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Background Gender-affirming hormones do not completely suppress fertility in transgender and gender diverse individuals, highlighting the need for counseling on pregnancy risk and contraceptive options. However, research on current contraceptive care is limited. Studies from the US have identified several barriers to care as well as facilitators, but no studies on this topic have yet been conducted in Europe. This study examined transgender and gender diverse contraceptive care in Germany from the perspective of healthcare providers, assessing its importance and their roles in it, as well as exploring barriers and facilitators. Methods Thirty semistructured qualitative interviews with German healthcare providers were conducted between December 2023 and February 2024. The interview guide included questions on contraceptive care for transgender and gender diverse individuals. Data were analyzed using structuring qualitative content analysis (Kuckartz) with deductive and inductive category development. Results Most interviewees highlighted the need for contraceptive care, depending on various factors such as the type of gender-affirming care applied, sexual practices, and transgender and gender diverse individuals’ desire for pregnancy prevention. Half of the interviewees also offered contraceptive care (depending on their specialization). Numerous barriers to contraceptive care, such as a lack of awareness of contraceptive needs, insufficient research and training programs for medical staff, have been reported, highlighting the importance of facilitators for care such as the implementation of contraceptive counseling as a standard protocol. Conclusion To improve contraceptive care for transgender and gender diverse individuals, the establishment of clear structures and responsibilities, more research, and qualifications among the involved specialties are needed. To gain a comprehensive understanding of the care situation, future research should include the perspectives of transgender and gender diverse individuals. Trial registration We obtained the approval of the Hamburg Medical Council (“Ärztekammer Hamburg”) to conduct our study by means of a “scientific case” (2023-300381-WF, September 11th 2023). Plain english summary Transgender and gender diverse people experience persistent incongruence between their experienced gender identity and their sex assigned at birth - diagnosed as gender incongruence. Many use gender-affirming hormones, such as testosterone or estrogen, to match gender identity and body. These hormones decrease the ability to get pregnant but do not stop it completely. That’s why it is important to give this population information about pregnancy risks and contraceptive options. So far, most research on this topic has come from the US, but little is known about the situation in Europe. This study looked at how healthcare providers in Germany think about contraceptive care for transgender and gender diverse people and how they experience care provision. Thirty healthcare providers (medical doctors and psychologists) in Germany were interviewed between December 2023 and February 2024. Most healthcare providers said they believed contraceptive care was important for transgender and gender diverse people, depending on factors like the type of hormones used and sexual practices, and half of the healthcare providers also offered contraceptive care. Some common challenges included a lack of knowledge about contraception for transgender and gender diverse people, lack of research, and limited training of medical staff. Healthcare providers said that better contraceptive care for transgender and gender-diverse people in Germany needs more research, clear protocols or guidelines, as well as more training for healthcare providers. Future studies should also ask transgender and gender diverse people themselves about their needs and experiences.

The Gram-negative bacilli Serratia spp., Providencia spp., Morganella morganii, Citrobacter freundii complex, Enterobacter spp. and Klebsiella aerogenes are common Enterobacterales that may harbor inducible chromosomal AmpC beta-lactamase genes. The purpose of the present study was to evaluate treatment outcomes and identify predictors of early treatment response in patients with bloodstream infection caused by potential AmpC beta-lactamase-producing Enterobacterales (SPICE-BSI). This cohort study included adult patients with SPICE-BSI hospitalized between 01/2011 and 02/2019. The primary outcome was early treatment response 72 h after the start of active treatment, defined as survival, hemodynamic stability, improved or stable SOFA score, resolution of fever and leukocytosis and microbiologic resolution. Among 295 included patients, the most common focus was the lower respiratory tract (27.8%), and Enterobacter spp. (n = 155) was the main pathogen. The early treatment response rate was significantly lower (p = 0.006) in the piperacillin/tazobactam group (17/81 patients, 21.0%) than in the carbapenem group (40/82 patients, 48.8%). Independent negative predictors of early treatment response (p < 0.02) included initial SOFA score, liver comorbidity and empiric piperacillin/tazobactam treatment. In vitro piperacillin/tazobactam resistance was detected in three patients with relapsed Enterobacter-BSI and initial treatment with piperacillin/tazobactam. In conclusion, our findings show that piperacillin/tazobactam might be associated with early treatment failure in patients with SPICE-BSI.

Adolescents spend a critical amount of their free time on the Internet and social media. Transgender and gender-diverse (TGD) adolescents, who report elevated rates of mental health issues, especially internalizing problems, have both positive and negative online social experiences (e.g., support and cyberbullying). This can have both beneficial and/or harmful effects on their mental health. Given the lack of research, the present study examined TGD adolescents’ online (social) experiences and the association of positive and negative online social experiences with internalizing problems. The sample consisted of n = 165 TGD adolescents (11–18 years) diagnosed with gender dysphoria who attended a Gender Identity Service for children and adolescents (Hamburg GIS) in Germany between January 2020 and December 2022 during the COVID-19 pandemic. Positive (use of online support networks) and negative online social experiences (cyberbullying or other adverse online interactions) were assessed using study-specific items and internalizing problems using the Youth Self-Report. Frequencies of various online (social) experiences were analyzed, and a multiple linear regression analysis was performed to test their association with internalizing problems. In total, 42% of participants reported positive online social experiences (use of online support networks) and 51% of participants reported negative online social experiences (cyberbullying or other adverse online interactions). There was no significant association between negative online social experiences and internalizing problems but between positive online social experiences and more internalizing problems (adjusted R2 = .01). TGD adolescents may seek online support, especially when struggling with mental health problems. Therefore, it is crucial to support youth navigating these online spaces more safely and positively and to empower them to buffer against potentially harmful experiences. Furthermore, strengthening offline relations with peers and family members is pivotal, given their importance for TGD adolescents’ mental health.

Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11–18 years, M age  = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% ( n  = 332) of the sample identified as binary and 10% ( n  = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.

Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its’ approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs.

Green Public Procurement can incentivize commercial investment in developing and adapting environmentally friendly products and services. However, the complexity of green aspects is a large obstacle for German procurers to include them in their tenders. Moreover, rigid public structures constitute an additional hurdle. The participation of engaged citizens in the public procurement process can counteract these obstacles. People-Public-Private Partnerships integrate engaged citizens and their expertise as end-users into the procurement process to support procurers. Due to the increasing public concern with regard to environmental issues, the potential for introducing People-Public-Private Partnerships is particularly high for Green Public Procurement. Eine Umweltfreundliche Offentliche Beschaffung kann die Anreize von Unternehmen erhohen in die Entwicklung und Adaption von umweltfreundlichen Produkten und Dienstleistungen zu investieren. People-Public-Private-Partnerships integrieren die engagierte Bevolkerung und ihre Expertise als Endnutzende zur Unterstutzung der Beschaffenden in den Beschaffungsprozess. Insbesondere aufgrund des zunehmenden offentlichen Interesses an umweltrelevanten Themen ist das Potenzial fur die Einfuhrung von People-Public-PrivatePartnerships innerhalb der Umweltfreundlichen Offentlichen Beschaffung hoch. Dieser Losungsansatz wurde von Schulerinnen des St. Raphael Gymnasiums in Heidelberg fur den Schulerwettbewerb YES! Young Economic Summit analysiert und weiterentwickelt.

Eine Umweltfreundliche Öffentliche Beschaffung kann die Anreize von Unternehmen erhöhen in die Entwicklung und Adaption von umweltfreundlichen Produkten und Dienstleistungen zu investieren. People-Public-Private-Partnerships integrieren die engagierte Bevölkerung und ihre Expertise als Endnutzende zur Unterstützung der Beschaffenden in den Beschaffungsprozess. Insbesondere aufgrund des zunehmenden öffentlichen Interesses an umweltrelevanten Themen ist das Potenzial für die Einführung von People-Public-Private-Partnerships innerhalb der Umweltfreundlichen Öffentlichen Beschaffung hoch. Dieser Lösungsansatz wurde von Schüler:innen des St. Raphael Gymnasiums in Heidelberg für den Schülerwettbewerb YES! Young Economic Summit analysiert und weiterentwickelt. Green Public Procurement can incentivize commercial investment in developing and adapting environmentally friendly products and services. However, the complexity of green aspects is a large obstacle for German procurers to include them in their tenders. Moreover, rigid public structures constitute an additional hurdle. The participation of engaged citizens in the public procurement process can counteract these obstacles. People-Public-Private Partnerships integrate engaged citizens and their expertise as end-users into the procurement process to support procurers. Due to the increasing public concern with regard to environmental issues, the potential for introducing People-Public-Private Partnerships is particularly high for Green Public Procurement.

The cytosolic accumulation of mitochondrial precursors is hazardous to cellular fitness and is associated with a number of diseases. However, it is not observed under physiological conditions. Individual mechanisms that allow cells to avoid cytosolic accumulation of mitochondrial precursors have recently been discovered, but their interplay and regulation remain elusive. Here, we show that cells rapidly launch a global transcriptional programme to restore cellular proteostasis after induction of a ‘clogger’ protein that reduces the number of available mitochondrial import sites. Cells upregulate the protein folding and proteolytic systems in the cytosol and downregulate both the cytosolic translation machinery and many mitochondrial metabolic enzymes, presumably to relieve the workload of the overstrained mitochondrial import system. We show that this transcriptional remodelling is a combination of a ‘wideband’ core response regulated by the transcription factors Hsf1 and Rpn4 and a unique mitoprotein-induced downregulation of the oxidative phosphorylation components, mediated by an inactivation of the HAP complex. Boos et al. show that impairing mitochondrial protein import induces a global transcriptional response to activate the ubiquitin–proteasome system and heat stress response and repress oxidative phosphorylation genes.​

Background Breast cancer and cervical cancer are among the most common cancers in women in Germany. Early detection examinations such as mammography and the cervical smear test (Pap-test) have been shown to contribute to the reduction in the mortality and/or incidence of these cancers and can be utilised free of charge by women in certain age groups as part of national screening programmes. Analyses show that the use of health services varies regionally, especially when comparing the federal states of the former German Democratic Republic (GDR, Eastern Germany) and the Federal Republic of Germany (FRG, Western Germany). This study investigated to what extent the utilisation of mammography examinations and Pap-tests by women differs in federal states of former GDR and FRG. Methods For this purpose, we analysed data from the nationwide health survey GEDA14/15 conducted by the Robert Koch Institute (RKI) in 2014 and 2015. We calculated weighted proportions and compared attendance between eastern and western German states by a Chi-Square-test. Additionally, we conducted regression analysis to adjust for socio-economic status, living environment and place of birth. Results 2,772 female participants aged 20–34 years were analysed for Pap-test attendance in the last two years and 4,323 female participants aged 50–69 years old were analysed for mammography screening attendance in the last two years. 50–69-year-old women in eastern German states were with 78.3% (95%-CI 75.3%, 81.2%) more likely to attend mammography screening than in western Germany with 73.4% (95%-CI 71.8%, 74.9%). Pap-test uptake was statistically significantly higher in the East of Germany with 83.3% (95%-CI 79.6%, 87.1%) compared to 77.5% (95%-CI 75.8%, 79.3%) in the West of Germany. This relationship was robust to adjusting for socio-economic status, living environment and place of birth. Conclusions Cultural influences and socialization in the GDR might explain the higher utilisation of these cancer screening examinations at least to some extent. This could have many reasons, for example a higher health awareness through education or a possible greater trust in medical structures and the associated higher compliance of women. These hypotheses should be further explored to increase the uptake of screening examinations by women in Germany.

Background The reduction of violence risk and crime recidivism is the core marker of progress in forensic psychiatry treatment for mentally disordered offenders, and commonly used to decide upon discharge from prison-based security clinics. While dynamic risk is expected to relate to treatment progress, static risk is expected to predict discharge from prison-based treatments. Integrated risk-protection assessment is thought to facilitate prediction of treatment outcome. Methods In a two-year prospective observational cohort study using a repeated measures design, we monitored treatment as usual induced changes in violence and protective factors, in 117 offenders of a medium-security forensic clinic in Switzerland. Mixed-effects and multinomial logistic regression models were used to predict longitudinal risk and protection evolution, length of stay, and discharge locations. Results Forensic psychiatry treatment was indeed associated with decrease in dynamic risk and enhanced protection, contrary to static risk. After 18–24 months of treatment, protective factors counterbalanced risk factors. For risk, both a numeric scale and a structured professional judgement approach equally showed significant improvement over time. For protection and integrated risk-protection, structured professional judgement ratings failed to show significant treatment-related change. Discharge to low-security psychiatry wards was predicted only by favorable baseline risk, protection, and integrated risk-protection, but not by their treatment-related evolution. Longer length of stay was predicted by higher baseline total risk only. Conclusions Study results confirm the need to distinguish dynamic from static risk in forensic psychiatric treatment monitoring, and to include integrated risk-protection measures. Treatment length and discharge are predicted by the offenders’ baseline risk profile, but not by the evolution of risk and protection factors. A structured professional judgment approach in risk and protection assessment leads to different longitudinal results than the use of numeric scale scores.