Accumulating data have shown that molecular aberrations have the potential to trigger the development of acute leukemia, and that the routine application of novel molecular biology technologies has facilitated the development of investigational drugs which target driver genetic mutations. In the last decade, a great number of clinical trials have been testing “druggable” mutations in the context of novel targeted therapies ,2.More recently, the importance of tumor (including bone marrow) microenvironment and immunologic host effectors have been subjected to an increasing number of clinical and biological studies. These have aimed to identify the interplay between acute leukemia blasts, the hematopoietic niche, and the cells of the immune system. A better assessment of these systems has contributed to the clarification of the pathogenesis of acute myeloid leukemia (AML) development and growth as well as to the mechanisms underlying the ability of leukemic cells to promote immunological escape and systemic tolerance. It has become evident that tolerogenic pathways may be responsible for an immunosuppressive microenvironment, one which is capable of negatively influencing anti-leukemia immune responses and of inducing resistance to chemotherapy ,4.Cancers (entitled “Cancer Immunology and Immunotherapy”) is focused on both the biological and clinical applications of immunotherapy in a variety of tumors, including hematological malignancies. This editorial will attempt to highlight key issues and crucial developments in the areas of AML, acute lymphoblastic leukemia (ALL), and related disorders, drawing from manuscripts published in the years 2022 and 2023 in Cancers to do so.This Special Issue of Interestingly, some of these metabolic pathways can be targeted by new drugs, such as immune checkpoint and macrophage checkpoint inhibitors ,4. This + T cells, was recently reported in a few studies, thus providing the rationale for the development of clinical studies using WT1 vaccines. In some preliminary studies, a WT1 peptide vaccine was capable of inducing WT1-specific cytotoxic CD8+ T cells, which resulted in disease improvement [Recent data seem to demonstrate that the involvement of a great number of immunotherapy strategies in implementing patients’ immunity against blast cells may be of clinical utility; in particular, the role played by anti-leukemia vaccines to control acute leukemia progression has been documented in several studies ,7. Data rovement ,6. Interrovement ,10,11.In the manuscript of Riillo et al. , the useInterestingly, as an alternative to checkpoint inhibitors (ICIs) constituted by monoclonal antibodies (mAbs), the concept of active immunization with vaccines has been reported in two manuscripts obtained from this series from Cancers.In the first paper included, published by Yusuke Oji , a promiInterestingly, as an alternative to checkpoint inhibitors mAbs, the concept of active immunization with vaccines was further discussed by Tobias , who repAnother area of investigation attracting a number of clinical studies across the world is represented by the assessment of immune-related adverse events during ICIs administration or during vaccine-based therapeutic interventions.In the paper by Garrison et al. , the autIn a review article by Shalit et al. , entitleCancers includes a collection of articles covering topics in basic, translational and clinical studies into several types of cancers, including hematologic malignancies, that will be of interest for a wide audience of researchers and clinicians working on this field. It is now well established that, despite the variety of mechanisms used by immunotherapies, these treatments require fidelity and accuracy in the identification of antigens in order to direct cell killing and avoid the occurrence of off-target effects. The best application of immunotherapy in AML may be represented by its use in combination with chemotherapy as a bridge to allogenic SCT or for those patients who are unfit or frail and therefore are not candidates to receive standard induction chemotherapy.In summary, this Special Issue of It is probable that immunotherapy will became more and more important in the treatment scenario of acute leukemia in the coming years. Indeed, it may contribute to the implementation of precision medicine and to improving the clinical management of acute leukemia.


Many older patients admitted to convalescent hospitals present with impaired oral function, which is an important function of daily life. This study aimed to investigate the actual status of the oral healthcare needs of inpatients in a convalescent hospital and to clarify the relationship between the level of independence at admission and the oral function. The participants were 147 patients  who received dental visits during their stay at a convalescent hospital. Information regarding general and oral health was extracted from medical records. Most patients were found to have low Functional Independence Measure motor scores, and approximately 70% had some form of oral intake, but approximately 80% had nutritional problems. The mean number of present and functional teeth were 16.6 and 20.8, respectively, and 65% of patients lost molar occlusal support. Multiple regression analysis showed significant positive correlations of high functional independence measure with age, eating status, nutritional status, and the number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status. The older adult population in Japan is increasing every year, and the number of older adults requiring nursing care is also increasing accordingly. Stroke, joint diseases, dementia, fractures, and weakness account for 70% of the major causes of the need for nursing care . PatientMany patients in such convalescent hospitals have impaired activities of daily living (ADL) due to stroke or fracture and undergo intensive long-term rehabilitation to improve ADL during hospitalization. The Functional Independence Measure (FIM) is often used to make decisions regarding discharge after the recovery phase of rehabilitation. According to the latest data, the FIM motor items and total score cutoffs for the discharge of stroke patients are 70 and 82 points, respectively. The long-term rehabilitation schedule is determined based on the FIM score at admission ,4,5,6.It is often challenging to spend time on improving the oral health of patients with stroke in the acute phase owing to their intensive treatment schedules. Nonetheless, paralysis may prevent independent oral hygiene care, and the inability to intake food orally due to tube feeding may worsen oral health. Convalescent hospitals have longer hospital stays, up to 6 months, and are more likely to provide treatment other than the main disease, such as dental care, in between rehabilitation treatments. Improving oral health by providing dental treatment, especially prosthetic denture treatment to increase functional teeth, during hospitalization at convalescent hospitals is important, because once patients are discharged, it is generally difficult for them to visit the dentist independently .Previous studies have demonstrated the importance of oral health management in patients with acute stroke through medical and dental cooperation ,9. HowevTherefore, the purpose of this study was to clarify the oral health management needs within convalescent hospitals, as well as to investigate the association between FIM scores at admission and the oral health status.A total of 154 patients with oral problems received dental visits during their hospitalization at a convalescent hospital between January 2019 and December 2020. Of these, 147 patients were included in this study, after excluding seven patients who met the exclusion criteria . We extracted the information regarding the patient and oral cavity characteristics from the medical records and conducted a cross-sectional survey. Informed consent was obtained from all study participants before the study was initiated using the opt-out method. This study was approved by the Clinical Study Review Committee of Showa University Fujigaoka Hospital .Information regarding the age, sex, main disease, independence , nutritional status , eating status , number of present teeth, number of functional teeth, Eichner classification, denture use, denture treatment needs, and physician requests were extracted from the medical records.Upon admission to the convalescent rehabilitation ward, the dentist makes ward rounds to patients within one week to perform an oral examination and oral health status  scoring to determine the need for treatment.General conditions were extracted from the medical records. The disease registered by the physician at the time of admission to the convalescent hospital was designated as the main disease. The FIM is an ADL evaluation instrument developed by Granger et al. in 1983 . It consThe CONUT variant method was used to evaluate the nutritional status by replacing the total cholesterol with hemoglobin ,19. The The ESS was used to determine the nutritional intake status based on a 5-point scale: oral feeding (unmodified), oral feeding (modified), oral intake > tube feeding, oral intake < tube, and tube feeding only.The number of functional teeth included natural teeth and the teeth in dentures but excluded the remaining roots and teeth with a mobility level of Grade III. The need for prosthetic treatment during hospitalization was classified into two groups: “presence” or “absence”. This classification represents the assessment of necessity by dentists and the patients’ demand for prosthetic treatment. Molar occlusal support was classified by Eichner classifications as follows: A1 to B3 were designated as having occlusal support of the molars, whereas those classified as B4 to C3 were designated as having no occlusal support of the molars . DentureA correlation analysis was used to analyze the correlation between the participants’ FIM scores and the respective factors. Multiple regression analysis was used to determine the association of level of independence, as the objective variable, with general and oral health, with the FIM score as the objective variable. SPSS ver. 27 (IBM Japan) was used for all statistical analyses, and the significance level was set at 5%.Regarding the reasons for referral to dentists from a medical doctor, 51.0% was for oral health examination, 36.1% was for denture treatment, and 10.2% was for oral hygiene management. .In the convalescent phase, rehabilitation is provided to improve the level of independence during hospitalization in order to make life after discharge as comfortable as possible. Therefore, with the level of independence as the outcome, we first analyzed the correlation between the level of independence and the general and oral health.Correlation analysis showed that the FIM total score was positively correlated with age and ESS. The presence or absence of stroke showed a negative correlation. The FIM total score was significantly correlated with the presence of stroke and eating patterns but not with oral health status. The strongest correlation was with ESS. . From thMultiple regression analysis was conducted with the FIM total score as the objective variable and age, sex, presence or absence of stroke, ESS score, CONUT variant score, number of functional teeth, and the presence or absence of denture treatment as the explanatory variables. There was a significant positive association between the FIM total score and age, ESS score, CONUT score, and the number of functional teeth .The results of this study showed that many convalescent patients who were referred to a dentist had malnutrition despite the fact that many of them eat unmodified food orally. Additionally, many patients did not use dentures despite the lack of molar occlusal support, suggesting that oral problems might be the cause of the discrepancy between the eating status and malnutrition at the time of admission. In addition, many patients did not wish to have their dentures treated, even though they needed such treatment.The reason for the poor nutritional status despite a good diet is presumably because patients suffering from stroke are often in poor general condition and may require feeding tubes. Additionally, since the participants of this study were patients with oral problems referred by medical departments, most of them had poor oral conditions. In other words, patients with low activities of daily living (ADL) may have easy access to nutrition regardless of their oral condition, while patients with high ADL may have relatively good eating patterns but may not be consuming enough food if they have oral problems. In fact, according to the table of molar occlusal support and denture availability , many paThe results of the correlation between the FIM total score and each of the factors showed no correlation with factors related to oral health. It is possible that because the patient in this case had oral problems and a dental request, the correlation may not have been influenced by a good or bad FIM score. The correlation results showed that age is positively correlated, which may be due to the lower average age of stroke patients and the fact that non-stroke patients, especially those suffering from fractures and spinal cord and spine disease, are older and more independent than stroke patients. From the results of this correlation, seven variables for multiple regression analysis were carefully selected. Seven was considered appropriate because of the 147 participants. As basic information, we extracted age, sex, stroke, and ESS with which we found a correlation, the CONUT variable as an indicator of nutrition, and the number of functional teeth and need for prosthetic treatment as indicators of oral health.In addition, from the results of multiple regression analysis, the total FIM score was found to be associated with the number of functional teeth, eating status, and nutritional status, suggesting that improvement of each factor might contribute to the improvement in the FIM independently. Therefore, it is important to provide occlusal support, including dentures, as soon as possible for patients in convalescent hospitals. Although there were few requests for denture treatment in convalescent patients, the potential need for dentures was recognized. This highlights the importance of conducting oral health examinations for all convalescent patients and an active collaboration between medical and dental specialties to help patients who need dental intervention but do not request it on their own.Previous studies have shown that patients with acute stroke benefit from oral health management. However, the average length of stay in acute care hospitals in Japan is 16.0 days, which is too short for prosthetic treatment such as dentures. Conversely, the maximum length of stay in convalescent hospitals is 180 days, which is more than enough time for denture treatment. This would mean that dentists could provide intensive oral health management for older people with declining ADL before they come back to their homes. . It is possible that the restoration of occlusion for inpatients with a reduced number of teeth at the time of admission may directly improve their ADL and indirectly help them improve their diet texture and nutrition by recovering proper masticatory and swallowing function.Comparing previous studies ,3,4,5,6,It is, therefore clear that the need for denture treatment in the recovery period is high. This study only examined the relationship between FIM and general health and oral health status. Therefore, the direct relationship between nutritional status and eating status is unknown. A possible reason for this difference is that previous studies ,14,21,22Some limitations of this study should be noted. The data used in this study other than prosthetic treatment were obtained only at the time of admission, and the degree of improvement is unknown because evaluation at discharge was not performed. In the future, it will be necessary to evaluate patients at the time of discharge to clarify improvements in oral health after dental treatment. In addition, the evaluation of the oral health was not performed on the day of admission but was referred by a medical doctor within approximately 10 days after admission, and it may be possible that rehabilitation progressed and the ADL improved by that time. Therefore, it is necessary to understand the schedule of the patients’ dental examinations and the number of rehabilitation procedures performed prior to these examinations. Furthermore, the results were obtained from a single recovery hospital, and bias can be expected as a result. A more comprehensive analysis can be conducted by collecting data from other facilities and evaluating patients at the time of admission and discharge. In addition, we did not specify the site of the stroke injury, and the relationship between the general condition and the oral cavity could also change depending on the fracture site. Therefore, it will be necessary in the future to classify patients according to the sites of stroke injury and fracture. There was also a difference between younger and older patients according to the age of the target patients, and restricting the age of the target patients may change the results. In addition, no differences were found in the oral health of the patients in this study, since only those patients were requested by their physicians, and all had oral problems. In the future, we would like to conduct a study on hospitalized patients to examine oral differences with and without intervention.However, with these limitations clarified, our study has shown the association between the total FIM score, nutritional status, feeding status, and prosthetic treatment needs of patients admitted to convalescent hospitals. These findings may provide useful data to guide future endeavors to implement effective oral health management strategies, including dental treatment for patients admitted to convalescent hospitals.Among the patients admitted to convalescent hospitals, a higher FIM was associated with a better diet texture, better nutritional status, and a higher number of functional teeth. This implied that oral health management is important for patients in a convalescent hospital and that enhancing oral health may be related to improved eating textures and better nutritional status.


Neurorobotics explores the human senses,” presents a variety of research studies at the crossroads between Neuroscience, Developmental Psychology, Artificial Intelligence (AI), and Robotics. The main common point of these studies is the need to better understand how humans  perceive their surrounding world and use this knowledge for Robotics. For human-robot interaction applications, this requires understanding how humans perceive and react to different robots and their behaviors. For applications to autonomous robots, this implies taking inspiration from the way humans perceive and react to different types of stimuli.The present Research Topic of Frontiers in Neurorobotics, entitled “Research in AI and Robotics has always drawn at least some degree of inspiration from biology and human cognition. Classical examples illustrating this inspiration include the design and testing of humanoid robots, whose body is inspired by human morphology. Another striking example is the research on deep neural networks, which are loosely inspired by biological neurons in the brain, whose connections are modified through learning as the synapses between real neuron. Furthermore, some of the current research in AI takes inspiration from the human brain's cognitive architecture (as it is currently understood) LeCun, , and froIndeed, the whole field of Neurorobotics aims at mimicking some of the physical, behavioral and even neural properties of animals' body, brain activity, and behavior  that can be used as a therapeutic aid with children with autism. The final stage of the participatory design, which took place in a Colombian clinic, involved two steps. First, 50 different sketches of possible robot appearance divided in five categories  were evaluated by volunteers including caregivers and parents, but not the children. From the nine best sketches resulting from this first evaluation, three were selected by a second selection process involving nineteen children with autism spectrum disorder (ASD): one robot-like, one fantastic-like, and one human-like. Finally, the three resulting appearances were tested in an experiment in which 21 children with ASD were given an emotion recognition and imitation task. In particular, children had to recognize and imitate four different emotions  expressed either by a cartoon in a card (control condition) or by one of the three selected robots. Very good performance was found with happiness and sadness, while fear and anger were recognized less well. While the results show no statistically significant difference in performance for the three appearances, the robot-like appearance was the one receiving more attention from the children, and, compared to the control condition, the presence of a robot, in general, increased the amount of attention demonstrated by the children.The paper “Do different robot appearances change emotion recognition in children with ASD?” by Davies et al. deals with the topic of endowing an artificial system with the visual skills necessary for counting from images of human or robot hands. The context and motivation of the article are rooted in Developmental (Neuro)Robotics, in which emphasis is placed on naturalistic training and application scenarios with a particular focus on, for example, the embodiment of a robotic system. Signaling numbers by means of hand gestures is a deeply-rooted and important strategy both for teaching and communication in humans and hence this work has an immediate connection to the target of the special collection. To this end, Davies et al. create a dataset of hand postures covering the digits “1” to “5” being signed by both robot and human hands in various postures. The authors test various artificial neural network systems on their data, taking care to report a full range of performance measures including confusions and computational cost, which allow for a better evaluation of the efficacy and effectiveness of the different approaches. Overall, the purely visual analysis of these images results in good recognition performance—in addition, the typical errors of the algorithms are shown to also represent challenging cases for human interpretation. The article has made the dataset and analysis tools openly available, adding a valuable resource to the field for further experimentation.The paper “A Database for Learning Numbers by Visual Finger Recognition in Developmental Neuro-Robotics” by Suzuki et al.  highlights the importance of sensory feedback in locomotion. Building on previous work where the authors had demonstrated sprawling behavior in a simulated quadruped robot, they test here their approach in a real, newly developed robot with nine actuated degrees of freedom (one in the trunk and two in each of the four legs). Taking inspiration from what is known about sprawling locomotion in vertebrate animals like salamanders, the controller consists in a series of oscillators representing central pattern generators that, in contrast with most previous models involving open-loop control, are sensory-coupled through bidirectional feedback between the legs and the trunk. The results show that a controller endowed with this cross-coupled sensory feedback is faster and more energy-efficient than one without it. Furthermore, the authors demonstrate that their system is also robust to morphological changes (showing stable locomotion with longer legs without changes in control parameters) and even to leg failure . These results underline the pivotal role played by sensory feedback in the coordination of the body and the limbs.Finally, the paper by From our point of view, these four papers well illustrate the common interest in neuroscience and psychology that the neurorobotics community shares even when the applications are different. In this respect, it is striking that this common interest, and the sharing of some of the methods to study human  behavior, have recently brought the neurorobotics community and the human-robot interaction (HRI) community closer to each other. Researches in HRI (Delaherche et al., All authors listed have made a substantial, direct, and intellectual contribution to the work and approved it for publication.


The objective was to assess the feasibility of incorporating trained community health mediators in COVID-19 prevention in a multicultural and disadvantaged setting in Bremen, Germany. Specifically, we aimed to develop and implement measures corresponding to the needs of the residents and to analyse the role of digital communication tools and sustainability factors of the health mediator approach.A comprehensive process evaluation using 41 qualitative interviews with residents, mediator short surveys and group discussions, work documentation sheets, and a stakeholder workshop was carried out.Uncertainties due to changing regulations, a lack of trust and fear of potential side effects were major themes identified in the needs assessment. The eight mediators documented more than 1,600 contacts. Digital communication via Facebook was a useful tool, but personal contacts remained crucial for communicating with residents. The participatory approach, multilingualism and the flexibility to react to dynamic situations were identified as relevant factors for the success and sustainability of the health mediator approach.Multilingual health mediators can facilitate contact with and dissemination of health information to different communities and also can play an important role in pandemic preparedness. Socioeconomic, ethnic and geographical inequalities in COVID-19 infections and mortality have been found in many countries worldwide . For exaVaccination was one of the most important strategies to control the COVID-19 pandemic , 18. In In earlier pandemics such as Ebola, H1N1 and Zika, one important element in fighting the pandemic was community involvement . The terHealth mediators are lay persons who receive lower levels of education and training than professional healthcare providers such as nurses and doctors or professional health educators. They can translate and deliver health information and advice in a culturally appropriate manner and establish trustful relationships with population groups which are otherwise considered as hard to reach. Since the 1990s, there has been an increase in the use of health mediators to help improve accessibility and quality of health care for refugees and migrants –24. The The objective of this study was to assess the feasibility of involving trained health mediators in COVID-19 prevention measures in a multicultural and socioeconomically disadvantaged neighbourhood in Bremen, Germany. More specifically, we aimed (a) to explore the needs and concerns of residents regarding COVID-19 prevention measures, including vaccination uptake, (b) to develop and implement measures that correspond to the needs of the residents, (c) to assess the role digital communication tools played in the work of the mediators, and (d) to identify factors that are relevant for the sustainability of the mediator approach.In the context of a project than was implemented between July 2021 and June 2022, we carried out a comprehensive process evaluation using several data sources including qualitative interviews with residents, mediator short surveys and group discussions, work documentation sheets, and a stakeholder workshop.Participatory action research was the underlying methodology of this study . That meEthical approval for the study was obtained from the ethics committee of the University Bremen, Germany (reference number 2021-07). All participants provided written informed consent. The COREQ-Checklist was used as a guideline for reporting the qualitative data .The research was conducted by a team of four scientists from the Leibniz Institute for Prevention and Epidemiology-BIPS  together with eight mediators, who were employed by the institute initially for the duration of the project. All research team members had previously worked in projects conducted in disadvantaged neighbourhoods, and the scientists had experience working with community researchers.The study was conducted in the city district of Osterholz in Bremen, home to approximately 37,000 people . The neighbourhood was selected as it is one of Bremen's most culturally diverse city districts, with 53.5% of the population having a migration background. The average annual income in the neighbourhood is lower than that of the overall city  . AccordiThe whole project was situated in the Leibniz Living Lab (LLL), a BIPS community office situated in Osterholz . The LLLMütterzentren in Germany. These mediators hence had regular close contact to residents.The eight mediators were recruited through local partners and pre-existing networks from earlier research activities in the neighbourhood. The requirements for becoming a health mediator were having a large social network in Osterholz, and good language skills in in German and another language spoken in the neighbourhood. The hired mediators were all female, aged 24–50 and spoke the following languages: German, English, Twi, Tamil, Turkish, Arabic, Russian, and Macedonian. Most of the mediators worked in centres where families  meet to get to know each other and share ideas/experiences, so-called The mediators received continuous training during the course of the project. The training sessions were aligned to the different phases of the project and covered various topics including recruitment of participants and conducting interviews, ethical and data protection aspects, interpersonal communication and the use of Facebook, basic information on the COVID-19 virus and its transmission, vaccines, and fake news. Some of the sessions were scheduled, while others took place on demand and covered topics raised by the mediators.Throughout the study, the collaboration with social service managers working in the neighbourhood, was intensified. This concerned in particular cooperation with professional health educators employed by the Federal State Association for Health and the Academy for Social Services, Lower Saxony (LVG & AFS Nds e.V.) and Federal State Association for Health in Bremen (LVG Bremen), with funds provided by the federal state of Bremen. The professional health educators were employed during the peak of the pandemic and their role was to provide COVID-19-related information to citizens in disadvantaged neighbourhoods .The mediators carried out semi-structured interviews focussing on COVID-19 related needs and concerns among residents in Osterholz using an interview guide they had helped develop and had pre-tested. The interview centred on COVID-19-related knowledge, vaccination, rules and the effects of the pandemic on everyday life see .Interviews were conducted with individuals who lived in the city district and were at least 18 years of age. The mediators used their personal networks to identify and recruit interview partners from diverse micro-communities. The interviewees determined the interview location. Some interviews were conducted at the interviewee's home, and others at their workplace or over the phone.The interviews were conducted during the phase when severe contact restrictions were in place, and the COVID-19 delta variant was dominant. There was no mandatory testing for people who had been vaccinated twice, and infected persons had to quarantine for 14 days . At thatThe study information, consent form and the interview guide were translated into the mediators' main languages.The needs assessment was followed by the development and implementation phase of COVID-19 prevention measures. As personal contacts were reduced to a minimum during this phase, the mediators were equipped with smartphones on which they could be reached by the members of the respective communities for advice and assistance regarding COVID-19 related issues. The smartphones hence served as a communication and a dissemination tool.Information on the availability of the mediators and their role was distributed via project flyers and posters at community centres and public places. Furthermore, to enhance project dissemination to a wider audience and to facilitate the availability of new COVID-19 regulations and vaccination opportunities in different languages, each mediator created Facebook profiles. The latter were created exclusively for the project and the mediators used these to promote short video messages in Arabic, Russian, and Turkish they had created via Facebook advertisement. The advertisement posts were tailored to residents in Osterholz. Facebook was chosen because the needs assessment showed that this was the most relevant source of information among the social media platforms used by the communities concerned (next to WhatsApp). It was also one of the sources that was most often associated with fake news.In line with the participatory approach, the project coordinator (MG) held regular meetings with the mediators during the development and implementation phase of the project. The meetings served as platforms to reflect about the project in general, generate new ideas as a team, as well as for continuous planning and providing background support.The main tasks of the mediators in this phase were individual counselling and serving as contact points for residents, as well as supporting and promoting the local vaccination campaign. Further activities that were implemented based on the needs assessment results were for example: developing and disseminating own COVID-19 educational material , a painting workshop with children, where the focus was on COVID-19 vaccination, and a stakeholder workshop on vaccination of children.To gain a rapid overview of the current situation on the needs of the residents, barriers, reach and impact of the mediators' work, the mediators completed a short survey (anonymously) at month 2 (September 2021) and month 10 (May 2022).In addition, the mediators anonymously documented all queries and issues raised by the community members using a pre-set documentation sheet that was collected by the project coordinator every two weeks. The sheet included information on the number and type of contacts the mediators had had, whether these had been face-to-face or digital, as well as the topics covered and material used.Moreover, at the end of the project, all mediators participated in a discussion round during which they reflected on different aspects of the project, including the project work itself, the training sessions, support and communication as well as on their empowerment and the level of participation throughout the project. In a final stakeholder workshop, the concept and sustainability factors of the mediator approach were discussed with stakeholders, such as local policy makers, health educators and residents.The semi-structured interviews for the needs assessment were audiotaped and transcribed verbatim by a professional multilingual transcription service. The latter also translated transcripts that were not in German or English into German. The meaning of sections that were found to be unclear were cross-checked with the mediators. After transcription, the data were anonymised and analysed according to applied thematic analysis  using MAThe short surveys conducted among the mediators and the documentation sheets were analysed descriptively using MS Excel. The mediators recorded each time they contacted someone within the context of the project, without indicating whether or not they had contacted the person before.Furthermore, to evaluate the Facebook video performances, key figures available on Meta Business Suite were used. The ensuing results were discussed with the mediators and they contextualized and amended them based on their experiences in the project.Finally, the main project results, including strengths and weaknesses, as well as factors related to the sustainability of the mediators were discussed with local stakeholders. Factors contributing to the sustainability of the mediator approach were extracted from group discussion notes and workshop documentation. Plain language summaries of the findings in the respective languages were disseminated to the interview participants.Overall, 41 interviews were conducted in August and September 2021. Most of the interview participants were known to the mediators beforehand. Of the 41 interviews, 18 were conducted in German, 12 in Arabic, four in Twi, three in Turkish, three in Russian and one in Tamil. On average, the interviews were 24 min long (range 8–70 min) .In terms of COVID information many respondents felt well informed and used a variety of information sources. However, they also pointed out that most of the information was only available in German and thus identified the need for multilingual COVID information. In addition, the respondents mentioned people with limited reading and writing skills and older adults as being particularly at risk for receiving no or misinformation. Facebook and WhatsApp were widely used among the respondents, but they were also concerned that these sources were drivers of misinformation and fake news. In general, the respondents perceived webpages from known institutions as being more trustworthy than social media channels. Several respondents were not satisfied with the amount of information they received from public institutions such as the local government, schools, and the public health office. Others described that ever-changing regulations and information overload made them ignore COVID related information. They called for someone to filter the information and provide personalized advice for them.Apart from situations in which adhering to COVID rules such as wearing a face mask or social distancing was difficult, respondents assumed that not believing in COVID, tiredness after several years of the COVID pandemic and the belief that being vaccinated would protect them from an infection were the main reasons for people not to follow the COVID rules. On the one hand, the respondents identified the need for more information and the need for credible explanations of why the rules are essential. On the other hand, several respondents called for stricter enforcement of the rules.“Well, because they think it hasn't been researched enough and it's unsafe, that they're not being properly educated about how safe it is by now. Well, they're assuming that other testing of drugs or viruses or vaccines took longer periods of time and now this had to be done in a very short period of time.” With regard to COVID vaccination, a mixture of uncertainty and fear was expressed. When asked about the reasons against vaccination of children, one respondent answered:fear itself in connection with the pandemic was used in a total of 161 times and in three quarters of the interviews (31/41). It was mentioned not only in relation to the vaccination but also in relation to general infection, infecting family and friends, long-term consequences, correct behaviour in public, and quarantine regulations. As one interviewee put it:“We almost didn't even dare to say “hello” to our neighbours when we ran into them in the stairwell.” The word “What made me want to get vaccinated was the fact that my relatives and friends had already been vaccinated. At first, I was against getting vaccinated, but they assured me that there was nothing wrong with it because they themselves had already been vaccinated” The reasons given by the respondents regarding whether or not they had been vaccinated against COVID-19 various ranged from the wish to protect others (pro vaccination) to lack of trust in government institutions (contra vaccination) . As showThe social and economic consequences of the pandemic were not only negative. Some respondents mentioned reduced costs for mobility, reduced working hours, and an increased recognition of the value of social contacts as positive aspects. Nevertheless, many respondents were burdened by limited social contacts or feeling uncomfortable with social contacts, and suffered financial strains. Homeschooling and reduced childcare hours were identified as the biggest challenges for families. The need for hands-on psychosocial support through low-threshold neighborhood and mediation services was mentioned several times.Needs and concerns that were considered as being important for the practical implementation of the mediator approach were: reducing fears and knowledge gaps through the dissemination of multilingual COVID-19 information, addressing vaccination of children as a particularly sensitive topic, the importance of a personal approach and the role of the social environment regarding confidence in preventive measures.According to the documentation forms submitted by the eight mediators, they jointly had approximately 1,600 contacts with residents during the course of the project, mostly via telephone, personal contact or e-mail/short messages . The majThe topic most frequently addressed during the contacts with residents was current COVID-19 regulations, followed by vaccination. Other topics included testing, proper behaviour after a positive test, self-help in the event of COVID-19 infection, and protecting at-risk groups. In the course of the project, concern was also raised in relation to Ukrainian refugees, for instance, concerning availability of COVID-19-vaccination and rapid test opportunities for them.The mediators also frequently used multilingual flyers to disseminate information on COVID-19.All three Facebook videos achieved a large reach in relation to the size of the district see . The durDuring the group discussions with the mediators as well as in the final stakeholder workshop, the participants expressed great satisfaction with the project's output. The mediators and researchers also found the participatory approach to be very instructive and enriching. While the mediators felt very self-efficacious in their work and strengthened by their participation in the project, they also reported difficulties in maintaining the balance between protection of own privacy and the project aim to be a visible contact person in the neighborhood. Some of the mediators feared that they could become targets of verbal or physical attacks from critics of the COVID-19 regulations. Another challenge was the blurring line between being a mediator and other social roles such as being a friend or neighbour.The success factors identified for the implementation of the approach were the flexible response to changing conditions during the pandemic and other crises such as the Ukrainian war, as well as the mediators' great freedom to make decisions and participate in shaping the project. The contribution of the mediators was seen primarily in the trust-centred and low-threshold approach to people who were uncertain about COVID-19 regulations and vaccinations. The multilingualism in the team was particularly beneficial. The factors identified for the sustainable implementation of the approach were the collaboration with independent and well-known institutions in the district, and intensive, continuous background support for the mediators.The short survey about the current COVID-19 situation in the social network of mediators showed that current regulations and guidelines on COVID-19 played less of a role in May 2022 compared to September 2021, but questions on the future were raised more and more frequently. Furthermore, the mediators' own assessment of the impact of their work towards improved pandemic management shifted from being fairly positive to positive in the second survey.This study assessed the feasibility of involving trained community health mediators in COVID-19 prevention measures in a multicultural and socioeconomically disadvantaged urban setting. In the process, different activities were developed corresponding to the needs and concerns about COVID-19 prevention measures among residents living in this community. The work with the mediators proved to be feasible, with many residents being reached and different activities being well implemented. The mediators and the research team also benefitted from the participatory approach applied and the close collaboration achieved.This study responded to the call for a stronger community involvement in efforts to address the COVID-19 pandemic, especially in high-income countries . ThroughSimilar to other studies –39, we fThrough a critical lens health mediator approaches have been depicted as neo-colonial tools of epistemic violence as they portray the communities that the mediators represent as “the problematic others” . We trieAlthough the potential for upscaling and sustainability is hard to assess from this study, discussions with local stakeholders and the health mediators provided at least some qualitative insights. In the context of community health worker programs, Zulu et al.  highlighThe main strength of the study is that it made use of a participatory approach, whereby the mediators were involved in all stages of the project as equal partners, and they in turn collaborated with the residents they contacted. Throughout the project, the mediators continuously developed a sense of ownership and belonging that showed itself in the way they conducted their work.The greatest contribution of the mediator approach probably lies in the relationships they managed to build with the individuals they reached and the positive experiences made. These can be used as a resource, for instance, for pandemic preparedness.One limitation of the study is that, due to its design, the exact impact of the mediators on the vaccination rate could not be determined. Nevertheless, it should be noted that the basic immunization rate in Bremen was rather high (87.5% in Bremen vs. 76.4% nationwide) . The medRegarding generalisability, it is difficult to say whether the approach would work in other neighbourhoods or cities in the same way as in the specific setting. However, many urban communities in Germany and elsewhere share social and economic characteristics of Osterholz.The study was conducted during the period where in-person events and contacts were restricted by COVID-19 regulations, which is an obstacle for participatory research . NeverthCo-working with community health mediators in a socio-economically deprived city district on COVID-19-prevention in participatory manner was feasible and led to a large number of personal contacts between mediators and residents. We believe that health mediators can be an important resource for pandemic response and preparedness as they can develop trustful relationships in communities that may otherwise not be sufficiently reached by public communication strategies.