IntroductionGerman government regulations such as physical distancing and limited group numbers, designed to curb the spread of COVID-19, have had far-reaching consequences for the very foundations of social life. They have, to name only a few, transformed greetings and goodbyes, blurred private and public worlds, and complicated basic communication with mandatory mask wearing. The ethnographic study CoronaCare investigates how these sociopolitical measures affect social health, a form of health which unfolds through and across social relations. It explores how caring as a fundamental human activity and one integral to sustaining social health is impacted when in-person and person-to-person contacts are restricted and everyone is radically redefined as at risk from others and a risk to others. It explores care relationships, relationships involving the giving or receiving of care in everyday life, institutional settings such as an assisted living facility, and informal settings, such as a housing block. Inside of the pandemic, relationships are a pivotal site at which the negotiation of caring and risk is intensified and where the consequences for social health and social life more generally are pronounced.Methods and analysisThis ethnographic project aims to understand the tensions that arise in the lives of individuals and communities living under the sociopolitical regulations and to analyse the tacit forms of practice that individuals and communities develop to uphold social health. Fueled by citizen science, the ethnography uses a variety of methods namely telephone and video interviews with 60–70 research participants, the collection of ethnographic material including video and audio diaries, storyboards, first-person camera footage, photographs and a survey to enrich the sample description based on the Copenhagen Psychosocial Questionnaire. The analysis will draw on elements of grounded theory and through the aid of the qualitative software MAXQDA it will rigorously document and explain how the social regulations are (re)shaping our ability to be cared for and to care for one another. The survey data will be analysed through the use of the quantitative software programme R.Ethics and disseminationThe ethics committee of the Brandenburg Medical School Theodor Fontane has approved the project (E-01-20200605). The dissemination strategy includes publications in medical, sociological and research methods journals, as well as a stakeholder discussion with political and civil society leaders where the research team will present its recommendations for future pandemic preparedness.
Introduction: Evidence on the association of socioeconomic deprivation with occurrence of acute myocardial infarction (AMI) is available from international studies and urban settings in western Germany. This study aimed to assess this association based on small geographical areas in a rural setting in eastern Germany. Methods: This study used routine data of all patients with AMI who were treated in the Hospital Brandenburg in the city of Brandenburg, Germany, between May 2019 and May 2020.Hospitalisation rates of AMI were calculated for postal code regions that were located within the catchment area of the Hospital Brandenburg. Poisson regression was used to compare hospitalisation rates in areas with medium socioeconomic deprivation to areas with high deprivation, controlling for age group, sex and period (before or during COVID-19 pandemic). Publicly available social, infrastructure and healthcare-related features were mapped to characterise the study region. Results:In total, 265 cases of AMI were registered in the study area, which comprised 116,126 inhabitants. The city of Brandenburg was characterised by the highest level of socioeconomic deprivation, while neighbouring areas showed a rural settlement structure and medium levels of deprivation. The number of general practitioners per 10 000 inhabitants did not differ between both areas. The adjusted rate ratio comparing hospitalisations due to AMI in areas with medium socioeconomic deprivation to areas with high socioeconomic deprivation was 0.71 p=0.01). Conclusion:This study adds evidence about the association of socioeconomic deprivation and AMI occurrence from a rural area in eastern Germany. Further research about the relationship of socioeconomic deprivation and cardiovascular health is needed from heterogeneous contexts.
ZusammenfassungDie Covid-19 Pandemie stellt das öffentliche, private und berufliche Leben vor große Herausforderungen. Das ethnografische Forschungsprojekt CoronaCare untersucht das alltägliche Leben von Menschen während der Covid-19 Pandemie in Deutschland mit Fokus auf die soziale Gesundheit und Sorgebeziehungen. Ziel war es, aus den Ergebnissen Empfehlungen für künftige Pandemieplanungen zu entwickeln, um deren Fokus um soziale Gesundheit zu erweitern. Gemeinsam mit Akteur*innen aus den Bereichen Wissenschaft, Gesundheits- und Sozialverwaltung auf lokaler und Länderebene, aus Pflegeeinrichtungen sowie Sozialverbänden wurden auf Basis empirisch begründeter Fallvignetten im Rahmen von drei Workshops zwischen Juni und November 2021 Handlungsempfehlungen für die Pandemieplanung formuliert, welche die Spannungsverhältnisse adressieren, denen Pflegekräfte während der Pandemie ausgesetzt sind. Die herausgearbeiteten Spannungsverhältnisse betreffen sowohl den Berufs- und Arbeitsethos als auch das private und berufliche Handeln der Arbeitskräfte und verweisen darauf, dass es sich bei Pandemieplanung um ein sogenanntes wicked problem handelt, bei dem es nur relationale, aber keine eindeutigen Lösungen geben kann. Daraus ergeben sich folgende Handlungsempfehlungen: 1. das grundsätzliche Spannungsverhältnis zwischen dem menschlichen Bedürfnis zu sorgen und zu versorgen und den Eindämmungsmaßnahmen der Pandemieplanung benennen und anerkennen; 2. die Pandemie lokal verstehen und gestalten; 3. eine enge Zusammenarbeit auf kommunaler Ebene zwischen Gesundheits-, Sozial-, Familienpolitik und Verwaltung gestalten; und 4. individuelle Gestaltungsfreiräume schaffen, um ethische Reflexionen des pflegerischen Handelns zu eröffnen. Für eine Pandemieplanung verstanden als wicked problem bedeutet das, dass Maßnahmen als Empfehlungen, nicht als festgelegte Regeln, ausgesprochen werden sollten, um Handlungsspielräume für eine am Individuum angepasste gute Versorgung zu ermöglichen. Politisch sollten diese flankiert werden mit eindeutig formulierten, stabilen Handlungsanleitungen („Handlungsplanken“). Unterstützt sollten diese durch regelmäßige Schulungen von Mitarbeiter*innen, um Prinzipien von Schutzmaßnahmen und Ziele der Pandemieplanung zu verstehen und damit Handlungsspielräume und eigene Abwägungsprozesse zu ermöglichen. Die entwickelten Workshop-Formate können als Form des multidimensionalen Wissenstransfers in einer gesellschaftlich herausfordernden Situation Berücksichtigung finden.
There is growing recognition of the importance of the residential environment for early detection of cancer. However, few studies have investigated area socioeconomic deprivation, social capital, and rurality in combination. Therefore, we aimed to estimate mutually adjusted associations of these characteristics with tumour size at diagnosis in Germany. We included incident cases of female breast cancer, colorectal cancer, malignant melanoma, uterine cancer, and male bladder cancer, collected by the cancer registries of eight German federal states between 2010 and 2014. Using information on T status at diagnosis, we defined an advanced tumour size for each cancer type. Sex‐specific mutually adjusted associations of area socioeconomic deprivation, social capital, and rurality with an advanced tumour size and variance partition coefficients were estimated in multilevel logistic regression. Missing data of the outcome were addressed by multiple imputation. Overall, 386 223 cases were included in this analysis. High area socioeconomic deprivation was associated with an advanced tumour size at diagnosis of colorectal cancer and malignant melanoma. For malignant melanoma, low social capital was associated with an advanced tumour size among females and males, while a rural settlement structure was associated with an advanced tumour size among males only. Since meaningful general contextual effects were found for malignant melanoma, our results underscore that the residential environment is an important predictor of melanoma tumour size. Secondary prevention programmes for this cancer type should target areas with high area socioeconomic deprivation, low social capital, and a rural settlement structure in order to reach those most vulnerable.
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