investigate (a) which contextual factors within the framework of the International Classification of Functioning, Disability and Health (ICF) are relevant for participation from the perspective of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices, and (b) how these contextual factors shape the subjective facets of participation, including a sense of connection, efficacy and meaning, based on the social identity approach to health and well-being. We conducted a qualitative analysis on data gathered from four online focus group interviews, each involving four to six people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices (totalling N = 19), and 12 individual online interviews conducted with participants from the focus group interviews. The analysis followed the qualitative content analysis according to Kuckartz. Mobility assistive devices such as walkers, manual wheelchairs and electric wheelchairs/scooters were seen as facilitators that enabled participation in various life situations and enhanced a sense of efficacy by promoting independence. Challenges were encountered in relation to architectural barriers, pathways, weather conditions, public transportation and the lack of integral accessibility to services and systems. Although instrumental support could ease participation, it was also associated with an impaired sense of efficacy. Attitudes, particularly developing an understanding of the experiences of people with multiple sclerosis and gait impairment from others' perspectives, were considered important but often lacking, and discriminatory attitudes were experienced. On the level of personal factors, acceptance of both the mobility assistive devices and the disease itself were seen as facilitators for maintaining involvement in life situations. This study extends the existing literature by shedding light on the interconnectedness of contextual factors within the ICF and various facets of perceived participation, including a sense of connection, efficacy and meaning. These findings provide valuable insights for stakeholders such as urban planners and policymakers in developing inclusive environments that enhance the overall quality of participation for people with multiple sclerosis and gait impairment. This study reports on the lived experiences of people with multiple sclerosis and gait impairment who (intend to) use mobility assistive devices. The research team stood in close exchange with project members of the German Multiple Sclerosis Society Lower Saxony, a group representing the interests of people with multiple sclerosis, to design and conduct the focus group interviews. The results from the focus group interviews were the basis for the design of a participatory future workshop in which people with multiple sclerosis and stakeholders involved in the healthcare process collaboratively developed recommendations for improving the provision of mobility assistive devices. German Clinical Trials Register number: DRKS00025532.

Implementation of a Virtual Reality Intervention in Outpatient Physiotherapy for Chronic Pain: Protocol for a Pilot Implementation Study.

Chronic pain is a global health issue that causes physical, psychological, and social disabilities for patients, as well as high costs for societies. Virtual reality (VR) is a new treatment that provides an opportunity to narrow the gap between clinical practice and recommended care in the use of patient education and behavioral interventions in the outpatient physiotherapy setting. However, there is currently no implementation strategy to integrate VR treatments into this setting. This protocol outlines a pilot implementation study that aims to (1) identify barriers and facilitators for implementing a VR intervention in outpatient physiotherapy care for people with chronic pain and (2) develop and pilot test an implementation strategy in 5 practices in Germany. The study consists of 4 phases. The first phase involves adapting the treatment protocol of the VR intervention to the local context of outpatient physiotherapy practices in Germany. The second phase includes the collection of barriers and facilitators through semistructured interviews from physiotherapists and the development of a theory-driven implementation strategy based on the Theoretical Domains framework and the Behavior Change Wheel. This strategy will be applied in the third phase, which will also include a 6-month span of using VR interventions in practices, along with a process evaluation. The fourth phase consists of semistructured interviews to evaluate the developed implementation strategy. The recruitment process and phase 1, including the adaptation of the treatment protocol, have already been completed. We recruited 5 physiotherapy practices in Lower Saxony, Germany, where the VR intervention will be implemented. The collection of barriers and facilitators through semistructured interviews is scheduled to begin in February 2024. This pilot implementation study aims to develop a theory-driven implementation strategy for integrating a VR intervention into outpatient physiotherapy care for people with chronic pain. The identified barriers and facilitators, along with the implementation strategy, will serve as a starting point for future randomized controlled implementation studies in different settings to refine the implementation process and integrate VR interventions into the outpatient care of people with chronic pain. German Clinical Trials Register DRKS00030862; https://tinyurl.com/3zf7uujx. DERR1-10.2196/58089.

An Open Information Model-Based Repository for Sustainable Re-Use of Heterogeneous Pandemics Research Data.

The COVID-19 Research Network Lower Saxony (COFONI) is a German state network of experts in Coronavirus research and development of strategies for future pandemics. One of the pillars of the COFONI technology platform is its established research data repository (Available at https://forschungsdb.cofoni.de/), which enables provision of pseudonymised data and cross-location data retrieval for heterogeneous datasets. The platform consistently uses open standards (openEHR) and open source components (EHRbase) for its data repository, taking into account the FAIR criteria. Available data include both clinical and socio-demographic patient information. A comprehensive AQL query builder interface and an integrated research request process enable new research approaches, rapid cohort assembly and customized data export for researchers from participating institutions. Our flexible and scalable platform approach can be regarded as a blueprint. It contributes, to pandemic preparedness by providing easily accessible cross-location research data in a fully standardised and open representation.

Einsamkeit in Deutschland – Prävalenz, Entwicklung über die Zeit und regionale Unterschiede

ZusammenfassungHintergrundEinsamkeit ist weitverbreitet und hat negative Folgen für die Gesundheit. Diese Studie soll die Fragen beantworten: (1) wie viele Menschen in Deutschland hocheinsam sind, (2) wie sich die Einsamkeit in Deutschland über die Zeit – insbesondere im Hinblick auf die Covid-19-Pandemie – veränderte und (3) welche regionalen Unterschiede es in der Einsamkeit in Deutschland gibt.MethodenDie vorliegende Studie verwendet Daten aus den Wellen 2013, 2017 und 2021 des Sozio-oekonomischen Panels, einer deutschen bevölkerungsrepräsentativen Panelstudie. Auf der Grundlage der University of California, Los Angeles(UCLA)-Einsamkeitsskala schätzen wir die Prävalenzen der Hocheinsamen. Mit Mehrebenenmodellen analysieren wir die Veränderungen der Einsamkeit von 2013 bis 2021. Schließlich erstellen wir Karten, um die regionale Verteilung der Einsamkeit in Deutschland zu illustrieren.ErgebnisseRund 2 % der in Deutschland lebenden Menschen gehören zu den hocheinsamen Menschen. Dieser Anteil änderte sich auch während der Covid-19-Pandemie nicht. Allerdings stieg die mittlere Einsamkeit in Deutschland an, vor allem während der Pandemie. Gleichzeitig ändert sich auch die regionale Verteilung von Einsamkeit. Während 2013 vor allem der Osten Deutschlands von Einsamkeit betroffen war, gehören während der Pandemie vor allem Regionen im Westen Niedersachsens, Rheinland-Pfalz und Hessen zu den am stärksten von Einsamkeit betroffenen Regionen.DiskussionUrsachen für diese Veränderungen können sowohl in strukturellen Veränderungen der deutschen Gesellschaft in den vergangenen 10 Jahren liegen, aber auch an unterschiedlichen Maßnahmen zur Bekämpfung der Covid-19-Pandemie. Da die neuesten Daten zu Einsamkeit aus 2021 stammen, bedarf es dringend weiterer Datenerhebungen, um die aktuelle Einsamkeit in Deutschland abzubilden.

Gelingens- und Hindernisfaktoren bei der Implementierung von Gesundheitsförderung in Kitas und Grundschulen anhand von 4 ausgewählten Projekten

ZusammenfassungHintergrundGesundheitsförderung (GF) ist eine komplexe, politisch geforderte Aufgabe. Die Implementierungsgüte korreliert mit der Wirksamkeit von GF. Sie erfolgreich zu implementieren, erfordert die Beachtung von Kontextbedingungen, was in Wirksamkeitsstudien eher unterbleibt. Ziel ist es, Gelingens- und Hindernisfaktoren für die Implementierung von GF in Kindertagesstätten und Grundschulen anhand von 4 Projekten (Fit fürs Leben, fit für pisa +, Buchprojekt Sonnige Traurigtage und The Daily Mile) in der Gesundheitsregion Göttingen/Südniedersachsen zu identifizieren. Die Auswirkungen der COVID-19-Pandemie werden als implementierungsrelevant für diese Projekte angenommen.MethodenIn 24 semistrukturierten Interviews und 2 Fokusgruppendiskussionen wurden im Zeitraum 08/2021–03/2022 hauptsächlich Lehrer*innen und Erzieher*innen zur Umsetzung der Projekte in ihren Tätigkeitsbereichen befragt. Nach Transkription wurde mittels qualitativer Inhaltsanalyse ausgewertet. Das Consolidated Framework for Implementation Research unterstützte die Analyse.ErgebnisseInsgesamt wurden 22 Faktorengruppen identifiziert, auf deren Basis 22 Handlungsempfehlungen für die Implementierung von GF formuliert wurden. Im Vordergrund standen Gelingensfaktoren auf der Individuen- und Interventionsebene. Die COVID-19-Pandemie wirkte sich positiv auf den Stellenwert der GF aus, obgleich ihre Umsetzbarkeit erschwert war.DiskussionZahlreiche Ergebnisse zur Implementierung von GF in kindlichen Lebenswelten konnten durch die Studie bestätigt werden. Auffällig ist der hohe Stellenwert der Individuenfaktoren, was sich auf die Befragung projektnaher Interviewpersonen zurückführen lassen könnte. Die Studienergebnisse tragen zur Weiterentwicklung von Implementierungsstrategien in der GF bei.

How contaminated is flatfish living near World Wars’ munition dumping sites with energetic compounds?

Seas worldwide are threatened by an emerging source of pollution as millions of tons of warfare materials were dumped after the World Wars. As their metal shells are progressively corroding, energetic compounds (EC) leak out and distribute in the marine environment. EC are taken up by aquatic organisms and pose a threat to both the marine ecosphere and the human seafood consumer because of their toxicity and potential carcinogenicity. Here, sediment samples and fish from different locations in the German North Sea of Lower Saxony were examined to determine whether EC transfer to fish living close to munition dumping areas. EC were found in sediments with a maximum concentration of 1.5 ng/kg. All analyzed fish muscle tissues/fillets and bile samples were positive for EC detection. In bile, the max. EC concentrations ranged between 0.25 and 1.25 ng/mL. Interestingly, while detected TNT metabolites in the muscle tissues were in concentrations of max. 1 ng/g (dry weight), TNT itself was found in concentrations of up to 4 ng/g (dry weight). As we found considerable higher amounts of non-metabolized TNT in the fish muscle, rather than TNT metabolites, we conclude an additional absorption route of EC into fish other than per diet. This is the first study to detect EC in the edible parts of fish caught randomly in the North Sea.

Transformer models for Land Cover Classification with Satellite Image Time Series

In this paper we address the task of pixel-wise land cover (LC) classification using satellite image time series (SITS). For that purpose, we use a supervised deep learning model and focus on combining spatial and temporal features. Our method is based on the Swin Transformer and captures global temporal features by using self-attention and local spatial features by convolutions. We extend the architecture to receive multi-temporal input to generate one output label map for every input image. In our experiments we focus on the application of pixel-wise LC classification from Sentinel‑2 SITS over the whole area of Lower Saxony (Germany). The experiments with our new model show that by using convolutions for spatial feature extraction or a temporal weighting module in the skip connections the performance improves and is more stable. The combined usage of both adaptations results in the overall best performance although this improvement is only minimal. Compared to a fully convolutional neural network without any self-attention layers our model improves the results by 2.1% in the mean F1-Score on a corrected test dataset. Additionally, we investigate different types of temporal position encoding, which do not have a significant impact on the performance.

Timely integration of specialist palliative home care (SPHC) for patients with congestive heart failure, chronic obstructive pulmonary disease and dementia: qualitative evaluation of the experiences of SPHC physicians in the KOPAL trial

ObjectiveChronic non-malignant diseases (CNMDs) are under-represented in specialist palliative home care (SPHC). The timely integration of SPHC for patients suffering from these diseases can reduce hospitalisation and alleviate symptom burdens....

An empirical analysis of organic micro-level agricultural knowledge and innovation systems (microAKIS) in three federal states in Germany

ABSTRACT Purpose To achieve the ambitious policy goals concerning organic agriculture in Germany, it is crucial to understand which actors and institutions in the German organic microAKIS are most important to farmers and how farmers within the system share knowledge. This study explores these questions by focusing on farmers who are members of organic producer associations (OPAs) in three federal states in Germany. Design/methodology/approach Fieldwork was conducted in Brandenburg, Lower Saxony, and Bavaria from April to September 2021 through qualitative research utilizing participant observation on organic farms and in-person and Zoom interviews with farmers and experts in the organic agricultural sector. Findings This study concurs with previous studies’ findings that German organic farmers obtain and exchange knowledge, information, and innovations from a wide variety of sources surrounding their farm business as a whole; however, regarding agricultural practices and technologies, fellow farmers and OPAs are the most important sources. Practical implications Through comparing the microAKIS in Brandenburg, Lower Saxony, and Bavaria this paper explores how farmers in different states depend diversly on state structures, how in the organic sector farmers rely heavily on the private sector for knowledge and information exchanges surrounding agricultural practices and technologies, and how these networks can be improved. This enables discussions on advancing the sector and meeting policy goals by addressing farmers’ needs. Theoretical implications The microAKIS framework is advanced by engaging in a comparative analysis and bottom-up approach to identify significant actors according to farmers in the organic sector in Germany. Originality/value This study outlines the individuals and organizations that make up the organic microAKIS in Germany, which has been underexplored in the fast-growing organic sector, and utilizes empirical evidence to display farmers’ perspectives.

Dating the Neanderthal environment: Detailed luminescence chronology of a palaeochannel sediment core at the Palaeolithic site of Lichtenberg in the Lower Saxony, northern Germany

Northern Germany is famous for its numerous Neanderthal (Middle Palaeolithic) archaeological sites and well-preserved palaeoclimate records. Nevertheless, our understanding of how hominins responded to climate fluctuations and adapted to changing environments in this region remains limited because there are only a few reliable, highly-resolved chronological frameworks of long stratigraphic successions. Most of the Middle Palaeolithic sites in this region lack a reliable chronostratigraphy beyond the radiocarbon dating range. In this study, we present a high-resolution optically stimulated luminescence (OSL) chronology derived from a ∼21 m long sediment core (Li-BPa) that was drilled in close proximity to the known Neanderthal site of Lichtenberg. Quartz OSL dating was applied to the upper 6.5 m of the core. Subsequently, the obtained quartz OSL ages were compared with feldspar post-infrared (IR) IRSL (pIRIR) measured at 290 °C (pIRIR290), pulsed IR50 (pre-pIRIR225), and pulsed pIRIR225 ages to select a suitable feldspar signal to date older samples. A comparison of the quartz and feldspar ages indicates that only fading-corrected pulsed IR50 (pre-pIRIR225) and pIRIR225 ages agree well with quartz OSL ages. Finally, the age framework of the sediment sequence was established based on the 11 quartz OSL ages and 23 fading-corrected pulsed IR50 (pre-pIRIR225) and pulsed pIRIR225 ages. The resulting Bacon age-depth model agrees with litho- and biostratigraphic designations, indicating that the whole sequence was deposited between ca. 275 ka and ca. 24 ka, corresponding to the Saalian to Weichselian periods.

Supporting Bereaved Family Members: A Qualitative Interview Study on the Experience of Bereavement Counselling by the Bereavement Network Lower Saxony (BNLS) in Germany for Parents Who Have Lost Children or Teenagers.

The "Trauer Netzwerk Niedersachsen" ("Bereavement Network Lower Saxony" (BNLS)) aims at supporting families after the loss of a child or teenager due to various causes. This study aims to describe the experiences of bereaved family members with the BNLS counsellors. 12 semi-structured interviews were conducted with parents who had received or were currently receiving BNLS counselling. The interviews revealed the vital role counselling played aiding individuals cope with their grief. Participants valued the bereavement support, which was often lacking in their personal support networks. Counselling assisted parents in returning to daily life and caring for loved ones. Discussing "death" and "dying" helped participants find peace with their loss. Our findings suggest that bereavement counselling should be considered an essential component of healthcare for family members dealing with the loss of a child. Additionally, there is need for awareness and publicity for both the BNLS and its bereavement counselling services.

Anti-Leptospira Seroprevalence and Associated Risk Factors among Forestry Workers in Lower Saxony, North-West Germany.

As leptospirosis is re-emerging, a seroprevalence study was conducted, assessing the prevalence of anti-Leptospira IgG antibodies and infection-associated risk factors among forestry workers (FWs) in Lower Saxony, Germany, to develop targeted public health measures. Sera of 877 FWs, sampled in 2016, were tested for anti-Leptospira seropositivity by commercial IgG-ELISA. Data on demographics and Leptospira-specific exposures, knowledge, sources of information, and preventive measures were collected by standardized, self-administered questionnaire. A subset of 244 sera was retested via in-house IgG-ELISA. Risk factors were assessed from the subset using multivariable logistic regression analysis. The commercial IgG-ELISA revealed a seroprevalence of 4.8% (95% confidence interval CI95 = 3.5-6.4). Of the 601 FWs who completed the questionnaire, 67.9% had been informed about leptospirosis and Leptospira spp., mainly by employers (55.2%) and peers (38.9%). Positive associations with seropositivity were observed for canoeing (adjusted odds ratio (aOR) = 2.35, p = 0.044), touching rodents (aOR = 2.4, p = 0.021), and living close to beech trees (aOR = 2.18, p = 0.075). Frequently cleaning animal stables was negatively associated (aOR = 0.20, p = 0.002). The unexpected positive association with wearing gloves when handling plants and soil (aOR = 2.16, p = 0.011) needs further discussion. Overall, seroprevalence was in the range of other studies in Germany. The identified factors will be used to develop targeted information reaching out to at-risk groups tapping various communication channels.

Ensuring Future Primary Care from a Municipal Perspective

In view of the continuing shortage of general practitioners, ensuring access to (primary) medical care close to home is also becoming increasingly important for local authorities. The aim of the present study was to analyse the current and future provision of primary care from the viewpoint of the municipalities in North Rhine-Westphalia (NRW). From the results, it should be possible to derive future health policy design of a needs-based primary care close to home. In an online survey in spring 2023, we surveyed the mayors or representatives of health departments of all 427 municipalities (396 cities and communities, 31 districts) in NRW in cooperation with the NRW Association of Cities and Municipalities, the NRW Association of Counties and the NRW Association of Cities. The items of the questionnaire (n=28) were developed on the basis of two other surveys on medical care in Lower Saxony and Baden-Württemberg, each with a municipal policy target group. They were tested in repeated pretests. In total, 192 municipalities participated in the survey (response rate: 45.0%). The majority of the municipalities (86.6%) considered the local provision of primary care to be (rather) not ensured within the next 10 years. The municipalities expressed the wish for more opportunities to exert their own influence (79.5% yes or rather yes), but nevertheless considered a stronger commitment, especially of the Associations of Statutory Health Insurance Physicians (85.4%), as well as an intensification of assumption of responsibility by the federal states (72.4%) to be necessary for ensuring primary care. The survey shows that municipalities are quite aware of the problem of future deficits in the supply of general practitioners at the local level. The results also indicate that, in view of increasing supply shortfalls, the municipalities see obligations for the Associations of Statutory Health Insurance Physicians and the federal states to take responsibility and to exert greater political pressure in the future. The municipal perspective is an essential building block in considerations of how primary care can be ensured in the future. The responsible stakeholders should therefore involve the municipal level in the planning and measures to secure primary care more closely than in the past.