Background: Young people in European countries are experiencing high levels of alcohol and drug use and escalating levels of sexually transmitted infections. Individually these represent major public health priorities. Understanding of the association between sex and substance use, and specifically the strategic roles for which young people utilise substances to facilitate sexual activity, remains limited.

Within nightlife settings, youth violence places large burdens on both nightlife users and wider society. Internationally, research has identified risk factors for nightlife violence. However, few empirical studies have assessed differences in risk factors between genders. Here, a pan-European cross-sectional survey of 1,341 nightlife users aged 16 to 35 assessed a variety of risk-taking traits, including violence, sexual, alcohol, and drug-related current and historic behaviors. Results show that the likelihood of having been involved in a physical fight in nightlife increases with younger age, drunkenness, and increasing preference for tolerant venues for both genders. The odds of involvement in a fight for females who were drunk five or more times in the past 4 weeks were almost five times higher than those who were never drunk (odds ratio for males 1.99). Use of cocaine more than doubled the risk of involvement in violence among males. However, no association was found for females. For heterosexual men, the odds for violence almost doubled compared with bisexual or homosexual men, whereas for women heterosexuality was a protective factor. The effects of structural risk factors (e.g., bar and club characteristics) for nightlife violence differed by gender. To develop effective violence prevention measures in nightlife, considerations need to be made regarding the demographic composition of patrons in addition to wider structural elements within the nighttime environment.

BackgroundIn Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients’ complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation.MethodsThirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support.The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology.ResultsThe results of this paper predominantly focus on GPs’ perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option.ConclusionsThe cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.

Measures to improve doctor office infrastructure and to enhance responsiveness towards patients under the age of 35 years and those with health problems are vital to increase responsiveness.

High levels of substance use contribute to violence being a relatively common feature of young people's visits to international holiday resorts. To protect the health and well-being of holidaymakers and local populations in popular resorts, violence and substance use prevention must adapt to an increasingly globalized nightlife.