Fulda University of Applied Sciences

The Nutrition and Health Claims Regulation (NHCR) has introduced a new regulatory perspective in food manufacturing, along with influencing consumers’ perception of health-related food claims. Since 2006, a new standard of science-based claims has significantly impacted the European health food market. Over the years, numerous additional decisions have been made, and the ongoing process remains challenging for policymakers striving to harmonize consumer protection and trade within and outside the European Union (EU). This paper presents the current state of the NHCR’s implementation, along with key events aimed at enhancing understanding among consumer organizations and food industry stakeholders, while also offering an insider perspective on relevant policy issues. Additionally, we address two pertinent policy issues to elucidate the associated challenges and opportunities, providing insights to support informed decision-making by policymakers. We use the nutrient profiles framework as a case study to illustrate considerations underpinning the objective of “consumer protection”, while the “probiotics” market serves as an example for exploring the goal of “facilitation of trade”. This historical perspective and reflection lead us to propose possible solutions for future food regulation.

Background Children and adolescents extensively use the internet in their daily lives, often seeking information related to health and well-being. In modern society, the volume of health information available in digital environments is constantly increasing. This includes both reliable and misleading content, making it challenging to assess trustworthiness. Digital health literacy is essential for navigating the digital information ecosystem, protecting oneself from misinformation, and making informed health decisions. Objective This representative study aims to examine the digital health literacy of children and adolescents in Germany and its association with sociodemographic factors. Methods A cross-sectional study design with face-to-face interviews was utilized to collect data from 1448 children and adolescents aged 9-18 years in Germany between October and November 2022. Digital health literacy was assessed using an adapted and translated version of the Digital Health Literacy Instrument (DHLI), which comprises 7 subscales: operational skills, navigation skills, information searching, self-generated content, evaluating reliability, protecting privacy, and determining relevance. Bivariate and binary logistic regression analyses were conducted to examine associations between digital health literacy subscales and sociodemographic characteristics (sex, age, migration background, school type, and perceived family affluence). Results The study found that 419 out of 1362 (30.76%) children and adolescents had a problematic level of digital health literacy, while 63 out of 1362 (4.63%) had an inadequate level. Overall, the least difficulties were observed in operational skills and determining relevance, whereas the greatest challenges were related to protecting privacy and navigation skills. Age was significantly associated with 6 of the 7 subscales (excluding protecting privacy), with younger children (9-11 years) facing a higher risk of limited skills (operational skills: odds ratio [OR] 5.42, P=.002; navigation skills: OR 4.76, P<.001; information searching: OR 4.68, P<.001; adding self-generated content: OR 7.03, P<.001; evaluating reliability: OR 3.82, P<.001; and determining relevance: OR 4.76.42, P<.001). Migration background was associated with fewer limited digital health literacy skills, while low perceived family affluence was associated with more limited skills. In the subscales of information searching, self-generated content, and evaluating information reliability, a lower risk of limited skills was observed among those with a 2-sided migration background (information searching: OR 0.62, P=.02; adding self-generated content: OR 0.30, P=.003; and evaluating reliability: OR 0.66, P=.03). By contrast, a higher risk was found among those with low perceived family affluence, including in the subscale of determining relevance (information searching: OR 2.18, P<.001; adding self-generated content: OR 1.77, P=.01; evaluating reliability: OR 1.67, P<.001; and determining relevance: OR 1.58, P<.001). Although school type was not associated with any dimension, sex was linked to operational skills, with females having an increased risk of limited skills (OR 1.58, P=.03). Conclusions The results highlight a strong need for interventions to improve digital health literacy among children and adolescents, particularly in protecting privacy, navigation skills, and evaluating the reliability of health information. Effective interventions should be tailored to address the varying needs associated with age, migration background, and family affluence.

Background A negative body image can have an impact on developing and maintaining obesity. Using virtual reality (VR) to conduct cognitive behavioral therapy (CBT) is an innovative approach to treat people with obesity. This multicenter non-randomized pilot study examined the feasibility and the effect on eating behavior and body perception of a newly developed VR system to conduct body image exercises. Methods Participants with a body mass index (BMI) ≥ 30.0 kg/m² without severe mental diseases attended three study visits in an interval of one to four weeks to receive virtual (VR intervention) or traditional (non-VR intervention) body image exercises. Data on anthropometrics, eating behavior (Dutch Eating Behavior Questionnaire, DEBQ), body perception (Body Shape Questionnaire, BSQ; Multidimensional Assessment of Interoceptive Awareness, MAIA), and satisfaction (standardized interview and questionnaire) were collected. Results In total, 66 participants (VR intervention: 31, non-VR intervention: 35) were included. The majority was female (52/66, 78.8 %), the mean age was 45.0 ± 12.8 years, and the mean BMI was 36.8 ± 4.3 kg/m². Both intervention groups showed non-significant body weight reduction (VR intervention: 1.7 ± 3.3 %, non-VR intervention: 0.9 ± 3.0 %) and showed no statistically significant difference between the groups (p = 0.35). Scores of DEBQ, BSQ, and MAIA showed over time no statistically significant changes neither between the two groups nor within the groups (all p ≥ 0.05). The overall satisfaction of the VR group with the two virtual body image exercises was high (4.1 ± 0.8 on a 5-point Likert scale). Conclusions The intervention with the developed VR system was feasible and the virtual and traditional body image exercises resulted in statistically non-significant weight loss. It seems that single focus on body image is not successful in improving eating behavior and body perception in people with obesity. Long-term human intervention studies with larger sample sizes are necessary to examine the efficacy of integrating this kind of VR system into standard obesity therapy. Trial registration This study was registered in the German Clinical Trials Register (Registration number: DRKS00027906, Date of registration: 8th February 2022).

Objective: Individuals who experienced childhood maltreatment show an increased sensitivity to stressful events and are at greater risk for adult psychopathology. Leveraging the natural event of unintended pregnancy, this study aimed (a) to examine heterogeneity in posttraumatic stress disorder (PTSD) trajectories in the context of a stressful life event and (b) to increase our understanding of traumatized individuals’ perinatal mental health to inform mental health care integration into abortion and maternity service settings. Method: 189 individuals who either terminated (41%) an unintended pregnancy or carried it to term (59%) completed a self-report questionnaire of childhood maltreatment and a clinician-administered interview to assess lifetime trauma exposure and PTSD symptoms in the month prior to and 12 months after the end of the pregnancy. Hierarchical multiple regression analysis, t-tests, and change score analysis were conducted to investigate the interrelationships among childhood maltreatment, trauma exposure, and PTSD symptoms. Results: Participants most frequently reported sexual violence (25.83%), birth trauma (18.54%), or physical assault (16.56%) as their index trauma. Individuals with childhood maltreatment showed increased lifetime trauma exposure and exhibited greater PTSD symptoms 12 months after the unintended pregnancy. Childhood maltreatment did not predict a change in PTSD symptoms from pre- to postpregnancy. Conclusions: Childhood maltreatment is linked to increased PTSD symptoms that persist up to 1 year after an unintended pregnancy. These results have clinical implications for the inclusion of trauma-informed practices into reproductive care.

Zusammenfassung Hintergrund Gesundheitsorganisationen und Gesundheitsprofessionen haben großen Einfluss auf die Gesundheitskompetenz (GK) von Patient:innen (Pat.). Entscheidend ist, wie gut das Gesundheitssystem insgesamt die GK der Adressat:innen erkennt, fördert und dadurch fundierte Gesundheitsentscheidungen ermöglicht. Die Autorinnen vermuten, dass pflegeprofessionelle Strukturen und Prozesse – organisationale und professionelle Konzeptelemente zur Förderung der GK beinhalten – auch wenn sie von Pflegefachpersonen nicht als solche wahrgenommen oder benannt werden. Studiendesign Das Ziel der Studie ist, strukturelle und prozessbezogene Maßnahmen der Pflegeorganisation zu identifizieren, die zur Förderung und Stärkung der GK beitragen können. Dazu wurde eine ethnografisch-qualitative Untersuchung auf internistischen Stationen in sechs Kliniken durchgeführt. Die Daten wurden durch 12 teilnehmende Beobachtungen sowie Ad-hoc-Interviews erhoben. Die Datenanalyse erfolgte mittels inhaltlich strukturierender Inhaltsanalyse. Ergebnisse Zwischen den untersuchten Stationen lassen sich keine bedeutenden Unterschiede in der Pflegeorganisation feststellen. Die vermuteten pflegeprofessionellen Strukturen und Prozesse konnten in der Studie nicht beobachtet werden. Es konnten auch keine weiteren Strukturen oder Prozesse erfasst werden, die die GK der Pat. unterstützen würden. Ein höherer Qualifikationsmix wirkt sich reduzierend auf die Interaktionszeit zwischen Pflegefachperson und Pat. aus. Die Patient-Nurse-Ratio beeinflusst die Umsetzung gk-fördernder Maßnahmen weder positiv noch negativ. Diskussion Fehlendes Wissen über gk-fördernde Elemente in pflegeprofessionellen Prozessen sowie ein hoher Qualifikationsmix sind mögliche Gründe dafür, dass gk-fördernde Maßnahmen nicht umgesetzt werden. Zudem zeigt sich, dass Prozesse, die Elemente der GK integrieren könnten, in der Praxis nicht umgesetzt werden. Dies erklärt, warum eine strukturierte und prozesshafte GK-Förderung von Patient:innen in der akutstationären Versorgung häufig ausbleibt. Schlussfolgerung Ein Bewusstsein für die GK-Förderung im Stationsalltag sowie die kritische Auseinandersetzung mit gk-fördernden Elementen und deren Integration in pflegeorganisatorische Strukturen und Prozesse könnten eine gezielte und nachhaltige Förderung der GK der Pat. ermöglichen. Konzepte der organisationalen und professionellen GK sollten dabei in die Implementierung und Weiterentwicklung pflegeprofessioneller Strukturen und Prozesse einfließen.

The present article analyses the theme of circularity in the fashion industry, with particular attention to the role of technology in favoring the adoption of circular economic models. The article explores the role of technology in supporting the circular economy in the fashion industry, focusing on the implementation of circular business models by three companies: SHEIN, Ralph Lauren, and Cotopaxi. The aim is to investigate the challenges and opportunities associated with the adoption of circular economy practices in an industry known for its environmental impact. The research highlights how technology, particularly software such as Materia MX, can facilitate streamlined supply chains, reduced waste, and optimized resource efficiency, thus, overcoming obstacles such as high investment costs and supply chain complexities. The case studies demonstrate how each company has integrated circular practices, such as recycling, reusing materials, and improving transparency through technologies such as AI, blockchain, and IoT, to promote sustainability. Thus, the study emphasizes the importance of technological innovation in enabling a more sustainable and circular future for the fashion industry while addressing challenges related to consumer awareness, regulatory pressures, and infrastructure. The results suggest that technology is a key factor in the fashion industry’s transition to a circular economy, offering a competitive advantage and facilitating the achievement of environmental objectives.

Background For a growing number of food-based dietary guidelines (FBDGs), diet optimization is the tool of choice to account for the complex demands of healthy and sustainable diets. However, decisions about such optimization models’ parameters are rarely reported nor systematically studied. Objectives The objectives were to develop a framework for (i) the formulation of decision variables based on a hierarchical food classification system; (ii) the mathematical form of the objective function; and (iii) approaches to incorporate nutrient goals. Methods To answer objective (i), food groups from FoodEx2 levels 3-7 were applied as decision variables in a model using acceptability constraints (5th and 95th percentile for food intakes of German adults (n = 10,419)) and minimizing the deviation from the average observed dietary intakes. Building upon, to answer objectives (ii) and (iii), twelve models were run using decision variables from FoodEx2 level 3 (n = 255), applying either a linear or squared and a relative or absolute way to deviate from observed dietary intakes, and three different lists of nutrient goals (allNUT-DRV, incorporating all nutrient goals; modNUT-DRV excluding nutrients with limited data quality; modNUT-AR using average requirements where applicable instead of recommended intakes). Results FoodEx2 food groups proved suitable as diet optimization decision variables. Regarding deviation, the largest differences were between the four different objective function types, e.g., in the linear-relative modNUT-DRV model, 46 food groups of the observed diet were changed to reach the model’s goal, in linear-absolute 78 food groups, squared-relative 167, and squared-absolute 248. The nutrient goals were fulfilled in all models, but the number of binding nutrient constraints was highest in the linear-relative models (e.g. allNUT-DRV: 11 vs. 7 in linear-absolute). Conclusion Considering the various possibilities to operationalize dietary aspects in an optimization model, this study offers valuable contributions to a framework for developing FBDGs via diet optimization.