North Rhine-Westphalia Research Articles

Textbooks, hunger, and humanitarian narratives: representations of U.S. food policies to Germany on a regional scale (1949–89)

AbstractThis article investigates the significance of United States (U.S.) post-WWII food aid to Germany in West German textbooks from a regional angle during the Cold War period. Previous studies have predominantly focused on interpreting the significance of U.S. aid in West Germany from a national standpoint, overlooking regional variations in humanitarian narratives. This study challenges the national scale as the exclusive basis of collective meaning. By exploring educational materials from three different German regions—Berlin, Bavaria and North Rhine-Westphalia, it examines the different afterlives of U.S. aid in West German humanitarian narratives. Further attention for nuances in reconstructing humanitarian narratives not only does justice to the distinct regional histories and memory cultures, but also gives scope to reassessments of dominant narratives.

Teachers with a refugee background work as educators in Germany

This study's focus is to determine refugee teachers' views regarding their ability to work as teachers in Germany, their initiatives, and the challenges they face. In this context, the study was conducted based on qualitative research methodology. In order to collect data a total of 265 teachers residing in the 16 states of Germany were reached. Upon examining the results, it is observed that the majority of participants express a desire to work as teachers in Germany, while only a few have actually obtained the opportunity to work as teachers in Germany. More than half of the participants who are currently working as teachers reside in the North Rhine-Westphalia state. When analyzing the results, it becomes evident that a significant portion of the participants are strongly inclined to pursue a teaching career in Germany. However, the data reveals that the actual attainment of employment as teacher in Germany remains relatively low among the respondents. Furthermore, it is noteworthy that a majority of the teachers currently employed in the profession are concentrated in the North Rhine-Westphalia state.

Prospection of faults on the Southern Erftscholle (Germany) with individually and jointly inverted refraction seismics and electrical resistivity tomography

As part of the Lower Rhein Embayment (LRE), the Southern Erft block is characterized by a complex tectonic setting that influences hydrological and geological conditions on a local as well as regional level. The study area is located in the south of North Rhine-Westphalia and traversed by several NW-SE-oriented fault structures. Since the tectonic structures were located by past studies based on a sparse foundation of geological data, the positions include considerable uncertainties. Therefore, it was decided to re-evaluate and refine the assumed fault locations by conducting geophysical measurements. Seismic Refraction Tomography (SRT) as well as Electrical Resistivity Tomography (ERT) was performed along seven measurement profiles with a length of up to 1.1 km. In addition to compiling individual resistivity and velocity models for all deduced measurements, ERT and SRT datasets were cooperatively inverted using the Structurally Coupled Cooperative Inversion (SCCI). This algorithm strengthens structural similarities between velocity and resistivity by adapting the individual regularizations after each model iteration. Previously assumed locations of the tectonic structures diverge from the new evidence based on ERT and SRT surveys. Especially in the western and eastern parts of the research area, differences between the survey results and formerly assumed locations are in the order of 100 m. Seismic and geoelectric measurements further indicate a fault structure in the southern part of the area, which remained undetected by past studies. The cooperative inversions do not improve the geophysical models qualitatively, since the individually inverted datasets already provide results of good quality and resolution.

Long-term Survival After Cancer: A Scoping Review of the Health Care Landscape in Germany

Abstract Background Cancer remains a global health concern, with a significant increase in new cases projected in the coming years. Although cancer treatment and diagnosis have advanced, leading to improved survival, survivors often face complex physical, emotional, and cognitive challenges. The objective of this scoping review is to provide an overview of the current landscape of specialized long-term survivorship care services in North Rhine-Westphalia (NRW) with a focus on vulnerable groups. Methods The scoping review involves two search approaches: a manual search performed by two review authors and a systematic search performed by an information specialist following Scoping Review guidance. The protocol was published on the OSF platform. The systematic search was conducted in databases such as LIVIVIO, MEDLINE and Scopus. The manual search involves identifying key categories of survivorship services and conducting online searches based on these categories in duplicate. Data extraction and synthesis is conducted using EPPI-Reviewer software, and focuses on services characteristics, patient demographics, program format, and accessibility. Results The study has identified more than 300 survivorship care services across North Rhine-Westphalia. According to preliminary results some services offer comprehensive care, while others have significant gaps, particularly in addressing the needs of vulnerable groups. One example of these gaps is the lack of tailored services specifically designed for people with a migration background. Most of the services are not available in multiple languages or gender-specific oriented. The results will be presented on the congress in detail. Conclusions This scoping review underscores the importance of tailored survivorship care, especially for vulnerable groups. Public health actions should focus on addressing disparities in access to survivorship services, enhancing existing programs, and developing new policies to support cancer survivors. Key messages • Effective survivorship care requires attention to vulnerable groups. • The care of long-term cancer survivors should receive more attention in research.

The influence of living environments on subjective health literacy in fourth-graders in Germany

Abstract Background Evidence suggests that worse family affluence is related to low health literacy in children. Still, for the targeted promotion of health literacy, a more nuanced understanding is needed of how living environments affect health literacy in early life. This study explores the relationships between health literacy and indicators of living environments in the neighborhood and at home. Methods A representative sample of 4th-graders (age 8-11) was surveyed from Oct. 2022 to Feb. 2023 in North Rhine-Westphalia, Germany. We included the HLS-Child-Q15 to assess subjective health literacy, 4 items about the neighborhood (e.g., “neighborhood is a good place to play outside” or “I often see people smoking in the neighborhood”), and 4 items about home (e.g., “there’s always fruit and vegetables at home” or “it’s important to my parents that I exercise”). The tendency to answer in a socially desirable way was controlled for with a validated scale. Likert-scale items were dichotomized for use in linear regression. Results n = 1085 students are included, 50.3% are female. The mean age is 9.5 years (SD=.6). The regression model explains 17.8% of variability in health literacy (corr. R²). Significant (p<.05) predictors for high health literacy were birthplace (Germany, not Germany), agreement to the statements “I often see people exercising in my neighborhood”, “my parents can answer all my question about health”, “there’s always fruit and vegetables at home”, “it’s important to my parents that I exercise”, but also social desirability scores. Family affluence was not a significant predictor. Conclusions In this sample of 4th-graders, subjective health literacy could not adequately be explained by family affluence. Indicators of living environments seem to be better suited to explore variability in health literacy. These findings can be used to explore entry points for the promotion of health literacy early in life and to identify groups at risk for low health literacy.

The influence of health literacy on health outcomes and behaviors in fourth-graders in Germany

Abstract Background For the adult population, evidence suggests that a high level of subjective health literacy is associated with a number of favorable health outcomes and behaviors. However, for younger populations, particularly children, little evidence is available. This study investigates the relationship between subjective health literacy, health outcomes, and health behaviors in children. Methods We conducted a representative survey of 4th-grade students (age 8-11) in North Rhine-Westphalia, Germany, between Oct. 2022 and Feb. 2023. Subjective health literacy was measured with the HLS-Child-Q15 questionnaire. For mental and physical well-being, the KINDL-R was used. For health behaviors, we asked about the frequency of (1) brushing teeth, (2) eating fruit and (3) vegetables, (4) exercising, (5) consuming sweetened drinks, and (6) wearing a helmet when riding the bike. Regression analysis was used to determine the impact of health literacy on outcomes, controlling for a number of sociodemographic indicators (birthplace, home language, sex, age), as well as the tendency to give socially desirable responses. Health behaviors were rated on a Likert scale and where dichotomized for ordinal regression. Results n = 1085 students are included with a mean age of 9.5 years (SD=.6). 50.3% are female. While controlling for a number of variables, health literacy was a significant predictor (p<.05) for every indicator except the frequency of (1) brushing teeth, (4) exercising, and (5) consumption of sweetened drinks. For mental well-being, health literacy was the strongest predictor. Conclusions Our findings highlight the potentially enabling role of subjective health literacy regarding favorable health outcomes and health behaviors. However, because this is a study among younger children, further research is needed on the interplay of individual subjective health literacy, social contexts (e.g., parental health literacy and health behaviors), and children’s health outcomes and behaviors.

Psychosocial Workloads and Resilience of Heads of Municipal Public Health Authorities in Germany During the COVID-19 Pandemic: Perceptions of Operational Organization, Communication, and Measures

Healthcare professionals are particularly vulnerable to mental health issues during epidemics, as evidenced by the COVID-19 crisis. German public health authorities, crucial for disease prevention, faced significant strain from chronic understaffing and resource limitations exacerbated by the pandemic. The study was designed as a cross-sectional, observational online survey. This study conducted an online needs assessment survey among heads of municipal public health authorities in Thuringia, Saxony, North Rhine-Westphalia, Bavaria, and Berlin between June and November 2023. Of the 191 contacted authorities, 74 responses (38.7%) were analyzed, focusing on professional demands, recognition, stress resilience, general life satisfaction, operational organization, and communication during the pandemic. Validated scales such as ERI, RS-13, L-1, and the COVID-19 add-on module of the COPSOQ were utilized. Statistical tests included descriptive statistics, correlation coefficients, Chi-Square tests, linear regression, T-tests, and ANOVA with a significance level set at p < 0.05. Respondents were mainly from North Rhine-Westphalia (43.3%) and Bavaria (24.3%), predominantly female (54.1%), and had a mean age of 52.7 years. The majority were medical specialists (71.9%). The RS-13 mean score was 72.66 (SD = 12.42), with 58.9% demonstrating high stress resilience. Public health degree holders showed the highest resilience. The ER-ratio indicated high effort versus reward for 96.7% of heads. Larger districts showed lower ER-ratios, suggesting resilient organizational structures. The study highlights high psychosocial workload and resilience among German public health authority heads during COVID-19, suggesting the need for optimized crisis management and scalable staffing for future pandemics and crises.

Depression symptoms, wellbeing, health-related quality of life, and diabetes-related distress in novel subtypes of recent-onset diabetes in Germany: a 5-year observational follow-up study.

The subjective experiences of individuals living with diabetes is commonly assessed with patient-reported outcomes (PROs; eg, depression symptoms, wellbeing, health-related quality of life [HRQOL], and diabetes-related distress). Cluster analyses have identified novel diabetes subtypes differing in phenotypic and metabolic characteristics. We aimed to investigate associations between these subtypes and PROs and whether subtype predicted PROs 5 years later. Baseline (<12 months after a diabetes diagnosis) and 5-year follow-up data were collected from German Diabetes Study (GDS) participants. Multiple regressions were applied to analyse associations between diabetes subtypes and depression symptoms (Center for Epidemiologic Studies Depression Scale), wellbeing (WHO-5), HRQOL (SF-36), and diabetes-related distress (Problem Areas in Diabetes Scale). Cluster analyses at baseline (n=1391) identified participants with severe autoimmune diabetes (SAID, 417 [30%]), severe insulin-deficient diabetes (SIDD, 33 [2%]), severe insulin-resistant diabetes (SIRD, 150 [11%]), mild obesity-related diabetes (MOD, 354 [25%]), and mild age-related diabetes (MARD, 437 [31%]). At baseline, multiple regression analyses showed that participants with SIRD had higher depression symptoms than participants with MARD and lower physical HRQOL than all other subtypes. Participants with SAID reported higher depression symptoms and lower mental HRQOL than participants with MARD, higher physical HRQOL than participants with MARD and MOD, and higher diabetes-related distress than most other subtypes. At the 5-year follow-up, clustering predicted no statistically significant changes in PROs after adjustment for multiple testing, whereas descriptive analyses demonstrated that individuals with SIRD were more likely to experience clinically relevant depression symptoms (16% vs 6%) and low wellbeing (31% vs 14%), respectively, than individuals with MARD. Diabetes subtypes already differ in PROs at diabetes diagnosis. Our analyses had limited predictive power during follow-up. However, our findings suggest that clustering could predict future changes in depression symptoms. The GDS was initiated and financed by the German Diabetes Center, which is funded by the German Federal Ministry of Health, the Ministry of Culture and Science of the state of North Rhine-Westphalia, and by the German Federal Ministry of Education and Research to the German Center for Diabetes Research. For the German translation of the abstract see Supplementary Materials section.

The Elephant(s) in the Newsroom: A Mixed Methods Study on the Use of News Agency Material

ABSTRACT News agencies remain one of the most important sources of journalistic reporting. It is all the more astonishing that, with a few exceptions, they still represent a major blind spot in journalism research. Using a mixed method approach of quantitative content analysis and qualitative interviews with practitioners from media outlets and news agencies, this study investigates how and how much online media outlets of different media types located in the German federal state of North Rhine-Westphalia use material from different news agencies. The study also examines the differences in subject areas and geographical reference areas and explores the rationale behind how and how much news agency material is used. The study confirms the very high and, partially, even increasing relevance of news agencies in media markets in the present and the foreseeable future. It also asks critical questions about the implications for journalism and democratic societies as a whole.

Spatiotemporal statistical features of velocity responses to traffic congestions in a local motorway network

Abstract The causal connection between congestions and velocity changes at different locations induces various statistical features, which we identify and measure in detail. We carry out an empirical analysis of large-scale traffic data on a local motorway network around the Breitscheid intersection in the North Rhine-Westphalia, Germany. We put forward a response function which measures the velocity change at a certain location versus time conditioned on a congestion at another location. We use a novel definition of the corresponding congestion indicator to ensure causality. We find that the response of velocities to the congestion exhibits phase changes in time. A negative response at smaller time lags transforms into positive one at larger time lags, implying a certain traffic mechanism. The response decays as a power law with the distance. We also identify a scaling property leading to a collapse of the response functions on one curve.

Eye Injury Incidence in Germany from 2008 to 2022: An Analysis of Hospital Quality Reports.

Eye injuries range from minor to severe and may lead to permanent visual impairment. There is still little in the way of epidemiological data on eye injuries in Germany. The aim of this study was to obtain an objective record of minor and severe eye injuries in Germany by evaluating hospital quality reports. We also investigated the relevance of injuries from fireworks in relation to the total number of eye injuries and the general population. This retrospective routine data study entailed analysing hospital quality reports from 2008 to 2022 in XML format. The R programming language was used for data processing and statistical analysis. The number of ICD-coded eye injuries was exported and analysed together with location data. We also included data from a prospective survey study on fireworks-related eye injuries from 2016 to 2023. Eyeball and/or orbital contusions are the most common eye injuries treated in Germany at up to 2,500 cases per year. The most severe injuries comprise traumatic globe rupture with loss of intraocular tissue at up to 990 cases per year. Numbers of eye injuries of any type have been declining since 2020. As a percentage of population, Mecklenburg-Western Pomerania treats the most eye injuries at up to 0.017%; in absolute numbers, North Rhine-Westphalia leads the country at up to 1,600 injuries. Private firework displays are probably responsible for 1.4% of annual globe ruptures and 8.3% of eyeball contusions. Our analysis of hospital quality reports has provided the first comprehensive epidemiological record on eye injuries in Germany. Firework-related injuries account for a relevant proportion of total injuries. These results could serve as a basis for preventive measures and health policy decisions.

교육과정의 교과 편제와 내용조직 비교 연구: 독일의 교과 편제와 역사 교육과정을 중심으로

This study aims to discuss the subject organization and time allocation by linking them to the contents of subject curriculum. To this end, this study compares the subject organization and time allocation of the secondary school curriculum and contents of learning of history subject curriculum by grade using the cases of three German regions (North Rhine-Westphalia, Bavaria, and Baden- Württemberg), in juxtaposition with the grade-specific learning topics in the current history curriculum of South Korea. In Germany, history is allocated a constant two hours per week for six years in grades 5 through 10. The scope of study is dominated by the history of Western Europe and Germany, and is organized to cover ancient, medieval, and modern times in chronological order only one time over the six years. This differs significantly from the curriculum of Korea, where Korean history is taught three times in chronological order for one semester or one year each in elementary, middle, and high school. World history taught once for one year covering all eras in middle school. This study argues the following two points. First, the Secondary Stufe I curriculum in Germany, based on the school system of grades 5-10, covers the content of a subject curriculum in a continuous manner without poses between school levels and grades, and this organization and allocation of time provides a foundation for depth of learning. Second, the Korean history curriculum, which covers the entire chronological period in a single semester or year, needs to be changed to lay the foundation for in-depth learning. In terms of individual students' learning experience and growth, the organization of subject and its content should be discussed beyond the distinction between school levels.

"Smoke-free in May 2024": concept and description of the participants

Far too many people smoke in Germany, and the number of serious attempts to stop smoking has been falling for years. Smoke-free in May 2024 is a low-threshold measure to encourage people to stop smoking. Adults who "regularly" consume nicotine products as well as support persons were eligible to take part. As part of the measure, participants and supporters were offered daily support via app notifications, emails and/or WhatsApp. They were also made aware of existing stop-smoking programmes. Finally, prizes were raffled off among the successful participants. A total of 6,386 individuals registered to take part. Of these, 550 individuals registered with a person of their choice to support them. Smokers were predominantly female (56.5%) and on average 42.9 (SD=13.2) years old. They came from all federal states in Germany, with a disproportionately high number from the federal states of Bremen, Schleswig-Holstein, Berlin, North Rhine-Westphalia, Hamburg and Bavaria in relation to the population distribution. Compared to a representative sample from a study by the Robert Koch Institute (2012), they reported a significantly higher subjective socio-economic status. Of the participants, 79.3% categorised their addiction as high. Regular use of more than one nicotine products occurred in 35.3% of the sample; 39.8% of the participants stated that they had not tried to stop smoking during the last 12 months. The number of smokers participating in the program is encouraging. In addition to an efficacy study, it should be examined in subsequent years how more males and individuals with a low subjective social status can be encouraged to initiate smoking cessation.

Getting breastfeeding started under pandemic visiting restrictions: lessons learned in Germany

BackgroundThe COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions.MethodsIn the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth.ResultsIn almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part.ConclusionsThe unprecedented visiting restrictions in hospitals during the pandemic were like an “experiment” born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital.Trial registrationGerman Clinical Trials Register (DRKS) (DRKS00027975).

Structural controls on hydrothermal fluid flow in a carbonate geothermal reservoir: Insights from giant carbonate veins in western Germany

This study examines the impact of polyphase tectonics on the development of structurally controlled hydrothermal fluid pathways in carbonate geothermal reservoirs. Our case study focuses on hydrothermal carbonate veins and vein-filled faults in Devonian carbonates from the North Rhine-Westphalia region in western Germany, currently being explored as a potential low-enthalpy geothermal reservoir at depths of 4–5 km. These veins, which can be up to 20 m thick, are subvertical and strike NNW, N, or ESE. They exhibit pinch-and-swell undulating geometries, faulted vein-wall contacts, and occasional fillings of hydrothermal breccias. Vein-filled normal faults show hybrid shear-dilatant openings, with fault tips characterized by horsetail vein terminations. The textures, orientations, and age of the veins suggest their formation at low confining pressures and at depths < 2 km during the Post-Variscan East-West extension. Orthogonal North- and East-striking strike slip faults, inherited from the Variscan orogeny, were likely reactivated during post-Variscan extension, with a significant dilatant component that formed the observed veins. In the Ruhr Basin, the dilation tendency analysis indicates that NNW-striking veins or joints are optimally oriented for re-opening under the current strike-slip stress regime, characterized by NNW-trending maximum horizontal stress. The intersections of fractures may currently create moderately SSE-plunging linear zones of enhanced fluid flow. The main uncertainty regards the presence of similar structures at geothermal reservoir depths of ∼4–5 km in the Middle Devonian carbonates underneath the Ruhr Basin. As the study veins are likely to have formed at depths <2 km, the existence of analogous dilatant conduits at greater depths remains speculative. Eventually, we propose that zones characterized by open discontinuities and channelized fluid flow in carbonate geothermal reservoir in strike-slip tectonic settings can be: (a) dilational jogs between overlapping strike-slip faults, (b) bends along faults, and (c) strike-slip fault terminations with horsetail extensional structures. These zones can also be prone to enhanced karstification.

Almanya’da Büyüyen Türk Öğrencilerin Türkçe Konuşmada Yaptıkları Telaffuz Hatalarının İncelenmesi

In the context of the labor migration agreement, the children of the first generation who arrived in the Federal Republic of Germany in 1961 often faced academic failure due to their lack of proficiency in German. Aware of this, the second and third-generation families started speaking predominantly German at home to help their children learn the language better, pushing Turkish to the background. Since speaking is the most common means of communication in society, effective communication largely depends on clear and correct speech. However, due to the phonetic differences between German and Turkish, children often make pronunciation errors when speaking. The aim of this study is to identify the causes of Turkish pronunciation errors among Turkish-origin students raised in Germany and to propose solutions. This research utilizes a case study within a qualitative research framework. Data collection was conducted through observation and interviews, and the data were analyzed using content analysis. In this study, sound recordings from six classrooms in two primary schools 62 students in North Rhine-Westphalia (NRW), Germany, were examined, and the causes of pronunciation errors, along with suggestions for correcting these errors, were provided. The findings reveal that although children are raised bilingually, they grow up in an environment where German is more dominant than Turkish. As a result, they tend to apply German language rules to Turkish when speaking, leading to pronunciation errors. Additionally, factors such as families speaking with dialects at home, the increase in intercultural marriages, similarities between some German and Turkish words, and differences in the letters of the two languages the number of pronunciation errors increases and contribute to these pronunciation errors. Keywords: Turkish-origin students, bilingualism, speech, pronunciation errors, stress

Prediction of depressive symptoms severity based on sleep quality, anxiety, and gray matter volume: a generalizable machine learning approach across three datasets

Depressive symptoms are rising in the general population, but their associated factors are unclear. Although the link between sleep disturbances and depressive symptoms severity (DSS) is reported, the predictive role of sleep on DSS and the impact of anxiety and the brain on their relationship remained obscure. Using three population-based datasets (N=1813), we trained the machine learning models in the primary dataset (N=1101) to assess the predictive role of sleep quality, anxiety problems, and brain structural (and functional) measurements on DSS, then we tested our models' performance in two independent datasets (N=378, N=334) to test the generalizability of our findings. Furthermore, we applied our model to a smaller longitudinal subsample (N=66). In addition, we performed a mediation analysis to identify the role of anxiety and brain measurements on the sleep quality and DSS association. Sleep quality could predict individual DSS (r=0.43, R2=0.18, rMSE=2.73), and adding anxiety, contrary to brain measurements, strengthened its prediction performance (r=0.67, R2=0.45, rMSE=2.25). Importantly, out-of-cohort validations in other cross-sectional datasets and a longitudinal subsample provided robust similar results. Furthermore, anxiety scores, contrary to brain measurements, mediated the association between sleep quality and DSS. Poor sleep quality could predict DSS at the individual subject level across three datasets. Anxiety scores not only increased the predictive model's performance but also mediated the link between sleep quality and DSS. The study is supported by Helmholtz Imaging Platform grant (NimRLS, ZTI-PF-4-010), the Deutsche Forschungsgemeinschaft (DFG, GE 2835/2-1, GE 2835/4-1), the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation)-Project-ID 431549029-SFB 1451, the programme "Profilbildung 2020" (grant no. PROFILNRW-2020-107-A), an initiative of the Ministry of Culture and Science of the State of Northrhine Westphalia.

Trial of labour after two caesarean sections (TOLA2C) and risk of uterine rupture, a retrospective single centre study

BackgroundMost German hospitals do not offer a trial of labour after two caesarean sections (TOLA2C). TOLA2C is claimed to be associated with too many complications, above all the high risk of uterine rupture. The objective of this study is to review our experience with TOLA2C, with special attention paid to the risk and probability of uterine ruptures. Secondary outcomes include comparing neonatal and maternal outcomes in the group of TOLA2C with the group of elective repeat caesarean section (ERCS) and to assess the success rate for vaginal birth after two caesarean sections (VBAC-2).MethodsThe retrospective cohort study was conducted in a community hospital in North Rhine-Westphalia. Inclusion criteria were all pregnant women with two caesarean sections in their medical history, with a current vertex singleton pregnancy and the absence of morphological abnormalities of the foetus, who gave birth in our facility between January 2015 and June 2021. Descriptive statistics were calculated and Kolmogorov-Smirnov tests, Mann-Whitney U tests, Fishers exact tests, Chi2 –tests and t-tests for independent samples were performed.ResultsA total of 91 cases were included in the TOLA2C-group. These were compared to 99 cases that, within the same time frame, had an elective repeat caesarean section (ERCS-group). There was no statistically significant difference found in the neonatal outcome between the two groups (except for the neonatal pH-value: p 0.024). The hospital stay was significantly shorter in the TOLA2C-group, while maternal complication rates were almost similar (13.2% in the TOLA2C-Group, vs. 16.2% in the ERCS-Group). The success rate for TOLA2C was 55%. No complete uterine rupture was found, but in three cases an incomplete rupture (3.3% rate for incomplete uterine ruptures) occurred, but had no influence on the neonatal outcome.ConclusionTOLA2C is not associated with a worse maternal or neonatal outcome compared to ERCS, and especially the risk of complete uterine ruptures seems to be low. TOLA2C should be more widely offered to suitable patients who are motivated for it.

Attitudes of Nursing Home Managers Regarding Cognitively Stimulating Activities in People With Dementia: A Multicentre Cross-Sectional Study.

Group-based cognitive stimulation has shown short-term benefits for the cognitive outcomes of people with dementia living in nursing homes (NH). However, group participation can be a barrier for people with advanced dementia, bedridden people or isolated people. The CogStim24 project seeks to develop and implement a new psychosocial intervention based on cognitively stimulating (CS) activities integrated into daily nursing care. As part of the intervention development process, this study aimed to survey NH managers' attitudes and describe currently used approaches to CS activities in German NH. We performed a multicentre cross-sectional study between September and December 2021 in randomly recruited NH in the German federal state of North Rhine-Westphalia. NH representatives were asked to fill in a self-developed online questionnaire. We analysed data descriptively, presenting means and standard deviations. For case scenario questions, we used a summative content analysis. We contacted 354 NH and 106 agreed to participate. Representatives of 64 facilities completed the survey. Almost all stated to have implemented CS activities. Cognitive exercises (98%), physical and relaxation exercises (98%) and reminiscence therapy (95%) were most often used. The majority (96%) thought that CS activities could support people with dementia in maintaining their cognitive functions and that nurses should have a key role in the implementation of CS activities. More than half believed that regular CS activities were easy to implement alongside routine nursing care. Results indicate that CS activities are frequently applied in German NH. The positive attitude of NH managers regarding the implementation and effects of CS activities is an important implementation resource. Nursing staff should be more involved in providing CS activities for people with dementia. Training, information, and implementation material must be made available for nursing staff who wish to have an active role in providing CS activities.

Mortality from prostate cancer in the years 2007–2021 in North Rhine-Westphalia, Germany

BackgroundThe crude mortality rate and the lifetime mortality risk from prostate cancer in Germany are above international average. However age-standardised mortality and years of life lost per capita from prostate cancer are declining. This study analyses the mortality-related measures for the federal state of North Rhine-Westphalia (NRW) in Germany.MethodsBased on the cause of death statistics and data from the NRW State Cancer Registry on 45,300 deaths in the years 2007–2021, mortality rates, the lifetime mortality risk from prostate cancer, median age at death and years of life lost are presented. Additionally, the 15 most frequent causes of death of 95,013 patients diagnosed with prostate cancer are reported.ResultsWith a stable lifetime mortality risk from prostate cancer, age-standardised mortality and years of life lost per capita are decreasing while crude mortality and median age at death are increasing in NRW. Less than half of the patients die from their prostate cancer. Cancers of the urinary bladder and other urinary organs also occur more frequently as a cause of death than it would be expected based on the age-specific risk in the total population.ConclusionsMore people in North Rhine-Westphalia are dying of prostate cancer over time due to demographic ageing alone. At the same time, the age-specific mortality risk has not increased and when patients die of prostate cancer, it is at an increasingly older age. However, there is a statistical association with deaths from cancers of the lower urinary tract in patients diagnosed with prostate cancer, which demands further evaluation.